Virtually every country in the world has been affected by COVID-19. Nepal a landlocked country located in Southern Asia. Nepal's population has suffered greatly due to a shortage of critical care facilities, resources, and trained personnel.For appropriate care, patients need access to hospitals in the centrally-located capital city of Kathmandu.Unfortunately, Nepal's resources and personnel dedicated to transferring COVID-19 patients are scarce. Road and traffic infrastructure problems and mountainous terrain prevent ground ambulances from performing effectively.This, in addition to Nepal lacking national standards for prehospital care, create great challenges for transferring patients via ground EMS. Concept of Helicopter Emergency Medical Services (HEMS) began in 2013 in Nepal. By now three hospitals, Mediciti, HAMS, and Grande coordinated with private helicopter companies run proper HEMS.One entity, Simrik Air, has dedicated two Airbus H125/AS350 helicopters for the sole purpose of transferring COVID-19 patients. HEMS effectiveness is expanding in Nepal, but much remains to be accomplished.
Objective of the study: To know the efficacy of transvaginal mesh repair augmented by synthetic polypropylene mesh for pelvic organ prolapse with objective and subjective result of the procedure. Material and methods: Evidence was gathered mostly about transvaginal synthetic polypropylene mesh using the search terms Transvaginal mesh, urinary incontinence, Mesh-complication, anterior prolapse, posterior prolapse, pelvic organ prolapse, vault prolapse, and mesh erosion-From April 2008 to March 2013. Online search range: Pub Med, Medline, RCT, Embase, database, Retrospective study and prospective study. Result: In vaginal Prolapse surgery, graft or mesh is used more frequently than traditional repairs, which has high failure rates. Vaginal approach of mesh placement and suspension of the upper part of the vagina is seen to be more appropriate and successful, showing effects similar to that of the invasive abdominal approach. Because of its lower failure rates it is recently supported by Cochrane review as well. To make such kinds of surgeries easier, more standard and least invasive vaginal kits are being upgraded. It is said that every surgeon can perform the procedure with mesh kits easily, but it is not so. It needs advance pelvic surgery skills, a lot to understand and the limitations of the technique as well. This current paper focuses the needs for the development of the kit, how to use it, results and complications till date and the techniques how to overcome the complications. Before recommending the technique for general use in all Prolapse patients, a lot of things like investigation on proper patient selection, continue research on graft composition, techniques that minimize complications of needle passes or mesh placement should be understood thoroughly. Apart from these we still should have more surgical skills to perform the procedures, to reduce complications and increase better results. Conclusion: Transvaginal repair using a synthetic polypropylene transvaginal mesh is a feasible and efficient procedure for the treatment of pelvic organ prolapse with less significant complications. Monofilament macro porous synthetic polypropylene mesh is effective, due to its low risk of infection and foreign body reaction. Proper patient selection is the best way to avoid unnecessary complications.
Introduction Non-cardiogenic pulmonary edema is the hallmark of the acute respiratory distress syndrome (ARDS). The amount of fluid and which fluid should be used in these patients is controversial. Methods 43 patients with ARDS treated in the intensive care unit (ICU) of the Second Hospital, Jilin University between November 1, 2011-November 1, 2012 were prospectively analyzed and was observational. Volume and the type of fluid administered were compared to 90 day mortality and the 24 and 72 hour sequential organ failure assessment (SOFA) score, lactate level, oxygenation index (PaO2/FiO2), duration of ICU stay, total ventilator days, and need for continuous renal replacement therapy (CRRT). Results Mortality was increased when hydroxylethyl starch (HES) was used in the first day or plasma substitutes were used during the first 3 days (P<0.05, both comparisons). Volumes of fluid >3000 ml during the first 24 hours or >8000 ml during the first 72 hours were associated with higher SOFA scores at 24 and 72 hours (P<0.05, both comparisons). Colloid, especially higher volume colloid use was also associated with increased SOFA scores at either 24 or 72 hours. Conclusions
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