bluuebunny/crossref_metadata_2025 huggingface dataset:
CULTURAL-HISTORICAL OBJECTS OF RIEBIŅI MUNICIPALITY IN THE 19th CENTURY – RIEBIŅI MANOR, PASTARI WINDMILLS AND BUFALIŠKI (GEĻENOVA)
Authors: Brīvere Inese
Published: November 2018

The present research is based on the method of source analysis, and its objective is to study a cultural and historical heritage of the manor of the end of the 19th century. In the documents of the Latvian State Historical Archives (the Russian Imperial Census of 1897) contain information about the manor and the buildings that had ben purchased by S. Kierbedz and M. Reut. The research does not confirm the widespread assertion that Eugenia Kerbedz has substantially renovated Riebiņi castle at the end of the 19th century for the work and recreation of the artists. The cultural-historical objects mentioned in the paper are not properly maintained today, and their potential regarding the tourism industry is not deployed. The potential of use depends on the type of use and location, as well as their technical condition. The census records are useful for family research.
RISKS AND RISK MANAGEMENT ALTERNATIVES FOR BUILDING CONSTRUCTION INDUSTRY ENTERPRISES IN LATVIA: THE RESULTS OF AN EXPERT SURVEY
Authors: Sārtaputna Sintija , Zvaigzne Anda
Published: November 2018

In the era of progressive globalisation, risk has become an integral component of entrepreneurship, which makes it necessary for every enterprise to design a risk prevention plan. The research aim is to assess the expert opinions on risks and risk management alternatives for building construction industry enterprises in Latvia.  To achieve the aim, the following specific research tasks are set: 1) to assess the most essential and widespread risks for building construction industry enterprises in Latvia; 2) to identify the most effective risk management alternatives for building construction industry enterprises.Research methods used: monographic, descriptive, analysis, synthesis, data grouping and a sociological method – a structured expert survey.The research results showed that almost half of the identified risks for building construction industry enterprises could be prevented by applying the risk mitigation strategy and taking various daily control and internal management measures, thereby investing no additional funds and reducing the consequences caused by the existing risks. A calculation of the average risk severity level by risk group revealed that the most essential risks affecting the building construction industry were those related to human capital.To reduce the effect of seasonality and the risk of unforeseeable orders, building construction industry enterprises have to diversify their business, developing some auxiliary kind of economic activity. This would ensure earning revenues throughout the year.
CONCEPT OF VIRTUAL CURRENCIES IN MODERN ECONOMIES
Authors: Kotane Inta
Published: November 2018

In recent years, development of blockchain technology and virtual currencies (VCs) have been followed not just by the media and industry professionals all over the world – there rarely could be found a person who has not ever heard the term ‘bitcoin’. Despite the popularity of VCs, there is a lack of comprehensible information in the Latvian language about what the virtual currency (VC) is, as well the concepts of digital and VCs are often misused as synonyms. The research is based on the analysis of special literature and scientific publications on the system of VCs. The aim of the research: to explore the concept of VCs in the modern economy. General scientific research methods are used in the research: the method of monographic or descriptive research, the comparative analysis method for studying the concept of VCs, the classification, legal regulation, and future development possibilities. The results of the research show that VCs are a type of digital currency, though, the opposite statement is not correct. Thus, all VCs are digital, but not all digital currencies are virtual. Exploration of the legal framework of VCs suggests that it is at an early stage of development. With the increasing number of VCs and along with strengthening of the legal framework of VCs, the issue of possible directions of the future development of VCs is raised. Two points of view dominate: the future currency or payment system, for example, smart contracts.
Виктимизация юридических лиц — жертв корпоративного мошенничества
Authors: Гулый Антон Андреевич
Published: November 2018

В статье подчеркивается, что корпоративная преступность оказывает негативное влияние на инвестиционную привлекательность России, чем обуславливает отток капитала, дестабилизирует фундаментальные факторы экономики, что опосредованно способствует спаду основных экономических показателей, в том числе росту инфляции, снижению производства, теневизации экономики. Основным видом экономических преступлений, с которым сталкиваются компании и в России, и в других странах мира, является незаконное присвоение активов путем мошенничества. Виктимизация хозяйствующих субъектов (организаций) продолжает увеличиваться, вместе с потерями жертв корпоративного мошенничества. В работе приводится характеристика жертв корпоративного мошенничества.
Статья подготовлена на основе доклада на Всероссийской научной конференции «Моисеевские чтения» (Москва, 26 мая 2018 г.).
¿Es posible la formación de personas éticas y comprometidas en la universidad? La asignatura de Educación para la paz y la igualdad en los Grados de Magisterio
Authors: Torrego Egido Luis , Martínez Scott Suyapa , Sonlleva Velasco Miriam
Published: November 2018

RESUMENLa universidad debería formar estudiantes bien informados, dotados de sentido crítico y comprometidos con la transformación social desde una ética universal basada en la solidaridad y en el bien común. Sin embargo, en la universidad actual predomina una visión utilitarista de la formación. La asignatura Educación para la paz y la igualdad se imparte en los Grados de Educación Infantil y Educación Primaria de la Universidad de Valladolid. Su finalidad es contribuir a la formación de personas éticas y comprometidas. En este artículo se analizan la potencialidad y los logros de esa asignatura. Mediante un estudio de caso en el que se utilizan entrevistas, observación no participante, cuestionarios, análisis de documentos y análisis de producciones del alumnado de la asignatura, se evalúa la valoración por parte de los estudiantes y la influencia que ejerce en ellos, así como los aprendizajes que genera. Se constata una mayor sensibilización, una mejora en la comprensión de la realidad global y el descubrimiento de estrategias didácticas para trabajar la paz y la igualdad en la escuela, pero sigue existiendo una actitud pasiva en buena parte del alumnado. Se precisa una educación contra el conformismo y la indiferencia.Palabras Clave: Formación inicial, Compromiso ético, Estudio de caso, Modelos de universidad.ABSTRACTThe university should educate well-informed students, endowed with critical sense and committed to social transformation from a universal ethic based on solidarity and the common good. However, at the current university, a utilitarian vision of education predominates. The subject Education for peace and equality is been taught in the Degrees of Early Childhood Education and Primary Education at the University of Valladolid. Its purpose is contributing to educate ethical and committed people. This paper analyzes the potentiality and achievements of this subject. Through a case study using interviews, non-participant observation, questionnaires, analysis of documents and that of student productions for the subject, assessment made by the students and their influence on them are evaluated, as well as the learnings generated by it. There is a greater awareness, an improvement in the understanding of the globalreality and the discovery of didactic strategies to work for peace and equality at school, but a passive attitude remains in many of the students. An education against conformism and indifference is needed.Keywords: Initial formation, Ethical commitment, Case study, University models.
How top exporters compete? Evidence from Spain
Authors: De Lucio Juan , Mínguez Raúl , Minondo Asier , Requena Francisco
Published: November 2018

This paper analyzes whether top exporters follow a cost-based or a quality-based strategy. Using Spanish firm-level export data for 2016, we show that firms that set lower export prices have larger export revenues. We also find that exporters obtain larger revenues from their low-price products than from their high-price products. Some results suggest that the negative effects of a higher export price on export revenues can be attenuated if firms export goods that provide scope for quality-differentiation.
The impact of Working Capital Management on firm profitability in different economic cycles: Evidence from the United Kingdom
Authors: Gonçalves Tiago , Gaio Cristina , Robles Frederico
Published: November 2018

Literature shows that Working Capital Management (WCM) affects profitability and liquidity. Economic conditions may stress those relationships, especially during economic downturns. We analyze the effects of economic cycle on the relationship between WCM and profitability, using a sample of UK unlisted companies between 2006 and 2014. We find that WCM efficiency increases profitability. This positive impact is even more important during economic downturns. Our results show multi-level effects of WCM on profitability and liquidity constraints, with varying economic conditions. Results matter economically and managerially and highlight the importance of considering WCM as part of overall corporate financial strategy.
On some physical and chemical properties of soils of sandy outcrops of the West Siberian northern regions
Authors: Kapitonova Olga A. , Aksarina Kristina Yu.
Published: November 2018

The ancient aeolian forms of relief, which are mainly covered with pineries and coniferous forests, are widely spread in the territory of Western Siberia. Anthropogenic transformation of these landscapes leads to the formation of technogenic deserts and sandy outcrops on soils of light mechanical structure generally because of the development of oil and gas extraction industry. Such transformed ecosystems are often met in the north of the West Siberian Plain within a subzone of northern taiga of the taiga natural zone and the zone of the forest-tundra. In 2016–2017, we explored three sites of sandy outcrops in the territory of Purovsky District of Yamalo-Nenets Autonomous Okrug (Tyumen region): in 27 km to the south from Muravlenko, in 32 km to the southwest from Gubkinsky and in 23 km to the East-southeast of New Urengoy. The first two sites are located within the northern taiga; the third site is at the southern border of the forest-tundra, in the area of its gradual transition to the northern taiga.

Results of the conducted researches show the considerable changes in a number of physical and chemical properties of podsolic sandy soils of technogenic deserts in comparison with soils of undisturbed ecosystems. We have revealed statistically significant decrease in the acidity of the surface soil layer to 5–6 units рН due to the destruction of the top soil horizons and exposure of the illuvial and eluvial horizons having smaller acidity. Our researches show the reduction of maintenance of fine fractions – clay and dusty particles – in the transformed soils and, respectively, increase in content of sand up to 95–100%. Also we have revealed statistically significant reduction of soil moisture content in soils of sandy outcrops. 

Thus, the soils of technogenic deserts are characterized by ease, flowability, they are usually not fixed by vegetation and easily are affected by wind. The ecotopes, which are formed on sandy outcrops, differ in extreme conditions. They can be mastered only by a small number of specialized species-erosiophiles, shifting to disturbed felted habitats with similar natural ecotopes with the friable sandy and sabulous sandy soils, often mobile soil typical of marine and lake shallows, river alluvium, taluses, slopes of ravines. On the periphery of sandy outcrops the shafts of falling up to 4,5–5,5 m high are formed. They constitute the real danger to natural undisturbed north taiga and forest-tundra ecosystems, burying them under sandy masses.
Anaerobic methane oxidation by nitrate: kinetic isotope effect
Authors: Vavilin Vasiliy A.
Published: November 2018

The ratio of stable carbon isotopes (13C/12C) in different environments serves as a significant limitation in estimating the global balance of methane [Hornibrook et al., 2000]. In this case, the value of 13C/12C largely depends on the kinetic isotope effect associated with the metabolism of microorganisms that produce and consume CH4. The article suggests a dynamic model of the processes of methane formation and its anaerobic oxidation with nitrate by methanotrophic denitrifying microorganisms (DAOM), which allowed estimating the fractionation factor of stable carbon isotopes. In the experiment with peat from the minerotrophic bog [Smemo, Yavitt, 2007], the dynamics of the amount of methane and was measured. The dynamic model showed that the introduction of nitrate leads to a slow decrease in the partial pressure of methane. Since methane in the DAOM process is a substrate, methane is enriched with heavier carbon 13C in the system under study. This leads to an increase in the value . The carbon isotope fractionation factor during methane oxidation with nitrate was equal to 1.018 and comparable with the fraction of carbon isotope fractionation in the process of acetoclastic methanogenesis (1.01). Model calculations have shown that during incubation the apparent fractionation factor of carbon isotopes with the simultaneous formation of methane and DAOM slowly decreases. The ratio of 13C/12C isotopes in dissolved and gaseous methane practically does not differ. The model showed that an increase in the initial concentration of nitrate increases the rate of DAOM, which leads to a decrease in the concentration of dissolved methane. In this case, the value of 13C/12C increases. In field studies, Shi et al. (2017) showed that the presence of DAOM in peat bogs in which fertilizers penetrate can be controlled by the amount of nitrate used and the depth of penetration into the anoxic layer. Two MATLAB files describing DAOM are attached to the article.
Foetal arrhythmias: an enigma of the missed beats
Authors: Kulkarni Ketki S. , Satoskar Purnima R. , Bansal Vandana , Kharate Rachana
Published: November 2018

Background: The synchronised depolarization and repolarisation of the atria and ventricles is achieved by specialised cardiac cells that generate an electrical impulse and propagate it along the conducting system in the myocardial tissue, leading to rhythmic activity of the atria and ventricles. Abnormalities of these rhythms lead to foetal arrhythmia.Methods: A retrospective observational study was conducted in a tertiary care hospital over period of one year to study the course and perinatal outcome of women with foetal arrhythmias.Results: The confinement in the study period was N=4302, of which 207(4.81%) women had foetal congenital malformations. Among them 21(0.48%) women had foetal cardiovascular abnormalities and 6(0.14%) women had foetal arrhythmias. There were two cases of maternal primary Sjogrens syndrome: one with foetal 2nddegree atrioventricular (AV) heart block with 2:1 AV conduction and another with foetal 3rd degree or complete heart block. Others were a case of Atrial premature contractions with compensatory pause, a case of Supraventricular tachycardia, one case of sinus tachycardia with non-immune hydrops and a case of foetal bradyarrhythmia with regular ectopic beats in a case of complex congenital heart disease. The course of these pregnancies, treatment options and perinatal outcome was studied.Conclusions: Foetal echocardiography and Doppler are effective tools for detection and monitoring of foetal arrhythmias. Early and correct diagnoses of arrhythmias help in management of foetal arrhythmias and multidisciplinary team-based approach gives optimum treatment results.
Maternal outcomes among emergency obstetric admissions at a tertiary care teaching hospital in Chitradurga, South India
Authors: Arpana Anju , B. M. Rashmi , V. Latha
Published: November 2018

Background: The maternal mortality is a vital index of the quality and efficiency of obstetric services prevailing in a country. The obstetric emergencies are unexpected occurrences during pregnancy or puerperium requiring immediate attention. Obstetric emergencies can either happen suddenly or they can develop as a result of complications that are not properly identified, monitored or managed. These emergencies, to a large extent, are preventable. The purpose of this study was to understand the contributing factors of obstetric emergencies, their clinical presentation, management and maternal outcomes.Methods: A cross sectional study was conducted among obstetric emergency admissions during October 2016 to September 2017, at a tertiary care hospital in urban area of central Karnataka.Results: A total of 100 emergency admissions were observed in the study period. A 41% of were un-booked antenatal cases. A 13% of patients reached with the longest delay of 10-12 hours duration. A 31% of emergency admissions were in compromised condition. The majority of the cases were delivered by LSCS (55%).Conclusions: In the study, nearly half of the pregnancies were unbooked. There were teenage pregnancies reported in the study. More than half of obstetric emergencies were from rural areas. In nearly 50% of admissions a delay of more than 5 hours in reaching this hospital was noted. Ignorance was a major factor which impeded the access of antenatal health care services. Health education to pregnant women about importance of accessing maternal health services, early ANC booking and regular checkups, identification of high-risk pregnancy and timely referral, availability of fully functional first referral units and transport facilities for these emergency patients. Availability of skilled medical professionals round the clock in these FRU’s are the need of the hour.
A comparative study of early and delayed cord clamping in term deliveries
Authors: Gonnade Nikita V. , Nikhate Surendra D. , Bal Himadri , Shrivastava Nikita
Published: November 2018

Background: Timing of clamping of the umbilical cord has always been a debatable issue. Early cord clamping (ECC) is defined as clamping of the cord within 30 seconds of delivery of the baby and delayed cord clamping (DCC) is defined as clamping of the cord between 30 to 120 seconds of delivery. Delayed cord clamping, despite some limitations, is said to be beneficial to the neonate.  A comparative study between ECC and DCC was carried out on a select group of term pregnant women without any high-risk factor and delivering at term. Aim of the study was to compare the effects of early versus delayed cord clamping on neonates and mothers. The focus was on the neonatal haemoglobin levels and adverse effects, if any on neonates and mothers in the two groups.Methods: 100 women satisfying the inclusion/exclusion criteria were recruited for the study. They were randomly divided into two groups of 50 each. Group A underwent early cord clamping and Group B delayed cord clamping. Mothers were observed for 1 hour post-delivery for any evidence of post-partum haemorrhage. Neonates were observed for any sign of tachypnea and blood sample was sent after 72 hours of delivery for analyzing Hb, hematocrit and bilirubin of the neonate.Results: The results revealed that neonates with DCC had a higher mean Hb level of 15.02 vis-à-vis the ECC group Hb of 11.69G/dl and the difference was statistically significant. Similarly mean hematocrit of DCC group was 48.67 while the ECC group mean was 42.36, the difference again was statistically significant. There was no significant side effects or complications in both mother and newborn babies.Conclusions: It was concluded that delayed cord clamping should be practiced in otherwise non high-risk deliveries.
Serum homocysteine and folate levels as a predictor of materno-fetal outcome in preeclamptic women
Authors: Jain Namita , Singh Abha , Bhattacharjee Jayashree
Published: November 2018

Background: To study the role of serum homocysteine and serum folate levels in prediction of materno-fetal outcome in preeclamptic women, especially in early onset preeclampsia.Methods: This prospective study was conducted in a tertiary care teaching hospital in India. 60 preeclamptic women (Group A) that were matched with 60 normotensive pregnant women (Group B), with singleton pregnancy and gestational age between 24-32 weeks attending antenatal clinics were included in the study. Maternal blood was collected twice first at time of enrolment and second at delivery. Serum homocysteine and serum folate levels were analyzed using enzymatic assay and chemiluminescent immunoassay. Mean rise in serum homocysteine and folate levels were calculated individually in all patients.Results: Mean homocysteine levels were significantly higher in Group A as compared to Group B both at enrolment and delivery (p <0.05). Women with higher rise in mean homocysteine levels were associated with an increased risk of adverse maternal complications (p <0.05). Mean rise in homocysteine levels were significantly higher in women who developed abruption and perinatal death (p <0.05) while no correlation was found with the mean change in serum folate levels (p >0.05).Conclusions: Serum homocysteine can be used as a reliable marker for predicting the severity of preeclampsia and adverse pregnancy (both maternal and fetal) outcome thus helps in reducing maternal and fetal morbidity and mortality, especially in women with early onset preeclampsia.
Study of the causes of non-acceptance of VBAC in patients with previous one LSCS in a tertiary institution
Authors: Karmali Deepa B. , Pednekar Guruprasad , Nagarsenkar Ajit A.
Published: November 2018

Background: Many women who are eligible candidates for a VBAC (Vaginal Birth after Caesarean) in the current pregnancy opt for a repeat LSCS (Lower Segment Caesarean Section) as a mode of delivery. We decided to evaluate the proportion of patients who opt out of a VBAC and to study the causality of this trend.Methods: All patients who presented to the Dept. of OBG in our institution and were eligible to have a VBAC were included in the study till the sample size of 100 cases was met. Consultant opinion was sought prior to deciding the mode of delivery.Results: Incidence of patients of previous one LSCS who were not willing for VBAC was 4%, out of total number of deliveries and 30.7%, out of all cases of patients with previous one LSCS. The reason for not opting for a VBAC in the current pregnancy in the majority of the eligible patients was the desire for a concurrent sterilization procedure. Others cited apprehension of a scar rupture or fear of labor pain or both as their primary reason for opting out of a VBAC.Conclusions: The high incidence of ERC (Elective Repeat Caesarean) as compared to TOLAC (Trial of Labour after Caesarean) has long-term clinical and financial implications. Counseling given to the pregnant woman with an emphasis on the advantages of VBAC in order that she opts for a VBAC with confidence and enthusiasm is the only way forward.
Transvaginal ultrasonographic assessment of cervical length in prediction of preterm labour in high risk asymptomatic women
Authors: Pushparaj Seeniamal , Nagaraj Prasanna
Published: November 2018

Background: Preterm birth is an important cause of perinatal morbidity and mortality and has long term health implications. Aim of this study was to predict preterm labour by Transvaginal ultrasonographic cervical length measurement in high risk asymptomatic women which may help in decision making in managing these women.Methods: This study was conducted in Department of Obstetrics and Gynecology, Mahathma Gandhi Memorial Government Hospital, Trichy from August 2016 to September 2017 in 130 antenatal women with high risk factors such as prior spontaneous preterm birth, miscarriage. Transvaginal cervical length was measured and Gestational age at which delivery occurred was correlated and results were analyzed.Results: In present study, sensitivity of transvaginal cervical length measurement (cut off cervical length <25 mm) was 70.9% and specificity was 63% in prediction of preterm labour in high risk asymptomatic women. Positive and negative predictive value of cervical length in predicting preterm labour were 63.7 %and 70% respectively.Conclusions: Transvaginal cervical length measurement can be combined with anomaly scan in high risk women to predict preterm labor and is objective, reproducible and cost effective.
Study the effect of mifepristone on fibroid and uterine volume
Authors: Seher Umbreen , Chauhan Nidhi , Mangla Mishu
Published: November 2018

Background: Fibroid is the most common benign tumour of the uterus affecting 20% of women of reproductive age group and is the most common indication for hysterectomy accounting for about 40% of all hysterectomies in premenopausal women. This study was undertaken to study the effect of Mifepristone, which is a progesterone receptor modulator with antagonistic action, on fibroid and uterine volume.Methods: The study was conducted in the Department of Obstetrics and Gynaecology, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Dehradun over a period of 12 months. A total of 40 patients were included in the study.Results: Mean baseline fibroid volume decreased by 49.17% at 1 month and by 77.4% and 3months of treatment with Mifepristone. Mean baseline uterine volume decreased by 34.13% at 1 month, and further reduction by 58.3% at the end of treatment.Conclusions: The study shows that there is a significant reduction in fibroid and uterine volume in patients treated with mifepristone.
Mifepristone for cervical ripening and induction of labour
Authors: G. Lata , N. Rana , R. Mittal , S. Kumar
Published: November 2018

Background: The study was aimed to evaluate the efficacy of Mifepristone for induction of labour and in improving the Bishop score at term. The study also aimed to assess induction delivery interval and maternal and fetal outcomes with Mifepristone.Methods: The study was carried out on 200 pregnant females with 2 study groups of 100 each. Group A females received tablet Mifepristone 400mg and   Group B females received placebo. Results: Time interval between induction to onset of labour was 28 hours 54 min and 42 hours 18 min respectively in cases and control group. Mean induction delivery interval was 35 hours 38 min and 49 hours 52 minutes respectively in cases and control group. LSCS rate was less with Mifepristone group.Conclusions: This study showed that treatment with Mifepristone is a simple and effective method of inducing labour in women with term pregnancy with unripe cervix. The use of Mifepristone provides an interesting new alternative to classic uterotonic agents when induction is necessary. The potential advantage of Mifepristone over PGs or oxytocin requires further evaluation in scarred uterus.
Sildenafil citrate and uteroplacental perfusion in fetal growth restriction
Authors: Singh Priya , Saiyda Hena
Published: November 2018

Background: Severe early-onset fetal growth restriction can lead to a range of adverse outcomes including fetal or neonatal death, neurodisability, and lifelong risks to the health of the affected child. Sildenafil, a phosphodiesterase type 5 inhibitor, potentiates the actions of nitric oxide, which leads to vasodilatation of the uterine vessels and might improve fetal growth in utero. The objective is to evaluate effectiveness and safety of Sildenafil citrate for treatment of Doppler velocimetry of uterine, umbilical artery for systolic/diastolic ratio (S/D ratio) at first visit, after 2 hours and then after 12 weeks of treatment.Methods: A case control study was carried out in 96 antenatal women with fetal growth restriction over a period of twelve months. A written informed consent was obtained. Out of 96, 12 were lost to follow up. Of remaining 84 women, 42 were included in the study group and 42 in the control group. First group (case) received Sildenafil citrate 50 mg stat followed by colour Doppler after 2 hours and then 25 mg three times a day for 12 weeks. The second group (control) received placebo in for 12 weeks.Results: Sildenafil treatment was associated with a significant increase in length of pregnancy (P> 0.05) overall mean S/D ratio pre-sildenafil was 5.34±0.93 which reduced to 5.18 ± 0.95 after 2 hours of sildenafil administration and this significant was highly significant (p<0.0001).and also the mean S/D ratio pre-treatment was 6.72±0.38 which decreased to 3.52±0.47 after 12 weeks of sildenafil administration. The difference between them was found to be extremely significant (p<0.0001).Conclusions: Sildenafil citrate can improve utero-placental perfusion and length of pregnancy in pregnancies complicated by IUGR. It appears to have a significantly positive effect on fetal weight. Sildenafil treatment may offer a new opportunity to improve perinatal outcomes, for pregnancies complicated by IUGR. However, these observations require further studies on wide scale.
Clinical, ultrasonographical and hormonal correlation in women with polycystic ovarian syndrome
Authors: G. Ashwini Sidhmalswamy , Ghongdemath Jyoti S. , Venkatesh Sreedhar
Published: November 2018

Background: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women of fertile age. The prevalence, time of onset and severity of clinical presentation vary among different ethnic and racial groups. Though there is significant reproductive, endocrine and metabolic morbidity of PCOS, very little is known about its different modes of presentation in Indian population. A cross sectional observational study. The objective To study the correlation between the clinical, ultrasonographical and hormonal features in women diagnosed as PCOS based on the revised diagnostic criteria, 2003.Methods: A cross-sectional study of 74 PCOS women who had oligo ovulatory cycles and polycystic ovarian morphology on ultrasound was done. Data about menstrual history and anthropometric measurements were collected. Clinical observations of acne and hirsutism were made.  Transvaginal ultrasonography and biochemical analysis for free testosterone was done.Results: In all, 74 PCOS women were studied and analyzed. The mean age was 24.884.03, mean BMI was 25.48 ±3.75 and mean free testosterone was 3.81±4.05. Among the PCOS women 39.8% were hirsute, 10.1% were obese, 2.3% had acne and 38% were hyperandrogenemic. Of the hyperandrogenemic women 61.2% were hirsute, 53.22% were obese and 36.54% had acne.  The association between BMI and free testosterone level was statistically significant (p=0.0023). BMI was moderately correlated with hyperandrogenemia (r=0.446). The mean left ovarian volume was higher in obese than in non-obese women, which was statistically significant (p=0.003). The mean left ovarian volume was high in hyperandrogenemic women which was statistically significant (p=0.00034).Conclusions: In the present study it was found that there is association between obesity and free testosterone level which was significant. There was statistically significant association between ovarian volume and obesity. Similarly, there was association between ovarian volume and hyperandrogenemia which was significant. Hirsutism and acne had no association with hyperandrogenemia.
Study of incidence and outcome of acute inversion of uterus
Authors: Bangal Vidyadhar B. , Gagare Swati D. , Bhardwaj Samita , Raut Sonal
Published: November 2018

Background: Acute inversion of uterus also called as puerperal inversion of uterus is a rare, but life-threatening complication of third stage of labour. Severe uterine atony, mismanagement of third stage of labour, adherent placenta are some of the common factors associated with the occurrence of acute inversion of uterus. Early recognition and prompt treatment are important to save life of the woman.Methods: A retrospective cross-sectional record-based study was carried out to find out the incidence, presentation and outcome of cases of acute inversion of uterus admitted to Pravara Rural Hospital Loni for a period of three years (October 2015 to September 2018).Results: During the study period, there were 27,134 deliveries including 8,834 caesarean sections. There were six cases of acute inversion of uterus in the hospital during study period. The incidence of acute inversion of uterus was 0.22 per one thousand deliveries (0.27 per thousand vaginal deliveries and 0.11per one thousand caesarean sections). Three cases were referred from outside hospital and three cases had delivered at Pravara Rural Hospital. Five cases had delivered vaginally, where as one case had undergone caesarean section. There were two maternal deaths and four survivals among six cases of inversion of uterus. Severe anaemia, irreversible hypovolemic shock and multi-organ failure were causes of maternal deaths.Conclusions: Prompt recognition of uterine inversion and its immediate reposition under anaesthesia was a key for successful management. Delay in recognition and transfer of cases resulted in haemorrhagic and neurogenic shock, leading to death of a women. Institutional deliveries with practice of principles of active management of third stage of labour (AMTSL) and improvement in emergency obstetric care services at peripheral hospitals, avoiding delays at all levels will help to reduce the incidence, morbidity and mortality associated with acute inversion of uterus.
A case series of masquerade postpartum haemorrhage
Authors: Bello Oluwasomidoyin O. , Lawal Olatunji O.
Published: November 2018

Postpartum hemorrhage (PPH) is an obstetric emergency with different causes. Management is directed towards the cause and can be medical or surgical. This is a case series report of four patients who presented to University College Hospital; Ibadan, Nigeria with PPH following emergency caesarean section (EMCS) with three performed for prolonged obstructed labour. All the cases had severe PPH, hemodynamic instability and presented 14 to 84 days post caesarean section. Surgical exploration revealed extension of caesarean incision into the uterine vessel with slipped ligature in two of them and bleeding vessel without ligature in the other two. Two had haemostasis secured with uterine artery ligation, one had repair of uterine incision extension while the 4th had hysterectomy. The length of hospital stay was 5 to 13 days. All recovered fully post-operatively and were discharge home in good clinical condition.
A case of PRES following intracranial hypotension, with spontaneous resolution with epidural blood patch
Authors: Mamilla Sarada Murali
Published: November 2018

Posterior reversible encephalopathy syndrome (PRES (also known as reversible posterior leukoencephalopathy syndrome)) presents with rapid onset of symptoms including headache, seizures, altered consciousness, and visual disturbance. It is often but by no means always associated with acute hypertension. Diffusion-weighted MRI is the most sensitive exam to confirm the diagnosis of PRES. If promptly recognized and treated, the clinical syndrome usually resolves within a week, and the changes seen in magnetic resonance imaging (MRI) resolve over days to weeks. Posterior reversible encephalopathy syndrome is an increasingly recognized disorder, with a wide clinical spectrum of both symptoms and triggers, and yet it remains poorly understood. Differential diagnosis includes venous sinus thrombosis, cerebral haemorrhage, encephalitis, vasculititis and metabolic encephalopathys. No clinical trials have evaluated the management of PRES, but rapid withdrawal of the trigger appears to hasten recovery and to avoid complications: for example, aggressive blood pressure management, withdrawal of the offending drug, or delivery in eclampsia. We report a case of women presenting with severe headache, tonic clonic convulsions 7 days after spinal anaesthesia for caesarean delivery, MRI showed evidence of intracranial hypotension and posterior reversible encephalopathy syndrome. She was treated with Blood patch which lead to complete resolution of symptoms and radiological findings. The possible pathogenetic relationship between intracranial hypotension, secondary to the inadvertent dural puncture, and PRES is discussed. Prompt diagnosis and proper treatment results in complete cure without permanent neurological sequelae.
Unusual giant central cervical leiomyoma: surgical challenge
Authors: Kaushal Aayushi , Kaur Manjeet , Bhalla Vidur , Kaur Dilpreet
Published: November 2018

Leiomyomas are most common uterine and pelvic tumours. The most common anatomical location is uterus. Fibroids arising from cervix are rare tumours accounting for 2% of all fibroids. A cervical leiomyoma is commonly single and is either interstitial or subserous, rarely it becomes submucous and polypoidal. Here authors report a case of huge cervical fibroid in an unmarried lady who presented to us with complaint of heaviness in abdomen. On per abdomen examination a firm mass of 32 weeks size arising from pelvis with restricted mobility was noticed. Ultrasound showed 21*10.3*10 cm heterogenous mass in pelvis with evidence of internal vascularity. MRI was suggestive of fibroid arising from body of uterus. True cut biopsy of the lesion was taken which showed benign lesion. Decision for myomectomy or Hysterectomy (according to intraoperative findings) was taken. While doing the procedure, after accidental ligation of left ureter and injury to bladder, diagnosis of cervical fibroid was made. Hence pre-operative diagnosis of cervical fibroid is very important in order to avoid damage to bladder and ureters.
Rare case reports of ruptured ectopic pregnancy
Authors: Paul Dhrubal Prasad , Debbarma Dibakar , Rakshit Ashis Kumar
Published: November 2018

Two patients of 30-35 years of age presented in Gynecological emergency of Agartala Government Medical College at unstable condition with the diagnosis of ruptured ectopic pregnancy. Both the cases were taken for emergency laparotomy after initial resuscitation, investigations & arrangement of blood products. In both the cases rupture were found in right side and hence right sided salpingectomy done in both the cases. Both the tubes (affected) after laparotomy were sent for histopathological examination where both the reports came to be partial mole. Ectopic hydatiform mole (either complete or partial) are rare events, among these Ectopic partial moles are rarer. Both the cases were in regular follow up & ß-HCG levels came to the base level within 6-7 wks. The 1st case became pregnant after 9 months of laparotomy.
Comparison of the diagnostic accuracy of fine needle aspiration cytology and core needle biopsy in patients with ultrasound detected breast lesions as well as the cost effectiveness of the screening modalities in the poor population visiting our institution
Authors: Tandon Nishi , Tiwari Neema , Tripathi Tanya , Jaiswal Amrisha , Lal Nirupma , Musa Osman
Published: November 2018

Background: Breast cancer is the leading cause of cancer relayed mortality and morbidity among women and the incidence of the disease is rising all over the world. Despite the imaging techniques, histopathological diagnosis still plays an essential role for differential diagnosis and for avoiding surgical over-treatment in case of breast lesions with suspicious features (10). Fine-needle aspiration cytology (FNAC), core needle biopsy (CNB) and vacuum assisted breast biopsy(VABB) represent the current methods of choice for pathological diagnosis, both with their specific advantages and limitations. The purpose of this study is to compare the diagnostic accuracy of FNAC and CNB in patients with US-detected breast lesions as well as the cost effectiveness of the screening modalities in the poor population visiting our institution.Methods: It was a retrospective study done using the department register data where we compared the FNAC findings and compared it with CNB findings in the same cases. This was a short study done for a period of 3 months only from January 2017-March 2017. We collected 50 cases of breast carcinomas where both FNAC and CNB findings as well as the clinical information and follow up were available for the patients. We compiled the data for these cases and slides were reviewed by two independent pathologists to remove observer bias. Authors tabulated clinical information, FNAC diagnosis, CNB diagnosis as well as the stage at presentation and follow up for each case.Results: As is seen in this study that 7 cases which were benign on FNAC were benign on CNB also. As for malignancy while CNB diagnosed 43 cases as malignant FNAC diagnosed 5 cases as suspicious [which were malignant on CNB] and 37 cases as malignant which came out to be malignant in CNB too. So, the while the NPV is 100% the PPV is comparable to CNB.Conclusions: In conclusion, FNAC and CNB represent accurate methods for the characterization of US-detected breast nodules, with similar values of diagnostic accuracy, sensitivity, specificity and NPV. In experienced hands, FNAC could be still considered the first method to evaluate breast lesions being less invasive. CNB has a higher PPV and should be performed for uncertain diagnostic cases and when the evaluation of the invasiveness or histological type of breast lesion is mandatory.
Role of CB-NAAT in diagnosing extra pulmonary tuberculosis in correlation with FNA in a tertiary care center
Authors: Komanapalli Sunil Kumar , Prasad Uma , Atla Bhagyalakshmi , Nammi Vasundhara , Yendluri Divya
Published: November 2018

Background: The diagnosis of extra-pulmonary tuberculosis (EPTB) is challenging due to the pauci-bacillary nature of disease. Recently, WHO recommends GeneXpert/CBNAAT to be used as the initial diagnostic test in patients suspected extra-pulmonary tuberculosis (EPTB). The study was done to assess the role of Cartridge Based Nucleic Acid Amplification Test (CB-NAAT) in the diagnosis of EPTB. Aims and objectives was to study the role of FNAC, CBNAAT and Fluorescent LED in diagnosing extra-pulmonary tuberculosis (EPTB).Methods: This is a descriptive observational study carried out over a period of 12 months (April 2017 to March 2018) at department of Pathology, Andhra Medical College. All presumptive cases of extrapulmonary tuberculosis and purulent aspirates from the various sites between the age group of <10yrs to 60 years of age were included in the study. FNA was done and material sent to CBNAAT and fluorescent LED (Light-emitting Diode) microscopy in all the cases and results tabulated.Results: The total number of cases with presumptive extra pulmonary Tb were 289. Majority of the aspirates are from lymph nodal and cervical swellings 94.1% (272/289). CBNAAT has detected 6.5 % of cases (19/289) which were not detected by FNA and 9.3% of cases (27/289) LED negative cases. Resistant to rifampicin was identified in 2.1% (3/142 cases) of CBNAAT positive cases.Conclusions: FNA still remains the cheapest test to diagnose TB. In cases with Granulomatous lymphadenitis and purulent aspirates CBNAAT has an important role in diagnosing EPTB. In addition it offered rapid detection of rifampicin-resistant M. tuberculosis strains which is an added advantage.
Role of biochemical markers in the prediction of osteopenia and osteoporosis in men and women of Sikkim, India
Authors: Soibam Deepa , Singh Amumacha T. , Nandy Parvati , Baruah Ankur
Published: November 2018

Background: Osteoporosis being a silently progressing disease, the real challenge is to identify the individual at high risk of osteoporosis. Many bone turnover marker have been associated with bone loss even before occurrence of any changes in bone structure. Therefore, this study was aim to evaluate the predictive value of bone turnover marker by correlating with low bone density.Methods: This was a case control study conducted in Sikkim Manipal Institute of Medical Sciences, India. A total of 300 subjects (150 case and 150 control) both male and female between the age group of 35- 65 were enrolled. We measure one bone formation marker serum osteocalcin and two resorption marker urine hydroxyproline (OHP) and urine N- terminal telopeptides of type I collagen (NTX). Calcaneal QUS device (GE Lunar Achilles Express heel- densitometer) was used to determine the bone density.Results: A significant difference of the bone markers i.e. hydroxyproline, NTx and osteocalcin were observed between cases and control of men and women with P<0.001. These variables statistically significantly predicts bone density with F (3, 71) = 5,671, P= 0.002, R2= 0.193 and F (3, 71) = 5.292, P= 0.002, R2= 0.183 in women and men respectively.Conclusions: Study showed that bone turnover markers are able to predict low bone mass. Resorption markers NTx and OHP were the main predictor in men whereas OHP and formation marker Osteocalcin in women. Therefore, BTM measurement along with BMD can provide useful information about the changes in the bone mass which will help to predict the risk of osteoporosis.
Hypertensive crisis induced acute pulmonary edema in emergency care unit Sumbawa hospital: a case report
Authors: Syammakh Muhammad Ahmad , Anthonius Franky Renato
Published: November 2018

Acute cardiogenic pulmonary edema is a common cause of respiratory distress in emergency department (ED) patients. Pulmonary edema is a problem of major clinical importance resulting from a persistent imbalance between forces that drive water into the air space of the lung and the biological mechanisms for its removal. A patient 66 years old female, with a history hypertency stage II and osteoarthritis admitted to emergency department with acute pulmonary edema. On evaluation, the patient had intense dyspnoe, agitated, diaphoresis without cyanosis, the pulse pressure was normal, rapid and regular. Noninvasive ventilation by noninvasive positive pressure ventilation or continuous positive airway pressure has been studied as a treatment strategy. Noninvasive ventilation and intravenous nitrates are the mainstay of treatment which should be started within minutes of the patient's arrival to the ED. Use of morphine and intravenous loop diuretics, although popular, has poor scientific evidence. We critically evaluate the evidence for the use of noninvasive ventilation on rates of hospital mortality and endotracheal intubation. Although is often results from atrial fibrillation, acute myocardial infarction, hypertension crisis, discontinuation of medication edema. It is important to understand this disease, rapid diagnostic with ultrasound and when treated promptly and effectively, these patients will rapidly recovery. Good oxygenation, intravenous nitrates, intravenous diuretics and low dose sedation which should be started within minutes of the patients arrival to emergency department.