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.

Introduction: The associations between programmed cell death ligand 1 (PD-L1) and the prognosis of various cancers have always been a research topic of considerable interest.However, the prognostic value of PD-L1 in breast cancer patients remains a controversial subject. We aimed to evaluate the role of programmed death-1 receptor and programmed death ligand-1 (PD-1/PD-L1) expressing lymphocytes, monocytes and granulocytes, as potential mechanism of immune escape in breast cancer patients. Also, serum levels of Bcl-2 were analyzed among patients with different stages of breast cancer. Material and Methods: The study was conducted on a total of seventy-five females; fifty-five of them represented the breast cancer females at early (24 females) and advanced (31 females) stages and 20 ages matched female donors represented the control group. Patients were recruited from the Cancer Research and Management Department, Medical Research Institute, Alexandria University. Venous blood samples obtained from all females under study were used for determination of PD-1/PD-L1 expression using flowcytometry technique and measurement of Bcl-2 serum levels using ELISA technique. Results: Significantly higher expression levels of PD-L1 were found in patients with positive lymph node, advanced tumor stage, histological grade II, tumor size T2, ER, PR, Her-2 negativity and TNBC subtype. Whilst a general increase in PD-1 positive expression between the breast cancer patients and control group regarding percentage and MFI of positive PD-1 expressing monocytes and granulocytes. Also, the results showed a highly significant association between PD-1+ and PD-L1+ expression in early and advanced breast cancer patients (p<0.0001). There was a significant increase in the mean of Bcl-2 serum concentration in patients compared to healthy individuals. Finally, the results showed that Bcl-2 serum concentration correlated positively with positive PD-L1+ expressing granulocytes. While the correlation between serum Bcl-2 and PD-1+ expressing lymphocytes, monocytes and granulocytes did not show any statistical significance. Conclusions: Our study suggested that PD-L1 could serve as an important target for antibody based immunotherapies, especially in the TNBC, where treatment options are limited. The direct correlation between PD-L1+ expression and serum Bcl-2 concentration may explore a role of apoptotic machinery in the pathogenesis of breast cancer.

Background: Malnutrition is a challenging problem fronting acute leukemia patients. Early identification of high-risk patients is crucial for disease outcome. Objective(s):The study aimed to assess the nutritional status of acute leukemia patients and to assess patient's length of hospital stay (LOS) and disease duration. Methods: A cross sectional study was conducted on 90 adult acute leukemia patients attending a Alexandria University Hospital, Egypt. Dietary intake assessment using 24 hour recall method, clinical assessment for subcutaneous fat loss and muscle wasting, body mass index (BMI), triceps skinfold thickness (TSF), mid-upper arm circumference (MUAC) and body composition measurements were done according to the standard procedures. Records for laboratory tests were reviewed for each patient. Body mass index (< 18.5 kg/m 2 ), MUAC (<25.5 cm in male and < 23 cm in female) and TSF (< 12.5 mm in male and < 16.5 mm in female) were used to rule in a state of malnutrition. Results: Nineteen patients (21.1%) according to BMI, 9 patients (10%) according to MUAC and 15 patients (16.6%) according to TSF were found to be malnourished. Based on BMI, ninety percent of the patients were taking less than their daily energy and protein needs (91.1%) with no significant difference between malnourished and well-nourished group. The percent of muscle mass was significantly lower among malnourished patients (36.22 ± 7.98 vs.31.53 ± 5.52%). Malnourished patients had significantly longer disease duration (16.32 ± 9.80), longer mean LOS (58.20 ± 16.44 vs 105.42 ± 38.36) and higher mean number of chemotherapy cycles (4.66 ± 1.62 vs 8.26 ± 3.12) Conclusion: Nutrition is an important aspect of patient care in acute leukemia. Attention should be paid for acute leukemia patient's nutritional needs to achieve better disease outcome.