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.

Giant cell arteritis is the most common systemic vasculitis in adults and especially in older people. Its development and treatment is often associated with comorbidities, relapses and va rious complications. The paper represents an analytical review, systema tic generalization and discussion of evidence on modern strategies, main risks, medicines and outcomes of the treatment of patients with giant cell arteritis. We studied specialized literature data published in English, Russian and German, found by electronic and manual search, checked for indexing in the main computer databa ses of evidence-based medicine (Cochrane Library and Medline) and selected without time limiting. Special attention is paid to prevention of early and severe complications and adverse effects of therapy -eye, cardiovascular, cerebrovascular and infectious diseases, diabetes, osteoporosis, fractures and malignancies. Best practice and the results of the introduction of an accelerated approach to management of a patient with suspected giant cell arteritis in primary healthcare setting are described, as well as current evidence base and prospects for early diagnosis and use of glucocorticoids and adjuvant immunosuppressive and biologic therapy with a focus on methotrexate and tocilizumab. Main principles, recommendations and evidence base of the 2020 British Society for Rheumatology guidelines on diagnosis and treatment of this vasculitis are represented and discussed.

На сегодняшний день атеросклеротические поражения брахиоцефальных артерий занимают одно из лидирующих мест среди сосудистой патологии, уступая лишь поражениям коронарных сосудов и сосудов нижних конечностей. Несмотря на развитие высоких технологий и малоинвазивных методик лечения, ка-ротидная эндартерэктомия остается ведущим методом лечения данной патологии. К настоящему времени методики обследования и показания к операциям четко определены, отработаны многие виды оператив-ных вмешательств. Однако проблема дальнейшего прогрессирования заболевания остается актуальной не зависимо от метода вмешательства и пластического материала используемого при операции. В среднем рестеноз выявляется у 10-15% ранее прооперированных пациентов.В обзоре проанализированы различные методики операций и их отдаленные результаты. Проверен сравнительный анализ пластических материалов, используемых при каротидной эндартерэктомии. Анализ литературы позволил определить наиболее значимые и успешные способы снижения частоты рестенозов в отдаленном послеоперационном периоде. В то же время установлено, что в литературе отсутствуют четкие данные по развитию рестенозов после различных методов оперативных вмешательств. Выявлено значи-тельное разнообразие мнений о применяемых пластических материалах, что свидетельствует об отсутствии единой точки зрения по их выбору.Проведенный анализ литературы подтверждает необходимость проведения дальнейших исследова-ний по изучению патогенеза рестенозов после вмешательств, а также по поиску методов оперативной коррекции и альтернативной ткани для реконструкции внутренней сонной артерии. Перспективным пред-ставляется изучение вопроса о применении бедренной вены для реконструкции ветвей дуги аорты. Ключевые слова: атеросклероз, брахиоцефальные артерии, внутренняя сонная артерия, оперативное ле-чение, каротидная эндартрэктомия, результаты, рестенозToday the atherosclerotic lesions of the brachiocephalic arteries occupy one of the leading places among vascular disease, second only to coronary vessels and lower extremities vessels. Despite the development of high technologies and minimally invasive treatment techniques, carotid endarterectomy remains a leading treatment method of the given pathology. By the present moment the methods of examination and indication for the surgery have been strictly determined; many kinds of surgeries have been worked out. However, the problem of further disease progression remains valid regardless of the method of intervention and the plastic material used in the operation. On the average restenosis is detected in 10-15% of earlier operated patients. Different operative techniques and their distant results have been analyzed in the review. Comparative analysis of plastic materials used for carotid endarterectomy has been carried out.Literature analysis has permitted to determine the most significant and successful ways to reduce restenosis incidence in distant postoperative period. At the same time it has been established that there are no distinct data concerning restenosis developm...

Objective: to assess the results of the microbiological study of wounds in patients with diabetic foot syndrome (DFS).Material and methods. The microbiological study of the wounds of 76 patients with the neuroischemic form of DFS having undergone inpatient treatment at Gomel Regional Diabetic Foot Center from 2016 to 2019 was performed.Results. The range of the microbial flora of the wounds of the patients with the neuroischemic form of DFS has been identified, the antibiotic susceptibility of the detected bacteria to antibacterial drugs has been analyzed.Conclusion. The microbiological profile of the wounds of the patients with the neuroischemic form of DFS was characterized by the variety of bacteria and included Enterococcusfaecalis (29%), Staphylococcusaureus (19%), as well as representatives of Enterobacteriaceae family (25%). The detected bacteria were most sensitive to glycopeptides, aminoglycosides, carbapenems, which makes it reasonable to prescribe these groups of antibiotics as the start antibacterial therapy.