Is perioperative COVID-19 really associated with worse surgical outcomes among vaccinated patients?

INTRODUCTION: During the surge of the SARS-CoV-2 pandemic, studies revealed high complication and morbidity rates following surgical procedures in COVID-19 positive patients. Anesthetic and surgical societies swiftly developed strategies to mitigate these risks, including a recommended postponement of elective surgeries for a minimum of 7 weeks post-COVID infection. Nowadays, with a predominantly vaccinated population, it has become crucial to discern the influencing factors on post-COVID morbidity and mortality and a reevaluation of the existing recommendations pertaining to elective surgery. METHODS: A single-center case-control study was conducted, including patients who underwent surgery between November 2021 and March 2022 and met the inclusion criteria. Eighty COVID-19 positive patients were matched 1:1 with 80 controls, each undergoing an identical intervention within a 2-week time frame. The primary outcome was 30-day postoperative mortality and secondary outcome postoperative complications (respiratory and thromboembolic). RESULTS: At the time of surgery, 88.8% of patients in the case group and 92.5% in the control group had received at least one vaccine dose. Mortality and morbidity did not show a significant difference when comparing the case and control groups (7.5% vs 6.2%, p = 0.755; 11.3% vs 8.9%, p = 0.541 respectively). In the COVID-positive group, mortality was significantly associated with age over 70 years, ASA score over III, RCRI over 1, emergency procedures, and absence of thromboembolic prophylaxis. CONCLUSIONS: In contrast to previously reported findings, we did not observe an increased morbi-mortality in patients with perioperative COVID-19 infection. It may not be necessary to delay elective interventions, except in cases with a high-risk.

Melanosis coli sobre colostomía terminal: revisión de la literatura / Melanosis coli over terminal colostomy: review

Introducción. La melanosis coli es una patología intestinal benigna y reversible que se caracteriza por el depósito de lipofuscina en la lamina propia de la mucosa del colon, adquiriendo una coloración oscura. Su aspecto macroscópico puede confundirse con una colitis isquémica avanzada como en el caso presentado a continuación. Caso clínico. Mujer de 86 años con estreñimiento crónico y consumo habitual de laxantes antraquinónicos que es sometida a cirugía de urgencia. Presenta perforación diastásica por oclusión de colon sigmoide. Se confecciona colostomía terminal apreciando desde el postoperatorio inmediato colostomía oscura aunque aparentemente bien vascularizada que presentó diagnostico diferencial entre isquemia y melanosis coli. Discusión. La melanosis presenta una incidencia en torno al 1% siendo más frecuente en mujeres mayores con estreñimiento crónico. Aunque su etiología no esta clara, se relaciona directamente con el consumo de laxantes antraquinónicos. La mayoría de los pacientes son asintomáticos y se trata de un hallazgo casual en estudios endoscópicos o anatomo-patológicos tras resecciones quirúrgicas. No tiene tratamiento especifico, pero parece que la interrupción de la toma de laxantes durante más de un año puede revertir el cuadro clínico. (AU)

Introduction. Melanosis coli is a benign and a reversible intestinal condition. MC is associated with the deposition of lipofuscin in the lamina propria of the colonic mucosa, causing the darkly pigmentation. Dark pigmentation can be considered a ischemic colitis, for example the next case. Clinical case. A 86 years old woman with a chronic constipation and a long-term using anthraquinone laxatives was undergoing emergency surgery. She had colonic perforation due to sigma occlusion. It was made terminal colostomy with dark pigmentation but adequate vascularization from immediate postoperative. The differential diagnosis between ischemic colitis and melanosis was necessary. Discussion. Melanosis has an incidence of around 1%, being more frequent in older women with chronic constipation. Although its etiology is not clear, it is directly related to the consumption of anthraquinone laxatives. Most of the patients are asymptomatic and it is an accidental finding in endoscopic or anatomopathological studies after surgicalresections. There is no specific treatment, but it seems that stopping the use of laxatives for more than a year can reverse the clinical symptoms. (AU)

Effects of oral exposure to silver nanoparticles on the sperm of rats.

It has been demonstrated that exposure to silver nanoparticles (AgNPs) can induce toxicological effects in rodents. In this study, we investigated whether sub-chronic oral exposure to different doses of polyvinil pyrrolidone (PVP)-coated AgNPs (PVP-AgNPs) (50, 100 and 200mg/kg/day) could induce harmful effects on epididymal sperm rat parameters. Sperm motility, viability and morphology were examined. Moreover, a histological evaluation of testis and epididymis was also performed. High doses of PVP-AgNPs showed higher sperm morphology abnormalities, while a progressive, but not significant effect, was observed in other sperm parameters. The current results suggest that oral sub-chronic exposure to PVP-AgNPs induces slight toxicological effects in sperm rat parameters.

SEM analysis of hybrid layer and bonding interface after chlorhexidine use.

OBJECTIVE: To evaluate the appearance of the hybrid layer of one total-etch and one self-etch bonding agent on human teeth with and with-out the application of 2% chlorhexidine after water storage. MATERIALS AND METHODS: Twelve human maxillary teeth (molars and premolars) had two Class II cavities (MO-OD) prepared. Teeth were separated in two groups (n=6) to receive either Adper Single Bond 2 or Adper SE Plus (3MESPE). In one cavity, the dentin donding agent was applied following manufacturer's instructions. On the adjacent cavity, 2% chlorhexidine was applied for 30 seconds before the application of the bonding agent. Teeth were sectioned mesiodistally with a slow-speed diamond disk and stored in water at 37°C for four months. The teeth were prepared for scanning electron microscope observation.The appearance of the hybrid layer was ob-served and measured by two variables: clear image of hybrid layer and presence of resintags in tubules. Data were analyzed with a Kruskal-Wallis test calculated at a 0.05 significance level. RESULTS: All groups treated with chlorhexidine had the clear presence of a hybrid layer,whereas only half the specimens without chlorhexidine had a clear hybrid layer. Chlorhexidine did not affect the presence of resin tags. CONCLUSIONS: The use of 2% chlorhexidine be-fore the application of a dentin-bonding agent reduced the deterioration of the hybrid layer when exposed to water.

Ruptured spinal arteriovenous malformation causing cauda equina syndrome: case report.

We describe the case of an acute cauda equina syndrome secondary to a confined subarachnoid bleed from a spinal arteriovenous malformation. The patient was elderly and made a complete neurological recovery following surgery.

Meningioma recurrence at a different site masquerading as a subdural hematoma. Case report.

It is unusual for a meningioma to recur at a distant site. It is more unusual for a meningioma to present as a subdural hematoma. The authors report a unique case in which both of these events occurred in the same patient during a 4-year period. The authors discuss the pathogenesis of these rare events with regard to meningiomas.

Group insurance.

Health insurers that traditionally have been dominant in the indemnity business are bypassing partnerships with hospitals and physicians and are building their own medical groups. The new relationships bring benefits for all parties.