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.

Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20–60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov , NCT04384926 . Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include...

Heat stress had a negative effect on laying hens’ performance, thus this research was to study the influences of betaine (Bet, 1000 mg/kg betaine), vitamin C (VC, 200 mg/kg ascorbic acid), and vitamin E (VE, 150 mg/kg α-Tocopherol acetate) and their possible combinations on egg production, digestibility of nutrients, plasma hormones and reproductive organs of dual-purpose hens exposed to chronic heat stress. Two hundred and eighty eight hens and thirty-six cocks from 32 to 48 weeks of age were divided into nine treatment groups of four replicates, each containing eight hens and one cock. One group was kept under thermo-natural condition and the eight others were kept under chronic heat stress (CHS). One of these eight was used as a negative control, while the others were supplemented with VC, VE and/or betaine and their possible combinations. Body weights, laying rate, feed intake, and feed conversion ratio in hens reared under CHS rooster without any supplementation during 32 to 48 weeks of impairment (P = 0.0052) were recorded. Hens reared under heat stress and fed a diet supplemented with either Bet, VC, VE or combination of the supplements increased production traits. However, hens supplemented with VC showed the greatest production traits. Plasma glucose, estradiol-17 (E2), progesterone (P4), tri-iodothyronine (T3) and thyroxine (T4) decreased in hens reared under CHS and fed a diet with no supplementation compared to the other treatments (P = 0.001). Liver weights, spleen weights, thyroid gland weights, ovary weights, oviduct weights and oviduct lengths were lowest in hens reared under CHS and fed a diet with no supplementation (P = 0.0480). In conclusion, dual purpose hens reared under CHS and supplemented with VC at 200 mg/kg diet and Bet at 1000 mg/kg enhanced the laying performance and combated CHS.

heat stress is one of the major challenges which the poultry industry faces during summer in tropical and subtropical regions. this study was conducted to evaluate the impact of vitamin (vit) E, c and/or probiotics on improving tolerance of broiler chickens to chronic heat stress (chs). a total of 294, 1-day-old cobb-500 broiler chicks were allocated into seven treatment groups; thermoneutral group was raised under a thermoneutral condition during 25-42 d of age. the other six groups were raised for three successive days per week at 36±2ºc and 75-85% relative humidity for 7 h daily: heat stressed group, vit E (100 mg/kg diet), vit c (200 mg/kg diet), vit c+vit E, probiotics (Saccharomyces cerevisiae and Lactobacillus acidophilus at 2 g/kg diet) and vit c+vit E+probiotics. Exposure to chs decreased body weight gain (bwg), feed intake (fi), and abdominal fat. it had adverse impact on feed conversion ratio (fcr), packed cell volume (pcv), monocyte, basophil, total protein, and phagocytic activity while increased plasma cholesterol and aspartate aminotransferase (ast) compared to the thermoneutral group. vit E, vit c or probiotics alone decreased the adverse effects of chs on growth rate throughout the experimental period. vit c and E were equally potent during the experimental period, but were less effective than the combination of both vitamins. vit E increased the dressing percentage and abdominal fat as compared to the thermoneutral group, but decreased ast while increasing basophil, monocyte and globulin compared to the heat stressed group. in addition, serum albumin and ast of vit E were lower compared to vit c, but cholesterol was higher. vit E increased red blood cells and white blood cells, but plasma cholesterol was increased compared with the heat stressed group. vit c increased pcv, lymphocytes, monocyte, basophil and albumin and decreased neutrophil. both vitamins without/with probiotic induced a further increase in basophil, serum total protein, and albumin. it could be concluded that supplementation of vit E, vit c, probiotics, and different combinations reduced some of the adverse effects of chs, and vit E+vit c+probiotics was the most effective for economic traits followed by vit E+vit c or probiotics.

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