bluuebunny/crossref_metadata_2025 huggingface dataset:
El reto de la educación: perspectivas sociales del profesor
Authors: Pacheco-Gualdrón Jorge Eliécer
Published: August 2020

Resumen

Propósito: este ensayo reflexiona sobre las finalidades de la educación en la actualidad, el rol del profesor y del estudiante y la importancia de la articulación entre la pedagogía y la sociedad. Temas: para ello, se consideran los conceptos de educación, sociedad, pedagogía, autoridad y liderazgo que deben estar presentes en el acto educativo. Desarrollo: A partir de algunos pasajes de la novela de Miguel de Unamuno: Amor y Pedagogía y tomando como referencia las ideas de Vigotski, Franco Serrano, Bazán, entre otros, se presentan algunas ideas sobre los retos de la educación actual. Conclusiones: esta reflexión sirve para definir los roles que asumen los profesores y los estudiantes en cuanto seres inmersos en una sociedad exigente que plantea nuevos retos.
La (im)posibilidad del patrimonio: entre conflicto social y el lugar del Estado
Authors: Serrano-Via Yura , Vizuete-Sandoval Daniel Alejandro
Published: August 2020

Aproximarse a la gobernanza del patrimonio implica hacer un ejercicio de comprensión profunda de lasdimensiones que intervienen allí: la distribución del poder, las prácticas culturales, la dimensión económica,imaginarios sociales y otros. En el presente trabajo se busca responder ¿qué factores posibilitanla gobernanza democrática de sitios con declaración patrimonial? A partir de la aplicación de la revisiónbibliográfica y visitas de campo, se recolectó información que, desde de una estrategia cualitativa quecombina observación estructurada y entrevistas, permitió analizar las particularidades y experienciascomunes en dos casos de gestión del patrimonio arqueológico en Ecuador: Ingapirca y Cerro de Hojas-Jaboncillo. El procesamiento del conflicto social, las trayectorias institucionales y los procesos de apropiaciónpatrimonial son elementos que conducen los hallazgos de este trabajo. La estrategia de indagaciónimplicó el diseño de una herramienta metodológica y su aplicación en los dos sitios mencionados a30 informantes locales de diferentes grupos sociales.
Formas de Cooperación al Desarrollo y funciones del Trabajo Social
Authors: Montes del Castillo Ángel , Montes-Martínez Alberto
Published: August 2020

El presente trabajo es una revisión y análisis de las diferentes formas o modelos de la cooperacióninternacional al desarrollo y una propuesta sobre las funciones que puede ejercer el Trabajo Social encada una de ellas. Lo primero se justifica por la dispersión teórica existente. Lo segundo por la crecientepresencia de los trabajadores sociales en este nuevo entorno social. Los objetivos de este trabajo sonanalizar las diferentes formas de cooperación y describir las funciones del trabajo social en cada una deellas. El procedimiento empleado ha sido doble. Por un lado, se ha recurrido a la propia experiencia delos autores en el campo de la cooperación internacional. Y por otro a los diferentes modelos ofrecidospor las instituciones de desarrollo. Los resultados del análisis son las valoraciones que se realizan en elartículo sobre cada una de las formas de cooperación internacional al desarrollo.
Refroflexio of the pregnant uterus. - Excessively distended bladder.-Cystitis.-Vistotomy.-Recovery.
Authors: Newmarch .
Published: August 2020

M. S. 32 years old; was admitted to the hospital on July 30, 1891. Until now, she was in good health; mother of five healthy children; now she is again pregnant at 5-6 months. Two weeks ago, the abdomen began to grow rapidly, there were more frequent urges to defecate, pain in the abdomen, urine began to give a burning sensation.
Abstract of а lecture on the treatment of metrorrhagia.
Authors: Edis А.
Published: August 2020

Recalling that uterine bleeding never represents an independent disease, but always serves only as a symptom of a general or local disease, the author insists on the possibly careful diagnosis of metrorrhagia in each case, which establishes rational therapy.
Cases of purulent and lumpy peritonitis treated by abdominal dissection and drainage
Authors: Robson M.
Published: August 2020

Cases of tuberculous peritonitis, cured by a section of the abdominal cavity, are no longer particularly rare in the medical literature. But the value of the 3 cases reported by the author is increased by the fact that the condition of all three patients was traced within 2 years after the operation.
Hazards and benefits of elective induction of labor at term
Authors: Fareed Perveena , Bashir Suzaira , Lone Sameer Ahmed
Published: August 2020

Background: The objective of this study was to compare the rates of caesarean section and neonatal outcome in patients with elective induction of labor compared to patients with spontaneous onset of labor.Methods: Authors studied 200 patients with 100 in elective induction group and 100 in spontaneous onset laboring group. Two groups were compared with respect to demographic profile, basic examination, ultrasound findings, P/A, P/V findings, duration of labor, mode of delivery and neonatal outcome.Results: Various parameters like age residence, per abdominal findings were comparable in two groups. Labor was not prolonged in study group compared to control group. Rate of caesarean section remained high in induction group (21%) in comparison to spontaneous laboring group (4%). Rate of instrumental deliveries did not differ significantly between the groups. 5 min Apgar score did not vary significantly; however, the NICU admission was higher in induction group compared to spontaneous laboring group. Duration of hospital stay was longer in study group.Conclusions: Elective induction of labor has higher rates of caesarean deliveries. NICU admission was also longer in induction group.
Impact of condom balloon tamponade on the rate of obstetric hysterectomy: a ten-year study
Authors: Roy Archana , Mishra Nalini , Sai Mamta , Pal Sanjita
Published: August 2020

Background: The objective of this present study was to assess the efficacy of condom uterine balloon tamponade (C-UBT) in averting the obstetric hysterectomy (OH) in cases of major postpartum haemorrhage (PPH) over a period of 10 years.Methods: A retrospective cohort study from January 2010 to December 2019. A historical cohort was drawn from a group of women who had OH for major PPH between Jan 2010 to December 2014 (Group 1) whereas those from January 2015 to December 2019 were designated as Group 2. Total 305 C-UBT were used in the later period. Women who had OH at <28 weeks were excluded from the study. Primary outcome was to determine the efficacy of C-UBT in averting the risk of OH. Secondary objective was to determine the success rate of C-UBT after five years of useResults: Total 37463 births occurred from January 2010 to December 2014 and 38808 during January 2015 to December 2019. Cases of OH were 33 in the first five years period (Group 1) and 20 in the later (Group 2), p=<05, odds ratio=0.58 with 95% CI 0.335-1.019 favoring C-UBT.  After exclusion of rupture uterus and placenta accreta syndrome, OH for uterine atony alone were 22 (66.6%) for Group 1 and 08 (40%) for Group 2, P=0.01 odds ratio=0.350 (95% CI 0.156-0.788). No OH was done in group 2 for placenta previa. Efficacy of C-UBT was 96%.Conclusions: C-UBT is very safe, cheap and effective option for averting OH and associated physical, emotional and psychosocial morbidity.
Prevention of wound infection: a new technique
Authors: Kumar Mahendra , Pawar Preeti
Published: August 2020

Background: Caesarean delivery is a major obstetrical surgical procedure aiming to save the lives of mothers and fetuses. Caesarean sections have a 5 to 20-fold greater chance of getting an infection compared with women who give birth vaginally. These infections can be in the organs within the pelvis, around the surgical incision. Microorganisms isolated from surgical site infection (SSI) were mostly from skin and vaginal flora. The most effective SSI prevention strategies involve a multi-faceted approach including protocols exercised before, during, and after surgery to reduce exposure and susceptibility to pathogens.Methods: It was a case control study conducted in our hospital on caesarean patients. Total 240 patients were recruited for study, divided into cases (DDT group) and control (SDT group). Demographic data collected and follow till 30 days of surgery. SSIs patients identified and treated.Results: Out of total 240 patients, mean age SDT, DDT and total patients were 28.46, 28.6 and 28.3 years respectively. Maximum numbers of cases were among multigravida (gravidity) and lower and lower-middle class (socioeconomic status). SSIs patients were seen mostly in SDT group, which was statistically significant. Among SSIs patient maximum numbers of patients were seen in age group of 18-22 years, primigravida and lower socioeconomic class. After their diagnosis most of the patients were treated with resuturing.Conclusions: SSI is common complication after caesarean section; it can be prevented by increasing the hygienic condition in laboring patients. Authors newer method can be a future option for maintaining the intraoperative hygiene.
Prevalence of asymptomatic and symptomatic bacterial vaginosis in pregnant women attending antenatal clinic in a tertiary care rural hospital
Authors: Ambike Abhijit S. , Singh Yogendra , Nakhate Prasanna , Patil Suvarna , Sankholkar Charvi
Published: August 2020

Background: Bacterial vaginosis (BV) is one of the most common lower genital tract conditions, occurring in 35% of women attending sexually transmitted infection (STI) clinics, 15% to 20% of pregnant women, and 5% to 15% of women attending gynaecology clinic. It has been associated with serious pregnancy complications, including premature rupture of the membranes, preterm delivery and postpartum endometritis. The diagnosis of BV is usually based on clinical criteria including homogeneous vaginal discharge, an elevated vaginal pH, the presence of clue cells, and an amine odour. Objective of this study was to study the prevalence of asymptomatic and symptomatic BV in pregnant women attending antenatal clinic in a tertiary care rural teaching hospital.Methods: Sample size of 301 patients over 6 months study duration in an observational cross sectioned prospective type of study. An unfixed vaginal smear was collected from pregnant women and sent to microbiology for staining and fixing and diagnosis was established.Results: The age range in pregnant women enrolled was 18 to 42 with mean age 26.10 years. As per the Nugent score criteria, 68 (23%) women tested positive for BV (Nugent score 7-10) and 77 (25%) had an intermediate score (Nugent score 4-6). While in 156 (52%) pregnant women’s Nugent score was in between 0-3 indicating no BV but 10% cases amongst these were showing presence of fungal elements mainly budding yeast cells with or without hyphae. In only 53% of cases of BV characteristic clue cells were present. In this study 69% cases of BV were observed in multigravida while 31% were present in primigravida.Conclusions: Screening of asymptomatic pregnant women’s by taking vaginal swab and evaluating gram smear using Nugent score system will play vital role early diagnosis of reproductive tract infections.
A comparative study of vaginal misoprostol, dinoprostone gel, foley catheter, extra amniotic saline infusion along with vaginal misoprostol for induction of labor at term
Authors: Shetty Ektha M. , Neravi Asha
Published: August 2020

Background: Objective of this study was to study the effect of vaginal misoprostol, dinoprostone gel, foley catheter, extra amniotic saline infusion along with vaginal misoprostol for induction of labor at term on maternal and fetal outcome.Methods: A one-year prospective observational study was conducted in the department of obstetrics and gynecology, SDM College of Medical Science and Hospital, Dharwad. Totally 100 postdated primigravida women with singleton gestation, vertex presentation and intact membrane who were induced with any four methods of induction 1) Tab. misoprostol 25 µg vaginally, 2) Intracervical dinoprostone gel, 3) Foley catheter and 4) Extra amniotic saline infusion along with tab. misoprostol 25 µg vaginally with 25 patients selected in each group, by random allocation technique and included in the study. Outcome measures analysed were the demographic profile, bishop score, induction to delivery interval, mode of delivery, maternal and fetal complications. Statistical analysis was done using SPSS 17 software.Results: Mean induction delivery interval was significant between PGE1 versus foley group (p=0.0034). In this study, 60% patients in dinoprostone group had Vaginal delivery and 72% in the EASI + misoprostol group underwent cesarean section (p=0.0372). NICU admission was maximum with EASI + vaginal misoprostol group and minimum with vaginal misoprostol alone.Conclusions: The groups were comparable with respect to maternal age, bishop score and fetal weight. The vaginal misoprostol group had shortest induction delivery interval. The maximum number of patients in dinoprostone gel group underwent vaginal delivery with a highest cesarean section and NICU admission with the EASI + misoprostol group.
Burden of anemia and its associated factors among pregnant women of Vindhya region: prospective observational study
Authors: Yadav Suman , Yadav Kalpana , Shukla Padma
Published: August 2020

Background: Anemia is major public health problem. It is especially prevalent in women of reproductive age, particularly during pregnancy. It affects both developed and developing countries. According to the National Family Health Survey, anemia is prevalent in approximately 53.1% of non-pregnant and 50.1% of pregnant women. Objective of this study was to study the prevalence of anemia in pregnant women of Vindhya region and also various degree of anemia and factors associated.Methods: All pregnant women attending the outdoor and indoor of the obstetrics and gynecology department of, GMH. Rewa, taken for calculation of prevalence of anaemia and among them 510 pregnant women were selected who were satisfying inclusion and exclusion criteria for studying association factors. Study period was 1 year. Haemoglobin estimation done by sahlis haemoglobinometer.Results: Prevalence of anaemia figures 81%, Out of them, 38.05% mild, 33.26% moderate and 7.80% of women were severely anemic. Maximum number of women were housewives 71.1%. Anaemia was found more commonly among those who are either taking iron prophylaxis irregularly or not taking. High prevalence was noted among those pregnant women who had <4 antenatal visits i.e., 54.51%.Conclusions: Considering the high prevalence of anaemia in Vindhya region, extensive efforts should be made not only to correct anaemia, but to prevent anaemia. Various programmes for anaemia control should be executed more resourcefully to overcome it. Strong reinforcement of government scheme should be done at Anganwadi, CH, PHC to ensure prevention as well as early detection of anaemia.
Role of anti-mullerian hormone as a diagnostic tool for polycystic ovary syndrome
Authors: Singh Shakun , Firdaus Arshiya , Choudhary Rachna , Dhama Vandana
Published: August 2020

Background: PCOS has been recognized as the most frequent endocrinopathy among reproductive aged women. This study has been done to determine whether the measurement of serum AMH can be used to diagnose PCOS and as a tool to predict the prognosis of PCOS.Methods: This was a prospective case control study on a woman attending gynae OPD of LLRM Medical College, Meerut, from May 2018 to June 2019. Study comprised of 50 women diagnosed with PCOS using Rotterdam criteria and 50 controls. Clinical data were collected including history, oligomenorrhea, hirsutism, examination included BMI, FG score and blood investigations including serum FSH, LH, TSH, prolactin, estradiol and serum AMH level. USG was done for all women.Results: Both PCOS cases and controls were matched for age and BMI. Mean level of AMH in PCOS cases and controls was 7.1096 and 2.423 respectively, AMH was two to three times higher in women with PCOS than controls which was statistically significant (p<0.05). Most frequent phenotype of PCOS in this study was phenotype A (48%). Highest mean level of AMH was also found in phenotype A (OA+HA+PCOM), thus reflecting the severity of PCOS. Maximum diagnostic potential for PCOS was at cut off 4.22 ng/ml with sensitivity of 92.5% and specificity of 100%.Conclusions: AMH level can be used as diagnostic and prognostic modalities in PCOS. AMH value rises when hyperandrogenism is present therefore serum AMH levels also reflect the phenotype of PCOS and severity of PCOS.
Abnormal placentation at a tertiary care centre
Authors: Sharma Suman S. , Gokhale Ashish V. , Agarwal Shonali , Hindocha Jaydip , Kondhia Ashini
Published: August 2020

Background: Placentation abnormalities such as placenta previa, placenta accreta and vasa previa are associated with antepartum and postpartum haemorrhage, which makes them an important cause of serious fetal and maternal morbidity and even mortality in India. In spite of the significant improvement in obstetric care and management and modern transfusion service, antepartum and postpartum bleeding continues to be a significant cause of very high-risk pregnancy.Methods: This is a retrospective study conducted in department of obstetrics and gynecology, Sir Sayaji Hospital, Baroda, for a period of 2 years from January 2018 to December 2019. All cases of placenta previa and morbidly adherent placenta admitted during pregnancy in this period were included in the study. All case records were obtained and carefully analysed to find out the incidence, various types of placenta previa and adherent placenta, its clinical presentation and its outcome in relation to mode of delivery, birth weight, maternal and perinatal morbidity and mortality.Results: The prevalence of placenta previa was 0.87% and was more commonly present among multigravida women (80.3%). Most common type of placenta previa was type 1 in 51 cases (35.9%) cases followed by type 2 in 33 cases (23.2%). 29 cases (20.4%) were of complete placenta. Morbidly adherent placenta comprised 4.2%. Single case (0.7%) was of vasa previa. Out of 142 cases, 12 (8.4%) had atonic PPH and 8 (5.6%) cases underwent peripartum hysterectomy, (12.6%) 18 patients had hemorrhagic shock due to severe blood loss. All cases of perinatal mortality were between 28 to 30 weeks weighing between 1-1.2 kg associated with complete placenta previa in 14 cases and type 3 (incomplete) in 8 cases. There was no maternal mortality in this studyConclusions: Abnormal placentation carries a very high-risk for maternal and fetal outcome. Anticipation, prevention, early detection and appropriate management will result in favorable outcome and will boost the present scenario of management of high-risk pregnancies.
Anaemia in pregnancy: prevalence and treatment response to various modalities: a prospective study
Authors: Maiti G. D. , Gupta Shilpa , Singh Jaskanwar
Published: August 2020

Background: Anaemia seen in pregnancy are largely preventable and easily treatable if detected in time, despite this, anaemia still continues to be a common cause of maternal and perinatal morbidity and mortality in India.Methods: A prospective observational study of 200 pregnant women with anaemia was carried out from Jun 2017 to December 2018 at a Tertiary care hospital with pan India population. Patients underwent clinical examination and laboratory tests to find out the severity and type of anaemia and were treated accordingly. Iron deficiency anaemia was treated with oral or intravenous iron therapy depending upon the hemoglobin concentration. Patients were followed up after 28 days of treatment and hemoglobin estimation was done to monitor the treatment response.Results: A total 36.49% pregnant women had hemoglobin less than 10 gm%. 151 out of 200 women had serum ferritin <12 ng/ml which indicates that iron deficiency anaemia is the commonest type of anaemia in pregnancy. Overall, out of 200 patients 5.5% patients were found to have hemoglobinopathies (β thalassemia trait). After 28 days of treatment mean increase in hemoglobin was 2.40 gm% and 4.24 gm% in patients receiving oral and intravenous iron therapy respectively.Conclusions: A total 36.49% pregnant women were found to have anaemia during pregnancy and iron deficiency anaemia is the commonest type of anaemia. Therefore, there is still a need for dietary counselling and health education in the community. 5.5% patients were found to have beta thalassemia trait which was detected only after conducting hemoglobin electrophoresis. Both oral and intravenous iron therapy are effective in treatment of iron deficiency anaemia but intravenous iron therapy results in a more rapid resolution of anaemia.
Effects of twin pregnancy chorionic properties on fetal outcomes: a comparative study
Authors: A. Gigi , Alexander Rachel , K. Radhamani
Published: August 2020

Background: Twins carry significant risks to both mothers and babies. The purpose of this study was to evaluate chorionicity and its impact on perinatal outcomes in twins.Methods: This prospective observational study was conducted in the department of obstetrics and gynecology, Government T. D. Medical College, Alappuzha, Kerala. A total of 106 cases of twin pregnancies were included in the prospective descriptive study. Based on the ultrasound results and methods of the postpartum pathologic examination of the placental membranes, the cases were divided into the twin group with monochorionic diamniotic (MCDA) and twin group with dichorionic diamniotic (DCDA group). The relationships of different chorionic properties and fetal outcomes were determined by comparing various fetal outcomes.Results: Among 106 twin pregnancies, 61.3% were DCDA twins, 38.7% were MCDA. Average maternal age of monochorionic twin was 25 and that of dichorionic twin was 27. Perinatal mortality of monochorionic twin was 14.7% when compared to 8.6% for dichorionic twin. The mean gestational age for monochorionic twin pregnancy was 34.78 weeks whereas it was 35.91 weeks for dichorionic pregnancy. Elective and emergency LSCS was done more for dichorionic twin pregnancies compared to monochorionic twin pregnancies. Low Apgar scores were seen in monochorionic twins compared to dichorionic twins.Conclusions: The incidence of fetal outcomes in the monochorionic group was inferior to those in the dichorionic group. The fetal outcomes may be improved by determining the chorionic properties in early pregnancy by using ultrasound and consequently planning for pregnancy monitoring and intervention.
Comparative study of oral mifepristone and endocervical prostaglandin-E2 gel as pre-induction cervical ripening agents in parturition
Authors: Dhillon Prabhkiran , Biswas Manash , Tripathi Priyanka , Nair Vinod G.
Published: August 2020

Background: Intracervical instillation of prostaglandin E2 is a well-known and widely practiced method of pre-induction cervical ripening. Mifepristone, due to its anti-progesterone action has been found to be a potential cervical ripening agent. This study was conducted to compare the safety, efficacy and outcome of these two drugs in pre-induction cervical ripening.Methods: One hundred antenatal women were recruited for the study; 50 in mifepristone arm and 50 in PG-E2 gel arm. Any singleton term pregnancy in vertex presentation with intact membranes and bishop’s score of <4 was included in the study. Any contraindication for vaginal delivery and any contraindication for mifepristone or PG-E2 were considered as exclusion criteria. Participants in the mifepristone arm were given tablet mifepristone 200 mg orally and those in PG-E2 gel group received endocervical instillation of PGE2 gel 0.5 mg, two doses 6 hours apart (if necessary). Induction of labour was considered successful if the parturient delivered within 48 hours of administration of mifepristone or first dose of PG-E2 gel, with or without labour augmentation with oxytocin. Delivery after 48 hours and caesarean delivery were considered unsuccessful induction.Results: There was a significant improvement in bishop’s score in mifepristone group 5.0±1.55 as compared to PG-E2 gel group 3.64±2.14; p value 0.001.Conclusions: Oral administration of 200 mg mifepristone is a safe, effective and convenient alternative to intracervical instillation of prostaglandin-E2 gel for pre-induction cervical ripening.
Delivering a female with missing cervix: a case report
Authors: Kumar Mahendra , Pawar Preeti
Published: August 2020

Authors received a case in our casualty, 26 years old, G2P1L1, with full term pregnancy, spontaneous conception, previous normal vaginal delivery, with labour pain. On evaluation, she was having uterine contraction, fetal heart rate normal, vitally stable, with no cervix on per speculum and per vaginal examination, with solid globular mass per rectum. She was shifted to emergency operation theatre with provisional diagnosis of uterine rupture or rectal perforation or pelvic mass. After delivering a live baby, uterus was intact, but there was an impacted mass in pouch of Douglas, it was a twisted ovarian mass, sent for histopathology examination. Post-operative period was uneventful, and patient was discharged with healthy baby with corrected pelvic anatomy.
Robert’s uterus: a rare mullerian anomaly mystery unfolded
Authors: Devi T. Ramani , Devi C. Archana
Published: August 2020

Anomalies of female genital tract may not be detected until after menarche when they present a cyclical pain due to outlet obstruction. Mullerian anomalies represent a vast array of structural abnormalities resulting from improper development and fusion of embryological mullerian ducts. 19-year-old girl attained menarche at the age of 14, had progressive dysmenorrhoea and diagnosed as right haemotosalphinx and ovarian endometrioma which were removed in 2008. As pain progressed, she underwent laparoscopic adhesiolysis in 2013. Since, pain persisted, diagnosed as right haematometra, and drainage done by laparotomy. Left adnexa were normal. She was given depot provera till she completed schooling. She developed recurrent dysmenorrhoea after stopping depot provera. USG and MRI revealed recurrent haematometra on right side with normal left horn. The possibility of atypical septum was thought about and hystero laparoscopy was done. It showed right side haemetometra with absent right adnexa. Left adnexa normal. Hysteroscopy showed normal left horn with septum with a bulge towards the left side. Hence, proceeded with hysteroscopic septostomy and haemetometra was drained to the left horn. Later patient was free from dysmenorrhea and repeat hysteroscopy was found to be normal. This case highlighting mullerian anomalies have to be considered when young girls present with severe progressive dysmenorrhoea and diagnosis remains a challenge most of the clinicians. This rare entity has to be kept in mind while evaluating such patients. Prompt diagnosis and early surgical correction are essential to avoid future morbidity in the form of repeated unnecessary surgeries.
A rare case of unruptured live second trimester ovarian ectopic pregnancy
Authors: Choudhary Saroj , Singh Preksha T. , Bhati Indra , Deora R. K.
Published: August 2020

Ovarian ectopic pregnancy is an extreme rare entity in all the cases of ectopic pregnancies. Before, the end of first trimester, it usually ends with rupture. It is such a unique and rare presentation that only 3% of all ectopic pregnancies are reported due to an ovarian cause. In this case report, authors have presented a patient with ovarian ectopic pregnancy which was found unruptured, live at the second trimester. The patient presented with abdominal pain and after routine check-up and ultrasound abdomen, patient was taken for an emergency explorative laparotomy and the ovarian pregnancy was excised and sent for histopathological examination, the histopathological examination further confirmed the diagnosis of the same. In some researches it has been seen that ovarian pregnancies are rising, considering that, the findings of the report may help frame future diagnostic and treatment guidelines.
A rare presentation of deep infiltrating cervical endometriosis mimicking cervical cancer
Authors: Swetha P. , Nagashree U. , Kondammal R.
Published: August 2020

Though endometriosis is a common progressive benign disorder of women, endometriosis of the cervix is rarely seen. It poses a challenge both for diagnosis and management. Most of the patients with Cervical endometriosis are asymptomatic, present with abnormal vaginal bleeding, post-coital bleeding or intermenstrual bleeding. In this paper, we report a rare case of deep infiltrating cervical endometriosis involving the ureter mimicking cervical cancer, the need for awareness to include cervical endometriosis as a differential diagnosis in case of menstural irregularities and its potential to cause serious complications.
Quality of life after gender reassignment surgery in transwomen
Authors: . Nivethaa , Subbaraj Saravanakumar , Tirougnanassambandamourty Tirou A.
Published: August 2020

Background: Gender dysphoria is a condition in which there is discrepancy between a person's gender identity and that person's sex assigned at birth. Gender reassignment surgery (GRS) has an important role in alleviating the distress caused by gender dysphoria and it is medically necessary. The literature on quality of life (QoL) of transgenders post-GRS is limited in India.Methods: This is a prospective study on transgender women who volunteered to undergo male to female (MtF) GRS from March 2015 to August 2017. The demographic details and the surgical complications were registered. The Quality of life using the WHOQOL-BREF questionnaire was measured both before and a year after the surgery. The data were compared and presented.Results: A total of 62 GRS were performed during the study period. In that, 43 patients are literate (69.35%) and only 31.93% are employed in a socially respectable position. Our study shows significant improvement in physical, psychological and social health domains after the Surgery. Highest improvement was observed in the psychological health domain. There were no major complications observed in our study group.Conclusions: The surgical management improved the QOL in the first three domains of WHOQOL-BREF instrument namely physical health, psychological health and social relationship. Among these three domains, there is a significant improvement in psychological health. Hence, GRS has an important role in relieving the psychological distress caused by gender dysphoria and significantly improves the quality of life postoperatively.
Response evaluation of locally advanced carcinoma ovary to neoadjuvant chemotherapy at a tertiary care centre
Authors: Shanmugasundaram Sundaram , Shunmugam Deepa , Gandhi Anitha , Velappan Arumugam
Published: August 2020

Background: Clear cell and mucinous types of epithelial ovarian cancers are relatively chemo resistant and have a poorer prognosis compared to other histologies. Aim of the study was to study the biochemical and histopathological response and surgical outcome of various histologies to standard platin based chemotherapy.Methods: All 42 cases of locally advanced carcinoma ovary who received several cycles of neoadjuvant chemotherapy (NACT) followed by, interval cytoreductive surgery (ICS) were included in this study. Serum CA125 levels before and after neoadjuvant chemotherapy, the ability to achieve optimal cytoreduction and the presence of residual tumour in the surgical specimen were the parameters measured. Continuous variables were compared by one-way ANOVA. Categorical variables were compared by the Pearson chi-square test. Significance was defined by p values less than 0.05. Survival analysis was done using Kaplan-Meier estimation.Results: There was a 95,84% reduction in serum CA125 levels for papillary serous carcinoma compared to clear cell and mucinous varieties, which had 81.2% and 78.5% reduction, respectively. More number of papillary serous tumours were able to achieve optimal cytoreduction (72%) compared to mucinous variety (25%). Residual tumour was present in 68% of serous papillary tumours compared to 87.5% in mucinous and 80% in clear cell histology.Conclusions: Our study concludes that mucinous and clear cell types of EOC are relatively chemo resistant compared to the serous subtype. We recommend more aggressive surgery especially for mucinous tumours. In the case of ovarian cancer, we observed that the mucinous and clear cell types of EOC are relatively chemoresistant compared to the serous subtype. From the results, we recommend the more aggressive strategy of surgery as a preliminary choice of treatment especially for mucinous tumours rather than chemotherapy in patients with EOC.
Study of the incidence of hypocalcemia in patients undergoing bilateral thyroid surgery
Authors: Dhiman Baleshwar , Dalal Satish , Dalal Nityasha , Raman Sethu
Published: August 2020

Background: Thyroid surgery are among the most common operations performed all over the world. Hypocalcemia following total thyroidectomy is a fairly common complication. Occurrence of acute hypocalcemia can be predicted in patients undergoing thyroid surgery, based on serial calcium measurement and this helps in early prediction of hypocalcemia. The aim of present study was to assess the incidence of post thyroidectomy hypocalcemia and factors which might play a role in its occurrence.Methods: A total 30 patients who underwent bilateral thyroidectomy were analysed. The study period was from June 2017 to March 2019. The incidence of hypocalcemia was analysed with serial calcium estimation in immediate post-operative period, 4 hours and 24 hours after surgery and on 5th post-operative day. The factors analysed included pre-operative and post-operative serum calcium levels, clinical features, the disease type and factors related to surgery. The ethical approval was taken from the ethical committee of the institute. At the end of the study data was collected and analysed by using student t-test and chi square test. A p-value of less than 0.05 was considered significant.Results: Post-operative transient hypocalcemia developed in 21 patients out of 30 (70%). Of them six patients (28.75%) developed severe hypocalcemia and 15 (71.42%) developed mild to moderate hypocalcemia. Out of six patients, five patients were histopathologically diagnosed as malignant thyroid disease. 15 patients who developed mild to moderate hypocalcemia were diagnosed to be having benign thyroid conditions.Conclusions: Patients underwent thyroid surgery for malignant conditions showed higher incidence and severity hypocalcemia as compared to cases where surgery was performed for benign thyroid disease. This complication can be prevented with meticulous perioperative dissection, prompt identification of parathyroid glands and frequent postoperative monitoring of serum calcium levels.
A prospective study of factors affecting seroma formation after modified radical mastectomy in patients of carcinoma of breast
Authors: Chaudhary Anuradha , Gautam Sonveer
Published: August 2020

Background: Seroma, a clinically evident subcutaneous collection of serous fluid after breast cancer surgery, developing in approximately 30% of cases. To prevent seroma formation, it is important to estimate individual risk of seroma formation, i.e., the identification of predictive variables will be helpful in designing future trials aimed at reducing the incidence of this seroma. This study intends to find out the association between certain pre-operative, intra-operative, and post-operative factors related to MRM and incidence of seroma formation.Methods: It was an observational prospective on 100 females undergoing MRM at Department of Gandhi Medical College Bhopal, Madhya Pradesh, India. Patients were observed postoperatively for seroma formation and factors affecting it.Results: patients with seroma formation in this study tended to be older age (age, 62.60±10.40 years versus 56.13±10.31 years; p<0.001) and more obese (BMI, 26.95±4.2 versus 24.61±3.61; p<0.001). Higher amount of initial drain volume was directly related to seroma formation.  Initiation of arm physiotherapy after surgery (3.14±0.23 days versus 2.17±0.74 days; p=0.043).Conclusions: The incidence of seroma is higher in older and in more obese patients. The incidence is decreased by flap fixation under muscles and early physiotherapy. Furthermore, few interventions in the operative period can help minimize the chances of seroma formation.
Study on 60 cases of common bile duct stone, there different modality of management and its inference
Authors: Ahirwar Sovat Lal
Published: August 2020

Background: The aim of the study was to determine the best treatment modality for common bile duct stone become more challenging as large number of options available such as endoscopic, laparoscopic or open surgical methods, we need to choose specific therapy according to patient’s clinical conditions, and individual expertise.Methods: It is prospective study including 60 patient having common bile duct stone along with gall bladder stone, its different modality of management and its inference, conducted in Bhopal Memorial Hospital and Research Centre, Bhopal, during period of January 2017 to January 2020.Results: In 60 cases 41 patients undergoes to endoscopic retrograde cholangio pancreatography (ERCP) first, stone successfully removed in 34 patients and stent placed, one patients developed pancreatitis after ERCP, managed conservatively, In 6 patients retained stone after ERCP procedure, one patients developed surgical emphysema after procedure, managed with ICD and conservatively, and one patient had bleeding during sphincterotomy so its procedure abandoned and one of the patient failed to cannulate common bile duct (CBD).  21 patients undergo laparoscopic common bile duct explorations, 2 lap CBD exploration converted to open CBD exploration with cholecystectomy, due to adhesion at hepatocystic triangle. Five patients undergoes open CBD exploration, in one patient hepaticojejunostomy was done as patient was having CBD stone with stricture. No mortality during and after procedure.Conclusions: Management of CBD stone is depends upon individual expertise and available modality. If surgeons are expertise then lap CBD exploration with cholecystectomy without attempting to ERCP guide stone removal is best approach in majority of patients.
Palliative surgery in gastrointestinal malignancy: experience from a regional cancer centre
Authors: Das Prafulla Kumar , Pandey Kalyan , Deavi Padmalaya , Mohanty Swodeep , Goutam Kunal , Samantara Subrat , Satpathy Bharat Bhushan , Patil Nilesh B. , Lekha Subhranshu
Published: August 2020

Background: With so much burden of advanced incurable disease, the role of palliative surgery is paramount for gastrointestinal malignancies improving quality of life. Aim of the study was to study the indications, risks and outcome of palliative surgeries in gastrointestinal malignancies, the burden of disease requiring palliative surgery, and to describe strategies to improve end of life care.Methods: All the patients diagnosed with gastrointestinal malignancy and who underwent palliative surgery between January 2017 and December 2017 were analysed.Results: A total of 186 cases underwent palliative surgery. The most common age group affected was between 50-60 years and the mean age was 54.55 years. Stomach was the most common primary consisting of 58.60% followed by colorectal (23.66%), small intestine (9.68%), hepato-pacreatico-billiary (4.30%), and oesophageal (3.76%) primary. Major complications were seen in 4.84% of cases. Average symptomatic relief was observed for 5.5 months in cases of stomach and 7 months in case of colorectal malignancies. 35.48% cases were alive at the end of one year.Conclusions: Present study concludes that palliative surgery improves quality of life of the patient, provides them with time to accept death and live rest of the life in a dignified manner.
A single-centre observational study of 124 surgically managed glioma patients: molecular subtyping and its correlation with clinico-radiological profile
Authors: Singh Ashutosh , Singh Suyash , Agrawal Sarita , Verma Jyoti , Singh Shalini , Misra Prabhakar , Jaiswal Awadhesh Kumar , Behari Sanjay , Jaiswal Sushila
Published: August 2020

Background: The World Health Organization (WHO) 2016 classification incorporated molecular subtyping in glioma, highlighting the diagnostic and prognostic significance. The study aims to determine the isocitrate dehydrogenase (IDH-1) gene, α-thalassemia/mental retardation syndrome X-linked (ATRX) gene, and tumor suppressor gene-53 (p53) mutation in glioma and their correlation with various clinical and radiological parameters.Methods: In this prospective observational study, histopathological slides of glioma (2017-2018), were analyzed for IDH-1, ATRX and p53 mutations and their correlation with various clinical and radiological parameters.Results: IDH-1 mutation was found in 48 (38.7%), ATRX loss in 38 (30.6%) and p53 mutation in 40 (32.5%) patients. The expression of IDH-1 was significantly higher (43.7%) in adults; however, no significant difference was seen with gender. Also 51.2% of patients, who presented with seizures, showed IDH-1 expression; and 27.7% of patients, who had neurological deficit also showed IDH-1 expression. IDH-1 expression was high in glioma located at insula (73.3%) and parietal lobe (71.4%); while ATRX loss was seen in glioma located at insula (80%). Intraventricular glioma characteristically lacks all three markers: IDH-1 expression, p53 overexpression and ATRX loss. IDH-1 expression and p53 overexpression was seen mainly in diffuse fibrillary astrocytoma, oligodendroglioma, anaplastic astrocytoma and glioblastoma.Conclusions: Molecular subtyping is of paramount importance in glioma management. IDH-1 mutation is commonly observed in adults and patients presenting with seizures. The duration of symptoms correlates with IDH-1 and ATRX mutations. Intraventricular tumors lack all three mutations.
Stuttering priapism post C-spine schwannoma excision: case report
Authors: Agwu Ngwobia Peter , Lasseini Ali
Published: August 2020

Priapism is prolonged penile erection that persists beyond or is unrelated to sexual stimulation and this is associated with significant psychological, socioeconomic and physical morbidity. It is a urologic emergency as delayed intervention may result in penile fibrosis and consequent erectile dysfunction. The aim of this paper is to present our experience in the management of the rare occurrence of stuttering priapism in a 32 years old man following surgical excision of cervical schwannoma during the early postoperative period and review relevant literature on management of this urologic entity. Stuttering priapism may complicate cervical spine tumor excision but may demonstrate complete patient recovery.
Abdominal perineal resection surgery: case report
Authors: Saimeh Haitham A.
Published: August 2020

Colorectal cancer in known to be the most diagnosed cancer in the world, the set gold standard for the treatment of colorectal cancer is excision of the tumor via surgery. There is different type of surgeries that tend to be performed depending on the location, size and extent of the mass in order to avoid recurrence. The main aim of this paper is to discuss the abdominal perineal resection surgery together with the complications faced and criteria in managing these complications intraoperatively.
Large anterior abdominal wall fibrosarcoma in a known case of recurrent dermatofibrosarcoma protuberans
Authors: Kamini Snigdha , Jain Sunil Kumar , Bajwa Jaspreet , Ahamad M. Nafees , Prasad Sumit Kumar , Sharma Shivam , Srinivas Pradeep Mekha
Published: August 2020

Dermatofibrosarcoma protuberans is a rare soft tissue sarcoma of low to intermediate malignant potential. Incidence is estimated to be 0.8 to 4.5 cases per million persons per year. The tumor is highly aggressive locally and is known to recur. Punch biopsy or excisional biopsy (in case of small tumors) are diagnostic. Computer tomography (CT) and magnetic resonance imaging (MRI) are useful in determining the size and extent of the tumor’s treatment is primarily surgical, with a wide local excision with at 2 cm margin. However, local recurrence after apparently adequate surgical excision is common. Mohs micrographic surgery has been recommended as it enables maximum preservation of tissue. When surgery is insufficient, imatinib mesylate is shown as a safe and effective treatment in dermatofibrosarcoma protuberans (DFSP), especially in cases of locally advanced or metastatic disease. Here, we report a case of a giant fibrosarcoma on the anterior abdominal wall, measuring 27×18×9 cm, which occurred in a recurrent dermatofibrosarcoma protuberans. Diagnosis was done by histopathological examination (HPE) of the previously excised tumor and CT was done. The tumor was excised with a 3 cm margin and extensive reconstruction of the anterior abdominal wall defect was done using synthetic mesh, myocutaneous flaps and split skin grafting. Keeping in view the recurrent nature of our case, large tumor size, DFSP-fibrosarcomatous (FS) transformation and close negative margins in the HPE of the postoperative specimen, the patient was planned for adjuvant radiotherapy.
Urachal cyst in adulthood: case report with detailed laparoscopic management and review of literature
Authors: Jadaon Abhiyutthan Singh
Published: August 2020

An urachal cyst anomaly occurs in approximately 1/5,000 births. Its treatment is surgical excision. We present a case report of 16-year-old female with presenting complaints of lower abdominal pain with burning micturition and increased urinary frequency. Computed tomography revealed a 40×38 mm low-density cyst image located in midline cranial to the bladder apex, suggesting the diagnosis of urachal cyst. Traditional open surgery was used for its excision, but now minimally invasive approaches have been used more frequently to minimize the morbidity. We did a trans-abdominal preperitoneal approach, which aided in both the purpose of diagnostic laparoscopy and also utilize the advantage of preperitoneal surgery.
A population-based study of teenage marriage in Upper Egypt
Authors: Saleh Lamiaa , Ashry Hamada , Al-Fakharany Reham S. , Abbas Ahmed M. , Elbahrawe Rasha S.
Published: August 2020

Background: Early marriage of teenage girls before the age of 18 is a serious problem concerning public health that perils the girls' childhood in developing countries. The current study aims to highlight the socioeconomic background and the adverse drawbacks of teenage marriage in Upper Egypt.Methods: A population-based, cross-sectional study was conducted on 962 married females who were selected randomly by using a multistage random sampling technique. The participants were attending four urban and four rural primary health care facilities in Beni-Suef governorate, Upper Egypt in the period between May 2018 and October 2018. An interviewing questionnaire was designed to detect the suspected socio-demographic factors associated with teenage marriage.Results: The mean age of marriage of the studied participants was 18.7±3.5 years. The study revealed that 50.8% of the studied population was 18 years or less at marriage versus 49.2% married at age more than 18. Also there is a significant difference between the age of marriage and the educational level of both husbands and wives (p<0.001). The rate of accidental hemorrhage (3% versus 1.4%), placenta previa (2.2 versus 0.6%), eclampsia (1.8% versus 0.4%), and intrauterine growth restriction (3% versus 0.6%) were significantly higher in those married before 18 years (p=0.028, 0.036, 0.038, 0.005, respectively).Conclusions: This study demonstrated a significant relationship between the marital age and the implicated socio-demographic determinants. Adverse sexual relationship and pregnancy outcomes were significantly related to the age of marriage.