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.

Tension pneumomediastinum is a rare complication of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection that has increased in incidence with the novel coronavirus disease 2019 pandemic. Although traditionally managed with conservative measures, we present the indications and methods for the first operative management of tension pneumomediastinum with concomitant SARS‐CoV‐2 infection.

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ResumenEl glioblastoma multiforme es el tumor primario del sistema nervioso central más frecuente en hombres. Su incidencia en Europa oscila entre 3 y 4 casos por 100.000 habitantes, y representa el 25% de todos los tumores de sistema nervioso central y el 50% de los tumores primarios. Menos del 3% de todos los pacientes con diagnóstico de glioblastoma sobreviven más de cuatro años y la supervivencia promedio es de seis meses.En la actualidad, se están adelantando estudios que tienen como objetivo lograr una mayor supervivencia y aumentar los periodos asintomáticos.Esta revisión tiene como objetivo principal hacer un breve recuento de los avances en el tratamiento del glioblastoma multiforme, haciendo énfasis en la terapia génica. En la literatura revisada se encontró que, en la actualidad, sólo hay dos tipos de mutaciones capaces de definir el pronóstico de la enfermedad; la presencia de la metilguanina-ADN metiltransferasa (MGMT) y la deleción 1p/19q, en las cuales se hará hincapié en el transcurso del documento.Palabras clave: glioblastoma multiforme, MGMT, deleción 1p/19q, vías de señalización. AbstractGlioblastoma multiforme is the most common central nervous system (CNS) primary tumor in men. Its incidence in Europe lies between 3 to 4 cases per 100,000 inhabitants and it represents 25% of all the CNS tumors and 50% of the primary tumors. Less than 3% of all patients diagnosed with glioblastoma multiforme survive more than 4 years and the average survival is of 6 months. Studies aiming to increase the survival rate, as well as to achieve longer asymptomatic periods are being carried out at present. ARTÍCULO DE REVISIÓNKey words: glioblastoma multiforme, MGMT, 1p/ 19q deletion, signaling pathways. Figura 1. Paciente de sexo masculino de 74 años con diagnóstico de glioblastoma multiforme en el hemisferio cerebral izquierdo.