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Introduction: There are increasing numbers of critically ill patients who need urgent emergency intubation in Emergency Service. Due to limited number of ventilators and even lack of portable ventilators in emergency room, we need to continue prolong manual bag ventilation of those patients after emergency intubation. Therefore, the aim was to analyse the impact of duration of prolong manual bag ventilated patients in the Emergency Service, Tribhuvan University Teaching Hospital in Nepal. Methods: This was a prospective non-interventional cross-sectional study conducted from August 2012 to July 2013 (one year). This study included those Emergency Intubation cases with written informed consent from patient's party/guardian/legal representative to enroll in this study and excluding otherwise. Results: 172 (0.4% of 45000 emergency room patients) patients were enrolled and divided in to Group I: Manual Bag Ventilation without Mechanical Ventilation (MBV-MV) n = 56 (32.6%) and Group II: MBV with MV (MBV+MV) n = 116 (67.4%) with accounting the incidence of such critically ill rarely found cases. The age ranges from 11 to 94 years with mean 49+-19. There were 33 Alive and 139 Death (p 0.006). M:F= 1.32:1. MBV duration was with median 540 min (p 0.02). 22.7% had < 180 minutes MBV with survival rate 28.2% (OR 1.98,/) 0.162 comparing with >181 minutes). 58.2% cases were only MBV in ER with 100% mortality. 41.2% had mechanical ventilation after MBV with median 3 days, mean 5.0+- SD 4.9 days in ICUs with 71.5% crude ill-defined mortality (p 0.042, ROC 0.704). The probability of survival after emergency intubation varies with duration of MBV as 0.8 in 1 hr (7.6% mortality) and 0.02 after 24 hrs (92.3% mortality) with underlying causes and availability of present treatment. Conclusion: Irrespective of underlying causes, due to prolong manual bag ventilation without mechanical ventilation; there was increase chance of mortality and even 100% mortality as ill-defined crude mortality. [ABSTRACT FROM AUTHOR]

The curriculum of the post graduate program in General Practice in Nepal is designed to develop comprehensive and effective health care as well as timely life-saving surgical services in the District Hospital. District hospitals in rural Nepal encounter many surgical emergencies. Most of the times, the patient can not afford to go to higher centers. General Practitioners (GPs) are effectively providing surgical services at district hospitals. The aim of this study is to focus the types of surgical cases that were managed by GP and establish the role and utilization of General Practice (GP) specialist as a surgeon at district, zonal and regional hospitals in developing countries. This is retrospective study of all cases at district hospital, Surkhet, (25 beds) of western part of Nepal during the period of one year (March 2000 to February 2001), that were managed by GPs. The surgical services provided by GP specialist at the district hospital were analyzed. A total of 16,975 cases were attended in the hospital during above period. Out of this, a total of 2,327(13.7%) were hospitalized. The total numbers of surgical cases were 1,205(51.8%). Out of this, 514(42.7%) cases had undergone surgery. The general surgery cases comprise 447(87.0%), Gynae / Obstetric and Orthopedic cases 67(13.0%). All surgeries were performed in limited resources by GPs. GP specialist can effectively manage the surgical cases and perform surgery at the district hospital competently. In country like Nepal, where number of surgical specialist are less and not available in majority hospitals, GPs can substitute the surgical specialist and provide emergency surgical services in urban areas (zonal and regional hospitals). [ABSTRACT FROM AUTHOR]

Abstract Background Emergency departments across the globe follow a triage system in order to cope with overcrowding. The intention behind triage is to improve the emergency care and to prioritize cases in terms of clinical urgency. Discussion In emergency department triage, medical care might lead to adverse consequences like delay in providing care, compromise in privacy and confidentiality, poor physician-patient communication, failing to provide the necessary care altogether, or even having to decide whose life to save when not everyone can be saved. These consequences challenge the ethical quality of emergency care. This article provides an ethical analysis of "routine" emergency department triage. The four principles of biomedical ethics - viz. respect for autonomy, beneficence, nonmaleficence and justice provide the starting point and help us to identify the ethical challenges of emergency department triage. However, they do not offer a comprehensive ethical view. To address the ethical issues of emergency department triage from a more comprehensive ethical view, the care ethics perspective offers additional insights. Summary We integrate the results from the analysis using four principles of biomedical ethics into care ethics perspective on triage and propose an integrated clinically and ethically based framework of emergency department triage planning, as seen from a comprehensive ethics perspective that incorporates both the principles-based and care-oriented approach.

Rapid regeneration of the injured tissue or organs is necessary to achieve the usual functionalities of the damaged parts. However, bacterial infections delay the regeneration process, a severe challenge in the personalized healthcare sector. To overcome these challenges, 3D-printable multifunctional hydrogels of Zn/tannic acid-reinforced glycol functionalized chitosan for rapid wound healing were developed. Polyphenol strengthened intermolecular connections, while glutaraldehyde stabilized 3D-printed structures. The hydrogel exhibited enhanced viscoelasticity (G'; 1.96 × 10 4  Pa) and adhesiveness (210 kPa). The dual-crosslinked scaffolds showed remarkable antibacterial activity against Bacillus subtilis (∼81 %) and Escherichia coli (92.75 %). The hydrogels showed no adverse effects on human dermal fibroblasts (HDFs) and macrophages (RAW 264.7), indicating their superior biocompatibility. The Zn/TA-reinforced hydrogels accelerate M2 polarization of macrophages through the activation of anti-inflammatory transcription factors (Arg-1, VEGF, CD163, and IL-10), suggesting better immunomodulatory effects, which is favorable for rapid wound regeneration. Higher collagen deposition and rapid re-epithelialization occurred in scaffold-treated rat groups vis-à-vis controls, demonstrating superior wound healing. Taken together, the developed multifunctional hydrogels have great potential for rapidly regenerating bacteria-infected wounds in the personalized healthcare sector., Competing Interests: Declaration of competing interest The authors declare that no conflicts of financial interests or personal relationships have influenced the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

COVID-19 pandemic has ultimately brought down the world in a status of standstill as a result of lockdown as one of the measures to combat the situation and to prevent cross transmission. On the other hand, it has raised issues like ethical obligation of medical doctors and other staff to attend COVID-19 patients without proper PPE and resources increasing the risk to the staff and their family. In addition, it has resulted in compromise of the services provided to the people like non-availability of medical services to chronic and non-urgent patients. Non-COVID-19 patients attending 'Fever Clinic' were harmed due to inappropriate management. Medical staff dealing with testing or working in hospitals, isolation wards or quarantine centres have been stigmatized as 'possibly infected' and even denied food and accommodation., (© 2020 Elsevier Masson SAS. All rights reserved.)