Large adnexal mass: is laparoscopic surgery a safe option?

Background: Laparoscopic surgery is regarded as the gold standard for management of adnexal tumours due to many advantages. Currently, the exact size of the adnexal tumour contraindicating laparoscopic management has not been clearly defined. Some studies suggest laparotomy for the treatment of adnexal tumours larger than 8 to 10 cm. Risk of malignancy increases with large cysts. Issues with operation of huge adnexal masses are limited surgical field, difficulty in inserting trocars and removing the specimen without rupture. This study aims to evaluate the feasibility and surgical outcomes of laparoscopic surgery for large adnexal masses.Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, JSS Medical College, Mysuru.Results: 35 patients with large adnexal masses, which were thought to be benign, were subjected to laparoscopic surgery. Mean diameter of masses as per the pre-operative ultrasound measurements was 12.2cm (range: 10.1-20.4cm). The mean operative time was 51.15minutes, estimated blood loss was 85.4ml, duration of postoperative hospital stay was 2.8 days. Serous cystadenoma was the most common histopathological finding. However, one case of borderline tumour was found.Conclusions: The potential risk of malignancy is the most important limiting factor for laparoscopic management of large ovarian cysts. Therefore, it is necessary to establish risk profiles of patients with adnexal masses in order to benefit from minimally invasive surgery wherever possible. The current study supports laparoscopic management of large ovarian cysts as a technically feasible method if proper case selection is made

Seeing double: the low-carb diet

No abstract available

Assessment of vitamin E status in patients with systemic inflammatory response syndrome: plasma, plasma corrected for lipids or red blood cell measurements?

<b>Background:</b> There is some evidence that the plasma vitamin E status is perturbed as part of systemic inflammatory response and correcting this with other plasma markers may not lead to reliable results. The aim of the present study was to examine the longitudinal inter-relationships between plasma and red blood cell vitamin α-tocopherol in patients with systemic inflammatory response syndrome. <b>Methods:</b> α-tocopherol concentrations were measured, by HPLC, in plasma and red blood cells in normal subjects (n = 67) and in critically ill patients with systemic inflammatory response syndrome (n = 82) on admission and on follow-up. <b>Results:</b> Plasma α-tocopherol was significantly lower in the critically ill patients compared with the controls (all p < 0.001) with 41% of patients having concentrations below the 95% confidence interval. In contrast, when corrected for cholesterol, α-tocopherol concentrations were significantly higher in the critically ill patients compared with the control group (p < 0.001, 27% above the 95% confidence interval) and when corrected for triglycerides, α-tocopherol concentrations were significantly lower in the critically ill patients compared with the control group (p < 0.001). Red blood cell α-tocopherol corrected for haemoglobin was similar (p = 0.852) in the critically ill patients compared with control subjects. The longitudinal measurements (n = 53) gave similar results. <b>Conclusions:</b> These results indicate that there is a discrepancy between vitamin E measurements in plasma, in plasma corrected for lipids and in red blood cells. Although the value of correcting vitamin E concentrations by lipids is well established in population studies, the present study indicates that such correction is unreliable in the presence of systemic inflammatory response syndrome and that vitamin E status should be assessed using red blood cell α-tocopherol measurement

Fibre Optics in Undersea Applications

Role of optical fibres for underwater communication cables and hydrophones is discussed. The fibre optics cables provide an excellent solution to the historical bandwidth-diameter problems of conventional coaxial cables.Fibre optic hydrophones are found to have many more advantages apart from high sensitivity and large dynamic range, over the classical sound sensors used in underwater work

Psychological and behavioral outcomes of social media-induced fear of missing out at the workplace

The intense proliferation of social media platforms into every facet of human lives has engaged researchers' attention towards understanding their adverse influences, referred to as the dark side of social media (DoSM) in the evolving literature. A relatively unexplored context in this regard is employees' personal use of social media during work hours and its impact on work-related outcomes. Since using social media during work hours can have implications for work performance and productivity, the lack of research in the area needs to be addressed by scholars sooner rather than later. Specifically, it is important to understand the drivers and outcomes of such behaviour. We have thus conceptualized a theoretical model based on the associations among individual tendencies (exhibitionism and voyeurism), fear of missing out (FoMO), and individual-level psychological (compulsive use of social media) and behavioral (work performance decrement and procrastination) outcomes of social media use during work hours. Grounded in the stressor-strain-outcomes (SSO) framework, the hypothesized associations were tested by a path analysis of 312 responses collected from individuals working in the United States. The results confirmed significant relationships between individual tendencies and FoMO, as well as psychological and behavioural outcomes. The findings contribute to the evolving literature around DoSM in the workplace and offer useful and practical insights

Balancing food waste and sustainability goals in online food delivery: Towards a comprehensive conceptual framework

Increasing food waste is a major threat to sustainability and food security. Recognizing the issue, the United Nations Sustainable Development Goal (SDG) 12 mandates reducing global food waste by 50 percent by 2030. This situation has also given impetus to academic research on consumer food waste in both household and out-of-home settings. However, food delivery apps (FDAs) remain under-researched from this perspective. This is a serious gap because operating under a business model that inherently facilitates food over-ordering, FDAs can be a major source of food waste. Understanding the demand-side factors that drive consumers to order more food than required to satiate their hunger can be useful in mitigating such wasteful indulgences. Noting this, we extend the seminal theory of planned behavior (TPB) to propose direct and intervening mechanisms that can better explicate why consumers indulge in a ‘shopping routine’ of ordering more food than required. We analyzed data from 487 FDA users to test the proposed hypotheses. Our results reveal the positive associations of (a) attitude and subjective norms with usage intentions and (b) trust, intentions, and leftover reuse routine with shopping routine. In addition, both proposed moderators—i.e., willingness to pay for eco-friendly packaging and number of years of FDA usage—do, in fact, moderate the associations of leftover reuse routine with both usage intentions and shopping routine. These findings can help marketers and policymakers devise appropriate strategies to promote pro-environmental green behaviors among FDA users without harming the commercial interests of the sector

Truthful Multi-unit Procurements with Budgets

We study procurement games where each seller supplies multiple units of his item, with a cost per unit known only to him. The buyer can purchase any number of units from each seller, values different combinations of the items differently, and has a budget for his total payment. For a special class of procurement games, the {\em bounded knapsack} problem, we show that no universally truthful budget-feasible mechanism can approximate the optimal value of the buyer within $\ln n$, where $n$ is the total number of units of all items available. We then construct a polynomial-time mechanism that gives a $4(1+\ln n)$-approximation for procurement games with {\em concave additive valuations}, which include bounded knapsack as a special case. Our mechanism is thus optimal up to a constant factor. Moreover, for the bounded knapsack problem, given the well-known FPTAS, our results imply there is a provable gap between the optimization domain and the mechanism design domain. Finally, for procurement games with {\em sub-additive valuations}, we construct a universally truthful budget-feasible mechanism that gives an $O(\frac{\log^2 n}{\log \log n})$-approximation in polynomial time with a demand oracle.Comment: To appear at WINE 201

Successful pulmonary thromboendarterectomy in a patient with sickle cell disease and associated resolution of a leg ulcer

© 2017 Indian Chest Society | Published by Wolters Kluwer -Medknow. Pulmonary hypertension (PH) is a relatively frequent and severe complication of sickle cell disease (SCD). PH associated with SCD is classified as Group 5 PH. The exact pathogenesis of PH in SCD in not known. There are also very limited treatment options available at this time for such patients with Group 5 PH. Patients with SCD are predisposed to a hypercoagulable state and thus can also suffer from chronic thromboembolism. These patients can have associated chronic thromboembolic pulmonary hypertension (CTEPH), thus being classified as Group 4 PH. We present such a case of a patient with SCD diagnosed with severe PH who was found to have CTEPH and successfully underwent a thromboendarterectomy with resolution of his symptoms such as reduction of his oxygen requirements and healing of chronic leg ulcer. This case illustrates the importance of screening patients with SCD and elevated pulmonary artery pressures for CTEPH as this would offer possible treatment options such as pulmonary thromboendarterectomy and/or riociguat in this subset of patients

Effect of vitamin A and undernutrition on the susceptibility of rodents to a malarial parasite Plasmodium berghei

The ability of vitamin A deficient rats to resist infection with P. berghei was investigated. When 10×106 erythrocytes bearing the parasite/100 g body weight were given to the vitamin A protein energy undernourished rats, parasitemia developed in these animals at a faster pace than the controls. A high number (60% to 95% ) of red blood cells (RBC) carrying the parasite were noticeable within 6 to 7 days after infection, at which time most animals in this group died. The pair-fed controls (protein-energy undernourished but supplemented with vitamin A) fared perceptibly better with an equivalent load of infection. Control ad libitum fed littermates were able to restrict the infection and neither high parasitemia nor death was noted in this group. Oral supplements of retinyl acetate to vitamin A deficient rats enabled the animals to recover from infection. A subclinical dose of 500 parasitized RBC given at an early stage of the vitamin A deficiency precipitated the deficiency symptoms at a faster rate and led to the development of higher order of parasitemia in these rats beginning from the 10th day after infection as compared to pair fed controls. The yield of glass adhering cells obtainable from peritoneal exudates was low in deficient rats. In vitro experiments further suggest a decrease in the capacity of the glass adhering peritoneal exudate cells in vitamin A deficient mice to clear the infection. This capacity was improved by addition of non glass adhering cells from sensitized control mice