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.

Diabetes mellitus is an enduring disease related with significant morbidity and mortality. The main pathogenesis behind this disease is its numerous micro- and macrovascular complications. In developing countries, diabetic retinopathy (DR) is one of the major sources of vision impairment in working age population. DR has been classified into two categories: proliferative diabetic retinopathy (PDR) and non-proliferative diabetic retinopathy (NPDR). NPDR is further classified into mild, moderate and severe, while PDR is further classified into early PDR, high risk PDR and advanced diabetic eye disease. DR is a disease caused due to high blood glucose levels which result in vision loss or permanent blindness. High-level advancements in the field of bio-medical image processing have speeded up the automated process of disease diagnoses and analysis. Much research has been conducted and computerized systems have been designed to detect and analyze retinal diseases through image processing. Similarly, a number of algorithms have been designed to detect and grade DR by analyzing different symptoms including microaneurysms, soft exudates, hard exudates, cotton wool spots, fibrotic bands, neovascularization on disc (NVD), neovascularization elsewhere (NVE), hemorrhages and tractional bands. The visual examination of the retina is a vital test to diagnose DR-related complications. However, all the DR computer-aided diagnostic systems require a standard dataset for the estimation of their efficiency, performance and accuracy. This research presents a benchmark for the evaluation of computer-based DR diagnostic systems. The existing DR benchmarks are small in size and do not cover all the DR stages and categories. The dataset contains 1445 high-quality fundus photographs of retinal images, acquired over 2 years from the records of the patients who presented to the Department of Ophthalmology, Holy Family Hospital, Rawalpindi. This benchmark provides an evaluation platform for medical image analysis researchers. Furthermore, it provides evaluation data for all the stages of DR.

Goldenhar syndrome is a congenital disorder with diverse clinical presentation. This case series describes variousclinical manifestations of Goldenhar Syndrome. Materials and Methods: 11 patients at least two of the described features of Goldenharsyndrome were randomly included in the study to form a case series. Clinical data of all these subjects was documented, described inpercentages and analyzed. Results: Out of the 11 patients studied, 6 were females and 5 males. Mean age was 7.3 years (ranging from 1year to 23 years). 7 (63.6%) patients had a limbal dermoid, 6 (54.5%) patient had mandibular hypoplasia, whereas only 3(27.3%)presented with hemifacial microsomia. Spinal defects and polydactyly were present in (36.4%) patients each. There was one patient (9%)who had both microphthalmia and lid coloboma in addition to limbal dermoid. Similarly, renal defect (atrophic kidney), cleft upper lip andpalate and CNS defect (7th nerve palsy) were present in one patient (9%) each. None of our patients had either cardiac or GIT defect.Conclusions: In our study we were able to document the variable manifestations of Goldenhar syndrome with their frequencies. Thisknowledge base will help us in planning treatment and assistance strategies or these patients.

Purpose:  To compare 0.1% Nepafenac ophthalmic solution with placebo in terms of decreasing mean intraoperative miosis in patients undergoing cataract surgery. Study Design:  Quasi experimental study. Place and Duration of Study:  Department of Ophthalmology, Holy-Family Hospital Rawalpindi from September 2017 to March 2018. Methods:  A total of 150 eyes with senile cataract of patients between 40-80 years of age and of both genders, undergoing uneventful cataract surgery and fulfilling the inclusion criteria were included. Patients were divided into 2 equal groups. Group A received Nepafenac eye drops and group B received placebo drops (Preservative free artificial tears). The diameter of pupil as viewed through the operating microscope was measured with Castroviejo Caliper at following steps; immediately before the start of surgery (baseline), after complete nucleus removal and at the end of surgery. Results:  Mean decrease in pupil size from the start of surgery to the end of phacoemulsification in Group A (nepafenac group) was 0.48 ± 0.26 mm while in Group B (placebo group) it was 1.40 ± 0.49 mm (P = 0.0001). Mean decrease in pupil size from start to end in Group A (Nepafenac group) was 0.75 ± 0.32 mm while in Group B (placebo group) was 2.02 ± 0.62 mm (P = 0.0001). Conclusion:  Intraoperative miosis in terms of mean decrease in pupils size (both from start of surgery till phacoemulsification and also from start of surgery till end of surgery) was lower in 0.1% Nepafenac group as compared to placebo group. Key Words:  Phacoemulsification, Miosis, Nepafenac.