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.

Державний заклад «Запорізька медична академія післядипломної освіти Міністерства охорони здоров'я України» м. Запоріжжя, Україна Мета роботи-визначити динаміку маркерів ендотеліальної дисфункції у пацієнтів з легеневою гіпертензією на фоні хронічного обструктивного захворювання легень під впливом лікування. Матеріал і методи. Результати дослідження ґрунтуються на даних комплексного обстеження 170 хворих на хронічне обструктивне захворювання легень (ХОЗЛ) віком від 40 до 65 років, з яких 123 пацієнти мали легеневу гіпертензію та 47 осіб були без неї. В амбулаторних умовах обстежено 31 практично здорову особу. Пацієнти з легеневою гіпертензією на фоні ХОЗЛ були розподілені на дві підгрупи спостереження залежно від лікування. Перша підгрупа застосовувала базисну терапію, а друга підгрупа-базисну терапію з додаванням рофлуміласту. Маркери ендотеліальної функції визначені при скринінгу та через 12 місяців спостереження. Результати. Медіана рівня ендотелину-1 у групі пацієнтів з легеневою гіпертензією на фоні ХОЗЛ склала 3,17 [2,19 ; 4,14] фмоль/мл і була достовірно вищою, як проти значення 1,78 [1,25 ; 2,18] фмоль/мл у групі хворих на ХОЗЛ без легеневої гіпертензії (р < 0,05), так і високодостовірно перевищувала в 10,2 раза рівень 0,31 [0,19 ; 0,36] фмоль/мл у групі здорових осіб (р<0,05). Сума метаболітів оксиду азоту (NO2+ NO3) достовірно була нижче (на 15,8 %) у групі осіб з легеневою гіпертензією на фоні ХОЗЛ проти значення 22,00 [21,00 ; 23,00] мкмоль/л у групі хворих на ХОЗЛ без легеневої гіпертензії, і високодостовірно нижче на 37 % порівняно з групою здорових осіб, де рівень цього показника склав 26,00 [25,00 ; 28,00] мкмоль/л (р<0,05). Далі проводили кореляційний аналіз. Визначені достовірні взаємозв'язки між наступними показниками: тривалістю ХОЗЛ і рівнем NO3 (R =-0,29, р = 0,001); тривалістю ХОЗЛ і рівнем NO2+ NO3 (R =-0,26, р = 0,003); середнім тиском у легеневій артерії і рівнем ендотеліну-1 (R = +0,70, р = 0,001); середнім тиском у легеневій артерії і рівнем NO2 (R =-0,59, р = 0,001); середнім тиском у легеневій артерії і NO2+ NO3 (R =-0,50, р = 0,001). Рівні ендотеліну-1 та метаболітів оксиду азоту в плазмі крові хворих були зіставні між першою та другої підгрупами спостереження при скринінгу (p > 0,05). Через 12 місяців виявлено статистично значуще зниження на

Chronic obstructive pulmonary disease significantly affects the quality of life, considerably limiting the physical capabilities of patients and is one of the main causes of morbidity and mortality in modern society. Currently, the problem of the comorbidity for the patients with chronic obstructive pulmonary disease is very relevant. The most common in patients of this category is hypertension. Today, it has been established that disorders in the immune system are detected in a very large group of diseases, including both chronic obstructive pulmonary disease and hypertension. The purpose of the study was to evaluate the dynamics of inflammatory markers in the patients with pulmonary hypertension on the background of chronic obstructive pulmonary disease in combination with hypertension under the influence of treatment. Material and methods. The results of the study are based on data from a comprehensive survey of 170 patients aged 40 to 65 years with chronic obstructive pulmonary disease, of which 123 had pulmonary hypertension (of which 87 had stage II hypertension and 36 were without hypertension) and 47 people were without pulmonary hypertension. The patients were chosen in the period from 2015 to 2018 on the basis of the municipal institution "Zaporizhzhia regional clinical hospital" of the Zaporizhzhia regional council. Results and discussion. The results of this study indicate the role of inflammation, or rather the levels of hs-CRP and IL-6, in the pathogenesis of pulmonary hypertension in patients with chronic obstructive pulmonary disease. The level of hs-CRP among the patients with pulmonary hypertension on a background of chronic obstructive pulmonary disease made up 10.46 [6,24 ; 15,30] mg/l and was significantly higher as against the values in the group of patients with chronic obstructive pulmonary disease without pulmonary hypertension and compared with group of healthy persons. The increase in the level of IL-6 in the group of patients having pulmonary hypertension with chronic obstructive pulmonary disease is significantly higher by 57 % compared to the value in the group of chronic obstructive pulmonary disease without pulmonary hypertension and by 7.4 times the value in the group of healthy individuals (p <0.05). Comparing the subgroups of patients, and depending on the variant of exacerbation of chronic obstructive pulmonary disease, the level of hs-CRP and IL-6 was considerably higher in the subgroup with the infectious type of exacerbation compared with the subgroup of the non-infectious type of exacerbation of chronic obstructive pulmonary disease. Conclusion. After 12 months of treatment, when roflumilast was added to the basic therapy, we revealed a statistically significant difference in the levels of IL-6, hs-CRP and IL-10 in the plasma of patients with pulmonary hypertension on the background of chronic obstructive pulmonary disease combined with hypertension

No abstract