Outcome of gastrointestinal surgery during COVID-19 lockdown in a tertiary care hospital, Nepal

Introduction: Perioperative strategies have been changing due to the COVID-19 pandemic to prevent the risk of postoperative complications and transmission of infection. This study was aimed to assess the outcome of gastrointestinal surgery and the risk of transmission by implementing COVID-19 testing criteria and surgical strategy. Method: This was a retrospective descriptive study conducted at the department of surgery at Patan Hospital, Nepal, during COVID-19 lock-down from 24 march to 15 June 2020. All patients who underwent gastrointestinal (GI) surgery were included. High-risk patients (as defined by the Hospital Incident Command System, HICS) were tested for COVID-19 preoperatively. Surgery was performed in COVID operating room with full protective gear. Low-risk patients were not tested for COVID-19 preoperatively and performed surgery in non-COVID OR. Data from patient’s case-sheets were analyzed descriptively for age, gender, comorbidities, hospital stay, RT-PCR results, surgeries, and postoperative complications. Result: There were total 44 GI surgeries performed; 31(70.5%) were emergency, 5(11.3%) semi-emergency and 8(18.2%) oncology. There were 11(25%) patients tested for COVID-19 preoperatively and were negative. Nine HCWs tested for COVID-19 randomly were negative. Severe postoperative complications developed in 3 patients, with one mortality. Conclusion: Among GI surgeries, there was no increase in postoperative complications and transmission of COVID-19 to the patients or HCWs following the implementation of standard testing criteria and surgical strategy

Spectrum of paediatric surgical cases and their outcome in tertiary care hospital: Pediatric surgical cases and their outcome

Introduction: Pediatric surgical cases are operated by general surgeon due to lack of pediatric surgeons. Complex cases in neonates and infants is being referred to other centers with pediatric surgical services. This study aims to compare the spectrum of pediatric surgical cases and their outcomes before and after the availability of pediatric surgeon. Method: This retrospective study was conducted at the Patan Hospital, Nepal, over a period of 4 years. Group 1 (G1) included surgeries during 1st 2 y before and Group 2 (G2) during 2nd 2 y period after the availability of pediatric surgeon. Ethical approval was obtained. Patient age, sex, diagnosis, operative procedure, type of surgery, and outcome were analyzed.  Result: Of 1157 cases, 369 were in G1 and 788 in G2. The male to female ratio was 2.8:1. Laparotomies 270(23.2%) was the most performed inpatient surgery and herniotomies (221(19.1%) in day care. There were 52 (4.5%) neonates; 2(4%) in G1 and 50(96%) in G2. Among total cases, the mortality rate was 8(0.7%) in G2, due to preterm birth, delayed presentation, and septicemia. Conclusion: Laparotomy and incision & drainage were the most commonly performed surgeries. There was a 96% increment in neonatal cases (50 v/s 2) after the availability of pediatric surgeon. Mortality was 8(0.7%) in group-2 due to delayed presentation and septicemia. Keywords: Daycare surgery, mortality, neonatal surgery, outcome, pediatric surgical services  

Tigers in the Terai: Strong evidence for meta-population dynamics contributing to tiger recovery and conservation in the Terai Arc Landscape - Fig 2

<p>Minimum Convex Polygon (MCP) from multiyear camera trap surveys carried out in a) core area of Suklaphanta National Park; b) Babai valley within Bardia National Park.</p

Trend in minimum population size (M_t+1) of the tiger population based on adhoc camera trap tiger population surveyed in between 2006 and 2016 in the core area of Babai Valley within Bardia National Park.

<p>Trend in minimum population size (M_t+1) of the tiger population based on adhoc camera trap tiger population surveyed in between 2006 and 2016 in the core area of Babai Valley within Bardia National Park.</p

Fitted polynomial growth curve based on 3%, 10%, 21% growth rates regressed on minimum population size (M_t+1) of camera trap tiger population surveyed in between 2009 and 2014 in core area of Suklaphanta National Park.

<p>Fitted polynomial growth curve based on 3%, 10%, 21% growth rates regressed on minimum population size (M_t+1) of camera trap tiger population surveyed in between 2009 and 2014 in core area of Suklaphanta National Park.</p

Infrastructure development (railways, highways and postal roads) along the transboundary tiger habitat between Nepal and India across Terai Arc Landscape.

<p>Infrastructure development (railways, highways and postal roads) along the transboundary tiger habitat between Nepal and India across Terai Arc Landscape.</p

A male tiger captured along the Bardia-Katerniaghat forest matrix connected through Khata corridor forest in the western part of Terai Arc Landscape.

<p>A male tiger captured along the Bardia-Katerniaghat forest matrix connected through Khata corridor forest in the western part of Terai Arc Landscape.</p

Terai Arc Landscape showing network of 16 protected areas in Nepal (5) and India (11) and forest corridor identified within the Nepal side of the landscape.

<p>Terai Arc Landscape showing network of 16 protected areas in Nepal (5) and India (11) and forest corridor identified within the Nepal side of the landscape.</p