Perception of non-alcoholic fatty liver disease: Real-life experience from Pakistan

Introduction: Non-alcoholic fatty liver disease (NALFD) has become one of the most pervasive causes of hepatic pathology. Because of its marked association with metabolic syndrome, type II diabetes and cardiovascular disease, NAFLD has gained substantial focus recently. Its prevalence and incidence are on the rise in Pakistan. However, due to its indolent and mostly asymptomatic course, NAFLD is often overlooked. This reckless behavior towards a potentially deadly disease is influenced most notably by disinformation or flawed perception, although there are a number of other complex socioeconomic components to this as well. With respect to NAFLD, the gap between disease understanding and steps for management is growing in the Pakistani society. With this study, we hoped and aimed to evaluate just how far and wide these shortcomings were found and how was NAFLD perceived in the local populace via a self-administered survey.Methods: This was a cross-sectional observational cohort study undertaken at the Department of Gastroenterology, Jinnah Postgraduate Medical Centre, and Medical Unit II, Dow University of Health Sciences, Ojha Campus, Karachi, Pakistan. All patients ≥18 years with a diagnosis of NAFLD were included in the study. NAFLD was diagnosed on the basis of sonographic evidence. All ultrasounds were done by a senior expert radiologist with at least 10 years of postgraduate experience. Ultrasounds were performed twice in all patients to rule out human error and bias. Perceptions regarding the knowledge of NAFLD were assessed using a self-administered survey questionnaire.Results: The female-to-male ratio in our cohort was 3:1. The mean age and body mass index (BMI) recorded were 39.85 ± 9.79 years and 31.21 ± 3.6 kg/m2, respectively. Sixty participants (26.4%) knew about their disease (NAFLD) while only 36 (15.9%) knew what NAFLD was and only 33 (14.5%) participants knew about the cardiovascular risk associated with it. Nearly two-thirds of the patients considered themselves overweight, while 180 (79.3%) of them were willing to lose weight. However, just about half of the cohort admitted the need for improved eating habits and increased physical activity/exercise in their daily lives. Fifty-seven (25.1%) patients admitted to using alternative or quack medications and only 45 (19.8%) patients considered them harmful.Conclusions: Patients harboring NAFLD have little to no knowledge about the disease and its nature or the fact that they are suffering from it despite being diagnosed clinically. Furthermore, while the general populace is willing to accept being overweight and having unhealthy eating habits, their willingness in initiating real-life practical steps to manage NAFLD is lacking

Systematic review on techniques for the creation of pneumoperitoneum in laparoscopic surgeries

Recently, laparoscopic surgeries (LPSs) are becoming increasingly prevalent. Incorporating these methods into clinical practice necessitates an in-depth understanding of the surgical techniques and multifaceted instrumentation that are specific to a slightly invasive operation. Within this systematic review, attention is directed to the technique for pneumoperitoneum creation, like the open and closed technique, to select optimal procedures along with appropriate utilization, with prominence on complication avoidance. This systematic literature review (SLR) examined significant findings from 2018 to 2023. This SLR complies with the quality standards suggested by the PRISMA document. Web of Science, SCOPUS, ProQuest, ScienceDirect, and SpringerLink are the resources. The exclusion criteria included case reports, abstracts, and letters, as well as inclusion criteria included randomized, quasi-randomized, non-randomized, and cohort investigations on human patients, provided that they liked access safety methods and presented values. According to the findings, it can be concluded that the LP inspection of the abdominal cavity (AC), which necessitates cannula implantation, is safe and effective. Closed (Veress needle technique) and open (Hasson technique) pneumoperitoneum induction techniques are frequently utilized. Most laparoscopy (LP) surgeons prefer closed LP utilizing a Veress needle and the first trocar’s masked insertion. Critics of the Veress needle, however, assert that this technique increases the risk of vascular injury. According to proponents of the open Hasson technique, vascular injury could be entirely avoided. The use of an open approach utilizing a blunt-tipped trocar for the formation of pneumoperitoneum may provide a potentially safer alternative during LPSs, depending on safety considerations

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

Problem of national education in India

Bibliography: p. 248-256.Mode of access: Internet

Free surface shear flow model for bow vortices phenomena

Der Auslöser für diese Untersuchung waren im Institut vorausgegangene Schleppversuche mit teilgetauchten Kreiszylindern, bei denen Bugwirbel vor dem Schleppkörper unmittelbar unter der freien Wasseroberfläche beobachtet wurden. In dieser Arbeit wurde versucht, eine theoretische Erklärung für dieses Phänomen zu finden. Dazu wurde die ebene Strömung unter der freien Wasseroberfläche vor einem quer zu seiner Achse halbgetaucht geschleppten horizontalen Kreiszylinder mit Hilfe eines Grenzschichtansatzes berechnet. Die durch viskose Kräfte an der (leicht) gekrümmten freien Wasseroberfläche erzeugte Vortizität verbleibt in einer dünnen Grenzschicht, während darunter im wesentlichen Potentialströmung herrscht. Die Berechnungen ergaben, dass die Strömung auf der freien Oberfläche (im mitbewegten Koordinatensystem) mit Annäherung an den Zylinder allmählich abgebremst wird, bis sich schließlich das Vorzeichen Umkehrt und eine Sekundärströmung in der Gestalt eines Bugwirbels entsteht, während die Primärströmung unter dem Zylinderhindurchfließt. Der berechnete Ablösepunkt der Grenzschicht an der freien Oberfläche wandert zwar mit zunehmender Froudezahl nach vorn, liegt jedoch im Vergleich zum Experiment viel zu nahe vor dem Zylinder. Möglicherweise sind Stabilitätsbetrachtungen erforderlich, um das theoretische Strömungsmodell zu verbessern.Free surface shear flow model for bow vortices phenomena Institut fur Schiffbau, Hamburg showed that when a horizontal circular cylinder is towed semisubmerged at a uniform speed, there exists a free surface shear layer ahead of the cylinder. The deceleration of the fluid particles in the free surface boundary layer gives rise to vortices before the body and a free surface separation point which separates the vortex zone Dear the body from rest of the flow. These observations provided an explanation to the origin of the phenomenon of bowwave-breaking which occurs as vortical motion ahead of the ships with usually blunt bows and extends all around the hull commonly called as necklace vortex. In the present study an attempt is made to formulate a shear flow-model for the free surface flow ahead of the cylinder in the framework of boundary layer theory in order to provide a theoretical analysis to the experimental observations. The vorticity generated due to viscous forces at the boundary is assumed to be concentra ted in a thin free surface boundary layer while the flow underneath this layer is assumed to be potential. Karman-Pohlhausen method is used to solve the two dimensional boundary layer equations in curvilinear coordinates. The boundary layer profile is assumed to be a cubic satisfying stress and velocity conditions at the boundary. The velocity defect in that boundary layer is assumed to be relatively small in order to simplify the problem. The free surface configuration which needed to be prescribed for the computations is substituted from that of constant pressure surface of the double body flow without satisfying any kinematic condition