bluuebunny/crossref_metadata_2025 huggingface dataset:
Topography and scale in a community-driven maternal and child health program in Eastern Indonesia
Authors: Grayman Jesse Hession
Published: July 2017

In 2007, the Indonesian government introduced Generasi, a community-driven development program to address village priorities such as reducing poverty, maternal mortality, and child mortality. When describing Generasi’s biggest challenges, program facilitators on the eastern Indonesian island of Flores used a geographic vocabulary of fields (medan, lapangan) and topography (topografi) that evokes the demands of supervising Generasi’s implementation across dozens of mountain villages with poor infrastructure. But their geographic language also extends metaphorically to the enduring problems of scale and governance. I analyze these discourses of topography and field in relation to the changing therapeutic landscape of maternal and child health services in the Manggarai highlands of western Flores, then follow Generasi’s scalar scaffolding from the meetings and clinics in villages, to the technocratic policy work in Jakarta, and to the academic spaces of Auckland and Cambridge.
HIV prevention, precarity, and fragmented landscapes of service provision in Ukraine
Authors: Phillips Sarah D. , Owczarzak Jill
Published: July 2017

n/a
‘When language skews narratives’
Authors: Premkumar Ashish , Raad Kareem
Published: July 2017

The ISIS-led attacks on Paris, Beirut, and Baghdad in November 2015 were covered in a variety of ways by major news outlets globally. Coverage of the Paris attack was widespread, and layered with personal stories about those personally affected and analysis about the effects of terrorism on the French way of life. By comparison, little coverage was given to either the Beirut or Baghdad events, the experiences of those suffering on the ground, or the wider issue of the effects of terrorism within Lebanese and Iraqi communities. In this think piece, the bombings in Beirut are used as a lens for examining the politics and consequences of mediated silence or ‘forgetting’ of violence and suffering in the Middle East. We employ a critical humanitarianism, rooted in a social medicine analysis, to connect these media trends to the training of health professionals. Our approach helps build accountability for the inequalities present in the Western construction of suffering and the emotive aspects of global violence, and promotes a wider conversation about the long-term biomedical effects of violence.
addicted.pregnant.poor
Authors: Sherman Melina
Published: July 2017

n/a
Navigating multipositionality in ‘insider’ ethnography
Authors: Vernooij Eva
Published: July 2017

In this article, I reflect on my experience of conducting ‘insider’ ethnography in a multidisciplinary collaborative project that evaluates HIV treatment as prevention in Swaziland. Having worked as the project’s social science coordinator for over five years, I discuss balancing my role as an insider on the study team with studying the project as the object of my doctoral research. Drawing on field notes taken during the design and implementation of the project, I discuss how my proximity to the study team created certain expectations in my interactions with team members and clinic staff. In some instances, I distanced myself from the study by not participating or not supporting a consensus option; my doing so engendered a sense that I was being disloyal and sometimes created frustration among my colleagues. The multipositionality that I navigated was a product of social interactions and therefore inherently relational and intersubjective. This article aims to stimulate self-reflective and methodological discussions of how anthropologists engage in global health research and what kind of knowledge and subject positions such collaborations produce.
El gobierno biopolítico de la sociedad. Identidades victimizadas y movilizaciones punitivas
Authors: Valencia Mesa David Enrique
Published: July 2017

A partir del análisis de una forma de movilización punitiva, el artículo rastrea las consecuencias del surgimiento de una nueva subjetividad social: la identidad victimizada. Se trata de una forma de subjetividad que desempodera a los individuos y grupos sociales de su potencia política fijándolos en una subjetividad deficitaria y retributiva, a partir de la cual se articulan estrategias de gobierno biopolítico sobre la sociedad en su conjunto.
Linear Optical properties of Pheomelanine pigment extraction from red wool
Authors: Obeid Mohammed , Hussain Waleed , Radhi Wisam , Jabir Abduljabar , Abd-Alammam Dhiaa
Published: July 2017

The aims of this research are the extract of Pheomelanine pigment from red wool and prepared of it as a thin film by repeat-spray method. We study the optical properties of the Pheomelanine thin film such as the absorbance (A), Transmittance (T), absorption coefficient (α), refractive index (n) and extinction coefficient (k). We calculate the energy gap ( Eg), Urbach tail (Eu), oscillator energy (Eᵒ), dispersion energy (Ed), static refractive index (nᵒ), static dielectric constant (εᵒ) and spectra moments ( M-1 and M-3).
Evaluation of the Important Properties of Liquid Crystal Elastomers (LCEs)
Authors: Majeed Dlzar
Published: July 2017

Liquid Crystal Elastomers (LCEs) have been the object of growing interest in recent years due to the combination of mesogenic ordering and rubber elasticity which allows them to respond to thermal stimuli by changing their shape, size and optical properties. The use of LCEs thus makes it possible to convert small quantities of external energy to mechanical energy which makes it easy to be used as energy harvesting. This paper will firstly focus on thermal and mechanical properties of LCEs it will be seen that they will be affected by elasticity of the polymer backbone and the nature of mesogenic monomer. Following this, the focus will turn to the electric field, light, and thermal energy that can be converted into mechanical energy induces thermomechanical, electromechanical and electrooptical effects by such materials. It will be observed that the shape of LCE materials can be changed through changing orientation of LC. Additionally, swollen samples can minimize threshold field by a factor of 200 compared with unswollen samples. Then, the emphasis will go to the impact of mixing nanoparticles with the LCE samples on its behaviour. This is done by increasing crosslinking agent content of the sample and then its impact is shown by the strain-stress curve which leads to reduction in the degree of nematic phase and increase in Young’s modules. The paper then gives a future direction to expand the work for instance its application in photovoltaic systems to convert solar energy into electricity.
An AHP-Evaluation Models for Ranking Construction Tenders Using Simulation: A Case Study in Kurdistan Region of Iraq
Authors: Fatah Khwazbeen , Ahmed Swar
Published: July 2017

In ranking decision alternatives, Analytic Hierarchy Process is regarded as one of themost successful techniques to deal with multiple criteria decision making problems.Recognizing that tender evaluation is a typical multi-criteria decision making problem,this paper introduces an evaluation approach based on AHP methodology for rankingvarious alternative options, each represents a construction project the tender, and thenselecting the best one. The proposed model can guide decision makers in constructionindustry identify contractors with the best potential to deliver satisfactory outcomes in afinal process of tender selection in Kurdistan Region of Iraq. Moreover, in order toreduce the inherent uncertainty within the AHP, which may significantly affect thedecision process, a new methodology is proposed by using simulation. This model istested by a hypothetical scenario where six tenders are evaluated and then, the bestcandidate is selected. Furthermore, the criteria used for the tender selection in the modeland the significance of each criterion had been arrived at by conducting the first surveystudy for public and private organizations in Kurdistan Region of Iraq.
On Limit Cycles of Planar Dynamical System Via Dulac- Cherkas Function
Authors: Amen Azad
Published: July 2017

The main aim of this paper is to construct Bendixson-Dulac and Dulac-Cherkas functionsto study the maximum number of limit cycles for several families of planar dynamicalsystem. We also apply the results to Lienard and biochemistry reaction systems.
Contra ( i,j ) -Sc- Continuous Function
Authors: Aziz Hardi
Published: July 2017

In this paper, a new type of continuity in Bitopological spaces has been introduced,namely Contra ( ) continuity. Also, the relationship between this type ofcontinuity and several other known type of continuity has been dealt with.
Measurement of ²²² Rn Concentrations in the Air of Qaysery Naqeeb Bazaar Located in Sulaimani Governorate of Kurdistan Region-Iraq
Authors: Abdullah Kamal , Ahmed Ali , Ahmed Salahaddin
Published: July 2017

In this study the level of 222Rn concentration at 35 positions in air of the big ancientfamous bazaar (Qaysery Naqeeb) which contains 110 shops and located in the center ofSulaimani city have been assessed. During the winter and summer seasons of 2014, 222Rnconcentrations have been measured by using (CR-39) solid state nuclear detector. Inwinter, the maximum and minimum values of 222Rn concentration were(206.901±10.958) Bq/mᵌ and (44.978±5.109) Bq/mᵌ respectively, with an average valueof (132.849± 8.780)Bq/mᵌ; while in summer the maximum and minimum values of 222Rnconcentrations were (255.476± 25.809) Bq/mᵌ and (99.852± 6.306) Bq/mᵌ ,respectively,with an average value of (158.215± 12.578)Bq/mᵌ, this difference reveals the role ofhigher temperature and humidity rates in the variation of radon concentrations were highradon concentrations corresponds to high temperature and low humidity rates. In severalpositions the obtained values were nearly within the acceptable range of radon levelrecommended by the International Commission on Radiological Protection and the limitrecommended by World Health Organization (WHO), but in the most other positionsthese limits were exceeded due to the structures of material building and lack ofventilation. The effect of temperature on radon concentration was also observed.
The Influence of Mulching and GA3+Iron Mixture on Head Folding,Bitterness and Quality of Produced Seeds of Lettuce Lactuca sativa var. Longifolia cv. Marul.
Authors: Mahmood Chinur , Abdel Caser
Published: July 2017

This study was carried out during the period between November, 2013 and August, 2014

to decrease unfolding, bitterness and tip burns through adopting a new screening method

and to produce lettuce seeds and head yields of high qualities. Seeds and plants raised

from them were treated with mixtures of [0 and 10 mg.l-1 GA3 + 25 mg.l-1 Fe, 10 mg.l-1

GA3 + 50 mg.l-1 Fe and 10 mg.l-1 GA3+ 75mg.l-1 Fe]. Plants grown on mulched and

unmulched soils. Mulched soil plants displayed superiority over bare soil in terms:

number of unfolded leaves, stem length and leaves number by 48.75, 110.85 and

22.23%, respectively. However, unmulched soil bypassed mulched soil in T.S.S. and dry

matter percentages of folded leaves, unfolded leaves, stem and folded leaf base (23.96,

19.41, 30.59, 22.17, 18.52, 28.6, 18.54 and 27.24%, respectively). Lettuce grown on

mulched soil revealed superiority over that grown on bare soil in N content of folded and

unfolded leaves (23.1 and 68.75%, respectively), K content of folded leaves, stem and

folded leaf base (57.85, 42.02 and 24.43%, respectively), Fe content of stem and folded

leaf base (106.11 and 54.02 g.kg-1, respectively), Ca content of folded leaves, unfolded

leaves, stem and folded leaf base (424.09, 235.96, 206.02 and 296.78%, respectively). 10

mg.l-1 GA3 + 75 mg.l-1 Fe displayed preponderance over untreated plants in head fresh

weight (26.43%), head yield (26.16%), TSS (15.52%), branches number after chopping

(92.9%), branch heights (66.98%) leaf number (30.82%), B content of folded leaves and

stem (143.23 and 57.89%, respectively), N content of the folded leaf base (49.73%), K

content of folded leaves (7.15%), Fe content of stem (152.14%) and Cu content of stem

(39.54%). Lettuce plant treated by 10 mg.l-1 GA3 + 50 mg.l-1 Fe grown on mulched soil

overwhelmed other dual interaction treatments as it showed the highest values in head

fresh weight (821 g), head yield.m-2 (4.93 kg), weight of folded leaves (483.75 g),

number of unfolded leaves (23.75) and weight of unfolded leaves (335 g).
Genetic Evaluation and Factors Affecting Post Weaning Growth Performance and Body Dimensions of Awassi Lambs.
Authors: Al-Barzinji Yousif , Gardi Haval
Published: July 2017

Present study was done to determent the genetic evaluations and effects of some nongenetic
factors on post weaning performance and body dimensions of Awassi lambs inIraqi Kurdistan Region. A total of 86 lambs were used in this study post weaning weight,gains and body dimensions until marketing age (6 month) were estimated on each lamb.Data was subjected to analysis of variance to determine the effects of sex, horn, andinteraction between them on the growth and body dimensions of lambs. Sex, horn andsex X horn significantly affected body weights and dimensions at all ages. Male andhorned lambs gave significantly higher weight and daily gain at different ages, as well asthe horned male and female gave higher weight and daily gain. Significant positivecorrelations were found among body weight at different age, and all correlation amongweights with body dimensions at different ages were significant positive correlationexcept the correlation among HG with body weight and dimensions at four month age.The stepwise regression model were used to predict the body weight at 4 months of ageobtained for three out of eight dimensions with 61% R², but the best model to predict thebody weight at 5 months of age obtained for five dimensions with 87% R² and best onefor marketing age obtained from six dimensions with 88% R².The effects of non-genetic factors necessary to be corrected before make the geneticevaluations among animals, for it mixed model procedure ( Such as BLUP) are to beused and BLUP values for lambs ranged from -11.902 to 10.697 kg for marketingweight. These results indicated that there are high genetic variations among lambs forthis trait and it means that selection can play a big role in improving growth performancein Awassi lambs.
Floquet Theory for Stability of Differential Algebraic Equations.
Authors: Yasir Kamal , Kadem Hassan
Published: July 2017

Motivated by a great useful of some types of non autonomous differential algebraic

equation systems ( so called strangeness free ) and its applied in different scientific

fields, we present several new results for studying such systems by classical Floquet

Theory, which we extended from linear periodic ordinary differential equation systems

into linear periodic differential algebraic equation systems. For both systems we

investigate that they have the same Floquet exponents. The relation between monodromy

matrices of both systems is also presented. Classification of solution according to the

nature of Floquet exponent is established. Then according to these results, we study the

stability and bifurcation phenomenon of our differential algebraic equation systems.
Numerical Solution of Fractional Differential Equations by using Fractional Spline Functions.
Authors: HamaSalh Faraidun , Muhammad Pshtiwan
Published: July 2017

In this paper, we consider a new suitable lacunary fractional interpolation with the idea

of the spline function of polynomial form, and the method applied to solve linear

fractional differential equations. The results obtained are in good agreement with the

exact analytical solutions and the numerical results presented by two examples, results

also show that the technique introduced here is robust and easy to apply.
Rehabilitation of Reinforced Concrete Corner Beam-Column Joints Subjected to Damage.
Authors: Aziz Zana , Abdulkadir Mohamed
Published: July 2017

Important structural properties related to strength and deformations of corner beam- column joints damaged and strengthened were studied in this investigation. For this   purpose a total of 18 corner beam-column joints divided into five groups were cast and tested. The cross sections were 150mm X 200mm and 150mm X 250mm for the beam and column, respectively. The legs of each beam and column were 900mm. Group1 specimens were consisted of two control specimens tested to failure. Other groups specimens each consisted of four specimens, two of which were tested up to first crack loading and the other two were tested up to 80% of the expected ultimate load. After preloading, the damaged specimens were strengthened in such a way that Group2 were strengthened with strip of CFRP, Group3 with steel plate strip, Group4 with ferrocement, and Group5 with full CFRP sheets. After strengthening process, the strengthened specimens were retested to failure. The test results indicated that the process of the rehabilitations is successful. After strengthening, the ultimate load was increased by 38.3, 4.25, 6.3, and 42.5 % for Group2, 3, 4, and 5, respectively. The stiffness of the strengthened specimens increased compared to the control specimens. The better strengthening technique was those specimens strengthened with full CFRP sheets. The   effect of cracking due to preloading on the flexural behavior of strengthened beam- column joint was found to be insignificant.
Classification Performance Enhancement for Students Realisation Model
Authors: Rashid Tarik
Published: July 2017

This research work aims at enhancing a classification task for student’s realisation model

at Salahadin University, Hawler, Kurdistan. 1000 records of data from different colleges

and departments at Salahadin University are collected to conduct this research work. The

collected data has been pre-processed, cleaned, filtered, normalized, then after, feature

selection techniques are applied to reduce the dimensionally of the data, finally a

classification task is carried out to find the realization of students. The results show that a

model of Support Vector Machine +Genetic Algorithm + Artificial Neural Network

produces promising results than other models.
Soil Pollution Assessment from Industrial Area of Erbil City
Authors: Khudhur Shelan , Khudhur Nashmeel
Published: July 2017

Present study assessed soil pollution by heavy metals and spent oil in three industrial

areas of Erbil City. Soil pH ranged from 7.53±0.017 to 8.25±0.012 and EC was ranged

between 103±0.882 and 465±9.955. Soils textures were loamy sand for south industry,

sandy for oil selling area and north industry while loamy for control soil. The ranges of

Pb, Zn and Ni were between 1.26±0.069 and 17.472±0.058; 1.439±0.006 and

3.078±0.003, and 0.399±0.061 and 0.982±0.048 ppm, respectively. The concentrations

of Cd and Cr were below the detection limit and Cu levels varied from 10.307±0.334

to 0.063±0.003 ppm, whereas Cu was not detected in some sites. The highest oil

residue was obtained in site 6. Oil and grease content for the groundwater samples in

the studied sites were zero. Pearson’s correlation showed a significant positive

correlation between Ni and moisture content and Ni and bulk density, beside to a

moderate correlation between Pb and Zn. A high significant negative correlation was

detected between bulk density and oil content. The lateral distribution of the heavy

metals and oil residues showed higher average concentrations at the point of impact

than 20 meters away. Relative Pollution Potential gave positive values for the metals

and oil contents in all sites.
Solving Two-dimensional Linear Volterra-Fredholm Integral Equations of the Second Kind by Using Series Solution Methods
Authors: Saeed Rostam , Berdawood Karzan
Published: July 2017

In this paper, we focus on obtaining an approximate solution of the two types of two-

dimensional linear Volterra-Fredhom integral equations of the second kind. Series

 

solution method is reformulated and applied with different bases functions for finding

an approximate solution (sometimes the exact solution) for the above two types of

integral equations. This is done by computer program with the aid of the Maple code

program version 13 for all the above prescribed methods. Furthermore, we proved

some theoretical results on the convergence analysis of the presented methods.
Iteration Method for Evaluation of the Price of a Government Contract for Designing Defense Aviation Equipment
Authors: PANAGUSHIN V. P. , IVANISOV V. YU. , LAPENKOV V. I. , CHAIKA N. K.
Published: July 2017

An approach to finding reasonable prices developmental works on creation of aviation equipment for defense purposes is based on the method of successive approximations.

The content of this method, its advantages and the reasons limiting its use is disclosed. Practical steps for its implementation in enterprises-performers of ROC of aviation technology for defense purposes are proposed.
Adolescent endometriosis
Authors: Nanthakumar Meenu P. , Arumugam Sendhil C.
Published: July 2017

Endometriosis is predominantly a disease of women of reproductive age group. Endometriosis is not uncommon in adolescents. Presentation tends to focus on pain, especially intractable dysmenorrhea and chronic pelvic pain. In around 60% of patients with endometriosis symptoms start in adolscence. Pain unresponsive to treatment is the usual indication for a Laproscopy. The appearance of endometriotic lesions is different from that of adults. Medical and surgical options for treatment are available. Endometriosis may be progressive and adverse effects may go beyond pain and cause infertility.
Panorama of fetal malformations at the maternity of Treichville teaching hospital (Abidjan - Côte d’Ivoire)
Authors: Yao Ignace N’guessan , Dia Jean-Marc Lamine , Adunfé Oyeladé Mouhideen , Kouamé Bohoussou Paul-Eric , N’guessan Edouard Konan , Okon Gérard , Guié Privat Yéret , Anongba Simplice Danho
Published: July 2017

Background: Congenital malformation is responsible for spontaneous abortion, the birth of a child born dead or a child with disabilities that can lead to long-term disability and have a detrimental impact on the individual, his family and society. The etiologies are diverse. The discovery in our maternity is not rare. The absence and high cost of these prenatal diagnostic are a brake on the detection of congenital malformations. It is these various malformations diagnosed in the ante natal and at birth in our service that we describe in this work which aims to make their panorama.Methods: The purpose of this cross-sectional and descriptive study curried out between 1 January 2003 and 31 December 2013 (10 years) was to describe the various congenital malformations observed at the maternity of the Gynecology and Obstetrics ward of the Treichville University Hospital Center and to identify the socio-demographic characteristics of mothers. This study concerned all women who had given birth at the Treichville University Hospital Center and whose child had a malformation.Results: During the period, 151 parturients gave birth to at least one child with a congenital malformation and among 30,698 newborns, 161 newborns (0.52%) had a malformation. Pregnant women were between 20 and 30 years old (66%), were primiparous in 46.4% of the cases, and 41.7% were housewives. The malformations were isolated in 101 newborns (62.4%), multiple in 60 newborns (37.6%), and dominated by those of the osteoarticular system and the nervous system. Fetal malformations had a poor prognosis in 77 cases (48%) and the fetus was stillborn in 44 cases (27%).Conclusions: Congenital malformations are a reality at the maternity clinic at Treichville. In our countries, the ultrasound stays a fundamental element for the congenital diagnosis of the malformations. A good training of the doctors in prenatal diagnosis is also necessary to make of good diagnoses who will allow a better care of new-born.
Efficacy and safety of pre-operative single dose parenteral tranexamic acid in moderately anaemic parturients undergoing caesarean section
Authors: Medhi Robin , Bawri Sonika , S.K. Chaitra , Ahmed Mansur , Mishra Asmita
Published: July 2017

Background: Preoperative administration of Tranexamic acid (TXA) has been found to be effective in reducing the amount of blood loss following Caesarean section in low risk women. However, studies in high risk women such as women with anaemia, where blood loss needs to be minimised are scarce.Methods: An experimental case control study was conducted with a total of 174 patients with moderate anaemia undergoing CS in a teaching hospital. Study group consisting of 87 patients received pre-operative TXA 1g intravenously. Intra operative and up to 6hours postpartum blood loss was calculated in both the groups. Requirement of blood transfusions were noted. Data analysed using Graphpad Instat® 3 statistical software.Results: Present study showed statistically significant reduction in intraoperative and postoperative blood loss among patients who received TXA compared to control group. The blood loss from placental delivery till completion of the procedure was significantly lowered (304.02ml vs 393.36ml; p value <0.0001). Postoperative blood loss (from end of the procedure up to 6hrs postpartum) was 62.57ml in comparison to 85.40ml in control group (p value <0.0001). The total blood loss from the placental delivery up to 6 hours postpartum was significantly reduced in study group (366.59ml vs 478.76ml; p value <0.0001). There was significant reduction of blood transfusion in study group (RR: 0.20, 95% CI, 0.045-0.887), without immediate adverse effect on mothers and new-borns.Conclusions: Administration of TXA preoperatively causes significant decrease in blood loss and the need for blood transfusion in patients with moderate anaemia undergoing CS.
Thyroid disorder in antenatal women in sub-himalayan region: a need for universal screening
Authors: Dubey Swati , Pradhan Anup
Published: July 2017

Background: Thyroid dysfunction constitutes the second most common endocrine disorder of pregnancy, associated with adverse maternal and fetal outcome and is often overlooked in pregnancy due to their nonspecific symptoms and the hypermetabolic pregnant state. Objective of present study was to establish the prevalence of thyroid dysfunction, study the effects in pregnancy in sub-himalayan population and whether universal screening for thyroid dysfunction is required.Methods: The study was conducted on 200 patients in the age group of 20 to 35 years with a singleton pregnancy and gestational age between 6 to 24 weeks.Results: In the 200 women screened, the prevalence of thyroid dysfunction was found to be 14% with 8% having subclinical hypothyroidism while an equal percentage of 2% having clinical hypothyroidism, subclinical hyperthyroidism and clinical hyperthyroidism. The mean age of patients with subclinical hypothyroidism was 28.6 ± 4.9 years, with thyroid disorder in pregnancy being significantly more common in primigravida. Statistically significant association was found between patients with thyroid dysfunction and abortions, preeclampsia, preterm labor, small for gestational age, low birth weight, and admission to NICU.Conclusions: Prevalence of thyroid dysfunction was found to be high in our study, particularly subclinical hypothyroidism and was associated with adverse pregnancy outcomes; hence, more research is required in the Sub-Himalayan goitre belt to assess the magnitude of the problem and formulate universal screening protocols in this particular subset of the Indian population accordingly.
A comparative study of ovulation induction with clomiphene versus clomiphene and bromocriptine in follicular phase of normoprolactinemic PCOS women
Authors: Gayathri S. R. , Tripathy Saswati , Muthulakshmi M.
Published: July 2017

Background: Hypothalamic pituitary axis dysfunction accounts for majority of ovulatory disorders and a predominant cause of women with PCOS. There is a dopaminergic control on gonadotropin secretion. In normoprolactinemic PCOS patients transient rise in serum prolactin can be observed during the late follicular phase and luteal phase. So, the aim of the study is to know the effect of bromocriptine and clomiphene in ovulation induction as compared to clomiphene alone.Methods: Based on the various inclusion and exclusion criteria, seventy patients were randomly assigned into two groups. The patients in the first group were treated with tablet of clomiphene citrate (100 mg) from day 3 to day 7 of each cycle. The patients in the other group received 100mg of clomiphene citrate from day 3 to day 7 of each cycle and tablet bromocriptine (2.5 mg) from day5 to day14. Both groups were followed up with follicular study for three months. At the end of the three cycles the hormonal statuses of the patients were determined.Results: There was no significant difference found in other hormones like serum FSH, LH and estradiol in both groups. The follicular diameter and the average endometrial thickness was increased to a significant level in the CC+Bcrt group as compared to the CC group. The rate of ovulation and pregnancy rate was higher in combination group.Conclusions: Bromocriptine with clomiphene in follicular phase has an advantage of improving follicular diameter, endometrial thickness and hence ovulation and pregnancy rates.
Evaluation of who guided pain management protocol in cases of carcinoma cervix
Authors: Bindal Jyoti , Agrawal Neha
Published: July 2017

Background: Pain in patients with cancer cervix is a complex process that occurs from many causes. Opioids, the major class of analgesic used in management of moderate to severe pain, are usually effective and have favorable benefit to risk ratio. Morphine is the most effective and commonly used opioid in cancer pain management.Methods: Patients of cancer cervix attending the Obstetrics and Gynecology Department, KRH for a period January 2016 to December 2016. 200 patients were included in the study. Pain intensity was measured by visual analogue scale.Results: Maximum number of subjects were in stage IIB (46%) followed by stage IIIB (42%). Minimum number of subjects were in stage IA and stage IVB. In stage I, 55.6% patients had mild pain, 27.8% had moderate and 16.7% patients had severe pain.  In stage II, carcinoma cervix patients 80.4% patients had moderate pain and only 12% patients had severe pain and stage III, 47.6% patients had severe pain and stage IV all patients had severe pain. Most common site for pain was lower abdomen in carcinoma cervix patients. The pain was recorded as moderate in maximum (49%) subjects followed by severe (39%). Mild pain was seen only in 12% subjects. Maximum response was seen for Step III (95.1%) while minimum for Step II (44.1%).Conclusions: Pain is a common symptom in cancer cervix patients. Morphine is most useful drug in cancer pain management. It is easily titratable and has a favorable benefit to risk ratio.
Study of serum lactate dehydrogenase level and seasonal variation in preeclampsia and eclampsia with its obstetric outcome
Authors: Ciryam Shilpa S. , E. Gomathy
Published: July 2017

Background: Preeclampsia and eclampsia complicate 6–8% of all pregnancies and lead to various maternal and fetal complications. LDH is an intracellular enzyme and its level is increased in this women due to cellular death. So, serum LDH levels can be used to assess the severity of disease, to improve the maternal and fetal outcome. Studies in several countries have shown higher incidence of the disease in the winter season. This study is being conducted to correlate serum LDH levels and seasonal variation in preeclampsia and eclampsia.Methods: It is a retrospective observational study. Data for 102 cases were collected from the parturition register and patient discharge record from January to December 2016. All singleton pregnant women who came to R L Jalappa Hospital with severe preeclampsia and eclampsia were included in the study.Results: Total of 102 patients were studied. Incidence of the disease was most commonly seen in younger age group, which was statistically significant (p=0.020). Even though most of the cases presented in winter (39), there was no statistically significant association between seasonal variation in occurrence of the disease and serum LDH levels. LDH raised to >800IU/L in the cases was seen more in the younger age group.Conclusions: This study only showed that preeclampsia and eclampsia occurred most commonly in younger women. This study did not show any variation in serum LDH levels in patients presenting in different seasons.
A study on contraceptive knowledge, attitudes and practices among women in the reproductive age group
Authors: Shukla Mansi , Fonseca Mallika , Deshmukh Prasad
Published: July 2017

Background: India, with one of the world’s fastest growing populations, is a nation very much in need of contraceptive counselling. To assess the knowledge and attitude regarding family planning methods and contraceptive practices among women of reproductive age group.Methods: A cross-sectional study was performed in which 547 women in the reproductive age group i.e., 15-45 years, attending a tertiary care hospital in Mumbai were interviewed with predesigned validated questionnaire. A total of 547 women were interviewed using a semi-structured questionnaire from January 2016 to December 2016. The proforma included details such as socio-demographic features, questions related to knowledge, attitude and practices (KAP) regarding contraceptive use.Results: Out of 547 women interviewed, 498 (i.e. 91%) had displayed an awareness of family planning methods (permanent/temporary). Out   of these 498 women, about 78% had procured the information from family and friends. 13% got their information through mass media. Only 9% of women had been counselled in detail by health personnel about the various contraceptive options available. Out of 547 women interviewed, 342 (62.5%) were using contraception. More than a third of these women (26.8%), resort to barrier contraception as a contraceptive method of choice for spacing and to prevent an unwanted pregnancy. Only 17% women used OC Pills as a contraceptive method though 66% women knew about them. Though 59.4% of the women knew about IUCDs only 3.5% were actually using IUCD. Most of the women were in the younger age group of 21-30years (62%) and already had one or two children.Conclusions: Ignorance regarding use and side effects various contraceptive methods is the reason for inadequate practice of family planning methods. There should be emphasis on focused awareness programs, based on bridging the knowledge gaps among the women in reproductive age group.
Prevalence of sexually transmitted infections at a tertiary hospital in Tamil Nadu
Authors: K. Durga , K. Karthika
Published: July 2017

Background: Sexually transmitted infections (STIs) present a huge burden of disease and adversely affect the reproductive health of people. The disease prevalence is about 6% in India. This study is done to determine the prevalence of STIs in women of reproductive age (15-49yrs) attending gynaec outpatient block at Institute of Obstetrics and Gynaecology, Chennai and to identify the risk factors.Methods: It is a prospective analytical study conducted at IOG from Febraury 2010 to January 2011 where 1000 women of reproductive age attending gynec op were included of which 500 women were asymptomatic and 500 women were symptomatic for STIs. A well-structured proforma was prepared for selection of women, history, examination, investigations and treatment. Asymptomatic women were also screened and treated. Partners were also screened and treated. Depending upon the statistical data, the risk factors were identified and analysed.Results: Overall prevalence of STI was 27.2% of which 22.5% was in symptomatic group and 4.7% in asymptomatic group. Bacterial vaginosis was the commonest STI. The important risk factors identified were age group between 26-30 years, high risk sexual behaviours, poor socioeconomic factors, poor menstrual hygiene and lack of contraception.Conclusions: STIs cause major health problem and it is important to diagnose and treat them at the earliest. The importance of STIs has been more widely recognised since the advent of the HIV/AIDS epidemic, and there is good evidence that their control can reduce HIV transmission. Women diagnosed with one STI should be screened for other STI due to coexistant infections. Screening and treatment of partners and follow-up tests of cure should be performed wherever possible.
Peripartum hysterectomy: a five year review at a tertiary care centre
Authors: A. V. Deepak , Jacob K. J. , Maria Sumi P.
Published: July 2017

Background: Peripartum hysterectomy is a life-saving procedure resorted to when conservative measures fail to control obstetric haemorrhage. Several predisposing factors, suboptimal care and lack of infrastructure may lead to this emergency procedure. We wanted to find out factors associated with peripartum hysterectomy and the adverse maternal outcomes at our centre.Methods: A retrospective case series analysis of 40 cases of peripartum hysterectomy performed over a period of 5 years from January 2010 to December 2014 at Government Medical College Hospital, Thrissur, Kerala was done.Results: The incidence of peripartum hysterectomy was 0.29%. The most common indication for peripartum hysterectomy was hysterectomy was uterine atony (50%). Thirty-five women (88%) were between 20 and 35 years. Most of the subjects were unbooked. There were two maternal deaths (case fatality rate of 5%) following peripartum hysterectomy during this period. All the subjects required blood transfusion.Conclusions: Prompt performance hysterectomy before the patient’s clinical condition deteriorates is the key to success. The incidence of adherent placenta is increasing, so every effort should be taken to reduce the caesarean section rates globally.
A case of post-partum hemorrhage and sterilization in the developing world
Authors: Crouch Mark Hughes
Published: July 2017

A woman delivers a term infant vaginally at a district hospital in Papua New Guinea complicated by a retained placenta, uterine inversion and post-partum hemorrhage. A tubal ligation to protect the life of the mother from possibly fatal complications in future pregnancy is suggested, but the couple's cultural beliefs make this a challenge. This case illustrates the impact of post-partum hemorrhage in a developing world context and cultural issues related to sterilization performed in these settings to protect the life of the mother.
Spontaneous uterine vessel perforation in late pregnancy following in vitro fertilisation: a rare cause of near miss maternal morbidity and fetal death
Authors: Gainder Shalini , Muthyala Tanuja , Chandra Saha Subhas
Published: July 2017

Spontaneous perforation of uterine vessels causing hemoperitoneum in pregnancy is rare and is associated with high perinatal and maternal mortality and morbidity. However, for the clinician identification of aetiology with ongoing resuscitation is important in order to affect the proper treatment. Case report: We report a case of spontaneous hemoperitoneum in pregnancy following IVF conception due to ruptured uterine vein successfully managed with emergency laparotomy and repair of the uterine vessel. Conclusion: Clinicians should be aware of such rare and potentially fatal complications after IVF, because early diagnosis and management in these cases can yield a favourable maternal and perinatal outcome.
Spontaneous closure of the hymen during term pregnancy
Authors: E. Gomathy , Liston Poonguzhali , G. Shilpa
Published: July 2017

The hymen is a thin fold of mucous membrane; partially closing the external vaginal opening.1It is composed mainly of elastic, collagenous connective tissue and covered on its both surfaces by stratified squamous epithelium. At pregnancy, the epithelium of hymen becomes very thick and rich in glycogen, which may lead to spontaneous closure. We aim to report a rare case of spontaneous closure of hymen in a 23-year old primigravida in labour with no prior history of menstrual problems or problems during intercourse. Two conditions can cause the secondary closure of the hymen: following previous scarring and in pregnancy. In pregnancy, it could be spontaneous closure due to increase glycogen content of the hymen or due to extensive scarring as seen in previous hymenal surgeries. Spontaneous closure of hymen during pregnancy though very rare can occur. Along with extensive scarring, prolonged abstinence and oestrogenic effect on hymen, gonococcal infection can also cause sponatenous closure of hymen during pregnancy.
Synchronous mucinous cystadenoma ovary, leiomyoma uterus and mucinous adenocarcinoma cervix infiltrating into uterine leiomyoma: a rare case report
Authors: Rawal Gireesha , Zaheer Sufian , Yadav Amit Kumar , Sahani Neelam , Dhawan Indrani
Published: July 2017

The overall incidence of synchronous female genital tract malignancies is 0.63%. The most frequently observed synchronous neoplasms are those of the ovary together with the endometrium. Cervical and ovarian malignancies are exceedingly rare. We present the case of a female patient who complained of abdominal distention and pain abdomen. A cervical pap smear was performed, and it showed inflammation and atrophic changes. USG abdomen revealed findings consistent with pyometra. Repeated dilatation and curretage for resolving the pyometra was attempted, but it yielded mucinous fluid only. Another USG abdomen was done, which showed a cervical growth. The patient was taken up for staging laparotomy. Per operatively, no growth could be identified in the cervix. However, dense adhesions of the cervix with the bladder were present. A bilateral salpingo-oophorectomy specimen was sent for intraoperative cytology, and showed mucinous cystadenoma, ovary. Further, the completion total hysterectomy specimen was sent for histopathology. Sections showed adenocarcinoma, cervix and leiomyoma, uterus. The cervical adenocarcinoma showed infiltration into the uterine leiomyoma. Thus, we document a very rare case involving a patient who presented with three coexistent tumours involving bilateral ovaries and uterus. To our knowledge, this is the first reported case of the combination. Accurate diagnosis as separate independent primary tumours or as primary tumour associated with its metastasis, and identification the site of origin in secondary tumours has important prognostic implications and is necessary for appropriate staging and treatment.
Successful management of an Rh alloimmunised twin gestation pregnancy with multiple atypical antibodies with severe fetal anemia
Authors: Sikarwar Rakhi , Satia Meena , Panchbudhe Shruti
Published: July 2017

Rhesus-D alloimmunization is characterized by production of antibodies as a result of immune response generated in an individual due to exposure to alloantibodies from different individual. Here we are reporting a case of successful obstetric and perinatal outcome of twin pregnancy with Rh-incompatibility along with other atypical antibodies leading to fetal and neonatal anemia in both the twins. Antenatal management consisted of serial obstetric Doppler to look for Middle cerebral artery blood flow and Peak systolic velocity to detect fetal anemia followed by Intra Uterine transfusion of packed red cells through umbilical vein to treat the same for both the twins. In the presence of multiple atypical antibodies in the maternal serum no compatible blood was available for transfusion for either the mother or the neonates after delivery so NICU management consisted initially of transfusion of intravenous immunoglobulin’s along with steroids to prevent auto and alloantibody reactions but in view of dropping hemoglobin in both twins least incompatible blood was given to both the twins.
Puerperal sub-acute uterine inversion: a rare case report
Authors: Sharma Reena , Malhotra Kapil , Dogra Poojan , Kumar Anil , Kaushal Sushruti , Priya Tanu
Published: July 2017

Puerperal uterine inversion is a complication of third stage of labour, which can lead to maternal morbidity and mortality due to haemorrhage shock and infection. Early cases can be managed by manual reposition of uterus but neglected or late cases of uterine inversion are managed by Haultain`s repair. Here we are presenting a case of subacute uterine inversion referred from peripheral hospital managed by Haultain’s technique.
“Finally when I started falling down”: Indigenous tuberculosis patient experiences of health and illness on the Canadian prairies
Authors: Abonyi Sylvia , Mayan Maria , Boffa Jody , Lopez Carmen , McMullin Kathleen , Heffernan Courtney , Hoeppner Vernon , King Malcolm , Orr Pamela , Long Richard
Published: July 2017

This paper adds evidence to a growing body of literature seeking to understand the disproportionate occurrence of tuberculosis (TB) in Indigenous populations of Canada and reveals insights that may inform effective interventions. As a disease, TB is recognized as a disorder of the body, for which there are successful treatments. Its persistence in some populations, however, requires an understanding of TB as an illness, whereby disease is shaped into behaviours and experiences. Fifty-five self-identified Indigenous participants with infectious pulmonary TB completed a questionnaire and an interview as part of the Determinants of Tuberculosis Transmission (DTT) project. Questionnaire data report on sociodemographic information and exposure to TB risk factors, while interview data describe participants’ experiences of TB within the context of their personal histories and everyday lives. Analysis showed that TB symptoms did not stand out as unusual in the everyday life and health experiences of participants. State of health and decisions about accessing healthcare were associated with socioeconomic deprivation, as well as negative experiences connected with historical and contemporary impacts of colonization. The “tipping point” concept effectively captures the shift in health that pushes participants to seek healthcare. Family, friends, and other caregivers are important influences and need to be part of the effort to avoid advanced TB illness and stop the cycle of transmission. More significantly, there is a need to address the structures and systems that produce and perpetuate life conditions that result in a usual state of compromised health.
Acknowledging the Māori cultural values and beliefs embedded in rongoā Māori healing
Authors: Mark Glenis , Chamberlain Kerry , Boulton Amohia
Published: July 2017

An exploration of rongoā Māori (a system of Māori healing based on Māori cultural traditions) was conducted to ascertain the cultural values and beliefs of Māori, the Indigenous peoples of Aotearoa/New Zealand, that are related to Māori healing. A Kaupapa Māori approach utilising Māori cultural concepts throughout the research process guided the overall study design. Semi-structured narrative interviews were conducted in 2009 and 2010 with 17 rongoā Māori healers. The rourou Māori method of data analysis, a 3-step process created specifically for this project, was employed to analyse healers’ talk about the underlying concepts of rongoā Māori healing. Two key topics emerged: concepts of healing, and the focus of healing. The importance of acknowledging Māori cultural values and beliefs inherent within rongoā Māori healing concepts and the focus of healing is discussed.