To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.

Objectives The aim of this study was to evaluate the differences in surgical capacity for head and neck cancer in the UK between the first wave (March‐June 2020) and the current wave (Jan‐Feb 2021) of the COVID‐19 pandemic. Design REDcap online‐based survey of hospital capacity. Setting UK secondary and tertiary hospitals providing head and neck cancer surgery. Participants One representative per hospital was asked to report the capacity for head and neck cancer surgery in that institution. Main outcome measures The principal measures of interests were new patient referrals, capacity in outpatients, theatres and critical care; therapeutic compromises constituting delay to surgery, de‐escalated surgery and therapeutic migration to non‐surgical primary modality. Results Data were returned from approximately 95% of UK hospitals with a head and neck cancer surgery specialist service. 50% of UK head and neck cancer patients requiring surgery have significantly compromised treatments during the second wave: 28% delayed, 10% have received radiotherapy‐based treatment instead of surgery, and 12% have received de‐escalated surgery. Surgical capacity has been more severely constrained in the second wave (58% of pre‐pandemic level) compared with the first wave (62%) despite the time to prepare. Conclusions Some hospitals are overwhelmed by COVID‐19 and unable to offer essential cancer surgery, but all have neighbouring hospitals in their region retaining good (or even normal) capacity. It is noteworthy that very few patients have been appropriately redirected away from the hospitals most constrained by their burden of COVID‐19. The paucity of an effective central or regional strategic response to this evident mismatch between demand and surgical capacity is to the detriment of our head and neck cancer patients.

Aims and Scope Eurasian Journal of Medicine (Eurasian J Med) is an international, scientific, open access periodical published by independent, unbiased, and tripleblinded peer-review principles. The journal is the official publication of

Persistan primer hiperparatiroidi gelişiminde etkili risk faktörleriAmaç: Başarısız paratiroidektomi sonucu gelişen persistan primer hiperparatiroidi seyrek, fakat yüksek komplikasyon ve oranlı reoperasyonu nedeni ile oranlarına sahip olduğu için zorlu bir problemdir. Bu çalışmanın amacı, persisten hiperparatiroidizmden sorumlu risk faktörlerini değerlendirmektir. Gereç ve Yöntem: Cerrahi Kliniğimizde 2000-2010 yılları arasında primer hiperparatiroidi nedeniyle paratiroidektomi yapılan hastaların verileri retrospektif olarak değerlendirildi. İlk paratiroidektomi sonrası en az 6 ay takip edilen hastalar çalışmaya dahil edildi ve hastalar persistan olup olmadığına bakılarak iki gruba ayrıldı. Grup 1'de persistan olmayan, grup 2'de persistan olan hastalar yer aldı. Gruplar yaş, operasyon tipi, ektopik bez varlığı, multipl bez ve nodüler tiroid hastalığı açısından Ki kare ve Fisher'in Kesinlik testi ile karşılaştırıldı. Rölatif risk hesaplandı. Bulgular: On yıllık dönemde kliniğimizde primer hiperparatiroidi nedeniyle 159 paratiroid ameliyatı yapıldı. Toplam kriterlere uygun 132 hasta çalışmaya dahil edildi ve seride toplam başarı oranı %97.72 idi. Hastaların yaş ortalaması 54.8±12.8 yıl olup, %81.1'i kadındı. Birinci grupta yer alan 124 hastada (93.9%) persistan hastalık yoktu. İkinci grupta yer alan 8 hastada (%6.1) persistan hastalık vardı. Ektopik bez varlığı, multipl bez hastalığı 1. gruba oranla 2. grupta (sırasıyla p=0.001, p=0.0001) anlamlı olarak yüksekti. Persistan hastalık riski ektopik bezi olan hastalarda 11.81 kat, tek adenoma olanlara göre çift adenomu olan hastalarda 32.29 kat daha fazla idi. Operatif yaklaşım ve guatrın persistan hastalık üzerinde bir etkisi yoktu. Sonuç: Primer hiperparatiroidinin başarılı cerrahi tedavisine rağmen, kabul edilebilir oranda persistan hastalık gelişebilmektedir. Çoklu bez hastalığı, özellikle de çift adenom ve ektopik yerleşim, persistan hastalık için en önemli risk faktörleridir. Persistan hastalık gelişen hastaların ameliyat öncesi dönemde dikkatli değerlendirilmesi ve uygulanan görüntüleme yöntemleri ile ikincil ameliyatlarda tatminkar oranda kür sağlanabilir.

Fibroadenomas are the most common benign breast tumors in young women aged between 20-30 years. Giant fibroadenomas are often larger than 5 cm, weigh more than 500 g or occupy 80% of the breast. They can mimic malignant tumors because they grow rapidly and cause breast deformity. We present a young female patient, in the second trimester of her pregnancy, who had a rapidly growing giant fibroadenoma. Since the mass was suspected of malignancy and caused deformity in the breast, surgical excision was indicated. The operation was performed without complications and the patient was discharged on the second postoperative day. Although the second trimester is suitable for semielective surgeries that cannot be postponed, the timing of the operation is decided by a multidisciplinary team including surgeons, anesthesiologists, obstetricians and perinatologists.