Anaesthetic challenges in a paediatric patient with escobar syndrome-difficult airway and postoperative pneumothorax

Escobar syndrome (ES) is an autosomal recessive disorder characterised by the presence of pterygia in cervical, antecubital and popliteal regions. Anaesthesiologist encounter notable challenges in this syndrome, especially airway management due to associated malformations like cleft lip/ palate, micrognathia, syngnathia, ankyloglossia, neck contracture, cervical spine fusion, limited neck extension and craniofacial dysmorphism. In addition to difficult airway, anaesthesiologist may encounter other perioperative challenges. Here, we report a paediatric patient with ES, who required general anaesthesia for laparoscopic inguinal hernia repair and orchidopexy. Initial attempt with video laryngoscope failed due to inability to visualise epiglottis. Subsequent attempt with fibreoptic bronchoscope also failed due to rapid decrease in oxygen saturation. He was finally intubated with fibreoptic bronchoscope along with oxygen insufflation with a 3mm internal diameter polyvinylchloride endotracheal tube inserted nasally and connected to oxygen supply. Further perioperative challenges faced were intraoperative hyperthermia and postoperative pneumothorax with mediastinal shift. To the best of our knowledge, this is the first case reporting pneumothorax with mediastinal shift as a postoperative complication and use of oxygen insufflation through nasal tube during fibreoptic intubation in paediatric patient with ES

Perioperative hypertensive response in a patient with implanted deep brain stimulation device: a case report

This case report features unique anaesthetic management of a patient with implanted deep brain stimulation (DBS) device undergoing abdominal surgery. It features the intraoperative measures taken for this patient for the implanted DBS. After turning off the DBS preoperatively, the patient showed an exaggerated sympathetic response which was very much resistant to medicines. It was unique to this patient that restarting the device alleviated refractory hypertension. The report also includes review of literature for anaesthetic management of patients with implanted DBS. Keywords: Deep brain stimulation, Dystonia, Hypertension, Hysterectomy

Comparative analysis of various machine learning algorithms to predict 28-day compressive strength of Self-compacting concrete

Construction industry is indirectly the largest source of CO2 emissions in the atmosphere, due to the use of cement in concrete. These emissions can be reduced by using industrial waste materials in place of cement. Self-Compacting Concrete (SCC) is a promising material to enhance the use of industrial wastes in concrete. However, there are very few methods available for accurate prediction of its strength, therefore, reliable models for estimating 28-day Compressive Strength (Câ\u80\u93S) of SCC are developed in current study by using three Machine Learning (ML) algorithms including Multi Expression Programming (MEP), Extreme Gradient Boosting (XGB), and Random Forest (RF). The ML models were meticulously developed using a dataset of 231 points collected from internationally published literature considering seven most influential parameters including cement content, quantities of fly ash and silica fume, water content, coarse aggregate, fine aggregate, and superplasticizer dosage to predict Câ\u80\u93S. The developed models were evaluated using different statistical errors including Root Mean Square Error (RMSE), Mean Absolute Error (MAE), coefficient of determination (R2) etc. The results showed that the XGB model outperformed the MEP and RF model in terms of accuracy with a correlation R2 = 0.998 compared to 0.923 for MEP and 0.986 for RF. Similar trend was observed for other error metrices. Thus, XGB is the most accurate model for estimating Câ\u80\u93S of SCC. However, it is pertinent to mention here that it does not give its output in the form of an empirical equation like MEP model. The construction of these empirical models will help to efficiently estimate Câ\u80\u93S of SCC for practical purposes.Validerad;2023;Nivå 2;2023-11-21 (joosat);CC BY-NC-ND 4.0 License;Funder: King Saud University (RSP2023R496), Riyadh, Saudi Arabia</p

Construction of a Well-Defined S-Scheme Heterojunction Based on Bi-ZnFe₂O₄/S-g-C₃N₄ Nanocomposite Photocatalyst to Support Photocatalytic Pollutant Degradation Driven by Sunlight

Currently, organic dyes and other environmental contaminants are focal areas of research, with considerable interest in the production of stable, high-efficiency, and eco-friendly photocatalysts to eliminate these contaminants. In the present work, bismuth-doped zinc ferrite (Bi-ZnFe2O4) nanoparticles (NPs) and bismuth-doped zinc ferrites supported on sulfur-doped graphitic carbon nitride (Bi-ZnFe2O4/S-g-C3N4) (BZFG) photocatalysts were synthesized via a hydrothermal process. SEM, XRD, and FTIR techniques were used to examine the morphological, structural, and bonding characteristics of the synthesized photocatalysts. The photocatalytic competence of the functional BZFG nanocomposites (NCs) was studied against MB under sunlight. The influence of Bi (0.5, 1, 3, 5, 7, 9, and 11 wt.%) doping on the photocatalytic performance of ZnFe2O4 was verified, and the 9%Bi-ZnFe2O4 nanoparticles exhibited the maximum MB degradation. Then, 9%Bi-ZnFe2O4 NPs were homogenized with varying amounts of S-g-C3N4 (10, 30, 50, 60, and 70 wt.%) to further enhance the photocatalytic performance of BZFG NCs. The fabricated Bi-ZnFe2O4/30%S-g-C3N4 (BZFG-30) composite outperformed ZnFe2O4, S-g-C3N4 and other BZFG NCs in terms of photocatalytic performance. The enriched photocatalytic performance of the BZFG NCs might be ascribed to a more efficient transfer and separation of photo-induced charges due to synergic effects at the Bi-ZnFe2O4/S-g-C3N4 interconnection. The proposed modification of ZnFe2O4 using Bi and S-g-C3N4 is effective, inexpensive, and environmentally safe

Integration of Mn-ZnFe2O4 with S-g-C3N4 for Boosting Spatial Charge Generation and Separation as an Efficient Photocatalyst

The disposal of dyes and organic matter into water bodies has become a significant source of pollution, posing health risks to humans worldwide. With rising water demands and dwindling supplies, these harmful compounds must be isolated from wastewater and kept out of the aquatic environment. In the research presented here, hydrothermal synthesis of manganese-doped zinc ferrites&rsquo; (Mn-ZnFe2O4) nanoparticles (NPs) and their nanocomposites (NCs) with sulfur-doped graphitic carbon nitride (Mn-ZnFe2O4/S-g-C3N4) are described. The samples&rsquo; morphological, structural, and bonding features were investigated using SEM, XRD, and FTIR techniques. A two-phase photocatalytic degradation study of (0.5, 1, 3, 5, 7, 9, and 11 wt.%) Mn-doped ZnFe2O4 NPs and Mn-ZnFe2O4/(10, 30, 50, 60, and 70 wt.%) S-g-C3N4 NCs against MB was carried out to find the photocatalyst with maximum efficiency. The 9% Mn-ZnFe2O4 NPs and Mn-ZnFe2O4/50% S-g-C3N4 NCs exhibited the best photocatalyst efficiency in phase one and phased two, respectively. The enhanced photocatalytic activity of the Mn-ZnFe2O4/50% S-g-C3N4 NCs could be attributed to synergistic interactions at the Mn-ZnFe2O4/50% S-g-C3N4 NCs interface that resulted in a more effective transfer and separation of photo-induced charges. Therefore, it is efficient, affordable, and ecologically secure to modify ZnFe2O4 by doping with Mn and homogenizing with S-g-C3N4. As a result, our current research suggests that the synthetic ternary hybrid Mn-ZnFe2O4/50% S-g-C3N4 NCs may be an effective photocatalytic system for degrading organic pollutants from wastewater

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research