Conversion from Laparoscopic to Open Cholecystectomy

Introductions: With the advent of newer technology, the era of open surgery for gall bladder diseases has been preferably taken over by laparoscopic cholecystectomy. However, certain cases still require conversion to open surgery. In this review we aim to analyze the reason for conversion.Methods: This retrospective study was conducted at Patan Hospital, Patan Acdemy of Health Sciences, Nepal. All patients who underwent laparoscopic cholecystectomy from February 2009 to July 2012 were included in the study. File numbers of all the patients were obtained from operation room register. The patient files were analyzed for age, sex, duration of symptoms, liver function tests, ultrasound findings and the description in operation note for reason for conversion.Results: The age ranged from 12 to 81 years with mean age of patients 32.76 years and male to female ratio 1:2.9. The mean operating time was 65 minutes and average post operative hospital stay was 1.61 days. Out of 305 patients, 34 (11.14%) required open conversion. Factors esponsible for open conversion were dense fibrosis at Calots in 11 (3.6%), adhesions due to previous abdominal surgery in 6 (1.9%), uncontrollable bleeding in 5 (1.6%), bile duct injury in 4 (1.3%) cholecystoenteric fistula in 3 (0.9%), Mirizzi’s syndrome 2(0.6%).Conclusions: Adhesions at the calot’s triangle was the common reason for conversion from laparoscopic to open cholecystectomy.Keywords: adhesions, conversion, gallstone, laparoscopic cholecystectom

Can REDD+ social safeguards reach the ‘right’ people? Lessons from Madagascar

AbstractThere is extensive debate about the potential impact of the climate mechanism REDD+ on the welfare of forest-dwelling people. To provide emission reductions, REDD+ must slow the rate of deforestation and forest degradation: such a change will tend to result in local opportunity cost to farmers at the forest frontier. Social safeguard processes to mitigate negative impacts of REDD+ are being developed and can learn from existing safeguard procedures such as those implemented by the World Bank. Madagascar has a number of REDD+ pilot projects with World Bank support including the Corridor Ankeniheny-Zahamena (CAZ). Nearly two thousand households around the corridor have been identified as ‘project affected persons’ (PAPs) and given compensation. We compare households identified as project affected persons with those not identified. We found households with more socio-political power locally, those with greater food security, and those that are more accessible were more likely to be identified as eligible for compensation while many people likely to be negatively impacted by the REDD+ project did not receive compensation. We identify three issues which make it difficult for a social safeguard assessment to effectively target the households for compensation: (a) poor information on location of communities and challenging access means that information does not reach remote households; (b) reluctance of people dependant on shifting agriculture to reveal this due to government sanctions; and (c) reliance by safeguard assessors on non-representative local institutions. We suggest that in cases where the majority of households are likely to bear costs and identification of affected households is challenging, the optimal, and principled, strategy may be blanket compensation offered to all the households in affected communities; avoiding the dead weight costs of ineffective safeguard assessments. The Paris Agreement in December 2015 recognised REDD+ as a key policy instrument for climate change mitigation and explicitly recognised the need to respect human rights in all climate actions. However, safeguards will be prone to failure unless those entitled to compensation are aware of their rights and enabled to seek redress where safeguards fail. This research shows that existing safeguard commitments are not always being fulfilled and those implementing social safeguards in REDD+ should not continue with business as usual

Prevalence and risk factors associated with chronic kidney disease in Nepal: evidence from a nationally representative population-based cross-sectional study.

OBJECTIVE: This study aimed to determine population-based prevalence of chronic kidney disease (CKD) and its associated factors in Nepal. STUDY DESIGN: The study was a nationwide population-based cross-sectional study. SETTING AND PARTICIPANTS: Cross-sectional survey conducted in a nationally representative sample of 12 109 Nepalese adult from 2016 to 2018 on selected chronic non-communicable diseases was examined. Multistage cluster sampling with a mix of probability proportionate to size and systematic random sampling was used for the selection of individuals aged 20 years and above. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome in this study was population-based prevalence of CKD in Nepal. A participant was considered to have CKD if the urine albumin-to-creatinine ratio was greater than or equal to 30 mg/g and/or estimated glomerular filtration rate is less than 60 mL/min/1.73 m2 at baseline and in follow-up using modification of diet in renal disease study equations. The secondary outcome measure was factors associated with CKD in Nepal. The covariate adjusted association of risk factors and CKD was calculated using multivariable binary logistic regression. RESULTS: The overall prevalence of CKD in Nepal was 6.0% (95% CI 5.5 to 6.6). Factors independently associated with CKD included older age (adjusted OR (AOR) 2.6, 95% CI 1.9 to 3.6), Dalit caste (AOR 1.6, 95% CI 1.1 to 2.3), hypertension (AOR 2.4, 95% CI 2.0 to 3.0), diabetes mellitus (AOR 3.2, 95% CI 2.5 to 4.1), raised total cholesterol (AOR 1.3, 95% CI 1.0 to 1.6) and increased waist-to-hip ratio (AOR 1.6, 95% CI 1.2 to 2.3). CONCLUSION: This nationally representative study shows that the prevalence of CKD in the adult population of Nepal is substantial, and it is independently associated with several cardiometabolic traits. These findings warrant longitudinal studies to identify the causes of CKD in Nepal and effective strategies to prevent it

The Reality of Antimicrobial Resistance and Antibiotic Usage Data in Asia: The CAPTURA Experience.

Antimicrobial resistance (AMR), particularly in low- and middle-income countries, is threatening to undermine advances in health and development. Scarce technical and human resources in these countries limit the collection of quality AMR data for evidence-based decision-making. The CAPTURA consortium, funded by the Fleming Fund, was implemented across 7 countries in the South and Southeast Asian region. The program focused on collating historical bacteriological data for qualitative and quantitative analyses. The team gathered standard data on the quality of laboratories and clinics and the quality and quantity of retrospective historical AMR data. In addition, retrospective data on antimicrobial use and consumption were analyzed. While standard protocols guided the project, a tailored approach for stakeholder engagement was implemented to work with countries and secure data-sharing agreements. The program also had to navigate the challenges of the COVID-19 pandemic, making some innovative adaptations to overcome logistical barriers. From 2018 through 2022, a large body of data was collected that was used to base a series of recommended key measures for strengthening the development of standardized national surveillance programs and to support alignment with international efforts

A differentiable forward model for the concurrent, multi-peak Bragg coherent x-ray diffraction imaging problem

We present a general analytic approach to spatially resolve the nano-scale lattice distortion field of strained and defected compact crystals with Bragg coherent x-ray diffraction imaging (BCDI). Our approach relies on fitting a differentiable forward model simultaneously to multiple BCDI datasets corresponding to independent Bragg reflections from the same single crystal. It is designed to be faithful to heterogeneities that potentially manifest as phase discontinuities in the coherently diffracted wave, such as lattice dislocations in an imperfect crystal. We retain fidelity to such small features in the reconstruction process through a Fourier transform -based resampling algorithm designed to largely avoid the point spread tendencies of commonly employed interpolation methods. The reconstruction model defined in this manner brings BCDI reconstruction into the scope of explicit optimization driven by automatic differentiation. With results from simulations and experimental diffraction data, we demonstrate significant improvement in the final image quality compared to conventional phase retrieval, enabled by explicitly coupling multiple BCDI datasets into the reconstruction loss function.Comment: 30 pages, 23 figure

Constraints on the χ_(c1) versus χ_(c2) polarizations in proton-proton collisions at √s = 8 TeV

The polarizations of promptly produced χ_(c1) and χ_(c2) mesons are studied using data collected by the CMS experiment at the LHC, in proton-proton collisions at √s=8  TeV. The χ_c states are reconstructed via their radiative decays χ_c → J/ψγ, with the photons being measured through conversions to e⁺e⁻, which allows the two states to be well resolved. The polarizations are measured in the helicity frame, through the analysis of the χ_(c2) to χ_(c1) yield ratio as a function of the polar or azimuthal angle of the positive muon emitted in the J/ψ → μ⁺μ⁻ decay, in three bins of J/ψ transverse momentum. While no differences are seen between the two states in terms of azimuthal decay angle distributions, they are observed to have significantly different polar anisotropies. The measurement favors a scenario where at least one of the two states is strongly polarized along the helicity quantization axis, in agreement with nonrelativistic quantum chromodynamics predictions. This is the first measurement of significantly polarized quarkonia produced at high transverse momentum

Long-Baseline Neutrino Facility (LBNF) and Deep Underground Neutrino Experiment (DUNE) Conceptual Design Report Volume 2: The Physics Program for DUNE at LBNF

The Physics Program for the Deep Underground Neutrino Experiment (DUNE) at the Fermilab Long-Baseline Neutrino Facility (LBNF) is described