Quality of Life of Patients with Chronic Obstructive Pulmonary Disease Attending a Tertiary Care Hospital, Kavre, Nepal.

Background Chronic Obstructive Pulmonary Disease (COPD) is one of the most common chronic health conditions and is increasingly becoming a major public health problem among the elderly population. As the chronic obstructive pulmonary disease is not curable, evaluation of and methods to improve quality of life among such patients is of utmost importance. Objective The objective of the study was to assess the quality of life among patients living with chronic obstructive pulmonary disease. Method This is a cross-sectional carried out in Dhulikhel Hospital, Kathmandu University Hospital, Nepal in 2017-2018. A total of 274 patients aged 40 years and above were selected for this study. The quality of life of participants was assessed through the widely used shorter version ST George's Respiratory Questionnaire (SGRQ-C). Result The mean age of the participants was 68.19 (SD ± 10.36) years, with the age range of 40-94 years. More than half (55.5%) of respondents were females, 55% were from rural areas, 42.7% were illiterate and 53.3% were from joint families. Agriculture (35.4%) and homemakers (32.5%) were the most prevalent occupation. The mean total score for all domains of quality of life was 68.06 (±18.87). The mean quality of life scores for symptom, activity, and impact domains was 70.11 (±22.33), 67.59 (±20.41), 67.64 (±20.41) respectively which suggested marked impairments in quality of life in all SGRQ-C domains. The symptoms and impact domains were most affected during the activity. Among socio-demographic variables, educational status, ethnicity, number of family members, type of family and economic status had a statistically significant effect on the quality of life. Initial health condition, smoking habit, number of cigarettes smoked, and years of smoking had statistically significant effects on quality of life. Conclusion Patients with chronic obstructive pulmonary disease have a low quality of life in three components of symptom, activity, and impact domains. Major factors associated with poor quality of life were low educational status, large family size, poor health condition, and smoking.

Outcome Analysis of Neonates following Laparotomy for Acute Abdomen: A Prospective Study.

Background Low and middle-income countries (LMIC) bear the majority of the global pediatric surgical burden. Despite increasing volume of pediatric surgeries being performed in LMIC, outcomes of these surgeries in low and middle-income countries remain unknown due to lack of robust data. Objective The objective of our study was to collect data on and evaluate neonatal surgical outcomes at a tertiary level center in India. Method The surgical outcomes data of all neonates undergoing laparotomy between February 15, 2015 and October 14, 2015, at Sir Ganga Ram Hospital, New Delhi, India was collected prospectively. Descriptive statistics were used to determine the rates of various postoperative outcomes. Result A total of 37 neonatal surgeries were performed during the study period. The mean age of the neonates on the day of surgery was 7 days (range: 1-30 days). Most of the neonates (72.9%, n=27) were males. About 40% (n=15) of the neonates were preterm and 15 (40.5%) of them were small for gestational age. In our study, 10 neonates (28.6%) needed ventilation for 48 hours or less after surgery and 5 neonates (13.5%) were kept Nil per Oral (NPO) postoperatively for more than 10 days. Out of 37 neonates, 4 (10.80%) developed a surgical site infection and 8 neonates (21.6%) had postoperative sepsis. The in-hospital mortality rate among neonates undergoing laparotomy during the study period was 8.1 deaths per 100 neonates. Conclusion Co-ordination of care among pediatric surgeons, neonatologists, nursing and anesthesia team is required for optimal surgical outcome.

Impact of Nanosize on Supercapacitance: Study of 1D Nanorods and 2D Thin-Films of Nickel Oxide.

We synthesized unique one-dimensional (1D) nanorods and two-dimensional (2D) thin-films of NiO on indium-tin-oxide thin-films using a hot-filament metal-oxide vapor deposition technique. The 1D nanorods have an average width and length of ∼100 and ∼500 nm, respectively, and the densely packed 2D thin-films have an average thickness of ∼500 nm. The 1D nanorods perform as parallel units for charge storing. However, the 2D thin-films act as one single unit for charge storing. The 2D thin-films possess a high specific capacitance of ∼746 F/g compared to 1D nanorods (∼230 F/g) using galvanostatic charge-discharge measurements at a current density of 3 A/g. Because the 1D NiO nanorods provide more plentiful surface areas than those of the 2D thin-films, they are fully active at the first few cycles. However, the capacitance retention of the 1D nanorods decays faster than that of the 2D thin-films. Also, the 1D NiO nanorods suffer from instability due to the fast electrochemical dissolution and high nanocontact resistance. Electrochemical impedance spectroscopy verifies that the low dimensionality of the 1D NiO nanorods induces the unavoidable effects that lead them to have poor supercapacitive performances. On the other hand, the slow electrochemical dissolution and small contact resistance in the 2D NiO thin-films favor to achieve high specific capacitance and great stability.

Conditions, preventable deaths, procedures and validation of a countrywide survey of surgical care in Nepal.

BACKGROUND: To determine a true denominator of worldwide surgical need, it is imperative to include estimations at a population-based level, to capture those individuals unable to access surgical care. This study was designed to validate the Surgeons OverSeas Assessment of Surgical need (SOSAS) tool with the addition of a visual physical examination, and describe the prevalence of surgical conditions, deaths possibly averted with access to surgical care, and the number of surgical procedures performed annually, in Nepal. METHODS: The SOSAS tool, developed to measure the prevalence of surgical conditions at a population level and used in two African countries, was employed. Fifteen of the 75 districts of Nepal were chosen proportional to population. Responses were recorded for the head of the household for demographic information and recalled deaths, and two randomly selected household members underwent a verbal head-to-toe interview for surgical conditions and a visual physical examination by a trained physician. RESULTS: A total of 1350 households were surveyed (2695 respondents). Observed agreement between the verbal response and physical examination findings was 94·6 per cent. Some 10·0 (95 per cent c.i. 8·9 to 11·2) per cent of respondents had a current condition requiring surgical care and 23 per cent of deaths may have been averted with proper access to surgical care. An estimated 291·8 major operations per 100 000 population are performed annually in Nepal. CONCLUSION: The visual physical examination component validated the SOSAS tool, and justified the estimates of previous studies in Sierra Leone and Rwanda. These data provide insights into the health needs of Nepal and provide evidence to develop surgical programmes, assist with monitoring and evaluation, and help with advocacy for increased resources in Nepal.

Impact of Surgical Waiting-List Times on Scoliosis Surgery: The Surgeon's Perspective.

STUDY DESIGN: Survey. OBJECTIVE: The aim of this study was to evaluate the surgeon's perspective on the potential impact of prolonged surgical waitlists on the surgical care and perioperative management of patients with scoliosis. SUMMARY OF BACKGROUND DATA: The long waits for surgical treatment of scoliosis found in some countries may have serious implications for the complexity of surgery and perioperative care required if the curve progresses while waiting. The surgeon's perspective on this problem provides important information that needs to be taken into account during resource allocation. METHODS: Radiographs from 13 patients who had waited more than 6 months for scoliosis surgery were selected. Each patient had radiographs from the time of surgical booking and immediately preoperatively. The radiographs and a questionnaire were sent to 3 surgeons to canvass their surgical and postoperative plan. The surgeons were blinded to the fact that the radiographs were of the same patients at 2 time points. The patients' actual course of treatment was documented. RESULTS: Data for 11 patients were available for analysis. The average wait for surgery was 24 months (range, 17-30 mo). The mean curve progression was 25.3° while on the waitlist, from an average of 52° to 77°. By the time the patients had to undergo surgery, more anterior releases were added to posterior instrumentation alone in the surgical plan. Mean estimated operative time increased by 2.2 hours, mean estimated length of hospital stay increased by 1 day, and the estimated level of difficulty of surgery increased 2.33 grades. The predicted estimated blood loss also increased. CONCLUSION: From the surgeon's perspective, lengthy waitlists have a significant negative impact on the perioperative and postoperative care of patients with scoliosis by increasing the complexity of surgery. The actual course of treatment corresponded to the responses from these different surgeons. LEVEL OF EVIDENCE: N/A.

Response of single leukemic cells to peptidase inhibitor therapy across time and dose using a microfluidic device.

Single-cell methodologies are revealing cellular heterogeneity in numerous biological processes and pathologies. For example, cancer cells are characterized by substantial heterogeneity in basal signaling and in response to perturbations, such as drug treatment. In this work, we examined the response of 678 individual U937 (human acute myeloid leukemia) cells to an aminopeptidase-inhibiting chemotherapeutic drug (Tosedostat) over the course of 95 days. Using a fluorescent reporter peptide and a microfluidic device, we quantified the rate of reporter degradation as a function of dose. While the single-cell measurements reflected ensemble results, they added a layer of detail by revealing unique degradation patterns and outliers within the larger population. Regression modeling of the data allowed us to quantitatively explore the relationships between reporter loading, incubation time, and drug dose on peptidase activity in individual cells. Incubation time was negatively correlated with the number of peptide fragment peaks observed, while peak area (which was proportional to reporter loading) was positively correlated with both the number of fragment peaks observed and the degradation rate. Notably, a statistically significant change in the number of peaks observed was identified as dose increased from 2 to 4 µM. Similarly, a significant difference in degradation rate as a function of reporter loading was observed for doses ≥2 µM compared to the 1 µM dose. These results suggest that additional enzymes may become inhibited at doses >1 µM and >2 µM, demonstrating the utility of single-cell data to yield novel biological hypotheses.