bluuebunny/crossref_metadata_2025 huggingface dataset:
Mean square filtering error as a criterion for detecting network traffic anomalies
Authors: Плаван А.И. , Карташевский В.Г.
Published: June 2023

Рассматривается способ обнаружения аномалий в сетевом трафике на основе фильтрации случайного процесса, представляющего ожидаемую интенсивность трафика. Для этого процесса синтезируется фильтр, оптимальный по критерию минимума среднеквадратической ошибки, учитывающий флуктуации трафика от ожидаемых значений в качестве шума. Для фильтра определяется минимальная среднеквадратическая ошибка. Проводится компьютерное моделирование фильтрации реализаций процесса, представляющего ожидаемый сетевой трафик, при отсутствии и наличии аномалии, имеющей определенную автокорреляционную функцию, и при различных значениях отношения сигнал/шум. Результаты моделирования позволяют говорить о том, что отклонение значения среднеквадратической ошибки фильтрации от минимального (ожидаемого) значения может указывать на наличие аномального источника трафика в сети, то есть использоваться в качестве критерия обнаружения аномалии.

The paper considers a method for anomaly detection in network traffic which is based on filtering a random process, representing the expected traffic intensity. A filter that minimizes mean square error is obtained for this process, taking into account traffic fluctuations from expected values as noise. The minimum value of mean square error is determined for the filter. Simulation is performed for the filtering of random samples of process, representing the expected traffic intensity, in the absence and presence of an anomaly with a certain autocorrelation function, and at various values of the signal-to-noise ratio. The simulation results suggest that the deviation of the mean square filtering error from the minimum (expected) value may indicate the presence of an anomalous traffic source in the network, i. e. can be used as an anomaly detection criterion.
Application of Valuation Approaches to the Assets of a Construction Company
Authors: Белов Е.А. , Морозова Н.С.
Published: June 2023

Рассмотрены подходы, применяемые при оценке стоимости активов строительных предприятий в современных условиях развития экономики России, возможность оценки управленческих решений с точки зрения их влияния на стоимость организации. Выявлена специфика применения оценочных подходов по отношению к объектам недвижимости и  незавершенного строительства, являющимся частью инвестиционного потенциала строительного предприятия. Раскрыта сущность объекта незавершенного строительства и дана его типология, от которой зависит корректный выбор метода оценки его стоимости. Описаны варианты оценки стоимости объекта в зависимости от выбранной методики.

The article considers the approaches used in assessing the value of assets of construction enterprises in the current conditions of the Russian economy development, with the possibility of assessing management decisions in terms of their impact on the value of the organization. The authors dwell on the specificity of the valuation approaches application in relation to real estate and construction in progress, which are part of the investment potential of a construction company. The article considers the essence of the object of construction in progress and its typology, which determines the correct choice of a method for assessing its value. The options for estimating the cost of an object depending on the chosen methodology are described.
The Development of the Sixth Technological Order as a Factor of Technological Unemployment
Authors: Цихоцкий М.А.
Published: June 2023

Рассматриваются вопросы влияния нового витка технико-экономического развития общества на безработицу. Для этого обозначаются известные в настоящий момент характеристики нового технологического уклада, проводится обзор литературы по проблематике, проводится ретроспективный анализ влияния технико-экономического развития на безработицу. По итогам делается вывод, что в настоящий момент шестой технологический уклад перешел в фазу роста, на этом фоне происходит замещение ручного труда, то есть отмирание ряда профессий, что ставит остро проблему технологической безработицы. Технологическая безработица – не новое для мировой истории явление, исследователи выделяют две ее волны. В то же время для смягчения ее последствий предлагается ряд мер, помимо классических, можно обозначить безусловный базовый доход.

This article discusses the impact of a new round of technical and economic development of society on unemployment. For this purpose, the currently known characteristics of the new technological order are indicated, a review of the literature on the problem is conducted, a retrospective analysis of the impact of technical and economic development on unemployment is carried out. According to the results, it is concluded that at the moment the 6th technological order has entered a growth phase, against this background there is a replacement of manual labor, i. e. disappearance of a number of professions, which poses an acute problem of technological unemployment. Technological unemployment is not a new phenomenon in world history, researchers identify at least two waves. At the same time, a  number of measures are proposed to mitigate its consequences, in addition to the classical ones, an unconditional basic income can be designated
Development of the Financial System of Execution of the Budgets of the Subjects of the Russian Federation in the Modern Realities
Authors: Пидимов А.А.
Published: June 2023

Проведена оценка контроля механизма денежных средств (на примере Смоленской области) с целью определения методов улучшения его качества. Анализ научной литературы позволил прийти к выводу, что придется конкретизировать и решить ряд задач и создать проекты по улучшению и оптимизации работы органов Федерального финансового управления.

The work of the control of the mechanism of funds (on the example of Smolensk region) has been evaluated in order to determine the methods of increasing the quality of the mechanism of this control. Th e analysis of the scientific literature has allowed to come to a conclusion that a number of big problems should be specified and solved and the projects to improve and optimize the work of the Federal financial management bodies should be created.
Rate and determinants of low fifth minute Apgar score at the federal medical centre Yenagoa, Bayelsa State, Nigeria
Authors: Makinde Olakunle I. , Awotundun Benjamin O. , Osegi Nkencho
Published: June 2023

Background: About a quarter of neonatal deaths and about 10% of deaths of children under 5 years are due to intrapartum related events reflected as low fifth minute Apgar score. This study is to assess the rate of low fifth minute Apgar score and its determinants at the Federal Medical Centre Yenagoa, Bayelsa State, Nigeria.
Methods: A cross-sectional study of births at the Federal Medical Centre Yenagoa between July 2020 and April 2021. Data was collected in real time from parturients’ case notes at delivery. Low fifth minute Apgar score was defined as Apgar score < 7 at the 5th minute of birth. Data was analysed using IBM SPSS Statistics version 23. Multivariate logistic regression was used to identify determinants of low fifth minute Apgar score. P Value was 0.05.
Results: Rate of low fifth minute Apgar score was 16.6%. Unbooked status (OR - 2.29; CI-1.11 - 4.71; p value - 0.024), emergency caesarean section (OR - 10.44; CI - 1.10 - 99.26; p value - 0.041), urgent caesarean section (OR - 25.75; CI - 2.58 – 256.72; p value=0.006) and breech presentation (OR - 1.96; CI - 1.03 – 3.82; p value=0.049) significantly increased the odd of low fifth minute Apgar score.
Conclusions: Unbooked status, emergency and urgent caesarean section, and breech presentation were the determinants of low fifth minute Apgar score in the population studied. This highlights the patient group and clinical scenario requiring a focus of intervention for prevention of morbidity and mortality from low fifth minute Apgar score.
Causes and trends in maternal mortality in a tertiary health facility in North Central Nigeria
Authors: Kahansim Makshwar L. , Da’ap Pannan , Nyango Dalyop D. , Anyaka Charles U. , Egbodo Christopher O. , Mutihir Josiah T.
Published: June 2023

Background: Nigeria remains one of the top three countries with the highest maternal mortality worldwide. Due to poor vital registration in the country, hospital-based maternal mortality statistics still remain an important source for tracking trends and causes of maternal mortality. The aim of the study was to determine the causes and trends of maternal mortality in a tertiary health facility in North Central Nigeria.
Methods: This was a retrospective review of cases of maternal deaths at the Jos University Teaching Hospital from 1st January 2016 to 31st December 2022. Case records of patients that died from pregnancy-related complications were retrieved from the medical records department and other service points of the hospital. The information extracted was maternal socio-demographic characteristics, clinical diagnosis on admission, and duration of hospital stay before demise. The maternal mortality ratio was calculated per 100,000 live births.
Results: There were 80 maternal deaths during the period, and 10,348 live births during the same period, giving a maternal mortality ratio of 773/100,000 live births. The mean age of the women was 27.0±8.1 years, 12.5% were teenage mothers, 6.4% were women ≥40 years. About 27.5% were nulliparous, 16.5% para 5 or more. For women where information on educational level were available 68(85.0%), 48.5% had only primary education or no formal education, 42.5% had no antenatal care. About 72.5% of the maternal deaths were due to direct causes-pre-eclampsia/eclampsia (30.0%), maternal sepsis (17.5%), complications of unsafe abortion (12.5%), obstetric haemorrhage and uterine rupture 6.3%. The main causes of indirect maternal deaths were sickle cell disease, cardiac disease, diabetes mellitus and liver disease in pregnancy. Most (41.3%) of the maternal deaths occurred within the 24 hours of admission. There was no consistent trend noted in maternal mortality between 2016 and 2019; however, a remarkable increase was observed during the Covid-19 period from 2020-2021.
Conclusions: The maternal mortality ratio in Jos, North Central Nigeria remains high, with major causes related to pre-eclampsia/eclampsia, maternal sepsis, unsafe abortion and obstetric haemorrhage. The global Covid-19 pandemic led to an increased maternal mortality in the health facility.
Role of combination of mifepristone and misoprostol versus misoprostol alone in the management of late intrauterine fetal death
Authors: Dhar Dipannita , Podder Bidhan Chandra , Swarna Sharmin Sultana , Bari Rubina , Sikder Minara , Begum Anjumanara , Sarmin Farjana
Published: June 2023

Background: Intrauterine fetal death (IUFD) occurs in 1% of pregnancies and has devastating consequences. Previous methods for inducing labor in IUFD involved oxytocin and prostaglandins. The combination of mifepristone and misoprostol is commonly used for early first-trimester termination. This study aimed to compare the effectiveness of mifepristone and misoprostol combination versus misoprostol alone for labor induction in intrauterine fetal death.
Methods: A randomized controlled clinical trial was conducted at Sir Salimullah Medical College, Mitford Hospital, Dhaka, from January 2017 to June 2017. Sixty-four pregnant women with intrauterine fetal death after 28 weeks of gestation were included. Participants were randomly assigned to either group-I (mifepristone and misoprostol) or group-II (misoprostol alone). Statistical analyses were performed using statistical package for the social sciences (SPSS) version 20.0 for Windows.
Results: The mean age was 27.7±5.6 years in group I and 27.5±4.3 years in group II. Majority of patients in group I were housewives (87.5%), while in group II, it was 78.1%. Most patients in group I (56.3%) came from lower-income families, compared to 65.6% in group II. The gestational age did not significantly differ between the groups. The induction to delivery interval was significantly shorter in group I (8.6±2.0 hours) compared to group II (15.1±3.5 hours). The dose administration pattern of misoprostol differed significantly between the groups.
Conclusions: Both methods are equally safe and effective for managing intrauterine fetal death. However, the combination of mifepristone and misoprostol showed greater efficacy in terms of reducing the induction to delivery interval and requiring a lower dose of misoprostol.
Changing trends over 5 years in indications of caesarean section as per Robson’s group classification in a tertiary care centre
Authors: Chaurasia Amrita , Shweta Kumari , Khan Alina
Published: June 2023

Background: Caesarean section is the most common obstetric operation that saves lives of countless mother and babies.  However, its inappropriate usage may also be a reason for circumstantial increase in maternal and perinatal morbidities and mortalities. Aim of this study was to examine Changing trends in indications of Cesarean delivery rates based on Robson’s groups classification in the Department of Obstetrics and Gynecology, MLN Medical College, Prayagraj over 5-year period.
Methods: Our study was a retrospective observational study over 5 years (January 1, 2016 to December 31, 2020) period in Department of Obstetrics and Gynecology, SRN Hospital, MLN Medical College, Prayagraj. All women who came to SRNH labor room for delivery during the duration of study. All vaginal deliveries including operative vaginal deliveries and all C section done after 28weeks of pregnancy. Analysis of C section indication according to Robson Classification.
Results: There were 10,332 vaginal deliveries and 5306 cesarean deliveries during this 5 year of study period. The 5-year overall CSR of our tertiary care hospital was 33.9 %, which varied from 38 % in 2016 and has steadily fallen to 26.8 % in 2019-2020. Robson’s group one had the maximum number of subjects (n = 3800), out of which 37% (n =1441) had cesarean section followed by group 3, of which, 15 % (n = 546) underwent cesarean section.
Conclusions: The ten-group classification relies on well-defined parameters, and it may well be easily applied to the present dataset of 15638 deliveries. It helped to spot the main groups of subjects who contribute most to the overall CS rate. It also aided to identify subgroups which required closer monitoring for in-depth investigation of the indications for cesarean section. It is important to target the first four groups of TGCS which constitute about 75 % of all deliveries.
Study of maternal near miss as an indicator of quality of obstetrics care in tertiary care centre: a prospective study
Authors: Patel Priyanka , Nagar Jagriti Kiran , Patel Rajesh Kumar , Kaur Siftie
Published: June 2023

Background: Maternal near miss is said to have occurred when women presented with life threatening complication during pregnancy, childbirth and within 42 days after delivery, but survive by chance or good institutional care. For identifying near miss cases five factor scoring system was used. In 2009 WHO working group has standardized the criteria for these cases.
Methods: The study was a descriptive study done for the period of 18 months between 1st June 2021 to 31st December 2022 conducted in the department of Obstetrics and Gynecology at Bundelkhand Medical College Sagar, Madhya Pradesh, India, which is a tertiary care centre. For each cases of near miss, data were collected on demographic characteristics including gestational age at the time of sustaining the near morbidity, nature of obstetric complications, presence of organ dysfunction/failure, ICU admission and timing of near miss event with respect to admission.
Results: A total numbers of 12252 live births were, 28 maternal deaths and 372 MNM cases were reported during the study period. Incidence of MNM was 30.3 %. In present study mortality index is 0.07. Maternal near miss to mortality ratio is 13.2:1. Hypertensive disorder of pregnancy 44.4% were most common cause of MNM followed by severe anemia 23% cases.
Conclusions: Critical analysis of MNM cases will help us in identifying the deficiencies in obstetric care. Maternal mortality and morbidity can be reduced if timely and effective care can be given to women experiencing acute pregnancy related complications .There is need for validation of MNM criteria at peripheral level which will enable them in early identification and timely referral of such cases to tertiary centers.
Comparative study of endometrial thickness with transabdominal ultrasonography and pelvis in perimenopausal women presenting with abnormal uterine bleeding and correlation with its histopathological findings
Authors: D. Rita , Sourya K. A. Pallavi , A. Lathasri
Published: June 2023

Background: Heavy menstrual bleeding is the most common presenting menstrual complaint in women of perimenopausal age group. Diagnostics tests to investigate the causes of abnormal bleeding are transabdominal ultrasonography (TAS), TVS, endometrial biopsy and uterine curettage which is invasive procedure performed under anesthesia. The objectives of this study were to correlate the transabdominal ultrasonography results with the histopathological findings to discriminate normal from pathological endometrium.
Methods: Comparative study including 100 perimenopausal women with abnormal uterine bleeding. Endometrial thickness was measured by TAS and then D and C was performed for all the patients.
Results: Out of 100 women, (86) had normal and (14) had an abnormal endometrium. 43 were of 41-45 years and 65 patients presented with complaint of heavy menstrual bleeding. Fibroid uterus (24%) was the commonest uterine pathology detected on TAS. 53 of patients had endometrial thickness in the range 10-11.9 mm. Most common finding on HPE was secretory endometrium (44). Endometrial carcinoma was found in 1. Endometrial thickness <12mm was associated with least abnormal endometrial pathology.
Conclusions: Irrespective of endometrial thickness all perimenopausal women with HMB should be subjected to TAS followed by D and C which helps in early detection and missing out of endometrial carcinoma.
Analysis of caesarean section using Robson’s ten group classification in a tertiary care centre
Authors: Ambat Gopika , Jain Madhu , Anuranjani Lavanya , Srivastava Yashi , Thakur Anita , Priya Prerna
Published: June 2023

Background: Caesarean section is the most common obstetric operation that saves lives of countless mother and babies. In the past few decades, caesarean section rates have been continuously increasing worldwide. WHO declared that there is no justification for any region to have a caesarean section rate higher than 10-15% and added that CS rates higher than 10% is not associated with reduction in newborn and maternal mortality rates. In 2015, WHO proposed Robson classification as a global standard of assessing, monitoring comparing and auditing the determinants of caesarean sections rates.
Methods: This Retrospective study was done in the department of Obstetrics and Gynecology, Heritage institute of medical Sciences, Varanasi. The study duration was from July 2021 to June 2022.
Results: A total of 2039 cases underwent delivery during the study duration. The caesarean rate calculated was 46.3%. Group 5 (previous CS, single, cephalic, >37weeks) made the greatest contributor to total CS rate followed by Group 1 (nulliparous, single, cephalic, >37 weeks in spontaneous labor). 100% of women with abnormal lie (group 9) and 87.9% women with breech presentation underwent CS.
Conclusions: The overall rate of Caesarean sections is on an increasing trend. Robson’s Group 5 and 1 were the major contributors to caesarean section in this study. RTGCS is a simple useful tool which is a starting point for meaningful analysis of CS both at facility level and across different facilities.
Study on maternal and perinatal outcome in eclampsia in a tertiary care hospital
Authors: Agrawal Sippy , Pandey Divya , Sharma Seema
Published: June 2023

Background: Eclampsia is an unpredictable multi-organ disease unique to pregnancy and is largely a preventable condition, responsible for high maternal and perinatal mortality.
Methods: The present study was conducted in the Department of Obstetrics and Gynaecology in Maharani Laxmi Bai Medical College, Jhansi. It was a retrospective study conducted over a period of 12 months on all eclamptic cases attending our hospital and feto-maternal outcome data was analysed.
Results: The incidence of eclampsia in our hospital was 2.22%. Most of the eclamptic cases were antepartum eclampsia constituting 81.48%. During the study period there were a total of 2430 obstetric admissions out of which 54 were eclamptic cases. There were 89 near miss cases and 21 maternal deaths. 16 (17.97%) near miss cases and 7(33.33%) maternal deaths were due to eclampsia. 37.03% patients had complications. Pulmonary edema/ARDS was the most common complication seen in our study. Early neonatal mortality in our study was 11.11%, 11 new-borns needed NICU care. Prematurity was the most common cause.
Conclusions: Adequate screening, monitoring and routine check-up during and after pregnancy may prevent worsening the maternal and foetal outcome. Lack of antenatal care is a common risk factor for eclampsia is and this needs to be addressed to prevent this serious complication of pregnancy.
A clinico-epidemiological profile of neonates with birth asphyxia in SNCU and NICU of a tertiary care hospital with special reference to renal parameters and serum calcium levels in birth asphyxia
Authors: Pattanayak Ujjwal
Published: June 2023

Background: Birth asphyxia accounts for around 23% of annual neonatal deaths in the developing world. Perinatal asphyxia or birth asphyxia as is more commonly used is one of the most common presentations of a neonate in Special Newborn Care Units (SNCUs) and Neonatal Intensive care Units (NICUs) all around the world. The main objective of the study was to study electrolyte status and renal parameters in asphyxiated newborns of different severity in early neonatal period and to determine the occurrence of renal failure in asphyxiated neonates and to correlate severity with Apgar score and hypoxic ischaemic encephalopathy grading of neonates.
Methods: The present study was a Prospective Cross-Sectional Hospital based single centre study conducted in the Department of Paediatrics, Midnapore Medical College, Paschim Medinipur, West Bengal, India. Term, appropriate for gestational age babies born/admitted in SNCU and NICU with birth asphyxia between January, 2020 to June, 2021 were included in the study.
Results: Our study showed that, in control group 1 (60%) were male and 6 (40%) were female. In case group 18 (51.4%) were male and 17 (48.6%) were female. Among 35 cases renal failure is seen in 68.57 % and none of the controls had renal failure. Oliguria >0.5 ml/kg/hr was found in 14 (93.3%) patients in the control group, in case group it was found in 32 (91.4%) patients. The incidence of renal failure is highest with moderate asphyxia accounting for 41.67%.
Conclusions: Perinatal asphyxia is one of the commonest cinical conditions encountered in the sick neonate. It affects almost all organ systems of the body. As the pre renal type of kidney injury is more common, these babies usually recover fully with fluid resuscitation in majority of cases.
Study of predicting perinatal outcome in patients with oligohydraminos at term pregnancy
Authors: Damor Jahanvi , Meena Pooja , Thakkar Bhoomika
Published: June 2023

Background: Amniotic fluid plays a major role in the fetal growth and development. It provides the fetus with a protective low resistance environment suitable for growth and development, a cushion against the constricting confines of the gravid uterus, allowing the fetus room for the movement and growth and protecting it from external trauma. The abnormalities of the fluid volume can interfere directly with the fetal development or may be an indirect sign of underlying disorder such as fetal hypoxia, neural tube defect or gastrointestinal obstruction. Aim of this study was to determine whether an amniotic fluid level of 5cm or less can be predictor of adverse perinatal outcome in terms of fetal distress, birth weight, APGAR score and neonatal morbidity and mortality.
Methods: Amniotic fluid index (AFI) was determined with a b-mode real time scanner with linear transducer operated at 3.5 MHz. AFI estimation done by four quadrant technique in supine position. The summation of measurement from each quadrant represented the amniotic fluid index in centimeters of each patient. Fetal outcome was assessed with respect to birth weight and gestational age; Apgar score at one and five minutes; any other neonatal complications intrapartum or postpartum during stay in hospital and maturity of baby - condition at the time of discharge of mother and baby.
Results: The labor was induced in 28% women with AFI <5cm, out of which 19 women delivered vaginally and 9 women underwent LSCS for failure of induction. The mean birth weight was 2.61 kg in our study. Maximum number of babies i.e. 57% were with birth weight between 2.1-2.5 kg. The APGR score at 5 min was 9 in 71% cases and 8 in 21% cases. The mean APGR score at 5 min was 8.63.
Conclusions: AFI can be used as an adjunct for fetal surveillance along with other methods to identify high risks foetuses to improve the perinatal outcome.
A randomized interventional study on clinico-surgical outcome of vaginal hysterectomy with hydro dissection versus without hydro dissection
Authors: Sharma Devika , Jhajharia Neelam , Banerjee Krishna Priya
Published: June 2023

Background: Hysterectomy is one of the most common gynaecological surgeries performed worldwide. The common indications for hysterectomy are benign like symptomatic uterine leiomyomas, endometriosis etc. We compare clinico-surgical outcome of vaginal hysterectomy with hydro dissection versus without hydro dissection.
Methods: Women attending Gynae OPD or admitted was included in study and 30 cases taken in each group. Group A: Vaginal hysterectomy with hydro dissection. Hydro Dissection was done by about 50 ml to 100 ml of saline was infiltrated under pressure all around the cervix, just under vaginal mucosa below the bladder sulcus. Group B: Vaginal hysterectomy without hydro dissection.
Results: The mean age of cases in Group-A was 49.63±8.91 yrs and in Group-B was 48.03±5.39 yrs was uniform. The mean operative time in Group-A was 49.07±6.46 min and in Group-B was 53.40±5.87 min which was statistically significant (p-value = 0.009). The mean intraoperative blood loss in Group-A was 89.77±6.49 ml and in Group-B was 97.67±12.93 ml which was statistically significant (p-value = 0.005). The mean level of change in Hb was 0.70±0.29 gm/dl in Group-A and was 1.01 ± 0.43 gm/dl in Group-B, which was statistically significant (p-value = 0.002).
Conclusions: Hydro dissection with saline in vaginal hysterectomy is associated with significant reduction in duration of surgery, blood loss and lower mean level of change in Hb.
Robson classification: beyond caesarean rates
Authors: Patil Shruti Bhavi , D. Rajitha
Published: June 2023

Background: Caesarean rates are increasing globally. Unnecessary caesarean sections are a public health concern and are associated with both short term and long-term risks. Robson’s ten group classification is the accepted classification for caesarean section and implementing it is an effective measure in understanding which group should be focussed to reduce the caesarean section rates. The classification can be used as a framework for assessing perinatal and maternal outcome.
Methods: All the deliveries with gestational age more than 28 weeks at Gadag Institute of medical sciences, Karnataka, during April 2022 were included. Obstetric characteristics like parity, gestational age, previous caesarean sections, onset of labour, lie, presentation, mode of delivery, indications for caesarean section and foetal and maternal complications were recorded.
Results: The caesarean rate was 57.9%. Groups 5, 1 and 2 were the major contributors. Previous LSCS was the most common indication 46%. In groups 1 to 4 foetal distress was the most common indication. The overall proportion of unfavourable foetal outcome among all deliveries was 17.7% caesarean deliveries (20.1%), vaginal deliveries 14.5%. The proportion of unfavourable maternal outcome was 1.6%; 8 women delivered by CS (2.5%) and 1 woman by vaginal delivery (0.4%).
Conclusions: Caesarean section should be used appropriately and increase in caesarean section does not ensure favourable maternal or perinatal outcome.
Recurrent hydatidiform moles: detection of a new mutation in the NLRP7 gene in the family
Authors: Balci Mücahit Furkan , Kaya Özge Özer , Gezici Atakan Emre , Oral Serkan , Akpak Yaşam Kemal , Karaduman Arda Batuhan , Cetin Hamit , Gülhan İbrahim
Published: June 2023

Hydatidiform moles are the most common type of gestational trophoblastic neoplasia. Hyperproliferative vesicular trophoblasts and imperfect fetal development are abnormal pregnancies, and recurrent hydatidiform moles are rare. Mutations in NLRP7 are responsible for recurrent hydatidiform mole. Genetic heterogeneity has been demonstrated in patients with the NLRP7 mutation. This study presents our case with gravida 11, parity 0, histopathologically diagnosed with six hydatidiform moles and five missed abortion histories at age 35. Karyotype analyses of the unrelated couple were normal. A genetic examination revealed a novel mutation of the NLRP7 gene in the patient, his brother, and his parents. Detecting a new NLRP7 mutation in recurrent hydatidiform moles cases provides further evidence for the predetermined role of NLRP7 mutations in the pathophysiology of recurrent moles hydatidiform. Based on our findings, we hope to contribute to the literature by expanding the spectrum of recurrent pregnancy loss associated with NLRP7 mutations in patients.
Ectopic molar pregnancy, rare entity: new case report
Authors: Kamal El Harcha , Soukaina Auragh , Hafsa Taheri , Hanane Saadi , Ahmed Mimouni
Published: June 2023

We report in this work the case of a 24-year-old patient who was admitted to the emergency room with an acute abdomen, the investigations were in favor of a ruptured EP, the patient underwent a salpingectomy the same day due to the state of the tube, the anatomopathological study of the product was in favor of an ectopic GTD, the patient benefited from a monitoring of the levels of BCHG according to the recommended protocols, we discussed through this case the different clinical and therapeutic aspects of this rare entity.
Expectant management for a high-risk pregnancy patient who had preterm premature rupture of membranes with placenta and vasa praevia plus velamintous cord insertion
Authors: Abdalla Mena
Published: June 2023

Objective of the study was to share a case of high risk pregnancy with premature preterm rupture of membranes (PPROM), placenta and vasa praevia plus velamintous cord insertion. PPROM carries the risk of increasing rates of neonatal respiratory distress syndrome, neonatal brain prematurity, and electrolyte imbalance. Having placenta previa and vasa praevia carries a significant risk of recurrent bleeding and increases the risk of making the pregnancy threatened by the antepartum haemorrhage with the chance of losing the baby and subsequent morbidities and mortalities to the mother and the baby. The velamentous cord insertion is linked to decreased foetal growth and premature births. Herein, we present the case of 28 years old that had multiple risk factors during her pregnancy in the form of having multiple miscarriages, stillbirth, PPROM early at 20 weeks of her gestation, placenta praevia, vasa praevia and velamentous cord insertion. Moreover, despite the above risk factors, which made the pregnancy very high risk, by expectant and management plans, we could push her pregnancy to reach near maturity and deliver her baby safely without complications either to the mother or to her baby. It could be theoretically imagined that the placenta praevia worked as a sealed system or a valve and prevented more leakage of the liquor in this PPROM case. Besides that, we can consider that the cervical stitch she had at 14 weeks, had a role in narrowing the cervical canal and decreasing the diameter of the membrane that has ruptured.
Adenosarcoma of uterus in mother and mucinous carcinoma of breast in daughter: a rare case study
Authors: Reddy Samskruthi S. , Nagesh Kavya , V. Shashikala , Modugala Vandana , Girigoudar Arpita , Prasad Madhva
Published: June 2023

Adenosarcoma is an infrequent malignancy which consists of benign glandular epithelium and malignant mesenchymal component. We report a 63-year-old woman diagnosed with adenosarcoma with sarcomatous overgrowth of the uterine corpus, with history of mucinous carcinoma of the breast in her daughter. Although endometrial and breast cancers share few similar hormonal, reproductive and genetic risk factors, the association of endometrial cancer with breast carcinoma is not well established. 63 years old, P4L4, postmenopausal lady presented to our hospital with post-menopausal spotting, foul smelling vaginal discharge and pain abdomen for 1 week. After evaluation she underwent total abdominal hysterectomy with bilateral salpingo-oopherectomy. Intraoperatively, a pedunculated fundal polyp measuring 6×7 cm distending the uterine cavity was noted. Post-operative histopathology examination was reported as adenosarcoma with sarcomatoid overgrowth of the uterine cavity. Immunohistochemistry revealed CK7 (epithelium (+), Vimentin (+), cluster of differentiation 10 (CD10) (+) and, Wilms tumor 1 (-). The possible association between these two conditions, adenosarcoma of uterus in mother and mucinous carcinoma of breast in daughter is explored and presented in this case report.
Successful delivery in a case of sickle cell disease with bilateral avascular necrosis: a case report
Authors: Mukherjee Susmita , Bhalla Amit
Published: June 2023

Sickle cell disease is an inherited hemoglobinopathy. The patients with sickle cell disease had a small life years, before the advancement of medical science and development of newer drugs. These have improved the life expectancy among the sickle cell disease patients. Females are reaching reproductive age and are expectant of becoming mothers. But pregnancy in a sickle cell disease carries major fetal and maternal complications. Managing the pregnancy from conception to delivery is a difficult task and needs a team effort. Here we presented a case report of a female who got pregnant without any planning and was already on hydroxyurea. On top of that she was not willing to get her pregnancy terminated.
Incidental finding of dysgerminoma in a full-term pregnancy: a case report
Authors: Isha A. Luniya  , Patil Vaibhav , K. Nayana
Published: June 2023

Ovarian tumors are reported in 1 of every 200 pregnancies. Dysgerminoma with pregnancy is extremely rare, with a reported incidence of about 0.2-1 per 100,000 pregnancies. They are generally discovered due to their large size related complications like torsion, infarction, and obstruction of vaginal delivery. These rapidly growing tumors can have a heterogeneous presentation and lead to peripartum complications and morbidity. We present a unique case where a dysgerminoma went undiagnosed until labor in a patient who otherwise had an uncomplicated prenatal course. The purpose is to report and discuss our case, as further studies are needed to confirm the best management especially in the management of the incidentally diagnosed tumor.
A rare case of peripartum cardiomyopathy with takayasu arteritis
Authors: Bendre Kirti , Maheshkar Shweta
Published: June 2023

29 years old primigravida 38.3 weeks came with complaints of bleeding per vaginum and sudden onset breathlessness. Major finding on examination was that there was no pulse in the left hand along with raised BP, low SPO2 and B/L crepitations. Emergency management was given and patient stabilized temporarily. D/D were discussed with acute LVF due to PPCM most likely and patient was taken up for emergency LSCS. Post section 2D ECHO was performed showing decreased EF. Peripartum cardiomyopathy is an uncommon but potential life-threatening cardiac failure of unknown etiology, encountered late in pregnancy or in the postpartum period. Diagnosis of PPCM should essentially include echocardiographic substantiation of left ventricular dysfunction. TA is a vasculitis that mainly affects women of childbearing age, so it is possible to find pregnant patients with the disease. Women with Takayasu arteritis require multidisciplinary management prior to and during pregnancy. Monitoring for and reducing risk of preeclampsia, FGR and thromboembolic disease are helpful in achieving favorable outcomes.
Rupture of Couvelaire uterus-a very rare case report
Authors: Singhal Savita Rani , Suneja Archana
Published: June 2023

Couvelaire uterus is a complication seen in some severe forms of abruptio placentae. A careful watch and early identification can prevent grave maternal and fetal outcome. In literature, there are very few cases reported of rupture of Couvelaire uterus as it is a very rare entity. Our study highlights a case of 24 year old with nine months amenorrhea presented with abruption placenta and intrauterine fetal death. Diagnosis of ruptured Couvelaire uterus made and the same was repaired and managed. We were able to save the mother successfully.
Management of enterocutaneous fistulas in UMAE Hospital de Especialidades Dr. Antonio Fraga Mouret La Raza hospital of specialties
Authors: Rebollar Rossy M.
Published: June 2023

Background: Describes the management of enterocutaneous fistulas in UMAE specialty hospital "Dr Antonio Fraga Mouret La Raza".
Methods: Descriptive, observational, retrospective and cross-sectional study, records were reviewed describing the management of patients with enterocutaneous fistulas, period from 01/01/2017 to 12/31/2021, each qualitative variable described in frequency and percentages, data processed by SPSS, quantitative variables described with measures of central tendency and dispersion.
Results: The 90 patients were included, 76.7% male and 23.3% female, median age 56 years. Anatomical location with greater frequency (42.2%) in ileum; 98.8% of the fistulas were surgical etiology, 100% operated by open procedure, 51.1% of the patients did not present comorbidities prior to the condition, 37.5% received definitive conservative management and 62.2% definitive surgical treatment, 36.7% presented definitive cure and 27.8% were recurrent, 35.6% presented chronicity.
Conclusions: Male sex was most affected, 58.9% received initial conservative management and 41.1% surgical treatment, so 37.5% received definitive conservative management and 62.2% definitive surgical management, of which 36.7% were cured compared to the 35.6% who cornified; which reflects that there is no high significance between cure and chronicity of patients treated with definitive management, either conservative or surgical, it is undoubtedly concluded that the most prevalent intrahospital treatment is definitive surgical.
Is 18 F-fluorodeoxyglucose-positron emission tomography or computed tomography scan a triaging technique for axillary dissection in breast cancer?
Authors: Krishnaswamy Uma , Vasantham Sai Sampath Kumar , Kumar Yasvanth
Published: June 2023

Background: To determine if fluorodeoxyglucose-positron emission tomography/ computed tomography (FDG PET/CT) scan identifies axillary nodal disease in conjunction with ultrasound (US) guided fine needle aspiration cytology (FNAC) of suspicious axillary nodes in breast cancer. To determine if this will enable axillary node dissection upfront, avoiding sentinel lymph node biopsy (SLNB).
Methods: Study was performed in Apollo main hospital, Off Greams-lane, Greams road, Chennai IRB approval was obtained from institutional ethical committee-bio medical research-Apollo hospitals, (IEC application number: AMH-C-S-029/04-23). Informed consent was obtained from all the patients who met the exclusion criteria. The 61 patients with cT1-T3, N0-N1, and M0 disease underwent 18F-FDG-PET/CT scans after mammographic evaluation and an US guided FNAC of nodes which were seen to be suspicious in the mammogram and correlated US of the Axilla. All patients underwent axillary lymph node dissection (ALND levels 1 and 2) without a SLNB.
Results: Out of 61 patients, 40 (65.6%) had axillary node uptake on PET/CT scan. But, after ALND, only 32 patients were found to have metastatic nodes on the histopathological examination (HPE) of the operative specimen. Out of these 32 patients, results for axillary metastasis had been noted on PET/CT, US, and guided FNAC in 18 patients (56.3%). Discordant results were noted in 14 (43.8%) patients, 29 patients had no metastasis on HPE. Negative results for axillary metastasis were noted on PET/CT, US and guided FNAC in 26 patients (89.7%). The results were discordant in 3 (10.3%) patients.
Conclusions: An expanded preoperative axillary assessment does not have sufficient reliability to serve as a reliable triaging technique in axillary management. Concordant positive results may permit directly proceeding to ALND without resorting to SLNB. Concordant negative results may similarly permit avoiding axillary surgery. But discordant results warrant SLNB for assessment of axilla.
Surgical management of intrahepatic and hilar cholangiocarcinoma: liver resection versus liver transplantation
Authors: Nirhali Ria P. , Bhoir Reshma M. , Prajapati Ram P. , Chaudhary Ashish Y. , Uikey Rahul H.
Published: June 2023

The incidence of cholangiocarcinoma is increasing worldwide. Patients present with abdominal pain, whereas weight loss and malaise are symptoms of advanced disease. Jaundice occurs when there is hilar obstruction by the tumor. Surgical management involves resection of the affected hepatic segments or liver transplantation, which requires a dedicated multidisciplinary team approach, and promising outcomes are seen in high-volume centres. The authors employed a search strategy for databases like PubMed and Google Scholar. The authors then reviewed the articles using the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines and compared data concerning postoperative complications, recurrence rates, five-year survival rates and prognosis. Liver resection confers long-term survival in patients with intrahepatic cholangiocarcinoma, though the prognosis and morbidity of this procedure are still gloomy. Liver transplantation could be an option, either in early stages diagnosed in the context of chronic liver diseases or locally advanced tumors, when neoadjuvant treatments have achieved sustained tumor response without extrahepatic tumor spread.
Central giant cell granuloma in a 10-year-old girl: microsurgical reconstruction with a microvascularized fibula flap
Authors: Pulido-López Ricardo Alberto , Martínez-Martínez Humberto Gustavo , Suárez-Ortega Héctor Manuel , Tego-Ortiz Gabriel Yamil
Published: June 2023

Central giant cell granuloma (CGCG) are rare, proliferative, benign bone tumors characterized by an abundance of multinucleated giant cells. It affects children and young adults, predominantly women, in the second and third decade of life, it’s commonly found in the mandible. The main treatment for giant cell tumors is surgical excision with free histologic margins; in case of mandibular involvement, the use of a vascularized composite bone flap represents the standard for a functional reconstruction. We present the case of a female patient in the first decade of life with a CGCG of aggressive type, located in the ascending branch and right mandibular angle. En bloc resection of the lesion was performed, with a 2-cm margin and mandibular reconstruction at the same surgical time with a free microvascularized flap from the right fibula. CGCG are rare and infrequent tumors during childhood. Due to its uncertain behavior, it is important to rule out other differential diagnoses prior to definitive treatment.
Cystic artery pseudo aneurysm in a patient with xanthogranulomatous cholecystitis: a multi-disciplinary approach towards management
Authors: Sreekumar Surabhi , Raghunath K. J. , Vijayalakshmi S.
Published: June 2023

Cystic artery pseudo aneurysm is a rare clinical entity, mostly occurring as a complication of laparoscopic cholecystectomy or following calculus cholecystitis. Patient presents with acute symptoms including upper gastro intestinal bleeding symptoms, abdominal pain and jaundice, the triad of symptoms termed as Quincke's triad, when there is a ruptured cystic artery pseudoaneurysm (CAP). Unruptured cases are mostly diagnosed incidentally. Here we present a 58-year-old patient presented to the emergency department with severe abdominal pain, malena and jaundice. CECT of abdomen was done which showed CAP. The patient was immediately taken up for radiological intervention and coiling of the pseudo aneurysm, which was unsuccessful. A covered stent was placed across the pseudoaneurysm in the right hepatic artery. Patient underwent Laparoscopic cholecystectomy and had an uneventful recovery. Owing to the fact that CAPs are rare entities, a high index of suspicion is required for diagnosis of the condition and when diagnosed, the patient can be managed by radiological intervention followed by definitive surgery which can be either open or laparoscopic.
Gastroesophageal Reflux Disease: diagnostic and therapeutic approach.
Authors: Dueñas Felipe Huerta
Published: June 2023

Gastroesophageal reflux disease (GERD) is a chronic condition of the digestive system characterized by the reflux of acidic contents from the stomach into the esophagus. Surgical treatment offers a long-term alternative to medications, providing symptomatic relief and improving the quality of life in many patients. However, the potential risks and complications associated with surgery must be considered, and careful selection of patients is critical.
Hiatal hernia: diagnostic and therapeutic approach
Authors: Dueñas Felipe Huerta
Published: June 2023

Hiatal hernia is a common condition of the digestive system characterized by displacement of the stomach into the chest through the esophageal hiatus of the diaphragm. As research progresses and more scientific evidence accumulates, continued advances in the surgical approach to hiatal hernia are expected to occur. This will allow for a better understanding of the disease’s pathophysiology and the development of new surgical techniques and approaches that further improve the long-term outcomes and quality of life of patients with hiatal hernia.
Periodontally accelerated osteogenic orthodontics: A narrative review
Authors: Khamlich Kenza , El-Aouame Amal , Farid El Quars
Published: June 2023

The orthodontic patient has evolved in recent years, leaving an important place for adult patients. These patients most often require special management, they are demanding aesthetic orthodontic treatments, but also shorter. The acceleration of orthodontic movement has long been sought for its multiple potential contributions, including the reduction of treatment time, a reduction of side effects linked to the maintenance of orthodontic equipment in the oral cavity (such as bacterial plaque retention, root resorption, and the open spaces of the gingival embrasure), an improved tooth movement envelope, differential tooth movement, and improved stability after treatment. Numerous surgical techniques have been developed to speed up orthodontic movements. The aim of this study was to review the current literature regarding the periodontally accelerated osteogenic orthodontics technique.
A literature review on periodontitis and systemic diseases
Authors: Kant Krishan , Sahni Aanchal , Verma Sakshi , Chandela Priyanka , Janvi
Published: June 2023

Periodontitis is found to be one of the most common infectious disease that is inflammatory in nature occurring in the oral cavity. A normal human being oral cavity contains variety of bacterias, that have the tendency to spread to different sites of the body that too particularly in the patients those are immunocompromised and ultimately results in the various systemic diseases. Maintenance of health of oral cavity is very much required and is a necessity as it is known as oral cavity is the mirror image of the systemic health of the individual.