The Bleeding and Burning Kashmir: Violence, Terrorism and Freedom Struggle

Efforts have been made to discuss various issues which Kashmir Valley had faced in the past six decades –Violence, Terrorism, Aggression and Bloodshed. Political conflict in the valley have marked a high degree of militarization and the presence of herse laws giving special powers to military forces makes Kashmiri people victims of violence. This article puts a view that how India and Mainstream parties of Jammu and Kashmir had and are trying to suppress the slogans and voices Kashmiri people and Separatists that are demanding nothing but Freedom. Keywords: Freedom, Jamat-I –islami, Kashmiri pundits, Ragdo Ragdo, Violence etc

Carotid intima-media thickness as a marker for assessing the severity of coronary artery disease on coronary angiography

Background: Coronary artery disease (CAD), the leading cause of death worldwide, has a huge area of primary prevention where patients at risk can be identified for more intensive, evidence-based medical interventions to reduce cardiovascular events. Whereas coronary angiography has stood the test of time to assess atherosclerotic burden, it is still unavailable to a huge population at risk of CAD. This study was devised in search of a cheap and simple tool to assess atherosclerotic burden. We aimed to investigate the relationship between Carotid Intima Media Thickness (CIMT) and Coronary Artery Disease (CAD) in patients evaluated by coronary angiography for suspected CAD and whether CIMT could predict the extension of CAD.Methods: This study was a cross-sectional study conducted from March 2013 to September 2015 in Department of Medicine, SMHS Hospital, J and K, India. A total of 100 patients admitted to for undergoing coronary angiography indicated for suspected coronary artery disease were enrolled. the risk factors evaluated in this study included age, body mass index, sex, dyslipidemia, hypertension, diabetes mellitus and smoking. CAD was assessed and classified by coronary angiography and CIMT was assessed by carotid doppler.Results: There was a positive relationship between CIMT and CAD. Risk factors like Age, smoking, BMI, cholesterol, hypertension, and diabetes had significant positive effect on CIMT; whereas gender, VLDL, triglycerides, HDL and LDL were statistically insignificant in affecting CIMT.Conclusions: CIMT is a cheap and simple tool to predict the extent of CAD

Carotid intima-media thickness as a marker for assessing the severity of coronary artery disease on coronary angiography

Background: Coronary artery disease (CAD), the leading cause of death worldwide, has a huge area of primary prevention where patients at risk can be identified for more intensive, evidence-based medical interventions to reduce cardiovascular events. Whereas coronary angiography has stood the test of time to assess atherosclerotic burden, it is still unavailable to a huge population at risk of CAD. This study was devised in search of a cheap and simple tool to assess atherosclerotic burden. We aimed to investigate the relationship between Carotid Intima Media Thickness (CIMT) and Coronary Artery Disease (CAD) in patients evaluated by coronary angiography for suspected CAD and whether CIMT could predict the extension of CAD.Methods: This study was a cross-sectional study conducted from March 2013 to September 2015 in Department of Medicine, SMHS Hospital, J and K, India. A total of 100 patients admitted to for undergoing coronary angiography indicated for suspected coronary artery disease were enrolled. the risk factors evaluated in this study included age, body mass index, sex, dyslipidemia, hypertension, diabetes mellitus and smoking. CAD was assessed and classified by coronary angiography and CIMT was assessed by carotid doppler.Results: There was a positive relationship between CIMT and CAD. Risk factors like Age, smoking, BMI, cholesterol, hypertension, and diabetes had significant positive effect on CIMT; whereas gender, VLDL, triglycerides, HDL and LDL were statistically insignificant in affecting CIMT.Conclusions: CIMT is a cheap and simple tool to predict the extent of CAD

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2

BJS commission on surgery and perioperative care post-COVID-19

Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues' experiences and published evidence

BJS commission on surgery and perioperative care post-COVID-19

Background: Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues experiences and published evidence. Methods: In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them. Results: BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training. Conclusion: The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)