bluuebunny/crossref_metadata_2025 huggingface dataset:
The incidence and risk factors for development of lower limb lymphedema after treatment for gynaecological cancers
Authors: Khalid Noori , Dharmarajan Adarsh , B. Satheeshan , M. S. Biji , S. S. Abina , Binesh Remya
Published: February 2018

Background: The development of postoperative lower limb lymphedema (LLL) is a disabling, yet usually overlooked sequele of most gynecological cancer treatment. It can lead to significant functional problems that negatively affect gynecological cancer survivors’ daily living, work, emotional state, and overall quality of life. The objective of this study is to calculate the incidence of lower limb lymphedema in patients undergoing surgery for gynecological cancer and to evaluate the risk factors for its development.Methods: Women with newly diagnosed carcinoma ovary, carcinoma endometrium and carcinoma cervix, who underwent surgery at a tertiary cancer centre from September 2016 were included in the study. The circumference of both lower limbs was measured at prefixed sites. The limb volume was calculated using the formula C2/pi. A baseline value was taken prior to surgery. The patients were followed up every 3 months and the limb volume were calculated at each visit. An increase in limb volume by >10% was defined as lymphedema.Results: The incidence of lymphedema after 1 year follow up was 43.5%. There was no significant association between known risk factors such as extent of lymphadenectomy (p value 0.633) number of pelvic or para aortic lymph nodes removed (p value 0.69 and 0.44 respectively) and type of adjuvant therapy (p value 0.455).Conclusions: The incidence of LLL according to the present study was 43.5%. There was no statistically significant association between development of LLL and risk factors like site and number of lymph nodes removed and type of adjuvant therapy.
Trial of scar in post caesarean pregnancies
Authors: Kuppulakshmi G. , Saranya S.
Published: February 2018

Background: The term caesarean delivery used to describe the delivery of a fetus through a surgical incision of the intact anterior uterine wall. The objective of this study was to analyse the maternal and perinatal morbidity between successful VBAC and failed vaginal delivery in cases selected for trial of labour.Methods: Prospective study conducted in Government RSRM Lying In Hospital, Government Stanley Medical College, Chennai over a period of one year from January 2017 to December 2017.Results: Trial of labour in previous caesarean section was more successful when the interval between previous caesarean and present pregnancy was between two to four years 86.40%. Conclusions: Most patients with a prior caesarean birth are candidates for VBAC. In properly selected women, a trial of labour after one previous low transverse caesarean section constitutes the best and safest form of obstetric management.
Downs syndrome and its screening: how aware are we?
Authors: Nambiar Murli Krishna , S. Roopa P. , C. Nisha , Kumar Pratap
Published: February 2018

Background: Down syndrome (DS) is the most common chromosomal abnormality found in live-born babies. The objectives of this study were to assess the knowledge, attitude and practices of pregnant women regarding Down syndrome and its screening.Methods: This was a prospective study done in the Department of Obstetrics and Gynecology, in a tertiary care hospital. All pregnant ladies who attended the antenatal clinic and consented for the study were included. A prevalidated questionnaire was given to these women and data was collected. Responses to pregnant women’s knowledge, attitudes and practices were evaluated in a three-point scale of yes/no/ don’t know. All correct answers or all but one correct answer was scored good and the percentage was calculated.Results: A total of 267 pregnant women were included in the study. Of the 267 women only 156 (58.4%) had heard about Down syndrome. Eighty five percent of the women unanimously agreed that Down syndrome babies had mental impairment. But only 21.1% patients had good knowledge score on Down syndrome. Eleven percent had good knowledge regarding Down syndrome screening tests. Almost sixty five percent of the women had the right attitude towards screening tests and 46.1% patients had followed good practice.Conclusions: Informed decision making rather than imposed decision making must be practiced. Compulsory and effective education regarding Down syndrome and its screening must be provided to all patients at the earliest antenatal visit. The gap between women’s knowledge, theirs attitudes and practice has to be addressed to. Non-invasive prenatal testing might be the future and is quickly bring about a shift in the paradigm in prenatal screening.
Prognosticating ovarian reserve by the new ovarian response prediction index
Authors: Tak Apoorva , Chauhan Madhubala , Tak Bharti
Published: February 2018

Background: Knowledge of patient's potential ovarian response can help individualise the medication dosage and thus prevent adverse effect of excessive ovarian response and, decrease the rates of cancelled cycles, overall it will help to improve the cost benefit ratio of ovarian stimulation regimes. In addition to age, several clinical, endocrine and USG markers and dynamic tests have been proposed for the prediction of ovarian response to stimulation. Among these use of AMH levels and AFC are of particular interest However, despite the predictive power that each marker for the ovarian response may individually have, all these markers have errors associated with their estimation. So, prediction of ovarian response using a single biomarker may not be sufficient for formulation of a precise treatment plan.Methods: This study includes 50 patients undergoing ivf cycle. All patients satisfied the following criteria; age <or equal to 39 yrs, BMI between 20-30, regular menstrual cycles, both ovaries present, no history of ovarian surgery, no severe endometriosis and no evidence of endocrine disorders. The only exclusion criteria was the presence of ovarian cysts as assessed by TVS.Results: The results showed significant correlation between the number of obtained follicles and the number and maturity of collected oocytes. In addition, the results using the ORPI were always better than those obtained using other predictive factors (AFC, AGE and AMH) separately.Conclusions: The present study reinforces the ORPI, which is a simple 3 variable index that exhibits an excellent ability to predict low and excessive ovarian response. ORPI might be used to improve the cost benefit ratio of ovarian stimulation regimens by guiding the selection of medication and by tailoring the doses and regimens to the actual needs of patients.
Laparoscopic management of heterotopic pregnancy in an IVF conception
Authors: Shah Nitin H. , Shah Riddhi J. , Kshirsagar Swapnali
Published: February 2018

Heterotopic Pregnancy cases are on the rise in the era of Artificial Reproductive Techniques and managing these pregnancies can be challenging especially in safeguarding the precious intrauterine pregnancy. These were traditionally managed by laparotomy and there are few cases reported wherein salpingectomy is done laparoscopically. We would like to report this case of a 7 weeks intrauterine pregnancy with 5 weeks tubal ectopic treated by laparoscopic salpingectomy under spinal anaesthesia while safeguarding the intrauterine viable gestation. In the light of increased incidence of abnormal implantations and growing demand and expertise of minimally invasive surgeries, laparoscopy is the treatment of choice for heterotopic pregnancies, especially in the interest of the intrauterine pregnancy.
Rare case of vaginal leiomyoma in an adolescent girl: a diagnostic dilemma
Authors: Upadhyay Manisha , Chauhan Meenakshi , Gautam Sarika , Yadav Tek Chand
Published: February 2018

Vaginal leiomyoma are very uncommon primary tumors of vagina. They are extremely rare in adolescent age group. They can have variable clinical presentations and could be difficult to diagnose at times in adolescents. We report an extremely rare and novel case of primary vaginal leiomyoma with hyaline degeneration in an adolescent girl which was primarily misdiagnosed as hematocolpos or vaginal malignancy due to its clinical presentation. A 14-year-old girl presented with complains of difficulty in passing urine and irregular vaginal bleeding. On per rectal examination an ill-defined bulge was felt anteriorly and altered chocolate color blood was coming out of vagina. Her ultrasonography report was suggestive of a cervicovaginal mass or hematocolpos. So, examination under anesthesia (EUA) was planned with probable diagnosis of hematocolpos due to secondary reasons or malignancy. On EUA a soft cystic vaginal mass was felt arising from the anterolateral wall obscuring the cervical os and cervix was felt behind it separately. Biopsy was taken from the mass which was confirmed histopathologically and immunohistochemically as vaginal leiomyoma with hyaline degeneration. Patient was managed successfully with complete tumor resection through vaginal approach followed by vaginal reconstruction. Though rare but the differential diagnosis of vaginal leiomyoma should always be kept in mind in adolescent girls presenting with vaginal mass and abnormal vaginal bleeding. Primary vaginal leiomyoma can be completely cured by surgery if diagnosed timely and appropriately so, should never be missed in adolescent age group.
A rare case report of congenital high airway obstruction syndrome presenting in a 23 weeks foetus
Authors: Kanchana Madurai Padmanabhan , Sellamuthu Muthu Prabha , Mahendran Revathy
Published: February 2018

Congenital High Airway Obstruction Syndrome or CHAOS is a blockage of the foetus’s trachea or larynx due to many factors including narrowing of the airway, a web-like membrane or even tracheal atresia. In the uterus, the foetal lungs constantly produce fluid and as a result of this airway blockage in the trachea, the lung fluid cannot escape out of the foetal mouth. Because of this the foetus’s lungs become distended with fluid and over distended lungs can put pressure on the heart and affect the heart’s ability to function. If the heart cannot function effectively hydrops or congestive heart failure can occur. We present a rare case of CHAOS diagnosed prenatally at about 23 weeks by USG in our hospital.
Postoperative outcomes of varicocelectomy and impact of on infertility among sample of patient in Baghdad, Iraq
Authors: Al-Gaysi Abdulraheem Ali Bakheet , Masaoodi Sami Hamad Oleiwi , AbuAlmaali Haider A.
Published: February 2018

Background: Varicocele is the possible cause of 35% primary infertility, 70-80 % secondary and it is associated with progressive and duration dependent decline in testicular function. The aim of this study was to assess the postoperative outcome of varicocelectomy and determine positive impact on ability to reduce infertility.Methods: Twenty-five infertile male patients with varicocele, their age range from (20-40) year mean (30 year), were included and evaluated prospectively and retrospectively in Al-Karama teaching hospital from 2013-2016. Patients were divided in present study according to age of patient, degree of varicocele, duration of infertility and type of infertility. Site of varicocele was either left unilateral or bilateral. All the patients were treated surgically using three different approaches; Retroperitoneal approach, Inguinal and Sub inguinal approach and Scrotal approach.Results: It is noticeable that scrotal swelling was the most frequent complication and infection was the second highest. According to the age of patient, it was shown that beneficial effect of the Varicocelectomy was most favourable among younger age group. It is observables that favourable outcome was better among those with secondary fertility. It was found that grade III varicocele was associated with better outcome in terms of pregnancy and sperms motility.Conclusions: Scrotal swelling and infection was the most highly reported complication. Favourable effect of the Varicocelectomy was most among younger age group, secondary fertility and grade III varicocele.
New technique for laparoscopic partial splenectomy to decrease blood loss
Authors: Morshed Ghada , El-Gaabary Tamer
Published: February 2018

Background: Laparoscopic splenectomy is feasible, effective, and safe with low morbidity rates, faster recovery when compared with patients who undergo open splenectomy. The aim of this study was to describe a new technique for laparoscopic partial splenectomy to decrease blood loss.Methods: This study started from May 2015 till April 2017. This retrospective study included total 20 adults containing 12 females, ten with hydatid cyst of the spleen with positive serological tests for Echinococcus granulosus (Indirect hemagglutination (IHA)) was used, and two cases with congenital splenic cysts with negative serology for Echinococcus granulosus and eight males with hydatid cyst positive serological tests for Echinococcus granulosus.Results: The mean time for laparoscopic resection was 150 minutes (range from 90 to 200 min). No bleeding, no postoperative pancreatic fistula or diaphragmatic injury. No conversion was necessary. The mean hospital stay was 4 days (range from 2 to 6 days). None of the patients needed postoperative blood transfusion. No post-splenectomy infections. Three weeks and after 6 months postoperatively, US Doppler was done and found normal vascularisation of the splenic remnant.Conclusions: Clipless, Sutureless laparoscopic partial splenectomy is feasible and safe. This surgical procedure offers advantages of decrease blood loss and preservation of splenic tissue, reducing the risk of post-splenectomy sepsis.
A clinical study of the incidence and disability caused by mesh neuralgia after inguinal mesh hernioplasty and the effects of prophylactic ilioinguinal neurectomy and its role in preventing chronic groin pain after inguinal hernioplasty
Authors: Sunkar Samrat , Brashier Dick B. S. , Bhagwat Kiran , Sharma Vipin , Angrish Piyush
Published: February 2018

Background: Residual neuralgia, called as Inguinodynia, is an important complication unique to groin hernia repair. The reported incidence ranges between 9-63%. The symptoms are potentially disabling. Symptoms are often more pronounced on axial twisting of body. Methods for prevention include identification and preservation of all nerves, Ilioinguinal Neurectomy and triple Neurectomy during surgery.Methods: One hundred patients underwent elective unilateral Lichtenstein’s tension free hernioplasty. 50 patients were subjected to elective ilioinguinal neurectomy. The remaining underwent standard Liechtenstein’s mesh hernioplasty, without ilioinguinal neurectomy. Randomization was achieved by allocating alternate patients to each group - prophylactic neurectomy, or nerve preservation. All patients, during each review were asked to fill out a Pain Disability Questionnaire to assess sensory loss and pain disability objectively.Results: At completion of 6 monthly follow up pain at rest (none in group ‘A’ compared with 3 in group ‘B’), after coughing 5 times (none in group ‘A’ compared with 7 in group ‘B’), after climbing 4 flights of stairs(3 in group ‘A’ compared with 16 in group ‘B’) and after cycling for 20 minutes (11 in group ‘A’ compared with 22 in group ‘B’) were all significantly lesser in the neurectomy group as compared with the non neurectomy group. More importantly, exertional chronic pain incidence at 6 months was significantly less in group ‘A’.Conclusions: It was concluded that pain after inguinal mesh hernioplasty is a cause of morbidity, pain was complained of by a significantly larger number of non-neurectomised patients at 6 months of follow-up, prophylactic ilioinguinal neurectomy is associated with reduced exertional chronic groin pain, disability caused by pain after inguinal hernioplasty, is significantly reduced by ilioinguinal neurectomy and an extremely significant reduction in the requirement of medication is brought about by neurectomy compared with controls.
Predicting difficult laparoscopic cholecystectomy
Authors: Gupta Atul Kumar , Shiwach Nitin , Gupta Sonisha , Gupta Shalabh , Goel Apoorv , Bhagat Tripta S.
Published: February 2018

Background: Laparoscopic cholecystectomy (LC) has become the gold standard treatment for gallstone disease. Though mostly safe occasionally it can be difficult due to various problems faced during surgical procedure. Anticipation of likely difficulty can help in avoiding complications.Methods: With the aim of identifying various predictors of difficulty and their correlation with likely difficulty this prospective study on 50 adults undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis was undertaken. Various clinical, radiological and biochemical predictors and frequency and type of intraoperative difficulty was recorded.Results: In present study adverse clinical factors only showed significant predictive value (p value - 0.005). Adverse radiological predictors although showing trend towards, did not achieve statistical significance (p value 0.065). In clinical predictors duration of symptoms >1yr, History of acute cholecystitis and BMI >30 showed statistically significant association. Age >50yrs, Male gender, radiological predictors (Thickened gall bladder wall, small contracted gall bladder, Single large impacted stone) and deranged LFT did not show significant predictive value.Conclusions: Clinical predictors are most reliable factors. Use of good clinical judgement regarding possibility of and likely difficulty along with understanding of available resources is important in making decision in each case.
Study of testicular perfusion after Lichtenstein hernioplasty in uncomplicated inguinal hernia
Authors: Nath Prabhu , Dey Subhajeet , Karim Tanweer , Jain Atul , Katiyar Vivek Kumar , Patel Gaurav
Published: February 2018

Background: Inguinal hernia repair is one of the most commonly performed surgical procedures in the world. The aim is to achieve a recurrence free hernia repair with minimum of complications. In mesh inguinal hernia repair testicular cord structures are in direct contact with the mesh. Testicular ischemia usually manifests within 48-72 hours after surgery. Aims of the study was to asses any changes in perfusion of ipsilateral testis after Lichtenstein hernioplasty and establish a baseline testicular perfusion pattern in the study population. This study was conducted in the Department of Surgery for one year at a tertiary care teaching hospital in Delhi.Methods: All consenting adult male patients undergoing Lichtenstein inguinal hernioplasty for unilateral inguinal hernia fulfilling the inclusion and exclusion criteria. A sample size of 50 was included in study.Results: In this study patients were above 18 and below 60 years of age with mean age of 43.58 years.  The paired T-test analysis revealed no statistically significant difference between pre and post-operative values of SV, DV, RI, PI and TV.Conclusions: Lichtenstein tension free mesh repair for uncomplicated inguinal hernia does not impair testicular perfusion after the procedure.
A case of ectopic testis: an intraoperative enigma instead of a diagnostic enigma
Authors: S. D. Veershetty , K. Manjunath , Prakash O. G. , Hanumanthaiah K. S. , S. Rajagopalan
Published: February 2018

Author present a case of persistent mullerian duct syndrome with transverse testicular ectopia with bilateral hernia uteri inguinalis in a 17 years old boy. This is a rare congenital anomaly and an uncommon form of male pseudo-hermaphroditism characterized by the persistence of well-developed Mullerian duct structures in an otherwise normal male with a 46 XY karyotype. Transverse testicular ectopia (TTE) is one of the rarest forms of testicular ectopia. In this condition, both testes are located on one inguinal side and the opposite inguinal canal and scrotum are empty. TTE associated with PMDS is much rarer. The exact cause of PMDS is uncertain. However, it is thought to result from the failure of synthesis or release of Mullerian inhibiting factor (MIF), the failure of end organs to respond to MIF, or a defect in the timing of the release of MIF. Patients with PMDS present with unilateral or bilateral cryptorchidism and an inguinal hernia containing a fallopian tube, uterus and testis. The case was diagnosed on doing diagnostic laparoscopy followed by bilateral inguinal herniorrhaphy and right Orchidectomy.
Isolated congenital microgastria in 4 years old child: a case report
Authors: S. Pramod , K. Ravikiran
Published: February 2018

Microgastria is a rare congenital anamoly. It was first reported in 1800s. It occurs in association with other anamolies. Common associated anomalies include asplenia, malrotation of intestine, upper limb anomalies, situs inversus. Isolated cases of Microgastria are very few in literature. Most cases of microgastria present during infancy. This is a report of a four year old child, eldest in litreature presenting with isolated microgastria. Child presented with vomiting, failure to thrive. Child underwent excision of stomach and oesophago-jejunostomy with pouch after initial stabilization. The child had an uneventful post-operative recovery.
Youth, Catholic Church and Internet: Approaches Possible?
Authors: Bungenstab Gabriel Carvalho
Published: February 2018

This article seeks to understand the relationship between the youth and the Catholic Church (specifically the community of young catholic) in today's society. Assuming that the Church influences the category of youth, despite the "disenchantment of the world" emerged in modernity. We tried to see what the understandings that the Youth Ministry (as Catholics) has on the conceptualization of contemporary Brazilian youth. This requires an analysis of the Youth Ministry (PJ), the Youth Ministry of the Catholic Charismatic Renewal (CCR MJ) and Christian Leadership Training (TLC) website has been performed as well as their social networks in order to find the position of this about today's youth.

Juventude, Igreja Católica e Internet: Aproximações Possíveis?

O presente artigo busca entender a relação entre a juventude e a Igreja Católica (especificamente as comunidades de jovens católicos) na sociedade hodierna. Parte da hipótese que a Igreja influencia a categoria da juventude, apesar do “desencantamento do mundo” surgido na modernidade. Buscou-se enxergar quais os entendimentos que as comunidades de jovens católicos têm sobre a conceituação da juventude contemporânea brasileira. Para tal, foi realizada uma análise dos sites da Pastoral da Juventude (PJ), do Ministério Jovem da Renovação Carismática Católica (MJ RCC) e do Treinamento de Liderança Cristã (TLC), bem como suas redes sociais, a fim de encontrar o posicionamento desta a respeito da juventude hodierna.
Canta Cardenio, canta. Un ovillejo de ida y vuelta
Authors: Ferrer Forés María Ángeles , De Dios Hernández Juan Francisco
Published: February 2018

Cervantes - de la Vega - Esnaola - Barbieri. Cuatro pilares sobre los que desenredar la estructura musical del Ovillejo quijotesco, una forma literaria ya de por sí sonora que tuvo una singular recepción en el catálogo musical cervantino. Esta investigación quiere presentar un trabajo analítico comparado desde el cual poder valorar elementos estéticos significativos del arranque de la música nacionalista tanto argentina como española. Tanto Barbieri como Esnaola coincidirán en las posibilidades musicales del Ovillejo cervantino desde la adaptación realizada por el dramaturgo Ventura de Vega. Encontraremos una resolución técnica diferente que define en buena medida las claves estéticas de una incipiente identidad sonora nacionalista que toma como centro y pretexto de acción la novela cervantina.
NILAI-NILAI PENDIDIKAN AKHLAK PADA NOVEL HAFALAN SHALAT DELISA KARYA TERE LIY
Authors: Zulaicha Siti
Published: February 2018

This study aims to find the values of moral education (ahklaq) and describe the characteristics of the characters who appear in the Hafalan Shalat Delisa novel and its relevance in the current era of globalization. It is a library research, whereas the data collection uses documentary method, data analysis uses content analysis. The results obtained from this study are: (1) moral values education contained in the novel include the educational value towards: a) God (prayer, dhikr, and pray to Allah, upright accept acts of God, fear of God’s torture, and fear of losing the God’s grace), b) family (mutual respect, devotion, love and care for his family), c) self or ahklaq Mahmudah namely: (impatient, upright, gratitude, optimism, mutual help, hard work, and discipline) and ahklaq madzmumah (ignorant, stubborn, lying and jealousy) d) family (conjugal affection rights, the rights of the husband and wife together, birul walidain) e) environment (nurture and care all created by Allah SWT well). (2) Characteristics of the existing characters in the novel such as Delisa, the errant six years old girl who has different characteristics with children in her age in the case of curiosity, the character Ummi Salamah is a wife as well as good mother (shalihah) who possess high discipline in educating her children. (3) The relevance of educational values in globalization era is the importance of moral education. Through the character education curriculum as well as moral education as early as possible either at home, school, environment, and society to overcome moral decadence.
Tumor de Frantz: el tumor de las mujeres jovenes. Correlacion Radiologico-patologica de dos casos en tomografia revision de la literatura.
Authors: Tafur Anzola Alvaro , Suarez Jiménez Daniel
Published: February 2018

El tumor de Frantz o tumor sólido pseudopapilar del páncreas, es un tumor raro único de bajo potencial maligno que afecta principalmente a mujeres jóvenes con un promedio de edad de 21,97 años. Las pacientes son generalmente asintomáticas y es descubierto de manera incidental mediante examen físico y la realización de imágenes por otras razones. La tasa de curación con la resección total del tumor es mayor al 95%. Por lo tanto, el análisis realizado por las imágenes en resonancia magnética o en tomografía y la posterior confirmación patológica, demuestra con precisión las características de este tumor para su mayor comprensión y poder realizar un rápido diagnóstico y tratamiento oportuno.
Compromiso pulmonar en la enfermedad hepática: una actualización
Authors: Vásquez Rodríguez Juan Felipe , Yurgaki James Milton , Rada Escobar Robin
Published: February 2018

La enfermedad Hepática es una causa importante de morbilidad y Mortalidad en el mundo; asociada a compromiso orgánico múltiple. En el pulmón, tres condiciones clínicas han sido descritas; estos cuadros Incluyen, el Síndrome Hepatopulmonar (SHP), que obedece a un trastorno de la oxigenación por dilatación de la vasculatura pulmonar. La hipertensión portopulmonar (HPP), mediada por desequilibrio entre agentes vasodilatadores y vasoconstrictores que conducen a un aumento de la presión media de la arteria pulmonar y por último el Hidrotórax Hepático (HH), que es la condición menos prevalente, se fundamenta principalmente en anomalías anatómicas del diafragma, con o sin relación a la presencia de ascitis. La presencia SHP o HPP es predictor independiente de mortalidad, resaltando su importancia en la elegibilidad de pacientes para trasplante hepático ortotópico como medida curativa.
Endocarcinoma gástrico y embarazo reporte de dos casos y revisión de la literatura
Authors: Fory A Johana , Arenas Vanesa , Carmona Vicente , Llanos Javier
Published: February 2018

La incidencia de cáncer durante la gestación es de 1: 1000 a 2000 embarazos, siendo los más frecuentes el de cérvix, mama, ovario, melanoma, tiroides, colon y hematológicos como linfoma y leucemia. A pesar de ser una entidad poco frecuente en el embarazo, se ha visto una tendencia a aumentar en los últimos años debido al incremento progresivo de la edad materna en el momento de la concepción.El carcinoma gástrico es una patología aún menos frecuente, siendo su incidencia durante la gestación de aproximadamente 0.016% a 0.026% en las series de casos de Japón, país con la mayor prevalencia de enfermedad.  La cirugía es el tratamiento oncológico menos controversial durante la gestación. En los últimos años, ha cobrado importancia la quimioterapia adyuvante con antineoplásicos de tipo antimetabolito como el 5 fluoracilo (5 – FU), medicamento que ha demostrado mejoría de la supervivencia en pacientes gestantes con adenocarcinoma gástrico. Desafortunadamente, el 96.7% de los casos son diagnosticados en estadíos avanzados, pues su presentación clínica suele confundirse con las manifestaciones propias de la primera mitad de la gestación como son las nauseas y el vomito. Presentamos dos casos clinicos, el de una gestante de 34 años con embarazo de 19 semanas y 3 días al momento del diagnóstico de un carcinoma gástrico Bormann III, llevada a laparotomía con intención curativa a las 21 semanas con hallazgo intraoperatorio de enfermedad metastásica avanzada y tumor ovárico izquierdo sugestivo de tumor de Krukenberg, a quien se le inicia a las 23 semanas quimioterapia paliativa con esquema FOLFIRI el cual recibió hasta la finalización de la gestación a las 33 semanas por restricción del crecimiento intrauterino y posteriormente durante el puerperio;  y el de una gestante de 31 años con embarazo de 26 semanas y 6 días quien se ingresa para estudio de emesis persistente durante la gestación con confirmación diagnóstica de adenocarcinoma gástrico Bormann III asociado a Restricción del crecimiento intrauterino que fue llevada a cesárea a las 34 semanas y en el puerperio a gastrectomía total con vaciamiento ganglionar del area celiaca y reconstrucción en Y de Roux.El objetivo de realizar estos reportes surge de la carencia de guias de manejo respecto a dicha entidad durante la gestación debido a la poca frecuencia de presentación de la misma. Es frecuente encontrar discrepancias entre los conceptos en cuanto a conductas médicas se refiere. Disponemos de reportes y series de casos que orientan el manejo hacia un enfoque interdisciplinario dirigido a sopesar los riesgos y beneficios derivados de implementar o no un tratamiento durante la gestación siendo pocos los casos exitosos reportados en la literatura.
Metodología de implementación del “plan de egreso hospitalario” para personas con enfermedad crónica en Colombia
Authors: Carrillo González Gloria Mabel , Sánchez Herrera Beatriz , Gómez Olga Janeth , Carreño Sonia Patricia , Chaparro Díaz Lorena
Published: February 2018

Objetivo: Diseñar y validar una metodología para implementar el “Plan de egreso hospitalario” como mecanismo de apoyo en el cuidado de la salud de personas con enfermedad crónica (EC) y sus cuidadores familiares (CF) en Colombia.Metodología:  Estudio de tipo descriptivo cuyo desarrollo contó con los siguientes pasos:1) Consolidación de una guía. 2) Validación del proceso propuesto para la implementación del “Plan de egreso hospitalario”. 3) Prueba piloto de implementación. Resultados: Con base en el estado del arte y la definición de pasos del cuidado que se requieren para el alta hospitalaria se propone una guía de acción basada en la revisión de las condiciones de la institución hospitalaria y en el nivel de competencia para el cuidado en el hogar de los usuarios, buscando garantizar un cuidado continuo y seguro al salir de la institución. Conclusiones: La Metodología utilizada para desarrollar el “Plan de egreso hospitalario” para personas con enfermedad crónica en Colombia que se elaboró y validó en el presente estudio aporta elementos conceptuales y de procedimiento para implementar y sistematizar un programa de alta hospitalaria con base en el fortaleciendo de las condiciones institucionales y de la competencia de cuidado por parte de las personas con EC y sus CF.  Dicha metodología constituye una herramienta para ayudar a disminuir la carga del cuidado de la EC en Colombia.
Pertussis: enfermedad reemergente
Authors: Pescador Vargas Beatriz , Roa Culma Laura Alejandra
Published: February 2018

Introducción:  Actualmente a pesar de las estrategias de vacunación a nivel mundial, B. pertussis se ha convertido en un problema de salud pública, sigue siendo una de las enfermedades menos prevenibles por vacunación en todo el mundo, aún en países desarrollados con amplia cobertura de vacunación.Objetivo: Describir los principales mecanismos de virulencia asociados a la infección mediante los cuales la bacteria logra evadir la respuesta inmune, además de dar a conocer un panorama actual del estado de inmunización contra la tos ferina y la problemática de su reemergencia a nivel mundial. Métodos: Se realizó una revisión mediante búsqueda electrónica de literatura; entre las estrategias de búsqueda se destaca el empleo de las bases de datos como PubMed, ScienceDirect, SciELO, Redalyc; y búsqueda en portales de salud; sobre aspectos generales de la enfermedad y su agente causal, además de últimas actualizaciones sobre el tema.Resultados: Como lo confirman recientes estudios, el incremento del riesgo de infección por B. pertussis sigue presentándose en adolescentes y adultos debido a la disminución en la respuesta inmune inducida por la vacunación y la infección natural, por ende, la información actual indica que está reemergiendo la tos ferina en todo el mundo, situación que es necesario conocer para un oportuno diagnóstico y tratamiento. Conclusiones: Análisis de la literatura demuestra la necesidad de ampliar el uso de técnicas moleculares; llevar a cabo la modificación de los programas de vacunación, con la administración de dosis de refuerzo entre adolescentes y adultos; además programas de monitoreo epidemiológico eficaces de recolección de casos con tos ferina y sistemas adecuados de notificación para lograr la reducción equitativa y sustentable de la morbilidad y mortalidad de ésta enfermedad.
Prevalencia de síntomas respiratorios y riesgo de obstrucción al flujo aéreo en Ginebra - Valle del Cauca
Authors: Bastidas Goyes Alirio , Villán Gaona Jorge , Betancourt López Valeria , Suarez Niño Andrea , Hincapié Díaz Gustavo Adolfo
Published: February 2018

Antecedentes y Objetivo: La prevalencia de los principales síntomas respiratorios en Ginebra (Valle del Cauca) es desconocida. Este estudio busca investigar la prevalencia de disnea, tos, sibilancias y expectoración en Ginebra, un municipio rural de Colombia.Métodos: Se realizó un estudio de corte transversal, con una estrategia de muestreo por conglomerados para tener una muestra representativa de adultos mayores de 40 años. Cada paciente fue entrevistado con dos cuestionarios, el cuestionario de síntomas respiratorios Ferris validado para el español y el cuestionario de función pulmonar (LFQ), de este último, un puntaje menor o igual a 18 puntos fue considerado como riesgo de obstrucción al flujo aéreo. El análisis de datos fue realizado con software estadístico, el tamaño de muestra fue de 115 sujetos (prevalencia 50%, precisión 10% y porcentaje de pérdida del 20%), las variables cuantitativas se resumieron en frecuencias y porcentajes y las variables cuantitativas en medianas y rangos intercuartílicos, la prevalencia de síntomas respiratorios se calculó con un intervalo de confianza del 95% y se realizaron cruces exploratorios entre las variables de síntomas respiratorios y antecedentes exposicionales.Resultados: 146 sujetos, 2 pérdidas, mediana de edad 60,5 años (RIQ:22), 52,1% hombres, prevalencia de tos 18,1% (IC95%:11,8-24,3), expectoración 20,1% (IC95%:13,9-27,1), sibilancias 28,2% (IC95%:21,1-35,9), disnea 33,3% (IC95%:25-41), personas a riesgo de limitación flujo aéreo 19,4% (IC95%:14,2-28,4). En la realización de cruces exploratorios se obtuvo una relación entre el número de paquetes año y la presencia de tos (p=0,008), antecedente de exposición a leña y tos (p=0,008), número de paquetes año y expectoración (p=0,018), sibilancias y consumo de cigarrillo (p=0,047), disnea y antecedente de enfermedad coronaria (p=0,028), disnea y antecede de hipertensión arterial (p=0,037).Conclusión: La disnea es el síntoma respiratorio más frecuente en pacientes mayores de 40 años en Ginebra (Valle del Cauca), el antecedente de tabaquismo se relacionó con tos y sibilancias. La utilización de un cuestionario de síntomas respiratorios puede ser útil para identificar pacientes con riesgo de obstrucción al flujo aéreo cuando se compara con el auto-reporte de enfermedad respiratoria.
Síndrome de Mauriac reporte de caso clínico
Authors: Gallardo Lizarazo María del Pilar
Published: February 2018

Se presenta un caso de un niño de 11 años evaluado en el Hospital Niño Jesús de la ciudad de Barranquilla con características de síndrome de Mauriac; dicho síndrome está descrito como una complicación en pacientes con diagnostico de diabetes mellitus tipo I, que no se encuentran metabólicamente controlados y se caracteriza por presencia de hepatomegalias, elevación de transaminasas, retraso puberal y cambios físicos cuchingoides asociados. Son pocas las referencias bibliográficas publicadas en los últimos años, ya que su morbilidad es muy baja debido al auto monitoreo glucémico, la intervención de nuevas insulinas y diagnóstico precoz.
Aspectos Socioambientais da Pesca Manejada de Pirarucus (Arapaima gigas) no Sistema de Lagos Jutaí-Cleto, Reserva de Desenvolvimento Sustentável Mamirauá, AM
Authors: Alencar Edna F. , Sousa Isabel Soares de
Published: February 2018

O artigo analisa os aspectos socioambientais do projeto de manejo de pirarucus (Arapaima gigas) desenvolvido por um coletivo de pescadores e pescadoras residentes em quatro comunidades da Reserva de Desenvolvimento Sustentável Mamirauá (RDSM), estado do Amazonas, no sistema de lagos do Jutai-Cleto. O objetivo é descrever a forma de organização do trabalho para a captura dos animais, e destacar a importância desse projeto para a conservação de recursos pesqueiros na várzea amazônica, para a reprodução de saberes ecológicos tradicionais e de técnicas de pesca. Os dados analisados resultam de pesquisas realizadas entre os anos de 2011 e 2016 com esse coletivo de manejadores, obtidos com uso de metodologias participativas, com a observação direta de suas práticas, participação em reuniões e realização de entrevistas formais com pescadores e pescadoras. O artigo mostra que os conhecimentos ecológicos tradicionais são combinados aos conhecimentos científicos, e permitem aos pescadores tomar decisões sobre o momento e lugar de realizar a pesca nos lagos. A organização do trabalho na pesca manejada é orientada por conceitos como igualdade, cooperação, e equidade de gênero, mas a divisão do grupo em equipes, e o domínio de conhecimentos especializados sobre a ecologia e o comportamento dos animais, e sobre as características do ambiente, repercutem na produtividade da pesca, e na individualização dos ganhos. Concluímos mostrando que o projeto de manejo está contribuindo para a circularidade de saberes relacionada à pesca de pirarucus, e a importância da participação das mulheres, criando as condições para que as crianças sejam envolvidas nessa atividade.
Conflito Social: O Caso da “Pesca de Marrecas” na Reserva Extrativista Marinha de Tracuateua (PA)
Authors: Rodrigues Monique Rocha , Schmitz Heribert
Published: February 2018

O artigo tem como objetivo analisar o conflito social relativo à captura da marreca na Reserva Extrativista Marinha de Tracuateua, no litoral paraense. Essa prática é conhecida localmente como “pesca de marrecas”. Foi realizado um estudo de caso em três comunidades localizadas na área circundante à reserva, por meio de entrevistas (não diretivas e semiestruturadas) e de observações diretas. O conflito social decorre de opiniões, interesses e necessidades divergentes em relação ao uso de recursos comuns. A análise indica que o conflito se encontra num nível elevado de escalação.
Histórias e Memórias Sobre a Pesca do Pirarucu no Auati-Paraná: do Barracão ao Manejo Comunitário
Authors: Silva Katiane
Published: February 2018

O presente artigo, de caráter etnográfico e histórico, tem como objetivo apresentar reflexões preliminares sobre a importância e as dinâmicas da pesca do pirarucu (Arapaima gigas) na bacia hidrográfica do Auati-Paraná (tributário do Rio Solimões, Amazonas). A partir da perspectiva de indígenas Cocama, conhecidos como especialistas em técnicas de pesca desta espécie. Assim, proponho uma discussão de como as estratégias de manutenção das técnicas “tradicionais” deste tipo de pesca foram se modificando de acordo com as intervenções empresariais e estatais que instituíram novos modos de regulação social.
A Participação das Mulheres na Reserva Extrativista Caeté/Taperaçu na Comunidade de Taquandeua-Bragança/PA
Authors: Pillett Edileuza Amoras
Published: February 2018

A pesquisa “A Participação das Mulheres na Reserva Extrativista Caeté/Taperaçu na Comunidade de Taquandeua”, tem como perspectiva compreender a participação da mulher na atividade extrativista, discutindo o seu papel na sociedade capitalista; tentando identificar como foi constituída a Reserva extrativista Caeté-Taperaçú na Comunidade de Taquandeua. Observou-se quais os benefícios e as vantagens da reserva extrativista para os moradores da referida comunidade; procurando descrever o papel da mulher da comunidade de Taquandeua. A pesquisa de campo ocorreu no período de janeiro a abril de 2016, na qual 31 mulheres participaram da pesquisa. É uma pesquisa de caráter qualitativo, com entrevistas semi estruturadas e observação participante. Uma breve análise nos leva a deduzir que o modelo de desenvolvimento ainda prioriza a figura masculina em detrimento ao feminino nos espaços de trabalho agrícola e de extrativismo. Sugere-se que as ações da gestão da Resex Caete/Taperaçú  também sejam direcionadas para as trabalhadoras rurais considerando as necessidades básicas das mulheres camponesas para garantir um desenvolvimento mais humano e sustentável.
Low-grade fibromyxoid sarcoma: a rare condition with high proliferation
Authors: KARİMİ KHEZRİ Marzieh , TAŞKAPILIOĞLU M. Özgür , TÜRKKAN Alper , YALÇINKAYA Ulviye , BEKAR Ahmet
Published: February 2018

Low-grade fibromyxoid sarcoma
(LGFMS) is a type of high metastatic potential of the fibrosarcomas. Most
of the time there is a long interval between tumor presentation and metastasis.
We present 2 cases of LGFMS. The first is a 31-year-old female with a mass in
anterior aspect of her left thigh, and the other is a 68-year-old female with
mass in posterior of her neck. Both cases underwent operation for several times
and confirmed as LGFMS histopathologically, there is no exact protocol for
postoperative follow-up to detect early metastases according to the relative variety
of LGFMS. So informing the patients about the long-standing metastatic
potential of their disease is important.
Çok Yıllık Serin Mevsim Buğdaygil Yem Bitkilerinde Yaz Dormansisi
Authors: ÖNAL AŞCI Özlem , EĞRİTAŞ Ömer
Published: February 2018

Bitkiler bazı
stratejiler geliştirerek olumsuz çevre şartlarında hayatta kalırlar. Bu
stratejilerden birisi de dormansidir. Bu makale, bitkilerin yaz mevsiminde
yaşadıkları yaz dormansisi hakkında bilgi sunmak amacıyla hazırlanmıştır. Yaz
dormansisi bitkilerin yaşadığı bir endo-dormansi türüdür. Fenotipe bakarak
bitkinin endo-dormansi yaşadığını belirlemek oldukça güçtür. Bu nedenle
dormansi türünü doğru belirlemek gerekmektedir. Yapılan çalışmalar sonucunda,
buğdaygiller familyası da dâhil olmak üzere farklı familyalara ait birçok bitki
türünde yaz dormansisi belirlenmiştir. Hem yem bitkileri tarımında üretimi hem
de meraların verimini artırmak için çok yıllık serin mevsim buğdaygil yem
bitkilerinin mutlaka yetiştirilmesi gerekmektedir. Yaz dormansisi yaşayan
bitkilerde toprak üstü aksamda kısmen veya tamamen ölüm yaşanırken, toprak
altındaki meristematik dokular ise canlılıklarını devam ettirmektedirler.
Dolayısıyla bitkiler ekstrem şartlarda hayatta kalabilmektedirler. Ancak yaz
dönemindeki verimleri oldukça düşüktür. Bu nedenle bitkilerin dormansi özelliği
net olarak belirlenmeli ve yetiştirileceği bölge, uygulanacak kültürel işlemler
doğru tercih edilmelidir.
Ak Üçgül (Trifolium repens L.) Populasyonlarında Genetik Çeşitliliğin Belirlenmesi
Authors: DEMİRKOL Gürkan , YILMAZ Nuri
Published: February 2018

Sürdürülebilirlik ancak sahip olunan genetik
kaynakların kullanımı ve korunması ile mümkün olabilmektedir. Ak üçgül (Trifolium repens L.) ülkemiz
meralarında, park ve bahçe alanlarında yaygın olarak bulunan çok yıllık bir
baklagil yem bitkisi olmakla birlikte önemli bir genetik hazine kaynağıdır. Bu
çalışma ülkemizin yedi ilinden farklı yüksekliklerden toplanan ak üçgül
populasyonlarının genetik farklılıklarının belirlenmesi amacıyla yürütülmüştür.
Çalışma kapsamında toplanan on beş populasyonun genetik farklılıklarının
belirlenmesinde altı adet Basit Dizi Tekrarları (SSR) markörü kullanılmıştır.
Çalışma sonucunda 56 allel belirlenmiştir. Genetik akrabalıkların görülmesi
amaçlı oluşturulan dendrogramda populasyonlar üç grup altında toplanmışlardır.
Elde edilen sonuçlara göre, özellikle yüksek rakımlı duraklardan toplanan
populasyonların çoğunlukla aynı grup içerisinde yer aldıkları görülmüştür. Bu
durum toplanan örneklerdeki genetik çeşitliliğin coğrafi dağılım ilişkisini
ortaya koymuştur. Sonuç olarak, ak üçgül ıslahı çalışmalarında gerekli
materyali sağlama açısından ülkemizin zengin bir genetik çeşitliliğe sahip
olduğu anlaşılmıştır.
Sıcaklık Nem İndeks Değerlerinin Süt Sığırcılığı Açısından Değerlendirilmesi: Siirt İli Örneği
Authors: KİBAR Mustafa , YILMAZ Ayhan , BAKIR Galip
Published: February 2018

Türkiye bulunduğu
coğrafi konum itibariyle dört mevsimin birlikte yaşandığı, ılıman iklime sahip
bir ülkedir. Yaz aylarındaki (Haziran, Temmuz, Ağustos, Eylül) günlük ortalama
sıcaklık değerleri 25 oC’nin üzerine çıkabilmektedir. Özellikle nem
oranının yüksek olduğu Akdeniz ve Ege Bölgesi’nde, ayrıca sıcaklığın çok yüksek
olduğu Güneydoğu Anadolu Bölgesi’nde bütün canlılar ısı stresine maruz
kalabilmektedir. Hayvansal üretim bakımından değerlendirildiğinde, ısı stresi
bu bölgelerde yetiştirilen süt ineklerinde önemli verim kayıplarına neden
olabilmektedir. Isı stresini belirlemede ve değerlendirmede bazı ölçütler
kullanılmakla birlikte en yaygın kullanılan parametre sıcaklık-nem indeksi
değeridir. Siirt ili ve ilçeleri için sıcaklık nem indeksi değerlerini saptamak
için Siirt Meteoroloji Müdürlüğü ile ilçelerdeki meteoroloji istasyonlarının
verilerinden yararlanılmıştır. Buna göre Siirt Merkez, Pervari, Baykan,
Kurtalan, Şirvan ve Eruh ilçelerine ilişkin sıcaklık nem indeksi değerleri
sırasıyla 72.43,  67.64,  71.80, 72.34, 71.67 ve 68.87 olarak
bulunmuştur. Çalışmada Siirt il merkezi ile ilçelerinde Haziran, Temmuz,
Ağustos ve Eylül aylarında sıcaklık nem indeks değerlerinin eşik değeri olarak
bildirilen 65 veya 72 değerlerinin üzerine çıktığı saptanmıştır. Ancak ısı
stresi açısından istatistiki olarak Pervari ve Eruh ilçelerinin diğer ilçelere
oranla süt sığırcılığına daha uygun olduğu anlaşılmıştır (p<0.05). Sonuç olarak, Siirt koşullarında
sürdürülebilir bir süt sığırcılığı için ısı stresinin ortaya çıktığı zamanlarda
yeterli serinletme sistemlerinin kullanılması gerekmektedir.