Background This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P = 0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P < 0.001) among patients who had surgery during the pandemic. The adjusted odds of death were higher during than before the pandemic (odds ratio (OR) 2.72, 95 per cent c.i. 1.58 to 4.67; P < 0.001). In mediation analysis, 54.8 per cent of excess postoperative deaths during the pandemic were estimated to be attributable to SARS-CoV-2 (OR 1.73, 1.40 to 2.13; P < 0.001). Conclusion Although providers may have selected patients with a lower risk profile for surgery during the pandemic, this did not mitigate the likelihood of death through SARS-CoV-2 infection. Care providers must act urgently to protect surgical patients from SARS-CoV-2 infection.

Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien–Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk.

Routine testing of 440 women (257 Fijians, 183 Indians) at the first antenatal attendance identified Chlamydia trachomatis in 50% of Fijians and 38% of Indians; the seropositivity rates for syphilis were 14.2% and 1.7% respectively, and the isolation rates for N. gonorrhoeae were 3.1% in Fijians and 1.1% in Indians.

Background: Diabetes-related complications in the form of lower limb amputations (LLA) remain a major concern globally in the form of both human suffering and increased fiscal burden. Studies conducted in developed countries have demonstrated that the burden of diabetes-related amputations is on the decrease. These decreasing trends in developed countries provide an insight (a surrogate marker) into overall diabetes control achieved in these countries. Similar data from studies conducted in South Africa and Africa itself are scarce. Methods: The data collected by Department of Health Information Systems (DHIS) for all patients with diabetes seen at public healthcare facilities within KwaZulu-Natal from 2013 to 2017 inclusive were assessed. The DHIS data element used for this study was 'diabetes-related amputations'. The location of the hospital was used to classify them as urban or rural. Data relating to type of housing, access to piped water, electricity and sanitation were obtained from the South African mid-year population estimates from 2016.Results: This study demonstrated that a strong positive correlation existed between amputation rate and the increasing years of the study (r = 0.70). The trend in diabetes-related LLA in 5 of the 11 districts (45.45%) had an upward slope. The incidence of LLA was on an upward trend in urban compared with rural areas (slope 71.90 ± 26.75 vs 5.20 ± 10.04, respectively). Positive slopes for LLA were noted in both regional and tertiary KwaZulu-Natal hospitals (48.00 ± 44.67 and 19.80 ± 36.38 respectively). The prevalence of diabetes-related LLA was associated with poor accessibility to adequate housing, piped water, electricity and sanitation. Each of these four variables independently had a significant effect on the prevalence of LLA within all districts in KwaZulu-Natal. Conclusion: Diabetes-related LLA serves as a surrogate marker for overall diabetes control within a country. This study has shown that there was a strong positive correlation between amputation rates and time within KwaZulu-Natal. This finding serves as an indicator that only sub-optimal diabetes control is still being achieved.

Background: Type 2 diabetes mellitus (T2DM) is a familial condition with a strong genetic component. International studies have highlighted associations between a positive family history of diabetes (FHD) and poorer glycaemic control. No current data are available on this association within the context of HIV. Objectives: To determine a relationship between FHD and glycaemic control in patients living with DM (PLWD) in an HIV endemic area. Methods: Standardised clinic sheets were used from the DM clinic at Edendale Hospital, Pietermaritzburg, South Africa, from January 1, 2019 to December 31, 2019. Statistical analysis was done. Results: This study had 957 patients living with diabetes (PLWD); 498 (52.2%) had a positive FHD while 456 (47.8%) had no FHD. There were 146 (15.3%) HIV-infected patients; with 84 (57.5%) on a fixed dose combination (FDC) of anti-retroviral treatment (ART). Patients aged between 18 and 30 with a maternal FHD had significantly higher mean HbA1c levels than those without a maternal FHD (HbA1c: 10.80% vs. 9.72%, p = 0.025). Patients living with type 1 DM (PLWT1DM) in the HIV-uninfected cohort had significantly higher HbA1c levels than patients living with type 2 DM (PLWT2DM) (10.38% vs. 9.46%, p = 0.002). HIV-infected PLWD (PLWDH) on a FDC with a positive FHD had significantly higher HbA1c levels than those without a FHD (9.52% vs. 8.52%, p = 0.04). PLWDH with a positive maternal FHD on an FDC had increased HbA1c levels (9.81% vs. 8.55%, p = 0.009). Conclusion: Genes significantly affect glycaemic control among PLWD. PLWT1DM and PLWDH with a positive FHD (especially a maternal FHD) should be regarded as being in a higher risk category requiring more intensive lifestyle and therapeutic intervention to achieve optimal diabetes control. Our study suggests that a positive FHD affects glycaemia in PLWT1DM as significantly, if not more, than in PLWT2DM and recommends screening for a FHD to be incorporated in the comprehensive management of DM.