Anesthesia Implications of Pediatric Obesity

Title: Anesthesia implications of pediatric obesity Background: Pediatric obesity is becoming an epidemic nationally and internationally. It poses several challenges to anesthesia providers because of the comorbidities associated with it. Anesthesia challenges posed by a 3-year-old obese patient led this author to do an independent study on pediatric obesity and anesthesia management. Purpose: The purpose of this independent study is to review the current literature, epidemiology, comorbidities and practice recommendation regarding the anesthetic management of pediatric obese patients. Process: A comprehensive literature review was conducted utilizing the University of North Dakota\u27s Harley. E. French library web~i.te. Current literatures was searched using the key words \u27pediatric anesthesia\u27 and \u27obesity\u27. Search engines such as PubMed, ClinicalKey and CINAHL were used. Journals were extensively reviewed for relevant inforn1ation. Results: The findings presented in the study are based on the published literatures in the year range of2005-2012. This paper will evaluate what the literature states about the prevalence and the pathophysiology of childhood obesity and provides suggestions on pre-anesthetic evaluation, airway management, dosage of anesthetic drugs, and postoperative care. Implications: Perioperative respiratory events seem more frequent in overweight and obese children. So anesthetist should anticipate and be prepared to optimize the anesthetic management of this high-risk population. Increasing number of pediatric obese surgical population demands more researches in areas of pharmacology, preoperative and intraoperative management. Kcywords :yediatric, obesity, anesthesia, management Childhood obesity is increasing substantially in industrialized nations, which poses multiple medical and social issues. Worldwide obesity has more than doubled since 1980, and approximately 43 million children under the age of five were overweight in 2010 (Owen & John, 2012). According to statistics, in United States the incidence of obesity in 6-11 year-olds increased by 54 % in the last tlu·ee decades and approximately one third of patients presenting to pediatric day surgery units are overweight or obese (Middlebrooks & Winters, 2011). Obesity is a systemic disease process that alters the physical and mental health of the pediatric patient. Because of comorbidities associated with obesity, the intra-operative and post-operative course is challenging to anesthesia care providers. Respiratory complications, airway management difficulties, prolonged post anesthesia care unit (P ACU) stays and postoperative nausea and vomiting (PONY) are more common with an elevated body mass index (BMI). Because of these consequent challenges, obese pediatric population demands more plaiming, consultations, management and time

Is Cryoanalgesia an Effective Supplemental Method of Post-Thoracotomy Pain Management?

Objective: The objective of this EBM review is to determine if cryoanalgesia is an effective addition to pain management protocols for patients post-thoracotomy. Study Design: This EBM review examines three randomized controlled trials. Data Sources: Data was gathered from the three studies found on PubMed and EBSCOhost. Each study was published in a peer reviewed journal, in English between 2010 and 2021. Outcome Measured: The outcome measured was pain reported by patients using a visual analag scale (VAS). Two studies utilized a 0-10 scale and the third a 0-100mm scale. Results: In the study by Sepsas et al. it was found that the difference in pain scores between groups was 2.1 on day 1 and 1.1 on day 7, with scores being higher in the control group both days. Both comparisons had a p-value \u3c 0.0001. In the study led by Momenzadeh et al., it was found that the control group had pain scores approximately 1.2 points higher on VAS on both days 1 and 7. P-value was \u3c0.0001 for both data sets. The third study, by Mustola et al., was found to be insignificant with the difference between groups being 0.1 on day and 3.6 on day 7. The scale used in this study was 0-100mm and the p-values for day 1 and 7 were 0.732 and 0.328 respectively. Conclusions: This EBM reviewed showed that while some studies found significant improvement in pain, evidence is conflicting. As such further, more broad investigation is warranted

Branched Chain Amino Acids: Causal or Predictive of Type 2 Diabetes

Branched Chain Amino Acids (BCAA) have been associated with insulin resistance and type 2 diabetes. However, there is not concrete understanding on whether BCAA is playing a causal factor or a predictive factor for type 2 diabetes. The aim of this review is to understand how Branched Chain Amino Acids act as a predictive biomarker of type 2 diabetes (T2D) or causal factor in insulin resistance. Two mechanisms have been proposed, but not enough studies have been done to prove which is true. There is still a lot of unknowns in BCAA mechanisms and how it affects metabolic disorders. Future study recommendations have been made to further understand BCAA pertaining to T2D and other metabolic disorders. After reviewing current studies, there is not enough evidence to confirm whether BCAAs are causative or predictive of T2D

Early oncological outcomes and accuracy of risk stratification and tailoring surgical staging based on preoperative histology, Ca125 and MRI in endometrial cancer: a prospective cohort study

Background: momentum to select patients who will benefit from the extensive procedures. However, the parameters used for risk stratification have variable accuracy outside of tertiary cancer centres. This study looks into the accuracy of risk stratification using preoperative histology, MRI and Ca 125 levels and the oncological outcomes after tailoring surgical staging based on the risk stratification by combining the three variables in a suburban centre with a growing cancer population.Methods: This prospective observational cohort study was undertaken in a suburban cancer center in Pushpagiri Medical College, Tiruvalla, Kerala between June 2014 and December 2018. All patients underwent surgical staging with hysterectomy and salpingo oophorectomy as the least procedure. Lymphadenectomy was tailored according to the preoperative risk grouping and changed only in the presence of gross findings at surgery. Adjuvant treatment and follow up data obtained and collected in Microsoft Excel and analysed using statistical software SPSS version 22.Results: Of 47 patients recruited for the study, 35 patients were available for final analysis. Preoperative histology was accurate in 73%. There was 20 % overestimation and 8% underestimation. Ca 125 levels were elevated in 15%.  MRI had an overall sensitivity of 74% and specificity of 60%. When MRI, Ca125 and histology were combined together, there was patients were deemed to be high risk. On final risk grouping, 9 patients were down staged and none were upstaged.Conclusions: Preoperative histology, MRI and ca 125 levels have moderate accuracy individually as preoperative risk determinates. The three parameters combined together show high specificity and PPV for preoperative risk stratification and the risk stratification has not been detrimental with respect to oncological outcomes of recurrence

Food Bloggers and Their Perceptions of Digital Preservation

This study explored the perceptions of food bloggers on digital preservation of their blogs through an anonymous, web-based survey. It also examined if the blog format changes authenticity. Survey questions asked for data on blogging behavior, technology and preservation and deletion, editing and loss. The survey was shared through Facebook pages and groups, discussion boards and forums, Twitter and Tumblr. This study looked at how bloggers view their blogs long-term. The study assessed if bloggers view their content as possessing enduring value. Furthermore, it ascertained if the participants have taken steps to preserve their blogs. The majority of the respondents were reasonably confident in their technical skills for blog maintenance. Despite this, half were not using any strategy to save their blog. Respondents questioned the enduring value of their blogs. Some sub-group differences found between hobby bloggers and for profit bloggers. In addition, issues of authenticity were not conclusively determined.Master of Science in Library Scienc

Implementación de una PMO en una empresa de tecnología: un análisis comparativo de metodologías de proyectos

En este artículo se analizan tres modelos de administración de proyectos que han sido exitosos en su implantación particular en proyectos de Tecnologías de Información y Comunicación (TIC) 1. De manera puntual, se revisaron las implicaciones de las visiones que contemplan tres metodologías de Gerencia de Proyectos (GP) y se presenta una comparación de sus características, identificando como contribuyen al desempeño de una Oficina de Administración de Proyectos (Project Management Office, PMO) en una empresa de outsourcing de servicios de tecnología, con el fin de establecer cuál es la más apropiada y finalmente resumir que su fusión es optima para generar valor como proveedor de servicios de tecnología y comunicaciones.This article analyzes three Project Management models that have been successful in their particular execution on ICT projects. Particularly, the authors make an implication assessment of the three methodologies and present a comparison of their characteristics, looking forward to identify how they contribute to the performance of a Project Management Office (PMO), in the context of a technology services outsourcing company. All of this, to realize which method is the best, and then conclude that their mix is an optimal alternative to create value as a provider of technology services and communications

Towards developing effective decontamination procedures for in vitro culture of embryonic axes excised from recalcitrant seeds.

Thesis (M.Sc.)-University of KwaZulu-Natal, Durban, 2013.Control of seed-associated micro-organisms is vital in reducing losses of plants of economic importance. Recalcitrant seeds being metabolically active and able to be stored only under conditions of high relative humidity makes it more difficult to control contaminants. Nevertheless, means need to be developed to eliminate, or at least curtail, seed-associated fungi and bacteria. The use of biological control is a highly recommended alternative to chemical control for reducing the risk of killing beneficial organisms, as well as in terms of health and environmental hazards. Furthermore, when working with seed-derived tissues, it is extremely important to optimise a method or methods to control contamination without compromising the viability or further development of the explants. The original aim of the present study was to determine whether the biocontrol agents, EcoT® and Eco77® (commercial products of the spores of Trichoderma harzianum) would effectively control/eliminate micro-organisms from the embryonic axes of Trichilia dregeana, while promoting growth under in vitro conditions. Other means were also tested for their efficacy in controlling contaminants; these were application of Benlate®, Nipastat® (a mixture of parabens), anodic water (the anodic fraction of an electrolysed dilute solution of calcium and magnesium chloride), sodium dichloro-isocyanurate (Medi-Chlor®[NaDCC]) and alginate gel encapsulation of the embryonic axes. Prior to the experiments, fungal contaminants from the embryonic axes were isolated on potato dextrose medium and identified using light microscopy. EcoT and Eco77 were initially individually tested by co-culture as conidial suspensions with the embryonic axes. A further approach used liquid culture (potato dextrose broth) as well as solid culture medium (based on sugarcane bagasse) in/on which the strains of Trichoderma harzianum had been grown. This was aimed at testing for the possible presence of compounds released by T. harzianum into the media, which might prove to be effective in curtailing/eliminating the axis-associated microflora. Among the different treatments tested, the best method was utilised to decontaminate the embryonic axes prior to minimal-growth storage (hydrated axes encapsulated in alginate gel ‘beads’). Penicillium spp. were predominant among the different fungi isolated, which included Fusarium spp., Rhizopus spp., Aspergillus niger and Aspergillus flavus. Co-culturing with T. harzianum for 24 h was successful in terms of the survival of the embryonic axes, although the roots produced were shorter than when axes were cultured alone, but had no effect in eliminating the contaminants. Longer periods of co-culturing with T. harzianum affected the germination of the embryonic axes of T. dregeana compared with axes germinated in the absence of the biocontrol agent (control). The culture filtrate negatively affected germination of the T. dregeana embryonic axes, although it was effective against the associated contaminants. Nipastat was effective in reducing the contamination, and, depending on the concentration, did not affect germination adversely. Medi-Chlor was highly effective in eliminating all the contaminants from axes in vitro. Both these treatments were therefore used to decontaminate axes before minimal-growth storage. All the NaDCC-treated, encapsulated axes examined after 14 d hydrated storage [in Magenta boxes] and after 14-42 d in polythene bags survived; however the axes stored in aluminium foil-lined bags and Eppendorf tubes soon lost viability. The recommendation is therefore made that the decontamination treatment based on use of NaDCC (or other preparations of sodium dichloro-isocyanurate) be tested on embryonic axes of a range of recalcitrant-seeded species, and, if successful, the procedure be introduced into cryopreservation protocols. The use of NaDCC has emerged as a promising method of eliminating contaminating microflora which otherwise compromise in vitro procedures, from seed-derived explants. Furthermore, containment of decontaminated encapsulated axes in sealed polythene bags offers an apparently ideal means of temporary storage and dissemination. The results should find considerable applicability when excised embryonic axes representing the germplasm of recalcitrant seeds, are cryoconserved

CO2 sequestration: microalgae genome analysis and its application of effective green source technology

Microalgae genome technology for CO2 sequestration is an appropriate vehicle for articulating the importance of the current need and solution for reduction of CO2 at the atmospheric level. In comparison with C4 plants, microalgae have greater capability to fix atmospheric CO2.The rate of CO2 fixation differs in different strains of microalgae. The photosynthetic enzyme RuBisCO is widely responsible for photosynthetic carbon assimilation in all plants including phototrophic algae.The gene rbcL encodes this enzyme. The catalytic activity of carbonic anhydrase achieves the CO2 generation in the RuBisCO. CAH3 gene is essential for generating CO2 concentration for RuBisCO by dehydration of accumulated inorganic carbon. There are also few other microalgae genes which involves for carbon assimilation. Genomic resource databases and several other nucleotide databases are being used for sequencing the microalgal genomes. Even though, recent advances in genomic studies are providing thrust to enhance the research on microalgal species, they are expensive and resources available for microalgal genomic studies are limited. This review article attempts first as a combined revise on microalgae CO2 sequestration in the field of basic science, applied aspects, and the role of specific gene(s) in the algal system is well defined which could be a supportive involvement of carbon dioxide reduction as “Green-Gene Technology”. This Green biotechnology could be used for Global warming reduction as well as creating wealth from the waste through valuable by-products from the selected microalgae strains in future