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.

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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.

Introduction:Magnetic resonance (MR) imaging is commonly used for differentiating infective from neoplastic brain lesion non-invasively. MR imaging techniques like magnetization transfer, MR spectroscopy and diffusion weighted and perfusion weighted imaging has been used to differentiate brain infection from neoplasm; it is still problematic to separate these conditions 1 . Endothelial permeability is a common feature of neo-angiogenesis 2 . Angiogenesis plays a crucial role in the growth and aggressiveness of brain tumor. It is also reported in the infective pathology in response to the expression of various cytokines 3 . The aim of this study is to assess the usefulness of physiological parameters i.e. permeability (k trans ) and leakage (v e ) which depend on the integrity of blood brain barrier (BBB), in differentiation of infective from neoplastic lesion. Materials and Methods:Study group: A total of sixty six untreated consecutive patients included in this study were classified in to three group 1) infective lesion (mean age±SD=26.6±9.31 years) [brain tuberculoma (n=18), brain abscess (n=6) and fungal granuloma (n=2)], neoplastic lesion containing 2) high grade glioma (HGG, n= 21, mean age±SD=47.5±11.3 years) and 3) low grade glioma (LGG, n=19, mean age±SD=36.28±11.20 years). The final grouping of all these lesions was based on the result of histopathology, microbial culture and response to specific therapy. Perfusion imaging and Data Analysis: With informed consent all these patients underwent dynamic contrast enhanced MR imaging, using a three dimensional spoiled gradient recalled echo sequence [TR/TE-5.0/1.4 ms, flip angle-15º, The field of view -360х270mm, slice thickness-6mm, matrix size-128х128, NEX=0.5]. At the fourth acquisition, Gd-DTPA (0.2 mmol/kg) was administered intravenously at a rate of 5 ml per second, followed by a bolus injection of 30 ml saline flush. A series of 384 images in 32 time points for 12 slices were acquired with a temporal resolution approximately of 5.25 seconds 4 . Fast Spin echo T 1 W and fast double spin echo PD and T 2 W imaging was performed for the same slice position to quantify voxel wise pre contrast tissue T 10 4 . Images were registered for voxel wise analysis and de-scalped manually. The absolute tissue T 10 value was used to generate concentration time curve from signal intensity-time curve 4 . Pharmacokinetic model was implemented for permeability (k trans ) and leakage (v e ) calculation 4 . k trans and v e were calculated by placing the region of interest (ROI) on the whole lesion of each slice. Contrast uptake curve using 95% confidence interval of mean was generated separately for infective lesion, HGG, and LGG. Scatter map of infective lesion, HGG and LGG were also plotted for k trans and v e at Y and X-axis respectively. Group wise descriptive statistics and ANOVA were performed. A linear discriminant analysis was performed to identify which factor is more efficient in classifying the group membership. All the statistical analysis was performed on SPSS-...

BACKGROUND AND PURPOSE: Neuroinflammatory molecules, including tumor necrosis factor-␣, interleukin1-␤, lymphocyte function associated molecule-1, and intercellular cell adhesion molecule-1 contribute to the development of brain abscess. We hypothesized that the high fractional anisotropy (FA) in the brain abscess cavity reflects the upregulation of these neuroinflammatory molecules.