Retained Percutaneous Tube—A Misery of Illiteracy

Percutaneous catheter drainage of liver abscesses is an established technique. Intracavitatory knotting of the tube is a rare and potentially preventable complication that can involve significant morbidity. However, because of the rarity of this complication, there remains a persistent lack of awareness in the clinical community. The risk of tube knotting can be reduced with proper technique and correct choice of tubes

An in-depth study of drugs prescribing pattern in the Surgery Department of a Tertiary Care Teaching Institute in Northern India

Background: In surgical patients, a number of drugs are prescribed to prevent post-operative infections and to relieve pain. Therefore, prescription audit should be periodically performed in Department of Surgery to analyze the present scenario of drugs prescribed for the surgical/post-operative patients. This will help us to use the medicines rationally and decrease the adverse effects in surgical patients. The main aim of the study was to evaluate the drugs prescribing pattern in the Surgery Department in Tertiary Care Teaching Institute.Methods: Patients’prescriptions or case record forms were randomly collected over a period of 1 year from the Department of Surgery at GGS Medical College and Hospital, Faridkot, Punjab (India) for analysis and rationalization.Results: A total of 900 prescriptions was collected and analyzed for drugs used in surgical patients. Average number of drugs prescribed is 4.26. The most commonly prescribed drugs were anti-microbial agents (AMAs), gastrointestinal tract (GIT) related, non-steroidal anti-inflammatory drugs (NSAIDs) and multivitamins and trace elements, and their percentages were 37.90%, 23.36%, 14.14 %, and 9.11% respectively. About 95% drugs were prescribed by non-generic (Trade) names. Drugs prescribed from National Essential Medicines List (EML) and World Health Organization EML were 69.25% and 45.31% respectively. Average cost per prescription per day was Rs. 610/- (INR) or $10.34 USD in a surgical patient.Conclusions: There is a high tendency and frequency to prescribe four and more than four drugs to post-operative patients. Most drugs prescribed were AMAs, GIT related, NSAIDs and Multivitamins and trace elements. There is an urgent need to develop proper prescription writing skills in budding doctors regarding the use of EML/drugs list and generic medicines to reduce the cost of treatment

Inelastic Neutron scattering in CeSi_{2-x}Ga_x ferromagnetic Kondo lattice compounds

Inelastic neutron scattering investigation on ferromagnetic Kondo lattice compounds belonging to CeSi_{2-x}Ga_{x}, x = 0.7, 1.0 and 1.3, system is reported. The thermal evolution of the quasielastic response shows that the Kondo interactions dominate over the RKKY interactions with increase in Ga concentration from 0.7 to 1.3. This is related to the increase in k-f hybridization with increasing Ga concentration. The high energy response indicates the ground state to be split by crystal field in all three compounds. Using the experimental results we have calculated the crystal field parameters in all three compounds studied here.Comment: 12 Pages Revtex, 2 eps figures

Attempting affirmative political ecologies: Collective transformative learning for social justice in Nepal's community forestry

Whilst political ecology scholarship has contributed much to articulating social injustices associated with Nepal's community forestry, here we took a different approach, by attempting an 'affirmative political ecology.' We drew on feminist and activist scholarship to inspire collective action that engaged directly with challenges of social justice and those charged with delivering it through their work. Guided by theories and practices of 'transformative learning' and a range of associated reflective practices, our participatory action research involved 4 facilitators and (up to) 25 participants who work across Nepal's forest bureaucracy (and for some, the wider community-based natural resource management sector). Together physically, remotely and through our writing, we reflect upon the operation of power in our professional – and personal – lives, exploring how that may enable a more informed and meaningful engagement with social justice within the workplace, and beyond. This article presents the process of our collective reflection and learning, and shares some of its initial outcomes based on the experiences of the 15 co-authors. Whilst 'simply' having the time and space to come together was hugely important, it was the form and feel of that space that was particularly significant, as we focused on co-creating a safe space which was non-judgmental and based on mutual respect, enabling comfortable and open discussion of often unspoken and uncomfortable issues. Ultimately, this article argues that collective practices of reflection and transformative learning can create shared learning, understanding, empathy and solidarity, and thus that it offers hope in the face of on-going social injustices. It therefore urges political ecologists to work towards such caring and affirmative collective engagements with practitioners as one way in which to affect change

Molecular Basis of Plant Adaptation against Aridity

Environment fluctuations have become the greatest threat to global food security. Of various abiotic stress factors, aridity hampers the most yield contributing attributes. In the context of agriculture, term “aridity” refers to a protracted period of insufficient precipitation, having detrimental influence on crop development and overall biological output. A sustained drought has considerable negative effects on crops and livestock, including the reduced production, destruction of property, and livestock sell-offs. Consequently, plants themself exert various kinds of defensive mechanisms to combat the ill effects of climate change. For example, plants with small leaves, benefit from aridity as part of their strategy for modifying the soil to water shortages and nutrient restrictions. Furthermore, low genetic diversity among significant crop species, together with ecological productivity limits, must be addressed in order to adapt crops to episodic drought spells in the coming days. A deeper understanding of the molecular and genetic underpinnings of the most important intrinsic adaptation responses to drought stress seems to be beneficial for gene engineering as well as gene-based expression investigations in plant systems under hostile environment. Recently, molecular markers and “omics” have opened a huge opportunity to identify and develop specific gene constructs governing plant adaptation to environmental stress

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake