bluuebunny/crossref_metadata_2025 huggingface dataset:
Carcinoid Heart Disease: Early Outcomes after Surgical Valve Replacement in Nine Patients
Authors: Mujtaba Syed Saleem , Clark Stephen
Published: February 2018

Aim: To describe the early outcomes of carcinoid patients undergoing surgical heart valve replacement.Methods: In a retrospective study, records of patients with symptomatic carcinoid heart disease referred for valve surgery between 2012 and 2016 were reviewed. The perioperative and early postoperative outcomes were analyzed.Results: Nine patients, with a mean age of 61 years (range 55-70 years) underwent cardiac surgery for carcinoid syndrome. 3 patients had quadruple valve replacement, 5 had tricuspid and pulmonary valves changed, while one had tricuspid, pulmonary, and aortic valves replaced. Right-sided valves were replaced with biological valves in 8 patients and a mechanical valve in 1 patient. Left-sided valves were replaced with a mechanical valve in 2 patients and with a biological valve in 1 patient. Mean postoperative follow-up was 24 months (range 6-50 months, median 16 months). All patients had a good left ventricle except one, in whom it was mildly impaired. The right ventricle was severely dilated in 4 patients, moderately in 2, and mildly in 3. One patient died of heart failure 10 days postoperatively. Functional improvement was noted in all survivors, and they were in New York Heart Association class I at last follow up.Conclusion: Although carcinoid syndrome is a rare and progressive disease, valve replacement in symptomatic patients is a reasonable option with survival benefit, low early postoperative mortality, without valve-related complications, and with functional improvement. Cardiac assessment is required in all patients with carcinoid disease from the earliest time of medical treatment to improve patients’ result.
Report of the Third Heart Surgery Forum Scientific Sessions: Zagreb, Croatia December 6-8, 2017: Conference Highlights
Authors: Firstenberg Michael S , Nguyen Tom C , Roberts, Jr Harold , Levinson, MD Mark M. , Rudez Igo
Published: February 2018

The Heart Surgery Forum is an online community dedicated to topics related to all aspects of cardiothoracic surgery. It consists of an informative website (www.hsforum.com), a traditional indexed journal both in print and online, and an email-based “list-serv” for discussion of surgical cases and techniques. The email list-serv, “OpenHeart-L” (The Forum) is composed of surgeons and allied specialties (perfusion, anesthesia, nursing). Dr. Mark Levinson (USA) started The Forum originally in 1995. He also served as the first Editor-in-Chief of the print journal for many years. Coinciding with the popularity of The Forum, and the desire by many members to meet in person, the First Heart Surgery Forum Conference (#1 HSF) was held in Savudrija, Istria, Croatia in 2010. The overwhelming success of this meeting, in terms of attendance and scientific content, resulted in #2 HSF being held in Split, Croatia in 2014. Recently, the #3 HSF meeting was held in Zagreb, Croatia on December 6-8th, 2017. This report highlights the scientific events of this meeting, and more importantly aims to inspire greater involvement by the international cardiothoracic community. Substantial increasing attendance was seen at each subsequent meeting, not only in terms of the number of participants and lectures, but also in the number of countries represented.
How Surrogate and Chemical Genetics in Model Organisms Can Suggest Therapies for Human Genetic Diseases
Authors: Strynatka Katherine A , Gurrola-Gal Michelle C , Berman Jason N , McMaster Christopher R
Published: February 2018

Genetic diseases are both inherited and acquired. Many genetic diseases fall under the paradigm of orphan diseases, a disease found in < 1 in 2000 persons. With rapid and cost-effective genome sequencing becoming the norm, many causal mutations for genetic diseases are being rapidly determined. In this regard, model organisms are playing an important role in validating if specific mutations identified in patients drive the observed phenotype. An emerging challenge for model organism researchers is the application of genetic and chemical genetic platforms to discover drug targets and drugs/drug-like molecules for potential treatment options for patients with genetic disease. This review provides an overview of how model organisms have contributed to our understanding of genetic disease, with a focus on the roles of yeast and zebrafish in gene discovery and the identification of compounds that could potentially treat human genetic diseases.
Simultaneous Confidence Bands for the Estimation of Expected Discounted Warranty Costs for Coherent Systems under Minimal Repair
Authors: Lopera Gómez Carlos Mario , Gónzalez Álvarez Nelfi Gertrudis
Published: February 2018

This paper develops simultaneous confidence bands using computer intensive methods based on resampling, for the expected discounted warranty costs in coherent systems under physical minimal repair, that is, when the system is observed at its components level and only the component that causes the fault is minimally repaired. For this purpose, it is shown that, under the framework of the Martingale processes and the central limit resampling theorem (CLRT) over stochastic processes, the discounted warranty cost processes satisfy the conditions set by the central limit resampling theorem (CLRT). Additionally, a simulation study is performed on the most relevant variables, such that the finite sample features of the proposed bands may be assessed, based on their actual coverage probabilities. The results in the considered scenarios show that resampling-based simultaneous confidence bands have coverage probabilities that are close to the nominal coverage. In particular, the agreement is good when there are 100 systems or more where a large number of resamples are used for the approximation.
Prática Deliberada em Ciclos Rápidos: uma estratégia moderna de simulação
Authors: Castro Leandro Teixeira de , Couto Thomaz Bittencourt
Published: February 2018

AIMS: To describe, through a literature review, the structure, effectiveness, advantages and disadvantages of a novel strategy in simulation-based training named Rapid Cycle Deliberate Practice.METHODS: The literature review was conducted from June to September 2017. We searched for the terms “Rapid Cycle Deliberate Practice”, “Deliberate Practice”, “Rapid Cycle”, and equivalent terms in Spanish and Portuguese, filtered for studies in human beings and for publications from January 2014 (when the term was coined) to August 2017, in the following databases: MEDLINE, Web of Science, Scopus and Scielo.RESULTS: Of the 264 articles found from the selected terms in our initial research, four studies were selected for this review. In Rapid Cycle Deliberate Practice, clinical cases are simulated in cycles progressively more complex, repeated until the acquisition of skills by the team of participants; when the objectives are reached, a new cycle begins, with more difficult tasks needed. This method offers multiple opportunities for skill practice, automation of skills and direct feedback. It presents a series of advantages over traditional simulation, like higher participants’ satisfaction and better performance in key-outcomes in cardiopulmonary arrest scenarios. It has some disadvantages: limited discussion of complex or behavioral scenarios and difficult time control of each cycle, which are limited by team performance.CONCLUSIONS: In Rapid Cycle Deliberate Practice, teams participate in a simulation scenario with repetitive practice until mastery of desired skills. This strategy leans on established techniques like mastery learning and deliberated practice. While having some disadvantages, like limited discussion of complex or behavioral scenarios and difficult time control, with proper planning and a good training of facilitators this method may be an excellent tool to increase learning with simulation.
Producción de ñame clon Criollo a partir de bulbillos aéreos
Authors: Borges-García Misterbino , Reyes-Avalos Diana María , Leyva-Domínguez Humberto , Ávila-Medina Ubail , Lambert-García Tania
Published: February 2018

The employment of air bulbils in yam plants, like plantation material, allows using a 100% of the tubers crop for its consumption, the aforementioned implicates a significant agronomic, economic, social, and environmental impact. The aim of this study was to evaluate the main morphological and agronomic indicators of Creole clone yam in vitro plants obtained by using air bulbils during a first cycle field cultivation as a local level seed source. The research was developed in the Biotechnology Studies Center Plant at Granma University in collaboration with the localities of “Las Tamaras” and “La Asunción” between April and December, 2014. At thirty days, the survival percentage and morphological analysis (stem diameter and length/wide leaf ratio) of 1, 4 and 7 months plants were determined under field conditions (twenty plants by treatment). The agronomical analysis was carried out when the plants of the plantation were nine months, and the following variables were determined: tubers per plant number; tubers plant fresh mass (kg); average fresh tubers mass (kg); air bulbils number and average fresh mass (g) with 100% of survival and the best morphoagronomical development for rapid production of air bulbils in Creole clone. The obtained air bulbils from Creole clone yam in vitro plants during a first field cultivation cycle, presented a 100% survival and the best morpho-agronomic development for sustainable recovery and production.
Potencial forrajero de nueve híbridos de maíz en la zona alta lechera de Costa Rica
Authors: Sánchez-Ledezma William , Hidalgo-Ardón Carlos
Published: February 2018

In the area, there are no selected maize materials for forage production, tall and long-cycle creole maize varieties are used, there are overturning problems that make management difficult. The study was conducted in the dairy highlands of Costa Rica at an altitude of 2200 m, between 2008 and 2009. This study was made in order to compare the forage production and the nutritive value of nine maize hybrids (Zea mays) with local oats (Avena sativa) in a randomized design of complete blocks and three replicates. Harvesting took place at grain stage called milky-doughy (4 and 6.5 months for oats and maize hybrids). Oats had a dry matter yield (14 t/ha) and dry matter digestibility (8.7 t/ha) higher (P<0.0001) than hybrids (7.8 and 4.9, respectively). Although hybrids showed a higher (p<0.05) percentage of dry matter (mean 19.2) and in vitro dry matter digestibility (mean 63.2), oats had percentages of 16.7 and 61.9 within the same order. The percentage of crude protein in oats (14.2) was higher (p <0.05) than maize hybrids (mean 10.9). The creole oat variety showed a higher forage resource than the evaluated hybrid maize.
Diversidad morfológica de semilla y fruto de diez colectas mexicanas de Lagenaria siceraria
Authors: Grimaldo-Juárez Onécimo , Súarez-Hernández Ángel Manuel , Ceceña-Durán Carlos , González-Mendoza Daniel
Published: February 2018

Lagenaria siceraria presents a great morphological diversity of seed and fruit, so it is necessary to group them in morphotypes according to the similarities in characters. The objective of this study was to analyze and quantify the morphological variation of seed and fruit of ten collections of L. siceraria, from different Mexican regions. The research was conducted in the experimental field of the Agricultural Sciences Institute of the Autonomous University Baja California, Mexico, during the spring-summer 2014 cycle. Seventeen quantitative fruit and seed characters were evaluated, and analyzed with multivariate techniques. The phenotypic variation of L. siceraria was identified mainly by the length and diameter of seed, and in fruit by the length and lower circumference. Two groups were formed at levels of dissimilarity of 0,76 and 0,69, respectively. The first group was integrated by collections L45, L46, L47, and L56, which had smaller dimensions in fruit and seed, with a higher level of similarity between the materials. The second group was formed by L43, L48, L50, L53, L54, and L55 landraces, this group had more variables and presented larger dimensions than previous one. The aforementioned shows that there exists a genetic variability in the Mexico’s native L. siceraria materials.
Biosphere, Noosphere, and the Anthropocene
Authors: Sideris Lisa H.
Published: February 2018

Visions of a high-tech ‘good’ Anthropocene as well as ambitious world-making projects like Biosphere 2 have roots in a quasi-religious form of cosmism and attendant notions of the noosphere: a planetary sphere of mind. Cosmic perspectives often celebrate and naturalize an image of humans as participants in and ultimately directors of planetary and cosmic processes. This brand of cosmism encourages fantasies of fleeing our ‘used’ planet in search of our presumed interstellar destiny, and it encourages a disregard of earthly, ecological, and even bodily limits. I argue that the turn to planetary and cosmic perspectives is the wrong move for those who care about the future of the Earth and more-than human life.
characteristics and experiences of international physiotherapy graduates seeking registration to practise in Australia
Authors: Foo Jonathan , Storr Michael , Maloney Stephen
Published: February 2018

This study aimed to identify the characteristics, and explore the experiences, of international physiotherapy graduates seeking registration to practise in Australia. Participants of a clinical-skills revision workshop run by an Australian University for internationally trained physiotherapists seeking to apply for registration were surveyed between 2013 and 2014. Survey questions focused on the experience of the registration process, and what it meant to participants. Data were analysed with descriptive statistics and thematic analysis. Seventy-three survey responses were received. Most participants were under 40 years old (88%), 48% were permanent Australian residents, and 37% had a Master’s level degree or higher. The median years since graduation was eight (interquartile range 6–12), 85% of participants spoke more than one language, and 56% reported that they would consider working in a rural location. Thematic analysis revealed insights into the risks perceived by participants while seeking registration to practise, affecting their personal wellbeing, professional development and recognition, partners and children, and resources. International physiotherapy graduates have potential to improve healthcare provision and address Australia’s growing health workforce needs, through their experience, diversity, and willingness to work in rural locations. However, international physiotherapy graduates also perceive significant risks associated with seeking registration to practise.
A Phase II Study of Tumor Ablation in Patients with Metastatic Sarcoma Stable on Chemotherapy
Authors: Hirbe Angela C. , Jennings Jack , Saad Nael , Giardina Joseph D. , Tao Yu , Luo Jingqin , Berry Shellie , Toeniskoetter Jacqui , Van Tine Brian A.
Published: February 2018

Lessons Learned

Ablation therapy appears to be a reasonably safe and effective approach to obtain a significant treatment-free interval for a subset of patients with limited sites of metastatic disease for which systemic control can be obtained with six cycles of chemotherapy.

Background

Metastatic sarcoma often becomes resistant to treatment by chemotherapy. There is sometimes prolonged stable disease from active chemotherapy that provides a window of opportunity for an intervention to prolong disease-free survival.

Materials and Methods

We performed a phase II study in patients with metastatic sarcoma who had been stable on six cycles of chemotherapy who then received ablation therapy to their residual disease. Histologies captured in this study included leiomyosarcoma, malignant peripheral nerve sheath tumor, pleiomorphic rhabdomyosarcoma, and myxoid liposarcoma. Sites ablated included lung metastases and retroperitoneal metastatic deposits. In this study, up to three lesions were ablated in any given interventional radiology session. After ablation, patients were not treated with any further therapy but were followed by surveillance imaging to determine progression-free rate (PFR).

Results

Although terminated early because of slow accrual, this study demonstrated a 3-month PFR of 75% for this cohort of eight patients treated with ablation performed after completion of six cycles of chemotherapy with stable disease. Median progression-free survival (PFS) was 19.74 months, and the median overall survival (OS) was not reached.

Conclusion

Our data are the first prospective study to suggest that ablation therapy in selected patients who are stable on chemotherapy can provide a significant progression-free interval off therapy and warrants further study in a randomized trial.
Report on EURCOLD workshop on overflow of dams and levees Aussois
Authors: Mitchell Chrissy , Brown Alan
Published: February 2018

The paper describes a 4 d international workshop held in France in December 2017 to share research needs and current research in overflow erosion of embankment and concrete dams. This paper summarises the various presentations, and key aspects relevant to the United Kingdom. It is a companion to a separate paper describing current practice and research needs in relation to UK levees and reservoirs.
City-scale analysis of subsoil thermal conditions due to geothermal exploitation
Authors: Barla Marco , Di Donna Alice , Baralis Matteo
Published: February 2018

Shallow geothermal energy is currently adopted in many countries for the heating and cooling of buildings. Interactions between close geothermal plants will become more and more relevant as a result of the widespread dissemination of such systems. This paper describes a preliminary investigation of the interactions at the city scale. The case study of a central district in the city of Turin (Italy) is considered. Data from existing installations were collected and thermo-hydro finite element analyses were conducted to establish the actual ground thermal conditions and predict their evolution. This allowed identification of the areas of the city where temperature anomalies could be expected, because of thermal exploitation.
Damage assessment of deficient reinforced concrete setback structures
Authors: Ayub Muhammad Ammar , Rizwan Muhammad , Waheed Abdul
Published: February 2018

The trend of adopting architectural designs with irregularities in elevation, meaning that the shape of the building is irregular, is on the increase. Seismically deficient structures are found in abundance in developing countries such as Pakistan, and structures with irregularities in elevation may result in failures due to sudden changes in stiffness, mass or strength along the building height. The aim of the work reported in this paper was to develop analytical seismic vulnerability curves for deficient mid-rise reinforced concrete building frames with setbacks. The vulnerability curves were derived by adopting a framework used in a previous study. Along with a regular frame, six-storey frames with different setback configurations were considered. The frames were modelled using the numerical analysis program Drain-3DX and their responses were estimated by generating force–displacement envelopes using non-linear static analysis. The response spectrum of the Uniform Building Code was used to impose a seismic demand. The hazard levels were evaluated at every point of the capacity envelope using a reverse procedure of Fema 440. The damage in the studied building frames was quantified through a direct correlation with the natural period of vibration of the buildings, as suggested in previous studies. The developed vulnerability curves showed brittle failure modes in seismically deficient buildings.
Hospitalidade como vantagem competitiva: um estudo de caso dos empreendimentos turísticos de Palmas na visão dos atores
Authors: Menezes Nascimento Maria Elenita , Erig Geruza Aline
Published: February 2018

O município de Palmas, no Estado do Tocantins, possui apenas 28 anos de existência. Como cidade planejada e que possui seu produto interno bruto baseado principalmente no setor de serviços, Palmas possui uma configuração territorial privilegiada, com espaços de preservação ambiental e de qualificação da área urbana, como a Praça dos Girassóis, a Praia da Graciosa e o Parque Cesamar que geram espaços sociais de uso do território para o lazer e o turismo. As questões de hospitalidade e território relacionadas ao turismo serão tratadas nessa pesquisa, a fim de responder ao objetivo proposto de analisar os sentidos da hospitalidade, na visão dos atores, expressa pela cidade de Palmas, enquanto destino turístico. Com base no referencial teórico (hospitalidade e turismo) um estudo de caso foi realizado, o que permitiu reunir informações detalhadas para o entendimento da hospitalidade. A vantagem competitiva utilizada nesta pesquisa deve ser entendida como uma vantagem fundamental que os estabelecimentos e locais turísticos apresentam em relação aos seus concorrentes, que pode ser demonstrada pelo desempenho superior ao das demais cidades. Trata-se de uma vantagem fundamental, pois representa aquele "algo mais" que mostra que a cidade pode ser diferenciada e que a coloca em destaque frente aos outros destinos turísticos. Como resultado conclui-se que a prática da hospitalidade em Palmas pode representar uma vantagem competitiva para alavancar o turismo na cidade.
O turismo de bem-estar como possibilidade de desenvolvimento de um cluster turístico: a proposta do Vale Do Paranhana – Rio Grande do Sul
Authors: Machado Álvaro Luís de Melo , Pontes Pinent Maximilianus Andrey
Published: February 2018

Este artigo tem por finalidade uma revisão conceitual sobre as características do turismo de bem-estar demonstrando sua amplitude para além do segmento de turismo de saúde, com ênfase, na perspectiva de promoção como destino o cluster turístico na Região Turística Vale do Paranhana, no Estado do Rio Grande do Sul, Brasil. O objetivo foi evidenciar a aproximação entre os saberes da saúde, do bem-estar, da qualidade de vida e do turístico no emprego das seis dimensões de bem-estar como oferta de produtos de viagem e turismo. Para tanto, a presente pesquisa, quanto aos objetivos, é exploratória e descritiva e, quanto aos procedimentos técnicos, é estudo de caso, bibliográfica e documental. Quanto à abordagem do problema, é qualitativa e, quanto ao método do trabalho, é dedutivo. Os procedimentos metodológicos consistiram inicialmente na busca em bases de dados de pesquisas relacionadas ao tema, sendo utilizadas as palavras chave: bem-estar, viagens, destino de bem-estar, prazer, relaxamento e autoconhecimento fora do seu cotidiano. Comtemplou também documentos que caracterizam o Direcionamento Estratégico do Turismo Regional do Vale do Paranhana. Foram identificadas e classificadas as pesquisas que resultaram em 24 estudos e documentos relacionados ao tema. Na sequência, foi realizada uma análise do referencial teórico de diversas pesquisas de autores que buscaram compreender os temas e estabelecer uma correlação entre os estudos. Por fim, foram descritas e evidenciadas as contribuições dos diversos autores e os respectivos resultados apresentados decorrentes das pesquisas. As conclusões deste estudo são apresentadas após a discussão dos conceitos analisados. Por fim, o estudo realizado contribui para a compreensão das dimensões do bem-estar como propósito para o desenvolvimento do turismo. Este artigo está dividido em três partes, a primeira trata sobre os conceitos de bem-estar, a segunda sobre o Vale do Paranhana, a terceira, sobre o segmento de turismo de bem-estar e, por fim, os resultados demonstrados na interpretação dos conceitos aplicados na organização no destino turístico caso de estudo.
Conference Session I: Mitigating Risk at the Front Lines: The Copyright First Responders Program. Presented by Kyle Courtney, Copyright Advisor, the Office for Scholarly Communication, Harvard University.
Authors: Benson Sara R.
Published: February 2018

This is a summary of Kyle Courtney's Invited Presentation at the 2017 Kraemer Copyright Conference titled "Mitigating Risk at the Front Lines:  The Copyright First Responders Program."  After reading this article you will better understand the method and purpose of the First Responders Program and, hopefully, like me, you will be ready to volunteer your institution to add to the growing list of libraries engaged in this hub-and-spoke model of copyright information system.
Breakout Session: “Workshopping” Copyright Questions and Practical Solutions. Presented by Kyle Courtney, Copyright Advisor, the Office for Scholarly Communication, Harvard University.
Authors: Van Stanley Zach
Published: February 2018

During a breakout session at the 2017 copyright conference, Kyle K. Courtney led a discussion focused on practical solutions to common copyright issues. Foremost among these is risk assessments, which involve judgments of risk versus reward. Kyle recommends taking reasonable steps to minimize risk through steps such as disclaimers, fair use, and identifying authorship. To combat copyright issues, copyright professionals must have proper awareness of each individual situation. Given the resources and skills available to librarians, Kyle advises that librarians have special abilities to handle issues such as orphan works. To make judgment calls, individuals must take information on a case-by-case basis. In addition to understanding individual objects concerning their copyright status, information professionals must also understand the different views taken by rights holders, as some are more open than others to use of the copyrighted object. Kyle also discussed what is copyrightable based on measures such as tangibility in a fixed medium and the somewhat unreliable “sweat of the brow” test. Kyle also gave useful tips such as utilizing 17 U.S. Code § 108(h) to copy works in their last 20 years of copyright terms without permission under certain circumstances. Kyle recommended continued exploration of potential solutions for copyright issues as new and novel issues arise.
The 2017 Kraemer Copyright Conference Proceedings: An Introduction
Authors: Myers Carla S.
Published: February 2018

An Editorial introduction to the proceedings from the 2017 Kraemer Copyright Conference.
A Prudent Approach to Fair Use Workflow
Authors: Patterson Karey
Published: February 2018

This poster will outline a new highly efficient workflow for the management of copyright materials that is prudent and accommodates generally and legally accepted Fair Use limits. The workflow allows library or copyright staff an easy means to keep on top of their copyright obligations, manage licenses and review and adjust schedules but is still a highly efficient means to cope with large numbers of requests to use materials. The poster details speed and efficiency gains for professors and library staff while reducing legal exposure.
Exploiting Elsevier's CC License Requirement to Subvert Embargo
Authors: Bolick Josh
Published: February 2018

In the last round of author sharing policy revisions, Elsevier created a labyrinthine title-by-title embargo structure requiring embargoes from 12-48 months for author sharing via institutional repository (IR), while permitting immediate sharing via author's personal website or blog. At the same time, all pre-publication versions are to bear a Creative Commons-Attribution-Noncommercial-No Derivatives (CC-BY-NC-ND) license. At the time this policy was announced, it was rightly criticized by many in the scholarly communication community as overly complicated and unnecessary. However, this CC licensing requirement creates an avenue for subverting the embargo in the IR to achieve quicker open distribution of the author's accepted manuscript. In short, authors may post an appropriately licensed copy on their personal site, at which point we may deposit without embargo in the IR, not through the license granted in the publication agreement, but through the CC license on the author's version, which the sharing policy mandates. This poster outlines this issue, our experimentation with application, and engages viewers in questions regarding its potential risks, benefits, and workflows.For more information, including supplementary notes, see http://hdl.handle.net/1808/24107 .
In vitro transcription of guide RNAs and 5'-triphosphate removal v10
Authors: Dewitt Mark , Julia Wong not provided , Wienert Beeke
Published: February 2018

sgRNA template assembly, in vitro T7transcription, and sgRNA column cleanup to remove 5'-triphosphate groups
Relaciones entre los movimientos cívicos por los servicios públicos y los medios de comunicación, el caso de la Tebaida Quindío
Authors: Espinosa Pérez Milton Jairo
Published: February 2018

Este ensayo sobre acciones colectivas, sociedad civil y medios de comunicación analiza la relación que existe entre estas tres categorías, tomando como antecedentes sincrónicos, la base de datos elaborada por los estudiantes de Sociología Política. Teniendo en cuenta que la unidad de análisis básica son las protestas de la ciudadanía en contra del alza en las tarifas de los servicios públicos domiciliarios, como fue el caso analizado en las protestas de la de población en la Tebaida, Quindío. El análisis se focaliza en el rol que juegan los medios de comunicación en la construcción de la opinión pública (lenguaje  de comunicación), con respecto a la compresión adecuada de las acciones que realiza la sociedad civil. En este texto se mira de manera crítica como los medios de comunicación son predominantemente utilizados por los sectores dominantes de la nación para ejercer un control social y político de las acciones sociales de la ciudadanía.
Precocious puberty: a clinical review
Authors: P. Pallavee , Samal Rupal
Published: February 2018

Precocious puberty is defined as pubertal development occurring more than 2.5 standard deviations earlier than the average age. It may comprise of central or gonadotropin-dependent precocious puberty and peripheral or gonadotropin-independent precocious puberty. Variants of precocious puberty include premature thelarche, premature pubarche and isolated premature menarche which principally implies onset of menstruation without any other signs of sexual development. Precocious puberty may have long-term consequences including short stature later on in adulthood owing to premature epiphyseal fusion as also psychosocial problems. Evaluation includes a detailed history, physical examination, biochemical tests and imaging directed towards detecting the cause. Gonadotropin Releasing Hormone (GnRH) analogues are effective for treatment of central precocious puberty. Treatment of peripheral precocious puberty should be based on the cause. Isolated variants are usually normal but should be closely monitored. Multi-speciality consultation with involvement of pediatricians and enocrinologists may improve treatment outcomes in these children, who otherwise pose significant challenges to the gynaecologist.
Evaluation of glucose challenge test using cut off values 130mg/dl and 140 mg/dl for gestational diabetes mellitus screening
Authors: Basnet Tulasa , Pradhan Neelam , Koirala Poonam , Bista Kesang D.
Published: February 2018

Background: Gestational Diabetes Mellitus (GDM) is associated with several adverse maternal and perinatal outcomes. Thus, screening for early detection of GDM and its treatment is important.Methods: This was hospital based descriptive study done over one year in department of Obstetrics and Gynecology, TUTH, Nepal. Six hundred ninety-seven women fulfilling the inclusion criteria were enrolled at 18-22 weeks of gestation. High risk factors were assessed and GCT was performed in women with risk factors during enrollment. Diagnostic OGTT was performed in women who screened positive (GCT ≥130mg/dl). Screen negative high-risk women were re-screened at 24-28 weeks. In women without known risk factors, GCT was performed at 24-28 weeks and OGTT was performed when screen positive. The diagnosis of GDM was made according to Carpenter and Coustan criteria.Results: Out of 697 enrolled women, 12 were excluded for various reasons and 685 women were analyzed. Women having risk of GDM were 28.9%. The prevalence of GDM was 2.92% and 2.48% with GCT cut off 130 mg/dl and 140 mg/dl respectively. Lowering the threshold to 130 mg/dl identified three extra cases (p=0.010). The prevalence among high risk group was 8.58% and 7.07% with the cut off value 130 mg/dl and 140 mg/dl respectively with three extra cases detected on taking cut off value 130 mg/dl (p=0.014). Among low risk women the prevalence of GDM was same i.e. 0.61% with both the cut off values.Conclusions: Lowering threshold of GCT to 130 mg/dl could identify significant percentage of extra cases of GDM especially in high risk women.
Maternal and fetal outcome in oligohydramnios: study from a tertiary care hospital, Ahmedabad, India
Authors: Ghosh Runoo , Oza Heena , Padhiyar Bhakti
Published: February 2018

Background: Most severe and frequent complication of pregnancy is Oligohydramnios and the incidence of this is observed to be about 1-5 % of total pregnancies. Objective of present study was to find the maternal and perinatal outcome, etiology associated with oligohydramnios at tertiary care hospital.Methods: This prospective study was done among 55 patients with gestational age from 30-40wks with Oligohydramnios AFI<5cms with intact membranes were analysed for perinatal outcomes admitted at department of obstetrics and Gynecology in B.J. Medical college, Ahmedabad during July 2008 to July 2010.Results: 65.5% participants were belonged to 20 to 25 age group and 35.5% participants were Primigravida. Mean age was 23.9±3.3 years and mean gestation age was 36.9 week. Almost 72.2% were in 34 to 37 weeks of gestational age. Study found FMC <10 in 56.4% of participants. Forty percent participants have AFI 4 and 27.3% have AFI 5.  47.3% delivery was done by vaginal route. 5.5% baby was still birth and prematurity were the most common cause of still birth. Around 71% babies were low birth weight and congenital anomalies were present in 7.3% babies. APGAR score measured <7 at 1 minute was in 65.4% and <7 at 5 minutes was in 43.6% babies.Conclusions: Oligohydramnios in obstetrics is a frequent occurrence and it points towards intensive surveillance and proper ante-natal and post-natal care. Due to high perinatal morbidity and mortality, the incidence of LSCS increases. However, vaginal delivery has similar outcome, but strict vigilance in labor is mandatory.
Effects of thrombocytopenia in pregnancy
Authors: Kapadia Shital N. , Patel Harsh S. , Parmar Kartikey G.
Published: February 2018

Background: Thrombocytopenia defined as platelet count of less than 1,50,000/cu.mm. Thrombocytopenia is divided according to severity into mild moderate and severe types. Multiple factors are responsible.Methods: This is a retrospective study of one-year period including 120 pregnant patients irrespective of their gestational age at civil hospital Ahmedabad. Etiology of this condition are identified and analyzed.Results: Gestational Thrombocytopenia is the most common etiology. This condition is self-limiting usually.Conclusions: Platelet count estimation should be a routine at first antenatal visit for timely diagnosis and to achieve favorable fetomaternal outcome.
Retrospective study of cesarean section by using the Robson’s ten group classification system
Authors: Bhatt Manoj , Kadikar Gunvant , Parmar Dipti C. , Kanani Medha
Published: February 2018

Background: The present study was done to determine the relative contribution of each of ten groups of robson´s classification to overall cesarean section rate and identify modifiable group for intervention to reduce the cesarean rate.Methods: Retrospective review of record of cesarean section from the statistical Dept of Obstetrics and Gynecology sir T. hospital, Bhavnagar from January 2017 to October 2017 and classify them in to Robson´s ten group classification system to find out total number of cesarean among total number of delivery in above 10 months duration.Results: Total number of delivery in my study institute in 10 months was 3804 out of them 1182 was cesarean section, so the overall cesarean section rate in Sir T. hospital, Bhavnagar was 31%. Group 1 (Nulliparous, single cephalic, >37 weeks in spontaneous labor), 2 (Nulliparous, single cephalic, >37 weeks, induced or CS before labor) and 5 (Previous CS, single cephalic, >37 weeks) contributes for around 66% of total cesarean. Group 5 (Previous CS, single cephalic, >37 weeks) was the major contributor among all. Least common cause of cesarean was group 8 (All multiple pregnancies (including previous CS)) and group 9 (All abnormal lies including previous CS).Conclusions: Incidence of cesarean was more common with patient having previous cesarean section. So, to decrease cesarean rate trial of labour should be given to the patient who was suitable for vaginal birth after cesarean section. Adequate assessment of pelvis and giving trial to patient having borderline pelvis also decrease the rate of cesarean in primi gravid (group 1).
Significance of umbilical artery doppler velocimetry in the perinatal outcome of growth restricted fetuses
Authors: Thomas Jyothi Susan , Malliga A. , Sethurajan S.
Published: February 2018

Background: The objectives of the study are to determine the relationship between the umbilical artery Doppler and perinatal outcome in growth restricted foetuses and to compare the outcome with those of normal foetuses.Methods: A prospective observational study in which subjects were divided into two groups, pregnancies affected with intrauterine growth restriction (IUGR) and pregnancies with normal fetuses. Both the groups were followed with Doppler velocimetry of umbilical artery after 28 weeks till delivery. The perinatal outcome of both the groups with normal and abnormal umbilical artery Doppler (reduced/ absent/ reversed end – diastolic flow) were analysed with Chi-square test and student t - test using SPSS software version 15.0.Results: Umbilical artery Doppler velocimetry showed significant abnormality in growth restricted foetuses in comparison to normal foetuses. There was significant increase in the delivery of IUGR foetuses <37 weeks gestation(p<0.05). There was a significant increase in operative deliveries in both the groups with abnormal umbilical artery Doppler. A significant rise in adverse perinatal outcomes, Apgar <7 at 5 min and low birth weight in IUGR foetuses in comparison to normal foetuses (p<0.05).Conclusions: There is a strict correlation between abnormal umbilical artery Doppler velocimetry and an increased incidence of perinatal complications in growth restricted foetuses compared to normal foetuses. Hence, umbilical artery Doppler velocimetry should be used in all patients with fetal growth restriction, to identify impending hypoxia, to optimise the time of delivery and to optimise the perinatal outcome in these patients.
Role of saline infusion sonography in evaluation of abnormal uterine bleeding
Authors: Gupta Neerja , Singh Geeta , Jain Bharti , Garg Satakshi
Published: February 2018

Background: Abnormal uterine bleeding (AUB) is one of the most common reasons for women seeking gynaecological advice. The objective of this study was to determine the accuracy of Transvaginal sonography (TVS) and Saline Infusion Sonography (SIS) in evaluation of Abnormal Uterine Bleeding (AUB) and to compare the diagnostic accuracy after hysterectomy.Methods: Prospective, comparative study of TVS and SIS in evaluation of AUB in patients who are being subjected to hysterectomy with uterus of less than 12 weeks.Results: 100 patients were included in the study. 98% were of 30-50 years. Heavy menstrual bleeding was the commonest symptom (52%) and most common finding was fibroid, and Polyp followed by abnormal endometrium. The overall sensitivity and specificity when correlated with operative and HPE were 66% and 88% respectively for TVS and 82% and 95% for SIS respectively. The false positive and false negative rates were more in TVS compared to SIS. Commonest histopathology was intramural fibroid in 42% followed by sub mucus myoma in 21%, polyp 18% and endometrial hyperplasia 10%.Conclusions: SIS is a simple highly sensitive and specific technique to detect intra uterine pathology in the evaluation of AUB when TVS findings are inconclusive.
Risk factors in pregnancy with heart disease and their co-relation with adverse feto-maternal outcome
Authors: Sharma Preeti , Malik Renuka , Pandit Neeraj
Published: February 2018

Background: Heart disease complicates 1% to 3% of all pregnancies and is responsible for 10% to 15% of maternal mortality. In India, the predominant heart disease is still RHD (rheumatic heart disease), whereas in the developed countries congenital heart disease is more common.Methods: This prospective observational study conducted in Department of Obstetrics and Gynecology in carried in PGIMER and Dr. RML Hospital, New Delhi from November 2015 to March 2017. 35 patients with heart disease were included in this study eight risk factors, four non-cardiac (age, parity, BMI and time of reporting to hospital) and four cardiac risk factors (etiology of lesion, type of lesion, prosthetic valve on anticoagulation and associated cardiac complication like atrial fibrillation (AF), pulmonary edema, pulmonary artery hypertension (PAH) were co-related with predefined indicators for adverse feto-maternal outcome. NYHA class, CARPREG score, modified WHO class were also co-related with adverse feto-maternal outcome.Results: RHD is still more common than CHD in our population. No association was seen between any non-cardiac risk factor and adverse maternal outcome. Among cardiac risk factors, severe MS, severe PAH, NYHA class IV, AF, CARPREG score ≥2 were significantly associated with adverse maternal and fetal outcome. There was no maternal or fetal death in the present study.Conclusions: Severe MS, severe PAH, AF, NYHA Class IV, CARPREG score ≥2 had positive predictive value for adverse feto maternal outcome in the present study which had no maternal or fetal mortality. Need for Preconceptional counselling which was seen to be totally absent in the present study is emphasized.
Maternal hemoglobin: socio-demographic and obstetric determinants in rural Central India
Authors: Tayade Surekha , Singh Ritu , Kore Jaya , Gangane Neha , Singh Noopur
Published: February 2018

Background: Maternal Anemia is a global health problem with adverse implications on materno-fetal outcome. Various socio-demographic and obstetric factors affect prevalence of anemia.Methods: A hospital based, cross-sectional, observational study was carried out among pregnant women seeking antenatal care at Kasturba Hospital of MGIMS, Sewagram, a rural tertiary care institute in central India. Information was collected about demographic variables, age, gravidity, parity, literacy, area of residence and socioeconomic status. Hemoglobin levels in first trimester and pre delivery were measured by coulter and correlated with socio-demographic and obstetric factors.Results: Among 500 pregnant women of first trimester, 249 (49.8%) had anemia, 154 (30.8%) mild, 86 (17.2%) moderate and 9 (1.8%) severe anemia. More women with anemia were of lesser age, resided in rural area, belonged to middle and lower economic class, lived with joint families and had less than 12 years of formal education.Conclusions: Anemia is prevalent in pregnant women in this geographic region of central India. Age, higher gravidity, higher parity, rural residence, low socioeconomic status and less than 12 years of formal education, are risk factors. Appropriate age at marriage, small family norm, education of girl child, anemia prevention strategy in adolescent girls and financial empowerment of women are suggested strategies for prevention of anemia and improved maternofetal outcome.
Study of liver function tests in hypertensive disorders of pregnancy
Authors: Pusuloori Radhika , Arora K. Dilzith
Published: February 2018

Background: Hypertensive disorders of pregnancy with spectrum complications is one among leading causes of feto-maternal morbidity and mortality especially when its associated with HELLP syndrome.Methods: The present prospective study was conducted over a period of three years in the department of obstetrics and gynecology at Chalmeda Anandarao Institute of Medical Sciences, Karimnagar, Telangana from January 2008 to January 2009. This is a prospective study on 50 pregnant women with 28-40 weeks of gestation with diastolic BP ≥110 mm Hg recorded 6 hours apart.Results: This is a prospective study on 50 pregnant women with 28-40 weeks of gestation with diastolic BP≥110 mm Hg recorded 6 hours apart. Severe pre eclampsia was seen in younger age group ˂25 years. In patients with raised LFTs unbooked cases were more (64%) showing complications are more in unbooked cases. Renal complications are seen in 16% of the total cases and in 28% of the cases with raised LFTs. In overall study group number of primi gravid were 50% and multi were 27%. Incidence of severe pre eclampsia was 78% in overall cases. In patients with raised LFTs the incidence was 30 (88%).Conclusions: Detection of increased LFTs in cases of severe pre-eclampsia is a risk category, associated with increased rate of feto-maternal complications, compared to severe pre-eclampsia with normal LFTs. Such cases need special attention with early detection and referral to higher centre with better facilities of NICU set up to reduce the complications and mortality.
Caesarean scar endometriosis: a case report
Authors: Cherrabi Fatimazahra , Moukit Mounir , Kouach Jaouad , Rahali Driss Moussaoui , Dehayni Mohammed
Published: February 2018

Endometriosis is a common disorder in women of reproductive age but is rarely observed in abdominal scar after caesarean section. The authors report a case of 35-year-old woman referred for a painful lump at caesarean scar. Preoperative diagnosis of caesarean scar endometriosis was made on the basis of clinical examination and radiological imaging and confirmed histologically after large surgical excision of the mass. Increasing awareness of this rare entity among clinicians can help in early diagnosis and appropriate treatment.
Diagnostic laparoscopy in isolated torison of hydrosalpinx: a likely cure for an unlikely disorder
Authors: Priya Manu , Chetia Modhusmita , Sharma Asha , Verma Mona
Published: February 2018

Isolated torsion of fallopian tubes is a rare cause of acute abdomen. It is a diagnosis that is often reached after much delay. This is primarily because it has no pathognomonic clinical, radiological or laboratory signs. In such cases, it is advisable to have a low threshold for diagnostic laparoscopy. We managed a middle-aged lady with acute abdomen and after initial tests were inconclusive, we proceeded to diagnostic laparoscopy without much delay and found a twisted right hydrosalpinx. We performed a right salpingectomy as her family was complete. The fallopian tube and ovary usually act as a unit and an isolated torsion of the fallopian tube is a rare occurrence with few tell-tale sign. After cross sectional imaging, we can be fairly certain of an adnexal pathology. A delay in making a diagnosis can lead to catastrophic consequences in such conditions. An early laparoscopy can be both diagnostic and therapeutic in these cases.
Vulval myiasis: a rare entity
Authors: Wapa Anchit , Namgyal Anu , Devi Anu
Published: February 2018

Human myiasis refers to parasitic infestation of body tissues by larvae of several fly species. The entity has a simple management. It is well-documented in the literature however genital myiasis in females is scarcely reported in the literature. We hereby report this entity in a female who presented in postnatal period with ulceration and severe pain in her vulvar region.