bluuebunny/crossref_metadata_2025 huggingface dataset:
Análisis de la aplicabilidad de los beneficios tributarios territoriales y su incidencia financiera en las Pymes del municipio de Circasia, Departamento del Quindío, entre los años gravables 2015 y 2020
Authors: Torres Castaño Ana Gladys , Fajardo Calderón Constanza Loreth , Santa Fajardo Laura Michel
Published: January 2023

The development of this part of the investigation allows the identification of the tax benefits established in the Revenue Code of the municipality of Circasia, in the Department of Quindio, Colombia, regulated through Agreements 024 of 2014 and 001 of 2015, within which the exemptions stand out, exclusions, rates and special bases in certain taxes; the classification of the SMEs of the municipality according to the economic activities and the norms that regulate them, typifying the business sector to which they belong, the legal status through which they were constituted and their position with respect to the other medium and small coexisting companies in the region; and finally, the analysis of the applicability of tax benefits by SMEs that are located in the municipality of Circasia between the taxable years 2015 to 2020. The research is carried out under the descriptive method using an approach mixed, considering a qualitative part given that there is a conceptual, theoretical and documentary referencing; and another quantitative part, by the use of statistical methods and data tabulation for the presentation of the results. In addition, a survey (32 questions) structured by sections according to the type of tax benefit is used as an information collection instrument, that was delivered to the target business population, allowing through its application to obtain relevant data, such as the limited action of the administration regarding the dissemination of information regarding the existing tax benefits in the Revenue Code, the significant use of of the entities on the benefits that encourage the prompt payment of some taxes, and at the same time that issues such as unusable benefits were exposed, given their restricted target audience, as well as the great utility that benefits present as a tool of the State to the time to encourage economic development, generate employment, correct the tax burden and allow them to cope with some of the different problems that companies have in the exercise of their activity, provided that the incentives are designed in such a way that they are profitable and that they are applied by the companies.
Transformation of Land Relations in Ukraine to Market Conditions
Authors: Shulga Mykhaylo , Yurkov Marko
Published: January 2023

Land ownership issues are especially important due to the historical experience of land nationalization of Ukrainian peasants. The sphere of land relations in Ukraine has undergone a process of constant reform since the country’s independence. At the present stage, the abolition of the moratorium on the transfer of ownership of agricultural land is historic for Ukrainian citizens. In consequence, the clarity and transparency of legal procedures for the transfer of land ownership to citizens of Ukraine become particularly relevant.

In connection with the European vector of Ukraine’s development and gradual economic integration with the European Union countries that have experience in the agricultural land market, it is important to find an appropriate legal model for regulating the circulation of agricultural land in Ukraine, using the experience of the European Union. Land lease relations, as a main means of using agricultural lands for a long time in Ukraine, are considered in the article.

The adopted Law of Ukraine “On amendments to some legislative acts of Ukraine concerning the circulation of agricultural lands” is analyzed. According to its provisions, the moratorium on the sale of agricultural land was finally canceled, which allowed landowners to freely dispose of their property. In the article, it is also proved that the main prospects for the development and functioning of the land market in Ukraine are: 1) foreign investment in Ukraine, 2) the possibility of free disposal of agricultural land plots, 3) attracting additional resources for local communities, 4) stimulating the agricultural sector, 5) increasing the efficiency of production on land.
Las diferentes olas de participación ciudadana en el proceso constituyente de 1991
Authors: Londoño Jaramillo Mabel
Published: January 2023

This reflection article describes the different waves of citizen participation that occurred in the constituent process of 1991. It begins with the student movement of 1989, continues with the great national debate that took place in the working groups and the preparatory commissions, and ends with the National Constituent Assembly, the most pluralistic and multicultural in national history. It concludes that the Political Constitution of 1991 emerged from an unprecedented constituent process, which changed the way of making constitutions in Colombia.
Effects of Gemcitabine/Nab-Paclitaxel and DMAPT in PDAC Cachexia in vivo and in vitro
Authors: Philleo Samuel A. , Counts Brittany R. , Jean Sephora , Gowan Annie E. , Narasimhan Ashok , Nakshatri Harikrishna , Zimmers Teressa A.
Published: January 2023

Cachexia is the involuntary wasting of skeletal muscle and adipose tissue, affecting over 80% of patients with pancreatic ductal adenocarcinoma (PDAC). Gemcitabine and nab-paclitaxel (GemNP) combination are commonly given as first-line treatments for PDAC. Data from our lab showed GemNP reduced tumor growth and prevented muscle and fat wasting.
Dimethylaminoparthenolide (DMAPT), a small molecule inhibitor, prevented muscle wasting and prolonged survival in a genetic murine model of breast cancer. It has yet to determine if GemNP in combination with DMAPT can improve indices of cachexia and overall survival. Therefore, I hypothesize that GemNP in combination with DMAPT will improve indices of cachexia and overall survival in a murine model of pancreatic cancer.
Male 10-week-old C57BL/6J mice underwent orthotopic injection of 5x104 KPC cells or SHAM surgery. Mice were randomly assigned to 1 of 4 groups (N=10/group): SHAM+Vehicle, KPC+Vehicle, KPC+GemNP, KPC+GemNP+DMAPT. Gemcitabine (120mg/kg) and Nab-paclitaxel (10mg/kg) were injected intraperitoneally starting on day 4 and continued every 6 days. DMAPT (100mg/kg) was administered by gavage Monday-Friday. To determine the role of GemNP and DMAPT in vitro, KPC cells were treated with GemNP and/or DMAPT and cell viability evaluated. Additionally, we treated myotubes with GemNP with/without DMAPT to assess myotube diameter in an established KPC conditioned media.
In KPC mice, GemNP (24.4days) increased survival compared to Vehicle (16.8days, p=.0007). However, the combination GemNP+DMAPT did not extend survival over GemNP alone (25.4days, p=.693). Tumor mass was similar between all groups (p=0.411). Interestingly, at the time of sacrifice, all KPC treated mice independent of treatment had similar reduction in adipose tissue and muscle mass compared to SHAM.
In conclusion, the addition of DMAPT to GemNP did not extend survival over GemNP alone in an aggressive pancreatic tumor cell line. Future studies should determine if less aggressive tumor cell lines might benefit from GemNP and DMAPT.
GCN2 inhibition sensitizes prostate cancer cells to loss of p21 cell cycle control
Authors: Mohiuddin Haroon M. , Cordova Ricardo A. , Sommers Noah R. , Klunk Angela J. , Staschke Kirk A. , Wek Ronald C.
Published: January 2023

Background: Activation of the Integrated Stress Response (ISR) by GCN2 is crucial for cells to survive in amino acid-depleted environments. We recently demonstrated in prostate cancer (PCa) that the GCN2 protein kinase that serves as a nutrient sensor in the ISR is critical for the regulation of transport of essential amino acids (EAAs) and for PCa growth and tumor progression. Inhibition of GCN2 results in lowered expression of amino acid transporters and a severe depletion of intracellular EAAs. Although loss of GCN2 in PCa cells reduces proliferation, this leads only in cell stasis and not cell death. We hypothesize that the senescent phenotype induced by GCN2 inhibition in PCa cells will render these cells vulnerable to cell cycle modulation and is a potential therapeutic target.Methods: Immunoblot analyses was used to measure protein levels. Cell cycle analysis was performed by flow cytometry, and cell death/apoptosis was measured by Annexin-V and Cytotox-Red using an Incucyte.Results: We determined that GCN2 inhibition in PCa cell lines results in G1-cell cycle arrest accompanied by induced p21 expression. p21 is a major regulator of the cell cycle by inhibition of cyclin/CDK complexes. Induced G1 arrest and p21 by GCN2 inhibition can be reversed by supplementation with EAAs, suggesting amino acid limitations is critical for the p21-dependent cell cycle checkpoint control. Combinations of GCN2 and p21 knockdowns using siRNAs resulted in cell death and apoptosis in PCa cells.Conclusions: Our results suggest that inhibition of GCN2 in PCa cells causes severe starvation for EAAs, triggering the cell cycle checkpoint by a p21-dependent mechanism. Although PCa cells survive and undergo growth stasis following loss of GCN2, these cells are vulnerable to loss of p21 cell cycle control. We propose that GCN2 inhibition in combination with cell cycle modulators is novel therapy for the treatment of PCa.
Relationships Between Health Behaviors, Social Determinants of Health, and Patient Demographics in an Urban Northwest Indiana Hospital
Authors: Nosbusch Sydnye , Love Emma , Ryan Elizabeth , Guerrero Jonathan E. , Muvuka Baraka
Published: January 2023

Background: Social determinants of health (SDOH) contribute to over 50% of health outcomes and inequities. Healthcare institutions are increasingly implementing SDOH screenings and referrals. St. Mary Medical Center (SMMC) in Northwest Indiana was the first acute care hospital to implement a comprehensive SDOH pilot screening and referral program in Indiana using the validated Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE). This study is part of a three-phased Community-Based Participatory Research (CBPR) partnership between IUSM-NW and SMMC to examine and address SDOH within SMMC’s service area from January 2022-January 2025. This study’s research question is: What are the relationships between SDOH, behavioral, and demographic factors in SMMC’s inpatients?Methods: This descriptive study analyzed a limited dataset generated by SMMC from EPIC™ with SDOH, demographic, behavioral (tobacco use, alcohol use, physical activity), and health outcomes data for adult inpatient visits from January 2021 to June 2022. Data analysis was conducted in SPSS 28.0 using descriptive statistics (i.e., frequencies and central tendency) and tests of association including Chi-square, Fisher’s Exact, Wilcoxon-Mann Whitney, and Kruskal Wallis H (p<0.05). This study was exempted by Indiana University Human Research Protection Program (IRB # 14040).Results: This study included 4370 inpatients, who were predominantly White (75.7%), older adults (65 ± 24), and publicly insured (76.3%). There were significant relationships between SDOH and tobacco use, alcohol use, and physical activity. Tobacco use was significantly associated with the majority of SDOH including insurance type (p<.001), housing risk (p<.001), financial resource risk (p<.001), unmet transportation needs (p<.001), and overall social risk (p=.012).Conclusions: Understanding how SDOH influence health behaviors will inform efforts to develop, implement, and evaluate multi-level interventions. The next phases of this CBPR will use advanced statistical techniques to further explore these relationships, evaluate SMMC’s pilot program, and co-develop SDOH interventions.
Complications in Burn Patients Following Fluid Over-Resuscitation
Authors: Peipert Leah J. , Kraatz James
Published: January 2023

Background/Objective: Over-resuscitation of burn patients leads to dangerous edema-related sequelae. The Parkland formula is commonly used to predict fluid requirements in the 24 hours following burn injury, yet studies report widely varying resuscitation rates. This study aims to assess fluid resuscitation practices at Lutheran Hospital and evaluate correlations between resuscitation rates and fluid-overload complications.Methods: A retrospective chart review assessed fluid resuscitation of 36 adult patients withburns affecting at least 15% total surface body area (TBSA) between May 2020-May 2022 atLutheran Hospital. Intravenous fluid rates and urine output (UO) were recorded for the first 24 hours of each patient’s hospital stay. Complications and mortality were recorded for the entirety of a patient’s hospital stay. Patients who received volumes exceeding those recommended by the Parkland formula were placed in the high-volume group whereas patients who received a lesser volume were placed in the low-volume group. Statistical analyses were performed using Microsoft Excel (α = 0.05).Results: The study included 36 patients with an average fluid resuscitation of 4.13 ±2.14mL/kg/%TBSA in the first 24 hours following hospital admission. Average UO in the high-volume group (n=14) was 1.33 ±0.76 mL/kg/hr compared to 0.75 ±0.47 mL/kg/hr in the low-volume group (n=22). Fluid complications were more common in the high-volume group (41.7%)compared to the low-volume group (19.0%), but this difference was not statistically significant (p=0.230). No difference in mortality was observed (p=1.000).Conclusion: The high-volume group had an average UO exceeding the recommended range(0.5-1.0 mL/kg/hr) and experienced greater rates of fluid-overload complications (pulmonaryedema, compartment syndromes, etc.). Due to the small sample size and limited power of this study, the difference in fluid-related complications was not statistically significant.Clinical Impact and Implications: Physicians should limit fluid volumes exceeding theParkland formula when resuscitating burn patients to avoid fluid overload sequelae.
Impact of Video Education to Train Trauma Staff
Authors: Redilla Nick , Isenberg Scott , Levin Jeremy , Meagher Ashley
Published: January 2023

Background:Management of trauma patients is challenging and requires a coordinated team effort inside a crowded trauma bay. Errors can result in disastrous consequences. Trauma is the leading cause of death in the United States of people younger than the age of 45. Maintaining a cohesive team dynamic is paramount, but academic medical centers must deal with the constancy of rotating staff and learners that may be unfamiliar with resuscitation workflows. This project aims to improve the trauma resuscitation process by identifying the gaps in knowledge and process through auditing of the highest-level trauma activations.
Methods:This is a pre- and post-intervention prospective cohort study of adherences to a standardized trauma resuscitation process through the use of an educational video at a busy level 1 academic trauma center. Process improvement resulting from the educational video will be assessed quantitatively through in-person and video review audits using a pre-defined checklist. This checklist scores the crucial elements highlighted in the educational video that must be addressed in each trauma resuscitation. The goal of this project is to illustrate improvement of the trauma resuscitation process through the comparison of trauma resuscitations audited before and after implementation of the training video.
Results:The most commonly observed deficits have been related to the donning of correct personal protective equipment (PPE) and communication. The most common PPE left out was eye protection and hair covering. Shortcomings in communication include failure to practice 1:1 communication and the performance of adequate pre-briefs.
Potential Impact:This study will establish a feasible method of improving the trauma resuscitation process at IU Health Methodist Hospital. Potential next steps of this study’s conclusions include improving the trauma resuscitation process at other Indianapolis trauma 1 centers outside of Methodist Hospital, and the implementation of similar video education training for additional team-based procedures.
The Gut Microbiome Influences the Gene Expression Profile of Neuroendocrine and Enteroendocrine Systems
Authors: Hnem Thian , Milhouse Wynne , Coley Jason M. , Clapp Anna R. , Yan Shijun , Cross Tzu-Wen , Ren Hongxia
Published: January 2023

Objective/Hypothesis: The gut microbiome influences metabolism, but the underlying mechanisms are not completely understood. We hypothesized that the gut microbiome modulates metabolism by regulating the expression of key neuroendocrine and enteroendocrine genes such as neuropeptide Y (Npy) which is a potent brain orexigenic peptide and G-protein-coupled receptor-17 (Gpr17) which decreases incretin secretion in the gut.
Approach: The gene expression profiles in mouse hypothalamus and gastrointestinal tract segments (duodenum, jejunum, ileum, and colon) were compared from germ-free (GF) mice (n=9 females, n=9 males) and conventional mice (n=9 females, n=9 males). Gene transcription was determined through total RNA yield extracted from the various tissues using qRT-qPCR. The data was analyzed using two-way ANOVA and unpaired t-test.
Results: We found that RNA yield in brain and gut tissues differed in a sex and microbiome dependent manner. The medial basal hypothalamus of the female germ-free mice had lower RNA yield compared with conventional female mice (p=0.0082). In the intestine, the RNA concentrations of the germ-free mice showed a decrease from the proximal to distal gut, however, an opposite trend was observed in the conventional mice with an overall increase of concentration from the proximal to distal gut. This trend may reflect the high concentration of the microbiota in the distal gut. Regarding gene expression of the neuroendocrine and enteroendocrine systems, Npy had lower expression in the medial basal hypothalamus (MBH) of conventional males (p=0.004), Gpr17 showed moderate duodenal expression in conventional mice (p=0.029), and Gpr17 showed increased duodenal expression in germ-free females (p=0.044).
Summary/Conclusions: With enriched microbiota in the ileum and colon, our results indicate that gut microbiota increase host gene transcription in the distal gut segments. Future studies will aim at investigating the mechanistic link between the microbiome and regulation of gene expression in neuroendocrine and enteroendocrine tissues.
Understanding the Effect of Medication Assisted Treatment on Recidivism of Persons with Substance Use Disorder
Authors: Hopf Brett M. , Messmore Niki
Published: January 2023

Background: The Dismas House of Indiana, Inc (Dismas House) is a nonprofit organization in St. Joseph County that provides transitional housing to men and women who have recently been released from incarceration. Dismas House offers a wide variety of programming, group therapy, and supports their residents in receiving Medication for Addiction Treatment (MAT). Dismas House currently allows for residents enrolled in MAT to be on Suboxone (Buprenorphine + Naloxone) and Vivitrol (Naltrexone). In the general population, substance use disorder is estimated to have a prevalence of approximately 10%. In stark contrast however, the prevalence of substance use disorder among those incarcerated in Indiana State Prisons is just over half at 53% and the prevalence of substance use disorder among those who return to prison is even greater at 75%. As such, a greater understanding of how effective MAT can be at reducing recidivism in those with substance use disorder leaving incarceration is critical in lowering the population of Indiana and federal prisons.
Methods: A literature review conducted via PubMed, JSTOR, and UpToDate on articles published on or after 2017 to research the effects of MAT on recidivism on persons with substance use disorder.
Results: Persons who are arrested or who have been arrested that have an SUD have a major higher incidence of recidivism than people who have been released from prison who do not have an SUD. MAT lowers the recidivism of those with SUD by 20% on average.
Conclusion/Future Implications: People with SUD who are incarcerated should be offered MAT while both in prison and once they are released in an effort to reduce recidivism in the state.
Intravital Microscopy Optimization for Murine Tail Lymphedema Model
Authors: Diaz Stephanie , Mohan Ganesh , Khan Imran , Sinha Mithun , Sen Chandan K. , Hassanein Aladdin H.
Published: January 2023

Background: Lymphedema is limb swelling caused by lymphatic dysfunction. It occurs in 30% of patients that undergo axillary lymph node dissection in the treatment of breast cancer. It can cause pain, impair function, and decrease quality of life. Lymphedema is treated with compression, excisional procedures and microsurgical physiologic procedures. There is no cure for this disease. The murine tail model of lymphedema is an established animal model for lymphedema. Visualization of lymphatics and functional assessment remains a challenge.
Project Rationale: Immunohistopathology and qRT-PCR are two commonly used in vitro techniques for molecular assessment of lymphatics in animal tissues. These methods provide incomplete information about the structure/function of lymphatics   and introduce the confounder of harvested tissue. Methods of functional evaluation such as lymphoscintigraphy or lymphangiography show transit of dyes through lymphatics without high resolution imaging of the lymphatic vessels. Intravitaltwo-photon microscopy (IVM) addresses these disadvantages through real-time imaging of subcellular level biological processes in live animals. The goal of this project is to optimize IVMmethods for the assessment of functional lymphangiogenesis in the murine tail lymphedemamodel.
Methodology Development: A full-thickness skin excision is performed near the base of the tail in    C57BL/6 mice. The lymphatic trunks are then surgically transected. Gene-based therapy is delivered to the tail at the surgical site. At 10 days post-treatment, a second full-thickness skin excision is made distal to the site of occlusion. FITC-Dextran (2000 kD) is injected at the distal tail for lymphatic uptake. Lymphatic vessels are visualized at the second skin excision site with the Leica SP8 Confocal/Multiphoton Microscope and assessed for number of branching points. Images are captured with Leica Application Suite Advanced Fluorescence Software and analyzed with Imaris Microscopy Image Analysis Software. This results in the ability of functional assessment of lymphatics and visualization of lymphangiogenesis following gene-based therapy.
Barriers to Accessing LGBTQ+ Inclusive Healthcare in Underserved Communities
Authors: Emerick Sarah , Messmore Niki
Published: January 2023

Background: LGBTQ+ individuals are more likely to face healthcare discrimination and thus delay medical care which contributes to increased mental health and psychosocial distress. Specific to transgender individuals, insurance denials and a paucity of providers that  provide trans-specific treatment make it increasingly difficult to access care that has been shown to lower psychological distress. Being situated in a medically underserved, rural area, accessing LGBTQ+ inclusive and competent care is a challenge that has been echoed by many who frequent the Pride Center of Terre Haute.
Methods: A literature search was conducted via PubMed and JSTOR. The 2015 US Transgender Survery and peer reviewed articles from 2011 - 2022 were utilized. Local healthcare providers were contacted via phone or email to discuss their willingness and ability to provide an inclusive environment to all LGBTQIA+ persons, as well as hormone therapy for transgender individuals.
Results: Transgender individuals are one of the most underserved patient populations within healthcare. In discussions of the disparity faced by those trying to access care, three issues discussed in the literature were as follows: insurance denials or inadequate financial coverage, lack of proper training of the provider, and distance to travel for gender-affirming care. Rural physicians are not as frequently  exposed to transgender individuals and therefore are less likely to be educated and trained in providing gender-affirming care as demonstrated through discussions with providers local to the Wabash Valley.
Conclusions & Future Implications: This work is part of an ongoing initiative to better understand the challenges faced by the LGBTQ+ community in a medically underserved area of southern Indiana. This study intends to further understand the challenges faced by the LGBTQ+ individuals in seeking care and also local healthcare providers' capability of administering competent trans-specific care.
Evaluating the AMPATH Surgical App (ASAP): Open Appendectomy Module
Authors: Standfest Makayla , Bhatia Manisha B. , Levy Jeffrey S. , Stefanidis Dimitrios , Hunter-Squires JoAnna L. , Saruni Seno I.
Published: January 2023

Introduction: Due to paucity of surgical personnel and lack of resources in low- and middle-income countries (LMICs), general practitioners with little surgical education are often relied upon to complete emergent appendectomies. To address this concern, a smart phone app-based curriculum called AMPATH Surgical App: Open Appendectomy Model (ASAP) was created to enhance learner’s appendectomy skills. The aim of this study was to evaluate the effectiveness of ASAP compared to standard curricula using Kirkpatrick’s Learning Evaluation Model.
Methods: A randomized controlled trial was performed. Participants were randomized by simple, random allocation into the intervention ASAP curriculum education group, or the control standard education group. The intervention group was provided access to ASAP while the control group received traditional appendectomy instruction that included textbook and atlas chapters on appendicitis. All participants were assessed at weeks 0, 3, and 6 for appendectomy knowledge and surgical skill, both Kirkpatrick Level Two outcomes, and confidence, a Level One outcome.
Results: 10 students were enrolled into 2 groups: control (6/10, 60%), and intervention (4/10, 40%). At baseline there was no significant difference between control and intervention groups for knowledge pre-test, skills self-assessment, skills expert assessment, and operative time; demonstrating that the groups are similar in baseline knowledge and skill. There was no significant difference in confidence between groups after the first simulation; both groups did increase in confidence from baseline. Both groups decreased operative from baseline to simulation 1, and despite no significant difference between groups for simulation 1 expert assessment, both groups increased points earned from baseline to simulation 1.
Conclusion: Preliminary results show ASAP to be an effective teaching tool, resulting in increased confidence and skills assessment improvements, corresponding to Levels One and Two of Kirkpatrick’s Learning Evaluation Model, respectively.
Ability and willingness of vascular surgery patients to use telemedicine
Authors: Martin Cameron , Westin Greg
Published: January 2023

Background/Objectives: This study aims to assess the ability and willingness of vascular surgery patients to use telemedicine (TM), as well as identifying some barriers restricting its use.
Methods: An observational, cross-sectional study was conducted among vascular surgery patients in 2022 who visited the clinic from 9/2019 to 12/2019. A telephone survey was used to assess patients’ perceptions and barriers to TM along with mobility. Distance and time traveled to the clinic were evaluated.
Results: A total of 107 patients were surveyed. General willingness to use TM for vascular surgery appointments was 3.35 (Likert scale 1-5). 33.6% of patients preferred TM over in-person appointments, 50.5% of patients believed their medical needs could be met using TM, and 57.9% of patients feel comfortable using TM. Positive correlations were found between technology access and willingness to use TM (web camera (M=+1.5, p<0.001), ability operatingweb camera (M=+1.2, p<0.001), stable internet (M=+0.7, p=0.026)), work hours impactscheduling appointments (M=1.0, p=0.007), and believing medical needs could be met using TM (M=+1.7, p<0.001). Negative correlations were found between age and technology access (web camera (M= -7.0, p=0.004) and ability operating web camera (M=-9.4, p<0.001)), preferring TM (M=-7.2, p<0.001), believing medical needs could be met using TM (M =-6.3, p=0.002), and feeling comfortable using TM (M-6.4, p=0.002). Younger patients have work hours that impact appointment scheduling (M=-10.9, p<0.001). Patients were less willing to use TM for initial appointments than follow-ups and long-term surveillance (M=-0.85, M=-0.90, p=<0.001).
Conclusion and potential impact: The COVID-19 pandemic caused many vascular surgery clinics to rapidly turn to telemedicine. The results from this study suggest that there is an ability and interest in TM for vascular surgery appointments, but limitations exist in older populations. This study serves to better understand the patient perceptions and limitations to use TM for vascular surgery appointments.
Examining the rate of pregnancy with assisted reproductive technology and the outcome of pregnancy in women referring to the infertility center of Ardabil city
Authors: Jalilvand Faranak , Farzipour Shahla , Amani Firouz , Biriya Atousa
Published: January 2023

Background: Assisted reproductive technology (ART), including in vitro fertilization (IVF) and microinjection or intracytoplasmic sperm injection (ICSI) and intrauterine sperm injection (IUI) has been widely used to solve the problem of human infertility and has brought many benefits to millions of women and men. The husband is dealing with infertility disorders. The aim of this study was to determine the rate of pregnancy with ART and the outcome of pregnancy in women.
Methods: In this descriptive-cross-sectional retrospective study 380 women who visited the infertility center of Ardabil city Alavi hospital from the beginning of October 2017 to the end of September 2019 to get pregnant with assisted reproductive methods. Data were collected by a checklist and then were analyzed by statistical methods in statistical package for the social sciences (SPSS) version 24.
Results: The most important cause of infertility was attributed to ovarian causes with 36.5% and then male causes with 27.8%. In total, 82 people (22.6%) got pregnant out of 380 people referred for infertility treatment. Among these 82 people, 51.2% of healthy and full-term babies and 22.0% of healthy and pre-term babies were born. Also, 26.8% had no birth due to various reasons.
Conclusions: The results showed that the results of treatment with pregnancy methods in Ardabil are acceptable. The IUI method had the highest success rate in terms of pregnancy and the IVF method had the highest success rate in terms of the birth of a healthy baby.
Five-years retrospective study on utilization and uptake pattern of family planning services in primary health centres in a peri-urban settlement in southwest Nigeria
Authors: Afolabi Esther K. , Oyebamiji Suliyat O. , Oyinlola Funmilola F. , Ani Odinaka B.
Published: January 2023

Background: Family planning is one of the most basic and essential healthcare services that can promote and ensure women's reproductive health worldwide. However, there has been a low level of utilisation of family planning services by women in developing countries. Therefore, the paper documented the utilisation rate, the uptake pattern of family planning services, and the socio-demographic characteristics of the women who attended the selected primary health centres in the Ife-Central local government area.
Method: A five-year retrospective review of primary health centre’s records of clients who attended selected health centres from January 2017-December 2021. Data was obtained from the client cards and the family planning record book. A total of 2572 clients’ records were evaluated.
Results: the study revealed the modal age group of 25-34 (58%) and modal parity of 3-4 (51%) children. The most significant proportion of the women was married (94.6%), with a secondary level of education (89%). Injectables were the most utilized family planning services among women in primary health centres, followed by the uptake of condoms. The Implant was the only increasing uptake pattern of family planning services within 5 years in primary health centres.
Conclusion: Injectable contraceptives have a higher utilization rate, and the uptake pattern of family planning services varied in selected PHCs. However, the uptake pattern of implants increased consistently. Therefore, there is a need for continuous awareness creation and advocacy for the uptake of family planning services to promote women’s health and well-being. Trial registration: It was not retrospectively registered.
Prevalence of pregnancy induced hypertension and associated factors in Kashmiri women attending a tertiary care hospital at Srinagar: a cross-sectional study
Authors: Ain Syed Najmul , Gull Shayista , Qulsum Reyana , Khan Zahid Ali , Qureshi Uruj Altaf
Published: January 2023

Background: Pregnancy induced hypertension (PIH) is a significant cause of morbidity among pregnant females and also affects the foetal outcome. Numerous risk factors have been identified. This study was conducted to estimate the prevalence of PIH and the factors associated with PIH.
Methods: This was a cross-sectional hospital-based study. Pregnant women admitted for delivery in the gynaecology and obstetrics department of SKIMS Soura formed the study participants. Patients with chronic hypertension were excluded. A minimum sample size of 295 was calculated but finally a sample of 402 was achieved. The data was collected over a 3-month period from July to September 2021 using convenient sampling. Data was entered in Microsoft excel and analysed using IBM SPSS version 23.
Results: A total of 402 pregnant women were included. Majority (61%) of the participants were up to 30 years of age, majority (97.8%) were up to para 3 and 89% were literate. The prevalence of PIH was 6.5%. Hypertension was more frequent among the women with age more than 30 years (p=0.041) and women with higher pre-pregnancy BMI (p=0.010). Maternal education, occupation and parity were not associated with hypertension in pregnancy.
Conclusions: In our study older women and women with higher body mass index (BMI) were more at risk of having PIH in pregnancy. Therefore, we would recommend earlier age at marriage and lifestyle modification for maintaining normal BMI.
Study of antecedents and risk factors of preterm labour at a tertiary care hospital
Authors: Mukadam Afrah Khalid , Sumondy Spenta Jawahar
Published: January 2023

Background: Preterm labor is an obstetrics emergency and a threat to population health. The 75% of infant mortality is related to preterm labor. Preterm labor not only inflicts financial and emotional distress on the family, it may also lead to permanent disability (physical or neurological damages) in infants. Aim and objectives were to assess the antecedents and risk factors for preterm labour and their preventive aspects and timely diagnosis of preterm labour, close monitoring and management of labour and providing neonatal care.
Methods:  Study design was of prospective study. Study setting was of department of obstetrics and gynecology at tertiary care centre. Study duration from 18 months, study population included were patients getting admitted in preterm labour in hospital during study period. Sample size was of 50.
Results: Mean age of the mothers was 29.7±5.1 years, ranging from 20 to 43 years. It was observed that 84% of the patients were in the age group of 21 to 35 years. 16% of the mothers had GA less than 28 weeks, 28% had GA of 28 to 32 weeks and rest 56% of the mothers had GA of 32 to 37 weeks. Half of all mothers were primigravida, 28% were gravida 2 and rest 22% were gravida 3 or higher. 6% cases with fibroid, 4% had bicornuate uterus and one case had septate uterus. Surgical history of Dilation and curettage in 18%, previous LSCS in 14% and hysterolaparoscopy in 6%.
Conclusions: It is recommended that specialized antenatal care for the patients, who are thought to be at risk of preterm birth, should be performed that can bring down the incidence to some extent.
Correlation of serum Nesfatin 1 level with metabolic and clinical parameters in Indian women with and without polycystic ovarian syndrome
Authors: Fatima Faeza , Saxena Pikee , Jain Anju
Published: January 2023

Background: Objective of the study was to compare serum Nesfatin 1 levels in Indian women with and without polycystic ovarian syndrome (PCOS) and to evaluate the association of serum Nesfatin 1 with metabolic and clinical parameters.
Methods: 40 PCOS and 40 age and body mass index (BMI) matched non PCOS controls were enrolled. Comparison of hormonal (serum Nesfatin 1, anti-Mullerian hormone (AMH), follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, testosterone, and estadiol) metabolic (blood pressure, fasting and post prandial blood glucose and insulin, HOMA-IR) and clinical (acne, acanthosis nigricans and hirsutism) parameters was done between two groups. Student’s t test, Mann Whitney test, Pearson’s correlation test was used. P value of <0.05 was considered statistically significant.
Results: There was a significant difference in levels of serum Nesfatin 1 in PCOS subjects and controls (8.6 ng/ml versus 0.75 ng/ml, p<0.01). Positive correlation was present between serum nesfatin 1 level and post prandial plasma glucose (r=0.009; p<0.009). A positive correlation was also present between serum Nesfatin 1 levels and AMH (r=0.512; p<0.01). No correlation was found between serum Nesfatin 1 and other endocrine, cardiovascular and metabolic parameters. Serum LH levels, LH/FSH ratio, post prandial plasma glucose and post prandial insulin were significantly higher (p<0.05) in PCOS subjects compared to controls.
Conclusions: Nesfatin 1 levels were ten times higher in PCOS subjects compared to controls irrespective of age and BMI. A positive correlation was observed between serum Nesfatin 1 and post prandial plasma glucose levels which indicates Nesfatin 1 may be a reliable marker of PCOS suggesting energy homeostasis imbalance in these women.
A study of effect of intra umbilical oxytocin in active management of third stage of labour
Authors: Desai Archish I. , Parikh Sonam K. , Patel Nidhi J. , Patel Vishwa T. , Baldaniya Amit K. , Agarwal Himanshi D.
Published: January 2023

Background: Postpartum haemorrhage is a single major and leading cause of maternal morbidity and mortality. PPH is the loss of more than 500 ml blood following vaginal delivery or 1000 ml blood following caesarean section. India has a maternal mortality ratio of 167 per 1 lakh live births. The most common cause of maternal mortality is haemorrhage which accounts for 25-30% of maternal mortality of which PPH is a significant cause.
Methods: 200 patients were included in this prospective observational study and divided into two groups, group A, underwent only active management of third stage of labour and group B received intra umbilical oxytocin administration in addition to AMTSL. The maternal and neonatal outcome was observed between the two and the difference was noted.
Results: Mean duration of third stage of labour of group A patients was 3.89±0.89 minutes and Mean blood loss was 386±85.30 ml and that of group B patients was 1.96±0.68 minutes and 235±72.99 ml respectively. These were found to be statistically significant among all the other parameters.
Conclusions: The duration of third stage of labour and the amount of postpartum blood loss was significantly less when intra umbilical injection of oxytocin was used in addition to AMTSL. So, to conclude intra umbilical vein oxytocin injection should be used routinely in addition to AMTSL in order to prevent PPH.
Awareness, knowledge about breast feeding practices among urban mothers
Authors: A. Jyotsna , K. Vijayalakshmi , Shinde Ranoji
Published: January 2023

Background: The knowledge and awareness about breast feeding practices is influenced by educational qualification, type of family and support from the family. Till date in India under- 5 mortality rate is mostly due to improper nutrition to the children since birth and infectious diseases among children. The aim of this study is to assess the knowledge and awareness about breast feeding practices among urban women attending a tertiary care hospital Chennai, India.
Methods: This hospital based; prospective, cross-sectional study was carried out among 200 antenatal women who visited a tertiary care hospital in Chennai. The data regarding the knowledge and awareness about breast feeding practices was collected.
Results: Knowledge about breast feeding practices like time of initiation, food that facilitate the secretion of breast milk is more among educated mothers. The type of family also showed a significant effect on the awareness about breast feeding. Proper posture of breast feeding was also not known to most of the antenatal mothers.
Conclusions: Antenatal women had poor knowledge about the posture of breast feeding, but awareness about the initiation of breast feeding, period of breast feeding and weaning period was satisfactory. Awareness about breast milk banking and storage of breast milk was also poor.
Neutrophil-lymphocyte ratio as inflammatory marker for clinical prediction and disease severity evaluation of preeclampsia
Authors: Khan Javid Ahmed , Ashraf Aadil , Qureshi Waseem , Fayaz Faizana
Published: January 2023

Background: Pre-eclampsia (PE) is a multisystem disorder that complicates 4-6% of pregnancies and constitutes a major source of morbidity and mortality worldwide. About 10-15% of maternal deaths are directly associated with PE and eclampsia. The aim of this study is to compare the neutrophil-lymphocyte ratio (NLR) values of mild and severe PE with the healthy normotensive pregnant women, in order to study the predictive role of NLR for PE and whether the NLR value has significant difference between normotensive pregnancy, severe and mild PE.
Method: A cross-sectional study conducted from January to July 2022 after proper informed consent and ethical clearance. The study population included 194 pregnant women divided into three groups (97 normotensive, 55 mild PE, 42 with severe PE). All the study participants were statistically compared in respect to NLR and the baseline data including age, parity and gestational age.
Results: Maternal NLR in mild PE group was statistically increased when compared to normotensive healthy women (p<0.05). Similarly, NLR was significantly higher in severe PE group when compared with normotensive pregnancy group (p=0.00). A statistically significant positive correlation was also seen between SBP (systolic blood pressure) and NLR in PE group (p<0.05).
Conclusions: NLR can be used as an inflammatory marker for clinical prediction and disease severity evaluation of PE but further cohort studies are required to determine and establish its role.
Intrauterine device is embraced by the placenta
Authors: Yared Georges J. , Al Hasan Jihad M. , El Hajjar Charlotte A. , Ghazal Kariman S.
Published: January 2023

The intrauterine device (IUD) is a contraceptive method which are tiny, T-shaped plastic, that is placed within the uterus and left there, is used all throughout the world with more than 99% effectiveness rate. Pregnancy with a levonorgestrel-releasing intrauterine system (LNG-IUS) in situ is very rare. Intracavitary pregnancy with an IUD can lead to a higher risk of infection and preterm birth. We described a case of a live birth with an IUD inserted into the placenta. A 27-year-old Syrian woman in G4P3 with a history of healthy vaginal deliveries arrived in our delivery room at 39+3 weeks gestation complaining of labor pain A vaginal examination revealed bulging membranes and a fully dilated cervix. She delivered a live baby boy, weighing 3100 g and being sent to the nursery with an APGAR score of 9 to 10. When the placenta was examined, a white foreign object that was embedded there was discovered to be an intrauterine device. Although intrauterine pregnancy is a potential problem that must be taken into account, ectopic pregnancy is a reasonably common complication of intrauterine contraceptive devices. Although several studies have shown that term pregnancies with excellent prognoses can occur after the removal of intrauterine devices, close monitoring is necessary to detect misplaced copper-T and prevent undesired births.
Pattern of skeletal metastasis in breast cancer patients of northern part of Bangladesh
Authors: Rahman A. M. M. Minhazur , M. Murshed Ali
Published: January 2023

Background: Breast cancer is the most frequent female cancer, especially in 'developed' countries. 30-85% of metastatic breast cancer patients will develop bone metastases during the course of the disease. The study was aimed to evaluate the pattern of skeletal metastasis in breast cancer patients with whole body bone scan using 99mTechnetium methyl diphosphonate (99m'Tc-MDP).
Methods: This single center based retrospective observational study was conducted among the histopathologically proven breast cancer patients referred to INMAS, Rangpur for 99m'Tc-MDP bone scintigraphy between March 2015 and March 2019. Bone scan was done with SPECT digital dual head gamma camera (Siemens S series) 3 hours after intravenous bolus injection of 20 mci99mI'c-MDP.
Results: Out of total 300 patients, 120 (40%) patients were found secondaries in bones. Among them 80(66.7%) had only axial skeletal metastases and 15 (12.5%) had appendicular skeletal metastases. Both axial and appendicle skeletal metastases were found in 25 (20.8%) patients. 
Conclusion: Thoraco-lumbar spine was the most common site of involvement in our study.
Comparison of two palliative regimens of radiation on the quality of life in metastatic non small cell lung cancer
Authors: Singh Tarun J. , Taggar Gurpreet K. , Fotedhar Vikas , Gupta Manish , Vats Siddharth
Published: January 2023

Background: Lung cancer is one of the most common cancers in males worldwide and its number is increasing every year. Of these cases 75-80% case are of non-small cell type.
Methods: This study was conducted on 30 patients of stage IV non-small cell lung cancer in the department of radiation oncology at tertiary care center, Shimla, Himachal Pradesh India from 1st Jun 2019 to 30th Jun 2020 by dividing them into study and control arm for assessing quality of life (QOL) with EORTC QLQ-C30 version3.0.
Results: We observed significant improvement in Global health scale of control arm (p=0.005) but it got worse in study arm (p=0.743). All the parameters of Functional scale i.e. Physical (p=0.584; 0.170), Role (p=0.213; 0.016), Emotional (p=0.239; 0.002), Cognitive (p=0.793; 0.247) and Social functioning (p=0.030; 0.231) got worse in study arm while they improved in control arm. As far as Symptom scale is concerned, in the study arm; dyspnea (p=0.724), appetite (p=0.836), constipation (0.192), diarrhea (p=0.341) improved but other symptoms like fatigue (p=0.566), nausea (p=0.347), pain (p=0.305), insomnia (p=0.025), financial difficulties (p=0.082) got worse while in control arm; fatigue (p=0.003), pain (p=0.000), dyspnea (p=0.022), insomnia (p=0.336), appetite (p=0.028), constipation (0.019), diarrhea (p=0.336), financial difficulties (p=0.336) improved and nausea (p=0.120) got worse.
Conclusion: QOL assessment by the physician before commencement of the treatment and later on at every visit seems to be beneficial for symptom relief and to allay the anxiety of both patient and their attendants.