Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Angle Based Double Boundary Detection in Wireless Sensor Networks

Abstract — Wireless Sensor Networks(WSN) have given a new approach for applications such as surveillance, tracking and monitoring. Such applications requires perimeter nodes to remain vigilant for event detect like objects entering and leaving the area under surveillance. Nodes performing surveillance of target area are called boundary nodes. Due to active participation in surveillance they suffers from a quicker energy exhaustion, results to a shorter lifetime. None of the reported works on boundary detection algorithms has considered the problem of maximizing the lifetime of boundary. In this paper, we have considered this problem and developed a distributed boundary detection algorithm for extending the lifetime of boundary nodes in sensor networks. The salient features of our proposed algorithm are firstly it relies on 1-hop neighbour information, secondly it produces less network overhead and lastly our algorithm is useful in enhancing the lifetime of boundary nodes. The complexity of our algorithm is O ( n k) time and O(kδ3) messages. Where n is the number of nodes, δ is the number of neighbour and k is the number of nodes simultaneously executing local computation. Simulation is conducted on randomly deployed wireless sensor networks. Results shows that, our proposed algorithm not only detects boundary nodes and holes accurately but also increases the lifetime of network boundary by 2.5 times. Index Terms — Wireless Sensor network, Boundary Nodes. I

Esthetic Rehabilitation with Ceramic Veneers: A Case Report

Veneers are the most frequently prescribed aesthetic restorations today. Ceramic veneers can be offered as the treatment option in a wide variety of different cases such as correcting tooth defects, abrasion, orthodontics, diastema, tooth discoloration, coronal fracture or to adjust occlusion. Before preparing the teeth a complete analysis should be carried out in order to optimize the result. In this way it can be ensured that the teeth being veneered will need only minimal preparation, or in some areas none at all.     Keywords: smile, ceramics, enamel hypoplasia, fluorosi

Time trends in the thesis work by post-graduate students of Community Medicine: A record based descriptive study of 40 years

Background: Thesis work conducted by post-graduate students of Community Medicine is critically appraised by not only their examiners but also by many other public health experts and researchers. Issues related to the repetition of work and quality of thesis work is raised by various authors. Objective: To assess the time trend in the thesis work done by post-graduate students of Community Medicine. Material and methods: This is a record based descriptive observational study conducted in the department of Community Medicine of S. N. Medical College, Agra (Uttar Pradesh). Data from all the 66 theses which were submitted by the Post Graduate students of our department till date was collected and assessed systematically. Result: Most preferred areas of research were MCH/Family Planning (28.79%) and Programme/Service evaluation (22.73%). 77.27% of theses were community based, 36.37% were done exclusively in a rural area, 24.24% of theses had children/adolescent as their study subjects and 28.79% were conducted exclusively among females. A knowledge, attitude and practice (KAP) or Knowledge, attitude, behavior and practice (KABP) study was part of many theses but exclusive KAP/KABP study was done only in 12.12% of theses. A purposive or convenience sampling was done in only 18.33% of theses, 86.67% were cross-sectional in design and median sample size was 450 participants per thesis. In comparison to the theses done upto the year 2000, theses thereafter were more often based in an urban area and less often done in an exclusive rural area (p=0.0003) and all KAP/KABP studies were done after the year 2000 (p=0.004). Conclusion: There is no repetition or excessive use of KAP/KABP studies in the theses done by post-graduate students of the department of Community Medicine, S. N. Medical College, Agr

A review of 196 suicides among medical students in India from year 2009 to 2018

Background: Study of medicine has always been challenging with immense pressure and high workload. This unjust pressure can sometimes transform into psychological illness and commitment of suicide. The objective of this study was to explore patterns and possible determinants of suicide among medical students in India. Methods: The present study is a record based retrospective study which included collection of data from news-articles published in various English, Hindi and regional dailies, news portal articles and publications in different streams of medical journals through web-based/electronic database search. More than 2000 such articles were reviewed from year 2009 to 2018 and data was extracted. Results: Among 196 medical students, who committed suicide over last 10 years, 42% were female, 42% belonged to the age group of 20-24 years and 68.37% were MBBS students. 31.12% of the victims were in their first year of medical education. Among 61 post-graduate students, most victims were from the department of Anaesthesia (10), General Surgery and Pediatrics (7 each). In 55% of the cases, method/mode of suicide was hanging. Academic & examination pressure was the most cited reason for commitment of suicide. Incidence density of suicide among medical students was calculated to be 6.82 per lakh students per year over the period of 2009-18; while it was 9.56 per lakh students per year in the year 2018. Conclusion: This study is first attempt to find incidence and possible reasons for suicide among medical students in India. It has comprehensively explored 196 suicides among medical students across the country over past 10 year

Health Problems of the International Travellers Visiting Agra City

Background: International travel to India is on the rise and the travellers comprise a diverse group of individuals in terms of their country of origin, preferences and risk taking behaviour. Different environment coupled with all other factors makes them more vulnerable to health problems. Aims & Objectives: To find out the health problems faced by the international travellers visiting Agra City, their perception and the factors associated with them. Material & Methods: Cross – sectional study design was used and International travellers in the age group 15 to 65 years were recruited from prominent tourist places and train stations of Agra, which was sometimes during their tour and just before their departure respectively. Data collection was carried out for a period of six months i.e. from November 2015 to April 2016.Results: Out of the total 422 study subjects, 208 (48.2%) faced one or more health problems. Primary purpose of visit (religious, educational, visiting friends and relatives) and the duration of visit (more than two weeks) were found to be significantly associated with a negative health outcome. Diarrhoea (131, 63%), fever (87, 41.8%) and respiratory problems (50, 24%) were the most frequent problems and many of them had more than one problem. A majority of the participants perceived the risk of health problems to be high and more than half of the them reported having experienced culture shock (57.4%). Conclusions: There may be a need for a travel clinic at the destination. The benefit of such a new offer must be validated

Health Problems of the International Travellers Visiting Agra City

Background: International travel to India is on the rise and the travellers comprise a diverse group of individuals in terms of their country of origin, preferences and risk taking behaviour. Different environment coupled with all other factors makes them more vulnerable to health problems. Aims & Objectives: To find out the health problems faced by the international travellers visiting Agra City, their perception and the factors associated with them. Material & Methods: Cross – sectional study design was used and International travellers in the age group 15 to 65 years were recruited from prominent tourist places and train stations of Agra, which was sometimes during their tour and just before their departure respectively. Data collection was carried out for a period of six months i.e. from November 2015 to April 2016.Results: Out of the total 422 study subjects, 208 (48.2%) faced one or more health problems. Primary purpose of visit (religious, educational, visiting friends and relatives) and the duration of visit (more than two weeks) were found to be significantly associated with a negative health outcome. Diarrhoea (131, 63%), fever (87, 41.8%) and respiratory problems (50, 24%) were the most frequent problems and many of them had more than one problem. A majority of the participants perceived the risk of health problems to be high and more than half of the them reported having experienced culture shock (57.4%). Conclusions: There may be a need for a travel clinic at the destination. The benefit of such a new offer must be validated

Prevalence of Developmental Delay and Factors Affecting the Development Status among Under 5 Children in an Urban Slum of Agra City

Background: Development during the early childhood, especially from fetus to two-year-old, is crucial in determining the nutrition, health and productivity status in the whole life course. The study was conducted to assess the developmental milestones’ achieve- ment of the children under study and also to find the association any between nutritional status and developmental achievement. Material & methods: A cross sectional community based study was conducted among under 5 years age children, in an urban slum of Agra. Nutritional status was assessed and classified as per WHO 2006 Growth Standards. Developmental Milestone Chart (DMC) was used to assess the childhood developmental status. Results: Overall 12.2 % of the children were found to be develop- mentally delayed. Prevalence of developmental delay increased significantly from infancy (0-11 months) (5.7 %) to 12-23 months of age, peaking at 12-23 months age (20.3 %), thereafter showing a decreasing trend to 15.3 % as the age of the child increased to more than 2 years. There was a close positive link observed between the nutritional status of the children and their development status. Mothers' education and low birth weight of the child were found to be significant influences on children's development. Conclusion: Childhood nutrition has received due attention, but the overall development of the child needs more focus