bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence Evaluation Relating to the Public Disclosure of the Community Design on the Internet
Authors: Kropiwnicka Magdalena
Published: November 2021

The issue of public disclosure of the design is regulated in Article 7 of Council Regulation (EC) no. 6/2002 of 12 December 2001 on Community designs. Pursuant to this provision, a design shall be deemed to have been made available to the public if it has been published following registration or otherwise, or exhibited, used in trade or otherwise disclosed, except cases where these events could not reasonably have become known in the normal course of business to the circles specialized in the sector concerned, operating within the Community. The design is made available to the public in a situation where these events could be known in the course of normal professional activity in an environment specialized in a given sector, operating within the Community. The list of methods of public disclosure contained in Article 7 of Council Regulation (EC) no. 6/2002 is not a closed catalog. Disclosure of the earlier design on the Internet causes difficulties in assessing whether it meets the conditions required for public access, i.e. whether the design could reasonably have become known in the normal course of business to the circles specialized in the sector concerned. Moreover, the disclosure of the design on the Internet generates problems of evidence related to proving the precise date of its disclosure to the public. The article analyzes the jurisprudence of the European Union Intellectual Property Office (EUIPO) and European jurisprudence in recent years. In particular, attention was paid to the issues of evidence necessary to recognize that the Community design was made available on the Internet. The article concerns a topic that is current both among representatives of the doctrine and in jurisprudence (Polish and European). It has theoretical and practical significance, because the issue of evidence submitted by the parties on the fact that an industrial design is made available to the public is very often a problem at the stage of court proceedings.
Global Constitutionalism and Legal Fragmentation: The Populist Backslide in Central and Eastern Europe
Authors: Medushevskiy Andrey
Published: November 2021

Globalisation has provoked a deep transformation in international law, political affairs and governance with contradictory consequences. It has stimulated the cosmopolitan project of global constitutionalism, transnational integration and the unification of democratic standards. However, it also resulted in the fragmentation of international affairs, the deterioration of constitutional democracy and a feeling of a growing shortage in democracy on national and international levels of governance. Trying to balance the impact of these two opposing trends, the author analyses the positive and negative effects of globalisation on constitutional development regarding such issues as transnational constitutionalisation, democracy and national sovereignty, the changing place of multilayer constitutionalism, the international separation of powers, and the system of global governance in the establishment of transnational constitutional democratic legitimacy. From this point of view, the populist backslide in Central and Eastern Europe (CEE) looks dangerous and unforeseen, but it is a systemic and potentially predictable reaction of global regions on the uneven character of integration, the lack of democratic legitimacy and a new answer to the contortions and dysfunctions of global governance. An adequate response to these challenges could be found in a new concept of constitutional integration based on ongoing dialogue between the transnational and national actors of legal globalisation. This dialogue is possible by using a conflict-mediation strategy, elaborated by international experts, especially, for the deliberation of complex and protracted conflicts, which have no clear practical solutions in the short to medium term.
Katedra Nauki Administracji i Prawa Administracyjnego Wydziału Prawno-Ekonomicznego Uniwersytetu Poznańskiego w okresie dwudziestolecia międzywojennego. Organizacja i główne kierunki badawczo-dydaktyczne
Authors: Ostrowski Adam
Published: November 2021

The aim of the article is to analyse source materials related to the functioning of the Chair of Administration Science and Administrative Law at the University of Poznań. The study discusses the problems experienced by the then-contemporary scientific and lecturing staff, and also characterised the atypical structure of the Faculty of Law and Economics, as composed of the sections of state law and economy. The organization of the chairs of administrative law at the University of Poznań was separated and their main research and development directions and the most important representatives were indicated. The article broadly discusses the issue of teaching administrative law in comparison to other chairs of the University of Poznań, so that the conclusions give the best possible image of the discussed subject.
Teacher Training College of the Jagiellonian University as an Example of Special-Purpose Training Institution within the Tertiary Education System of the Second Republic of Poland
Authors: Pyter Magdalena
Published: November 2021

The article aims to define the position of specialised training in the system of tertiary education. The study looks into the basic legal acts of the Second Republic of Poland governing higher educational establishments in terms of the position awarded to such establishments as special-purpose colleges. The problem was discussed using the example of the Teacher Training College of the Jagiellonian University in Kraków inaugurated in 1921. Information sourced from the archives of the Jagiellonian University reveals how important a social role that institution played in pre-war Poland. It was a major training centre for secondary school teachers in the recovered general educational system. While remaining part of the university and denied academic status, the college was not an ordinary teacher training facility. Its significant position is confirmed by its operation within the framework of the Jagiellonian University, the use of university staff as lecturers, the practical and scientific nature of the curriculum, and students access to internships abroad. All things considered, the Teacher Training College of the Jagiellonian University operating in newly reborn Poland earned the status of a pioneer of specialist education and set the trend for other special forms of training. The novelty of the research carried out and the results obtained arise from the fact that this subject has not yet been analyzed by legal historians. Also for this reason, it should be recognized that the presented issue has a cognitive value for science.
Ratio legis of Criminalization of the Offence against Religious Feelings (and Blasphemy)
Authors: Sitarz Olga
Published: November 2021

This article deals with the criminalization of violating religious feelings is of a scientific and research nature. The scientific problem is to determine the actual ratio legis of the act described in Article 196 of the Polish Criminal Code, which will ultimately allow to assess whether the criminalization decision is right. The author does not share the commonly held views on the protection and justification of the criminality of offending religious feelings. A comparison of crimes that provide for punishment for violating other feelings, as well as violating feelings of a different nature with impunity, allows for the formulation of the thesis that in the case of Article 196 of the Criminal Code it was not religious feelings and their protection that became the reason for the criminalization decision. This reason is the fear of the social consequences of violating religious feelings. Since this behavior is criminalized in most countries around the world, the significance of these scientific findings is of international significance both theoretically and practically.
Legal and Political Aspects of the Council of National Defense Functioning in 1920
Authors: Szczepański Damian
Published: November 2021

The Council of National Defence, established on 1 July 1920, was to be a temporary governmental body having full legislative and executive power in all matters relating to the conduct and ending of the war, and also with the conclusion of peace with Bolshevik Russia. As regards the above matters, the Council of National Defence was to issue orders and regulations, which were immediately enforceable. Despite acquiring very broad powers, both legislative and executive, none of its regulations went beyond its competence scope. The Council of National Defence regulations had to be approved by the Legislative Sejm in order to be valid. During the three months’ period of its functioning, the Council of National Defense issued over 90 different legal acts aiming at strengthening of defense of the Polish State that was threatened with a loss of its independence. The Council of National Defense played a major role in holding back the Bolshevik invasion of Poland. It contributed to formation of a large army, and made the nation regain its faith in successful end of the military conflict with Soviet Russia.
Pozycja ustrojowa notariusza na gruncie pierwszego polskiego Prawa o notariacie z dnia 27 października 1933 r. Część druga
Authors: Woś Tomasz
Published: November 2021

The article addresses the notary’s systemic position under the first Polish Law on Notaries of 27 October 1933. The analysis of the position of the notary carried out in part one of this article pointed to serious difficulties in the precise defining of this position, both among the scholars in the field and the judicature. To precisely define the systemic position of the notary, part two has provided an analysis of the provisions of the Law on Notaries regarding the professional self-government of notaries, supervision over notaries and their activities, disciplinary liability and compensatory liability of the notary, and the rules of preparation for the profession of notary. The analysis of the Law on Notaries of 1933 presented in the first and second part of this article, leads to the conclusion that the notary’s position included in its legal position a combination of features of a public officer and a liberal profession. The legislature, using in Article 1 the term “public functionary”, and not “state official”, and giving notaries in Article 23 of the Law on Notaries the legal protection enjoyed by state officials, wanted to clearly emphasize the existing differences between them while at the same time underlining their close relationship to the state. The adoption of such a definition made it possible to grant notaries a wide range of powers. At the same time, it provided the basis to establish a professional self-government and entrust its bodies with significant powers in the area of disciplinary jurisdiction. The dualistic approach to the position of the notary was also reflected in the separate rules of training for the profession and in the special rules of notary’s liability for damages. The state, by entrusting notaries with activities related to non-contentious judiciary, secured for itself an exclusive influence on the staffing of notary positions and covered the system of notaries by a strict supervision exercised by the Minister of Justice. The discussion presented in the article leads to a conclusion that the legislature approached the position of a notary in the Law on Notaries of 1933 in a special way, creating a combination of official and professional elements, which can be called a public function. In terms of the political and administrative system, regardless of the definition itself, the notary in practice performed the function of a person of public trust.
Spray Characteristics at Preheating Temperatur of Diesel-Biodiesel-Gasoline Fuel Blend
Authors: Arifin Moch Miftahul , Ilminnafik Nasrul , Kustanto Muh. Nurkoyim , Triono Agus
Published: November 2021

Technological developments in diesel engines require improvements to the fuel injection system to meet the criteria for economical, high-power and efficient combustion and meet environmental regulatory standards. One method that has a lot of interest is changing the characteristics of the fuel, with the aim of producing optimal combustion. Spray characteristics have a big role in determining the quality of combustion in diesel engines. A good spray can improve the quality of fuel atomization and the homogeneity of the air-fuel mixture in the combustion chamber so that it can produce good engine performance and low emissions. This study aims to determine the effect of a diesel-biodiesel (Calophyllum inophyllum)-gasoline blendandfuel heating on the spray characteristics. The research was conducted with variations in composition (B0, B100, B30, B30G5 and B30G10) and fuel heating (40, 60, 80, and 100 °C). Fuel injected atapressure of 17 MPa in to a pressure chamber of 3 bar. The spray formed was recorded with a high-speed camera of 480 fps (resolution 224x168 pixel). In B100 biodiesel, the highest viscosity and density cause high spray tip penetration, small spray angle, and high spray velocity. The addition of diesel oil, gasoline, and heating fuel reduces the viscosity and density so that the spray tip penetration decreases, the spray angle increases and the velocity of spray decreases.
Infección urinaria nosocomial y microorganismos implicados
Authors: Beltrán Marvin , Muñoz Diana , Dávila Fabián
Published: November 2021

Introducción: Las infecciones urinarias nosocomiales constituyen una complicación frecuente e importante problema de salud debido complicaciones y recidivas frecuentes. Se pretende identificar los microorganismos implicados en las infecciones urinarias nosocomiales, su relación con el uso de sonda y estancia hospitalaria. Materiales y métodos: Estudio descriptivo–retrospectivo. Se revisaron bases de vigilancia epidemiológica restringiendo a infección de vías urinarias de origen hospitalario; se describieron las características generales y se exploraron diferencias entre los tiempos de estancia por microorganismo por Kluskal Wallis para un nivel de significancia del 95%. Resultados: Se encontraron 167 de infección de vías urinarias de origen hospitalario, la mediana de edad fue de 75 años; la mayoría de género femenino (58%), 34,1% asociadas al uso de sonda; 10% fallecieron en la hospitalización, la mayoría provenían de la unidad de cuidados intensivos adultos. El microorganismo más frecuentemente aislado fue Escherichia coli (46,1%); los pacientes aportaron una mediana de estancia de 20 días. Se encontraron diferencias significativas en los tiempos de estancia por microorganismo aislado en infección urinaria asociada a sonda, el microorganismo relacionado con los mayores tiempos de estancia fue Proteus mirabillis; el resto de diferencias no fueron significativas. Conclusiones: El microorganismo más frecuentemente aislado fue Escherichia coli, el Proteus mirabillis se encontró fue el más relacionado con uso sonda y tiempo de estancia, se requieren estudios adicionales para determinar asociaciones entre la estancia hospitalaria y fenotipos de resistencia, los protocolos de tratamiento empírico disponibles a la fecha, concuerdan los microorganismos aislados.
Hidrops fetal no inmune por parvovirus: manejo mediante transfusión intrauterina
Authors: Muñiz Algarín Flabia Katherine , Romero Ozuna Ana Jacinta , Parra Saavedra Miguel
Published: November 2021

El Hidrops fetal es la acumulación anormal de líquido en al menos 2 compartimientos fetales. Su origen puede ser inmune o no inmune. El parvovirus B19 es responsable de una parte importante de los casos de hidrops no inmune. El pronóstico fetal ante esta entidad, es malo, y presenta alta mortalidad. Se presentar un caso clínico de una gestante con un feto afectado por hidrops no inmune secundario a anemia severa, causada por infección fetal por parvovirus B19, manejado mediante transfusión sanguínea fetal intrauterina.
Sindrome de Behçet: Enfermedad de la ruta de la seda
Authors: Clavijo Tinoco Fair , Herrera Alvarado Alcides , Herrera Villalba Harol , Fernández Franco Jorge , Diaz Alcendra Oscar , Varela Lourdes , Silva Olivia
Published: November 2021

La enfermedad de Behcet es un trastorno inflamatorio multisistémico vasculítico de vaso variable caracterizado por úlceras aftosas orales, genitales,  recurrentes,  panuveítis bilateral posterior, manifestaciones articulares y ocasionalmente compromiso del sistema nervioso central y grandes vasos . Las variadas manifestaciones clínicas y la falta de pruebas patognomónicas hacen de la enfermedad un reto diagnóstico cuya prevalencia en Colombia se desconoce. El diagnostico se basa en criterios diagnósticos propuestos ante la falta de una prueba Gold Standard. Con relación a la etiología se han estudiado diversas teorías, entre ellas las de origen inmunológico, especialmente por la existencia del HLA - B51, le siguen aquellas que responsabilizan a agentes infecciosos, daño endotelial, entre otros. Se presenta el caso   de un paciente femenino de 35 años, con cuadro crónico y recurrente de aftas orales, presencia de lesiones dermatológicas y aparición de ulceras genitales. Descartándose causas inmunomediadas, infecciosas e inflamatorias. Considerándose un cuadro de aftosis bipolar recurrente y ante los síntomas dermatológicos, se propuso aplicar los criterios diagnósticos del International Team for the Revision of International Criteria for Behçet Disease, con una puntuación de 4, lo que avala el diagnostico de enfermedad de Behcet. El manejo se basó en la instauración de medidas terapéuticas a base de corticosteroides sistémicos e inmunosupresores, con adecuada respuesta clínica.
Dampak Kerusakan Lingkungan Akibat Penambangan Pasir Merapi di Klaten
Authors: Syaifulloh Arief K.
Published: November 2021

Penelitian yuridis empiris ini dilakukan untuk mengkaji dampak kerusakan lingkungan akibat penambangan pasir Merapi  di Klaten. Amanah konstitusi menegaskan bahwa bumi, air, dan kekayaan alam yang terkandung di dalamnya dikuasai oleh negara dan dipergunakan untuk sebesar-besar kemakmuran rakyat. Hasil penelitian diperoleh bahwa penambangan pasir merapi di Klaten Jawa Tengah memiliki beberapa dampak. Pertama, penambangan berdampak pada rusaknya lahan pertanian dan lahan perkebunan. Rusaknya lahan ini mengancam ketersediaan lahan bagi generasi petani yang akan datang dan tentu akan berpengaruh pada ketersediaan pangan. Dampak kedua yang diakibatkan penambangan yaitu merusak jalur evakuasi dan yang ketiga yaitu mengganggu resapan air, ekologi, serta rawan longsor.
Does female genital mutilation/cutting have any effect on normal birth?
Authors: Tamburaci Esra , Birge Özer
Published: November 2021

Background: World Health Organization’s (WHO) defines female genital mutilation (FGM) as all procedures involving the total or partial removal of female external genitalia without any medical reasons. It is estimated that about 100 million women worldwide are circumcised. After circumcision compications such as bleeding, infection, shock, menstrual irregularity, dysuria, frequent urinary tract infections, pelvic pain and difficulty in sexual intercourse occur with varying frequencies.Methods: In this article, we aimed to discuss normal vaginal delivery results of 45 term pregnant cases with 3 types of  female genital multilation/circumcision. We know that the vaginal entrance is closed as a result of adhesions in the genital area due to circumcision and secondary complications may develop.Results: The mean age of 45 patients included in the study was 26.2±8.78 years. Considering the postpartum complications, bilateral labial tissue ruptures in 15 cases, followed by vaginal hematoma in 9 cases, anal sphincter damage in 11 cases, deep episiotomy tears in 8 cases, periurethral tears in 8 cases, deep cervical tears in 8 cases, vulvar epidermoid cyst ruptures in 4 cases and 4 cases. perineal body ruptures were seen in 4 cases, vulvar hematoma in 4 cases, and vaginal mucosal damage in 9 cases.Conclusions: It has been shown once again that FGM/C is a method that completely changes the female vaginal anatomy and has very serious delivery complications. It is obvious that serious educations and studies need to be done in the countries where this method is applied.
Role of safe space in improving menstrual awareness and menstrual hygiene practices among adolescents in Zamfara: a case study of REACH project intervention
Authors: Lawali Yakubu , Bello Murtala , Hussaini Rahinatu Adamu , Jongshwan Chanan Solomon
Published: November 2021

Background: Menstrual awareness and hygiene practices have been a challenge for adolescent girls in African countries and Nigeria inclusive which subsequently affects their health, and wellbeing. The aim of the study was to evaluate the effects of REACH project intervention in improving knowledge and practice of menstrual care among adolescent girls.Methods: A post-test only non-equivalent groups quasi-experimental design was adopted with Kaura Namoda and Talata Mafara as the intervention Local Government Authorities (LGAs) and Bungudu and Maru as the control LGAs conducted between August 2021 to October 2021. Quantitative approach was employed using self-developed questionnaire for data collection. Multi-stage sampling technique was used. A total of 400 questionnaires were administered with 200 each for control and intervention LGAs.Results: The result of the study shows that, adolescents in the REACH Project intervention communities have higher level of awareness and more likely to practice menstrual hygiene as compared to non-REACH intervention communities. Therefore, it is recommended that, safe space strategies should be adopted in any matters related to adolescents sexual and reproductive health.Conclusions: Safe space is effective in improving adolescents sexual and reproductive health.
Analysis of maternal mortality at tertiary care centre
Authors: S. V. Hemalatha , M. S. Manickadevi
Published: November 2021

Background: The aim of the study was to analyse the causes of maternal mortality at a tertiary care centre and find measures to reduce it.Methods: A retrospective study of maternal deaths from January 2018 to December 2020 that occurred at Government Vellore Medical College and Hospital, a tertiary care hospital in Tamil Nadu. Data collected from case records and death reviews.Results: There was total of 71 deaths at the tertiary care hospital during the period January 2018 to December 2020 out of 31407 live births giving Maternal mortality rate of 226/1,00,000 live births. The MMR is high as it is a tertiary hospital catering referral from six districts. Most of the cases were due to late referrals. The majority of the deaths occurred in primigravida (50.7%), in the age group of 21 to 25 years (35.2%) and around term gestational age (49.3%). The most common cause of death in our study was hypertensive disorders of pregnancy (29.5%) followed by PPH (14.08%).Conclusions: From our study we concluded that the most common causes of maternal death were due to direct obstetric causes like severe pre-eclampsia, eclampsia and post-partum haemorrhage. Early identification of high-risk cases, early identification of GHT, anaemia and its correction, early referral of high-risk cases to tertiary centre can prevent most of the deaths.
Review of thyroid profile in patients with heavy menstrual bleeding in a tertiary care hospital
Authors: R. Pooja , Palve Tushar , Mutyapwar Sneha , Saha Payal
Published: November 2021

Background: Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss which interferes with a woman's physical, social, emotional and/or material quality of life. It can occur alone or in combination with other symptoms. Thyroid hormone affects menstrual pattern. The objective of this study was to evaluate thyroid function in women with menorrhagia (HMB).Methods: It is a type of journal article. Study design- retrospective study. The present study was conducted in the Department of obstetrics and Gynecology, cama and albess hospital, Mumbai, Maharashtra, India, from a period of January 2021 to July 2021, 51 women of reproductive age group between menarche-menopause with HMB. Quantitative determination of T3, T4 and TSH by CLIA estimated in autoanalyser.Results: About 51 women participated in the study in which most of the subjects belong to 45-49 years of age group. Maximum patients are multipara. Commonest cause of menorrhagia is fibroid. Most females with menorrhagia are euthyroid. Most of patients with HMB are O +ve. In most of the patients, anaemia due to HMB is treated by blood transfusion.Conclusions: Biochemical evaluation of thyroid function tests should be compulsory in all patients with menorrhagia to detect thyroid dysfunction. Most females with menorrhagia are euthyroid.
Psychological effects of isolation on antenatal women during COVID-19 pandemic
Authors: Kamalakshy Chandramathy , Chenicheri Mini , Ratheesh Lakshmi Chirayil , Gangadharan Ragesh
Published: November 2021

Background: Pregnancy is a time of increased vulnerability for the development of anxiety and depression. This study evaluated the psychological effect of isolation on antenatal women admitted with COVID-19 disease.Methods: A cross-sectional study conducted at Government medical college Kozhikode from 1 November 2020 to 31 January 2021. One hundred antenatal women with COVID-19 disease admitted in isolation ward in quarantine were randomly selected. Clinical and demographic data collected at the time of admission. After one week of admission, mental health assessment done using following mental health assessment tools. They were general anxiety disorder-7 (GAD-7), perinatal anxiety screening scale (PASS), patient health questionnaire-9 (PHQ-9).Results: Out of the 100 women selected, 74 responded with the questionnaires. All of them were educated, 62% studied up to plus two. Majority from joint family contributed 68.9% and 85.1% were home makers. Mean age was 26 years. Primigravidae were 48.6% and mean BMI of 25.71 kg/m2. Commonest medical comorbidity was diabetes mellitus present in 28.4%. Mental health assessment done using 3 sets of questionnaires, PHQ-9, GAD-7 and PASS showed that women in our study did not have any increased risk of depression, general anxiety or perinatal anxiety. Infact they reported of feeling safer and more comfortable at the hospital compared to home.Conclusions: Present study showed that antenatal women with COVID-19 disease admitted in hospital did not have any increased risk of general anxiety, depression or perinatal anxiety.
Obstetric hysterectomy: a retrospective study
Authors: Kamble Savita N. , Jamdade Yuga M.
Published: November 2021

Background: Obstetric hysterectomy (OH) is last resort usually opted to save life of a mother in critical obstetric conditions compromising her reproductive potential. With increasing caesarean deliveries incidence of morbidly adhered placenta is increasing, thus increasing need of OH. We aimed to study socio-demographic factors, incidence, indications, complications and feto-maternal outcomes associated with obstetric hysterectomy. Also, we aimed to study factors which affect the maternal and fetal outcome in obstetric hysterectomy case so as to minimize maternal and neonatal mortality and morbidity.Methods: We conducted a retrospective analytical study of 2 years 6 months in Department of Obstetrics and Gynecology at a tertiary and teaching institute of western Maharashtra.Results: The incidence of obstetric hysterectomy was 0.4%. Majority of women were between 25-35 years age group and parity two or more. Most common indication was postpartum haemorrhage (PPH) (41.1%) followed by uterine rupture (29.4%) and adhered placenta (23.5%). Most common risk factor found was previous caesarean delivery. Most common complication was need of intensive care unit (ICU) and vasopressor support.Conclusions: Proper antenatal care, screening for high-risk obstetric cases and registration of those patients at a well-equipped hospital and early referral and delivery at tertiary hospital by expert surgeon with timely decision, timely and adequate transfusions can prevent maternal and fetal complications.
Takotsubo cardiomyopathy in peripartum period: a case report
Authors: Sundararajan Chitramani , Naveena Thamizh , Kubendiran Priya
Published: November 2021

Cardiomyopathy is a group of disorders characterised by structural and functional abnormalities in the myocardium in the absence of other cardiac diseases of myocardial abnormality. Its occurrence in pregnancy is uncommon and exact incidence is unknown even though some studies shows that the incidence of peripartum cardiomyopathy is 1 in 1000 to 4000 births. Here we have discussed about a 34 years primigravida with twin pregnancy conceived after 12 years of married life by assisted reproductive technique (ART), admitted with preterm premature rupture of membranes (PPROM) at 28 weeks of gestation who developed a rare condition called Takotsubo cardiomyopathy (TC) in the peripartum period. She was managed in intensive care unit with oxygen supplementation, beta blockers, diuretics and heparin. Patient had an excellent recovery in the early postoperative period.
Partial HELLP syndrome: case report
Authors: Dagar Sheetal , Gupta Monika , Shekhawat Vrinda , Minhas Santosh
Published: November 2021

HELLP syndrome is a complication in pregnancy clustered by haemolysis, elevated liver enzymes, and a low platelet count. It is seen as a serious complication of preeclampsia and eclampsia. Serious manifestations like haemorrhage, infarction, rupture and other hepatic manifestations are usually associated with it. In this case study, 29 years old primigravida is a booked case admitted in ward at 39 weeks 1 day with decreased fetal movement for 2 days. No history of pain abdomen, bleeding per vaginum, discharge per vaginum. Her blood pressure records at the time of admission was 110/72 mmHg and she was normotensive throughout pregnancy. Urine routine examination was negative for urinary protein. However, blood tests showed platelet count of 66,1000/cumm, with ALT of 174 U/L and AST of 123 U/L on peripheral blood film. RBC were predominantly normocytic, normochromic with few macrocytes. WBC has normal morphology. Platelets were reduced on smear. Giant platelets were seen. Ursodeoxycholic acid 300 mg 12 hourly were given to the patient and 3 doses of vitamin K I/M 24 hourly. She was delivered by cesarean section which was performed due to failure of progression of labor with a deflexed head. There was presence of retroplacental clot of 4×3 cm indicating placental abruption, a complication of HELLP syndrome. From this we conclude that we should be careful in suspecting complications of full blown diseases even when the patients are asymptomatic but have atypical laboratory findings.
Risks and challenges in multiple pregnancy
Authors: Agarwal Aditi , Sharma Arti , Bansal Neeta , Panwar Neha , Singh Shweta , Kohli Swati
Published: November 2021

Because of breakthroughs in reproductive medicine, multiple pregnancies have become more common in the industrialized world. As a result, obstetric care for women with multiple pregnancies and neonatal care for the same has become more demanding. Multifetal pregnancies are linked to an elevated risk for both the mother and child. There is increased incidence of obstetric complications such as spontaneous abortion, hypertensive disorders, placenta previa, and fetal malformations. Perinatal outcome is also affected which is attributable to increased incidence of fetal complications like prematurity, congenital malformations, growth discordance and cord accidents. We are presenting 2 cases, one of MCMA twin pregnancy with fetal congenital anomaly and another of a triplet pregnancy and their perinatal outcomes.
Rare case of two siblings with complete androgen insensitivity syndrome
Authors: Shankar Ambika , Nagar Oby , Saini Suwaram , . Babita
Published: November 2021

Androgen insensitivity syndrome (AIS) also called testicular feminizing syndrome is a rare X linked disorder of sexual differentiation caused by mutation in the androgen receptor (AR) gene, which is located on the X chromosome (Xq11-q12). In the reported cases, individuals with complete androgen insensitivity syndrome (CAIS) presented with a female appearance and normal breast development, absence of uterus and ovaries, bilateral undescended testis, and elevated testosterone levels. The syndrome is usually detected on evaluation of a phenotypic female with primary amenorrhea who presents for treatment of infertility. Here, we report 2 cases of CAIS in siblings 21 and 19 years of age who presented to us with primary amenorrhea. The elder sibling presented to us with primary amenorrhea, thelarche +, absent adrenarche, blind pouch of vagina, b/l inguinal masses suggestive of undescended testes, raised serum testosterone and absent uterus on USG. While the younger sibling also presented with similar findings but had history of b/l orchidectomy at the age of 14 years. Both the sisters were admitted in our unit and the elder sister underwent b/l orchidectomy and McIndoe’s vaginoplasty. While the younger sister underwent McIndoe’s vaginoplasty on the same day. Post-operative recovery was uneventful and they were given hormone replacement therapy (HRT). AIS is a rare X linked disease caused by mutation in the AR gene. which when diagnosed early can be treated appropriately. Precise diagnosis requires clinical, hormonal and molecular investigation and is of great importance for appropriate gender assignment and management in general. With timely gonadectomy, vaginoplasty or vaginal pouch deepening, hormone replacement and appropriate psychological support help the person live a healthy and almost normal life.
A huge mesenteric teratoma in reproductive age woman: a case report
Authors: Kishore Ruchi , Lambodari Pratibha , Verma Kritika , Khan Anjum , Singh Neelam
Published: November 2021

The incidence of dermoid ovarian cyst is 15-20% of all ovarian neoplasm, which is a common entity. Mesenteric cyst are one of the very rare entities with incidence of 1 in 2, 50, 000. Dermoid cysts rarely present as mesenteric cysts. Mesenteric dermoid cyst have good prognosis. Here, we report a rare abdominal tumor which was initially diagnosed clinically as an ovarian dermoid cyst but operative and histology revealed it to be mesenteric dermoid cyst. A 36 year-old, multiparous presented with abdominal mass, gradually increasing in size since 1 year with recent onset of abdominal pain. Physical examination revealed abdominal mass of 22×20 cm size, globular, non-tender, mobile, and cystic to solid in consistency. Contrast-enhanced computed tomography (CECT) showed 23×21×14.4 cm heterogeneous enhancing mass lesion with areas of fat density and calcifications within, suggestive of neoplastic mass lesion, likely teratoma. Tumor markers were within normal limit. Patient was managed surgically. Laparotomy findings revealed a huge solid mesenteric mass (22×20 cm) weighing 6.5 kgs. Histopathology showed mature cartilage, osteoid formation, fibro-adipose connective tissue, focal lymphoid aggregates, congested blood vessels and focal mature neuronal component and no immature elements seen, confirming dermoid cyst. Mesenteric cyst are rare intra-abdominal tumor found most commonly in ileum (60%) next is ascending colon (40%). However, if a mesenteric cyst locates within the pelvic cavity, as in this case, it may be misdiagnosed as an ovarian cyst.
Inadvertent laparoelytrotomy in second stage of labour: a case report
Authors: Mohanty Shristy , Marandi Satyabhama , Chhatria Bhismadev
Published: November 2021

Laparoelytrotomy is the accidental delivery via a vaginal incision during caesarean section in second stage of labour. It refers to the inadvertent delivery of the foetus through a transverse incision given over the vagina during a caesarean section (C-section). It is a rather uncommon complication of C-section encountered at advanced dilation which can lead to maternal complications such as traumatic postpartum hemorrhage, injury to bladder, ureters and difficult reconstruction of vagina. Here, we present a case report of inadvertent laparoelytrotomy during C-section.
Comparative study of brainstem evoked response audiometry in diabetic patients and non-diabetic subjects to assess the involvement of central auditory pathway
Authors: R. Shanthimalar , S. Muthuchitra , Nirmala S. Mary , Chandrika G. Udhaya , Rasith H. Mohamed
Published: November 2021

Background: Diabetes mellitus (DM) which is prevalent in world is associated with sensorineural hearing loss. Brainstem evoked response audiometry (BERA) is a simple, non-invasive procedure to detect early impairment of acoustic nerve and auditory pathway. The present study is under taken to evaluate the impact of DM on BERA parameters. Aim of the study was to compare the BERA of diabetic patients to those of age and gender matched controls to assess the involvement of central auditory pathway.

Methods: A cross sectional study was conducted on 35 diabetic patients, aged 35 to 55 years, who were on treatment for at least 2 years, and 35 age and sex matched control participants, were subjected for BERA at 70,80 and 90 dB. The waveforms, absolute latency of wave I, wave III, wave V and interwave/ inter peak latency of I-III, III-V and I-V were analyzed with respect to both groups.

Results: The absolute latency of wave III and wave V, interpeak/ interwave latency of I-III, interpeak/ interwave latency of I-V, III-V and absolute latency of wave V were highly significant at corresponding tested stimuli in the diabetic group compared to the control group.

Conclusions: Early involvement of central auditory pathway in diabetic patients, can be detected with fair accuracy with auditory evoked potential studies; if done on a regular basis warrants meticulous glycemic control and prevents further damage.
Checklist approach to vertigo: audit of current practice in a tertiary referral center
Authors: Venkataramani Nithya , Sachidananda Ravi , Nagarajaiah Rajesh Karalumangala
Published: November 2021

Background: Vertigo is a complex symptom which can be present in multiple conditions, some of which are life threatening. Diagnosing a patient with vertigo could sometimes be challenging and there is a need for a comprehensive, yet easily reproducible diagnostic model with emphasis on the red flag signs. A simple way to achieve this is a checklist. The aim of the study was to propose a diagnostic checklist for patients presenting with vertigo to an ENT clinic to aid diagnosis and prevent diagnostic errors.

Methods: A diagnostic checklist was used in all patients who presented with the symptom of vertigo, necessary tests were conducted and referrals were done when required.  

Results: Out of eighty-five patients who presented with symptom of dizziness to ENT clinic, all patients received a definitive diagnosis treatment plan with the help of checklist.

Conclusions: Checklist is an effective way to ensure elaborate assessment of the patient with emphasis on the red flag signs. It is a very important tool to arrive at diagnosis and formulate treatment plan.
A study on otorhinolaryngological manifestations in pregnant women
Authors: Jamwal Shallu , Kalsotra Gopika , Manhas Monica , Raina Apurva , Kalsotra Parmod , Ul Islam Owais , . Youshita
Published: November 2021

Background: Pregnancy is characterized by various endocrinological and physiological changes affecting different organs including ear, nose and throat. Otorhinolaryngological manifestations in pregnant women are mainly due to changes in levels of sex hormones such as estrogen and progesterone. While majority of these conditions are benign and reverse after parturition, some do not. The study was conducted with an objective to find the incidence of various otorhinolaryngological manifestations among pregnant women and to create awareness among the medical professionals to diagnose these conditions.

Methods: This is a hospital based cross sectional study of 240 pregnant women who presented to the department of otorhinolaryngology with ENT symptoms. Detailed history, general physical examination and complete ENT examination was done on all subjects.

Results: 47.9% of the study cases had otological manifestations among which otitis media was the main finding.

16.7 % of the cases had nasal symptoms among which rhinits was the main condition predominantly observed in the 3rd trimester. 19.6% of the cases had oral cavity lesions with stomatitis being the most commonly found cause. 15.8% of the cases had throat complaints, among which gastroesophageal reflux disease (GERD) was the most common cause found during 2nd and 3rd trimester.

Conclusions: Recognition and understanding of pregnancy related ear, nose throat complaints will allow otolaryngologist to reassure and manage these patients, improving their experience of the gestational period.
Mastoiditis and Citelli’s abscess: a case report
Authors: Siddig Amin M. A.
Published: November 2021

Citelli’s abscess is a rare often undocumented complication of otitis media. This is a case of a 52-year-old lady with learning difficulties, who presented with right sided mastoid swelling. On initial consultation the patient denied any otological symptoms but after being discharged and returning with her mother it was revealed she suffered with otalgia the previous month. On her return, the mastoid swelling had increased in size and there was also a large swelling across the right side of the neck. CT scan showed mastoiditis with Citelli’s abscess. The patient underwent a cortical mastoidectomy and myringotomy as well as drainage of the neck abscess. The report emphasises the importance of a clear, concise history and urgent surgical intervention to prevent further spread of the infection and potential intracranial complications.
Septal pyogenic granuloma: a continuing riddle
Authors: Radhakrishnan Vaishnav , Gajapathy Sowmya , Thangaraj Priyanka , Poduval Jayita Das
Published: November 2021

Pyogenic granuloma (PG) is a benign vascular lesion of the skin and mucous membranes commonly affecting the head and neck but less common in the nasal septum. Septal PG and can present with epistaxis and nasal obstruction. It is also called a lobular capillary hemangiomas (LCH) as histologically, pyogenic granuloma consists of circumscribed aggregates of capillaries arranged in lobules. Granulomatous lesions like Wegners granulomatosis, sarcoidosis and also tumours like squamous cell carcinoma, malignant melanoma can all mimic a septal PG. Surgical excision is the treatment of choice and diagnosis can be confirmed by histopathological examination. Complete resection can decrease the rates of recurrence. Here we reported a case of pyogenic granuloma of the nasal septum in a young female patient.
Xanthogranuloma of nose in an adult: an uncommon presentation
Authors: Palo Seetu , Barsagade Ashwinkumar K. , Sikdar Neha
Published: November 2021

Xanthogranuloma is a relatively rare histiocytic cutaneous disorder that typically affects the pediatric age group. Its occurrence in adulthood is still rarer with only a handful of cases on the record. The present case report describes a case of adult-onset xanthogranuloma in a 49 years old lady who presented to the otorhinolaryngology clinic with a 6 months history of a nodule on the left side of the columella. There was no history of associated pain or bleeding from the site. Local examination revealed a 0.6×0.6 cm, non-tender, soft-to-firm, pinkish dome-shaped lesion with rounded edges. No similar lesions were found elsewhere. Excisional biopsy of the lesion was performed and microscopy showed a dermal lesion comprising of sheets of histiocytes admixed with lymphoplasmacytic infiltrate, touton giant cells and few spindle cells. A diagnosis of xanthogranuloma was rendered. A number of lympho-histiocytic lesions comes in the differential diagnosis of xanthogranuloma and hence it is important to be aware of such unusual presentations in order to make correct histological diagnosis.
Impact of COVID-19 on obstetric care delivery and maternal and perinatal outcome
Authors: Thomas Susan , Kattukaran Anoj , Menon Prameela
Published: November 2021

Corona virus disease 2019 (COVID-19) has changed all our lives in a significant way. Despite the fact that pregnant women were placed in the ‘vulnerable group’, antenatal care services have been affected by the pandemic. We are conducting the study to find the impact of COVID-19 on antenatal care and its impact on maternal and perinatal outcomes and thereby giving us an insight on how to improve our provision of care.

1. To find the effect of COVID-19 on obstetric care delivery in non-covid and covid patients. 2. To assess the maternal and perinatal outcome in Covid positive patients.

This is a descriptive study conducted at Amala Institute of Medical Sciences, Thrissur, Kerala during the period of April 2020 to December 2020. All pregnant women who delivered here during the period were taken in the study. Data was collected through pre prepared questionnaire by direct or telephonic conversation.

Total deliveries were 919 with response rate of 85.6%. During pandemic, approximately 54% of women missed their ANC visit due to fear of Covid. Absence of partner during visits, delivery and postnatal period was a cause for nervousness for 56.40% of mothers. Telemedicine was used by 52% of subjects and was found effective.

Antenatal care is essential but challenging during COVID-19 pandemic. A protocol based approach is needed which is cost-effective and easy.
Compare safety and efficacy of intramuscular progesterone versus vaginal progesterone in prevention of preterm labour
Authors: Chaudhari Shilpa , Mishra Aparajita , Hol Kishor , Shastri Shraddha
Published: November 2021

Currently preterm labour is one of the most challenging problem faced by both obstetricians and perinatologists, this episode in the course of woman’s pregnancy takes a heavy tool for perinatal mortality which accounts for approximately 50-75%. The incidence of preterm labour is estimated to be 5-10% of all pregnancies.

It was a prospective randomize control study. All the cases with inclusion and exclusion criteria were selected during the study period. The subjects were randomized into two groups with group A received vaginal micronized progesteron and group B intramuscular 17a hydroxyprogesteron caproate. Total of 100 cases were included in this study.

All preterm pregnancy of more than 20 weeks were considered in this study. Initial nefidipine 10 mg, 4 tablets 15 min apart was given for tocolytic activity for 48 hours. Injection bethamethasone 12 mg I.M 2 doses in a duration of 24 hours apart is given for fetal lung maturity.

One group will receive weekly intramuscular 17a hydroxyprogesteron (250 mg) injection while other group will receive daily micronized vaginal progesteron suppository (200mg).

Subsequently compare the safety and efficacy of intramuscular progesterone versus micronized progesterone as a maintenance therapy in preventing preterm labour and analyse maternal and fetal factors.

Subsequently compared the safety and efficacy of intramuscular progesterone versus micronized progesterone as a maintenance therapy in preventing preterm labour.

This analysis showed that women who randomized to progesterone prophylaxis had a significantly increase in duration of pregnancy. The mean ± SD of birthweight in Group A and Group B was 2784.2 ± 490.7 gm and 2813.9 ± 363.3 gm respectively which confirmed the positive effects of progesterone on increasing infants’ weights at birth.

Authors concluded that progesterone therapy had acceptable efficacy in the prevention of preterm labor in terms of prolongation of delivery and by increasing gestational age at delivery.