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Endovascular repair of abdominal aneurysm (EVAR) has become the main stay of treatment for abdominal aortic aneurysm. Long-term follow-up studies have shown a variety of complications following EVAR, few of which are dangerous with high morbidity and mortality. Open surgery for complications of EVAR poses unique challenges to the surgeon. We present one of the serious complications following EVAR which was successfully managed by open surgery.

Background & Aims: Amiodarone is a purposive medicine useful in restoring sinus rhythm (SR) after cardiac surgery. The aim of the study was to evaluate the effect of prophylactic intraoperative single-dose intravenous amiodarone and to convert atrial fibrillation (AF) into normal sinus rhythm (NSR) in the patients undergoing valve replacement surgery. Materials & Methods: In this prospective and interventional study, 180 patients of ASA III (American Society of Anesthesiologist) classification between the ages of 18-60 years, posted for Rheumatic Mitral Valve Replacement were allocated randomly to two equal groups (Group-1 and Group-2). Their hemodynamics parameters, Pre and post pulse rate, ECG findings and incidence of AF and VT/VF and ICU, Hospital stay were noted. Data was analysed with SPSS v26 using chi-square test. A two-tailed P value of 0.05 or less was regarded as statistically significant. Results: In our study, we found that there was suggestive significance between both groups as regard to mean pulse rate changes after 5 and 10 minutes of induction (P value >0.05). At the end of surgery, there was developing atrial fibrillation in few patients and sinus rhythm in more (P value >0.05). Postoperative arrhythmias in the first 24 hrs, AF was seen in 9(10%) patients in the Group 1 compare to Group 2 49 (54.4%) (P

COVID-19 laid bare many failings and shortcomings of state systems, institutions and structures which aim to protect citizens against harm. As observed from the outcomes of the pandemic in many parts of the Global South and Global North, the resilience of health, social protection, governance, economic, education, and social welfare systems has been significantly eroded or challenged, leaving large segments of the population open to heightened risk and vulnerability. This has been noted to have significantly eroded social capital, namely the trust, communication, and dialogue between citizens in the state as well as citizens with each other. Based on comparative research carried out on the return to schooling process in five countries, Lebanon, Nigeria, Colombia, Georgia, and Zambia, the paper highlights the important role and function that educational governance, decision-making, and control throughout the pandemic has played a key role in either maintaining or erode social capital, and ultimately the resilience of the entire education system. Much of this was based on how well state officials and local education officials both considered and communicated their actions to educators, students and their families. The importance of education as a site where both bridging and linking social capital is both strengthened, but also capitalized on is also discussed. Specifically, the paper highlights, using the example of COVID-19 education responses, how a state that is responsive and accountable to its citizenry in a time of crisis, stands the greatest chance of ensuring such periods do not lead to an erosion of social capital.

A 6-month-old infant was operated on for supracardiac total anomalous pulmonary venous connection (TAPVC) with usual anatomy. The vertical vein was ligated. Weaning from bypass was attempted twice but was unsuccessful. Coronary sinus atresia was suspected and identified on the opening of the right atrium. A smooth postoperative course occurred after unroofing the coronary sinus. Coronary sinus atresia should be remembered as an uncommon association with TAPVC.

Cladophialophora bantiana is a rare melanized neurotropic fungus. We report a case of cerebral pheohyphomycosis due to C. bantiana in an immunocompetent child. The patient was a 12-year-old male who presented with a headache, intermittent vomiting associated with decreased movements of the right upper and lower limbs, and right-sided deviation of the mouth. Brain magnetic resonance imaging showed multiple conglomerated lesions in the left gangliocapsular region and corona radiata with perilesional edema and mass effect and a few small ring-enhancing lesions also. Aspiration of brain abscess sent for a culture and isolated C. bantiana. The clinical and radiological presentations are similar to the common organisms such as tuberculosis and thus can be misleading while diagnosis. Despite aggressive management, the patient succumbed to his illness. It is imperative to isolate microorganisms, using all microbiological tests. Fungi should also be considered irrespective of the immunocompetency.

Pompe disease is an autosomal recessive, lysosomal storage disorder wherein affected individuals are deficient in the lysosomal enzyme acid alpha-glucosidase (acid maltase). Here, we describe a case of a 2-year-old male child, who initially presented at the age of 16 months with complaints of difficulty in walking without support associated with frequent falls. On follow-up after 6 months, progressive deterioration in clinical signs was noted. His serum Creatine Phosphokinase (CPK) levels were 2067 U/L. Given the progressive nature of the condition, we ruled out congenital muscular disorder, metabolic and endocrine myopathy. A clinical exome sequence was ordered to check for the myopathy panels. The results revealed a homozygous missense variation in exon 11 of the Acid Alpha Glucosidase (GAA) gene. His alpha-glucosidase levels were 0.8 nmol/hr/mg, which was indicative of the deficient activity of the enzyme in the leukocytes.

Over the course of the COVID-19 pandemic, education systems have grappled with the complexity of protecting the wellbeing of learners and educators, along with ensuring learners' continued engagement with learning. This has led to an increasing number of calls to strengthen education-sector resilience to future shocks and stressors, particularly for the most marginalized, in order to maintain momentum toward achieving Sustainable Development Goal 4. Resilience has been and continues to be a key focal point for the US Agency for International Development (USAID), both across the agency and within its education portfolio. In this paper, we reflect on case study research in five contexts—Colombia, Georgia, Lebanon, Nigeria, and Zambia—during the COVID-19 pandemic and apply it to USAID's resilience framework for education. We identify practices and structures used in each context that were either operationalized or could be leveraged further to absorb, adapt, and ultimately transform these education systems when facing a pandemic and other types of stressors and shocks.

Introduction: Nanophthalmos characterized by short axial length, high lens-to-eye ratio and thick sclera, is more prone to develop uveal effusion syndrome (UES). This rare entity can result in idiopathic exudative detachment of the choroid, ciliary body and retina. Abnormality in the scleral thickness with resultant obstruction of the vortex veins and reduced trans-scleral drainage of fluid is responsible for exudative retinal detachment (ERD). Methods: A retrospective study of UES in nanophthalmic patients treated with partial thickness sclerectomy in tertiary eye care centre from January 2015 to June 2019. Five eyes of five patients (four males and one female) with a diagnosis of nanophthalmos suffered from angle closure glaucoma associated with ERD. Raised intra-ocular pressure (IOP) not amenable to conservative medical management were subjected to surgery. Lamellar sclerectomy was performed in two or more quadrants without drainage which was judged on the basis of maximum amount of exudative fluid present in the subsequent quadrants. Results: The average age at surgery was 39.2 years and the mean follow-up duration was 9.2 months (6 to 18 months). Revision sclerectomy was required in 2/5 (60%) eyes. The serous fluid gradually resolved and retina remained reattached at the end of final follow up. The useful vision was preserved and IOP was normalized. Conclusion: Nanophthalmic UES remains a challenging clinical entity. Partial thickness sclerectomy may be an effective option in the treatment of nanophthalmic UES, not amenable to the conventional medical management in a low resource setup.

The airway compression poses a challenge for the anesthesiologist in airway management during aneurysm repair surgery.

The suspended particle aerosols especially anthropogenic are recognized to have degradation in the quality of the atmosphere and one of the factors to cause uncertainty in climate. In this paper, we have investigated the trend of the parameter ‘Aerosol Optical depth’ and by application of spectral based wavelet analysis; we extracted spatial and temporal variation over the selected AERONET sites of Nepal. We have taken the site Kyanjin_gompa, Lumbini, Pokhara and Kathmandu under the consideration of our study because of their geographical variability which is a significant factor for causing variation in local as well as global circulation of aerosols. As per data retrieved from Ground-Based remote sensing system for the year 2018 over the site Kyanjin gompa, Lumbini and Pokhara and for the year 2016 over the Kathmandu, we extracted the periodicity and frequency of the variation in AOD for each site by the application of continuous wavelet analysis on AOD at three different wavelengths. On reviewing the previous studies, it is seen that the area lying at the Indo-Gangetic plain exhibit high aerosol loading in comparison with the Himalayan foothills and central Himalayas of Nepal. We found not only the higher aerosol loading in atmosphere over site Lumbini but also higher periodicity. Likewise, we also found Pokhara as highly polluted as Lumbini. The investigation of data records over the site Kathmandu has shown increment in aerosol loading in the year 2016 compared with previous years. BIBECHANA 17 (2020) 80-88

Background: We sought to compare the effectiveness of oxygen (O2) treatment administered by an O2 mask and nasal continuous positive airway pressure (NCPAP) in infants after congenital cardiac surgery. Methods: In this retrospective observational study, 54 infants undergoing corrective cardiac surgery were enrolled. According to the anesthesiologist's preference, the patients ventilated for more than 48 h were either put on NCPAP or O2 mask immediately after extubation. From pre-extubation to 24 h after treatment, arterial blood gas and hemodynamic data were measured. Results: After 24 h of NCPAP institution, the patients showed a significant improvement in oxygenation compared to O2 mask group. Respiratory rate (per minute) decreased from 31.67 ± 4.55 to 24.31 ± 3.69 (P < 0.0001), PO2 (mmHg) increased from 112.12 ± 22.83 to 185.74 ± 14.81 (P < 0.0001), and PCO2 (mmHg) decreased from 42.88 ± 5.01 to 37.00 ± 7.22 (P < 0.0076) in patients on NCPAP. In this group, mean pediatric cardiac surgical Intensive Care Unit (PCSICU) stay was 4.72 ± 1.60 days, with only 2 (11.11%) patients requiring re-intubation. Conclusion: NCPAP can be used safely and effectively in infants undergoing congenital cardiac surgery to improve oxygenation/ventilation. It also reduces the work of breathing, PCSICU stay, and may reduce the likelihood of re-intubation.

Component malpositioning during Birmingham hip resurfacing increases the risk for component wear, metallosis, component loosening, and the likelihood of dislocation and revision surgery. Computer-assisted navigation can increase the accuracy to which components are placed, and the utilization of this technology in Birmingham hip resurfacing is increasing. The present report summarizes the accuracy of acetabular component positioning in a Birmingham hip resurfacing case utilizing navigation. Intraoperative C-arm fluoroscopy following the use of the navigation tool confirmed excellent seating, positioning, and stability of the acetabular component. In addition, post-operative antero-posterior radiographs confirmed device accuracy and revealed a stable joint with no evidence of acetabular loosening or femoral fracture. Computer-assisted navigation may therefore be an effective tool to improve the accuracy of component positioning during Birmingham hip resurfacing.

Introduction. Scleral buckle surgery retains a special place in treatment of retinal detachment despite development of new and advanced vitreoretinal surgical techniques. The outcome of any retinal detachment surgery depends on correct selection of patient, type and nature of detachment, and the expertise. This study aims to evaluate various other parameters that determine the outcome of scleral buckle surgery. Method. Records of 55 patients with primary rhegmatogenous retinal detachment treated with scleral buckling over a duration of 18 months that had a minimum of 3-month follow-up were retrospectively reviewed. Preoperative and postoperative characteristics were recorded. Parameters that were evaluated to determine the outcome were best-corrected visual acuity (BCVA), anatomical success, and complications. Results. A total of 51 eyes of 50 patients that met the inclusion criteria were included. Mean age was 41 ± 19.9 years (range: 9 to 83). Primary anatomical success was achieved in 80.4%. Parameters significantly associated with the anatomical outcome of surgery were status of lens, preoperative visual acuity, and extent of retinal detachment. There was a significant improvement of visual acuity postoperatively. Conclusion. Scleral buckle surgery is a highly effective surgery in uncomplicated retinal detachment cases, and single surgery success rates are better in cases with good preoperative visual acuity, partial detachment, and clear crystalline lens.

In this paper, and as a team of researchers/practitioners spanning the globe, we reflect on the historical and ongoing legacies of (neo)colonialism and imperialism in education in emergencies (EiE) research and practice using collaborative auto-ethnography. Specifically, we explore how we've experienced hierarchies of power, positionality and privilege, and how we've benefited and/or been victims of this in the past. We then move to explore how we are striving to realise authentic and meaningful co-production in ACCESS (Accelerating Change for Childrens' and Youths' Education for Systems Strengthening), a 44-month research-practice partnership that aims to improve education provision for out-of-school children and youth. We identify both opportunities and challenges to doing this and highlight how decolonising EiE research/practice is an ongoing process rather than finite, singular actions.

The present study describes the development and validation of a dissolution method for carvedilol compression-coated tablets. Dissolution test was performed using a TDT-06T dissolution apparatus. Based on the physiological conditions of the body, 0.1N hydrochloric acid was used as dissolution medium and release was monitored for 2 hours to verify the immediate release pattern of the drug in acidic pH, followed by pH 6.8 in citric-phosphate buffer for 22 hours, to simulate a sustained release pattern in the intestine. Influences of rotation speed and surfactant concentration in medium were evaluated. Samples were analysed by validated UV visible spectrophotometric method at 286 nm. 1% sodium lauryl sulphate (SLS) was found to be optimum for improving carvedilol solubility in pH 6.8 citric-phosphate buffer. Analysis of variance showed no significant difference between the results obtained at 50 and 100 rpm. The discriminating dissolution method was successfully developed for carvedilol compression-coated tablets. The conditions that allowed dissolution determination were USP type I apparatus at 100 rpm, containing 1000 ml of 0.1N HCl for 2 hours, followed by pH 6.8 citric-phosphate buffer with 1% SLS for 22 hours at 37.0 ± 0.5 ºC. Samples were analysed by UV spectrophotometric method and validated as per ICH guidelines.O presente estudo descreve o desenvolvimento e a validação de método de dissolução para comprimidos revestidos de carvedilol. O teste de dissolução foi efetuado utilizando-se o aparelho para dissolução TDT-06T. Com base nas condições fisiológicas do organismo, utilizou-se ácido clorídrico 0,1 N como meio de dissolução e a liberação foi monitorada por 2 horas para se verificar o padrão de liberação imediata do fármaco em condições de pH baixo, seguidas por pH 6,8 em tampão cítrico-fosfato por 22 horas, para simular o padrão de liberação controlada no intestino. Avaliou-se a influência da velocidade de rotação e a concentração de tensoativo no meio. As amostras foram analisadas por método espectrofotométrico UV-visível validado, em 286 nm. O laurilsulfato sódico a 1% (SLS) mostrou-se ótimo para aumentar a solubilidade do carvedilol em pH 6,8 em tampão cítrico-fosfato. A análise da variância não mostrou diferença significativa entre os resultados obtidos a 50 e a 100 rpm. O método da dissolução discriminante foi desenvolvido com sucesso para os comprimidos revestidos de carvedilol. As condições que permitiram a determinação da dissolução foram: aparelho USP tipo I a 100 rpm, contendo 1000 mL de HCL 0,1 N por 2 horas, seguido de pH 6,8 com tampão cítrico-fosfato, com 1% de SLS por 22 horas a 37,0 ± 0,5 ºC. Amostras foram analisadas por método espectrofotométrico e validadas pelas normas ICH.

Background: There are different risk factors that affect the intensive care unit (ICU) stay after cardiac surgery. The aim of this study was to evaluate possible risk factors influencing prolonged ICU stay. Methodology: We conducted 443 adult patients undergoing different cardiac surgery to determinate causes of prolonged ICU stay. These patients were divided into two groups according to ICU stay ≤ 4 days and >4 days. We evaluated preoperative, intraoperative and postoperative risk factors for prolong ICU stay. Results: Among the 443 patients studied, 277 (62.52%) had stayed ≤ 4 days and 166 (37.42%) had stayed >4 days in ICU. Frequency of prolonged ICU stay was 42.7% in patients undergoing coronary artery bypass graft (CABG), 37.3% in patients with valve surgery, 9% in patients with CABG plus valve surgery and 10.8% others surgery. Patients with > 4 days of ICU stay received more blood transfusion and higher inotropes duration. They also had longer time duration of surgery, cardiopulmonary bypass, and long ventilation hours and other preoperative and postoperative risk factors. (P < 0.05 for all comparisons). Conclusions: The relationships between the pre-, intra- and postoperative risk factors and prolonged ICU stay after coronary artery bypass grafting with cardiopulmonary bypass, suggest that serum creatinine, urea and liver dysfunction were risk factors for prolong ICU stay, Whereas among surgical variables cardio pulmonary bypass time, cross clamp time and time duration of surgery are the main associates of higher ICU duration.

Background: Since many surveys for the prevalence of β thalassemia have been made in area with high prevalence of malaria, it is important to find out whether malaria can modify Hb A2 levels. In present study, analysis of Hb A2 level of patients with malaria and thalassemia has been done and has been compared with control group to conclude that whether Hb A2 level was affected or not. Methodology: Total 99 samples of malaria patients, 111 samples of β thalassemia trait patients& 105 samples of healthy individuals were tested. The p value of < 0.05 was used to consider difference as significant & to reject null hypothesis. The t test (two tailed distribution, two samples unequal variance) was used as hypothesis test. Results: Hb A2 level in malaria group ranged from 1.9 – 4.0 % (n = 89, mean 3.09 % & SD 0.32 %); those of the β thalassemia trait group ranged from 4.0 – 7.3 % (n = 111, mean 5.37 %& SD 0.74%); and those of the control groupranged from 1.8 – 3.9 % (n = 105, mean 2.82% & SD 0.43%). The Hb A2 level of the malaria patients was elevated statistically significantly then that found in 105 healthy controls (P < 0.05 at 95 % confidence limit). Conclusion: From the study, we can conclude that one should remain conscious while interpreting laboratory tests in patients with malaria or patients from malaria endemic zone for β thalassemia trait which rely mainly on Hb A2level.

Objective: The objective of our study was to determine the feasibility of early extubation and to identify the risk factors for delayed extubation in pediatric patients operated for ventricular septal defect closure. Methods: A prospective, observational study was carried out at our Institute. This study involved consecutive 135 patients undergoing ventricular septal defect closure. Patients were extubated if feasible within six hours after surgery. Based on duration of extubation, patients were divided two groups: Group 1= extubation time ≤ 6 hours, Group 2= extubation time >6 hours. Results: A total of 99 patients were in Group 1 and 36 patients in Group 2. Duration of ventilation was 4.4±0.9 hours in Group 1 and 25.9±24.9 hours in Group 2 (P