bluuebunny/crossref_metadata_2025 huggingface dataset:
Mutational Analysis of Hepatitis B Virus Precore Region Molecular Variants in Ile-ife, Nigeria v1
Authors: Osasona Oluwadamilola , Ariyo Olumuyiwa
Published: April 2021

Abstract Introduction Evolution of phenotypic diversity among viruses occurs as an escape mechanism against host immune pressure or drug selective pressure. Among HIV/HBV co-infected individuals, various HBV basal core promoter (BCP)/precore (PC) region molecular mutants had been reported with associated phenotypic defect in HBeAg production. The emergence of HBeAg negative variants of HBV in HIV co-infected individuals have profound implication on the diagnosis, management and prognosis of this subset of individuals. This includes delayed clearance of HBV, early development of adverse hepatic events such as liver cirrhosis and hepatocellular carcinoma . Currently, little is known about HBV BCP/PC region genomic heterogeneity in HIV/HBV co-infected patients in Nigeria. Therefore, this study was focussed on investigating evidence of precore/core region genomic variability among HIV/HBV co-infected patients in Nigeria. Materials and methods A total of 40 patients (20 HIV/HBV co-infected and 20 HBV mono-infected samples) were enrolled into the study and subsequently tested for HBsAg, HBeAg and HBeAb using specific Enzyme-Linked Immunosorbent Assay (ELISA).The BCP/PC genome regions (nucleotides 1653-1959) were amplified using a nested PCR assay and then subjected to BCP/PC mutational analysis in genome sitesaffecting HBeAg expression especially at the BCP transcriptional and PC Translational stop codon sites. Results Overall, 5(83.3%) of the six exploitable sequences after analysis showed various BCP/PC mutations. Only 1(16.6%) sequence from an HIV/HBV co-infected patient had the BCP transcriptional (double mutation; A1762T/G1764A) mutant. Analysis of the PC translational stop codon showed4 (66.6%) having the G1896A mutants while 33.3% (2) had G1899A mutants. Conclusion This study has broadened the available evidence of BCP/PC region molecular mutants among HIV/HBV co-infected patients in Nigeria and assessed the difference of mutation prevalence in comparison with HBV mono-infected cohort . We therefore recommend that HIV/HBV co-infected patients be routinely screened for hepatitis B virus precore region mutants to improve their patient outcome.
Motor neurorehabilitation in patients with epileptic seizures: limitations of methods with proven efficacy in stroke
Authors: Lyukmanov R. Kh. , Rimkevichus A. A. , Shalimanova E. V. , Voronkova K. V. , Suponeva N. A. , Piradov М. А.
Published: April 2021

Patients with epilepsy may require a neurorehabilitation aid particularly due to developing motor alterations related to stroke, sequelae of traumatic brain injury, multiple sclerosis and  other brain damage. Modern neurorehabilitation approaches  directly or indirectly affect neuroplastic processes altering cerebral cortex excitability, stimulate the afferentation systems,  and result in fatigue and may act as factors provoking seizures or  aggravated epilepsy. In addition, developing seizures may  temporarily coincide but unrelated to the neurorehabilitation  activities: e.g., while omitting antiepileptic drug administration,  sleep deprivation or long-term stress occurring to patient etc. Here we present a review on recent studies aimed at  investigating epilepsy triggers by aligning them with the factors  of interventions used in motor rehabilitation. We also emphasize  the safety data for routine use of the main neurorehabilitation methods as well as propose actions to reduce the risk of developing epileptic seizure.
Problems of diagnosing focal cortical dysplasia
Authors: Yakovleva K. D. , Kantemirova E. A. , Dmitrenko D. V.
Published: April 2021

Focal cortical dysplasia (FCD) is one of the most common causes in developing pharmacoresistant epilepsy. We present the clinical case of the patient with generalized seizures. Routine electroencephalography (EEG) data registered diffuse epileptiform activity that allowed to diagnose genetic  eneralized epilepsy and pharmacoresistant course of seizures.After performing magnetic resonance imaging using the epileptological program and video-EEG-monitoring, the diagnosis was revised: structural focal epilepsy with seizures with  focal onset with oroalimentary, gesture automatisms in the right hand, bilateral tonic-clonic, uncompensated by levetiracetam monotherapy (1500 mg/day). Background disease: congenital  malformation of the brain: FCD in the basal parts of the left temporal lobe. Lacosamide was added to the therapy in the drug dose 300 mg/day, and the frequency of epileptic seizures decreased. Differential diagnosis between genetic generalized  epilepsy and structural epilepsy with FCD usually poses no  obstacles. However, in some cases, structural epilepsy occurs  under the “mask” of generalized epilepsy. Hence, this clinical  case demonstrates the importance of diagnostic measures in the  differential diagnostics of various forms of epilepsy to determine  further tactics of patient management.
Clinical case of epilepsy, hearing loss and mental retardation syndrome associated with mutations in SPATA5 gene
Authors: Kozhanova T. V. , Zhilina S. S. , Meshcheryakova T. I. , Luk’yanova E. G. , Osipova K. V. , Ayvazyan S. O. , Prityko A. G. , Zavadenko N. N.
Published: April 2021

We present the clinical case of patient with epilepsy, developmental retardation and hearing loss. The whole exome sequencing allowed to reveal compound heterozygous variants  of the nucleotide sequence in SPATA5 gene (c.1714+1G>A, c.1678G>A). Mutations in the SPATA5 gene have been described  in patients with epilepsy, hearing loss and mental retardation  syndrome (MIM 616577). Paired parents were carriers of one  heterozygous gene variant. Such mutations lead to the  development of epileptic disorders in 3% of cases, and should be  considered in patients not only as a possible cause of  neurodegenerative diseases, but also leading to pathology with  clinical manifestations mimicking mitochondrial disease.
Epileptological service in current Russia
Authors: Karlov V. A. , Burd S. G. , Mironov M. B. , Kukina N. V. , Rubleva Yu. V.
Published: April 2021

Objective: to assess the status of the epileptological service in Russia by conducting a questionnaire survey of epileptologists working in different regions of the Russian Federation.Material and methods. To assess the structure and mechanisms of the antiepileptic service in the Russian Federation, The Russian League Against Epilepsy (RLAE) offered a questionnaire to 63 epileptologists, among which answers were provided by 37 subjects from 28 regions of the country. The questionnaire data are presented as diagrams and expressed as a percentage.Results. The analysis of data obtained allows to assess differences in the structure of the epileptological service in diverse regions of Russia, the level of care transition and interaction between outpatient and inpatient specialists, specialists in various fields as well as those involved in the scientific and practical fields of healthcare. Besides, it has also started to shape insight into further development of epileptological service in Russia envisioned by practicing epileptologists.Conclusion. A feedback from geographic regions is an ultimate goal posed by the Russian League Against Epilepsy. It is necessary to continue involve medical specialists in diverse regions to cooperate and develop new types of collaboration.
Utilização do ZEBMAX® para aumento de produtividade na alface
Authors: Zullo Godinho Emmanuel , Gasparotto Hélio Vagner , De Lima Caneppele Fernando
Published: April 2021

Dentre as hortaliças cultivadas a Alface (Lactuca sativa) destaca-se devido a sua fonte de vitaminas B1, B2, C, ferro e minerais, além da disponibilidade de ser cultivada em quase todas as regiões do globo terrestre. Diante do exposto, o objetivo do trabalho foi avaliar, em uma cultura de alface, a massa fresca de parte aérea e massa fresca da raiz com aplicação do ZEBMAX®. O experimento foi realizado à campo no Colégio Agrícola de Toledo no período de 10 de junho a 15 de julho de 2018. No tratamento foram realizadas aplicações de duas doses de 0,5 ml L-1 aos 15 e 25 dias após o transplantio. Já na testemunha só foi utilizada água. Utilizou-se o delineamento de blocos ao acaso em triplicata e no total foram avaliadas 10 plantas por bloco. Os dados foram submetidos às análises estatísticas usando o teste de Tukey, ao nível de 5 % de probabilidade. As plantas do tratamento obtiveram um peso de massa fresca de parte aérea de 12,55 g pl-1, com a massa fresca de raiz de 10,88 g pl-1, já na testemunha o peso da massa fresca de parte aérea ficou 11,08 g pl-1 com a massa fresca de raiz 9,44 g pl-1. Portanto, o presente trabalho apresentou diferenças significativas para as variáveis de crescimento (raiz e da parte aérea), em relação a aplicação do ZEBMAX® como fonte de adubação, na relação entre o tratamento e a testemunha.

 

Palavras-chave: Massa Fresca de Parte Aérea. Massa Fresca de Raiz. Peso de Planta.

 

Abstract

Among the vegetables grown, Lettuce (Lactuca sativa) stands out due to its source of vitamins B1, B2, C, iron and minerals, in addition to the availability of being grown in almost all regions of the globe. Given the above, the objective of the work was to evaluate, in a lettuce culture, the fresh mass of aerial part and fresh mass of the root with the application of the ZEBMAX®. The experiment was carried out in the field at the Colégio Agrícola de Toledo from June 10 to July 15, 2018. In the treatment, two doses of 0.5 ml L-1 were applied at 15 and 25 days after transplanting. In the witness, only water was used. A randomized block design in triplicate was used and a total of 10 plants per block were evaluated. The data were submitted to statistical analysis using the Tukey test, at the level of 5% probability. The treatment plants obtained a weight of fresh mass of aerial part of 12.55 g pl-1, with a fresh root mass of 10.88 g pl-1, while in the control the weight of fresh mass of aerial part was 11.08 g pl-1 with fresh root mass 9.44 g pl-1. Therefore, the present study showed significant differences for the growth variables (root and shoot), in relation to the application of ZEBMAX® as a source of fertilization, in the relationship between the treatment and the control.

 

Keywords: Fresh Mass Of Aerial Part. Fresh Root Pasta. Plant Weight.
Avaliação das Variantes Genéticas dos Genes AMELX e ENAM na Cárie Dentária em Adolescentes
Authors: Paschoalini Romagni Gabriela , Marino Costa Paula , Mara Maciel Sandra , Jacobucci Maria Paula , Célia Poli-Frederico Regina
Published: April 2021

A doença cárie é considerada, atualmente, como biofilme sacarose dependente, entretanto, estudos recentes apontam que fatores genéticos também podem influenciar seu desenvolvimento. Variantes nos gene amelogenina (AMELX) e enamelina (ENAM), responsáveis pela formação do esmalte, têm sido propostas como potencialmente envolvidos na doença. O objetivo deste estudo foi avaliar se a ocorrência de cárie dentária em adolescentes está relacionado às variantes nos genes AMELX e ENAM. Para a avaliação da prevalência de cárie foi utilizado o índice de dentes cariados, perdidos e obturados (CPO-D), segundo critérios da Organização Mundial de Saúde. As amostras de DNA foram extraídas das células da mucosa oral. Para a análise dos polimorfismos de nucleotídeo único (SNPs) dos genes AMELX (rs17878486) e ENAM (rs7671281) foi utilizada  a técnica de amplificação de fragmentos de DNA pela reação em cadeia da polimerase foi realizada (PCR) em tempo real pelo sistema TaqMan (Applied Biosystems, Foster City, EUA). Para a análise estatística, foi utilizado o teste exato de Fisher e qui-quadrado com nível de significância de 5%. Apenas os fatores socioeconômicos influenciaram a experiência de cárie. Concluiu-se que o componente genético, na população deste estudo, não influenciou o desenvolvimento da cárie.

 

Palavras-chave: Polimorfismo genético. Adolescentes. Esmalte.

 

Abstract

Caries disease is currently considered a sucrose-dependent biofilm, however recent studies indicate that a genetic component can also influence its development. Variants in the amelogenin (AMELX) and enamelin (ENAM) genes, responsible for the enamel formation, have been proposed as potentially involved in the disease. The purpose of this study was to evaluate whether the occurrence of dental caries in adolescents is related to variants in the AMELX and ENAM genes. To assess the caries prevalence, the index of decayed, missing and filled teeth (DMFT) were used, according to World Health Organization criteria. DNA samples were extracted from oral mucosa cells. For the analysis of single nucleotide polymorphisms (SNPs) of the AMELX (rs17878486) and ENAM (rs7671281) genes, the amplifying DNA fragments technique  by the polymerase chain reaction was performed (PCR) in real time by the TaqMan system (Applied Biosystems, Foster City, USA). For the statistical analysis, Fisher's exact test and chi-square were used with a 5% significance level. Only socioeconomic factors influenced the caries experience. It was concluded that the genetic component in the population of this study, did not influence the development of caries.

 

Keywords: Genetic polymorphism. Adolescents. Enamel.
MENUJU SEKOLAH SIAGA BENCANA DI SD MUHAMMADIYAH KLATEN UTARA
Authors: Nursetiawan Nursetiawan , Wiyagi Rama Okta
Published: April 2021

Muhammadiyah memiliki amal usaha termasuk bidang pendidikan mulai dari tingkat Pendidikan Dini sampai dengan Pendidikan Tinggi dengan jumlah mencapai ribuan yang tersebar di seluruh wilayah Indonesia. Membangun kesadaran akan kesiapsiagaan bencana oleh seluruh komponen masyarakat, termasuk oleh sekolah-sekolah sangat diperlukan mengingat kondisi Indonesia yang secara geografis terletak di wilayah dengan tingkat kerawanan terhadap bencana cukup tinggi. Kaitannya dengan upaya penanggulangan bencana di Indonesia, sekolah-sekolah Muhammadiyah sebagai bagian ruang publik harus memiliki peran nyata dalam membangun ketahanan masyarakat melalui program sekolah siaga bencana. Kegiatan Pengabdian Kepada Masyakat UMY berupa program kesiapsiagaan bencana telah dilakukan di SD Muhammadiyah Klaten Utara berkerja sama dengan BPBD Kabupaten Klaten. Walaupun ditengah situasi pandemi covid-19, kegiatan dilakukan dengan melihatkan pihak guru-guru sekolah sekaligus juga dengan pemasangan alat pendeteksi getaran gempa sebagai bagian early warning system dan juga sebagai media pihak sekolah untuk melakukan simulasi terhadap para siswa.
Epidemiological aspects of uterine myomas among nulligest women at the general reference hospital of Panzi in Democratic Republic of the Congo
Authors: Balungwe Sifa , Maroyi Raha , Joyeux Mpakanyi , Omari Mukango , Philémon Mulongo , Olivier Nakiyo
Published: April 2021

Background: Myomas appear early in young women. The objective of this study was to evaluate the frequency of uterine myomas among nulligest women screened at the Panzi Hospital in South Kivu.Methods: A cross-sectional study was conducted among women aged 20-35 years during the period from 01 August 2018 to 01 August 2019. Women were recruited for screening after their informed consent. Informed consent was sought prior to participation in the study. The main data collection tools were the survey questionnaire. An individual survey questionnaire was used for data collection, laboratory records and trans-abdominal ultrasound. Descriptive statistics were calculated.Results: The median age of the women was 25 years. Positive myotomy was noted in 45.9% of cases. Submucosal and subperitoneal localization was predominant (48.6%). Young, unmarried, overweight women were the most common. The mean age of the menarche was 11.83±1.48 years. The consumption of red meat, green vegetables and alcohol was more noted. Exposure to the sun and wearing half-covered clothing were also noted. Abdominal and lumbar pain were the main symptoms observed. The majority used lightening products.Conclusions: The study notes the early appearance of uterine myomas among women aged 20-35 years in our environment. A mass evaluation and screening of this population is necessary to establish prevention and the best management.
Sonographic estimation of foetal weight versus actual birth weight at term
Authors: Ero-Phillips Akinshola A. , Jinadu Faosat O. , Ottun Abimbola T. , Olumodeji Ayokunle M.
Published: April 2021

Background: Estimated foetal weight is very critical to decision making in the management of pregnant women. It is therefore important to evaluate the accuracy of ultrasound estimated foetal weight (USEFW) at term in our environment. We compared ultrasound estimated foetal weight at term with the actual foetal birth weight at delivery.Methods: This was a prospective, comparative cross-sectional study at the Lagos State University Teaching Hospital over a 6-month period. Four hundred and five pregnant women with normal singleton pregnancy, who had sonographic estimation of foetal weight at term, using the Hadlock IV formula, were followed up and had their actual birth weight (ABW) determined at delivery. Accuracy was determined by proportion of estimates within 10% of actual birth weight and mean absolute percentage error (MAPE). The p<0.05 was considered significant at 95% confidence interval.Results: The prevalence of macrosomia was 10.3%. At 10% margin of error, ultrasound accurately estimated the weights of 73.3% of babies. The mean USEFW was 3559.89±316.9g and mean ABW was 3477.42±422.9g with a mean difference of 82.44g (p<0.001) and MAPE of 7.11. There was positive correlation (r=0.669) between the EFW and ABW (p<0.001). The USEFW had a sensitivity of 66.7%, specificity of 91.5%, positive predictive value of 47.5% and negative predictive value of 96.0% in predicting macrosomia.Conclusions: Ultrasound estimation of foetal weight at term is reliably accurate in predicting actual birth weight in south-western Nigeria.
Knowledge, attitude and practice of menstrual hygiene among adolescent schoolgirls of rural area, Dakshina Kannada, India
Authors: S. Pramodha M. , D. Shashirekha H.
Published: April 2021

Background: Adolescent girls constitute a vulnerable group not only with respect to their social status but also in relation to their health. Menstruation is accompanied by a cultural taboo in almost every society in the world. Although very common issue of everyday of life, menstruation is associated with many menstruations negative attitude in young girls. The young population is seen to be trapped and confused due to the different schools of thoughts at home and the outer world. This indicates an urgency to investigate girls, menstrual needs, to inform effective responses and educate them about the right strategies of menstrual hygiene, attitudes and practices. The aim of our study was to assess the knowledge, attitude and practices about menstrual hygiene among adolescent school girls from rural areas of Dakshina Kannada.Methods: This was a cross sectional study conducted from January 2020 to February 2020 among 130 secondary schools and high school girls of rural area of Dakshina Kannada, using predesigned questionnaire after obtaining informed consent.Results: In our study, most of the students had attained menarche by 12yrs of age. 86.15% were lacking primary knowledge about menstruation, and 80% of our participants had good knowledge about cleanliness of undergarments, and 65% of students knew that menstruation was a physiological phenomenon and 71% of the participants, still believed in the taboos and myths associated with menses and 30% were shy about carrying sanitary products to school. 63.85% participants still used cloth and most worrisome finding of our study is that 63% of our students did not feel comfortable to approach their family/elders/health care workers to solve their queries about menstruation.Conclusions: The study aimed at assessing the knowledge, attitude & practices of the adolescents regarding menstruation and menstrual hygiene. The low level of knowledge among participants is evident from their unpreparedness while entering menarche and their strong views of menstruation as social taboo can be judged from their various restrictions, owing to such strong socio-cultural beliefs and practices. Group discussions, media campaigns, sex education in schools are required to overcome taboo associated with menstruation.
Hormonal effects of drosperinone and ethinyl estradiol based combined oral contraceptives on polycystic ovarian syndrome
Authors: Nayak Madhusmita S. , Kala Deepa D. , Agarwal Amit
Published: April 2021

Background: Polycystic ovarian syndrome (PCOS) is a common endocrine disorder treated with combined oral contraceptives (COCs). The androgenic potential of any type of COC is in part determined by the progestin present. A newer form of progestin, drospirenone, has been recently introduced, and is available in combination with ethinyl estradiol.Methods: The study was conducted on 60 patients fulfilling inclusion criteria, in the department of obstetrics and gynecology, Terna Medical College and Hospital. Patients were diagnosed as PCOS according to Rotterdam criteria. After initial evaluation, blood samples were sent for levels of serum luteinizing hormone (LH), follicle stimulating hormone (FSH), dehydroepiandrosterone-sulphate (DHEA-S), free testosterone, sex hormone binding globulin (SHBG). Each patient was advised to take a combination of EE (30 mcg) + drosperinone (3 mg), 1 tablet daily from the second day of her menstruation for 21 days then a 7 days gap and again for 21 days and so on cyclically for 3 cycles, then to repeat the tests as done at the beginning.  Hirsutism was assessed clinically using the Ferriman-Gallwey scale at initial visit and three months later.Results: We found a significant improvement in the Serum LH, FSH levels and a significant fall in free testosterone levels accompanied by a rise in SHBG levels. There is also overall improvement in the hirsutism scores.Conclusions: Drosperinone based COCs are a good and effective means of treatment of PCOS. Treatment duration of three months was found to be effective in our study.
Role of GeneXpert in endometrial biopsy for diagnosis of genital tuberculosis in women presenting with infertility
Authors: Naaz Aafreen , Sarbhai Vikram , Sarbhai Vinita
Published: April 2021

Background: The diagnosis of female genital TB is challenging due to low sensitivity of conventional diagnostic modalities. The new GeneXpert Test on endometrial biopsy is studied for its role in diagnosis of female genital TB.Methods: This is an observational cross-sectional study on 50 infertile women. Premenstrual endometrial biopsy was performed and sent for AFB Smear, M. TB (LJ) medium culture, CB-NAAT by GeneXpert, and histopathology. The results were compared for diagnosis of FGTB.Results: Endometrial Biopsy (EB) could confirm diagnosis of genital TB in 4 cases (8%) out of 50 infertile women. Amongst these 4 cases, GeneXpert was positive in two, AFB were detected on smear in three while one showed both AFB on smear and positive GeneXpert. GeneXpert adds additional value but surely cannot replace any of the other gold standard investigations.Conclusions: GeneXpert is a rapid diagnostic method which is accurate, feasible and affordable. It is useful adjunct to the existing armamentarium in diagnosis of female genital tuberculosis.
Analysis of postpartum intrauterine contraceptive devices
Authors: Shrigadhi Sandhya A. , Gawandi Prabhakar S.
Published: April 2021

Background: PPIUCDs are the only postpartum family planning  method for couples requesting a highly effective and reversible, yet long acting, family planning method that can be initiated during the immediate postpartum in lactating women. The public health benefits from PPIUCDs stemmed from the women’s increased accessibility to PPIUCDs following facility births, as PPIUCDs could be offered at health facilities after childbirth. It is an attempt to reduce unmet family planning need. The specific aims of this study were to assess the acceptability, feasibility expulsion rate and complications of PPIUCD insertion among women delivering at term in our institute who were eligible and counselled for PPIUCD.Methods: Prospective study undertaken at Dr. Vaishampayan memorial government medical college, Solapur, Maharashtra conducted from September 2015 to August 2017. All women undergoing delivery at term in this institute and not having any contraindications for postpartum IUCD insertion were counseled for PPIUCD.Results: A total 3032 were eligible for PPIUCD insertion and were counseled for the same. 1.97% women accepted PPIUCD insertion while 98.03% of them declined insertion. 1124 underwent caesarean section while 1908 had vaginal delivery. Among vaginal delivery group rate of acceptance was 1.20% while that in caesarean section group was 3.29%.Conclusions: The present study concluded that overall acceptance of PPIUCD in our institute is 1.97 %. Considering fear of complications related to IUCD and partner refusal as major causes of refusal for PPIUCD in our study, emphasis on this aspect during counseling can improve acceptance.
Study of the efficacy of tranexamic acid in reducing blood loss after child birth
Authors: Gunturu Nagajyothi , Shivani D. , Sravanthi P.
Published: April 2021

Background: The aim was to study the efficacy of tranexamic acid in reducing blood loss after childbirth in normal vaginal delivery and LSCS.Methods: 200 pregnant women divided into two groups group 1 and group 2, 100 women undergoing LSCS and 100 women undergoing vaginal delivery. Study group will be given 1 g iv tranexamic acid along with active management of third stage of labor and control subjects will be given only active management of third stage. Clinical observations and laboratory examinations, measurement of blood loss were measured.Results: Distribution with respect to indication of LSCS like fetal distress, cephalopelvic disproportion, abnormal presentation, previous LSCS, arrest of descent, failed induction and onset of labor were comparable between both the groups. Study group showed marked decrease in blood loss when compared to controls from time of placental delivery to 2 hours postpartum in women undergoing vaginal delivery and caesarean section. There was a significant fall in mean Hb level among the control group when compared with the study group. There was no significant difference in the vital signs of the subjects in both the groups. The incidence of adverse effect like nausea, vomiting and diarrhoea were not increased in the study group when compared to the control group. Also the incidence of thrombosis was not increased with tranexamic acid.Conclusions: Tranexamic acid significantly reduced the amount of blood loss after vaginal delivery and lower segment caesarean section. Its use was not associated with any adverse drug reactions like nausea, vomiting, diarrhoea or thrombosis. Tranexamic acid can be safely administered in pregnant women undergoing vaginal delivery and lower segment caesarean section.
Abortion and contraception practices in COVID-19 era
Authors: Maheshwari Bharti , Manchanda G. S. , Sharma Preeti , Setiya Taniya
Published: April 2021

Background: To protect the gains made in sexual and reproductive health in over the past several decades, care for childbearing women and newborn infant’s needs to continue during the pandemic. The provision of safe abortion and contraceptive services remains critical. When staff and services are under extreme stress there is a real risk of increasing avoidable harm. Aim and objectives were to determine the effect of COVID-19 on accessibility and acceptance of contraception and safe abortion care services.Methods: Questionnaire survey was Done among 500 women in 6 months from April to September 2020, on availability and utilization of safe abortion and contraception services during lock down in covid time from patients getting treatment by Department of Obstetrics and Gynecology, Muzaffarnagar Medical College and health care workers (paramedics and others staff) of reproductive age group working in the institute.Results: Majority (56%) of women were in the age group of 20-30 years. 70% of women have access to contraception at present while it was reduced to 60% during lockdown. Most commonly used method was barrier method (70%) followed by OCP’s which they could avail maximum from pharmacy (40%). 65% of women had access to post delivery and post abortion contraception with most common method adopted being injectables, in 3% cases IUCD was inserted, 1% ligation with LSCS. Among them 42 cases were covid positive who underwent caesarean section and adopted contraception thereafter with tubal ligation in 2 cases.  In this study 32% of women had unwanted pregnancy, among them 35% underwent surgical abortion 61% medical abortion and 4% continued pregnancy.Conclusions: The COVID-19 pandemic has impacted safe abortion and contraception services. Unwanted pregnancy increased to 32%. 62% subjects claimed for accessibility at government centre and door to door by health worker.
Interventions for gestational diabetes: impact of assisted reproduction
Authors: Ravi Preethi , Sundaram Lakshmi Shanmuga , Shankar Kundavi
Published: April 2021

Background: This study was to assess whether assisted conception acts as a predictor for insulin therapy in gestational diabetes (GDM) treatment. The secondary aim of this study was to analyse the type of interventions that aided control of blood glucose. The role of ART as a risk factor that increases the risk of insulin therapy in GDM remains elusive. Many studies have established the increased association of GDM with ART conceptions. Factors like advanced maternal age, polycystic ovarian syndrome or obesity that increase GDM risk also contribute to subfertility. Increased level of  Hb A1C, elevated FBS values are considered as risk factors for antenatal insulin therapy in women with GDM. This study was to assess if assisted reproduction is an independent variable associated with insulin therapy.Methods: In this retrospective study, GDM was diagnosed by fasting blood sugar and 2 hours postprandial or 75 gms OGTT based on IADPSG criteria with FBS >90, 2hr >140. Among the 121 GDM mothers, 42 women were ART conceptions and 79 were spontaneous conceptions. The entire study population (121) was divided into 3 groups based on the treatment required. Diet and lifestyle modifications only, diet and life style modifications with OHA and OHA with or without insulin therapy. The demographic, clinical, biochemical data were compared between groups. Details were obtained from case notes and entered in an excel sheet and SSPS software was used for statistical analysis. Inclusion criteria was all GDM pregnancies in the study period (4 years; January 2014 to December 2017) for whom case notes were available. Exclusion criteria was women with diabetes prior to pregnancy, those who moved elsewhere for delivery and multiple gestations.Results: There was no difference in the insulin requirement between ART conception and spontaneous conceptions. Out of 121 women, 34 women (28%) required diet and life style management, 38 women required OHA (31%), 49 women required insulin (40%). 73% of women who were managed with diet were spontaneous conceptions. Preterm labor was the commonest complication encountered (17%). ART women had more number of perinatal complications, in all treatment groups.Conclusions: ART was not a predictor for insulin therapy in this study group. The largest group of intervention for GDM was with insulin, 40%. Perinatal complications were seen more in ART mothers with GDM compared with spontaneous conceptions. Spontaneous conceptions women had more percentage of management with diet and life style modifications.
Partographic analysis of labour by modified WHO partograph in tertiary care centre
Authors: Jain Prekshi , Shah Akshay C. , Patel Babulal S. , Jani Shashwat K.
Published: April 2021

Background: The partograph is a simple, inexpensive tool to provide a continuous pictorial overview of labor. The goal of this study is to use partograph to monitor labor, initiate uterine activity that is sufficient to produce cervical changes, fetal descent while avoiding uterine hyperstimulation, hypostimulation and fetal distress and provide timely surgical intervention where required. Methods: A hospital-based observational study involving prospective review of partographs for births that occurred in 2020 was conducted in 2 hospitals including SVP Hospital and V.S hospital Ahmedabad. A partographic analysis of labour was done in randomly selected 200 patients using modified WHO partogram. The study population was divided into Primigravida (96) and Multigravida (104) term patients. partograph recording were commenced at 4 cm dilatation. close maternal and fetal monitoring was done throughout the labour and partogram was plotted to detect any deviation from normal course.Results: Patients were grouped into primigravida and multigravida and based on partogram finding divided into mode of delivery. 22 of total 96 primigravida underwent caesarean section and 74 delivered vaginally. 8 of total 104 multigravida underwent caesarean section and 96 delivered vaginally. Out of 200 newborn only 11 had Apgar score <7 at 5 minutes.Conclusion: The WHO modified partograph is highly effective in reducing both maternal and neonatal morbidity. It aids in assessing the progress of labour and to identify when intervention is necessary. It is effective in preventing prolonged labour, obstructed labour, reducing operative intervention and improving neonatal outcome.
A five-year retrospective study of maternal mortality in a tertiary referral centre
Authors: Sarmalkar Meenal S. , Nayak Arun H. , Faisal Shameel , . Abhakumari
Published: April 2021

Background: The objectives of this study were to calculate the maternal mortality ratio (MMR) and the causes of maternal deaths in an urban tertiary care institution.Methods: A retrospective study of 305 maternal deaths over the period from January 2014 to December 2018 was carried out. Data was analysed using frequency and percentage with the help of Microsoft Excel 2019.Results: The MMR during the study period was 666.75per 100,000 live births. Majority of maternal deaths (130, 42.62%) occurred in age group 21-25 years. Maximum number of women (288, 94.1%) came from urban area. Majority of maternal deaths occurred in referred cases (238, 78.03%) to our institution. Majority were registered cases (235, 77.0%).  Maximum women (201, 62%) died in the postnatal period. Majority of maternal deaths (222, 72.79%) occurred within 7 days of admission. Direct and indirect causes contributed to 40% and 59.67% of maternal deaths. Among the direct causes of maternal deaths, haemorrhage (45, 14.75%)) was the leading causes for death followed by hypertensive disorders (42, 13.77%) and sepsis (11, 9.02%). Tuberculosis (34, 18.68%) was the most common indirect cause of maternal mortality in our study followed by hepatitis (30, 16.48%) and respiratory conditions (25, 9.02%).Conclusions: Adequate surveillance of tuberculosis in the antenatal period, health education of pregnant women, proper antenatal, intranatal and emergency obstetric care in the first referral unit with proper blood banking facilities and timely referral to the tertiary care institute will help to lower the high death rate.
Clinical profile of patients with 46 XY disorders of sex development: a single centered experience
Authors: Das Darvin V.
Published: April 2021

Background: XY disorders of sex development are a complex entity that needs medical attention from childhood to adolescence and throughout life. The aim of the study was to analyze retrospectively the medical records of subjects with 46 XY disorders of sex development (DSD) and characterize their clinical profile and management course in a tertiary care centre.Methods: 32 subjects with 46 XY DSD attending Endocrinology OPD / Gynecology between 2010 to 2020 were enrolled in the study. Data collected includes age at presentation, symptoms, sex of rearing, phenotype, external masculinisation score (EMS), karyotyping, gonadal features like location and histopathology, psychosexual domain and their management and follow up. Statistical Analysis: The mean and standard deviation was calculated for normally distributed data.Results: The mean (SD) age of all study subjects (n=32) were 15.5 ± 5.32 years. 46 XY DSD included cases of complete gonadal dysgenesis (n=6), mixed gonadal dysgenesis (n=6), complete androgen biosynthetic defects (n=9), partial gonadal dysgenesis (n=2), 5-alpha-reductase type 2 deficiency (n=8) and 17 betahydroxysteroid deficiency (n=1). The most common clinical presentation was for primary amenorrhea followed by genital ambiguity and virilisation in females. Resection of testis at the earliest or a biopsy of the testis if resection is postponed in a female sex assigned 46 XY DSD is favored. Male sex assigned 46 XY DSD needs corrective surgeries and orchidopexy for undescented viable testis with periodic follow up for testicular malignancy.Conclusions: 46 XY DSD’s may shares similarities in their clinical presentation, though age of presentation may be in a wide range. Proper gender assignment, gonadectomy, reconstructive surgeries, hormone replacement and time to time follow up for testicular malignancy in cases where the testes are preserved is the ideal management.
Comparative study of pharmacological and combined pharmaco-mechanical method of induction of labour: a randomised study
Authors: Kumari Anshu , Chiniwar Mahantappa A. , Menasinkai Sharada B.
Published: April 2021

Background: Comparative study of Pharmacological and Pharmaco- Mechanical method of induction of labour- A Randomised study. The objective of the study was to compare efficacy of pharmacological and combined pharmaco-mechanical method of induction of labour.Methods: A study was conducted in the department of Obstetrics and gynaecology, Adichunchanagiri Institute of Medical Sciences and Research Centre for a period of 18 months. 200 pregnant women requiring induction of labour were included in the study.  In group 1 Dinoprostone 0.5 mg gel was inserted into cervical canal. In group 2 Foley’s catheter No 18 F was inserted within the cervix. The balloon of the catheter was filled with 30 ml normal saline and at the same time Dinoprostone 0.5 mg gel was inserted into posterior vaginal fornix. The Excel and SPSS (SPSS Inc, Chicago V 18.5) software packages were used for data entry and analysis. The results were averaged (mean ± Std Deviation) for each parameter for continuous data in tables.Results: Mean induction to active phase interval in group 1 was 8.43±4.11 hrs, in group 26.82±3.01 hrs (p =0.001). The rate of vaginal delivery in group 1 and group 2 was 55% and 66% respectively, difference was statistically significant (p=0.026).Conclusions: Synchronous use of intracervical Foley’s catheter and Dinoprostone 0.5 mg resulted in a shorter time for progress to active phase and also shortened induction to delivery interval as compared to Dinoprostone 0.5 mg alone. Higher risk of caesarean delivery was associated with single method as compared to combined methods.
Invasive genetic testing in pregnancy: experience from a tertiary care center
Authors: Rai Gunjan , Singh Sudhirman , Bhardwaj Bikram
Published: April 2021

Background: Evaluation of outcome of pregnancies with high risk first trimester screening or abnormal ultrasonographic findings and complications of amniocentesis in second trimester and chorionic villous sampling in first trimester in a tertiary care hospital in India.Methods: This is a retrospective study in a tertiary care hospital from 2015 to 2017. All antenatal patients underwent combined nuchal translucency scan and dual screen ratio and who detected to have high risk for trisomy, they underwent amniocentesis/CVS. These procedures were done at minor OT in our hospital, taking aseptic precaution and under ultrasound guidance. First trimester combined screening included a detail nuchal translucency scan as per the international society of ultrasound in obstetrics and gynecology (ISUOG) guidelines and also biochemical screening done with serum beta human chorionic gonadotrophin (HCG) and pregnancy-associated plasma protein A (PAPP-A) in same genetic lab. Combined risk scoring done as high risk or low risk. Low risk patients without any genetic abnormality in previous obstetric history were followed as normal pregnancy. Results, complications and outcome of invasive genetic testing in pregnancy was observed. At our center CVS was done mostly for single gene disorder.Results: Out of 179 patients who underwent amniocentesis, total abnormal chromosomal were 14 (7.82%). The most common abnormality was trisomy 21 (4.46%). The other abnormalities were trisomy 18 (1.67%), trisomy 13 (1.11%) and triploidy XXY (0.55%). CVS was done for Nieman Pick disease, androgen insensitivity syndrome, both parents thalassemia minor and ultrasound abnormality detected early in pregnancy. For single gene disorder mutation identified in index case or in parents and same mutation looked in to fetus by chorionic villus sampling (CVS). For Nieman Pick disease, androgen insensitivity syndrome and both parent thalassemia minor, fetus detected to have heterozygous for same and nonpathogenic. Two patients underwent CVS for ultrasound abnormality out of which one detected to have trisomy 18 and other had loss of 2.1 Mb on Ch 22 in 22q11.21 region.Conclusions: Combined first trimester screening with nuchal translucency scan and dual screen ratio is an efficient method of screening with high sensitivity and low false positive rates. In our study prevalence of trisomy is slightly greater than other studies because number of patients were less and if we increase the number of patients probably we will have a prevalence data of trisomy similar to other studies which has been done for aneuploidy in fetus.
Outcomes and analysis of fetomaternal elements and delivery strategies with neonatal respiratory distress
Authors: . Sambedna , Kumar Amit , Chakore Rita
Published: April 2021

Background: Perinatal asphyxia is one of the most important causes of morbidity and mortality in neonates. Perinatal asphyxia occurs in association with different maternal and fetal determinants. However, the relation of associated factors with perinatal asphyxia is not well studied. The aim of this study was to determine the association of maternofetal factors and mode of delivery with perinatal asphyxia in a tertiary care centre.Methods: This was a retrospective comparative study conducted in department of OBG in tertiary care health centre. A total 200 newborns were selected for study out of which100 newborns were with asphyxia at birth as study group and 100 non asphyxiated newborns were taken as control group. Maternal factor like age, parity, gestational age and fetal factor like weight at birth and mode of delivery were studied to established association on perinatal asphyxia.Results: Maternal factor like age, parity, gestational age had not significant relationship with perinatal asphyxia. Maximum number of babies delivered in both control and the study group were in the range of 2.6 to 3kg.In this study birth weight did not have significant relationship with perinatal asphyxia. Proportions of LSCS was comparatively higher in the study group though. The delivery mode did not have any statistically significant influence on the newborns affliction with birth asphyxia (p>0.05).Conclusions: Findings of this study highlight the need for the better obstetrical care and awareness of the possible presence of the risk factors of PNA (perinatal asphyxia) among mothers and fetus, so that the incidence and complications of PNA could be prevented or at least appropriately managed. It can reduce the high incidence of morbidity and mortality due to birth asphyxia.
Analysis of caesarean section rate using WHO’s Robson’s 10-group classification system: a hospital based retrospective study
Authors: Desai Devika V. , Mishra Nigamananda , Prabhu Santoshi , Jadhav Vaishali , Savani Gayatri
Published: April 2021

Background: Maternal morbidity and mortality has been an utmost priority worldwide as it is an indicator of healthcare system. In order to bring it down, it has become the need of the hour to decrease the number of caesarean sections as it is one of the most common cause of morbidity among women. Every institution should have an audit to determine the rate of caesarean section and corresponding indications in order to implement new protocols or modify existing ones to improve caesarean section rates.Methods: All women who underwent caesarean section between time period Jan 2015- Dec 2019 were included. All vaginal deliveries were excluded. Delivery and operative registers, logbooks and online entries were used for data collection in the obstetric and gynecologic department. A retrospective data collection was done, tabulated and entered in excel sheet.Results: Robson’s group 1, group 2, group 5 were the main contributors to overall caesarean section rate. The major indications for caesarean section were found to be as previous caesarean section (33%), non-progress of labor (22%) followed by meconium stained liquor, cephalopelvic disproportion both around 10%.Conclusions: Robson’s group 1, group 2, group 5 were the main contributors to the overall caesarean section rate. The major indications for caesarean section were found as previous caesarean section and non-progress of labor. Further studies are needed for comparison and to make amendments to protocols.
Repeated ultrasound guided local infiltration of methotrexate in persistent gestational trophoblastic disease with myometrial invasion: case series and review of literature
Authors: Said Tamer H. , Elkerm Yasser
Published: April 2021

Gestational trophoblastic disease is a group of rare tumors that involve abnormal growth of cells inside a woman's uterus. An invasive mole is a hydatidiform mole that has grown into the muscle layer of the uterus. Invasive vesicular moles can develop from either partial or complete moles, but complete moles become invasive much more often than do partial moles. Invasive moles develop in a little less than 20% of women who have had a complete mole evacuated. Treatment of invasive mole is classically by giving systemic chemotherapy. Objectives of current study were to evaluate the effect of repeated local methotrexate injection in treatment of invasive mole. Cases with invasive mole assigned for local injection of 50 mg methotrexate in 10 cm normal saline using local injection in the myometrium under transvaginal ultrasound guidance. Follow up weekly till negative results are obtained. All cases showed rapid decrease of the level of b-hCG level after local injection and showed negative hormone results within 6 weeks after injection. Local methotrexate intra-myometrial local injection therapy has successful results in cases with persistent invasive hydatidiform mole and should be tried before referring them for systemic therapy.
Correlation between pregnancy and eye blindness (valsalva retinopathy)
Authors: Ali Mostafa Maged , Abdelafatah Laila Ezzat
Published: April 2021

Eye diseases during pregnancy can be classified according to the cause of disease as the disease can be pregnancy-induced or due to presence of pre-existing eye disorder or due to normal physiological changes with pregnancy. Here, we have a case of valsalva retinopathy which demonstrates a condition resulting from increase in the intra-abdominal and intra-thoracic pressures owing to multiple bearing-downs in normal labour due to bad management of the process of normal labour. Ophthalmologists plus obstetricians play great role in prevention and diagnosing valsalva retinopathy. Prevention could be managed through curbing the patient from straining and by proper management of normal labour so pregnancy is a risk factor for valsalva retinopathy.