Life-saving Surgery Research Articles

Post-traumatic reactions and quality of life after pelvic exenteration for gynecologic cancer: a retrospective cohort study.

We examined post-traumatic reactions and quality of life in women with recurrent gynecologic cancer who underwent a pelvic exenteration (PE), a potentially life-saving radical surgery associated with life-altering sequelae. Twenty-one women who had completed PE at least 6months prior completed the Impact of Event Scale-Revised, a measure of post-traumatic stress, the Post-Traumatic Growth Inventory, a measure of post-traumatic growth, the Center for Epidemiologic Studies-Depression Scale, and the European Organization for Research and Treatment of Cancer 30-item core Quality of Life Questionnaire. We examined the associations between these outcome variables, and quality of life scores were compared to normative values for the general and gynecologic cancer populations. Thirty percent of women reported clinically significant post-traumatic stress symptoms and 71% endorsed clinically significant depressive symptoms. More post-traumatic stress was associated with less post-traumatic growth, more depressive symptoms, and worse quality of life. In general, women's quality of life was worse than the general population but comparable to women with stage III-IV ovarian cancer and women with cervical cancer. Social functioning was markedly lower in our sample and women reported more pain, diarrhea, and financial difficulties post-PE compared to published norms for the general population and women with ovarian or cervical cancer. There were no differences in quality of life based on age, type of PE, type of urinary diversion, or cancer type. Findings support long-term continued symptom management and the ongoing rehabilitation of patients to optimize physical, psychological, and social well-being in PE survivorship.

Pregnancy Management and Outcomes in a Small Bowel, Pancreas, and Liver Transplant Recipient: A Case Report and Literature Review.

BACKGROUND Small bowel transplantation (SBT) is a rare but life-saving surgery. However, successful full-term pregnancies in individuals with SBT are exceedingly rare due to the nutritional and immunosuppression challenges this transplant poses for pregnancy. Therefore, clear guidelines for treating pregnant SBT recipients are unavailable. Here, we report the second case of a successful pregnancy in an individual with a triple organ transplant, including SBT, highlighting the need for careful immunosuppressive management and multidisciplinary care. CASE REPORT A 20-year-old woman in the third trimester of pregnancy with a history of small bowel, liver, and pancreas transplantation at age 1 year presented with elevated liver function test results. She had been taking tacrolimus, sirolimus, and prednisone before pregnancy, with no signs of organ rejection. While sirolimus and prednisone was discontinued upon conception, laboratory test results at presentation revealed low serum tacrolimus levels. The patient had an acute kidney injury and pulmonary edema during her hospitalization and received a diagnosis of preeclampsia. She underwent a successful cesarean delivery, due to labor induction complications; however, about 1 month after hospital discharge, the patient experienced elevated liver enzymes, which was treated with high-dose steroids and adjusted tacrolimus. Sirolimus was restarted, and the patient's liver enzymes have been normalized to date. CONCLUSIONS Comprehensive multidisciplinary care, as well as monitoring and optimizing immunosuppression, are essential for pregnant SBT recipients throughout the prenatal, perinatal, and postpartum periods to mitigate risks, prevent graft rejection, and ensure positive maternal and fetal health outcomes.

Complications and implications of Caesarean delivery: Facts and perceptions

Background/objectivesCaesarean delivery (CD), though considered a life-saving surgical procedure, poses a public health problem and puts mothers and babies at higher risk of post-delivery complications. The present study aims to explore the post-delivery maternal complications among CD and normal vaginal delivery (NVD) mothers in India. MethodsThe present study is a PAN-India study conducted across various Indian states, considering a significant increase in CD rates. Data was collected from face-to-face interviews of 1407 recently delivered mothers during January–March 2023. ResultsThe findings indicate that 22 % of CD mothers reported post-delivery complications compared to 15 % of NVD mothers. Notable complications among CD mothers include body/abdominal pain (12.9 %), infection/pain in the suture area (6.2 %), and high blood pressure (1.1 %). Conversely, higher proportion of NVD mothers reported pelvic pain (3.3 %). Further, a greater proportion of NVD (22 %) and CD (28 %) mothers reported pain in the pelvic area and infection/pain in the suture area, respectively. Socio-economic and demographic factors such as age, education, and residence significantly influenced the incidence of self-reported maternal complications. Mothers aged 25 and above, with at least ten years of education, and those residing in urban areas reported higher complications. Additionally, CD mothers also experienced longer hospital stays, higher costs, and delays in breastfeeding initiation. ConclusionThe study underscores the necessity for targeted healthcare interventions to mitigate the specific risks associated with CDs and improve maternal outcomes through appropriate policy formation to address the rising trend of CDs and their implications on maternal health.

Rupture of the ascending aorta 6 months after TAVI procedure caused by TAVI prosthesis

BackgroundTranscatheter aortic valve implantation (TAVI) is indicated for elderly patients who often have severe comorbidities and high operative risk. Despite many advantages, it carries the potential for both early and late complications. The literature reports mainly periprocedural problems. This case report describes a rare instance of ascending aortic rupture as a late complication following TAVI.Case presentationAn 81-year-old male with severe aortic stenosis (AS) was a non-surgical patient due to a high operative risk (EuroSCORE II 14.08%) and comorbidities, including cardiovascular problems, chronic obstructive pulmonary disease, myelodysplastic syndrome. During the TAVI procedure Medtronic CoreValve™ Evolut™ R-26 was implanted via the right femoral artery. Postoperative period elapsed without complications and the patient was discharged home. Six months later, the patient was re-admitted to the hospital on an emergency basis and transferred directly to the operating room due to ascending aortic rupture (EuroSCORE II 53.20%, GERAADA score 64.9%). Computed tomography angiography (CTA) showed aortic rupture with a multiple fresh blood reservoirs and thrombus around the ascending aorta originating from the spot where the nitinol frame of the TAVI valve was attached to the native aorta. Supracoronary excision of the ascending aorta with implantation of a vascular graft (Intergard Woven Graft 34 mm) was performed, preserving the earlier implanted TAVI valve. On the 9th day after surgery the patient’s general condition deteriorated, he suffered from circulatory and respiratory insufficiency. Furthermore, a gastrointestinal bleeding with the need for gastro-, and colonoscopy and multiple blood transfusions occurred. Patient developed urosepsis and acute renal failure with the need for hemodiafiltration. Despite intensive treatment, further deterioration of the medical condition of the patient. and finally the multiple organ failure was observed. Patient died on the 50th postoperative day.ConclusionsTAVI is a safe method of treating severe AS, especially recommended for non-surgical candidates. Rupture of the ascending aorta is a rare but serious complication of TAVI that usually occur during or shortly after the procedure. This case report highlights the importance of post-procedural monitoring for such TAVI complications, even in the late period following TAVI, and if such complications occur, taking the risk to perform a life-saving operation.

Fetomaternal Outcome of Pregnant Women at Term Undergoing Cesarean Section.

Cesarean section is one of the most common procedures performed in obstetric practice today and is a lifesaving surgery for mother and fetus. Cesarean sections are classified traditionally, as elective cesarean section or emergency cesarean. The purpose of this study is to compare the maternal and neonatal outcomes in elective and emergency cesarean section so that measures can be taken to reduce maternal and neonatal morbidity and mortality. A descriptive study including 400 pregnant women who underwent caesarean section were included in this study. Patients were subjected to elective or emergency cesarean section as per the indication and protocol of institute. were included in the study. During the study period there were total 1080 deliveries. The average age of the women was 29.21±4.07 years. Of the 400 cesarean section cases, only 2.8% had wound infection, 3.8% had fever, 4.8% urinary tract infection (UTI) whereas no women had observed with post-partum hemorrhages (PPH) and maternal death. Regarding fetal outcome, neonatal intensive care unit (NICU) admission was observed in 16%, birth asphyxia was 2.3% poor Apgar score 2.5% and neonatal death was not observed. Rate of fever, UTI, wound infection, need of resuscitation and poor Apgar score was significantly high in emergency section than elective caesarean section whereas NICU admission was not statistically significant. The most common indication of emergency cesarean section were fetal dress and for previous LSCS. Emergency cesarean was associated with increased maternal and perinatal complications than in elective cesarean section.

Caesarean Section Trend in a Selected Hospital between 2014 And 2019: Observational Study

Caesarean Section Trend in a Selected Hospital between 2014 And 2019: Observational Study

Method of storage impacts graft immune cell populations in intestinal transplantation

Intestinal transplantation (IT) is the only treatment for intestinal failure patients who cannot tolerate parenteral nutrition. Although cold storage (CS) is the gold standard for intestinal allograft preservation, normothermic machine perfusion (NMP) has improved transplantation success in other organs. Allograft immune modulation is thought to contribute to this success. The objective of this study was to assess the impact of NMP on intestinal immune cell populations as it relates to ultimate allograft and recipient health. We hypothesized that NMP would stabilize overall immune cell populations while reducing pro-inflammatory cohorts, thus improving IT success. Porcine intestines were stored for 6H at 4°C (CS-T6, n=6) or perfused at 34°C (NMP-T6, n=8) and transplanted. Samples were collected following intestinal procurement (T0), storage (T6), 1-hour post-transplant (T1PT), and euthanasia (T48). Flow cytometric profiling and quantification of intraepithelial (IEL) and lamina propria (LP) lymphocytes and NK cells were performed at T0, T6, and T48. Immunofluorescence (IF) identified CD3+ T-cells at T1PT. One-way ANOVA analyzed cell counts with significance set at p< 0.05. Flow cytometry revealed that NMP preserved CD3+ IELs in the jejunum at T6 (63.74% vs 32.79%, p< 0.0001), and in the ileum at T6 (51.31% vs 42.77%, p< 0.0001) and at T48 (57.73% vs 34.21%, p<0.0001). Immunofluorescent cell quantification confirmed this preservation of CD3+ IEL at T1PT in the crypts of the jejunum (4.9% vs 2.1 %, p< 0.05) and ileum (6.9% vs 2.8%, p< 0.001) compared to CS. However, upon further subpopulation analyses using flow cytometry, ileal IEL T-cells were reduced throughout NMP compared to CS (T6 28.7% vs 44.0%; T48 16.65% vs 22.37%; p< 0.0001). NK cells were also decreased in ileal and jejunal LP at NMP-T6 compared to T0 (3.6% vs 5.6%, p< 0.01; 2.4% vs 4.3% p< 0.05). NMP reduces NK cells, a cell type known to be associated with rejection. Interestingly, NMP preserved the overall CD3+ T cell populations in the jejunum and ileum at T6, T1PT, and T48. The subpopulation of IELs, however, were reduced in the ileum following NMP. The role of these populations, specifically in IT, has yet to be determined. Further characterization of T-cell subpopulations and dynamics is needed. Complimentary evaluations of the microbiome and proteomic responses to IT NMP are ongoing. Understanding immune cell dynamics will improve IT outcomes for patients requiring this critical, lifesaving surgery. U.S. Department of Defense PR181265; NIH K01OD010199 SERCA, T32OD011130-15. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Navigating Life Post-emergency Laparotomy: A Narrative Review on Quality-of-Life Outcomes.

An emergency laparotomy is a life-saving surgical procedure performed to address acute abdominal conditions. While crucial for immediate survival, this procedure can have significant long-term implications for patients' quality of life. This comprehensive review examines the physical, psychological, and social outcomes following emergency laparotomy, highlighting the importance of addressing quality-of-life concerns in this patient population. Key findings reveal that patients may experience complications, psychological distress, and challenges in social functioning post-procedure. Age, gender, and access to support networks influence outcomes. Recommendations for clinical practice include routine assessment of quality of life, multidisciplinary care, and patient education. Further research is needed to understand predictors of poor outcomes and evaluate interventions to improve quality of life post-emergency laparotomy. Healthcare providers can enhance patient care and outcomes in this vulnerable population by addressing these issues.

Prevalence and Causes of Blood Deferral in Tertiary Care Teaching Hospital Islamabad

Background: A blood transfusion is a vital and potentially life-saving operation in modern therapeutic and surgical procedures; yet, it requires a sufficient supply of safe blood from a healthy donor. In addition to laboratory testing of blood bags for infectious illnesses, appropriate, safe, and healthy donor selection is required. On the other hand, the loss of valuable blood components that are accessible for transfusion results from fit donors deferring. Understanding the reasons for both temporary and permanent deferrals can help us prevent this, put our knowledge into practice. The current study aimed to assess the incidence and reasons behind blood donor deferrals at Islamabad teaching hospital that provides tertiary care. Methods: This cross-sectional study was conducted at Dr. Akbar Niazi Teaching Hospital’s blood bank. All Blood donors reporting to donate blood at a blood bank between the periods of 1st September 2020 to 24th December 2021 were included in the study. The data was obtained by interviewing the donors using specially designed Performa. The collected data of deferred blood donors was analyzed using SPSS version 21. Results: Out of a total of 2054 blood donors, 523 (25.5%) were deferred due to different reasons and ineligible to donate blood. Out of 523 deferred donors, 455(87%) were males and 68(13%) were females. The average age of the blood donors was 26(4.2%) and most blood donors were between 20 to 40 years age. The common causes for deferral were low hemoglobin (41.3%), recent COVID-19 vaccination (12.6%) and increased TLC (7.1%). Hepatitis B virus 39(7.5%), Hepatitis C virus (4.4%), HIV 5(1.0%) and Syphilis 18 (3.4%). Conclusion: The most frequent reasons for delay were elevated TLC count, recent COVID-19 immunization, and low hemoglobin levels. The cornerstone of a safe blood supply is the donor education on self-exclusion and strict selection criteria.

Optimizing diagnosis and treatment of infants with congenital heart disease and pneumonia: A 15 years’ experience

Pneumonia is the most frequent infectious intercurrent pathology in children with Congenital heart disease. It is the reason for forced postponement of life-saving cardiac surgery. Our fifteen years’ experience of children with congenital heart disease and pneumonia during the preoperative period, allows not only to predict the course of pneumonia in infants with CHD but also to provide an optimal algorithm for diagnosis and therapy to reduce the time of convalescences and preoperative preparation.

Infections associated with bacteria of the genus Elizabethkingia in children with cystic fibrosis and operated on due to congenital heart defects: microbiological features and clinical significance

Bacteria of the genus Elizabethkingia are gram-negative rod-shaped bacteria found throughout the world. The main reservoir for representatives of this genus is water and soil. Despite this, more and more clinical data are emerging indicating the role of these representatives in the development of nosocomial and community-acquired infections, most often sepsis and meningitis. Risk groups include newborns, children, the elderly, patients with cystic fibrosis (CF) and people with immunodeficiencies. Infections associated with Elizabethkingia spp. are generally associated with high mortality rates (18.2-41%) and are most often observed in neonates and immunocompromised patients. Members of the genus Elizabethkingia are naturally resistant to many of the antibiotics traditionally prescribed for infections with gram-negative bacteria. Timely diagnosis and early initiation of appropriate combination therapy are critical in the treatment of such infections. During the period 2018-2023. Isolation of bacteria of the genus Elizabethkingia was observed from biological material obtained from children with CF and 8 newborn children with a cardiac profile who underwent life-saving surgery due to the presence of congenital heart defects. Bacteria of the genus Elizabethkingia were isolated from 15 patients with CF, of which repeat cultures were noted in five patients; 28 strains were identified during the specified period. Of these, in 2018 and 2020 there were 2 strains each, 2019-13, 2021-6 and 2022-5 strains. In the examined newborns, isolation of these bacteria was detected in 4 patients in 2021, in 3 patients in 2022, and in one patient in 2023, respectively. Bacteria of the genus Elizabethkingia are relatively new and poorly studied pathogens of nosocomial infections associated with a high risk of complications and mortality in premature newborns and immunocompromised patients, which requires increased attention from both medical microbiologists and clinicians of various profiles.

Functional prognosis following spontaneous intracerebral hemorrhage in patients on hemodialysis: a retrospective study of 100 consecutive cases

BackgroundRecently, discussions have increasingly focused on “withdrawal from dialysis” among patients undergoing dialysis who experience severe brain dysfunction as post-stroke sequelae. In this context, the lack of understanding regarding functional prognosis after spontaneous intracerebral hemorrhage in patients undergoing hemodialysis becomes a particularly important issue. Therefore, we aimed to evaluate the functional prognosis of intracerebral hemorrhage in patients undergoing hemodialysis when life-saving was prioritized and dialysis was not withdrawn. Furthermore, we sought to identify factors influencing life and functional prognosis.MethodsWe retrospectively analyzed data of 100 consecutive hemodialysis patients who experienced spontaneous intracerebral hemorrhage between 2012 and 2021. The in-hospital mortality rates and modified Rankin Scale (mRS) and Functional Independence Measure (FIM) scores at discharge and 90 days after onset were examined.ResultsThe mean age of the patients was 65.7 years, with 29% of them undergoing life-saving brain surgery. The mRS score at discharge was 0, 1, 2, 3, 4, 5, and 6 (indicating death) in 0, 1, 13, 9, 26, 20, and 31 cases, respectively. Among the 69 surviving patients, the median FIM score at discharge was 37 (19–81), with 14 patients having an FIM score of 18 (i.e., complete dependence). Patients who underwent life-saving brain surgery showed a higher median mRS score [5, interquartile range (IQR) 5–6] and a lower FIM score (18, IQR 18–22) at discharge compared with those who did not undergo the surgery. Patients discharged with mRS and FIM scores of 5 and 18, respectively, had the same functional status at 90 days. The Functional Outcome in Patients With Primary Intracerebral Hemorrhage (FUNC) score and intraventricular extension at admission were predictive of a mRS score ≥ 5 (area under the receiver operating characteristic curve = 0.92, p < 0.0001) and FIM score at discharge (adjusted R2 = 0.3, p = 0.0003).ConclusionIn our single-center study, more than 14% of patients on hemodialysis with cerebral hemorrhage incurred severe, irreversible neurological and functional impairments, necessitating discussions on hemodialysis withdrawal. Moreover, FUNC score and intraventricular extension at admission were highly accurate predictors of functional prognosis.

Current management of acute Stanford type A aortic dissection complicated with mesenteric malperfusion

The management of acute type A aortic dissection (aTAAD) with mesenteric malperfusion (MMP) is quite challenging as it is often associated with high mortality and poor outcomes, and an optimal treatment strategy is lack of consensus for this critically ill condition. Emergent open surgical repair of the ascending aorta is a life-saving operation and remains the standard of care for aTAAD with MMP, but is associated with a high rate of mortality. In recent years, reperfusion of superior mesenteric artery (SMA) by endovascular repair as the first treatment strategy in the treatment of aTAAD with MMP has been concerned and reported. Only endovascular repair and conservative medical treatment are also introduced in few cases with poor outcomes. There are many urgent issues that need to be addressed in current strategies. The optimal management strategies remain controversial, and further investigation and research are needed. These issues were addressed in this article.

Allergic contact dermatitis due to 1,6-hexanediol diacrylate in ostomy patients.

Many people live with ostomies after life-saving surgery. Ostomy patients often suffer from peristomal dermatitis. Allergic contact dermatitis (ACD) has been reported, mostly due to contact allergy (CA) to topical agents. We present three patients with therapy resistant peristomal dermatitis, suggesting ACD caused by different stoma products. Patch testing was performed with baseline series, additional series, and selected allergens. They were also tested with their own ostomy products as is and separate extracts of the products. Extracts were analysed using Gas Chromatography-Mass Spectrometry (GC-MS). In all three patients we diagnosed CA to 1,6-hexanediol diacrylate (HDDA), +++ in case (C) 1 and 3, ++ in C 2. HDDA was detected in C 2's ostomy pouch adhesive and in C 1's and 3's flange extenders used to improve the adhesion of the ostomy pouches. Therapy resistant peristomal dermatitis should always be suspected of ACD and patch testing, especially with the patient's own products, should be performed.

Role of Complement-dependent Cytotoxicity Crossmatch and HLA Typing in Solid Organ Transplant.

Solid organ transplantation is a life-saving medical operation that has progressed greatly because of developments in diagnostic tools and histocompatibility tests. Crossmatching for complement-dependent cytotoxicity (CDC) and human leukocyte antigen (HLA) typing are two important methods for checking graft compatibility and reducing the risk of graft rejection. HLA typing and CDC crossmatching are critical in kidney, heart, lung, liver, pancreas, intestine, and multi-organ transplantation. A systematic literature search was conducted on the internet, using PubMed, Scopus, and Google Scholar databases, to identify peer-reviewed publications about solid organ transplants, HLA typing, and CDC crossmatching. Recent advances in HLA typing have allowed for high-resolution evaluation, epitope matching, and personalized therapy methods. Genomic profiling, next-generation sequencing, and artificial intelligence have improved HLA typing precision, resulting in better patient outcomes. Artificial intelligence (AI) driven virtual crossmatching and predictive algorithms have eliminated the requirement for physical crossmatching in the context of CDC crossmatching, boosting organ allocation and transplant efficiency. This review elaborates on the importance of HLA typing and CDC crossmatching in solid organ transplantation.

Survival Prediction of Children after Bone Marrow Transplant Using Machine Learning Algorithms

Bone marrow is the source of many blood-related diseases, such as blood cancers, and Bone Marrow Transplantation (BMT), also known as Hematopoietic Stem Cell Transplantation (HSCT), is a life-saving surgical procedure. However, this treatment is associated with a high risk of mortality. Predicting survival after BMT is therefore essential for effective and accurate treatment. BMT is considered a treatment-related mortality due to several primary causes of death such as infections, toxicity, and Graft-versus-Host Disease (GvHD) that occur after treatment. In addition, several risk factors affect the success of BMT and long-term survival after treatment. Therefore, there is a need for a prediction system based on machine learning techniques that can predict whether the patient will survive after BMT or not, which will definitely help the physicians to make the right decisions before performing the surgery for the patient. In this paper, using a publicly available BMT dataset from the University of California, Irvine ML repository (UCI ML repository), different machine learning models were investigated to predict the survival status of children undergoing BMT treatment. In particular, Random Forest (RF), Bagging Classifier, Extreme Gradient Boost (XGBoost), Adaptive Boosting (AdaBoost), Decision Tree (DT), Gradient Boost (GB), and K-Nearest Neighbors (KNN) were trained on the given dataset. The dataset consists of 45 variables after applying a series of preprocessing steps and removing the multicollinearity features based on the correlation heat map. Then, a feature engineering and modelling step was applied to identify the most significant features, followed by the use of machine learning models to simplify the overall classification process. It’s important to note that the most important features obtained by DT and those obtained by GB were the most suitable for training the Bagging classifier and the KNN model, respectively. In addition to that, hyper-parameters optimization using Grid Search Cross-Validation (GSCV) was applied to both approaches to improve the accuracy of the survival prediction. RF, AdaBoost, GB, and Bagging techniques have achieved the best accuracy of 97.37%

Moral Injury Among Transplant Providers: Evaluating the Effects of Training in End-of-Life Counseling.

Ethical issues are pervasive in healthcare, but few specialties rival the moral complexity of transplant medicine. Transplant providers must regularly inform patients that they are no longer eligible to receive a potentially life-saving operation and the stress of these conversations poses a high risk of moral injury. Training in end-of-life counseling (EOLC) has proven to significantly reduce provider stress and burnout. The purpose of this study was to determine whether training in EOLC reduces levels of moral injury among transplant providers. This was a mixed methods study. We interviewed 10 patient participants and administered a survey to staff in the solid organ transplant department at the University of Kansas Health System. Respondents indicated whether they had received training in EOLC and completed the standardized Moral Injury Symptom Scale-Healthcare Professionals version (MISS-HP). A two-sample, one-sided t-test compared levels of moral injury between trained and untrained staff. Subsequently, we conducted semi-structured interviews with transplant providers, then performed inductive coding followed by thematic network analysis. Thirty-seven percent (14/38) of respondents reported a moral injury score at or above the threshold for psychosocial dysfunction associated with moral injury. Analysis revealed no difference in moral injury scores between the trained and untrained groups (p = 0.362, power (1-β) = 0.842). Thematic network analysis demonstrated high-level themes of "challenges", "training", and "stress relief". Our study demonstrated a concerning prevalence of moral injury among transplant staff and suggested that EOLC training did not significantly mitigate the threat of moral injury.

An Emergency and Challenging Life-Saving Surgery in a Newborn with Imperforate Anus in a Remote Village in South Sudan – A Case Report

Anorectal malformation, a congenital defect is usually detected at birth and managed by a multispeciality team in a tertiary care hospital. We present a case of a five day old neonate, born in a remote village in South Sudan, who presented in a critical condition to our field hospital and was managed with basic resources. A 5 day old neonate was detected with imperforate anus and presented to our hospital on day 5 with abdominal distension, severe dehydration, tachycardia and tachypnoea. Radiographic investigations revealed findings suggestive of a high ano-rectal malformation. The neonate underwent an emergency exploratory Laparotomy with diversion double barrel Colostomy in a set up catering for adult combatants. The neonate gradually improved before developing burst abdomen managed with emergency wound closure. The neonate gradually accepted breast feeds and was discharged for subsequent need for definitive surgery. This was a challenging surgery with respect to the resources available at a field hospital catering to adult combatants.

A Study to Assess the Knowledge and Practice Regarding Cardiopulmonary Resuscitation Among Nursing Students of Agra, Uttarpradesh

Background: Cardiopulmonary resuscitation (CPR) is a life-saving operation performed in an emergency when the heart stops beating. Immediate CPR following a cardiac arrest can double or triple the odds of survival. The American Heart Association welcomes you to join us in our vision of a future without cardiac arrest. In the United States, 350,000 individuals die from cardiac arrest each year. CPR keeps the blood pumping and the body supplied with oxygen until specialized treatment is available. There is normally enough oxygen left in the blood to support the brain and other organs for a few minutes. Objective: To assess the knowledge and practice regarding cardiopulmonary resuscitation among diploma nursing students. Methods: Descriptive research design was used. This study included 60 students. Knowledge and practice checklist was used to assess the knowledge and practice and chi-square test used to see the association between dependent and independent variables. Result: In this study, level of knowledge regarding cardiopulmonary resuscitation pretest level poor knowledge 23(38.3%), poor knowledge 19(31.7%) and good knowledge 18(30%) . level of skills regarding cardiopulmonary resuscitation pretest level skills 60(100%) poor skills 0(0.0%) good skills. Age, Gender, religion, Course of study, Family history of cardiac disease, Aware about cardio pulmonary resuscitation, source of information regarding cardio pulmonary resuscitation, Classes on cardio pulmonary resuscitation within the last 6 months had shown no statistically significant association with the pretest levels of skills regarding cardio pulmonary resuscitation among students. Conclusion: Despite the fact that more than half of students had good knowledge, so students required proper skill development about cardio pulmonary resuscitation.

Emergency Peripartum Hysterectomy and its Outcome in a Tertiary Care Hospital in Dhaka City, Bangladesh

Introduction: Emergency peripartum hysterectomy (EPH) is a life-saving surgical procedure performed when medical and surgical conservative measures fail to control postpartum hemorrhage. EPH is a challanging but life saving obstetric procedure performed when medical and surgical conservative measures fail to control postpartum haemorrhage .The present study aimed to review the peripartum hysterectomies and to compare the incidence, indications and outcome of EPH. Materials and Methods: This retrospective study was conducted at a tertiary care hospital in Dhaka, Bangladesh. Total 62 cases have taken, who had hysterectomy that was performed in Obstetric and gynaecology department of Addin Womens Medical College Hospital during the period between January 2020 and December 2022. Result: There were total of 36371 deliveries over the study period and EPH was performed in 62 cases making an incidence of 0.408. In this study 33.8% patients were between 35 to 39 years. Here 45.16% had their parity between 2nd and 3rd child. Here 61.2% had previous history of caesarean section, 24.19% had previous history of antepartum haemorrhage, 74.19% cases intrapartum operation had done. Among 62 cases of EPH 77.4% cases subtotal hysterectomy had done. Here, among 62 cases of caesarean section 35.48% had placenta accrete and 20.96% had history of placenta previa with haemorrhage and 12.9% had severe PPH due to atony of uterus. 22.5% cases had fetal outcome of still born but 32.25% baby born alive. In this study 51.6% cases patients develop haemorrhage as perioperative complication, 19.5% develop shock but 100% required blood transfusion among which 50% were in post operative period. Here 6 out of 62 cases had bladder injury, 5 patients needed relaparotomy due to haemoperitoneum caused by vaginal cuff bleeding. Mortality rate was 4.83%. Conclusion: Now a days the indication of EPH has changed from uterine atony to abnormal placentation. It is a most important obstetric surgery performed in life threatening haemorrhage. Involvement of an experienced obstetrician at an early stage of management and efforts should be taken to reduce morbidity and mortality. Sir Salimullah Med Coll J 2023; 31: 107-111