Role of pre-operative counseling with NSQIP surgical risk calculator in the surgical patients

Introduction

Patient satisfaction is important tool to monitor health care performance and quality of health plans, emphasizing effective counseling and consent processes. The objective of the study is to assess patient satisfaction and anxiety with the use of NSQIP surgical risk calculator in comparison to standardized questionnaires.

Methodology

This is an interventional prospective randomized study. Difference in patient satisfaction is assessed by a 7-point Likert scale and anxiety assessment by 5-point Likert scale of Amsterdam Preoperative Anxiety and Information Scale (APAIS) questionnaire written in Nepalese. Satisfaction scores were compared using analysis of variance (ANOVA), or the Kruskal-Wallis test. P- value <0.05 was considered statistically significant.

Results

Satisfaction score regarding comfort during counseling and consent process was similar with and without use of NSQIP surgical risk calculator (83.3 % and 76.9 %, respectively). Satisfaction score regarding plan of anesthesia was 63.33 % with the use of NSQIP and 53.8 % without NSQIP tool. 30.76 % of patients with high school education developed negative feelings following counseling when NSQIP tool was not used (p value 0.002). NSQIP usage increased anxiety about anesthesia and surgery and led to higher continual thinking about the procedure.Duration of counseling was 12 min with NSQIP tool use in comparison to 9.67 min following conventional counseling (p value 0.047).

Conclusion

NSQIP surgical risk calculator is a reliable tool that can be used alongside conventional methods during preoperative period for decision-making and counseling with similar satisfaction scores but a higher incidence of anxiety and continual thinking about procedures.

A rare case of Boerhaave syndrome with cervico-thoracic esophageal junction rupture causing bilateral empyema; case report from Nepal

INTRODUCTION AND IMPORTANCE

Boerhaave syndrome is a rare finding where spontaneous rupture of esophagus occurs, usually in distal segment. It is a life threatening condition that requires urgent surgical intervention.

CASE PRESENTATION

We present a case of 70 years male who presented with pleural effusion and later empyema following spontaneous rupture of cervico-thoracic junction of esophagus who was managed successfully with primary surgical repair.

CLINICAL DISCUSSION

Although Boerhaave syndrome is tricky to diagnose but it should be considered in all cases with a combination of gastrointestinal and pulmonary signs and symptoms.

CONCLUSION

Clinical correlation along with imaging such as HRCT chest or gastrografin study is required to come to a diagnosis, however surgical intervention should not be delayed to reduce the mortality.

Retrospective Analysis of Spinal Anesthesia for Daycare Surgery during the COVID-19 Pandemic

Introduction: We preferred general anesthesia over spinal anesthesia for day care surgeries in our center. During COVID-19 pandemic, we planned subarachnoid blocks for daycare surgeries, to minimize aerosol generation and to reduce virus transmission risk to health care professions. Objectives: This study intended to compare time of discharge after  subarachnoid block with general anesthesia in day care surgeries. We compare time to achieve post-anesthetic discharge score (PADS) equal to or more than nine; need for overnight hospitalization; and complications. Methodology: A retrospective analysis of cases posted for elective daycare surgery in our institute during COVID-19 pandemic from April 2020 to July 2020 were identified. We compared  time to  discharge home in patients who received general anesthesia and spinal anesthesia. Normality of distribution was determined using Two sample Kolmogorov-Smirnov Tes. Student t test was used for normally distributed data, Mann-Whitney U test was used for non-normal distributed data. Categorical variables were analyzed using a chi-squared or Fisher’s exact test.  Results: A total of 2214 patients were included in this study.181 patients remained for analysis; 70 in the general anesthesia group and 91  in the spinal anesthesia group. Mean time (+SD) to achieve PADS score in group GA is 263.47(+75.06) whereas in group SAB was 339.55(+156.903). Mean time (+SD) taken to discharge home in group GA was 296.08(+74.76) whereas in group SAB was 365.66(+158.68) minutes respectively. Post hoc power of the study was 95.8. Conclusion: With low dose bupivacaine, spinal anesthesia is a safe alternative for ambulatory day care surgeries.

Diabetic Retinopathy Awareness among Diabetic Patients Attending COMS-TH

Background Diabetic retinopathy (DR) is one of the leading causes of blindness in Nepal. Objective The main objective of the study is to know the awareness of diabetic retinopathy among new cases of diabetes mellitus (DM) attending the college of medical science- teaching hospital, Bharatpur, Nepal. Method All the diabetic cases referred for ophthalmic consultation and also referred outpatient department cases from other departments to ophthalmic outpatient department was carried out. Detailed demographics of the subjects and their awareness of potential ocular problems from diabetes mellitus were noted. Result Total one hundred and thirty-one patients were enrolled during the study period from 15 November 2016 to 15 May 2017. Brahmin 39.69% and 19.08% Mongolian were the most predominant ethnical group. The predominant group of patients were housewives (41.22%) then followed by service (19.85%), business (13.74%), agriculture (12.21%), others (12.98%). Among 36.64% of the literate patients, 19.85% had passed school level, 9.92% had passed intermediate level, 88.55% were aware of Diabetic retinopathy. Among them majority 88.55% were referred by physician. Family history were present in 35.68% and fundus evaluation was done for the first time in almost half of diabetic cases (64.12%) and diabetic retinopathy was found in 32.06% of total cases in right eye and 30.53% of total cases in left eye. Conclusion Along with the awareness, routine dilated fundoscopy is mandatory for slight threating stage of retinopathy and to reduce the burden of blindness from diabetic retinopathy in Nepal.

Hexagonal close-packed structure of au nanocatalysts solidified after ge nanowire vapor-liquid-solid growth

We report that approximately 10% of the Au catalysts that crystallize at the tips of Ge nanowires following growth have the close-packed hexagonal crystal structure rather than the equilibrium face-centered-cubic structure. Transmission electron microscopy results using aberration-corrected imaging, and diffraction and compositional analyses, confirm the hexagonal phase in these 40-50 nm particles. Reports of hexagonal close packing in Au, even in nanoparticle form, are rare, and the observations suggest metastable pathways for the crystallization process. These results bring new considerations to the stabilization of the liquid eutectic alloy at low temperatures that allows for vapor-liquid-solid growth of high quality, epitaxial Ge nanowires below the eutectic temperature.

Oxide-encapsulated vertical germanium nanowire structures and their DC transport properties

We demonstrate the p-type doping of Ge nanowires (NWs) and p-n junction arrays in a scalable vertically aligned structure with all processing performed below 400 °C. These structures are advantageous for the large scale production of parallel arrays of devices for nanoelectronics and sensing applications. Efficient methods for the oxide encapsulation, chemical mechanical polishing and cleaning of vertical Ge NWs embedded in silicon dioxide are reported. Approaches for avoiding the selective oxidation and dissolution of Ge NWs in aqueous solutions during chemical mechanical polishing and cleaning of oxide-encapsulated Ge NWs are emphasized. NWs were doped through the epitaxial deposition of a B-doped shell and transport measurements indicate doping concentrations on the order of 10(19) cm(-3).

Metastability of Au-Ge liquid nanocatalysts: Ge vapor-liquid-solid nanowire growth far below the bulk eutectic temperature

The vapor-liquid-solid mechanism of nanowire (NW) growth requires the presence of a liquid at one end of the wire; however, Au-catalyzed Ge nanowire growth by chemical vapor deposition can occur at approximately 100 degrees C below the bulk Au-Ge eutectic. In this paper, we investigate deep sub-eutectic stability of liquid Au-Ge catalysts on Ge NWs quantitatively, both theoretically and experimentally. We construct a binary Au-Ge phase diagram that is valid at the nanoscale and show that equilibrium arguments, based on capillarity, are inconsistent with stabilization of Au-Ge liquid at deep sub-eutectic temperatures, similar to those used in Ge NW growth. Hot-stage electron microscopy and X-ray diffraction are used to test the predictions of nanoscale phase equilibria. In addition to Ge supersaturation of the Au-Ge liquid droplet, which has recently been invoked as an explanation for deep sub-eutectic Ge NW growth, we find evidence of a substantial kinetic barrier to Au solidification during cooling below the nanoscale Au-Ge eutectic temperature.

Germanium nanowire epitaxy: shape and orientation control

Epitaxial growth of nanowires along the 111 directions was obtained on Ge(111), Ge(110), Ge(001), and heteroepitaxial Ge on Si(001) substrates at temperatures of 350 degrees C or less by gold-nanoparticle-catalyzed chemical vapor deposition. On Ge(111), the growth was mostly vertical. In addition to 111 growth, 110 growth was observed on Ge(001) and Ge(110) substrates. Tapering was avoided by the use of the two-temperature growth procedure, reported earlier by Greytak et al.