bluuebunny/crossref_metadata_2025 huggingface dataset:
Is routine urine dip stick testing justified in asymptomatic women in early pregnancy?
Authors: Gaughran Jonathan , Chung Bethany , Lyne Tom , Syedab Nuhaat , Fieldb Daniel , Hamiltona Judith
Published: December 2020

Background: Routine urinalysis is commonly performed in early pregnancy units (EPUs) based on historic evidence that bacteriuria is linked to pyelonephritis, pre-term birth, mid trimester loss and low birth weight. Aim was to assess the cost and diagnostic yield of routine urinalysis in asymptomatic women in early pregnancy. A secondary outcome was the birth outcomes for women with proven bacteriuria.Methods: Retrospective review of all urinalysis performed over 12 month period in a tertiary EPU and analysis of pregnancy outcomes in the proven bacteriuria group.Results: 10,490 urinalyses performed at a cost of £40,385.50. 1162 (11%) positive urine dips; 68 (0.6%) nitrite positive. 179 microscopy, culture and sensitivity performed at a cost of £2593.71. Of the 179, 65 were culture positive giving a proven bacteriuria rate of 0.6%. The most common pathogen was E-Coli. There were no recorded episodes of pyelonephritis and no statistical significance in the pre-term birth, mid trimester loss or low birth weight rate in the culture positive versus culture negative group.Conclusions: The cost associated with routine urinalysis is significant and the diagnostic yield is extremely low. We did not identify an association between bacteriuria and adverse pregnancy outcomes. As such, urinalysis should only be performed in symptomatic/ high risk patients presenting to the EPU.
Maternal and perinatal outcomes in pregnancy with high BMI in the Jabal Akhdar region of Libya
Authors: Elghazal Zahia , Langhe Ream , Bettamer Nagat , Hamad Karima
Published: December 2020

Background: Overweight maternal pre-pregnancy, obesity and excessive gestational weight gain are significant risk factors for unfavorable maternal and perinatal outcomes during pregnancy. The association of obesity with maternal and perinatal outcomes is poorly understood in Jabal Akhdar region of Libya. This study was to examine maternal and perinatal outcomes in obese mothers compared to non-obese mothers in Jabal Akhdar region of Libya.Methods: This is a Cross sectional survey design study with internal comparison groups. The study was conducted between May 2015 and May 2016 in Jabal Akhdar region od Libya. A total of 415 women at reproductive age were deemed eligible for this study. BMI categories were defined as; underweight (BMI< 18.5), normal (BMI 18.5 – 24.99), overweight (BMI 25 – 29.99), grade I obesity (BMI 30 – 34.99), grade II obesity (BMI 35 – 39.99) and grade III obesity (BMI 40+). Data obtained in this study was analysed using SPSS, version 17.0 was used in analysis.Results: Of 415 women included in this study, 282 had a BMI <30 kg/m2 and 133 women had a BMI >30 kg/m2. Pregnancy-induced hypertension was more prevalent in obese mothers compared to non-obese women. The rate of operative delivery and caesarean section were also demonstrated between obese and non-obese mothers and these differences were significant.Conclusions: This study demonstrates extent of obstetric risks associated with obesity in pregnancy, though more research is required to fully elucidate the effect that maternal obesity is having on maternal and perinatal outcomes in pregnancy in Libyan populations. Since high weight gain is a modifiable risk factor, pre pregnancy health education awareness of health care providers, good behavioral counseling and weight control program during pregnancy should help to modify this risk.
Second trimester amniocentesis for prenatal diagnosis of genetic disorders in Bangladesh
Authors: Kazal Rezaul Karim , Chowdhury Saima Akhtar , Pervin Tabassum , Pervin Hasna Hena , Kaniz Paromita Waheeda
Published: December 2020

Background: Amniocentesis is characteristically carried out under ultra-sonographic control, between 15 and 17 weeks of pregnancy. The term prenatal diagnosis firmly comprises all diagnostic modalities aimed at gaining information about the embryo. Its history includes the development of cytogenetic, molecular genetics and molecular cytogenetic methods. Prenatal diagnosis is now possible for a considerable number of genetic diseases and/or birth defects using a variety of techniques. Objective was to evaluate the safety, feasibility and outcome of second trimester amniocentesis for prenatal diagnosis of genetic disorders.Methods: This was a descriptive study, conducted at fetal medicine center, Family Care Foundation, Dhaka, Bangladesh from June 2014 to December 2019. A total of 350 pregnant women had undergone 15-20 week’s transabdominal amniocentesis under real-time ultrasound guidance. A 23 gm/ 88 mm spinal needle was used. The needle was passed though the maternal abdomen into the amniotic cavity in its longitudinal direction. Once the needle was adequately placed, the amniotic fluid is aspirated with a suction force through a 20 cc syringe. All amniocentesis was performed with “two operators” technique.Results: A total of 350 Amniocentesis were done. Beta thalassemia was most common (79.7%). Followed by aneuploidy (10.2%), hemophilia (6.2%), SMA (2.0%), DMD (1.7%), hematoma (7%), intra amniotic bleeding (2%) and per vaginal bleeding (2.8%). 3.7% aspiration was difficult due to fibroid and retroverted uterus. The overall aspiration success rate was 100%.Conclusions: Second trimester transabdominal amniocentesis in an outdoor setting with the help of real-time sonography is a safe procedure with no significant risk to the mother and the fetus.
The impact of COVID-19 outbreak and lockdown on maternal complications during pregnancy
Authors: Ghazal Kariman , Hasan Jihad El , Hijasi Hanine , Khayrallah Maysalloun , Sinno Loubna , Koulaymi Eva
Published: December 2020

Background: The COVID-19 outbreak has affected pregnant women. The aim of this study was to examine the effect of COVID-19 outbreak and lockdown on maternal complications in pregnant women.Methods: A retrospective review of pregnant patients who presented for antenatal care to the private clinic in Beirut, Lebanon before or during the COVID-19 lockdown which started in March 2020. The first group consisted of women before the lockdown between September 1, 2019 and February 29, 2020. The second group included women during or after the lockdown between March 1, 2020 and August 31, 2020.Results: A total of 97 women were included, 48 in the before lockdown group and 49 during or after lockdown group. The percentage of epigastric pain was significantly lower in the first group (12.5% vs. 71.4% respectively, p-value<0.0001). Anemia was significantly lower in the before group (60.4% vs. 83.7%, respectively p-value=0.01). Vomiting and hypotension were significantly higher in the after group. Around 87% of women in the before group had flu-like symptoms such as muscle ache and dizziness compared to 44.9% and 46.9% in the after group (p-value<0.0001). None of the patients in the after group visited the emergency department or were hospitalized during pregnancy. Almost 43% of patients in the after group had severe anxiety compared to 14.6% in the before group (p-value=0.001).Conclusions: Lockdown influenced maternal complications during pregnancy and resulted in anxiety for many women. Management practices regarding pregnancy and childbirth after lockdown are necessary to minimize the associated negative consequences.
A study on the modified menopause rating scale as a tool in the assessment of prevalence of menopausal symptoms in women of Dakshina Kannada district: a cross sectional study
Authors: Sushmitha Vangara , Shettian Nishita
Published: December 2020

Background: Menopause is defined as complete cessation of menses for a period of twelve months or more as a result of complete loss of ovarian follicular activity. Issues related to menopausal symptoms are complicated in terms of experience, severity, and dynamics of the symptoms. Various studies had showed that these symptoms vary among individuals depending on the menopausal stage, ethnicity, geographic location, and other factors menopause rating scale is an effective tool to assess the severity of these symptoms. The aims and objectives of this study were to assess the commonly reported menopausal symptoms among the women of Dakshina Kannada district using a modified menopause rating scale.Methods: This study was conducted in A.J Institute of Medical Sciences and Research Centre from January 2019. A total of 360 postmenopausal women were interviewed using predesigned questionnaire. Menopausal symptoms were assessed using modified menopause rating scale.Results: Majority of women attained menopause at the age of 51-55 years and the calculated mean age was 51.33+3.36. 85% were symptomatic with at least one symptom. The most common symptom reported was joint and muscular discomfort (80%), psychological symptoms like depressive mood (68%), vasomotor symptoms (60%), sleep disorders (50%) urogenital problem (30%). The menopausal symptoms were more prevalent in women of lower socioeconomic status and the ones who were illiterate and this difference was significant.Conclusions: There is an increasing need for establishment of specific health intervention for postmenopausal women by specialty clinics as the burden of menopausal symptoms is high in the Indian women due to lack of awareness, socio cultural and economic factors, and inaccessibility of health services, which may negatively affect the attitude of women towards menopause.
Effectiveness of oral versus parenteral antibiotics in cesarean section: an observational study
Authors: Bharadwaj Malini , Momaya Rani R. , Kaushal Rituja
Published: December 2020

Background: Women undergoing caesarean section are associated with high rates of post-operative infections, which causes significant rise in infectious morbidity, duration of hospital stay and cost treatment. Implementation of appropriate antibiotic prophylaxis is desirable to prevent these complications. We aimed to observe the outcome of Intravenous single dose antibiotic prophylaxis pre-operatively followed by oral antibiotics post-operatively, in comparison to other group with multiple dose Intravenous antibiotic prophylaxis post-operatively.Methods: An observational study conducted in the department of obstetrics and gynaecology, L.N.M.C and J.K. Hospital, Kolar Road, Bhopal, on patients undergoing Elective or Emergency Lower segment caesarean section (LSCS) for a period of 6 months, on 100 subjects, with 50 participants in each group. Null hypothesis was invalidated by statistically analysing the data using chi square test, Unpaired t-test and odds ratio.Results: Prevalence of c-section was more in 25-31year age group. Abnormal presentation was the most common indication for elective LSCS in both the groups (8%), non-progress of labour and foetal distress was the most common indication for emergency LSCS in group A and B respectively (10%). There was statistically insignificant difference in the occurrence of post-operative complications in both the groups (chi sq. value=0.4285, p value=0.5127) with overall, most common complication was febrile morbidity (8% vs.12%). Significant difference noted in total bed occupancy days (unpaired t-test 1.9844) (p-value.0.000000049<0.05%).Conclusions: We recommend the use of cost-effective single dose antibiotic prophylaxis in prevention of post-operative infectious morbidity in women undergoing caesarean section.
Impact of increase of caesarean section on postpartum hemorrhage in a tertiary care center of India over 6 years
Authors: Madan Shikha , Sangwan Neetu , Nanda Smiti , Sirohiwal Daya , Dahiya Pushpa , Singhal Savita , Arora Tarun
Published: December 2020

Background: PPH (postpartum hemorrhage) is the leading cause of maternal mortality. Despite of all the medical advancement, maternal mortality rates have declined greatly in the developed world, PPH remains a leading cause of maternal mortality elsewhere. Caesarean section is an obstetric intervention where, normal delivery can pose a risk for mother or foetus. The rate of caesarean section has increased worldwide. A survey conducted by WHO found that the worldwide rate of caesarean section increased from 26.4% between 2004 to 2008, to 31.2% between 2010 to 2011.Methods: We collected data of the caesarean sections and patients who developed PPH over 6 years. We studied the association of temporal increase of caesarean section with PPH.Results: Uterine atonicity continues to be the most common etiology of PPH each year, however, there is an increase in tissue abnormality (retained placenta, placenta praevia, accreta, increta, percreta) over years as there is a significant increase in the incidence of caesarean section. Atonic uterus was the most common cause for obstetric hysterectomies and mortality due to PPH every year.Conclusions: Family planning advise is essential in developing country like ours to counsel patients to prevent multiparity, thus reducing PPH. It is also important to train all the health workers in periphery and referral centers to manage the third stage of labor and atonic uterus to save the mothers. Sagacious attitude towards the decision of caesarean section is needed to prevent maternal morbidity and mortality.
Frequency of urinary tract infections among pregnant women receiving antenatal care in a tertiary care centre: hospital based cross-sectional study
Authors: Sadhvi Kumari , Kose Varsha
Published: December 2020

Background: Urinary tract infections (UTI) are one of the most frequent human bacterial infections, causing substantial morbidity and mortality, with nearly 150 million cases globally per year. The prevalence of UTI (including both asymptomatic bacteriuria and symptomatic infection) in pregnant women in India is reported to range from 3% to 24%. This infection must be adequately diagnosed and efficient treatment must be initiated to prevent maternal and perinatal morbidity.Methods: This was a hospital based cross sectional study. 625 ante natal women recruited during first visit attending antenatal care outpatient department (ANC OPD). We tested their clean catch mid-stream urine sample for routine, microscopic and culture sensitivity test.Results: Out of 625 antenatal women frequency of urinary tract infection was 16.2%. 17% women were symptomatic having one or more symptoms indicative of urinary tract infection and 83% women were asymptomatic. Among symptomatic women, 92.5% women showed culture positivity for one or more bacteria whereas in asymptomatic women, culture was positive in 10.8%. E. coli followed by Klebsiella were the most common isolate identified in both symptomatic and asymptomatic women. On antibiotic sensitivity testing, we found good overall sensitivity of bacteria to commonly used antibiotics such as nitrofurantoin, and norfloxacin but resistant to ampicillin was observed in all women. UTI adversely affects the mother like pyelonephritis, preterm labour and preterm baby and its complications.Conclusions: It is important to identify presence of UTI during pregnancy by doing urine routine and culture sensitivity test in all antenatal women and administration of appropriate antibiotic to affected women so as to reduce the morbidity both in mother and baby.
Maternal outcome in preterm labor in a tertiary care hospital
Authors: Lewis Preeti Frank , Kumari Ayushi , Bavdekar Nitin
Published: December 2020

Background: To study the fetal and maternal outcome in preterm labor cases.Methods: It was Prospective, single centered, observational study. All women with preterm labor in the study period i.e. from September 2018 to March 2020 were included in the study i.e. 100 patients.Results: Out of 100 subjects, majority of mothers 65(65%) were in age group of 21-30 years followed by 23 (23%) in age group of ≤20 years. Majority 52 (52%) of study subjects were primigravida followed by 28 (28%) having parity 1. Only one case had parity 4. Majority 36 (36%) of study subjects were in lower class followed by 28 (28%) cases in lower middle class. 23 (23%) cases in middle class and 6 (6%) were in upper class. Maximum 61 (61%) cases were unbooked cases and rest 39 (39%) cases were booked. Out of 90 babies who were <2500 grams, maximum 57 (63.33%) were low birth weight (less than 2.5 kg) followed by 22 (24.44%) being VLBW babies. 10 cases were ≥2.5 kg, which are not LBW babies according to WHO Classification of low birth weight. Majority 34 (47.22%) stayed for 1-10 days followed by 17 (23.61%) babies for 11-20 days. Also 15 (20.83%) babies stayed for 21-30 days.Conclusions: Compared with term infants, preterm infants are at high risk of overall morbidity and mortality. Clinical suspicion, early detection and correction of risk factors, institutional delivery and good neonatal care back up facilities can improve the outcome of preterm labour and decrease the maternal complications as well.
Perception and satisfaction regarding breast feeding among breast feeding mothers: a hospital based study
Authors: Prakash Vimarshitha , R. Sheela S. , Raj Krithika , Satyanarayana Pradeep Tarikere
Published: December 2020

Background: World Health organization (WHO) states that to ensure child health and survival, Breast feeding can be best tool. It also mentions that nearly 2 out of 3 are not exclusively breast fed and a special note that only 41 % are exclusively breast fed for 6 months. Breastfeeding satisfaction is defined as, “the satisfying feeling obtained during breastfeeding resulting from cooperation between the mother and the infant to fulfill desires or needs”.Methods: This was a hospital based cross sectional study carried at Department of Obstetrics and Gynecology, Sri Devaraj Urs Medical College, SDUAHER, Kolar from December 2019 to August 2020 for a period of 10 months. Sample size was calculated based on previous study.Results: The present study was a cross sectional study carried out for a period of 9 months at SDUMC tertiary care center. 270 mothers were part of study among which 82 (30.3%) had completed high school, 110 (40.7%) belonged to 21-25 years, 184 (68.07%) were Hindus, 125 (46.2%) belonged to Upper middle class of Modified BG Prasad’s classification 2019, 199 (73.6%) had delivered through normal delivery and 142 (52.7%) had more than one child. Out of 270 breast feeding mothers, 214 (79.3%) has satisfactory knowledge, 148 (54.8%) had satisfactory attitude and only 47 (17.4%) had satisfactory practice. Mothers having  higher education status, having more than one child, home makers and those delivered by Normal delivery had higher scores were statistically significant.Conclusions: Perceptions regarding breast feedings were not satisfactory at various segments and breast feeding satisfaction were influenced by education, working status, number of children and family members were significant factors influencing breast feeding satisfaction.
Obstetric outcome in primigravida with unengaged versus engaged fetal head at term
Authors: Sirisha Vandana Sai , Chiniwar Mahantappa A. , Menasinkai Sharada B.
Published: December 2020

Background: Labour although a physiological process can present challenges to clinician and patient. Primigravida and nulliparae are obstetric high-risk group, especially the very young and the elderly, where pregnancy and labour must be supervised. The study was done to compare the maternal and fetal outcome in primigravida with unengaged and engaged head at term.Methods: A prospective study was done for a period of 18 months from June 2018 to December 2019 in Department of Obstetrics and Gynaecology Adichunchanagiri Institute of Medical Sciences and Research Center. 100 women with unengaged head at term (group A) and 100 women with engaged head at term (group B) as controls were selected.  All the relevant data was filled in the partogram. Following observations were made, station of fetal head at the onset of labour, course of labour, duration of labour, any medical or surgical interventions or caesarean delivery. Data was analysed by SPSS 20.0 software and p value<0.05 was taken as statistically significant.Results: in group A 49% and 63% in group B had vaginal delivery. 17% of group A and 14% of group B had instrumental vaginal delivery. Caesarean delivery was 34% in group A and 23% in group B. The mean total duration of labour was 13.53 hours in group A and 9.73 hours in group B. P value was 0.000.Conclusions: Duration of labour was more in group A than group B.  Proper supervision and timely intervention in cases with an unengaged head can have vaginal delivery.
Visual estimation of blood loss versus quantification of blood loss after vaginal birth using an innovative drape: a prospective study
Authors: Mishra Nalini , Dhruw Suman , Mishra Ishan , Daharwal Abha
Published: December 2020

Background: This study was done to compare the accuracy of visual estimation of blood loss (EBL) and quantitative assessment of blood loss (QBL, sum of volumetric and gravimetric assessment) against a reference standard i.e. calculated QBL (C-QBL) and also with each other after vaginal birth.Methods: Prospective observational cohort study conducted at Pt. JNM medical College Raipur, Chhattisgarh, India and involved 101 low risk women after vaginal birth. Women were allocated alternately to EBL or QBL group (volumetric component of measured blood loss was done with an innovative low cost drape prepared with a plastic apron at the point of care. Gravimetric component was measured by weight difference of the mops and pads before and after use). C-QBL was calculated for each case with a standard formula. Main outcome measure was comparing the correlation coefficient of EBL and QBL each with C-QBL.Results: The mean blood loss in 51 women of EBL group and 50 women of QBL group was 275.29 ml and 380 ml respectively. Pearson’s correlation coefficient (r) of EBL with C-QBL was 0.4984 (weak correlation) compared to that of QBL with C-QBL (r=0.9093, strong positive correlation). The error of underestimation by EBL compared to QBL was 28% (mean=104.71 ml p<0.0001). The relative risk (RR) of underestimating blood loss of >500 ml by EBL method was 5 (95% CI .605-41.3).Conclusions: Visual EBL should be replaced with QBL for measurement of postpartum blood loss. Using innovative under-buttock low cost drape greatly helps in routine QBL.
A study to assess the effectiveness of initiation of breast feeding during third stage of labour among mothers on their physiological parameters at selected sub-divisional Hospital in West Bengal
Authors: Bag Jyotsna , De Sima
Published: December 2020

Background: There is paucity of Indian literature regarding effect of early breast feeding in subsequent course of labour. So, this study was undertaken to find out the effectiveness of early initiation of breast feeding during third stage of labour on the duration of labour, amount of blood loss during labour and nature of placental expulsion, along with the changes in vital signs during second and third stages of labour among mothers of both experimental and control groups.Methods: A quasi experimental post-test only control group study design was adopted. The conceptual framework for the study was based on general system model. Non-probability purposive sampling technique was used to select 20 intra-natal mothers and 10 mothers were randomly assigned to experimental group and another 10 mothers were randomly assigned to the control group. A structured interview schedule, observation checklist on progress of 1st, 2nd, and 3rd stages of labour, measurement of blood loss and measurement of vital signs were used to collect data after establishing validity and reliability of the tools.Results: The finding of the study revealed that there was significant difference in duration of 3rd stage of labour, t (18)=5.237 at 0.05 level and blood loss during 3rd and 4th stage of labour, a t (18)=3.95 at 0.05 level. There was true difference in pulse rate but not the respiration rate and blood pressure.Conclusions: Initiation of breast feeding during third stage of labour is effective in reducing maternal morbidity and mortality.
Fear and concerns of women delivering during coronavirus pandemic
Authors: Bahadur Anupama , Mundhra Rajlaxmi , Kuncham Rupendra , Kashibhatla Jyotshna , Verma Neha , Chaturvedi Jaya
Published: December 2020

Literature is sparse regarding the fears and concerns of women delivering during COVID 19 pandemic. We interviewed 12 women delivering during the initial first week of lockdown period. There were three key concern of women- fear of being exposed at hospital, restricted number of hospital visitors made them confined and self-isolated thereby making them bored and frustrated, risk of baby being infected. Virtual communication through mobile was seen as a major support in all serving as a means of contact with their loved ones. Understanding a pregnant women’s concern and fear during this pandemic will enable a health care worker in better counselling.
A case of cornual pregnancy at ten gestational age accompanied by heterotopic pregnancy
Authors: Yun Jisun , Seo Jong-wook , Lee In Ok , Chung Jae Eun
Published: December 2020

Objective of the study was to report a case of cornual pregnancy at 10 weeks gestational age, accompanied by heterotopic pregnancy. A 41-year-old woman was transferred to the emergency department of the national health insurance service Ilsan hospital at amenorrhea 10 weeks 5 days after being diagnosed of cornual pregnancy from a primary hospital. The patient was nulliparous with a history of 1 induced and 2 missed abortions. Other than a previous myomectomy, her medico-surgical history was not significant. She was initially diagnosed with blight ovum at amenorrhea 8 weeks 4 days, and dilatation and curettage were performed at the primary hospital of which she was referred from. At amenorrhea 10 weeks 5 days, another gestational sac was noted at the left cornu of the uterus by ultrasonography. The tentative diagnosis was cornual pregnancy accompanied by heterotopic pregnancy. Serum ß human chorionic gonadotrophin (hCG) at the time of arrival was 84573.8 mIU/ml. Trans-abdominal ultrasonography showed a mass protruding from the left cornu of the uterine cavity, containing a gestational sac (mean sac diameter 39.0 mm, 10 weeks size) and an embryo of cranio-caudal length of 38.2 mm (10 weeks 5 days size). There was no sign of intraperitoneal hemorrhage. Emergency operation was planned under the diagnosis of cornual pregnancy. Entering the abdominal cavity, a 5×5 cm sized conceptual mass surrounded by thin and fragile myometrium was noted on left uterine cornu. Open wedge resection of the left cornual pregnancy with left salpingectomy was performed. The resected mass was 4.0×3.5 cm2 in size. An embryo with 45 mm size was confirmed inside the mass.
A case of transverse vaginal septum causing obstructed labour
Authors: Bello Saratu , Eze Ukwu , Umar Adoke
Published: December 2020

Transverse vaginal septum (TVS) is a congenital mullerian malformation resulting from failure of fusion or canalization of the urogenital sinus and the mullerian ducts. This results in amenorrhea, inability to consummate marriage and primary infertility if left untreated.  It is a rare finding in pregnancy and labor. However, due to ignorance, poor health seeking behavior and poverty in our setting the diagnosis of transverse vaginal septum may only be encountered in labor. We describe an 18 year old primigravida at term presented with history and findings of obstructed labor due to transverse vaginal septum (low-type) with a small central aperture first diagnosed in labor. This report is aimed at alerting clinicians that all primigravidae should have a routine pelvic examination during their antenatal visit to rule-out lower genital abnormalities.
Hepatocellular carcinoma associated with pregnancy about 2 cases at the gynecological and obstetrical clinic of the Aristide Le Dantec hospital, Dakar, Senegal
Authors: Diakhate Abdoulaye , Gassama Omar , Diadhiou Mohamed , Ndour Simon B. , Wade Mouhamadou , Diop Daba , Wade Adja M. , Niang Ndama , Guèye Mame D. N. , Guèye Mamour , Moreau Jean Charles
Published: December 2020

The objective of our study was to report 2 cases of hepatocellular carcinomas associated with pregnancy followed in our structure and to review the literature. Our patients were 30 and 37-year-old multi-gesture females with chronic unattended viral hepatitis B in whom the diagnosis of hepatocellular carcinoma was made in the third trimester of pregnancy at 31 weeks of amenorrhea and 4 days and at 32 weeks of amenorrhea after the incidental finding of tumor hepatomegaly on abdominal-pelvic ultrasound. The main clinical signs were jaundice and hepatomegaly and paraclinical signs were dominated by hepatic cytolysis and anemia in addition to ultrasound images. Follow-up of pregnancies revealed no particularities. A caesarean section was scheduled at 32 weeks of amenorrhea and 32 weeks of amenorrhea and 3 days allowing the birth of two preterm newborns weighing 1210 and 1500 gm with Apgar scores of 8-10/10 and 7-9/10 respectively at the fifth minute. The immediate post-operative follow-up was simple. However, the maternal-fetal prognosis was poor with the death of both patients in a multi-visceral failure table occurring respectively at 6 weeks and 3 weeks after caesarean section. The newborns had died 8 days after birth. Although rare, these two cases challenge any obstetrician to think about liver cancer in pregnant women, especially those with chronic hepatitis B. Ultrasound examination of the liver, or even better, the MRI, which is more efficient, in order to suspect early on a possible liver cancer. Indeed, early diagnosis and a thorough medical approach are essential for the treatment of HCC in pregnant patients.
Benign papillary cystadenofibroma of fallopian tube presenting as posterior fornix cyst: case report
Authors: Narayanrao Gude Prajakta , Srinivasan P. V. , Kala R.
Published: December 2020

Benign papillary cystadenofibroma of fallopian tube is very rare tumor of female genital tract. Usually asymptomatic and incidental finding. Worldwide literature only 18 cases were found. On account of its rarity and best of our knowledge, is the first case of benign papillary cystadenofiboma presented as posterior fornix cyst, so we are presenting this case. We report a rare case of benign papillary cystadenofibroma of fallopian tube in a 30-years old female P3L3 presenting with abdominal pain. On examination abdomen was soft, per vaginally mobile non-tender cystic mass of 5×4 cm was noted. Laparotomy was planned. Intraoperatively 5x4 cm cyst arising from serosal surface of left fallopian tube near fimbrial end noted with bilateral ovaries normal. Left fimbrial cystectomy with salpingectomy was done with sparing both ovaries. Histopathology suggestive of benign papillary cystadenofibroma of fallopian tube. Patient had uneventful recovery in follow up period. Benign papillary cystadenofibroma of fallopian tube is rare tumor found incidentally. Tumor seems to have benign course only cystectomy is required for treatment.
Failure of intrauterine contraception in a multigravida lady with an undiagnosed uterus didelphys: a case report
Authors: Bhattacharyya Shreemanti , Sarkar Partha S.
Published: December 2020

Uterus didelphys remains one of the rarest uterine anomalies partly because; majority women experience no symptoms with an uneventful reproductive life. Despite the cost-effectiveness and efficacy paired with fewer side effects and convenience of using an intrauterine contraceptive device, it is most likely to prove futile in an unsuspected case of didelphic uterus resulting in an unintended pregnancy. Hence, intrauterine contraception is generally considered a contraindication in cases of uterine malformations. We present a case of a multigravida mother (G7 P3 L3 A3) with a history of three term vaginal deliveries, with an undiagnosed uterus didelphys, carrying a single live intrauterine pregnancy of approximately 6 weeks period of gestation, in the right uterine horn and a copper containing intrauterine contraceptive device in the left uterine horn, willing to undergo medical termination of pregnancy. A high index of suspicion, on the part of the gynaecologist as well as the radiologist, is required to investigate concurrent pregnancy with a history of an intrauterine contraceptive device insertion, in order to rule out rarer uterine malformations like uterus didelphys. Thorough history taking and clinical examination accompanied by improved imaging techniques should be performed at the time of first pregnancy in order to avoid an unsuitable placement of an intrauterine contraceptive device.
A recurrent case of pyruvate dehydrogenase complex deficiency
Authors: Venkatesan Dhivya , Samal Sunil Kumar , Vishalakshi Ashwini , P. Pallavee , S. Prabh C.
Published: December 2020

Pyruvate dehydrogenase complex deficiency is an inherited inborn error of metabolism causing lactic acidosis and several neurological symptoms. Its incidence and prevalence are not known. Here we report about a child with global developmental delay, central hypotonia and dyskinesia. Sanger sequencing was done and found to have homozygous nonsense mutation in exon 4 of PDHX gene causing lactic acidosis. In the next pregnancy selective Sanger variant analysis was carried out and the fetus was also found to be affected with the same genetic defect. Hence medical termination of Pregnancy was carried out. We conclude that early selective genetic testing will prevent further affected births.
Fatal case of acute fatty liver of pregnancy
Authors: Mamilla Sarada , Rani Sandhya , . Gayathri , . Bhavana , Bharghavi Ramya , . Tejaswi
Published: December 2020

Acute fatty liver in pregnancy is a catstrophic condition with high mortality and morbidity. Delay in managing complications would result in fatality. We present a case of 22-year-old primi, who presented to us in labor with jaundice and later developed, disseminated intravascular coagulation, Vulval haematoma, reexploration, sepsis, ARDS and cardiac arrest and death.
A rare case of unruptured tubal ectopic pregnancy at 14 weeks gestation with live foetus in situ and review of literature
Authors: Biswas Jayanta K. , Tewari Vivek
Published: December 2020

Ectopic pregnancy is a condition, where the fertilized ovum implants anywhere other than normal uterine cavity. It is life threatening emergency condition and it can present in diverse ways. More than 95% of ectopic pregnancies usually occur in fallopian tube, ampulla being commonest site of tubal ectopic pregnancy. Diagnosis with location of pregnancy is usually possible by ultrasonography in 1st trimester. However, in most of the developing countries with limited resources, many women do not undergo ultrasonography and medical examination in early pregnancy, leading to late diagnosis. It may lead to life threatening presentation of ectopic pregnancy. Reported average duration of diagnosis of unruptured tubal ectopic pregnancy is usually between 5 to 9 weeks of gestation. Very rarely tubal ectopic pregnancy can remain asymptomatic and unruptured for longer than this usual period of gestation. The reported case is a rare case of viable, unruptured tubal ampullary ectopic pregnancy of 14 weeks of gestational age.
The Infinity of the World (Book Review Tengelyi L. Welt und Unendlichkeit. Zum Problem phänomenologischer Metaphysik. 3. Aufl. Freiburg/München: Karl Alber Verlag, 2015. 604 S. ISBN (PDF-E-Book): 978-3-495-86049-6)
Authors: Patkul Аndrei
Published: December 2020

In my review, I survey the main content of L. Tengeli's book World and Infinity, reconstruct its structure and discuss the author’s research results in the field of phenomenology of the world, presented in it. In particular, I note here that Tengelyi conducts a detailed criticism of onto-theology, starting from the problem of the katholo-protological structure of metaphysics in Aristotle. He outlines Husserl’s doctrine of primordial facts and Heidegger’s idea of metontology. In addition, here I give a relatively detailed description of Tengeliy’s understanding of a thing and the world, as well as his interpretation of infinity as a basic characteristic of the world.
Tengelyi’s weißer Fleck. Transl. from German Elfir Sagetdinov
Authors: Kolka Constance
Published: December 2020

Tengelyi, so the author‘s research approach, mainly refers to traditional patterns, when he tries to say what the structure of the world might be. She considers Welt und Unendlichkeit (World and Infinity) a history of philosophy, revealing the sources of Tengelyi‘s inspirations. The author puts a focus on the „diakritische Differenz“(diacritical difference) and the „heterologisches Prinzip“ (heterological principle) as Tengelyi‘s propositions of a dynamic formation of the world. Even though the philosophical terms in ancient Greek and Latin reveal Tengelyi‘s tendency to unambiguousness. The author contends that Tengelyi does not recognize rhetorical figures as possible schemes of the openess of the world  (Weltoffenheit) and that he therefore misses a vital phenomenological aspect.
Carbonization Law of Fly Ash Concrete under Freeze-Thaw Cycles Based on Image-Pro Plus
Authors: Yuan Jing , Zhao Boxin , Wang Zhenqiang , Liu Yan
Published: December 2020

To understand the influence of freeze-thaw on the carbonization performance of concrete in severe cold areas, this paper conducted experiments to explore the carbonization law of fly ash concrete under freeze-thaw cycles. First, carbonization tests were conducted under different freeze-thaw cycles and fly ash contents; then PS (Photoshop) and IPP (Image-Pro Plus) were adopted to measure the carbonized area and calculate the ratio of carbonized area (RCA). The experimental results showed that, when the fly ash content was between 10% and 30%, RCA increased slowly; when the fly ash content was 20%, the convergence point showed up; when the fly ash content was 0, the air-entrained fly ash concrete had the best resistance to carbonation. With the help of PS and IPP, this paper calculated the RCA more accurately and found that, the freeze-thaw cycles can aggravate carbonization, and there is a linear relationship between carbonization depth and RCA. The research findings in this paper can provide a reference for the durability evaluation and design of concrete structures in severe cold areas.
Characteristics of Blended Geopolymer Concrete Using Ultrafine Ground Granulated Blast Furnace Slag and Copper Slag
Authors: Rathanasalam Vijayasarathy , Perumalsami Jayabalan , Jayakumar Karthikeyan
Published: December 2020

This paper presents the properties of blended geopolymer concrete manufactured using fly ash and ultrafine Ground Granulated Blast Furnace Slag (UFGGBFS), along with the copper slag (CPS) as replacement of fine aggregate (crushed stone sand). Various parameters considered in this study include different sodium hydroxide concentrations (10M, 12M and 14M); 0.35 as alkaline liquid to binder ratio; 2.5 as sodium silicate to sodium hydroxide ratio and cured in ambient curing condition. Further, geopolymer concrete was manufactured using fly ash as the prime source material which is replaced with UFGGBFS (0%, 5%, 10% and 15%). Copper slag has been used as replacement of fine aggregate in this study. Properties of the fresh manufactured geopolymer concrete were studied by slump test. Compressive strength of the manufactured geopolymer concrete was tested and recorded after curing for 3, 7 and 28 days. Microstructure Characterization of Geopolymer concrete specimens was done by Scanning Electron Microscope (SEM) analysis. Experimental results revealed that the addition of UFGGBFS resulted in an increased strength performance of geopolymer concrete. Also, this study demonstrated that the strength of geopolymer concrete increased with an increase in sodium hydroxide concentration. SEM results revealed that the addition of UFGGBFS resulted in a dense structure.
Modal Analysis of Orthotropic Thin Rectangular Plate Based on Analytical and Finite Element Approaches
Authors: Deghboudj Samir , Boukhedena Wafia , Satha Hamid
Published: December 2020

The present work aims to carry out modal analysis of orthotropic thin rectangular plate to determine its natural frequencies and mode shapes by using analytical method based on Rayleigh-Ritz energy approach. To demonstrate the accuracy of this approach, the same plate is discritisated and analyzed using the finite element method. The natural and angular frequencies were computed and determined analytically and numerically by using ABAQUS finite element code. The convergency and accuracy of the numerical solution was examined. The effects of geometrical parameters and boundary conditions on vibrations are investigated. The results obtained showed a very good agreement between the analytical approach and the numerical simulations. Also, the paper presents simulations results of testing of the plate with passive vibration control.
Creativity of Religion Teachers as a Determinant of Students’ Creativity
Authors: Zellma Anna
Published: December 2020

Kreatywność nauczycieli religii jako determinanta kreatywności uczniów

Analizy podjęte w artykule mają na celu ukazanie znaczenia kreatywności nauczyciela religii w rozwoju kreatywności uczniów w toku lekcji religii. Punktem wyjścia uczyniono tezę, że kreatywność nauczyciela religii stanowi determinantę kreatywności uczniów. Takie założenie wymagało zastosowania metody analizy i syntezy. Analizie poddano dostępną literaturę przedmiotu. Na tej podstawie – w sposób syntetyczny –  najpierw scharakteryzowano tożsamość kreatywnego nauczyciela religii. Wskazano przy tym na jego cechy osobowe oraz kompetencje merytoryczne i metodyczne. W tym kontekście analizowano konkretne działania nauczyciela religii, które świadczą o jego kreatywności, a zarazem motywują uczniów do wielostronnej, twórczej aktywności. Wśród nich zwrócono uwagę na zastosowanie zróżnicowanych form organizacji pracy uczniów na lekcji religii, metody, techniki i środki dydaktyczne. Za istotne uznano pytania stawiane nie tylko przez nauczyciela, ale także przez uczniów. Zauważono też, że kreatywny nauczyciel religii dąży nie tylko do zewnętrznej aktywizacji uczniów, ale także wspiera ich w odkrywaniu wartości ewangelii, w nawróceniu i zawierzeniu Chrystusowi. W swojej pracy dydaktyczno-wychowawczej potrzebuje on odpowiedniej pomocy. Sam bowiem powinien nieustannie rozwijać się i formować oraz doskonalić warsztat metodyczny.
Językowa kreacja świętego Huberta na przykładzie miesięcznika „Łowiec Polski”
Authors: Janicka-Szyszko Renata
Published: December 2020

Celem artykułu jest próba językowej analizy kreacji św. Huberta w artykułach opublikowanych w latach 2015-2019 w „Łowcu Polskim”. W różnych gatunkowo tekstach: artykułach, sprawozdaniach, życzeniach, notatkach patron myśliwych został przywołany ponad 50 razy. Językowy obraz świętego Huberta kreują różne środki językowo-stylistyczne. Oprócz form nominalnych i werbalnych odnajdujemy frazeologizmy, porównania, zmetaforyzowane wyrażenia, wyrazy i zwroty typowe dla hierarchicznej relacji i kultury rycerskiej, terminologię zarówno religijną, jak i łowiecką. Analiza wskazuje, iż w wyekscerpowanych tekstach funkcjonuje pozytywny wizerunek opiekuna myśliwych. Święty Hubert troszczy się o nich, okazuje im swą łaskę, odgrywa decydującą rolę w czasie polowania, nagradza polujących powodzeniem w czasie łowów. W życiu myśliwych patron odgrywa znaczącą rolę, jest władcą nie tylko za życia polujących, ale i po ich śmierci, zaś oni służą mu wiernie.
Sporadic pregnancy loss and recurrent miscarriage
Authors: A. Coomarasamy  , A. J. Devall
Published: December 2020

Progesterone is essential for the maintenance of pregnancy, and progesterone deficiency is associated with miscarriage. The subject of whether progesterone supplementation in early pregnancy can prevent miscarriage has been a long-standing research question and has been investigated and debated in the medical literature for over 70 years. During this time, several different progestogens have been synthesised and tested for the prevention of miscarriage. In this article described the prior evidence alongside the latest research using micronized natural progesterone as well as synthetic progestogens, which were used to treat both recurrent and threatened miscarriage. The totality of evidence indicates that women with a past history of miscarriage who present with bleeding in early pregnancy may benefit from the use of vaginal micronized progesterone. The clinical implications of the findings are discussed.
Problems of the implementation of the principles of criminal proceedings in special consideration of the case
Authors: Rogava I.G. , Danilenko N.E.
Published: December 2020

The article examines the features of the operation of the principles of criminal proceedings, applied in a special order. The problems of compliance of this form of production with such principles of criminal proceedings as adversarial and equality of the parties, immediacy, orality, free assessment of evidence, publicity are called. Ways of solving the identified problems are proposed by making appropriate changes to the Criminal Procedure Code of the Russian Federation in the form of an indication in the verdict passed in a special court procedure, the analysis of evidence and their assessment by the judge, as well as limiting the range of cases in which it is possible to conclude a pre-trial cooperation agreement.
On the issue of the modern system of tax law
Authors: Cel'niker G.F. , Fityunina N.A. , Zvyaginceva S.A.
Published: December 2020

The article reveals the features of the tax law system, which is considered, on the one hand, as an Autonomous, separate branch of law in the system of branches of law of the Russian Federation, and on the other, as a derived category from the norms that determine financial law and, thus, are a sub-branch by their functional purpose. The criteria on the basis of which it seems appropriate to allocate institutions in the tax law system are highlighted. The General and special parts of tax law are characterized through the prism of their Conditioned norms.
Generation of optical signals carrying OAM based on vortex fiber-optic periodic structures
Authors: Gizatulin Azat R.
Published: December 2020

In this article, author considers the process of generation of fiber modes carrying orbital angular momentum (vortex modes) using chiral fiber Bragg gratings; in this context, the formation of vortex modes is carried out by converting thefundamental mode into higher order modes. Within the framework of the article, a generalized mathematical model of chiral fiber Bragg gratings is presented, which includes an arbitrary function of apodization and chirping, which makes it possible to calculate gratings that form vortex modes of a given order for the required frequency range with the required reflection coefficient. In addition, a matrix method for describing chiral fiber Bragg gratings is proposed, based on the mathematical apparatus of the coupled modes theory and scattering matrices. This matrix approach is convenient for describing complex and / or cascaded gratings. In addition, in this work, simulation of the considered fiber structures is carried out.
An Algorithm for Treatment of Cervical Pregnancy: Report of a Series of Eight Patients
Authors: Tarafdari Azam , Borna Sedigheh , Janatrostami Sheida , Farajzadeh Vajari Fatemeh
Published: December 2020

Being considered as an important life-threatening condition, Cervical Pregnancy (CP) is defined as the implantation and growth of the gestational sac in the endocervical canal. Due to high maternal mortality and morbidity expectant management is not recommended. There is no definite treatment for this complication. During this case series study, we usedan algorithm for CP treatment according to gestational age, presence of fetal heart activity, hemodynamic stability, and patients desire for future fertility in 8 patients. We used a combination of several modalities such as fetal heart reduction, systemic methotrexate, and uterine artery embolization to successfully treat all of them. Reproductivity ability of all patients has been reserved and 3 pregnancies including 2 terms and 1 preterm occurred during the follow-up period.