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.

The kidney plays an essential function in one's body by eliminating nitrogenous waste products. Loss of renal function gives rise to uremia, which is a progressive increase in the level of the metabolites of protein breakdown circulating in the blood 1.Dialysis is a process used to extract a nitrogenous substance from blood and to remove excess water. It usually carried out three times a week for 3-4 hours. During the process, kidneys are not able to get rid of enough waste products and fluid from the blood and body 2 .Diet is essential. Patient must have the right amount of protein, fluids, calories,vitamins and minerals each day. Malnutrition is common in dialysis patients and closely related to morbidity. Therefor assessment of nutritional status and nutritional, management of dialysis patients play a central role in every day Nephrological practices 3Methodology: A descriptive survey design is adopted for this study. The participants were 30 hemodialysis patients who met the inclusion criteria were selected as the sample. The tool was prepared to assess knowledge and practice regarding dietary regulation in hemodialysis patients. Results:The findings shown that majority of the samples (70%) were males, 90% of subjects were not having the history of kidney disease in their family and with regards to the years of having the history of Chronic Kidney Disease (46.7%) were diagnosed to have CKD with less than 6 yrs.According to the level of knowledge regarding dietary management (10%) of the subjects had poor knowledge, (73.3%) of the subjects had average knowledge, (16.7%) of the subjects had good knowledge. With regards to the management of dietary regulation, 50% of patients scored between the ranges 10-13, in their practices were beneficial, and 50% of patients scored between the ranges 13-16 in their practices were non-beneficial. Chi-square test was used to find out the association between the knowledge and practices, and the results showed that there is no statistically significant relationship between knowledge and practices at 0.05 level of significance (P>0.05). Discussion:The purpose of the health care system is to provide quality services, and communication is the best way to gain patients satisfaction. Thus results of this study, shows that there is no relationship between knowledge and practice of hemodialysis patients regarding dietary regulations.

Objective This study was done to evaluate the effectiveness of a planned teaching program on the knowledge of staff nurses with regard to the nutritional requirements of patients with chronic kidney disease. Methods Uncontrolled before-and-after study was conducted among staff nurses of a hospital. Convenient sampling was used to select the participants. Pretest knowledge was assessed using a structured questionnaire among staff nurses. After the pretest, the experimental group was administered a planned teaching program for 60 minutes. On the 7th, 14th, 21st, and 28th day the posttests were conducted by delivering the same tool to determine the posttest level of knowledge after the administration of the planned teaching program. Results The staff nurses’ pretest knowledge scores reveal that the majority (77.5%) had an average knowledge level and 10% had poor knowledge levels. The effectiveness of the planned teaching program showed that the mean pretest knowledge score of the staff nurses (x̄ 1=16.10) was significantly lower than the mean posttest knowledge scores of the participants (x̄ 2 = 20.78, x̄ 3 = 24.35, x̄ 4 = 24.20, and x̄ 5 = 28.75). Conclusion In this study, the planned teaching program was found to be efficient on the knowledge level of staff nurses regarding the nutritional requirements of patients with chronic kidney disease.

Aim: To study the efficacy of clonidine given orally as premedication on attenuation of rise in intraocular pressure, haemodynamic responses to induction aided with suxamethonium, laryngoscopy and subsesequent tracheal intubation, its sedation and antisialogogue effects and compare with oral diazepam premedication. Patients were randomly divided into two groups i.e. each group of 30 patients. One group was assigned to receive oral clonidine 4-5mcg/kg or diazepam 0.2-0.25mg//kg body weight oral premedication 90mins before induction. Patients received this premedication randomly and in double blinded manner. Pulse rate, blood pressure and intraocular pressure of both eyes were recorded prior to premedication in both the groups. The degree of preoperative sedation was determined according to a Ramsay sedation scale. Patients were asked for oral secretions (salivation) and antisialagogue effect was determined. It has been observed that clonidine premedication is superior to diazepam in attenuating the rise in intraocular pressure, pulse rate, blood pressure (systolic, diastolic and MAP) associated with laryngoscopy and intubation aided with suxamethonium. Clonidine is superior to diazepam in decreasing the IOP and maintaining stable haemodynamic responses following i.v. suxamethonium, laryngoscopy and intubation. Diazepam caused more sedation as compared to clonidine. Clonidine exhibits antisialogogue effect which is not seen with diazepam.