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.

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Objective:This study’s objective was to explore the disaster management knowledge, attitude, behavior, willingness, and assistance among Nigerian dentists.Methods:This cross-sectional, questionnaire-based study was conducted in Edo State (Nigeria) among selected Nigerian dentists that attended the Annual Scientific Conference of School of Dentistry, University of Benin (Benin City, Nigeria) between 2016 and 2017. The 54-item, modified Chhabra, et al disaster management questionnaire, which elicited information on demographic characteristics, disaster management knowledge, attitude, preparedness, and willingness, was the data collection tool.Results:A total of 126 dentists participated in the study, giving a 68.1% retrieval rate. The willingness to render assistance in the case of disaster among the participants was 95.2%. More than three-quarters (81.0%) reported that they had not received any disaster management training and 92.9% reported that they were not familiar with any government paper on response to disaster. The mean disaster management knowledge and attitude scores were 16.95 (SD = 0.40) and 34.62 (SD = 0.56), respectively. Disaster management knowledge had positive significant correlation with attitude and behavior. The disaster management attitude had positive significant correlation with behavior and negative significant correlation with preparedness. Disaster management behavior had positive significant correlation with preparedness and willingness to render assistance. Willingness to render assistance had significant correlation with preparedness.Conclusion:Data from this study revealed high-level of willingness to render assistance in disaster, high disaster management attitude, but with low disaster management knowledge, behavior, and preparedness. The significant correlation between knowledge, attitude, behavior, and preparedness implies that training will offer immense benefit.Odai ED, Azodo CC, Chhabra KG. Disaster management: knowledge, attitude, behavior, willingness, and preparedness among Nigerian dentists. Prehosp Disaster Med. 2019;34(2):132–136

Introduction:There has been global concern regarding road traffic injuries. Motorcyclists constitute a high proportion of fatalities in road traffic crashes. Commercial motorcyclists (Okadas) constitute a unique group in this regard. The purpose of this study was to evaluate driver-related risk factors in Okada accidents in Benin City, Nigeria.Methods:This was a prospective study. Interviewers administered questionnaires that were used to assess Okada drivers during a two-month period (November–December 2006).Results:A total of 996 Okada drivers were interviewed, 995 males and one female. Their ages ranged from 16–80 years with a mean age of 36.4 ±2.4 years. In the majority of cases, the maximum educational level achieved was primary or secondary. The majority of Okada drivers (82.8%) took to the Okada business as a last resort. Driver's licenses for Okada operation were possessed by 73.5% of drivers, but only 27.2% had taken a road test before being given a license. No form of training on the use of Okadas was received by 45% of drivers before they commenced operations. Crash helmets were owned by 56.4%, but they did not use them on a regular basis. Inconvenience was the reason provided for poor compliance by 52.7% of drivers. Regular intake of alcohol was present in 39.8% of drivers.Conclusions:Okada drivers are mainly young males with a low level of education who are ill-prepared and ill-equipped for the road. This is a recipe for traffic crash-related injuries and fatal motorcycle crashes. There is an urgent need for job creation, better licensing procedures, road safety education, national legislation, and enforcement of crash helmet laws as well as alcohol breath tests for Okada drivers in Nigeria.