Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

RESUMENSegún estudios epidemiológicos, las várices de miembros inferiores tienen una elevada prevalencia en la población general 1 , sobre todo en las profesiones que obligan a estar de pie por largos períodos de tiempo. Objetivos: Determinar la prevalencia de várices en miembros inferiores en el personal sanitario del Hospital de Clínicas y el porcentaje de la población estudiada que practica medidas profilácticas. Material y Método: Diseño prospectivo observacional de corte transversal, realizado en el periodo de abril-agosto de 2006, en el Hospital de Clínicas. Los datos se obtuvieron mediante encuesta a 366 funcionarios del Hospital de Clínicas. Resultados: 65% de la población presenta várices en miembros inferiores, el 75% de las mujeres y el 25% de los varones. El tiempo que permanecen de pie, durante sus actividades laborales las personas con várices es > de 8 horas en el 49%, y menos de 8 hrs en el 51%, siendo en las personas sin várices > de 8 horas en el 18% y menos de 8 hs en el 82% (p=0,03). Índice de masa corporal en personas con várices: IMC >25 en el 54%. El 76% y el 33% de las personas que presentan várices, refieren dolor de piernas y edema respectivamente. El 13% que presenta várices utiliza medias elásticas, y el 6% deja de trabajar antes de que termine el día laboral por presentar dolor de piernas. Conclusión: Gran porcentaje del personal sanitario presenta várices en miembros inferiores. El sexo femenino constituye un factor de riesgo bien demostrado, sobre todo durante la edad fértil. El dolor de piernas después de estar mucho tiempo de pie, hace que un 6% de las personas con várices dejen de trabajar antes de que termine el día laboral, lo cual tiene implicancia tanto en el ámbito social como económico del país.PALABRAS CLAVE: Várices de miembros inferiores, personal sanitario. SUMMARYBackground: Varices are common among people that must work in the standing position for long periods. Aim: To assess the prevalence of varices of the inferior limbs among hospital personnel. Material and methods: An enquiry about the presence of varices in the inferior limbs, along with demographic data an family history of varices, was applied to 366 individuals of both genders, working at a Clinical Hospital in Asuncion, Paraguay. Results: Seventy five percent of women and 25% of men had varices in the inferior

In neurodegenerative diseases, progressive oxidative stress is a major event that precedes neuronal death. Oxidative stress is characterized by an imbalance between oxidants and antioxidants. This imbalance induced oxidative molecular and cell damage, reducing cellular viability. 3-Nitropropionic acid (3NP) causes oxidative stress and other molecular and cellular changes similar to those observed in neurons of patients with Huntington's disease. Since carvedilol and melatonin act as free-radical scavengers, this study examined the effect of carvedilol (10(-5) M) and melatonin (10(-5) M) on oxidative and cell damage induced by 3NP in N1E-115 neuroblastoma cells. Carvedilol and melatonin prevented the increases in lipid peroxidation and total LDH activity, as well as the depletion of reduced glutathione (GSH) and the reduction of antioxidative enzymes activities in N1E-115 cells incubated with 100 mM 3NP. All these carvedilol and melatonin effects were more intense when the drugs were added before rather than after inducing the damage by 3NP. These results also provided evidence supporting the hypothesis that carvedilol and melatonin can be useful for treating neurodegenerative diseases, such as Huntington's disease.

La paracoccidioidomicosis es una micosis profunda, enfermedad granulomatosa subaguda o crónica, que compromete la piel, mucosas, ganglios linfáticos y órganos internos, de evolución maligna, sin tendencia a la curación espontánea. Realizamos una revisión de lo publicado sobre esta patología y reportamos un caso que representa una forma visceral pura, de presentación rara, aunque existen unos pocos casos publicados sobre todo en la literatura peruana y brasilera.