bluuebunny/crossref_metadata_2025 huggingface dataset:
Theoretical and Methodological Approaches to the Definition of Legal Norms Aimed to Regulate Relations in the Field of Administrative-Territorial Structure and Territorial Organization of Local Self Government
Authors: Vasiliev S. A.
Published: October 2019

In modern legal literature quite a large number of papers are devoted to the problems of legal regulation in which legal scholars try to improve the texts of normative legal acts. However, most of the problems in this area occur for another reason. They occur because of inconsistency of legal norms with regard to the relations that they are supposed to regulate. The paper not only attempts to present a different view on the process of lawmaking. It also suggests some ways to improve the procedure for creating normative legal acts on the basis of the theory of the balance between subjects of law. The article focuses on the relations that develop with regard to the territory as the most obvious physically expressed standing area determining relations between people. The paper has applied the main provisions of the previously developed theory of correlation of subjects of law in the framework of which the relations between different participants of legal relations concerning a certain territory are being analyzed. In addition, the author investigates the problems of the current legal regulation and the practice of implementation of legal relations. The modern legal doctrine has been analyzed in the context of the issue under consideration. The whole set of the presented approaches allowed the author to build logically more correct, in contrast to the existing, procedure for creating the rules of law concerning the territory. As the result of the study, the author suggests using new approaches to law-making processes on the basis of the identified problems of the balance between legal norms and relations that they are expected to regulate. The paper also describes the methodology of creating lawmaking and contains a case study of transformation of the existing normative legal regulation in Sevastopol.
Legal System of Kazakhstan in the Horde Period
Authors: Ablaeva E. B.
Published: October 2019

The paper is devoted to the study of the historical aspect of the formation and development of justice in modern Kazakhstan, i.e. from the time when Genghis Khan established the Great tribal state throughout the vast territories from the Yellow to the Black sea. The choice of the topic is due to the lack of modern dissertation researches devoted to the history of formation and development of justice, chronologically sequential periodization covering the co-evolution phase of the research subject that must include the Mongol and Golden Horde period. Differences in historiography and misconceptions about the way of life of nomads also led to the choice of the research topic. The paper shows the similarities and differences of some features of the court procedure at the co-evolutionary and modern stages of development of statehood.

The relevance of the topic is due to the fact that in the context of the presidential programs «Modern state for all» and «Spiritual revival», focused on the revival of spiritual values of Kazakhstan, the study of justice in the Mongolian and Horde period is important for improving the efficiency of the modern judicial system. The theoretical and practical significance of the work is that it describes the legal views, legal culture, legal system of two ethnically close modern states, namely Mongolia and Kazakhstan based on a deep comparative analysis of written and historical versions.

According to the results of the study, the author comes to the following conclusions. First, the author connects the loss of the role of customary law in the regulation of social relations with the process of Kazakh-Russian integration and the adoption of the law of the Russian Empire, not the norms of the Mohammedan doctrine. Secondly, in the author’s opinion, the legal field of the Mongolian and Horde period covers a variety of rules governing social relations in the early feudal state. Thirdly, the author considers that during the period under consideration there were no clear criteria differentiating the categories «law» and «legislation». Fourth, according to the author, a mixture of functions of the legislative, executive and judicial authorities characterizes the legal system of modern Kazakhstan, which is the successor of the Golden Horde.
Budesonide/formoterol Turbuhaler® as needed in mild asthma: results of SYGMA-1 and SYGMA-2 trials (SYmbicort® Given as needed in Mild Asthma)
Authors: Avdeev S. N. , Aisanov Z. R. , Belevskiy A. S. , Emelyanov A. V. , Knyazheskaya N. P. , Kurbacheva O. M. , Leshchenko I. V. , Nenasheva N. M.
Published: October 2019

According to the modern concepts, asthma is a heterogeneous disease characterized by chronic airway inflammation and respiratory symptoms, which vary in time and intensity and manifest together with variable obstruction of the airways. Asthma is responsible for the deterioration of health status and quality of life in approximately 339 million of adult patients and children worldwide. Despite the fact that asthma is a chronic inflammatory disease, patients with asthma generally inadequately receive anti-inflammatory therapy in real clinical practice and rely on short-acting beta2-agonists (SABA) too much; this can “mimic” worsening of asthma symptoms. SABA monotherapy “on demand” does not affect chronic airway inflammation, underlying asthma occurrence and progression. As a result, such patients still have the risk of asthma exacerbation and disease progression. Therefore, the need of a new therapeutic strategy for patients with milder asthma (steps 1 and 2), which would provide anti-inflammatory treatment considering the low adherence to the regular maintenance therapy and high dependency on SABA, is obvious. Such approach has become available after the SYGMA (SYmbicort® Given as needed in Mild Asthma) trial was completed. According to the results of this trial, budesonide/formoterol 160/4.5 µg/dose as needed was superior to as needed SABA in better asthma control and decrease in severe asthma exacerbation rate by 64% (p < 0.001). Results of SYGMA 1 and 2 trials also demonstrated that budesonide/formoterol 160/4.5 µg/dose as needed was noninferior compared to regular treatment with budesonide in preventing severe asthma exacerbations while the cumulative dose of budesonide was reduced by ≥75%.
An efficacy of ninedanib in patients with idiopathic pulmonary fibrosis (two case reports)
Authors: Terpigorev S. A. , Nikishenkov A. M. , Nikishenkova S. G.
Published: October 2019

Idiopathic pulmonary fibrosis (IPF) is an irreversible progressive diffuse parenchymal lung disease with the median survival of 3 to 5 years. However, antifibrotic therapy can significantly reduce IPF progression rate. The natural course of the disease is difficult to predict in an individual patient. The prognosis and the response to therapy could differ in different IPF patients. Two clinical cases with modified rate of IPF progression under the treatment with nintedanib are described in the article. The late initiation of therapy with nintedanib in a patient with rapidly progressive disease did not slow down the progression rate, while a patient with a relatively favorable course of IPF demonstrated less rapid worsening in clinical and functional parameters under the treatment with nintedanib.

Conclusion. The time-course of clinical and functional parameters is individually related to the disease severity and the potential therapeutic efficacy. The rapidly progressive course of IPF should be considered as a criterion for early initiation of antifibrotic therapy as this treatment could improve the prognosis. Effects of antifibrotic therapy should be assessed using a complex of parameters described the disease severity because IPF can differ in clinical course and progression rate.
Inteligencia emocional y creatividad en alumnos de 1º y 2º de Primaria. ¿Existen diferencias por género?
Authors: Salavera Bordás Carlos , Larraz Rábanos Natalia , Usán Supervía Pablo
Published: October 2019

El objetivo de la presente investigación fue analizar la relación entre creatividad e inteligencia emocional. El método empleado en la investigación ha sido de naturaleza cuantitativa, basado en la aplicación del Test de pensamiento creativo de Torrance (expresión figurada) y el cuestionario de inteligencia emocional EQ-i-YV para niños y adolescentes de Bar-On y Parker, a una muestra de 957 estudiantes de 1º y 2º de Primaria (6-8 años). Los resultados muestran como la edad y el género tienen efecto en la creatividad y la inteligencia emocional. Además, un 47,43% de los participantes presentaba bajos niveles de creatividad, mientras un 14,10% presentó altos niveles en este constructo. Las correlaciones entre creatividad e inteligencia emocional fueron bajas. Cuando se tiene en cuenta el género, se observa como mientras esta relación entre las variables es baja en el caso de los varones (r =,06), en el caso de las mujeres es menor (r =,02). El modelo presentado presentó un ajuste óptimo: χ2 (33) = 62,879 p 0,001; χ2/gl = 1,905; CFI = 0,96; NFI = 0,96; TLI = 0,95; RMSEA = 0,042, IC 95% (0,028 – 0,057). Como conclusión, afirmar que los datos de la investigación evidencian la necesidad de trabajar programas que trabajen la creatividad y la inteligencia emocional, que puedan proporcionar soporte emocional y servir en el desarrollo personal de los alumnos desde los primeros cursos de Primaria.
Inclusión efectiva de los alumnos talentosos en la escuela actual en el marco del Programa de Desarrollo de Capacidades
Authors: Cascarosa Salillas Esther , Lorda Pérez Carlos , Martínez Peña Begoña
Published: October 2019

El objeto de este trabajo ha sido investigar cómo la aplicación de metodologías activas y participativas con alumnos talentosos favorece su inclusión en las escuelas ordinarias y, por otro lado, facilita las interacciones sociales positivas al trabajar en equipo. Una escuela inclusiva debe garantizar, a todos los alumnos, una capacitación y formación adaptada a sus necesidades e intereses, pero, el diseño del sistema educativo actual dificulta en gran medida que el profesorado apueste por metodologías que fomenten el desarrollo de las competencias en todos los alumnos en general y, en particular, en los alumnos con buenas capacidades. A través de la implantación del  rograma de Desarrollo de Capacidades en un centro de ESO, los alumnos talentosos han desarrollado proyectos basados en sus propios intereses. Se han recogido datos mediante cuestionarios estructurados, hojas de observación y entrevistas. Los resultados aquí mostrados, prueban que este Programa es un contexto apropiado para trabajar en entornos de aprendizaje que comprometan a los alumnos (y familias) en la construcción de su propio conocimiento. Dicho Programa sirve de medio para que los alumnos desarrollen sus aprendizajes como lo harían fuera del marco escolar, usando las TICs y el trabajo colaborativo, como herramientas principales.
Alta capacidad y género: la autoestima como factor influyente en las diferencias entre sexoss entre sexos
Authors: García Perales Ramón , Canuto González Inmaculada , Cebrián Martínez Antonio
Published: October 2019

Los resultados obtenidos en el diagnóstico de altas capacidades son significativamente menores en niñas que en niños; sin embargo, no se encuentran estudios concluyentes que confirmen diferencias en la inteligencia en función del sexo. La literatura publicada sitúa los estereotipos de género y la autoestima como variables fundamentales en la brecha existente. Razonadamente, hemos realizado una investigación cuantitativa de la autoestima en 118 sujetos de 4º, 5º y 6º de Educación Primaria, comparando después los resultados en función de distintas variables moduladoras. Se ha utilizado la Escala de Autoestima de Rosenberg. Los resultados confirman que sí existen diferencias en la autoestima en función del sexo, siendo las niñas las que presentan niveles más bajos. El rendimiento académico es otra variable que correlaciona positivamente con la autoestima. No se han hallado resultados significativos que relacionen el constructo evaluado con la edad, el curso, las altas capacidades diagnosticadas o el tipo de centro de los sujetos. Las conclusiones se centran en la demanda de nuevas investigaciones que analicen la posible vinculación de la discriminación de la mujer con su no adecuada autoestima, centrándonos en las mujeres con altas capacidades.
Empoderamiento docente en el ámbito de las altas capacidades intelectuales. Mitos y creencias en los docentes de Educación Primaria
Authors: López Parra Emilio , Martín García María Inés , Palomares Ruiz Ascensión
Published: October 2019

El alumnado con altas capacidades intelectuales tiene necesidades educativas que por diversas causas no siempre son atendidas adecuadamente. En esta compleja situación se enmarca esta investigación cuya finalidad es la de conocer cuáles son las percepciones de los docentes de Educación Primaria sobre aspectos tan relevantes como el rendimiento, conductas y habilidades sociales, género y respuesta educativa que satisfaga sus necesidades educativas. Se indaga sobre la formación de estos docentes, y la influencia de estereotipos y mitos sobre las altas capacidades. Se utiliza una metodología mixta, que en su enfoque cuantitativo analiza las percepciones de 343 docentes mediante un cuestionario, y desde la perspectiva cualitativa, recoge las preferencias sobre la respuesta educativa más eficaz para este alumnado, mediante una entrevista estructurada a 6 docentes. Los resultados muestran que todavía continúan arraigados algunos de los mitos y estereotipos más comunes sobre este alumnado, existiendo deficiencias importantes en el plano formativo y que la respuesta educativa debería de ser más individualizada según las necesidades de cada alumno. Esto nos lleva a concluir que es necesario establecer programas formativos en altas capacidades para los docentes, como medida fundamental para mejorar la vida académica y personal del alumnado con altas capacidadesintelectuales.
Presentación
Authors: Palomares Ruiz Ascensión , Gargallo Ibort Esther
Published: October 2019

Presentación
Doppler predictors of perinatal outcome in intra-uterine growth retarded foetuses
Authors: Hingorani Varshika Mahesh , Shah Dharita S. , Ghate Madhura , Patel Sachin
Published: October 2019

Background: The study aims at early detection of intrauterine growth retarded fetuses which are at high risk of perinatal complications. It can help obstetricians take appropriate preventive steps and prevent serious perinatal complications.Methods: The study undertaken over 100 pregnant women with pregnancy induced hypertension between 28-36 weeks subjected to umbilical artery and uterine artery doppler. The outcome data including gestational age at birth, birth height, APGAR score, admission to NICU, need for positive pressure ventilation and neonatal mortality.Results: The study shows that 58% mothers with IUGR foetuses were primigravida; gestational age at delivery is 34.2 weeks and 82% of IUGR foetuses were delivered by C-section. Average birth weight of foetus with abnormal doppler was significantly lower and there was high incidence of NICU admission. The study also shows that oligohydroamnios was common with abnormal doppler group.Conclusions: Umbilical artery doppler velocity in addition to uterine artery velocity doppler should be considered as a primary tool for foetal surveillance in pregnancy induced hypertension patients and for planning management of IUGR foetuses.
Awareness of cervical cancer and practice of Papanicolou smears among adult women availing health services or visiting a rural maternity hospital, Ramnagara District, Karnataka, India
Authors: Kona Chandralekha , Joseph Merlyn , Varghese Jilshy , Aksha Mary , Joseph Anju , Jose Ria , Johnson Avita Rose
Published: October 2019

Background: Cervical cancer is a leading cause of cancer-related deaths among women worldwide. Almost 87% of cervical cancer deaths occur in low and middle-income countries. The study was conducted to assess the awareness of cervical cancer and practice of Papanicolou (Pap) smears among women availing health services or visiting a rural maternity hospital, Karnataka.Methods: A hospital-based cross-sectional study was conducted using a 50-item interview schedule. The interview was administered to women >18 years of age who availed services at the hospital and their caretakers.Results: Mean age of the 158 women interviewed was 32.68±13.7 years. Only 21% of women had heard about cervical cancer. Only 11.4% knew at least one symptom and 1.9% knew one risk factor of cervical cancer. Most of the women (99%) were not aware about prevention of cervical cancer. Only 4% of the women had heard about Pap smears and 3% of the women had undergone a Pap smear test.Conclusions: Women in our study had very poor awareness of cervical cancer and practice of Pap smears. Gainfully employed women (OR=32; 8.8-111.2) and women who reported cervical cancer among family members or friends (OR=116; 20.2-665.4).  were more likely to have heard about cervical cancer. This study indicates a need to increase the awareness on cervical cancer and its prevention especially regarding Pap smears among rural women in Karnataka.
Assessment of maternal serum β hCG level in pregnancy induced hypertension and normotensive patients and to correlate between the level of β hCG with the severity of pre-eclampsia and eclampsia
Authors: Dev Kapil , Sharma Anoop , Sood Rajeev
Published: October 2019

Background: Hypertensive disorders during pregnancy are one of the most common medical complication seen during pregnancy, affecting around 5-10% of all pregnancies. Spectrum of this disease ranges from mildly elevated blood pressure with minimal clinical significance to severe hypertension with multi organ dysfunction. Pre-eclampsia complicates about 2-8% of all pregnancies. Pre-eclampsia incidence in India is about 8-10%. Various studies have depicted that, there is a strict relationship between PIH and elevated serum β-hCG level.Methods: This one-year prospective case control study toteled 200 pregnant women attending antenatal care and admitted in eclampsia ward fulfiling the inclusion criteria were studied. Serum βhCG levels were estimated by chemiluminescent microparticle immunoassay. Statistical analysis of data was done by student’s t-test and p-value.Results: The mean β hCG level in PIH patients was found to 36851.59 mIU/ml with standard deviation of 22916.58 while the mean β hCG in normotensive patient was 15433.26 mIU/ml with standard deviation of 6861.56. (p <0.001). The mean β hCG level in gestational hypertensive patients was 25206.19 mIU/ml with a standard deviation of 8696.9. The mean β hCG level in pre-eclamptic patients was 61697.67 mIU/ml with standard deviation of 18498.57. The mean β hCG level were 84106.38 mIU/ml with standard deviation of 11295.05 in the eclamptic patient. The above values were statistically significant (p <0.001).Conclusions: We concluded that there was a striking relation between the PIH including pre-eclampsia and eclampsia with the elevated serum βhCG level. Concluding that early detection of altered serum βhCG shell aid in better management of pre-eclampsia and eclampsia cases which would play a pivotal role in improving the maternal and fetal outcome.
The challenge of neuroimaging during pregnancy
Authors: Ghazal Kariman Suel , Shatila Abdul Rahman
Published: October 2019

Background: Central nervous system conditions may affect every aspect of female reproduction from fertility to lactation. The objective of this study was to examine the performance of computed tomography and magnetic resonance imaging in the diagnosis of maternal neurologic disorders and to examine the outcome of pregnancies complicated by abnormal neurologic imaging.Methods: Retrospective observational study of 20 parturients presenting with severe neurologic symptoms (January 2006 to January 2016).Results: Abnormal neuro-radiological findings were found. Only 10% of the computed tomography-scans were normal. Both magnetic resonance imaging and computed tomography that were performed in all cases showed cerebral edema (90%) with different degrees, thereby cerebral edema was the predominant lesion. Pertaining to its localization, 65% were localized in the parietal or occipital area, 10% in the paraventricular area, and 10% were diffused. Also, 35% showed intracerebral hemorrhage and 10% showed cerebellar hemorrhage. The incidence of neurological disorders in pregnancy and puerperium was high. Epilepsy and headache were the most common primary and secondary neurological disorders.Conclusions: The role of neuroimaging in diagnosing neurological disorders is crucial for prevention of severe complications.
Fetal transverse cerebellar diameter measurement in intrauterine growth restriction: a more accurate parameter for gestational age assessment at term
Authors: Mourya Saroj , Mourya Harish Kumar , Jain Vimla , Verma Manoj
Published: October 2019

Background: Assessment of fetal gestational age (GA) is an essential part of obstetric USG. Accurate knowledge of fetal GA is important to facilitate the best possible prenatal care and successful pregnancy outcome.  For the estimation of GA the commonly used parameters in third trimester are:- BPD, HC, AC and FL. As all these parameters are affected by fetal growth disorders and fetal position. TCD can be used as another parameter for the estimation of GA in growth restricted fetuses.Methods: This study was conducted at Mahila Chikitsalaya Sanganeri Gate; SMS Medical College Jaipur from July 2005 to September 2006. A total of 80 pregnant women in third trimester with singleton pregnancy including 40 pregnant women with known cases of IUGR and 40 AGA fetuses were studied for TCD measure.Results: Correlation coefficient between TCD and gestational age was highly significant and no significant difference was found in TCD of AGA and IUGR fetuses.Conclusions: TCD measurement can be used as more reliable parameter for accurate estimation of gestational age in IUGR fetuses in third trimester.
Tamoxifen for treatment of abnormal uterine bleeding in etonorgstrel implant users: a randomized clinical trial
Authors: Fetih Ahmed N. , Abbas Ahmed M. , Kamel Fatma A. , El Nashar Ihab H.
Published: October 2019

Background: The current study aims to compare the use of tamoxifen and oral contraceptive pills in women using implanon and complain with irregular uterine bleeding.Methods: Women attended family planning clinic using implanon presented by bleeding were invited to participate in the study. They were randomized into two groups: Group A: 100 women received Tamoxifen 10 mg twice daily for 10 days taken at the onset of an episode of bleeding or spotting episode. Group B: 100 women received Combined oral contraceptive pills (microcept) once daily for 21 days take at the onset of an episode of bleeding or spotting episode.Results: No difference regarding the baseline criteria of both groups. No difference between both groups regarding the duration of irregular bleeding in the implanon users (p=0.090). Additionally, the number of bleeding days and spotting in the last month was similar in both groups (p=0.554). The percentage of women who stopped bleeding during the period of treatment is 84% in the tamoxifen group and 92% in the COCs group, but the COCs needs longer treatment time, where the mean of days required to stop bleeding is 5.03±1.8 days in the tamoxifen group and 6.5±2.5 in the COCs group. Headache and nausea were the most prominent adverse effects found in the COCs group (p=0.000).Conclusions: Oral administration of tamoxifen 10 mg twice daily for 10 days is effective on stopping bleeding attacks in implanon users.
Successful vaginal delivery of spontaneously conceived twins in each horn of a bicornuate uterus with previous caesarean: a case report
Authors: Mazhari Farhat , De Arpita , Tripathi Reva
Published: October 2019

Mullerian duct fusion anomalies resulting in uterine malformations have prevalence of 3-4%. Among this, bicornuate uterus has a rare incidence of 0.4%. Uterine malformations pose significant threat in terms of obstetric outcomes. We report an extremely rare case of spontaneous conception of twin pregnancy with the fetus occupying each horn of a bicornuate uterus (bicornis unicollis), in a woman with a history of previous caesarean section. She was booked at our hospital and the pregnancy remained uneventful. At 35 weeks she went into spontaneous labour and delivered vaginally without any maternal-fetal complications. The case is unique and the management is worth discussing as till date no protocols or guidelines have been proposed for the mode of delivery of bicornuate uterus with twins with previous cesarean.  Only 12 cases of twins with bicornuate uterus have been reported till date. This is the first case in literature in which a successful VBAC has been conducted in a woman with bicornuate uterus with twins with previous caesarean.
A rare case of steroid cell tumor of ovary: case report
Authors: . Sharanya , Peter Monalisa
Published: October 2019

Steroid cell tumors of the ovary account for less than 0.1% of all ovarian tumors. These tumors may present at any age with presentations related to the hormonal activity and virilizing properties of tumor. A 61-year-old postmenopausal women presented with complaints of postmenopausal bleeding for 15 days. Parity score of P3L3, not tubectomised. Menopaused 16 years back. History of weight loss noted. She is a known case of diabetes mellitus for 6 years not on any treatment and a known case of depressive disorder for 35 years on treatment on trihexphenidyl lurasidone. Had undergone sigmoid colon polyp removal in June 2018. On examination, P/A- mild gaseous distension (+). P/S- cervix flushed with vagina, pulled up cervix. P/V- uterus size and position couldn’t be made out, anterior fornix fullness (+). Ultrasonography showed bulky uterus with fibroid 4x4cm, endometrial thickness- 9 mm? Krukenberg tumor and posterior mediastinal lymph nodes. Patient underwent Total abdominal hysterectomy with bilateral salpingo-oophorectomy with frozen section on 01/07/19. Frozen section: 1. Ovaries: right ovary - fibrothecoma, left ovary- simple cyst. 2. Uterus- endometrial hyperplasia with atypia. 3. Myometrium- leiomyoma and adenomyosis. Postoperative period was uneventful. On microscopic examination, impression: right ovary- steroid cell tumor, uterus-endometrial hyperplasia with cytological atypia. Ovarian steroid cell tumors are grouped under sex chord stromal tumors and are usually benign, unilateral and characterized by a steroid cell proliferation. Steroid cell tumors are associated with androgenic changes with variable frequency, ranging from 12% to over 50% respectively. The primary treatment is surgical extirpation of the primary lesion and there are no reports of effective radiation or chemotherapy. In a young patient with stage IA disease, a unilateral salpingo oophorectomy is adequate.
A rare case report: successful outcome of a patient at near term pregnancy with maternal chronic obstructive hydrocephalus due to tubercular meningitis
Authors: Mahesh Sowmya , Srivastava Himshweta
Published: October 2019

The incidence of tubercular meningitis leading to obstructive hydrocephalus is extremely rare accounting for 1% cases and is even rarer during pregnancy. A 20-year-old 2nd Gravida presented at 32 weeks gestation with complaints of intermittent headache, decreased vision since 3 months and irrelevant talks and agitated behavior since 1 day. On examination patient had stable vital signs but constant irritable behavior. Obstetric examination revealed a pregnancy corresponding to 32 weeks with a live fetus. Patient had a past history of Anti-tubercular therapy taken 2 years back for tubercular meningitis. Neurological examination revealed a GCS of 12/15 and Ophthalmologic examination revealed patient to be having only Perception of Light with optic atrophy on fundoscopy. NCCT head revealed moderate dilatation of bilateral ventricles and 3rd ventricle without any periventricular ooze suggestive of Chronic Obstructive Hydrocephalus. Supportive therapy was instituted with Dexamethasone and Mannitol infusion after Neurosurgical consultation along with antenatal care. Decision for termination of pregnancy was taken at 35 weeks by an elective caesarean section with simultaneous ventriculo-peritoneal shunt insertion by neurosurgical team under general anesthesia. A live male baby of 2.25 kg was delivered. Patient with baby was discharged on 10th post-operative day. Obstructive hydrocephalous developing post tubercular meningitis in pregnancy is a rare event. Caesarean section was done along with shunt surgery in our case. Very few cases have been reported in the medical literature so far.
A point prevalence study of catheter associated urinary tract infections among patients admitted in an university hospital
Authors: Binda Filippo , Demarchi Antonia , Galazzi Alessandro , Nicolò Gabriella , Bisesti Alberto , Accardi Roberto , Laquintana Dario
Published: October 2019

Background: Urinary tract infections (UTIs) are the most common type of healthcare associated infection in acute care hospitals. Most involve urinary drainage devices, such as urinary catheter. The objective of this study was to investigate the prevalence of catheter-associated urinary tract infections in adult patients of a tertiary level university hospital.Methods: The point prevalence study was conducted in one single day and included all adult patients admitted in medical, surgical wards and intensive care units. The Centre for Disease Control (CDC) criteria were adopted to classify the different type of UTIs.Results: Out of a total of 497 adult inpatients, 94 patients had a urinary catheter for at least 48 hours. The prevalence of symptomatic urinary tract infection (SUTI) in this sample is 17%. Escherichia coli (31.2%), Enterococcus faecium (25.0%) and Enterococcus faecalis (12.5%) are the most common pathogens found.Conclusions: The main isolated uropathogens in this study are Gram-negative and Escherichia coli remains one of the most frequent cause of UTIs in human. Gram-negative pathogens have multiple virulent factors responsible for their adherence to uroepithelium and urinary catheter positioning facilitates the transmission of these pathogens to urinary tract. Urinary catheterization is frequently used as solution to facilitate continence and maintain skin integrity in elderly patients. Urinary incontinence frequently is an example of inappropriate use of urinary catheter: for that reason, urinary catheter should be considered as the last option if other solution, like incontinence pads, are not indicated.
Investigating risk factors for developing autism, cerebral palsy and down syndrome in a Trinidadian population
Authors: Sagireddy Sowmya , Nayak Shivananda B. , Brewster Natasha , Nanan Varsha , Harry Rajiv , Ali Mikhail , Fraser Alexander , Greaves Rachelle , Singh Visham , Barclay Sally
Published: October 2019

Background: Autism, Cerebral Palsy and Down Syndrome are three lifelong, non-curable common developmental disorders that affect approximately 1 in 59, 1 in 323, and 1 in 700 children respectively. This research is to study the effects of prenatal, perinatal, and postnatal factors on the development of Autism, Cerebral Palsy (CP) and Down Syndrome (DS) in a Trinidadian population.Methods: This was a descriptive case-control study comprised 75 subjects, with 25 cases from each of the three disorders investigated, i.e. autism, CP and DS.Results: The highest risk of autism was associated with mothers having high stress levels (p=0.002), high blood pressure (0.042), and low iron levels (p=0.012) during the pregnancy, as well as having a family history of autism (p=0.002) and residing in an air polluted area (p=0.034). The highest risk of cerebral palsy was associated with a child being born preterm (case 24%, control 0; p=0.009), experiencing postnatal complications (case 80%, control 4%, p=0.000), having a birth weight less than 2500 g (p=0.002), having an abnormal appearance at birth (p=0.045), specifically the prevalence of blue baby (case 20%, control 0) and abnormal appearance (case 12%, control 4%), a case father having a low educational level (p=0.002), a case of mother having gestational diabetes during the pregnancy (p=0.037) and having older mothers (p=0.033) and fathers (p=0.033) than the controls. The highest risk of down syndrome was associated with mothers having high stress (p=0.017) and blood pressure (p=0.021) during pregnancy.Conclusions: The findings of our research confirm that autism, CP and DS are multi-factorial developmental disorders. A combination of environmental conditions, genetics, prenatal and postnatal factors are associated with an increased risk of developing autism, cerebral and down syndrome.
Spectrum of pediatric urinary stone composition in North Western India: analysis at tertiary care center
Authors: Saran Rama Kishan , Katti Pawan , Mirdha Kiran , Saran Sanya , Takhar Rajendra Prasad
Published: October 2019

Background: Pediatric urolithiasis results in significant morbidity in later life. Incidence as well as site and chemical composition of calculi varies according to the changes in socio-economic conditions over time and the subsequent changes in dietary habits leading to a marked variation in the spectrum of urinary stone composition. To evaluate the spectrum of urinary stone composition in pediatric population from North-western India.Methods: This was a prospective observational study conducted between October 2013 and February 2019 which included pediatric patients with urolithiasis. Demographic and epidemiological characteristics including age, sex, geography, religion, socio-economic status, dietary habits were recorded. The location and sizes of stones were documented. The data was collected, analyzed and presented using summary statistics.Results: A total of 163 patients with urolithiasis were enrolled, of which 86 (53%) aged between 6 and 10 years, 49 (30%) aged between 11 and 14 years and 28 (17%) were aged between 0 and 5 years. The majority of patients were male (n=134; 82.21%). The most common location of the stone was urinary bladder (n=106; 65.03%) followed by kidney (n=33; 20.25%), urethra (n=16; 9.82%) and ureter (n=8; 4.91%). The upper tract (kidney and ureter) to the lower tract (bladder and urethra) stone ratio was 1:4. Stones with mixed composition were more than pure stones (73.62% versus 26.38%). The most common composition was the mixed stone of calcium oxalate, calcium phosphate and uric acid (n=36; 22.09%) followed by mixed stone of calcium oxalate monohydrate and dihydrate with uric acid (n=29; 17.79%), calcium oxalate and uric acid (n=25, 15.34%), calcium oxalate and calcium phosphate (n=20; 12.27%). Calcium oxalate was present in 80% of the stones, followed by uric acid in 7%, struvite in 6%, cystine in 3% and calcium phosphate in 2%.Conclusions: These results suggest that the prevalence of mixed stones with calcium oxalate as the predominant chemical component in the urinary stones of pediatric patients studied.
Awareness and post counselling acceptance of eye donation in a tertiary care centre in Northern Kerala
Authors: V. Latha N. , Kumar Ponny J. , K. Praveena K. , Ravendran Risha
Published: October 2019

Background: Corneal diseases are among the major cause of vision loss and blindness in the world today. Corneal transplantation remains the mainstay of treatment. Hence creation of awareness carries paramount importance. Aim of this study is to assess the awareness about eye donation amongst attendants of deceased patients, their willingness to donate eyes and the reasons for poor donation rate. To assess the efficacy of grief counselling by Eye Donation Counsellor (EDC), its impact on the conversion rateMethods: A prospective hospital based study was done in 135 participants (guardians of deceased subjects) admitted in intensive care units, from June 2017 to June 2018. Counsellor accompanied with a junior resident would first screen the cases. Relatives of suitable cases were approached and counselled in a systematic manner following a standard interview pattern. Responses were noted in a predesigned proforma.Results: Among 618 deceased cases 135 potential donors were identified.57.8% next of kin were aware of the concept of eye donation, but 42.2% were not. After counselling, willingness for eye donation was seen in 54.1%, others refused. Among 57.8% kin who were aware, 51.3% gave consent. Prior knowledge of eye donation, literacy and socioeconomic status did not have any significant influence on willingness. Counselling was found to be the best method to facilitate eye donation.Conclusions: An active counselling by eye donation counsellor is the main factor which is responsible for eye donation.
Prevalence of elderly patients who refuse to get discharge from coronary intensive care unit in a tertiary care hospital of North India: a pilot study
Authors: Singla Sanjeev Kumar , Singla Ankush , Panditrao Mridul , Bansal Ishan , Singh Rakendra
Published: October 2019

Background: The elderly population ≥60 years is increasing as the life span is increasing. So is the number of elderly patients who are refusing to get discharge from the hospital is also increasing. Authors are conducting this study in the elderly population who want to stay against medical advice.The aim to find the prevalence of elderly patients who refuse to get discharge from Coronary Care Unit (CCU) in a Tertiary care hospital of North IndiaMethods: A retrospective, observational study conducted in patients of age ≥60 years admitted to the coronary intensive care unit of a tertiary health care centre who refused discharge from the unit, were included in the study. Results: Of the 575 patients 44(7.65%) were willing to stay against medical advice. Of these 24(54.5%) were males and 20(45.5%) females. 6(13.6%) patients were terminally ill suffering from malignancies. Among all the patients who were willing to stay against medical advice, 8(18.2%) were covered by some health insurance scheme of either State or Central Government. 3(6.8%) patients were discharged after 24 hours, 22(50%) patients after 48 hours, 14(31.9%) patients after 72 hours and 5(11.3%) patients after 96 hours of advising discharge from hospital.Conclusions: As the intensive care beds at tertiary healthcare level are limited, the treatment of other salvageable sick patients who need the intensive care is affected by the unnecessary stay in hospital. Apart from the worsened nurse to patient ratio this increases the cost of treatment. This is need of hour to provide safe environment for the elderly outside the hospital settings and increase resources to provide better homecare.
Comparative study of standard laparoscopic cholecystectomy and single incision laparoscopic cholecystectomy: outcome and complications
Authors: Goyal Kirti Savyasacchi , Utaal Maneshwar Singh , Bhatia Pramod Kumar
Published: October 2019

Background: Laparoscopic cholecystectomy (LC) has evolved to be as gold standard treatment for gall bladder disease and is the most common laparoscopic procedure performed worldwide. In recent times, the innovative techniques of Natural orifice Transluminal Endoscopic Surgery (NOTES) and Single Incision Laparoscopic Surgery (SILS) have been applied as a step forward towards scar less surgery with added benefits of less pain and less analgesic requirement, shorter hospital stay, quick return to work.Methods: A retrospective study of 50 patients admitted with gall bladder disease through outdoor for laparoscopic cholecystectomy from November 2018 to January 2019 in Maharishi Markandeshwar Institute of Medical Sciences and Research Mullana (AMBALA) were randomized into two groups of  25 each for Single Incision Laparoscopic Cholecystectomy (SILC) and standard laparoscopic cholecystectomy (LC) comparing the operative time, outcome and  complications.Results: 50 patients admitted to MMIMSR Mullana from November 2018 to January 2019 with gall bladder disease were divided into two groups of 25 each who underwent three port SILC and four port laparoscopic cholecystectomy (4PLC). The average intra-operative time in SILC (80.56 mins) was significantly more than standard laparoscopic cholecystectomy. The average length of stay in the hospital for SILC was 1.8 days (1-3 days), was significantly less than in standard four port laparoscopic cholecystectomy. Incidence of Intraoperative complications were more in SILC than standard LC.Conclusions: SILC as the newer novel technique had better outcomes in terms of cosmesis, early discharge, shorter stay at hospital.
Pattern distribution of abnormal hemoglobin variants by cation exchange High Performance Liquid Chromatography: a study of 9,116 subjects
Authors: Gamit Sejal Kalyanbhai , Nishal Arpita , Shah Pinal , Patel Archana
Published: October 2019

Background: The present study was conducted to identify pattern distribution of abnormal haemoglobin variants by using HPLC method in a tertiary care hospital, Surat, Gujrat, India.Methods: A cross sectional study of one-year duration was conducted including 9,116 patients screened for the presence of abnormal haemoglobin variants. Blood samples were initially tested for solubility test and run on automated haemoglobin analyzer for complete haemogram. All the suspected and family study cases were processed for HPLC (Bio-Rad Variant II) for conclusive diagnosis. Patients with a history of recent blood transfusion of less than 3 months duration were excluded from the study.Results: A total of 9,116 cases (1390 males, 7726 females) were included in the present study. The age group of patients ranged from 1 month to 95 years. Solubility test and complete haemogram were performed in all the cases. Out of the 9,116 cases, 8409(92.24%)cases had normal HPLC pattern. 492(5.40%)cases were diagnosed as sickle cell trait, 176(1.93%) cases as sickle cell disease, 29(0.32%) cases as β thalassaemia trait, 1(0.01%) case as β thalassaemia major, 2(0.02%)cases as Hb E heterozygous and 03 (0.07%) cases as Hb D Punjab heterozygous. One case of double heterozygous for Hb E-β thalassaemia was also found.Conclusions: HPLC is a rapid, accurate and useful method for diagnosing haemoglobinopathies. It serves as an reliable tool in diagnosing the presence of abnormal haemoglobin variants in suspected cases on routine haematology in developing countries like India, where the resources for detection of haemoglobinopathies are limited. Early diagnosis may help in proper management of patients.
The study of cutaneous malignancies at a tertiary care hospital in central india
Authors: Saldanha Elroy , Dhakad Vinod , Patel Dhruv , Mehta Nikhil , Ahmed Zeeshanuddin , Jain Amar , Desai Sanjay
Published: October 2019

Background: There has been an alarming rise in the incidence of various diseases including that of cancer in the world with increase in the incidence of cutaneous malignancies owing to various changes that have taken place in the society over the past few years with respect to the culture, the lifestyle and also a contributory role has been played by the changes in the atmosphere as a result of increase in the air pollutants in the environment. Based on the scenario, we decided to conduct a study to evaluate the presentation and the management cutaneous malignancies in a teaching hospital set up in central india.Methods: A retrospective study was conducted between the time period of 1 year on the records of patients who were diagnosed with cutaneous and related malignancies who were treated at our Institute on a predesigned semi structured performa. SPSS version 23.0 was used for the analysis of the data collected.Results: We evaluated a total of 29 cases, Squamous cell carcinoma (SCC) was the most common histological type (51.72%) followed by melanoma (27.59%) and basal cell carcinoma (BCC, 20.69%). 75.86% of patients with cutaneous malignancies were males and 24.14% were females. Mortality rate observed was 13.7%.Conclusions: The most common cutaneous malignancy seen in this study was squamous cell carcinoma having increased propensity towards males than females. Rate of loco-regional disease and median disease-free survival is directly dependent on the adequacy of disease-free surgical margin and to the limited extent on the adjuvant therapy.
Intestinal obstruction in case of internal hernia through congenital defect in falciform ligament in adult
Authors: Parikh Archit Pankajkumar , Tyagi Mohan Prakash , Kapadia Dheerta Atul
Published: October 2019

Small bowel obstruction due to internal herniation of ileum through congenital defect in falciform ligament is exceedingly rare, about 0.2% such cases of hernia through congenital defect in falciform ligament have been reported. The case presentation of 60 year old male patient present in surgery department with acute abdominal pain since 7 days. Based on clinical assessment and radiological evidence, intestinal obstruction was diagnosed. For which patient underwent exploratory laprotomy. The discussion of Intraoperative a loop ileum was found obstructed in congenital defect in falciform ligament. Obstruction was relieved by division of leaf of defect, without the need of intestinal resection.
A case of hereditary sensory and autonomic neuropathy type 4 presenting with chronic trophic ulcers
Authors: Tilak Kedar M. , Shamkuwar Pratibha B.
Published: October 2019

Hereditary Sensory and Autonomic Neuropathy (HSAN) is a rare group of diseases involving varying degrees of peripheral nervous system. It is classified into five main types. HSAN type 4 is associated with insensitivity to pain and temperature and anihidrosis. The method of this study was to authors present a case report of a 3 year-old boy with Hereditary Sensory and Autonomic Neuropathy Type 4 presenting with chronic ulcers. Conclusions of this study was to HSAN type IV is a rare condition. There is no definitive treatment available presently for this condition.
Consensus statement on the management of invasive candidiasis in Indian scenario
Authors: Shastri Prakash , Nangia Vivek , Sathe Prachee , Pande Rajesh , Abraham Abi , Hegde Ashit , Ansari Abdul Samad , Kapoor Dharmesh , Mandal Amit , Jain Alok , Dinaker M. , Mohanty Deepali , Das Dimbeshwar , Kola Venkat Ramana , Sinha Sharmili , Mohanty Amitav , Girn Hardev Singh
Published: October 2019

Invasive fungal infections in critically ill patients are associated with increased morbidity and mortality. Candida species are among the most common causes of nosocomial bloodstream infections and of invasive infections in intensive care units (ICUs). The high mortality mandates early identification of invasive candidiasis which is vital to initiate appropriate and timely treatment and improve outcomes. Delaying the initiation of treatment could result in an increase in mortality which can be avoided by usage of more rapid diagnostic techniques. There are multiple diagnostic tests including culture and non-culture tests like 1,3-β-D-glucan and newer techniques like MALDI-TOF which are available to diagnose candidemia but each with their drawbacks. Additionally, there are various guidelines like IDSA and ESCMID on treatment which aim to minimize death, late complications from deep-seated candidiasis and rise of drug- resistant Candida strains. Through this consensus statement prepared by a panel of experts, all of whom are senior intensivists, infectious disease specialists and microbiologists, we aim to address the major aspects of management of invasive candidiasis in the Indian population as per the authors opinions, backed by published evidence and supported by the latest clinical guidelines.