bluuebunny/crossref_metadata_2025 huggingface dataset:
Relação entre eficiência da hemodiálise e estado nutricional em pacientes com doença renal crônica
Authors: Claudino Larissa Marjorie , De Souza Thainá Feliciano , Mezzomo Thais Regina
Published: September 2018

AIMS: To verify the relationships between the dialysis adequacy index (Kt/V) and nutritional parameters of individuals with chronic renal disease on hemodialysis.METHODS: A retrospective study was performed at a hemodialysis institute. Data on sex, age, biochemical tests, dry weight, height, arm circumference (AC) and triceps skin fold (TSF) were collected from the medical charts. Nutritional risk index (NRI), body mass index (BMI), arm muscle circumference (AMC), corrected arm muscle area (AMAc), Kt/V and urea reduction rate (URR). The Mann-Whitney test and the Spearman correlation were used for the statistical analysis, and a p<0.05 was considered significant.RESULTS: A total of 164 patients were evaluated, with a mean age of 58±14.4 years, of which 96 (59%) were male. The median time on hemodialysis was 35.0 (5-234). Among the 164 patients, 60 (37%) presented nutritional risk. In the evaluation of nutritional status, the mean values obtained were 25.0±4.5 kg/m2 for BMI, 99.0±12.3% for CB adequacy, 86.7±14.5% for WBC adequacy, 122.9±66.8% for CBA adequacy and 1.4±0.4 for Kt/V. The median adequacy for PCT was 107.8% (11.5%-305.4%). There was no correlation of Kt/V with serum albumin, CB, CMB, AMAc and NRI. Kt/V had a low positive correlation with time on hemodialysis (r = 0.2197) and a low negative correlation with PCT (r = -0.1692) and with BMI (r = -01970). The correlation between Kt/V and dry weight was moderate and negative (r = -0.3710) and between Kt/V and URR the correlation was strongly positive (r = 0.81129).CONCLUSIONS: Adequate dialysis efficiency and good nutritional status were observed in most patients of the evaluated sample, with significant correlations between dialysis adequacy and parameters of nutritional status assessment.
Venous Thromboembolism in Patients with Sarcoma: A Retrospective Study
Authors: Alcindor Thierry , Al-Fakeeh Ali , Goulding Krista , Solymoss Susan , Ste-Marie Nathalie , Turcotte Robert
Published: September 2018

Background

Little has been published about the association of venous thromboembolism (VTE) and sarcoma. In this study, we sought to identify clinical features of patients with sarcoma presenting at least one VTE episode.

Methods

Our study was a retrospective case–control study of a single-institution database with univariate and multivariate analysis using chi-square and Student's t test. A p value less than .05 was considered significant.

Results

The overall incidence of VTE in patients with sarcoma was 7.9%. Predictive factors identified by multivariate analysis were metastatic disease and administration of chemotherapy. It was not statistically possible to correlate the risk of VTE with specific sarcoma subtypes, but observations suggested malignant peripheral nerve sheath tumor, osteosarcoma, and liposarcoma as having the highest propension.

Conclusion

VTE is not infrequent in patients with sarcoma. Adoption of common guidelines for cancer-associated thrombosis is recommended.
Launched south approach viaduct in the Queensferry Crossing, UK: design and construction
Authors: Bernardo Hector , Thompson Steve , Vazquez Antonio , Ward Alan , Gonzalez Jose Manuel , Niño Francisco
Published: September 2018

Launched bridges are becoming a widely used structural solution for the construction of medium- and long-span bridges. This construction technique has been used in the erection of the approach viaducts of the new Queensferry Crossing, a major cable-stayed bridge over the Firth of Forth in Scotland, UK. A description of the approach viaduct south, a twin-girder bridge with composite section and spans ranging from 64 m to 90 m is provided in this paper. The importance of close interaction between the design (for both permanent and temporary situations) and construction methods is emphasised. The strict design assumptions leading to tight fabrication tolerances, accurate launching control and bespoke temporary works items are highlighted. Finally, the construction method for the concrete slab is presented as a practical solution between programme and structural requirements.
Effect of past history on liquefaction resistance of level ground in shaking table test
Authors: Teparaksa J. , Koseki J.
Published: September 2018

In recent years, many researchers have discovered that using relative density as a single index parameter, cannot be correlated well with liquefaction resistance. In general, it is also governed by past-liquefaction history. To study the effect of liquefaction history on liquefaction resistance of level ground in more detail, a series of shaking table tests was performed on loose and dense silica sand models. Small base acceleration was implemented on loose models and then increased up to 1000 gal. Ground motion, behaviour and relative density change during each liquefaction stage were monitored. The results showed that liquefaction history can greatly affect future liquefaction resistance. After being subjected to repeated liquefaction, loose sand models stopped liquefying at 1000 gal with a relative density of approximately 80%, regardless of the initial acceleration. However, the dense sand model with initial relative density of 80% subjected to the initial acceleration of 700 gal continuously liquefied until reaching a relative density of nearly 100% at 1000 gal.
An overview of the chemical modifications of chitosan and their advantages
Authors: Madera-Santana Tomás Jesús , Herrera-Méndez Carlos Hernán , Rodríguez-Núñez Jesús Rubén
Published: September 2018

The use of chitosan, a natural polymer, has recently increased due to its antimicrobial and antifungal character, null toxicity, biocompatibility and ability to form biofilms and hydrogels. The areas of application and research include biomedical, pharmaceutical, biomaterials, water treatment and haircare and skincare products. However, the applications of chitosan are limited due to the difficulty associated with modification of its structure and its poor solubility in water. Among the main chemical modifications for functionalising the chitosan structure are the N-substitution, O-substitution (with or without protecting the reactive sites of the chitosan) and cross-linking with other compounds; these chemical modifications allow improvement of its chemical and physical properties. In relation to the current importance of the use of chitosan with chemical modification, the present review attempts to explain in a simple way the main chemical reactions carried out with chitosan and its wide range of applications, and provides a future perspective.
Summarising wave data for the purpose of operational planning on coastlines
Authors: Villarroel-Lamb Deborah
Published: September 2018

The trends within various coastal hydrodynamic data sets were investigated with the aim of providing a general methodology to gather, condense and store useful wave statistics using data collected on the eastern coast of Trinidad, an island located in the Caribbean region. The lack of local comprehensive long-term data sets necessitates the use of short- to medium-term data in order to establish probabilistic descriptions to be used in long-term modelling, planning and hazard assessment exercises. While the paucity of data at certain locations initially stimulated the investigation of monthly and quarterly trends, as well as near-shore and off-shore differences of the wave parameters, it also identified a method to reduce large data sets while retaining the critical wave characteristics. The summarised data sets can be more readily used for planning and decision making, but can also be used for application to advanced scientific tools for further investigation. General methodologies for analysing the short- to medium-term data were established in order to derive basic statistical parameters, deduce persistence statistics, assess multi-modality and subsequently generate a generic wave height probability density function for the coastal location.
Dijital Çağda Sanatın ve Sanatçının Konumu
Authors: AKBLUT Doğan
Published: September 2018

ÖZET“
Hayat dengeye kavuştukça sanat ortadan kalkacaktır” Piet MondrianDünyanın
teknolojik değişimine koşut şekilde biçimlenen yaşam koşulları sadece ekonomik,
siyasi ya da tüketim alışkanlıklarımızı/algılarımızı biçimlendirmekle
kalmamakta, aynı zamanda kültürel, edebi ve sanatsal bakış açılarımızın da yeni
bir gözle değerlendirilmesini zorunlu kılmaktadır. Neo-liberal politikalar,
küreselleşme ve melezleşme üzerine kurulu postmodern algı insanın geçmişte
oluşturduğu neredeyse tüm siyasi, kültürel ve sanatsal birikimle yıkıcı ve
inkara dayalı bir hesaplaşma içine girerek kendi meşru zeminini oluşturmaya ve
söylemini kitlelere aşılamaya başlamıştır.

Aristoteles’ten
günümüze kadar yaşamla sanat arasında gerçeklik algısını yansıtma (mimesis)
kuramının türevleri üzerine kurgulayan ve işlevsel boyutunu arınma (katharsis),
ideolojik biçimlendirme, yeni ufuklar açan yaratıcılık gibi pek çok biçimde
tanımlayan sanatçı, günümüz dünyasında yeni olgularla yüzleşmek zorunda
kalmıştır. Her şeyden önce, dijital tasarımın hükümranlığında sanat ve sanatçı
öznel konumunu koruyabilecek midir? Sanat insanın elinden kayıp yapay zekânın
eline mi geçecektir? Bu ve buna benzer pek çok soru sanatın yenidünya düzeninde
konumunu belirlemeye çalışan sanatçı, sanat tarihçisi, akademisyen ve icracı
rolündeki kişilerin sorunsalına dönüşmüştür. Üstelik sadece “evet” ya da
“hayır” gibi yanıtlar tatmin edici olmaktan uzaktır. Bunun yanında, “nasıl?”
sorusuna da yanıt vermek gerekecektir, çünkü en azından bir insan-yapay zeka
yarışı görüntüsü sunan yeni evrende sanatçı, yaratıcılık, insan zekası, ruhsal
konumlandırmalar, düşüncenin dışavurumu, duyguların ifadesi gibi pek çok önemli
boyutu olan varlık alanının sürdürülmesi ya da yeniden tasarlanması da söz
konusudur.
PESQUISA ESCOLAR: POSSIBILIDADES PARA PENSAR OUTROS MODOS DE ESCOLARIZAÇÃO
Authors: Schvingel Cláudia , Giongo Ieda Maria , Vier Munhoz Angélica
Published: September 2018

O presente artigo, oriundo de parte de uma dissertação de Mestrado, tem como objetivo problematizar a proposta da pesquisa escolar como princípio pedagógico. Metodologicamente, de cunho qualitativo, o material empírico de um lado se constituiu de documentos de propostas governamentais das escolas estaduais de Ensino Médio do estado do Rio Grande do Sul a partir da década de 1990 e da proposta do Manifesto dos Pioneiros da década de 1930. Por outro, foi realizada uma revisão teórica acerca de ideias sobre a pesquisa, o ensino e o professor. Estes materiais foram analisados tendo como aporte teórico um conjunto de noções foucaultianas, como a continuidade e descontinuidade da história dos acontecimentos e da análise de documentos. O estudo destes materiais permitiu inferir que o princípio do ensino pela pesquisa vigora desde a década de 1930 no documento do Manifesto dos Pioneiros e em documentos de propostas governamentais do estado a partir da década de 1990. Constata-se que a pesquisa na Escola Básica ainda não ganhou força enquanto princípio pedagógico que perpassa por todas as disciplinas escolares. A pesquisa escolar é potente para pensarmos em outras formas de criação no ensino e para outros modos de escolarização no que diz respeito ao ensinar e ao aprender dos estudantes e dos professores de modo mais (re)inventivo e (re)criativo. Defende-se a proposta do hífen de ligação necessário para compor as palavras professor e pesquisador, resultando em professor-pesquisador. Além disto, que este estudo possa fomentar para demais discussões acerca da temática - pesquisa escolar -, permeando principalmente nos espaços de formação dos professores.
A EDUCAÇÃO COMO CALEIDOSCÓPIO DO HUMANO: REFLEXÕES SOBRE A ESCOLA E A MÍDIA
Authors: Paiva Maria Soberana de , Souza Karlla Christine Araújo , Evangelista Jucieude Lucena , Fonseca Ailton Siqueira de Sousa
Published: September 2018

Partindo dos princípios da teoria da complexidade humana, buscamos tecer neste trabalho reflexões sobre as características cosmológicas e culturais que constituem o ser humano e a possibilidade de aliá-las ao ensino formal escolar, objetivando um ensino completo para a vida. Acreditamos na necessidade da instituição escolar em utilizar os conteúdos midiáticos como fontes de apoio a esse processo, pois os mesmos falam ao íntimo humano e possuem a empatia e familiaridade necessária para tocar os jovens aprendizes. Utilizamos os pressupostos teóricos desenvolvidos por Edgar Morin; Borys Cyrulnik e Orozco Gomes para compreendermos o desenvolvimento da condição humana no sujeito, e as proximidades e disparidades possíveis entre a mídia e a escola nesse processo. As pesquisas acadêmicas “A televisão na escola” e “Sobre imagens, pensamento e educação: narrativa de uma caminhada ao encontro do sujeito imaginador na escola” embasam nossas reflexões e apontam para a necessidade da integração entre os conteúdos pedagógicos e os conteúdos midiáticos e envolver o aprendizado para o humano. Defendemos que ensinar para o humano compreende incluir todas as variáveis que compõe esse ser, que o singularizam diante das outras espécies de seres vivos e conscienciais. Ensinar para o humano significa refletir sobre seus processos e dilemas interiores aliados às pulsões externas que emanam da sociedade.
Immobilization of Laccase in poly (Vinyl Alcohol)-Calcium Alginate Beads
Authors: ALTINOK Haydar
Published: September 2018

Laccase enzyme (L) obtained from Tramates versicolor was
entrapped into polyvinyl alcohol–calcium alginate (PVA-CaAlj) beads.
Michaelis-Menten constant (Km) and maximum reaction rate (Vmax) values were
found to be 1.70x10-2 mM and 2.08x10-3 mM.min-1
for free enzyme respectively. Km and Vmax values were found as 2.87x10-2
mM and 5.30 x 10-3 mM.min-1 for entrapped enzymes
respectively. Optimum pH was determined as 5.0 and 6.0 and optimum temperature
determined as 40oC and 45oC for free laccase and
entrapped laccase respectively. After 30 days of storage at 4 oC
free laccase retained 60 % of its original activity. Also after 30 days of
storage at 4 oC, entrapped enzymes were retained 85 % its original
activity. Immobilized enzyme was used repeatedly 10 times, were retained 75% of
its original activities.
Solution of Vector Equation of Transfer in a Finite Plane Parallel Media
Authors: ŞENYİĞİT Menekşe
Published: September 2018

HN method is used for the solution of
vector equation of transfer, which includes two Stokes parameters, with a
combination of Rayleigh and isotropic scattering in a finite plane-parallel
atmosphere. The behavior of albedo and transmission factor are obtained
according to the slab thickness and reflection coefficient.
Approximation by Double Deferred Nörlund Means of Double Fourier Series for Lipschitz Functions
Authors: SEZGEK Şeyda , DAĞADUR İlhan
Published: September 2018

In this paper, the concept of Double Deferred Nörlund means is defined and some important results are obtained. Particularly, we investigate the rate of uniform approximation by Double Deferred Nörlund means of the rectangular partial sums of the double Fourier series of a function  belong to  on the two dimensional region . We also obtain the rate of uniform approximation by Double Deferred Cesáro means.
Chitosan Based Edible Films Enriched with Black Cumin Oil for Potential Food Packaging Applications
Authors: Altıok Duygu
Published: September 2018

In this study, chitosan based edible films were
prepared by incorporation of black cumin oil. The resultant films were
characterized in terms of their surface morphology and mechanical strength. The
surface and cross-sectional properties of the films were analyzed by scanning
electron microscopy. Essential oil incorporated films had the smooth surface
and plate structure at the cross-section. The average thickness of the films
was 4-8 mm. Adding essential oil increased film opacity.
The mechanical properties of films were determined by texture analyzer.
Addition of essential oil improved the mechanical property of chitosan film.
Antioxidant and antimicrobial activity of black cumin oil were determined to
put forward the functional property of resultant films. The trolox equivalent
antioxidant capacity of black cumin oil was found as 0.552 μM trolox/g. Black
cumin oil showed antimicrobial activity against Escherichia coli,
Pseudomonas aeruginosa, Staphylococcus aureus and
Staphylococcus epidermidis. Chitosan based films enriched with 1% black cumin oil revealed both
the antioxidant activity and the antimicrobial activity on test microorganisms.
Regarding to these results, it has been considered as a functional edible film
enriched with essential oil that can protect the food from microbiological
deterioration and oxidation.
Preparationand Characterization of pH-Sensitive Hydrogels Based on Crosslinked Maleic Anhydride-Styrene-Methyl Methacrylate Terpolymer
Authors: İMREN KOÇ Dilek , BOLSU Saliha Esra , DURMAZUÇAR Hasan Hüseyin , BOZTUĞ Ali
Published: September 2018

In
this study, the hydrogels have been synthesized by the crosslinking reactions maleic
anhydride-styrene-methyl methacrylate terpolymer with N, N'-methylene-bis-acrylamide and glutaraldehyde in various
crosslinker ratios. Crosslinking reactions were carried out in the presence of tetrahydrofuran
as solvent at 25-50ºC for different time period, and the resulting material
properties compared. The best conditions for effective crosslinking, i.e., crosslinking
temperature, time and crosslinker ratios were determined for each crosslinker
type. The swelling behaviour of the hydrogels was examined in Tris-buffer
solutions at various pH at 37ºC. Swelling depending on pH was observed in the
hydrogels. The pH-dependent swelling of hydrogels was strongly influenced by
the functional group of crosslinker. The molecular structure of the hydrogels
was studied by Fourier Transform Infrared Spectroscopy and their pore structure
was investigated by using Scanning Electron Microscope.
Uso de Imagens de Satélite Como Ferramenta para Análise da Vegetação do Monumento Natural Morro de Santo Antônio/MT
Authors: Souza Celso Arruda , Danelichen Victor Hugo Morais
Published: September 2018

ecossistema em diversas escalas. Diante disso, o objetivo deste trabalho foi avaliar os efeitos sobre o uso e ocupação do solo, após a criação da unidade de conservação Monumento Natural Morro de Santo Antônio no Estado de Mato Grosso. O estudo foi realizado no Morro de Santo Antônio, distante 15 km da capital do Estado de Mato Grosso, localizado na divisa dos municípios de Cuiabá e Santo Antônio de Leverger no Cerrado Brasileiro. Foram adquiridas, junto ao USGS, imagens dos satélites Landsat 5 e 8, dos anos de 2005 a 2015, com resolução espacial de 30 m. Para o estudo da dinâmica da vegetação foram computados os índices de vegetação e de umidade da superfície NDMI. Os resultados apresentados neste trabalho demonstram que após a criação da MoNa, o índice foi menor no ano de 2006, enquanto que no ano de 2015 foi maior.Palavras-chave: Sensoriamento Remoto. Unidade Conservação. Índices de Vegetação.AbstractSatellite imagery is a great tool for monitoring ecosystem conservation units at different scales. Therefore, the objective of this work was to evaluate the effects on the soil use and occupation after the creation of the conservation unit Morro de Santo Antônio Natural Monument in the state of Mato Grosso. The study was carried out in Morro de Santo Antônio, distant 15 km from the capital of the State of Mato Grosso, located at the border of the municipalities of Cuiabá and Santo Antônio de Leverger in  Brazilian Cerrado. Images from the Landsat 5 and 8 satellites were acquired from the USGS from 2005 to 2015, with spatial resolution of 30 m. For the study of vegetation dynamics, vegetation and moisture indexes of the NDMI surface were computed. The results presented in this study demonstrate that after the MoNa creation, the index was lower in 2006, while in the year 2015,  was higher.Keywords: Remote Sensing. Conservation Unit. Vegetation Indexes.
Análise da Utilização de Coletores para Descarte de Medicamentos na Cidade de Anápolis, Goiás
Authors: Silva Joel Rocha da , Lemes Erick de Oliveira , Vargem Daiana da Silva , Neves Ana Claudia Pereira , Trindade Hérika Christine Torres , Eleutério Priscilla Busch de M , Trindade Sandys Torres
Published: September 2018

Com o aumento excessivo de drogarias e farmácias abertas, atualmente, cresce consequentemente a comercialização de medicamentos e resíduos gerados pelos estabelecimentos e por toda a população. O motivo deste estudo foi a preocupação em saber como ocorre o descarte dos medicamentos vencidos ou não utilizados pela população de Anápolis – GO, uma vez que não há coleta seletiva para esta classe de resíduo. Para isso foi realizado, inicialmente, uma pesquisa teórica sobre resíduos sólidos, classificação, serviços de saúde, medicamentos vencidos, mais especificadamente sobre descarte desses medicamentos com prazo de validade expirado e não utilizados. A metodologia aplicada foi o estudo de caso, a partir de entrevistas estruturadas, que foram aplicadas junto à população em algumas farmácias da região, buscando obter informações importantes a respeito de como é realizado o descarte dos medicamentos por cada uma das pessoas e a possível compra de medicamentos fracionados.Palavras-chave: Fármacos. Ambiente. Descarte. Resíduos.AbstractExcessive increase in drugstores and pharmacies currently open causes to the commercialization of medicines and waste generated by facilities and all the population. The reason for this study was the concern about how to discharge expired or unused medicines by the population of Anapolis - GO, since there is no selective collection for this class of waste. A theoretical research was inititally done on solid waste classification, health services, expired medicines, more specifically on discharging expired and unused medicines. The methodology applied was the case study, from structured interviews that were applied to the population at some drugstores in the region, seeking important information about how each person discharges medicines and the possible  fractionated drugs purchase.Keywords: Drugs. Enviromment. Discard. Evaluation.
Cost effectiveness analysis of cervical cancer screening in women until age 70
Authors: Quon James C.
Published: September 2018

Background: 2017 US Preventive Services Task Force guidelines for screening cervical cancer and pre-malignant lesions advise that screenings cease for women over age 65, with qualifications. Recent literature has identified significant discrepancies in rates of cervical cancer in older women – if hysterectomies in this patient population is accounted for, cervical cancer incidence does not decline with age as previously established. This adjusted incidence of cervical cancer necessitates a re-examination of current practice.Methods: This study seeks to demonstrate the utility of extending the cervical cancer screening age recommendations to age 70. Cost effectiveness will be estimated, from a payer perspective, of extending screening to age 70 for the United States women’s population in those who have not undergone hysterectomy or otherwise been treated for past cervical cancer or premalignancy. A Markov model was constructed to project outcomes in a hypothetical cohort of 10 000 women aged 65 to 70, with a time horizon of lifetime. A Probability Sensitivity Analysis determined the robustness of the result, and the Incremental Cost-effectiveness Ratio (ICER) is charted.Results: The economic evaluation of screening compared to none in this population was determined to be cost effective, with an ICER demonstrating a cost benefit, and Quality Adjusted Life Year (QALY) benefit, to extended screening.Conclusions: The sensitivity analysis confirms the robustness of this result. Implementing extended screening guidelines could potentially be a significant gain for both patients and society.
Prediction of preterm birth by evaluating the fetal adrenal gland volume and blood flow: a pilot study
Authors: Ali Ali Saber , Hussein Mostafa , Fetih Ahmed N. , Ahmed Abdelghafar M. , Abbas Ahmed M.
Published: September 2018

Background: The aim of the current study was to estimate the risk of preterm birth (delivery < 37 weeks of gestation) by evaluating the fetal adrenal gland volume and blood flow at Women’s Health Hospital, Assiut University, Egypt.Methods: A pilot prospective cohort study included pregnant women presented to our hospital with threatened preterm labor between December 2016 and May 2018. All women were recruited consecutively at the emergency unit of Women’s Health Hospital at Assiut University. The fetal adrenal gland volume was assessed using 3-dimensional images of the fetal adrenal with the aid of Virtual Organ Computer-Aided Analysis (VOCAL) software. Doppler evaluation of the fetal adrenal blood vessels was carried out. The RI, PI and S/D ratio was calculated for every case. The neonatal outcomes at delivery were assessed and compared with respect to the duration of actual delivery from the time of evaluation. The obtained data were analyzed by SPSS software (version 22.0) and p<0.05 was taken as the significant level.Results: The study included 30 pregnant women at the final analysis. Women were classified according to the time of actual delivery into two groups. Group (I, n=13) those who delivered within 7 days and group (II, n=17) those who delivered 7 days or more. No difference between both groups regarding the baseline characteristics. No difference regarding the mode of delivery (p=0.708). All Doppler indices were statistically in-different between both groups. The fetal adrenal gland volume was significantly lower in group II than group I (p=0.001). On ROC analysis, the area under the curve (AUC) for prediction of preterm birth based on the fetal adrenal gland volume was (AUC= 0.873). The ROC curve shows that the best cut off value using the volume was ≥0.461 with 76.92% sensitivity and 88.24% specificity for prediction of preterm birth with an overall accuracy of 83.3%.Conclusions: Fetal adrenal gland volume was identified as a significant predictor of delivery in pregnant women who had spontaneous preterm births with intact membranes.
Knowledge, attitudes and practice of condom use among the married women in Mirpur area of Dhaka city, Bangladesh
Authors: Methe Fatema Zohora , Sultana Shirin , Muhammad Faisal
Published: September 2018

Background: Condom is an important method of family planning and prevention of sexually transmitted infections. Condom is the only contraceptive method that can protect against both pregnancy and sexually transmitted infections. Unprotected sex leads to many unintended pregnancies and sexually transmitted infections (STIs). The family planning saves lives of women and children and improves the quality of life. This study was aimed to assess the knowledge, attitudes and practice of condom use among the married women in Mirpur area of Dhaka city in Bangladesh.Methods: A descriptive cross-sectional study was conducted among the randomly selected sample of 101 women aged 15-49 years from selected areas of Mirpur in Dhaka city of Bangladesh. Pre-designed and pre-tested questionnaire was used to elicit the required information from the study participants using face to face interview. The collected data was analyzed using SPSS 21.0 version.Results: Only 5.9% of the study participants had ever used condom. Most of the study participants (93.1%) considered a condom as an effective method for birth control and prevention of sexually transmitted infections (10.9%). However, 36.6% of them believed that condom use had some harmful effects. The main reason for condom use among the users was for family planning (83.3%) and the rest (16.7%) mentioned that it was due to STIs prevention and family planning. The condom use was found significantly associated with age, educational level, partner’s educational level, socio-economic status, and perceived risk of STIs.Conclusions: The study revealed that the rate of condom use was very low among the study participants. This might be due to lack of knowledge about proper and effective use of condoms, low perception of risk of STIs, misperception about harmful effects of condoms and the use of other family planning methods by respondents.
Study of effects of combined spinal epidural analgesia on the course of labour and feto maternal outcome in comparison with the parturients receiving no analgesia
Authors: Bembalgi Shoba , Kallapur Basavaraj , S. Prasad , M. Shruthi , Amble Amit S.
Published: September 2018

Background: The study was aimed to evaluate the effects of combined spinal epidural analgesia on the duration and outcome of labour in nulliparous parturients in comparison with parturients not receiving any analgesia.Methods: It is a prospective clinical study. The present study was carried out in the labour ward, KIMS Hubli. Nulliparous parturients in early active labour were divided into two groups.  CSE group (n=40) and non CSE group. In present study CSE was performed with intrathecal 1.25mg of levobupivacaine with   25mcg fentanyl initially and this was followed by epidural boluses of 10ml of 0.0625% Levobupivacaine with 2mcg/ml fentanyl through the epidural catheter whenever the patients’ pain score is more than 4.Results: Mean duration of active labour was 139+/-41.2min in CSE group and 251.1+/-57.9 min in non CSE group. The rate of cervical dilatation was 2.63+/-0.66cm/hr. in CSE group as compared to 1.45+/-0.38cm/hr in non CSE group. The duration of second stage of labour was similar in both groups. The spontaneous vaginal deliveries was77.5% in CSE group as compared to 79.5% in non CSE group. Assisted vaginal deliveries were 15% in combined spinal epidural analgesia group compared to 10.3% in non CSE group which was statistically insignificant. LSCS was 7.5% in control CSE group compared to 10.3% in non CSE group. Maternal satisfaction was excellent in majority of parturients in CSE group. The perinatal outcome was not affected in CSE group. The incidence of complications were very minimal in present study.Conclusions: Authors concluded that combined spinal epidural analgesia provides safe and excellent analgesia with no significant increase in the caesarean section and instrumental delivery rates. In addition, CSE decreases the duration of first stage of labour with no effect on perinatal outcome.
Study of maternal mortality in a tertiary care hospital (GMERS-Dharpur, Patan, Gujarat, India): a three-year review
Authors: Jani Parul S.
Published: September 2018

Background: Epidemiological data related to maternal mortality is valuable in each set up to design the progress to maternal mortality. This study was done to evaluate maternal death over period of 3 years at tertiary care centre of North Gujarat, India.Methods: This was retrospective study conducted at department of Obstetrics and Gynecology at GMERS medical college Dharpur, Patan (N.G.), India. Epidemiological data was collected from hospital register from January-15 to Dec-17 of maternal death in the hospital maternal age, parity, educational status, ANC registration, mode of delivery, admission death interval and direct and indirect causes and maternal deaths were noted and analyzed statistically.Results: There were 41 maternal deaths from Jan-15 to Dec-17. Maximum deaths were in 21-30 age group with multipara, unbooked and illiterate patients. Majority of maternal deaths are due to hemorrhage, eclampsia and sepsis.Conclusions: Many different factors interact in a complex way to increase the risk of death of pregnant women. Regular ANC, early identification of complication and timely referral, delivery by skill birth attendant and adequate post-partum case and follow up are required. To avoid maternal death unwanted pregnancy, too early pregnancy should be avoided adequate counseling and contraception facility also required for sepsis prevention, safe abortion services according to the law and quality post abortion care. There is a wide scope of improvement as most of the maternal deaths are preventable.
Comparative study of various oxytocics in management of third stage of labour
Authors: Gadappa Shrinivas N. , Sharma Deepika , Gavit Yogita
Published: September 2018

Background: Causes of maternal mortality are haemorrhages, infections, unsafe abortions, and obstructed labour. 25% of these are caused by haemorrhages and are preventable, one of the measures is active management of third stage of labour (AMTSL). For prevention, treatment of postpartum haemorrhage oxytocics are available oxytocin, methylergometrine, misoprostol, prostaglandin F2α.Methods: Study was conducted, 160 patients were randomly given one of following oxytocics a) tablet misoprostol 600 µg per rectal b) Inj. Oxytocin 10 IU IM c) Inj. Methylergometrine 0.2 mg IM d) Inj. PGF2α. Duration for the delivery of placenta and amount of blood loss was measured, side effects were noted, and comparison of haemoglobin and blood loss done.Results: No significant difference in mean blood loss in all group with respect to parity and type of labour. In present study it seems that no oxytocic is superior to other in reducing the blood loss. Misoprostol has variable onset of action. Mean duration of 3rd stage in various groups is same. In respect to side effects HTN is common with methylergometrine, shivering and fever with misoprostol and diarrhoea with PGF2α.Conclusions: Study concluded that all uterotonics have some advantages, oxytocin is ultimate drug of choice in skilled hand due to its definite onset of action while Tab misoprostol in unskilled hands, other oxytocin are reserved for complementary usage and treatment of PPH but Misoprostol has variable onset of action.
Spot urinary albumin creatinine ratio as a predictor of preeclampsia and dilemma in clinical interpretation
Authors: Devi L. Thulasi , Nimonkar Anurag Ravi
Published: September 2018

Background: The objective of this study was to evaluate the efficacy of spot urinary albumin creatinine ratio (UACR) as a predictor of preeclampsia and dilemma faced by clinicians in interpretation of lab values expressed in different units, lack of standardization and its further ramifications in long term follow up and prevention of complications of preeclampsia. Wide variation for estimation of UACR leads to confusion in practice guidelines and its interpretation as single International practical information regarding laboratory measurements, calculation, reporting and interpretation doesn’t exist. This prospective randomized study was conducted in Out Patient Department of Obstetrics and Gynaecology in a tertiary care hospital over a period of 1 year after due clearance was obtained from Ethical Committee.Methods: This was prospective study involving 400 ladies reporting for Outpatient ANC services within the given time period as per existing guidelines at a tertiary care hospital. Patients were assessed at first booking visit at 18-20 weeks, and thereafter based on clinical and haematological findings, severity of disease more frequently if desired and were admitted in case of imminent eclampsia. The mean age of the patients was 20.5±0.5 and 24.5±0.5 years and treatment duration were till successful delivery and 06 weeks postpartum for persistent microalbuminuria and exclusion of underlying medical cause for Hypertension. Fetomaternal morbidity and mortality was not a criterion of exclusion.Results: Compared with 24-hour urinary protein excretion, the spot UACR may be a simple, convenient, and accurate indicator of significant proteinuria and future complications in women with preeclampsia with proper and intensive clinical follow up and intervention to prevent feto maternal morbidity and mortality. A strong correlation was evident between spot UACR with high sensitivity and specificity.Conclusions: UACR measurement is a simple, quick, and reasonably reliable method for prediction and assessment of severity of preeclampsia. Spot UACR correlates better than spot UPCR to 24-hour urinary protein excretion to the severity of disease and as predictor of severity of disease.
Maternal risk factors and perinatal outcome in meconium stained amniotic fluid: a cross sectional study
Authors: Mohan Meera , A. V. Deepak
Published: September 2018

Background: Meconium staining of amniotic fluid has long been regarded as a sign of fetal distress and fetal asphyxia. Although exact cause is unknown, meconium is thought to be passed from fetal gastro-intestinal tract as a response to hypoxia, mesenteric vasoconstriction induced gut hyper peristalsis, vagal stimulation and normal physiologic function of a mature fetus. Overall frequency has ranged from 5 to 24.6%. Present study is undertaken to detect incidence, mode of delivery, fetal heart rate variability and neonatal outcome in neonates born through MSAF. The objective of the study was to maternal risk factors, mode of delivery and perinatal outcome in labors complicated with meconium stained amniotic fluid.Methods: This is a cross sectional study done at Government Medical College, Thrissur on term, singleton pregnancies complicated with meconium stained amniotic fluid satisfying the inclusion criteria. Patients detailed history, gestational age, per abdominal examination, per speculum and per vaginal examination, admission tests including intrapartum cardiotocography (CTG) was recorded in a predesigned proforma.Results: The age of the patients varied between above 19 and 30 years. Majority of the study population were 69.3% Primi gravidas. Out of 130 cases, 56.2% were grade 2 meconium stained liquor, 30.7% were grade 3 meconium stained and 13.1% were grade 1 meconium stained. Association between neonatal complications in relation to grades of meconium was found to be statistically significant (p = 0.001). NICU admission was 24.7% in grade 2 meconium group. Hypoxic Ischemic encephalopathy was high in grade 3 meconium group, 45%. Majority of babies born through grade 1 meconium were asymptomatic and 10% of babies in grade 3 meconium groups were asymptomatic. Meconium aspiration syndrome, Respiratory distress were more in babies born through deliveries complicated with grade 3 meconium.Conclusions: The study indicated meconium stained amniotic fluid during labour increases the prevalence of abnormal intrapartum CTG, Caesarean section, lower Apgar score, increased duration of NICU and hospital stay, poor perinatal outcome and non-significant difference in incidence of lower birth weight in babies.
Role of amniotic fluid index on maternal and neonatal outcomes among obstetric women with preterm premature rupture of membranes
Authors: Britto J. Jennifer , R. Sailatha , Nalini Amrita Priscilla
Published: September 2018

Background: Preterm Premature rupture of Membrane (PPROM) is one of the major complications of a pregnant women with risk factors like low socioeconomic class, infections, STDs etc. Maternal complications such as Chorioamnionitis, Abruptio placenta, sepsis and neonatal complications like neonatal sepsis, RDS, intraventricular hemorrhage are common with those with PPROM. The objectives of the present study were to find the association between AFI values and maternal and fetal outcomes in patients with preterm premature rupture of membranesMethods: A cross sectional study was conducted in a Multispecialty Teaching Hospital, North Chennai, Tamil Nadu with the sample size of 100. The study participants included pregnant women with gestational age of 28 to 34 weeks presenting with PPROM. Maternal outcomes included clinical diagnosis of chorioamnionitis, placental abruption, meconium in liquor, fetal distress, prolapsed cord and mode of delivery. Neonatal outcomes include neonatal hospitalization in NICU, APGAR score at 1st minute and 5 minutes, early neonatal sepsis neonatal death. Significance of difference in means was calculated using independent t test.Results: Total study participants were divided into 2 groups with Amniotic Fluid Index (AFI) of >5 and <5. Latency period, Chorioamnionitis, placental abruption and mode of delivery were compared between the groups. Chorioamnionitis was present in 8% and 12% in group 1 and group 2 respectively. Neonatal outcomes like NICU admission, RDS and neonatal sepsis were also compared between the groups. NICU admission was required for 18% and 48% in group 1 and 2 respectively. APGAR scores at 1 and 5 minutes were found to be lower among those with Group 2. (p =0.000).Conclusions: PROM is associated with increased maternal and neonatal complications. AFI has been proven a role in predicting maternal and neonatal outcomes in PROM. Identifying the risk factor and its treatment remains the main mode of prevention for PROM.
Transcerebellar diameter: an effective tool in predicting gestational age in normal and IUGR pregnancy
Authors: Dashottar Sunita , Senger Krishna Pratap Singh , Shukla Yashashvi , Singh Ankita , Sharma Surabhi
Published: September 2018

Background: Gestational age is the common term used during pregnancy to describe how far advanced is the pregnancy. In the second and third trimesters, estimation of gestational age is accomplished by measuring the biparietal diameter, head circumference, abdominal circumference, and femur length. The transverse cerebellar diameter (TCD) may serve as a reliable predictor of gestational age (GA) of the fetus and a standard against which aberrations in other fetal parameters can be compared.Methods: The study was conducted in the tertiary care teaching hospital from July 2016 to March 2017. 200 pregnant women of gestational age 15-40 weeks of pregnancy referred from Dept of Obs and Gynae for antenatal scan comprised our study sample.Results: Age of women ranged from 18 to 43 years with maximum number of patients aged 26-30 years. Maximum cases with clinical suspicion for IUGR were in gestational age >36-40 weeks (50%). Evaluation of difference in actual and estimated gestational age between normal and actual gestational age showed that for normal pregnancy as well as in IUGR pregnancies mean difference between estimated and actual gestational age was minimum in TCD followed by other established parameters.Conclusions: TCD being a stable parameter irrespective of growth status of fetus, provides a basis for its usefulness as a ratio to predict IUGR and other perainatal outcomes as used in several studies. Thus, despite not being a direct marker for IUGR it can serve as a surrogate marker for detection of IUGR and another adverse perinatal outcome.
Study of correlation of ultrasonography with surgical evaluation of adnexal masses: a prospective study
Authors: Tripathi Urmila , Munda Geetanjali
Published: September 2018

Background: Adnexal masses are one of the most common pathologies among women of all age groups. Ovarian tumors, alone, represent two thirds of these cases. Malignant ovarian tumors are the fourth most common cause of death in women. Accurate diagnosis is required foremost for proper treatment and management of the patients.Methods: A prospective study done on 100 patients with adnexal masses presenting to Department of Obstetrics and Gynecology at Kamla Raja Hospital, G.R.M.C, Gwalior from February 2015 to August 2016. Firstly, the cases were studied by ultrasonography then intraoperatively and simultaneous sampling for HPE done. The study included women with clinical symptoms of pain abdomen/ discomfort, bleeding per vaginum, abdominal mass was subjected to ultrasonography, diagnosed with adnexal mass. 100 indicated patients were taken for surgery and intraoperative tissue and fluid samples were taken and sent for HPE.Results: No discordance found regarding laterality of adnexal masses between ultrasonographical findings and surgical findings. 69% cases were devoid of any septation/locules/nodules. Most common pathology found to be ectopic pregnancy. Most common benign ovarian mass encountered was serous cystadenoma (31.1%) and malignant mass was serous adenocarcinoma (12.7%). Apart from 13 malignant adnexal masses, 2 adnexal masses had malignant changes found on histopathological examination. 11 cases were found to be of advanced stage on surgical findings, which then confirmed by HPE.Conclusions: There is positive correlation between ultrasonographical and surgerical evaluation of adnexal masses. Correlation of the lesion’s location and appearance at imaging with the surgical findings will aid in the detection of potential pathology reporting errors.
Comparative study of nitroglycerin dermal patch versus nifedipine in the management of preterm labour
Authors: Kaur Manjeet , Goel Bharti , Singh Jasveer
Published: September 2018

Background: The aim of present study was to compare the effect of nitroglycerin dermal patch and nifedipine for taking control of preterm labor (tocolysis) and to find the safer drug for mother and foetus.Methods: Women with signs and symptoms of preterm labor between gestational ages 26-37 weeks were studied. These women were divided into 2 groups. Group A-50 women were prescribed nitroglycerin dermal patch and in Group B-50 women were given nifedipine. Primary outcome of the study was to delay the delivery for at least 48 hours. Secondary outcomes were gestational age at the time of delivery, prolongation of labor, effect on neonate and adverse effects.Results: Both groups were comparable regarding cervical effacement in cm and gestational age in weeks at the time of enrollment. Gestational age at the time of delivery in weeks (p < 0.01), prolongation of pregnancy in days (p > 0.05), neonatal Apgar score at 5 minutes (p < 0.05), neonatal weight in kg (p < 0.05) and foetal outcomes were better in nifedipine group in comparison to nitroglycerin. The overall side effects were less in nifedipine group as compared to nitroglycerin group. Overall success rate was 88% with nifedipine and 76% in nitroglycerin cases.Conclusions: Both the drugs were able to postpone the delivery for 48 hours. Nifedipine was found to be superior to nitroglycerin dermal patch in prolongation of gestational age at the time of delivery, in perinatal outcome and maternal acceptance.
Study of efficacy of compression suture in the surgical management of atonic PPH
Authors: Gadappa Shrinivas N. , Gavit Yogita B. , Sharma Deepika , Mahajan Rasika
Published: September 2018

Background: Study was conducted to analysis efficacy of compression suture in the surgical management of Atonic PPH. It’s prospectively carried out with 60 cases required compression suture in managing Atonic PPH. Atonic uterus is preventable cause of maternal mortality and morbidity constituting 80% PPH cases.Methods: Prospective study carried out at tertiary care center for studying efficacy of compression suture in the surgical management of atonic PPH for one year, started after approval from ethical committee.Results: Compression suture is effective in managing atonic PPH. out of 60 cases, 4 patient's required obstetric hysterectomy as a last resort to control Atonic PPH. Uterus was conserved in 93.3% of cases.Conclusions: Development of compression suture technique has proved to be effective in the control of massive Atonic PPH not responding to medical management is an alternative to hysterectomy when timely applied. It proves to be valuable addition for surgical treatment of PPH and for saving uteri after medical management of PPH failed. Authors can adopt compression suture as a mid-step before resorting to uterine devascularisation or hysterectomy when medical line of management fails. Resident doctors in teaching institutes must be well trained in this technique.