Ruptured mycotic reverse saphenous vein graft aneurysm: A late complication of mediastinitis

Reverse saphenous vein graft aneurysm (RSVGA) is a rare complication that occurs after coronary bypass grafting surgery. Mycotic aneurysm of reverse saphenous vein graft is even more rare. We describe the case of a 76-year-old man who underwent coronary artery bypass grafting 10 years back and had mediastinitis four to five months after surgery. He presented with chest pain in July 2017 and was diagnosed as NSTEMI. Angiography showed left main coronary artery disease (90%) with aneurysm of reverse saphenous vein graft to right posterior descending artery(RPDA). Emergent percutaneous coronary intervention (PCI) of the left main artery was performed as the patient suffered ventricular arrhythmia for which cardiopulmonary resuscitation (CPR) was done. After CPR, haematoma appeared on the left side of the sternum subcutaneously. CT scan of the chest was conducted which showed a pseudoaneurysm measuring 35 mm in the mid-segment of reverse saphenous vein graft (RSVG) to the right posterior descending artery (RPDA) with a surrounding mediastinal haematoma communicating with subcutaneous haematoma, so RSVGA to RPDA was coiled. As blood culture grew candida, antifungal medication was started. When the patient\u27s condition stabilised he was discharged

DEVELOPMENT OF A NEW HYBRID MULTI CRITERIA DECISION-MAKING METHOD FOR A CAR SELECTION SCENARIO

Increasing competition in the automobile industry has led to a vast variety of choices when buying a car thus making car selection a tedious task. The objective of this research is to develop a new hybrid multi-criteria decision-making technique, with accuracy greater than that of the already existing methods, in order to help the people in decision-making while buying a car. Hence, considering a broader spectrum, this study aims at easing the process of multi-criteria decision-making problems in different fields. To achieve the objective, seven different alternatives were evaluated with respect to the enlisted evaluation criteria, which were selected after analyzing the secondary data obtained from Pak wheels based on style, fuel economy, price, comfort and performance. These criteria were then analyzed using the proposed Full Consistency Fuzzy TOPSIS method. As the name tells, this method is a unique combination of two techniques. The Full Consistency method is used to calculate the weights of the criteria while the Fuzzy TOPSIS approach is applied to rank the alternatives according to their scores in the selected criteria. The outcomes demonstrate an increase in the consistency ratio of the weight coefficients due to which the ranking of the alternatives by the FCF-TOPSIS is more accurate than the TOPSIS and the Analytical Hierarchy Process. The novelty of the method lies in the fact that this combination has not been used for an alternative selection scenario before. In addition to this, it can be used in various industries where a choice between the available alternatives arises based on a set of evaluation criteria

Network analysis of global stock markets at the beginning of the coronavirus disease (Covid-19) outbreak

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Delay between onset of indication and definitive surgery for tracheal trauma

Tracheal stenosis is rare but a recognized complication after traumatic injury or prolonged intubation. We assessed the time lag between onset of indication for tracheal reconstruction surgery following trauma and actual surgical intervention. We reviewed our operative records for all patients undergoing tracheal reconstruction over the past 10 years. Files were reviewed retrospectively to collect all the relevant data. Surgically all patients were operated via cervical approach. Series 12 cases were identified with an equal split between external trauma and iatrogenic tracheal trauma from prolonged intubation. On, an average patients presented 185 days after initial indication of surgery however there was a wide range of time lag which leads to the importance of early diagnosis of such injuries to reduce delay of definitive management

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Simultaneous off-pump coronary artery bypass grafting (CABG) and right upper lobectomy for critical left anterior descending artery (LAD) stenosis and aspergilloma

A 58 years old man with a history of ischemic heart disease presented with massive hemoptysis. On evaluation with CT chest, he was found to have a large aspergilloma in the left upper lobe. Coronary angiogram was also performed for increasing episodes of angina which showed critical 100% ostial left anterior descending (LAD) stenosis. In view of aspergilloma and hemoptysis, patient could not have conventional open heart surgery and heparinization. Therefore, coronary artery bypass grafting (CABG) was performed on beating heart and this was followed by left upper lobectomy at the same time. Patient had an uneventful post-operative course

Numerical Investigation of the Finite Thin Film Flow for Hybrid Nanofluid with Kerosene Oil as Base Fluid over a Stretching Surface along with the Viscous Dissipation and Variable Thermal Conductivity Effects

This study examines the flow and heat transfer of a finite thin layer of a hybrid nanofluid across an unstable stretching surface with varying thermal conductivity and viscous dissipation effects. A hybrid nanofluid model is considered to comprise two different types of nanoparticles, Go and Ag, with kerosene oil used as a base fluid. To study the phenomenon of thermal conduction, a modified version of Fourier’s law model is adopted because in the power-law model, the thermal conductivity depends on the velocity gradient. A system of nonlinear ordinary differential equations is obtained by considering the similarity transformations over the obtained rheological system of partial differential equations which is then tackled by a well-known numerical approach, i.e., the bvp4c MATLAB technique. The rheological impacts of the power-law index, solid volume fraction, film thickness, Eckert number, and modified Prandtl number on temperature and velocity fields are graphically discussed and illustrated. In the presence of nanoparticles, the temperature of the working fluid is enhanced and the power-law index has an inverse relation with the velocity of the hybrid nanofluid

Donor safety first: Postoperative hepatectomy outcomes in living liver donors

Background: Living donor liver transplantation (LDLT) has become a popular treatment option because some countries lack a deceased organ program and the growing demand for liver transplants. Although postoperative outcomes are similar to deceased donor liver transplants, there is still an element of risk to the donor. The Clavien-Dindo classification system has been used to standardize reporting across different institutions and surgeons to categorize surgical outcomes. Methods: Between January 1, 2022, and December 31, 2022, 207 living donors underwent hepatectomies at our center. All donors underwent a 3-step process of mandatory screening. Postsurgical complications were classified using the Clavien-Dindo classification. Results: A total of 207 donor hepatectomies for LDLT were performed during our study period. Most donors (92.8%) were aged between 18 and 39 years. The most common type of graft used was a right lobe without the middle hepatic vein (82.6%). Most donors (91.7%) experienced an intraoperative blood loss of ≤500 mL. A total of 140 patients had an ordinary postoperative course. Grade 1 complications were observed in 16.9%, grade 2 in 12.1%, and grade 3 in 3.4% of the remaining patients. No grade 4 or grade 5 (patient death) complications were observed in this cohort. Conclusions: Living donor liver transplantation remains the most practiced liver transplant surgery in Pakistan. Our findings highlight the safety of the LDLT program with minimal risk of significant complications. The study also underscores the importance of careful screening and monitoring of living donors and the need for standardized reporting of surgical outcomes using the Clavien-Dindo classification syste