Pregnancy in two patients of Glanzmann’s thrombasthenia: a rare case report

Glanzmann’s thrombasthenia (GT) is inherited platelet disorder with an autosomal recessive mode of inheritance. Though, quantitatively normal, the aggregation ability of platelets is reduced in this condition. Pregnancy and delivery are rare in these patients and have been associated with a high risk of severe postpartum hemorrhage. We describe two GT here 1st case was a primigravida, who was diagnosed to have GT 11 yrs back and was admitted as a term pregnancy which was terminated by elective caesarean section and was was successfully managed by platelet transfusion. 2nd case was a 24 year old lady got diagnosed as GT during the evaluation of frequent mucocutaneous bleed. Her antenatal management was like that of normal pregnancy. She was hospitalized 6 weeks prior to expected date of delivery. Elective LSCS (Lower Segment Caesarean Section) was done and was managed with 4 units of single donor platelet (SDP) without any other complication

Cosmic-ray soil water monitoring: the development, status & potential of the COSMOS-India network

Soil moisture (SM) plays a central role in the hydrological cycle and surface energy balance and represents an important control on a range of land surface processes. Knowledge of the spatial and temporal dynamics of SM is important for applications ranging from numerical weather and climate predictions, the calibration and validation of remotely sensed data products, as well as water resources, flood and drought forecasting, agronomy and predictions of greenhouse gas fluxes. Since 2015, the Centre for Ecology and Ecology has been working in partnership with several Indian Research Institutes to develop COSMOS-India, a new network of SM monitoring stations that employ cosmic-ray soil moisture sensors (CRS) to deliver high temporal frequency, near-real time observations of SM at field scale. CRS provide continuous observations of near-surface (top 0.1 to 0.2 m) soil volumetric water content (VWC; m3 m-3) that are representative of a large footprint area (approximately 200 m in radius). To date, seven COSMOS-India sites have been installed and are operational at a range of locations that are characterised by differences in climate, soil type and land management. In this presentation, the development, current status and future potential of the COSMOS-India network will be discussed. Key results from the COSMOS-India network will be presented and analysed

Contribution of changes in atmospheric circulation patterns to extreme temperature trends

Surface weather conditions are closely governed by the large-scale circulation of the atmosphere. Recent increases in the occurrence of some extreme weather phenomena have led to multiple mechanistic hypotheses linking changes in atmospheric circulation to increasing extreme event probability. However, observed evidence of long-term change in atmospheric circulation remains inconclusive. Here we identify statistically significant trends in the occurrence of mid-atmospheric circulation patterns, which partially explain observed trends in surface temperature extremes over seven mid-latitude regions of the Northern Hemisphere. Utilizing self-organizing map (SOM) cluster analysis, we detect robust pattern trends in a subset of these regions during both the satellite observation era (1979–2013) and the recent period of rapid Arctic sea ice decline (1990–2013). Particularly substantial influences include the contribution of increasing trends in anticyclonic circulations to summer/autumn hot extremes over portions of Eurasia and North America, and the contribution of increasing trends in northerly flow to winter cold extremes over central Asia. Our results indicate that although a substantial portion of the observed change in extreme temperature occurrence has resulted from regional- and global-scale thermodynamic changes, the risk of extreme temperatures over some regions has also been altered by recent changes in the frequency, persistence, and/or maximum duration of regional circulation patterns

Dexmedetomidine versus ketamine infusion to alleviate propofol injection pain

Introduction: Propofol a widely used anesthetic agent administered for induction and maintenance of anesthesia, post operative and ICU sedation and anticonvulsant agent. Pain on injection is a common complain during propofol administration. Many drugs like local anesthetic, opiates, esmolol, clonidine, ketamine have been tried to alleviate propofol injection pain. Here we have compared the effect of dexmedetomidine and ketamine in alleviating propofol injection pain. Materials and methods: 108 patients of either sexes, in the age groups 20-50 years, posted for routine surgical procedure under general anaesthesia were included in the study. The cases were randomly divided into 2 groups of 54 each. Group-D:-Patients received dexmedetomidine 0.5µg/kg in 20 ml Normal saline at a rate of 120 ml / hr Infused over 10 min. Group-K:- Patient received ketamine 0.5mg/kg in  20ml Normal saline at a rate of 120ml/hr infused over 10 mins. Immediately after infusion, 1% propofol in a dose of 2mg/kg IV was given over 20 seconds. Starting from the time of injection, the patients were assessed for pain by asking an open ended question, “Does it Hurts” in every 5 seconds until the patient become unresponsive. Degree of pain score was advocated by “McCririck and Hunter Scale

Effects of fentanyl and dexmedetomidine as adjuvants to bupivacaine in paravertebral block for postoperative analgesia in patients undergoing modified radical mastectomy: A prospective randomised double-blind study

Background and Aims: Paravertebral block (PVB) is an established method, indicated for postoperative analgesia after modified radical mastectomy (MRM). Although many additives to bupivacaine in PVB have been tried to prolong the analgesia in postoperative period, no additive has been found without any adverse effects. We have compared the duration of analgesia in PVB using adjuvants like dexmedetomidine and fentanyl with bupivacaine after MRM. Methods: A total of 60 female patients enroled for MRM were divided into two groups of 30 patients each. Group BF received PVB with 20 ml bupivacaine 0.25% with fentanyl 1 μg/kg and group BD received 20 ml bupivacaine 0.25% with dexmedetomidine 1 μg/kg for PVB. After confirming successful PVB, surgery was done under general anaesthesia. Time for first rescue analgesic request was the primary outcome of the study. The secondary outcome was comparison of visual analogue scale scores for pain and total analgesic consumption. Side effects like sedation, nausea, vomiting, bradycardia and hypotension in the postoperative period till 24 h were also assessed. Results: The time for first rescue analgesic request was 6.32 ± 1.75 h in the BD group contrary to 3.94 ± 2.12 h in group BF (P < 0.05). Total paracetamol consumed as rescue analgesia in the first 24 h of postoperative period was remarkably reduced in group BD (1.7 ± 0.94 gm) in contrary to group BF (2.6 ± 0.98 gm) (P < 0.05). There was no significant difference in the incidence of complications between the groups. Conclusion: Dexmedetomidine provides prolonged postoperative analgesia compared with fentanyl when used as an adjuvant to bupivacaine in PVB after MRM

Climate change is narrowing and shifting prescribed fire windows in western United States.

Escalating wildfire activity in the western United States has accelerated adverse societal impacts. Observed increases in wildfire severity and impacts to communities have diverse anthropogenic causes-including the legacy of fire suppression policies, increased development in high-risk zones, and aridification by a warming climate. However, the intentional use of fire as a vegetation management tool, known as prescribed fire, can reduce the risk of destructive fires and restore ecosystem resilience. Prescribed fire implementation is subject to multiple constraints, including the number of days characterized by weather and vegetation conditions conducive to achieving desired outcomes. Here, we quantify observed and projected trends in the frequency and seasonality of western United States prescribed fire days. We find that while ~2 C of global warming by 2060 will reduce such days overall (-17%), particularly during spring (-25%) and summer (-31%), winter (+4%) may increasingly emerge as a comparatively favorable window for prescribed fire especially in northern states

Increasing co-occurrence of fine particulate matter and ground-level ozone extremes in the western United States

Wildfires and meteorological conditions influence the co-occurrence of multiple harmful air pollutants including fine particulate matter (PM2.5) and ground-level ozone. We examine the spatiotemporal characteristics of PM2.5/ozone co-occurrences and associated population exposure in the western United States (US). The frequency, spatial extent, and temporal persistence of extreme PM2.5/ozone co-occurrences have increased significantly between 2001 and 2020, increasing annual population exposure to multiple harmful air pollutants by ~25 million person-days/year. Using a clustering methodology to characterize daily weather patterns, we identify significant increases in atmospheric ridging patterns conducive to widespread PM2.5/ozone co-occurrences and population exposure. We further link the spatial extent of co-occurrence to the extent of extreme heat and wildfires. Our results suggest an increasing potential for co-occurring air pollution episodes in the western US with continued climate change

A clinical comparison between 0.5% levobupivacaine and 0.5% levobupivacaine with dexamethasone 8 mg combination in brachial plexus block by the supraclavicular approach

Background and Aims: Dexamethasone as an adjuvant to bupivacaine for supraclavicular brachial plexus (SCBP) block prolongs motor and sensory blockade. However, the effect of dexamethasone (8 mg) when added to levobupivacaine has not been well studied. This study was conducted to find out analgesic efficacy of dexamethasone as adjuvant to levobupivacaine in SCBP block. Methods: Ultrasound- guided SCBP block was given to sixty patients, randomly assigned into two groups. Group S (thirty patients) received 2 mL normal saline with 25 mL levobupivacaine (0.5%) and Group D (thirty patients) received 2 mL of dexamethasone (8 mg) with 25 mL of levobupivacaine (0.5%), respectively. Time for the first rescue analgesia, number of rescue analgesics required in 24 h and different block characteristics was assessed. Chi-square test and Student's t-test were used for statistical analysis. Results: Time for request of the first rescue analgesia was 396.13 ± 109.42 min in Group S and 705.80 ± 121.46 min in Group D (P < 0.001). The requirement for rescue analgesics was more in Group S when compared to Group D. The onset of sensory and motor block was faster in Group D when compared to Group S. The mean duration of sensory and motor block was significantly longer in Group D than Group S. Conclusion: The addition of dexamethasone to levobupivacaine in SCBP blockade prolonged time for first rescue analgesia and reduced the requirement of rescue analgesics with faster onset and prolonged duration of sensory and motor block

Recent amplification of the North American winter temperature dipole

During the winters of 2013-2014 and 2014-2015, anomalously warm temperatures in western North America and anomalously cool temperatures in eastern North America resulted in substantial human and environmental impacts. Motivated by the impacts of these concurrent temperature extremes and the intrinsic atmospheric linkage between weather conditions in the western and eastern United States, we investigate the occurrence of concurrent "warm-West/cool-East" surface temperature anomalies, which we call the "North American winter temperature dipole." We find that, historically, warm-West/cool-East dipole conditions have been associated with anomalous mid-tropospheric ridging over western North America and downstream troughing over eastern North America. We also find that the occurrence and severity of warm-West/cool-East events have increased significantly between 1980 and 2015, driven largely by an increase in the frequency with which high-amplitude "ridge-trough" wave patterns result in simultaneous severe temperature conditions in both the West and East. Using a large single-model ensemble of climate simulations, we show that the observed positive trend in the warm-West/cool-East events is attributable to historical anthropogenic emissions including greenhouse gases, but that the co-occurrence of extreme western warmth and eastern cold will likely decrease in the future as winter temperatures warm dramatically across the continent, thereby reducing the occurrence of severely cold conditions in the East. Although our analysis is focused on one particular region, our analysis framework is generally transferable to the physical conditions shaping different types of extreme events around the globe

Remote Linkages to Anomalous Winter Atmospheric Ridging over the Northeastern Pacific

Severe drought in California between 2013 and 2016 has been linked to the multiyear persistence of anomalously high atmospheric pressure over the northeastern Pacific Ocean, which deflected the Pacific storm track northward and suppressed regional precipitation during California's winter 'rainy season.' Multiple hypotheses have emerged regarding why this high pressure ridge near the west coast of North America was so resilient-including unusual sea surface temperature patterns in the Pacific Ocean, reductions in Arctic sea ice, random atmospheric variability, or some combination thereof. Here we explore relationships between previously documented atmospheric conditions over the North Pacific and several potential remote oceanic and cryospheric influences using both observational data and a large ensemble of climate model simulations. Our results suggest that persistent wintertime atmospheric ridging similar to that implicated in California's 2013-2016 drought can at least partially be linked to unusual Pacific sea surface temperatures, and that Pacific Ocean conditions may offer some degree of cool-season foresight in this region despite the presence of substantial internal variability