Virilization and abdominal mass in a newborn female: A case report

We describe virilization in a newborn female secondary to bilateral congenital juvenile granulosa cell tumor (JGCT). The patient presented with abdominal mass and ambiguous genitalia at birth, and bilateral ovarian masses were discovered on further imaging. The patient underwent bilateral salpingo-oophorectomy in staged procedures, as it became apparent that we could not spare the ovaries. Diagnosis of JGCT was confirmed by surgical pathology. She required no adjuvant therapy and has no signs of recurrence at two-year follow-up

Industry and Extension Partnership to Enhance STEM and Agricultural Education

STEM education has become essential in the United States, and agriculture allows for a great opportunity to teach STEM education in a fun, hands-on manner. The Virginia Southern Piedmont Agriculture Research and Extension Center (SPAREC), in partnership with King Arthur Flour, has created a program that reinforces what is taught in the classroom while also adding in new lessons in citizenship. This program has been very successful and serves as an excellent model for future partnerships between industry and Extension

La atención y la satisfacción del cliente en la discoteca Magno, en la ciudad de Chiclayo, 2016

Hoy en día las empresas de entretenimiento que quieran mejorar su rentabilidad y crecer cada día más y ser mejores que sus competidores, tienen que mejorar sus productos y servicios, ofrecer mayor calidad, en definitiva, satisfacer las necesidades del cliente, de este modo captarlos y mantenerlos, ya que es una oportunidad para crecer rápidamente a través del “boca a boca”. Es dentro de este contexto, que el objetivo de esta investigación fue conocer el nivel de satisfacción del cliente, en la Discoteca Magno S.A.C a través del método o modelo SERVPERF. El enfoque fue cuantitativo y la investigación fue tipo de descriptiva. La población estuvo conformada, por 6600 personas que asistieron los fines de semana (viernes y sábados) a la referida Discoteca. Este es el número de clientes mensuales, al aplicar la fórmula se obtuvo un total de 363 personas encuestadas. En este trabajo se utilizó como instrumento de recolección de datos, el cuestionario de ítem cerrado, basándose en las preguntas planteadas por el método SERVPERF, para su posterior análisis, se utilizaron los programas microsoft word, microsoft excel 2016 y IBM SPSS Statistics 25. Se comprobó que el nivel de satisfacción en la calidad de servicio al cliente, en la Discoteca Mango fue satisfactorio.Tesi

Echocardiographic Guidance During Neonatal and Pediatric Jugular Cannulation for ECMO

Background Internal jugular vein extracorporeal membrane oxygenation (ECMO) cannula position is traditionally confirmed via plain film. Misplaced cannulae can result in need for repositioning and increased morbidity. Echocardiography (ECHO) may be used during cannulation as a more accurate means of guiding cannula position. This study reviews the effect of a protocol encouraging the use of ECHO at cannulation. Methods and materials Single institution retrospective review of patients who received ECMO support using jugular venous cannulation. We compared those who underwent ECHO (ECHO+) at the time of cannulation with those who did not (ECHO−). Results Eighty-nine patients were included: 26 ECHO+, 63 ECHO−. Most ECHO+ patients underwent dual-lumen veno-venous (VV) cannulation (65%); 32% of ECHO− patients had VV support (P = 0.003). There was no difference in the rate of cannula repositioning between the two groups: 8% ECHO+ and 10% ECHO−, P = 0.78. In the VV ECMO subgroup, ECHO+ patients required no repositioning (0/17), while 20% (4/20) of ECHO− VV patients did (P = 0.10). After cannulation, there were 0.58 ECHO studies per patient to verify cannula position in the ECHO+ group compared with 0.22 in the ECHO− group (P = 0.02). Each group had a major mechanical complication: atrial perforation from a guidewire during cannulation in ECHO+ and late atrial perforation from a loose cannula in ECHO−, and there was no difference in minor complications. Conclusions ECHO guidance during neonatal and pediatric jugular cannulation for ECMO did not decrease morbidity or reduce the need for cannula repositioning. ECHO may still be a useful adjunct for precise placement of a dual-lumen VV cannula and during difficult cannulations

Fetal MRI in management of complicated meconium ileus: Prenatal and surgical imaging

Objective To review fetal MRI cases surgically proven to have meconium ileus (MI) and obstruction, describe the common fetal MRI findings that distinguish cases of complicated MI, and to compare these findings with surgical images and perinatal outcomes. Method We performed a retrospective review of all fetal MRI examinations and the corresponding medical record from our tertiary care children's hospital over an 18‐month period. Postnatal management and outcomes were reviewed for these patients, and those patients with surgical or postmortem diagnosis of complicated MI were included in the study. Results Our analysis revealed 7 cases. In this cohort, 3 imaging features of the fetal bowel were repeatedly seen: gradient appearance of intraluminal bowel contents, abnormally localized meconium signal, and collapsed appearance of the colon on MRI. Surgical diagnoses confirmed MI. All live‐born infants underwent surgical repair. Conclusion Fetal MRI should be included in the diagnostic algorithm of any pregnancy where fetal bowel obstruction is suspected to better risk stratify patients

Restenosis After Tack Implantation is Associated with Less Complex Patterns of Restenosis Compared to Stent Implantation

In-stent restenosis is complex, difficult to treat and has led to a ‘leave less metal behind’ approach to femoropopliteal intervention. Postangioplasty dissection often requires scaffolding to maintain patency. The Tack Endovascular System provides minimal-metal dissection repair that preserves future treatment options. Tack implants are designed to minimise the inflammation and neointimal hyperplasia that lead to in-stent restenosis. An independent angiographic core laboratory evaluated the restenosis patterns in clinically driven target lesion revascularisation (CD-TLR) during the 12 months following the index procedure in the Tack Optimized Balloon Angioplasty (TOBA) II study and compared these results to those published for nitinol stent implantation. Of the 213 patients in TOBA II, 31 (14.6%) required a CD-TLR. Of these, 28 had angiograms that were evaluated by the core laboratory, and 45.2%, 16.1%, and 29% were graded as Tosaka class I, II and III, respectively. There were no significant differences (p>0.05) in lesion length, degree of calcification or dissection class between the three groups. Tack restenotic lesion classification and analysis show a prevalence of both class I and shorter lesions relative to in-stent restenosis, which may be beneficial to long-term patient outcomes

The Strong Protective Effect of Circumcision against Cancer of the Penis

Male circumcision protects against cancer of the penis, the invasive form of which is a devastating disease confined almost exclusively to uncircumcised men. Major etiological factors are phimosis, balanitis, and high-risk types of human papillomavirus (HPV), which are more prevalent in the glans penis and coronal sulcus covered by the foreskin, as well as on the penile shaft, of uncircumcised men. Circumcised men clear HPV infections more quickly. Phimosis (a constricted foreskin opening impeding the passage of urine) is confined to uncircumcised men, in whom balanitis (affecting 10%) is more common than in circumcised men. Each is strongly associated with risk of penile cancer. These findings have led to calls for promotion of male circumcision, especially in infancy, to help reduce the global burden of penile cancer. Even more relevant globally is protection from cervical cancer, which is 10-times more common, being much higher in women with uncircumcised male partners. Male circumcision also provides indirect protection against various other infections in women, along with direct protection for men from a number of genital tract infections, including HIV. Given that adverse consequences of medical male circumcision, especially when performed in infancy, are rare, this simple prophylactic procedure should be promoted