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 (5.4 (95%CI 4.3–6.7)). 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.

Abstract

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care.

Background: The incidence of HER-2 over expression among Omani breast cancer patients was reported as 40% (higher than international published figures). Since 2002 a total of 76 patients with early and metastatic breast cancer received Trastuzumab, the results and incidence of developing brain metastasis during treatment are presented. Methods: Prospective, single arm, single centre experience. Patients with confirmed HER-2 positive (+++ by Herceptest, or FISH positive) breast cancer who received Trastuzumab (either as adjuvant or for metastatic disease) were included. Eligible patients were aged > 18, ECOG PS ≤ 2, LVEF >50% and with adequate renal & liver function and with no evidence of brain metastasis prior to starting treatment. Adjuvant Trastuzumab was received for 1 year following chemotherapy in early breast cancer cases or as a single agent or in combination with …

Background and Objectives: A prospective, singlearm study was carried out to evaluate the safety and efficacy of neo-adjuvant chemotherapy in advanced head and neck cancer (HNC) in Oman.

Materials and Methods: The study was carried out in the Oncology and Ear, Nose and Throat (ENT) Departments, Muscat, Oman between October 1998 and December 2001. Eligible, previously untreated patients with confirmed diagnosis of locally advanced non-metastatic carcinoma of the head and neck were examined. A maximum of three cycles of neo-adjuvant chemotherapy (Cisplatin 100mg/m2 Day 1 plus 5-Fluorouracil 1gm/m2 continuous infusion for four days) were administered, followed by radical radiotherapy according to primary site. The main end-points were toxicity, response rate, disease-free survival and overall survival.

Results: Seventy-three patients (45 males and 28 females) were eligible; all were evaluable for response and toxicity. The median age of studied patients was 52 years (range: 17-83 years). Forty-four patients (60%) had stage III disease and 29 (40%) had stage IV disease. After neo-adjuvant chemotherapy, Overall Response (OR)[Complete Response (CR)+ Partial Response (PR)] was observed in 50 patients (68%), 33 patients (45%) had clinical CR and 17 patients (23%) had PR. Sixteen patients (22%) showed Stable Disease (SD) and 7 patients (10%) progressed while on chemotherapy. After completion of radiotherapy, the OR rate was 80%. Forty patients (55%) had clinically confirmed CR, 18 (25%) had PR, 9 patients (12%) had SD and 6 patients (8%) had progressive disease (PD). The median follow-up period …