bluuebunny/crossref_metadata_2025 huggingface dataset:
Legal Protection of Competition in the Emerging Digital Markets
Authors: Egorova M. A. , Kozhevina O. V. , Kinev A. Yu.
Published: February 2021

At a new stage in the development of digitalization, the main challenge is the expotential growth of quantity, quality, diversity of links between citizens, organizations, development institutions and legal regulation, public authorities. Interrelations are dynamic and unstable due to a number of factors because of insufficient synchronization between all elements of socio-economic systems and institutions.

The paper examines topical issues of competition law in terms of legal regulation of digital markets. The authors provide for the legal interpretation of the digital market. Key aspects of legal regulation of digital markets are defined. The authors propose instruments of legal regulation of emerging digital markets for the Russian Federation. Their proposals are based on generalization of European experience and practice of the OECD countries.

The authors substantiate that widespread digitalization threatens to monopolize economic relations. And this is monopolization of a new, not classical character. Therefore, it is important to identify properly the forms and methods of legal protection of competition in specific digital markets.

Based on the results of the study, the authors conclude that the development of the digital economy and the formation of new market relations establish prerequisites for the improvement of antimonopoly regulation, legal rules unification for the protection of competition in global digital markets. Digital markets differ from traditional ones. Therefore, they need special legal regulation. The practice of antimonopoly regulation in the OECD countries should be considered in the context of their consistency with Russian legislative conditions.
Budgetary Regulation in the Context of Preventing the Consequences of the Spread of a New Coronavirus Infection in the Russian Federation
Authors: Tkachenko R. V.
Published: February 2021

The paper is devoted to the examination of issues related to the increasing importance of budgetary regulation for the proper functioning of a modern innovative society. The key role of the budgetary regulation in the financial process of the State is particularly acute in the context of systemic crises that include socio-economic consequences caused by the spread of a new coronavirus infection (COVID-19) in Russia. In the course of the study, the features of changes in the state financial policy caused by the above-mentioned crisis phenomena are highlighted. The paper describes various approaches to the interpretation of the budgetary regulation as a category of financial law, explores various types and legal forms of methods of the budgetary regulation, analyses mechanisms and the impact of the State on the budget system through the existing legal structure of the budgetary regulation. It is determined that the rules of financial law governing the whole complex of public relations concerning the distribution and redistribution of the national product between the levels of the budget system of the Russian Federation constitute the institution of financial law, namely: the budgetary regulation. The author concludes that the approach based on the concentration of basic powers in the financial field at the federal level significantly slows down the dynamics of development of economic activity in the majority of regions of Russia, while the need for breakthrough innovative development of Russian society determinates the expansion of long-term tax sources of income for regional budgets. In this regard, it is proposed to consolidate additional regulation for revenues gained by regional and local budgets in the form of targeted deductions from federal taxes on a long-term basis.
Breast cancer in adolescent and young adult Ivory coast women: epidemiological and clinical features and molecular subdivision
Authors: Aka Edele Kacou , Horo Apollinaire , Koffi Abdoul , Fanny Mohamed , Didi-Kouko Coulibaly , Nda Guy , Abouna Alain , Kone Mamourou
Published: February 2021

Background: To describe the anatomy and clinical features and then determine the histological and molecular profile of Ivorian women under 40 years.Methods: This is a retrospective multi-centre study descriptive and analytic performed over a period of 20 months. It involved 76 women on 355 selected in the Ivoirian cancer registry. An additional immunohistochemical analysis to assess hormone receptors and HER overexpression in a single unit.Results: Adolescents and young adults represented 20.3% of women with breast cancer. The average age of women was 35 years. (∂=3.4 years, 95% CI=[2.6415 to 4.1785]). 15.8% of patients had a good socioeconomic level with a stable job, well paid and 28.9% had a university degree. The discovery circumstances were a breast nodule (53%) followed by locoregional complications (21%) and breast self-examination (20%). The consultation delay was less than three months in 34.2% of cases. 78% of cancers were diagnosed in stage II and III. The most common histological subtypes were respectively RP (+) / Her (-) (41%) followed by triple negative (30%).Conclusions: This study showed that 20,3% of women under 40 years. The most tumors were classified as stage II and III of tumors at diagnosis. the most common histologic subtypes are the Luminal A (41%) and triple-negative (30%). This disease is more aggressive with a poor prognosis in this age group.
Severe malaria during pregnancy at the maternity ward of the municipal medical center of Ratoma, Guinea-Conakry
Authors: Diallo Mamadou H. , Baldé Ibrahima S. , Barry Alpha B. , Sylla Ibrahima , Diallo Fatoumata B. , Sagno Christine , Keita Namory
Published: February 2021

Background: Gestational malaria remains a major public health problem in malarious areas. The objectives of this work were to describe the socio-demographic, clinical, paraclinical, therapeutic and prognostic characteristics of patients who developed severe malaria during pregnancy.Methods: It was a descriptive prospective study carried out in the maternity ward of Ratoma municipal medical center, which was carried out over a period of 6 months from 01 October 2018 to 31 March 2019. This study involved all pregnant women who had presented severe malaria according to WHO criteria.Results: The incidence of severe malaria during pregnancy was 7%. The average age of our patients was 22.4 years with extremes of 15 and 47 years. The symptomatology that motivated the consultation was variable, the most frequent signs were: hyperthermia (100%), headache (79%), vomiting (99%). The general examination at admission objectified a fever with an average temperature of 39°C with extremes of 38-40.4°C. All patients had a positive rapid diagnostic test (RDT) as well as their thicker drop. The hemogram revealed the existence of a more or less severe anemia in 89.9% of cases. All patients were treated with parenteral quinine (100%). Maternal lethality was 1.8%. After severe malaria, 70 patients (62.5%) carried their pregnancy to term and 40 delivered an eutrophic child (35.71%), 30 (26.78%) delivered a hypotrophic child, 20 (17.85%) had a spontaneous abortion, premature delivery was observed in 10 patients (8.9%), and fetal death in utero was observed in 12 patients (10.71%).Conclusions: All patients had received parenteral quinine curative therapy. Maternal and perinatal complications were common. To improve this prognosis, intermittent preventive treatment and the use of insecticide-treated nets, which are the most effective prevention method at this time, must be further promoted in anticipation of the much hoped-for vaccine.
Prediction of chronic endometritis using 2D and 3D transvaginal ultrasound examination in infertile women
Authors: Said Tamer H.
Published: February 2021

Background: Chronic endometritis is a pathology of continuous and hidden inflammatory process characterized by the infiltration of plasma cells into the endometrial stroma. Transvaginal bi-dimensional ultrasonography is in need to be evaluated in prediction of chronic endometritis in women with delayed pregnancy or infertility as a non-invasive, cheap, acceptable, and safe tool of diagnosis. Previously, 3D ultrasonography had been described as a novel for diagnosis of chronic endometritis and correlation of the images with hysteroscopic view results. Objectives were to predict the presence of chronic endometritis in infertile women during their reproductive age through examination of the uterine cavity by 2D and 3D transvaginal sonography to elicit proposed ultrasonographic signs of endometritis.Methods: This observational prospective study took place at Shatby university hospital, Alexanderia universtiy and was done on two hundred infertile women. Women were assigned for ultrasonographic evaluation as a part of pre-treatment assessment. Detailed history was taken from all the patients included in the study. General examination and routine laboratory investigations were done according to hospital protocol. All patients were asked to do ultrasound examination immediately postmenstrual and at the time of ovulation. We used 2D transvaginal ultrasound to predict chronic endometritis, we searched for 1) presence of persistent endometrial focal or diffuse thickening postmenstrual, 2) presence of focal echogenic foci in the triple line endometrium during ovulation. The 3D ultrasonography was done as confirmatory examination. Office hysteroscopy as the main method for diagnosis of endometritis was performed to all patients either after menses if the first sign was detected or at the time of ovulation if the second sign was detected.Results: The combination of persistent endometrial shreds and/or endometrial focal thickening or echogenicity can significantly predict presence of endometritis as the sensitivity and specificity of the combination were 94.90 and 81.37, respectively.Conclusions: Bi-dimensional ultrasonography done to infertile women at 2 phases of the menstrual period can predict the presence of chronic endometritis as a subtle cause of infertility and might be an indication for hysteroscopic evaluation for these patients.
Birth and emergency preparedness and associated factors among postnatal mothers at Base Hospital Balangoda, Sri Lanka
Authors: Perera Nadeeka , Goonewardena Sampatha E.
Published: February 2021

Background: Birth and emergency preparedness is a cost effective and evidence based intervention recommended by the current WHO maternal care model and used in maternal care package in Sri Lanka. The aim of the study was to describe the birth and emergency preparedness and its associated factors among postnatal mothers at Base Hospital, Balangoda, Sri Lanka.Methods: A descriptive cross sectional study was conducted among 427 postnatal mothers delivered after completion of 37 weeks of period of amenorrhoea. Participants were recruited by systematic sampling. Data was collected using a pre tested interviewer administered questionnaire. Data was analysed using SPSS version 21. Descriptive statistics and multiple logistic regression analysis were done to calculate the adjusted Odds ratio and 95% confidence interval. A probability of p<0.05 was considered significant.Results: Majority 84.3% (n=338) had registered at antenatal care before 12 weeks and 89.3% (n=358) had received domiciliary care during antenatal period. Majority of the mothers (59.4%,n=238) were well prepared for birth and emergencies. Univariate analysis showed a significant association with well preparedness were ethnicity (p<0.001), religion (p<0.001), married mothers in union (p<0.05), higher educational qualifications by both partners (p<0.01), receiving adequate maternity social support (p<0.001), received domiciliary care by PHM (p<0.05) and participation at antenatal classes by mother (p<0.05). After adjusting for confounders, attained higher educational qualifications by mother (OR=1.89, 95% CI=1.27-2.93) and having received social support (OR=2.64, 95% CI=1.43-4.87) were significant factors associated with birth preparedness.Conclusions: The overall preparedness for birth and emergencies was satisfactory. Modifiable significant associated factors need due attention.
Factors affecting stillbirth: prospective study
Authors: Jadhav Balaji , Khade Shweta Avinash , Shinde Ganesh , Chandan Shilpa
Published: February 2021

Background: Stillbirth is defined by WHO as the birth of a baby with a birth weight of 500 gm or more, 22 or more completed weeks of gestation or a body length of 25 cm or more, who died before or during labour and birth.Methods: This was prospective observational study of factors affecting stillbirth was conducted in tertiary hospital for a period of 1 year from 1st June 2014 to 31st May 2015. During the study period, 200 parturient of gestational age 28 weeks or more and fetal weight 1000 gm or more with or without medical disorders were included.Results: The total number of births during study period was 11,951. Stillbirth rate in the present study was 16.73 per 1000 births. Most of stillbirths were seen in the antepartum period (76%) when compared to intrapartum period (24%). Maximum stillbirths occurred in gestational age of 36 weeks and above (52%) and fetal weight between 2001-2500 gm (27.50%). Patients with inadequate antenatal care, less than three visits had 86% stillbirths.Conclusions: Proper antenatal care, prompt referral services and availability of emergency obstetric care will provide a pivotal role for reduction of stillbirths.
A comparative study of intravenous hydration and amnioinfusion for IUGR associated with oligohydramnios in pregnant women and fetomaternal outcome
Authors: Kumari Garima
Published: February 2021

Background: Ultrasound assessment of amniotic fluid has significant implication in obstetric care and it has become an integral and important component of pregnancy assessment.Methods: A prospective study done in all pregnant women (n=30) who had been diagnosed with oligohydromnios (with AFI<8 by Phelan’s method) by ultrasonography will be attending in obstetric gynecology department SMS Medical College, Jaipur will be selected according to inclusion or exclusion criteria (as per sample size) after written informed consent.Results: Higher incidence of preterm delivery in the i.v. infusion group as compared to the amino acid group and difference was significant (p value <0.05). In amnioinfusion group 3 cases (20.0%) had LSCS and in i.v. infusion group 6 cases (40.0%) had delivered by LSCS. The distribution of delivery mode did not differ significantly across two intervention groups (p value >0.05). Significantly higher proportion of cases from amino acid group had larger birth weight and significantly higher proportion of cases from i.v. infusion group had smaller birth weight (p value <0.001).Conclusions: This study points towards the use of intravenous hydration and amnioinfusion in increasing the liquor in oligohydramnios associated with IUGR and proves useful in reducing perinatal morbidity and mortality.
Prevalence and risk factor analysis for postpartum depression: a cross sectional study at tertiary care center, Mangalore
Authors: Kamath Vatsala , Ajila Disha , D. Shashirekha H.
Published: February 2021

Background: The overall pooled estimate of the prevalence of Postpartum depression in Indian mothers is 22%. In India, women who deliver at a health facility often stays less than 48hrs after delivery and this leaves little opportunity for health personnel to counsel the mother and family members on the signs and symptoms of Postpartum depression (PPD) and when to seek care. So, it is important to screen the postpartum woman for depression. Edinburgh Postnatal Depression Scale is used as an effective tool to assess the level of postnatal depression. The objective of the study was to assess the prevalence and risk factors associated with postpartum depression in the postnatal mothers using EDPS scale.Methods: This study was conducted at A. J. Institute of Medical Sciences and Research Center from January 2019 to May 2020. A total of 950 postnatal mothers were interviewed using Edinburgh Postnatal Depression Scale.Results: A total of 950 cases were studied. Prevalence of Postpartum depression was 15.78%. Increased incidence was seen in the primigravida (12.2%) compared to multigravidas (3.57%). This study showed 1.89% mothers belonging to upper middle class, 5.05% belonging to lower middle class had PPD and 7.26% belonging to upper lower class and 1.57 % patients belonging to lower class had PPD. In our study, 9.26% patients who underwent normal vaginal delivery had PPD and 6.52% of patients who underwent lower segment caesarean section had PPD. In the present study, it was found that 1.05% mothers having IUD babies and 5.2% (96/950) mothers who required NICU admission developed PPD.Conclusions: In this study, the prevalence of postpartum depression was 15.78%. Risk of PPD is more with primigravida, belonging to lower middle class status, mothers who had NVD and mothers of IUD babies. Postpartum depression screening should be an integral part of postnatal care using EPDS scale. A multidisciplinary approach including obstetrician and psychiatrists and counsellor can jointly take care of the depressed mothers. Early screening of the women may reduce the adverse outcomes among both mother and child. Proper counselling should be done to all the pregnant women and the family members for the birth preparedness.
Mifepristone safety and efficacy in preinduction of labor: an observational study
Authors: Tejaswi Thota Sai , Bidri Shailaja R.
Published: February 2021

Background: When the continuation of pregnancy adversely affecting the mother and fetus, termination of pregnancy is planned. Mifepristone as a method of pre-inducing agent in late pregnancy by increasing sensitivity of the uterus to the actions of prostaglandins and increasing uterine contractility. Objective of this study is to know the efficacy of mifepristone as a preinduction cervical ripening and induction of labor.Methods: In this prospective randomized study, 130 pregnant women are included and divided into two groups i.e. study group(n=65), has received tab mifepristone 200 mg and control group (n=65) has not received any drug.  After the end of 24 hours, Bishops score in both the groups are assessed and those not in labor or with unfavourable cervix are administered with intracervical dinoprostone gel every 6 hourlies for maximum of 3 doses or until pregnant woman entered into active labor. Statistical analysis regarding improvement in Bishops score, induction active phase interval, induction delivery interval is observed.Results: After 24 hours, observation in the mean Bishops score has showed significant improvement in the study group (72.33%), when compared to control group (54.58%). % woman has gone into spontaneous labor in study group (61.5%), and in control group (75.4%). Induction to active phase time duration is less in study group with mean (10.53), and in control group (17.4). Induction to delivery time duration is also less in study group with mean (15.100) when compared to control group (22.100). 67.7% of patients has delivered by vaginally in study group, and in control group 41%.Conclusions: Tab. mifepristone 200 mg has a pre inducing agent for cervical ripening, shown better improvement in Bishops score within 24-48 hours and decreases time duration from induction to active phase and induction to delivery.
Assessment of the pregnancy rates using sequential day 3 and day 5 embryo transfer in IVF/ ICSI patients
Authors: Agrawal Priti , Agrawal Rishi , Lobo Anandi
Published: February 2021

Background: To assess the pregnancy rates using sequential day 3 and day 5 embryo transfer in IVF/ ICSI patients.Methods: This prospective study was conducted in Aarogya Hospital and test tube baby Centre, Raipur from 1st January 2013 to 30th November 2019. Total 100 patients undergoing IVF/ICSI in the study period were offered sequential transfer.Results: Our fertilization rates were 80% with 85.7% grade I embryos on day 3. Blastocyst formation rate was 71.42%. Cycle cancellation rates were nil. Clinical pregnancy rates per retrieval cycle were 50% and implantation rates were 24% with acceptable multiple pregnancy rates of 12%.Conclusions: We advocate that this technique is useful in all patients having good quality embryos in adequate number for double transfer as this optimizes the chance of selection of the most viable embryo for transfer which is probably the key for a successful IVF program.
Maternal and neonatal outcome in premature rupture of membranes: a retrospective study
Authors: Rajakumar Shery Angel , Myneni Sindhura , Samuel Ajay Nickson
Published: February 2021

Background: Premature rupture of membranes (PROM) is one of the most challenging and controversial obstetric dilemma which occur even in low risk pregnancies. This study was done to analyse the maternal and neonatal outcomes in PROM cases.Methods: This was a retrospective study conducted in the department of Obstetrics and Gynaecology at Chettinad Hospital and Research Institute, during a period of 3 years from August 2017 to August 2020. All the women who admitted with PROM were included in the study. The data regarding parity, gestational age, number of fetuses, presentation, duration of PROM, PROM to delivery interval, mode of delivery, weight of the baby, NICU admission was collected from the hospital records and analysed.Results: A total of 115 cases of PROM were recorded. High incidence is found in the age group of 20-30 years. Among them 73.04% were admitted at term. 71.3% were primigravida. 58.26% of them delivered vaginally where as 41.74% delivered by LSCS. Majority of them admitted within 6 hours of PROM. Majority of them delivered within 12 hours of PROM. High APGAR scores in majority of the cases. Most of the babies had birth weight >2.5 kg. 16 babies were admitted in NICU. There was no maternal mortality in our study though we had one neonatal mortality.Conclusions: Careful identification of present or impending complications and individualizing the management based on gestational age and presence of complications holds good in optimising fetomaternal outcome in PROM.
Depression, anxiety and stress among COVID positive pregnant women
Authors: Kurian Simi , S. Ajith , Raghavan Malini
Published: February 2021

Background: Impact of the news that patient is covid positive may increase the risk of depression and anxiety among the vulnerable population such as pregnant women. Aims of the study were to estimate the prevalence of depression, anxiety and stress among covid positive pregnant women. To evaluate the demographic and obstetric factors contributing to the psychological manifestations in covid positive pregnant women.Methods: A cross sectional descriptive study was conducted at a tertiary hospital of North Kerala from July to August 2020. The demographic and factors were recorded and DASS 21 self-reported questionnaire was used to assess depression, anxiety and stress.Results: We found that using the DASS 21 scoring system, 37.5% out of the 120 study subjects were having psychological symptoms either of depression, anxiety or stress. Depression was seen in 32 (26.7%), anxiety in 29 (24.2%) and stress in 14 (11.7%) of the study participants. The psychological symptoms of depression and anxiety were more pronounced in those with low education, unemployed and in the first and third trimester of pregnancy.Conclusions: The current study shows that COVID-19 positive pregnant women have a high prevalence of depression and anxiety. Our findings can be used to formulate psychological interventions to improve mental health and psychological resilience during the COVID-19 pandemic.
Prospective study to assess the obstetric and perinatal outcome in fibroid complicating pregnancy
Authors: Mhatre Shalaka Dilip , Vazirani Ayushi , Selvam Vidhya
Published: February 2021

Background: Fibroids are the most common benign tumour of the uterus. Complications ranges from approximately 10-40% in fibroid complicating pregnancy. The objective of the study was to assess obstetric and perinatal outcomes in fibroid complicating pregnancy.Methods: A prospective study was carried out over a period of 01 June 2019-30 October 2020 on 42 women diagnosed with fibroid uterus in pregnancy. The study was conducted in the Obstetrics and Gynaecology department of Sree Balaji Medical College and Hospital, Chennai. Routine basic investigations were done. Ultrasonogram was done at booking visit and during subsequent visits to assess the increase in the size of the fibroid and degeneration and other obstetric complications such as malpresentation and placenta previa.Results: Major proportion was in the younger age group of 25-35 years. Fibroids were more frequent in multigravidae 34 (80.96%), and primigravidae were 8 (19.04%). The reported incidence of fibroid in pregnancy ranges from 0.01%-10.7%. 27 (64.28%) women were asymptomatic during pregnancy. Out of 42 women, 10 (23.80%) were known cases of fibroid became pregnant, remaining 32 (76.19%) were diagnosed as having fibroid during routine antenatal visits. 2 women (22.22%) had pain, 3 of them (7.14%) had preterm labor, 3 (7.14%) had spontaneous miscarriage, 6 (14.2) had threatened abortion, and 1(2.3%) had abruption placentae and 1(2.5%) had placenta previa. Out of 39, 27 (69.23%) women had vaginal delivery of which 2 (7.40%) women had assisted vaginal delivery. Lower segment cesarean section done in 12 women (30.76%). 32 babies delivered (82.05%) appropriate for gestational age infants, 3 (7.69%) had LBW, and 4 (10.25%) were IUGR.Conclusions: Fibroid complicating pregnancy are associated with complications during the antepartum, intrapartum, and postpartum period hence a regular follow up and evaluation is a must. Most pregnancies with fibroids are asymptomatic but may adversely affect the obstetric and perinatal outcome.
Outcome of expectantly managed small-for-gestational-age pregnancies with normal Doppler parameters- a prospective cohort study
Authors: Mishra Sneha , Agarwal Krishna
Published: February 2021

Background: SGA foetuses with normal Dopplers are not at risk of IUD. However, there is lack of consensus about timing of delivery of SGA foetuses. Clinicians commonly induce all SGA pregnancies at 37 weeks. Expectant management of SGA foetuses beyond 37 weeks is not well studied.Methods: We followed up women with clinically suspected growth restriction with foetal biometry, Doppler and biophysical profile. Pregnancies with foetal AC between 10th to 3rd centile with normal Dopplers were recruited in the study group. The women were allowed to go in spontaneous labor till 39+6/7 weeks or were induced at 39+6/7 weeks. The outcome of such cases was compared with controls who were induced at 37+0/7 weeks.Results: Spontaneous labor occurred in 42% subjects in study group whereas in control group all were induced. Mean gestation at delivery in the study group was increased (39.57±0.71 versus 37.0±0.0, p value <0.001). Almost 81% of the subjects in study group delivered after 39 weeks. The rate of caesarean section was significantly lower in study group (3% versus 22%, p value-0.024). Also, the risk of intrapartum foetal distress was lower in study group (3/36 versus 1/36).The mean birth weight in the study group was higher (2426.5±154.1 gm versus 2297.9±101.4 gm, p value <0.001.Conclusions: Expectant management of SGA pregnancies with normal Doppler parameters leads to a significant increase in gestational age at birth and the mean birth weight and a significant reduction in caesarean section rate.
Pregnancy with adnexal masses: an institutional experience and review of the literature
Authors: Bahadur Anupama , Sri Modalavalasa Swetha , Mundhra Rajlaxmi , Chawla Latika , Ajmani Megha , Afreen Tuba , Kumari Payal , Sharma Shloka
Published: February 2021

Adnexal masses in pregnancy are not uncommon. We prospectively analysed all cases with adnexal masses detected during pregnancy presented to our antenatal outpatient department from January 2019 to August 2020. Herein we report six such cases with their pregnancy outcome. Among the 6 cases, 3 were diagnosed during first trimester of pregnancy, 2 in third trimester and 1 was found incidentally during caesarean section. The mean age of the cases was 25.33+2.33 years. Two cases underwent oophorectomy and rest had ovarian cystectomy. In terms of histopathological findings, one was endometriotic cyst, two were borderline tumors (mucinous and serous variety) and three were mature cystic teratomas. There was no perinatal mortality, but 2 babies required NICU admission for observation. Mature cystic teratoma was the most common adnexal mass detected in our series. Timing of surgery depends on urgency of situation. Asymptomatic/small/unilocular cyst with low suspicion should be kept under observation and follow up throughout pregnancy.
Surgically assisted medical management of interstitial ectopic pregnancy
Authors: Devi Lekshminarayanan Thulasi , Kumar Sangeet
Published: February 2021

An interesting case of interstitial ectopic pregnancy in a primigravida managed by surgically assisted medical management with intracardiac instillation of KCl and methotrexate. It was diagnosed based on transvaginal and transabdominal ultrasound and procedure was done as USG guided under local anaesthesia in OPD by transabdominal route and immediate disappearance of foetal cardiac activity was noted on Doppler. She was followed up with serial sβ-hCG and TVS. She had no post procedure complication and was discharged on day 2 of procedure.
Impact of chronic kidney disease on fetomaternal outcome: a case report
Authors: Khairnar Neha , Bora Ananya , Bava Amarjeet Kaur
Published: February 2021

Chronic kidney disease is a heterogenous group of disorders resulting from anatomical and physiological alterations in the kidney. Pregnancy might accelerate the renal disease-causing progression of renal failure, development of preeclampsia, anemia. This increases the risk of adverse fetomaternal outcomes including prematurity, fetal growth restriction, fetal deaths and development of hypertension, nephrotic syndrome, renal failure in the mother. Chronic kidney disease affects approximately 3% of pregnant women. This study was carried out to assess the course of chronic kidney disease in pregnancy and the effect it has on the fetal outcome. A case of chronic kidney disease presenting to the OBGY emergency unit was studied. a detail history was taken and examination was done. Baseline antenatal investigations were carried out. Special tests including renal Doppler, ophthalmoscopic examination, ECG, were done to assess the renal function. Treatment was started for control of hypertension and further progression of the disease. Pregnancy has adverse outcome when associated with acute kidney injury. Maternal hypertension and proteinuria are the major predisposing factors. Prematurity is one of the commonest fetal complications apart from growth restriction. Chronic kidney disease in pregnancy requires a multidisciplinary approach involving experienced obstetricians, nephrologists, radiologists, intensivists and neonatologists. The etiology, degree of renal dysfunction, development of additional obstetric complications determines the prognosis. Supportive therapy in the early course of the disease and timely definitive management as per the etiology is found to improve the feto-maternal outcome.
Isolated fallopian tube torsion
Authors: N. S. Bandamma , Prabhudev Prema , . Pooja
Published: February 2021

Fallopian tube torsion is a rare cause of acute abdomen, occurring commonly in females of reproductive age. It lacks pathognomonic symptoms, signs, or imaging features, thus causing delay in surgical intervention. Current study report one case of isolated fallopian tube torsion in adolescent girl. In this case a 13 year old patient presented with acute pain in the right iliac region associated with 3 episodes of vomiting for one day and severe tenderness on examination. Laparoscopy revealed right sided twisted fallopian tube associated with gangrenous fimbrial end. The tube was untwisted and salpingectomy done. Salpingectomy was done as the tube was gangrenous. Fallopian tube torsion, though rare, should be considered in women of reproductive age with unilateral pelvic pain. Early diagnostic laparoscopy is important for an accurate diagnosis and could prevent the rupture of the gangrenous tube.
A case benign struma ovarii
Authors: Paul P. G. , Annal Anjana , Chowdary K. Anusha , Paul George , Shilotri Manali
Published: February 2021

Struma ovarii is a rare ovarian tumor and a monodermal variant of dermoid tumors of the ovary in which thyroid tissue components constitute more than 50% of the mass. Struma ovarii accounts for 0.5–1.0% of all ovarian tumors and 2-5% of ovarian teratomas. Most cases are benign, but malignant transformation is found in a small percentage. It usually presents as a unilateral adnexal mass at fifth and sixth decades of life, with symptoms like other ovarian tumors. The definitive diagnosis is made by histological examination. Adnexectomy remains the standard line of treatment for benign disease. A 41-year-old lady presented with pain in abdomen for 3 months. On ultrasonography and MRI, a multiloculated solid cystic lesion of 7×6 cm with internal echoes was found in the right adnexa. Laparoscopic right adnexectomy was performed. Histopathology was consistent with struma ovarii. Due to its vague clinical manifestations and diverse imaging characteristics, pre-operative diagnosis is challenging.
Health literacy level in rural Bayelsa, Nigeria’s Niger Delta Region
Authors: Zibima Soupriye B. , Ennag Kingsley , Oniso Juliet Imawaigha , Moses Eunice B.
Published: February 2021

Background: Health literacy data is critical for enhancing self-care abilities and improving healthcare outcomes. However, information on health literacy level in rural Bayelsa, Nigeria’s Niger Delta region, is dearth. Objective of the study was to determine health literacy level of rural dwellers utilizing the services of Primary Healthcare Centers in rural Bayelsa.Methods: A total of 800 participants were randomly selected through multistage sampling procedure in a cross-sectional survey. Demographic data assessment questionnaire and the Brief Health Literacy Screening Tool were used for data collection. Descriptive statistics was done to obtain summaries of demographic and health literacy data while independent samples t-test, and one-way between group analysis of covariance was conducted to determine area-based differences in health literacy scores and the impact of frequency of health center visit on participants’ health literacy scores, respectively.Results: Health literacy assessment showed that, 570 (71.25%) participants had limited health literacy; 142 (17.75%) had marginal health literacy, and 88 (11.00%) had adequate health literacy. Health literacy scores were significantly higher in the upland (M=22.08, SD=8.64), than riverine areas of rural Bayelsa (M=18.66, SD=8.46; t (800)=8.02, p=0.00, 2-tailed). Frequency of health center visit significantly accounted for 20% of the variance in participants’ health literacy scores (F (2, 796) = 95.72, p=0.00, eta squared=0.20)).Conclusions: Health literacy level is low, and indicates a public health emergency. Rural educational development and modification of rural healthcare communication pattern may reduce health illiteracy and its attendant effect.
Knowledge, attitude, and practices towards COVID-19: a cross-sectional study among nursing and midwifery students in Jalingo, Nigeria
Authors: Inegbenosun Hope , Azodo Clement Chinedu , Anionye John Chukudi , Inegbenosun Collins Usunobun , Njoku Obinna Chukwunwike
Published: February 2021

Background: The coronavirus disease (COVID-19) infection rate and mortality among Nigerian health care workers appear to be on the increase. Aside from health workers, it has caused millions of infections and deaths worldwide.  This study determined the level of knowledge, attitude, and practices of nursing and midwifery students towards COVID-19 in a North-Eastern Nigerian state.Methods: A total of 156 respondents were involved in this institutional-based cross-sectional study, conducted after the lockdown period. A total of 17 questions were used to assess the KAP with knowledge appraised with 12 questions, attitudes with 2 questions, and practices with 3 questions.Results: The majority of the students (53.80%) possessed a good level of knowledge regarding COVID-19, while 40.4% had fair knowledge regarding COVID-19 with only 5.80% having poor knowledge of COVID-19. The mean knowledge of COVID-19 in this study was 9.40±1.353 with an overall 78% correct answer rate. A vast majority of the respondent (82.7% and 98.1%) had strong confidence in Nigeria and believed that the pandemic will soon be over, respectively. Only a few avoided large gatherings of people (30.8%) with the vast majority reporting to have worn a mask when going out (84.6%) and washing their hands with running water and soap frequently as recommended (73.1%). In multiple logistic regression analyses, the COVID-19 knowledge score (OR: 0.39-0.40, 95%CI: 0.26 – 0.62, P<0.05) was significantly associated with a lower likelihood of negative preventive practices towards COVID-19.Conclusions: The participants in this study showed good knowledge, positive attitudes, and good practices toward COVID-19. There is still a need to strategize and implement periodic educational interventions and training on infection control practices among healthcare workers including students.
Socio-demographic factors influencing practice and awareness of exclusive breastfeeding benefits among women of reproductive age attending maternal and child health clinic in tudor sub county hospital
Authors: Machila Consolata Mandi , Karonjo Jane , Mogere Domnic , Kariuku Peterson
Published: February 2021

Background: Knowledge of exclusive breastfeeding (EBF) among women is essential when promoting optimal breastfeeding practices. Breastfeeding is recommended for the first six months of life and continuation of breastfeeding and adequate complementary foods for up to two years of age or beyond.Methods: A descriptive cross-sectional study design was used. This study utilized a mixed method approach (qualitative and quantitative).Results: Four socio-demographic factors were found to be influencing the practice of exclusive breastfeeding. Those include child gender, level of education, marital status and parity. Two socio-demographic factors were found to influence awareness of the benefits of EBF. Those are Level of education and Occupation.Conclusions: The government should improve on the level of education of women in the area. Increase in number of educated women.
The plight of menstruating secondary school-girls: a wake-up call for parents and the school system
Authors: Metta Emmy , Mwita Hellen , Leshabari Melkizedeck
Published: February 2021

Background: This study assessed secondary schoolgirls’ menstruation experiences and the appropriateness of the school environment in fostering menstrual hygiene management in Tanzania’s rural settings.Methods: A cross-sectional study was conducted among 506 secondary schools girls from Mara Region, Tarime district in Northern Tanzania. Self-administered questionnaire were used for generating data which was analysed using SPSS version 20.Results: The age at menarche for the 506 secondary schoolgirls in the study ranged from 9-17 with a median age of 14 years. Less than a third (31.6%) were informed about menstruation and how to manage it before the first experience. Mothers were the first source of information to 50.2%of the girls. Slightly more than a half (51.4%) were scared and 43.3% were uncomfortable about the experience when it first occurred. More than half (54.8%) missed school for two days and 18% could not go to school for four or more days during menstruation. Almost three-quarters (73.5%) did not have access to sanitary pads. None of the schools had suitable and appropriate WASH facilities to support girls during menstruation.Conclusions: Secondary school girls in Tarime district experience various challenges during their menstruation. Improved awareness and knowledge on menstruation, enhanced access to sanitary and WASH facilities at the school environment would improve menstrual hygiene management among secondary schoolgirls and boost their school attendance and participation in education generally.
Smokeless tobacco and its dependence among the urban-slum population of Jodhpur city
Authors: Joshi Vibha , Chakraborty Sourabh , Joshi Nitin Kumar , Bajaj Komal , Sati Bhawana , Purohit Anil
Published: February 2021

Background: Socio-economic status can be an important determinant for patterns of tobacco consumption and its related health risks. Easy availability and affordable price may lead to the indulgence of smokeless tobacco; this deprived the section of society towards addiction of smokeless tobacco. Therefore, this study was conducted to ascertain smokeless tobacco use and its dependence in urban slum population of Jodhpur city.Methods: A cross-sectional survey was conducted in the urban-slum population of Jodhpur in 2019. A cluster sampling strategy was used to collect data from 1200 participants in different slums of Jodhpur city. The semi-structured questionnaire was used to obtain information on tobacco usage and willingness to quit.Results: Out of surveyed 1200 participants, 48.5% were males and 51.4% were females. 65.7% of the tobacco users reported in study population. Among tobacco user’s majority were using smokeless tobacco (75.4%), followed by 14.8% dual tobacco users and 9.8% were smoking tobacco. Out of female and male tobacco users, 95% females and 86.3% males were using smokeless forms of tobacco respectively. The frequency of daily tobacco use, time of tobacco chewing, duration of tobacco use was significantly associated with gender. No significant association was found between willingness to quit and gender.Conclusions: Smokeless tobacco was prevalent as compared to smoking form in urban-slums of Jodhpur city. Younger population and women were more attracted towards smokeless tobacco and willingness to quit tobacco was equally prevalent among males and females. An effective health education strategy for tobacco cessation should be designed according to age and gender of urban-slums.
Knowledge, practices and health seeking behaviour regarding dengue among household in an urban slum of Visakhapatnam, Andhra Pradesh
Authors: Konar Amrita Kumari , Manasa Rangala Venkata
Published: February 2021

Background: Dengue/dengue hemorrhagic fever is an emergent disease in India. It is a mosquito-borne viral disease. The aim of this study is to assess the knowledge, attitude and practice regarding dengue among households in urban slum area and to find out the health seeking behavior of respondent during first episodes of fever. Methods: This study was a descriptive cross sectional study undertaken in field practice area of UHTC of GITAM institute of medical science, Visakhapatnam, Andhra Pradesh. The sampling technique was two stage simple random sampling. Face-to-face interview based on a pre-designed and pretested questionnaire. The data was compiled and analyzed.Results: Out of total 262 individual were interviewed, 69.8% were aware about dengue. The major source of information was TV/radio (74.4%). The most common health seeking behaviour for first episode of fever was nearby UHTC and then government hospital.Conclusions: The knowledge and awareness regarding dengue was satisfactory in the study population but the knowledge about the mode of transmission and breeding habit is still lacking. More awareness campaign and health education will improve.
Attitude towards childhood vaccination among parents in a rural area of Trivandrum district
Authors: Girija Nithya , Sreelatha Deena Divakaran , Vasanthamani Benny Purandaran , Sukumaran Anil Bindhu , Jose Regi , Leelavathy Manju , . Divija , Raja Ramiz
Published: February 2021

Background: Vaccines are simple and widely accepted as one of the most important medical strategy of modern world in the prevention of morbidity and mortality. In order to ensure the protective benefits of vaccines, it is essential that the vaccine coverage should reach between 80-100% of a population, with required coverage dependent on the concerned vaccine and the illness that it is designed to prevent. Vaccine hesitancy is defined as the reluctance to be vaccinated or have one's children vaccinated. In this study, we assess the attitude of parents towards childhood vaccinations and the prevalence of vaccine hesitancy among parents in a rural area in Thiruvananthapuram district.Methods: A cross-sectional study was carried out among parents of children below the age of 15 years, who are residents of a rural area in Thiruvananthapuram district. Data was collected using the parents’ attitude about childhood vaccination (PACV) survey, with the consent of the participants. The collected data entered into MS Excel and analysis was carried out using SPSS 20.Results: Out of 100 participating parents, 14 (14%) parents were concerned about the adverse events following immunization (AEFI). At the same time, the maximum score obtained on the PACV scale was just 24 out of 100. Further, vaccine hesitancy among the parents was found to be only 2 (2%).Conclusions: There is good vaccine acceptance among the parents residing in a rural area, even though many are from low socio-economic status.
An observational study on prevalence and determinants of PCOS in women presenting with acne vulgaris to a tertiary care hospital in North India
Authors: Chandra Mini , Garg Palak , Vats Koshinder , Tibrewal Abhishek O.
Published: February 2021

Background: Acne vulgaris is an inflammatory disease of pilosebaceous gland that usually affects people from puberty to young adulthood. Apart from being a dermatological condition, acne is now recognised to be related to a plethora of systemic disorders, notably endocrinal abnormalities, like Polycystic Ovarian Syndrome (PCOS). We conducted this study with the aim of finding the prevalence and determinants of PCOS among patients presenting with acne vulgaris.Methods: In this prospective observational study, 100 women were selected who presented with acne, to the out-patient dermatology department of our hospital. The study subjects were 14 to 36 years old, non-pregnant females, who agreed to be a part of the study. PCOS was diagnosed using Rotterdam criteria. Statistical software (SPSS version 22) was used for the statistical analyses.Results: Out of the 100 study subjects, 81 (81%) had PCOS and 19 (19%) did not. The subjects who had PCOS were older (Median of 22 years vs 20 years), higher FSH levels (Median of 5.8 vs 3.2), higher LH/FSH ratio (Median of 0.7 vs 0.6), and higher DHEA levels (Median of 285.5 vs 160.3), though these differences were not statistically significant. The PCOS group was more likely to be suffering from irregular menses (OR, 1.51; 95% CI: 0.5-4.5, p value 0.46), weight gain (OR, 1.02; 95% CI: 0.37-2.7, p value 0.97), and hirsutism (OR, 1.17; 95% CI: 0.43 - 3.24), as compared to the non-PCOS group. However, PCOS was not significantly associated with age, duration of acne, fasting blood sugar levels, HOMA-IR, or levels of hormones like FSH, LH, Testosterone, DHEA, and Insulin.Conclusions: The study concludes a high prevalence of PCOS among acne patients. All women with acne should be considered for underlying PCOS and asked about their menstrual patterns and examined for other sign of hyperandrogenism.