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Background: Surgical site infection (SSI) is one of the most common healthcare-associated infections. The use of negative pressure wound therapy (NPWT) has shown to decrease the overall rate of SSI, wound dehiscence, and length of hospital stay in surgical conditions. This study aims to determine the impact of NPWT applied on closed surgical incisions on patients with coexisting ostomy undergoing exploratory laparotomy. Methods: A retrospective study on patients who underwent exploratory laparotomies from 2017 to 2019 was conducted. NPWT was compared to standard post-operative surgical wound dressing. A sub-analysis of patients with ostomies was performed. Results: A total of 286 patients who underwent exploratory laparotomy were identified; 51 patients received NPWT and 235 received standard dressing. The NPWT group had a higher percentage of patients with an ostomy (37.3% vs 20.4%, P=.016), of which 25.5% were colostomies (vs 12.3%) and 11.8% were ileostomies (vs 8.1%) with P=.002. No significant difference in the overall rate of SSI (7.8% vs 5.5%, P= .517), wound dehiscence (7.8% vs 2.1 %, P=.057), and seroma formation (3.9% vs 2.1%, P=.612) were observed. The mean length of ICU stay (3.5 vs 7.0, P=.051) and unplanned reoperation (5.9% vs 16.6%, P=.051) were lower in the NPWT group compared to the control group. Sub analysis of patients with stoma found no significant difference in SSI. Conclusions: In our study, the use of NPWT on closed surgical incision wound was not associated with the reduction of SSI in patients with ostomies. Large studies are needed to ascertain significant benefits in patients with ostomies. Keywords: negative pressure wound therapy, surgical site infection, ostomy, exploratory laparotomy

Introduction Self-Immolation injuries, although rare, incur a high mortality rate due to the high injury burden. These patients often require a long hospital stay including extended periods of time in the ICU due to the systemic burden of their burns. They often present with active suicidal ideation leaving medical decisions to be made by their next of kin who want to see everything done to preserve the life of their loved ones. Over the past several years our burn center has taken a more holistic approach to the care of these patients involving both the psychiatry team as well as the palliative care team to discuss concurrent treatment and prognosis with both patients and their families. Previous ICU dogma often discourage earlier palliative care consultation as many providers and families see such actions as the care team no longer wishing to provide care for patients Methods Single patient case study and review Results The early consultation of a supportive care team allowed the patient's family more access to resources to better make a better informed decision that was in keeping with the patient's wishes Conclusions Patients who commit self immolation often present with active suicidal ideations and are deemed unfit to make their own medical decisions. It is of utmost importance to not only treat their burns but also for early psychiatric treatment of their underlying condition when possible. These patients often are not coherent or are determined to not have the autonomy to make their own medical decision. Until the patient is deemed capable of making their own medical decision, it is up to the providers to determine a surrogate decision maker. The role of the surrogate decision maker is difficult as they must use substitute judgment in order to make decisions based on the subjective wishes of the patient. The difficulty in this situation arises from the fat that the decisions although made based upon the patient’s wishes can be at conflict with the patient’s best interest. When these conflicts arise it is up to medical providers to have an open dialogue and convey all revelevent information related to prognosis and outcome with the decision maker. There have been no studies that look at the ethics of palliative care among these patients and how to best honor their wishes. Applicability of Research to Practice This study is to help foster a discussion around the ethics of early discussion of palliative measures in regards to the treatment of self-immolation burns

The intense natural disasters have been causing the great loss of life and properties in Nepal. This study attempts to figure out the status and role of Nepalese academia for the contribution of disaster risk reduction and management (DRRM). The methodology adopted for the study is reviewing the literature, policies, and academic documents including university curricula. The study highlighted that the constitution of Nepal 2015 and DRRM Act 2017 have provided ample opportunities via several legal provisions for federal, provincial, and local government to make their own modalities for making a disaster-resilient society. The universities and higher academic institutions are responsible for sound knowledge-based research activities to address the issues of DRRM which could be directly adopted by different levels of governments in terms of their plans, policies, and programs. In this connection, attempts are being made by governments and academic institutions to develop disaster resilient communities by shifting the traditional way of just responding during disaster focusing on the disaster cycle. Precisely, ten major universities of Nepal have incorporated disaster components including preparedness, response, recovery, and mitigation-related academic curricula in their undergraduate and graduate levels academic programs. Introducing the Environmental Health in Disaster, and Public Health and Disaster Engineering in Tribhuvan University and Pokhara University, respectively is one of the good initiatives taken by the academia. However, there is still room for improvement in terms of the integration of DRRM courses in the curricula of higher academic institutions for making disaster-resilient communities.

While reperfusion of autologous blood using the Cellsaver (CS) device is routine in cardiothoracic surgery, there is a paucity of evidence-based literature regarding its use in trauma. Utility of CS was compared in these two distinct populations at a Level 1 trauma center from 2017 to 2022. CS was successfully used in 97% and 74% of cardiac and trauma cases, respectively. The proportion of blood requirements provided by CS, compared to allogenic transfusion, was also significantly higher in cardiac surgery. However, there was still net benefit for CS in trauma surgery, with median salvaged transfusion volume of one unit, in both general & orthopedic trauma. Therefore, in centers where the cost of setting up CS, both in terms of equipment and personnel, is less than the cost of one unit of blood from blood bank, use of CS in trauma operations should be considered.

Influenza affects many lives worldwide each year during the months of October through February. The 2020-2021 influenza season saw a sharp decline in the cases reported in the United States and in other countries like Great Britain in comparison to previous influenza seasons. The most likely explanations for this decline are the safety measures taken during the COVID-19 pandemic, such as physical distancing, face mask use, and better hand hygiene in the mass population, which likely reduced the transmission and infection rates of influenza this season. Key words: influenza, surveillance, pandemic, transmission

Background Completion cholecystectomy (CC) is performed for recurrent or persistent biliary symptoms following subtotal cholecystectomy (STC) or incomplete cholecystectomy (IC). Due to its complexity, cases are often referred to hepato-pancreato-biliary (HBP) surgeons. There is little published literature on indications or outcomes of CC. Methods Completion cholecystectomy cases performed between 2016 and 2021 by the sole HPB surgeon covering a rural referral base of >250-mile radius in West Texas were included. Primary variables of interest include indications and outcomes of CC. Results Of the eleven patients included, 5 (45.5%) had laparoscopic STC, 3 patients (27.3%) had laparoscopic converted to open STC, and 2 (18.2%) had laparoscopic IC. Most STC cases (6/9, 66.6%) were reconstituting, while 3 STC cases were fenestrating (all had persistent bile leak). For reconstituting STC, indications were symptomatic cholelithiasis in 5 patients (45.5%), and choledocholithiasis in 3 patients (27.3%). The median (IQR) duration between index procedure and subsequent CC was 15 (1.4-92) months. The median (IQR) remnant gallbladder length was 4 (3-4.5) cm. Completion cholecystectomy was performed robotically in 8 cases (72.7%). Post-CC complications occurred in 3 patients (27.3%); these were 1 superficial surgical site infection, 1 hepatic abscess requiring percutaneous drainage, and lastly atrial fibrillation. Conclusions All patients requiring CC had residual gallbladder remnant >2.5 cm; this is longer than recommended for STC. Completion cholecystectomy is a complex operation that carries significant morbidity, even when performed using minimally invasive techniques. As bailout procedures become more common in severely inflamed cholecystitis, it is important to collate more data on the outcomes of requiring CC.

Loss of life and property due to human induced and natural landslides are common in Himalayan region of Nepal. Intense precipitation over a short period of time, unplanned road construction, degradation of forests, and change in land use are expected to increase the number and intensity of landslides in the already fragile mountainous tracts of the country. The landslide susceptibility assessment using GIS and remote sensing tools identifying hazard/susceptibility, vulnerability and risk are very useful for disaster risk reduction and management. In this chapter, Statistical Index Model and Logistic Regression Model were compared for performance through Geographical Information System (GIS), to derive landslide Susceptibility map of the Chepe River corridor. Eleven factors (slope, aspect, geology, distance to road, land use, rainfall, elevation, relief, drainage density, plan curvature, and profile curvature) were considered as possible key factors for the landslide susceptibility assessment. To validate the models, Receiver Operating Characteristic (ROC) was used. The result shows the Logistic Regression Model has 82% prediction accuracy, whereas Statistical Index Model has 63% prediction accuracy. Based upon the accuracy assessment, the logistic regression model seems to have better applicability in the Chepe River corridor in comparison to statistical index method using same eleven triggering factors.