Mosaicism of 50,XX/51,XX in a Murrah buffalo Bubalus bubalis

International audienc

Anaesthetic management of endoscopic resection of juvenile nasopharyngeal angiofibroma: our experience and a review of the literature

Background: Juvenile nasopharyngeal angiofibroma (JNA) is a rare, benign, vascular tumour in adolescent males with potential life-threatening complications. Advances in endoscopic surgery, invasive monitoring and hypotensive anaesthesia have made JNAs amenable to endoscopic surgical resection. We present the anaesthetic management of endoscopic resection of 14 JNAs, together with a review.Method: The medical records of patients who underwent endoscopic excision of JNAs within the last seven years were reviewed retrospectively. Information was collected and analysed with regard to demographics, preoperative evaluation, intraoperative management, complications and postoperative course. Fourteen patients were included in the study. If the surgery needed to be converted to open surgery, the patients were excluded from the study.Results: The age of the patients ranged from 10-18 years. Two patients had preoperative embolisation of the feeding vessel. Standard anaesthesia induction technique, together with invasive monitoring, was used. Controlled hypotension (mean arterial pressure of 60 ± 5 mmHg) was achieved with the help of inhalational anaesthetics, vasodilators and beta blockers. Mean duration of surgery was 197.14 ± 77 minutes, and median blood loss was 500 ml (100- 4 300 ml). Seven patients were extubated in the operating room. The other seven patients remained intubated for 24 hours owing to extensive surgery with a risk of postoperative bleeding, and were monitored either in the postoperative care unit (five patients) or the intensive care unit (two patients). There was no significant morbidity or mortality in any of the patients.Conclusion: JNAs remain a challenge for anaesthesiologists because of excessive intraoperative bleeding. Anaesthetists should be aware of recent techniques to reduce tumour vascularity, such as embolisation of the feeding vessel and controlled hypotension. Invasive monitoring, together with multimodal blood conservation strategies, decreases blood loss and provides a clear field of vision for endoscopic surgery.Keywords: anaesthetic management, JNA, endoscopic resection, controlled hypotensio

Spring inter monsoon algal blooms in the Eastern Arabian sea: Shallow marine encounter off Karwar and Kumbla Coast using a Hyperspectral radiometer

We encountered the presence of algal blooms in the shallow coastal waters; typical of case II conditions off Karwar (Karnataka) and Kumbla (Kerala), eastern Arabian Sea during the Inter Monsoon. The algal blooms are Trichodesmium species and appear in shades of brown strands and tufts representing T. Erythraeum. Sites of the algal blooms depict a high spectrophotometric surface chlorophyll-a value ranging from 32- 39 mgm-3 and sea surface area surrounding the bloom sites depict lower values of chlorophyll-a (1-3 mgm-3). In-situ Hyperspectral radiometer measurements depict the existence of Chlorophyll Maxima at various depths (3.0-37.31 ug/l) representing the blooms along with their surface appearance. Contrary to the Karwar blooms that are dense, the blooms at Kumbla were dispersed and scantly distributed on the surface waters. Our sea-truth data on mean Sea Surface Temperature of Karwar (30.61 °C) that simulates the Kumbla (30.34 °C) scenario and the mean salinity of Kumbla was 35.86psu, and that of Karwar that is slightly elevated (35.40psu), suggests that SST and salinity probably do not either directly enhance or provide an environment for the eterioration of algal blooms

The Impact of Marketing Mix on the Consumer Purchase Decision in the Surabaya - Indonesia Hotel Residence

The hospitality business is rapidly growing and has caused fierce competition in this industry. It can be seen from the number of new hotels particularly for the 2 and 3-star hotels, and budget hotels in Surabaya. The hotels applied various strategies in acquiring new customers and retain loyal customers in the pursuit of a high level of occupancy in order to maintain business continuity. Performing appropriate marketing tactics is one of the ways to enable the hotel to increasing occupancy rates. Marketing strategy is associated with the products, prices, promotions, and distribution. This study aims at seeking the impact of the product, prices, promotion, and distribution on the consumer purchasing decisions. The population is all visitors to budget hotels located in the city of Surabaya. The data collection was conducted by distributing the self-administered questionnaire to 150 visitors. Of the 150, 125 questionnaires were valid for further analysis. The sampling frame uses judgmental sampling techniques. Data processing used multiple linear regression using SPSS software. The results showed that hotel products have an influence on consumer purchasing decisions; prices have an influence on consumer purchasing decisions. The location of the hotel affects the purchase decision. Promotion performed by the hotel influence the purchase decision by the consumer. This research model needs to be developed by providing service process variables and employee competencies in hotels in Surabay

Leadership Style, Employee Engagement, and Work Environment to Employee Performance in Manufacturing Companies

The fast changes in global order have to be anticipated by the company�s management in order to be able to compete. This change affects the organizational system and the company�s leadership style to improve their employees� participation. Leadership style determines the level of employees� participation and empowers them in reaching the targets that have been determined by the management. The data retrieval is using a questionnaire from the employees of an animal feed manufacturing company. The data retrieval technique is by using all the 50 employees of the company. The data analysis of this study is using partial least square (PLS). The result of this study is to find that leadership style has a significant influence on employee engagement and work environment. Employee engagement and work environment impact significantly toward the performance of the employees. The result of the study also shows that leadership style can not directly impact the performance of the employees, because leadership style is an interaction between top management with the employees so that it needs an intermediate variable in increasing the performance of employees

Epidemiology of Cardiopulmonary Resuscitation in Critically Ill Children Admitted to Pediatric Intensive Care Units Across England: A Multicenter Retrospective Cohort Study

Background Cardiopulmonary arrests are a major contributor to mortality and morbidity in pediatric intensive care units (PICUs). Understanding the epidemiology and risk factors for CPR may inform national quality improvement initiatives. Methods and Results A retrospective cohort analysis using prospectively collected data from the Paediatric Intensive Care Audit Network database. The Paediatric Intensive Care Audit Network contains data on all PICU admissions in the United Kingdom. We identified children who received cardiopulmonary resuscitation (CPR) in 23 PICUs in England (2013-2017). Incidence rates of CPR and associated factors were analyzed. Logistic regression was used to estimate the size and precision of associations. Cumulative incidence of CPR was 2.2% for 68 114 admissions over 5 years with an incidence rate of 4.9 episodes/1000 bed days. Cardiovascular diagnosis (odds ratio [OR], 2.30; 95% CI, 2.02-2.61), age <1 year (OR, 1.84; 95% CI, 1.65-2.04), the Paediatric Index of Mortality 2 score on admission (OR, 1.045; 95% CI, 1.042-1.047) and longer length of stay (OR, 1.013; 95% CI, 1.012-1.014) were associated with increased odds of receiving CPR. We also found a higher risk of CPR associated with a history of preadmission cardiac arrest (OR, 20.69; [95% CI, 18.16-23.58) and for children with a cardiac condition admitted to a noncardiac PICU (OR, 2.75; 95% CI, 1.91-3.98). Children from Black (OR, 1.68; 95% CI, 1.36-2.07) and Asian (OR, 1.49; 95% CI, 1.28-1.74) racial/ethnic backgrounds were at higher risk of receiving CPR in PICU than White children. Conclusions Data from this first multicenter study from England provides a foundation for further research and evidence for benchmarking and quality improvement for prevention of cardiac arrests in PICU

Impact of adversity on early childhood growth & development in rural India: Findings from the early life stress sub-study of the SPRING cluster randomised controlled trial (SPRING-ELS)

INTRODUCTION: Early childhood development is key to achieving the Sustainable Development Goals and can be negatively influenced by many different adversities including violence in the home, neglect, abuse and parental ill-health. We set out to quantify the extent to which multiple adversities are associated with impaired early childhood growth & development. METHODS: This was a substudy of the SPRING cluster randomised controlled trial covering the whole population of 120 villages of rural India. We assessed all children born from 18 June 2015 for adversities in the first year of life and summed these to make a total cumulative adversity score, and four subscale scores. We assessed the association of each of these with weight-for-age z-score, length-for-age z-score, and the motor, cognitive and language developmental scales of the Bayley Scales of Infant Development III assessed at 18 months. RESULTS: We enrolled 1726 children soon after birth and assessed 1273 of these at both 12 and 18 months of age. There were consistent and strongly negative relationships between all measures of childhood adversity and all five child growth & development outcome measures at 18 months of age. For the Bayley motor scale, each additional adversity was associated with a 1.1 point decrease (95%CI -1.3, -0.9); for the cognitive scales this was 0.8 points (95%CI -1.0, -0.6); and for language this was 1.4 points (95%CI -1.9, -1.1). Similarly for growth, each additional adversity was associated with a -0.09 change in weight-for-age z-score (-0.11, -0.06) and -0.12 change in height-for-age z-score (-0.14, -0.09). DISCUSSION: Our results are the first from a large population-based study in a low/middle-income country to show that each increase in adversity in multiple domains increases risk to child growth and development at a very early age. There is an urgent need to act to improve these outcomes for young children in LMICs and these findings suggest that Early Childhood programmes should prioritise early childhood adversity because of its impact on developmental inequities from the very start