bluuebunny/crossref_metadata_2025 huggingface dataset:
Enfoque de la parálisis flácida en urgencias
Authors: López Barreto Juan Camilo , Cardenas Jose Mauricio
Published: March 2023

Introduction: Flaccid paralysis is a cause of consultation in emergency services, with different etiologies, it can be immune-mediated or secondary to systemic diseases, which can lead to quadriparesis and ventilatory failure due to bulbar paralysis.
Objective: To review the initial approach to flaccid paralysis due to neurological syndromes, the pathophysiology, clinical manifestations, diagnosis and treatment of the neurological diseases that make up this entity.
Methods: a critical review of the scientific literature was carried out in MEDLINE, PUBMED, ELSEVIER, SCIENCE DIRECT, filtering results from subject reviews, case reports, cross-sectional studies, controlled clinical trials, meta-analysis and management guidelines with a total of 13934 documents, prioritizing 30.
Results: The main cause of flaccid paralysis is Guillain barre syndrome, followed by systemic diseases and other neurological diseases such as myasthenia gravis or transverse myelitis, signs of respiratory failure must be identified early, diagnosis It is mainly clinical, although there are confirmatory studies, and treatment must be started early and in a timely manner with steroids, immunoglobulin or plasmapheresis, and immunomodulation. Conclusion: Flaccid paralysis is a neurological emergency with different etiologies, warning signs must be recognized, an initial approach and early clinical diagnosis must be carried out to initiate timely treatment.
Mejora de procesos en el área de caja para incrementar la satisfacción del cliente en un centro comercial
Authors: Acosta Chavarria Jeferson , Gutierrez Gozzer Luis , Vilcarino Zelada Edgard , Quiliche Castellares Ruth Margarita
Published: March 2023

El trabajo de investigación tiene como objetivo implementar la mejora de procesos en el área de caja para incrementar la satisfacción del cliente en un centro comercial en la ciudad de Chimbote. La investigación es aplicada con un diseño de tipo preexperimental, la población evaluada fue de 384 personas, con un muestreo probabilístico, se usó instrumentos como la guía de observación para poder visualizar los problemas en la caja, ficha de diagrama de flujo para poder reconocer el punto crítico del problema, y el cuestionario basado en el modelo Servqual para medir el grado de satisfacción de los clientes. Los resultados obtenidos de la guía de observación fue 3 principales problemas que daban un acumulado del 60.59% el cual se mejoró a través de la metodología Kaizen, porque al final la percepción del cliente aumentó en cuanto a las diferentes preguntas del cuestionario, para los productos sin código de barra la percepción del cliente fue 18% marcando el valor 4 y 5, en el ágil servicio del área de caja la percepción del cliente fue 17% marcando el valor 6 y en el conocimiento de los códigos de los productos la percepción del cliente fue 18% marcando el valor 4,5 y 6. Se concluye que la mejora de proceso en el área de caja incrementó la satisfacción del cliente.
Diseño y simulación de una maquina clasificadora neumática de materiales, Trujillo 2022
Authors: Alfaro Cabello Mario Alberto , Aguirre Segura Carlos Daniel , Cipiran García Stuart Christien , Aranguri Hernández José Manuel , Zapata Baquedano Gabriel Luisin
Published: March 2023

En este artículo, se presenta la implementación de un proceso de clasificación de materiales (madera, metal y cartón) para la clasificación de estos materiales en un mismo grupo, con el fin de contar con un mejor orden y control para el almacenamiento de estos materiales. Para su elaboración, se utilizaron las fórmulas de diseño de fajas trasportadoras, diseño eléctrico y la simulación en un software utilizado industrialmente para diseños de procesos automatizados. También, se realizaron 4 pruebas con 10 pruebas cada uno, en donde se ingresaron 10 materiales de diferente tipo para obtener resultados de la clasificación, con el cual se realizaría el funcionamiento de la máquina y las pruebas para medir la eficiencia. Finalmente, se concluyó que, el porcentaje de eficiencia fue de 100% estos comparando con antecedentes que aplicaron metodologías para procesos similares, siendo este muy beneficioso para aplicaciones futuras.
Artvin Ardanuç yöresi Doğu Karadeniz göknarı - Doğu ladini karışık meşcereleri için hacim denklemleri
Authors: KAHRİMAN Aydın , ÇAKIR Celal Yavuz , ŞAHİN Abdurrahman
Published: March 2023

Bu çalışmada, Ardanuç Orman İşletme Müdürlüğünde yayılış gösteren Doğu Karadeniz göknarı - Doğu ladini karışık meşcerelerinde gövde hacminin tahmin edilmesi amaçlanmıştır. Bu amaçla 107 adedi Göknar ve 106 adedi ise Ladin olmak üzere toplamda kesilen 213 adet örnek ağaçtan elde edilen veriler kullanılmıştır. Bu denklemler Düzeltilmiş Belirtme Katsayısı (R_(düz.)^2), Tahminin Standart Hatası (Sy.x), Ortalama Hata (D ̅), Ortalama Mutlak Hata (|D ̅ |), Ortalama Mutlak Hata Yüzdesi (%OMH) ve Toplam Hata Yüzdesi (%TH) ölçütüne göre rölatif olarak sıralanmış ve en başarılı denklemler belirlenmiştir. Doğu Karadeniz göknarı ve Doğu ladini için tek ve çift girişli gövde hacim denklemlerinin düzeltilmiş belirtme katsayıları sırasıyla 0.982-0.988 ve 0.981-0.992 olarak elde edilmiştir. Her iki ağaç türü için geliştirilen hem tek hem de çift girişli ağaç hacim denklemleri bağımsız veri seti ile “Wilcoxon T Testi” kullanılarak test edildi ve bu denklemlerin verilerin alındığı Ardanuç yöresindeki meşcerelere uygun olduğu 0.05 anlamlılık düzeyinde belirlenmiştir. Çalışma kapsamında bu veriler kullanılarak her iki tür için tek ve çift girişli ağaç hacim denklemi geliştirilmiştir.
Internal Working Conditions and Well-being of Bank Employees during the Pandemic: A Case Study of Yogyakarta City
Authors: Setiawan Bagoes
Published: March 2023

Since the pandemic conditions, the well-being of employees in Indonesia has continued to decline. The Work Trend Index survey from Microsoft stated that the level of employee well-being reached 68% in 2019, which then dropped to 61% in 2021. This decline in well-being is inseparable from the relationship between the company and employees, manifested in the internal work situation. This study aims to identify the influence of internal working conditions on the well-being of employees, especially in the banking sector, considering the pressure and work stress are pretty heavy. Banking employees are vulnerable to work stress due to high pressure, competition, and demands to provide the best service. Specifically, This study compares the well-being of employees in conventional and Islamic banks, considering that there are differences in the work system between the two. The city of Yogyakarta was then chosen as the object of this research because of the low City Minimum Wage (UMK) of Yogyakarta compared to the five other provincial capitals on the island of Java. The data obtained through a questionnaire from as many as 107 respondents were then processed using multiple regression analysis. The finding of this study is that the well-being of conventional bank employees is statistically higher than that of Islamic banks. In general, work pressure has a negative and significant effect on well-being. Like income, work motivation also positively and significantly impacts well-being.
Measuring Islamic Modernity: Between Positive Alarms or Setbacks for Democracy in Indonesia
Authors: Prayogo Imam , Fithor Alin , Hussin Rosazman
Published: March 2023

Researchers have intensively studied Islamic modernity since the movement has become a reasonably effective tool in mobilizing the masses and seeking political support. Almost 90 percent of Indonesian people are Muslim. The concept of Indonesia in making policies on state issues has resulted in a deadlocked relationship between its people and the concept of a state that tends toward the Dutch colonial nation. Islam is a characteristic of Indonesian society; however, the state does not use the concept in Islam. Hence, the concept of the state not being in line with society has resulted in today’s Indonesian people living full of poverty, even though they live in a country with abundant earth, air, and water wealth, coupled with captivating and unique seas for the world to see. However, how does the modern measure of Islam in Indonesia affect democracy? Using qualitative descriptive research methods with a literature study approach, this study discovered that modern Islam in Indonesia has various motives when viewed from multiple aspects used to describe problems occurring in the past, currently, or projecting issues that will arise in the future as suggestions and constructive criticism. On the one hand, it is a form of community solidarity in mobilizing diverse aspirations for humanitarian aid. Nevertheless, on the other hand, it is ridden by the oligarchs of the political elite to gain votes. Moreover, on the outside, it stretches the actions of Islamic radicalism.
Evaluasi Laju Pengelasan terhadap Mikrostruktur Sambungan Aluminium 5052 dengan menggunakan Metode Friction Stir Welding
Authors: Purwanto Helmy
Published: March 2023

Friction stir welding (FSW) adalah salah satu jenis pengelasan yang mampu menyambung bahan paduan aluminium. Pada penelitian sebelumnya telah dilakukan penyambungan aluminium 5052 namun hasil pengujian tarik memperlihatkan penurunan kekuatan sambungan. Sehingga pada studi ini bertujuan untuk mengevaluasi secara focus mikrostuktur yang terbentuk pada sambungan plat aluminium 5052 yang telah dilakukan FSW. Plat aluminium dengan dimensi 150 x 75 mm dengan tebal 6 mm dilas dengan metode FSW, pahat pin berbentuk silinder pada kecepatan putar 1000 rpm dan laju pengelasan 20, 30 dan 40 mm/menit. Penampang hasil las diamati dengan menggunakan mikroskop optic dan Scanning Electron Microscope (SEM). Hasil pengamatan memperlihatkan adanya cacat makro dan perubahan struktur mikro pada sambungan. Cacat ini dipengaruhi desain pin yang tidak tepat sehingga daerah adukan tidak merata yang berakibat sambungan menjadi tidak sempurna.Friction stir welding (FSW) is one type of welding that is able to joining aluminium alloy. In previous studies, aluminium 5052 has been joined, but the results of the tensile test showed a decrease in the strength of the connection. Therefore, in this study the aim is to focus on evaluating the microstructure formed at the 5052 aluminium plate welding join that has been carried out by FSW. Aluminium plates with dimensions of 150 x 75 mm with a thickness of 6 mm were welded by the FSW method, cylindrical pin chisel at a rotational speed of 1000 rpm and welding rates of 20, 30 and 40 mm/minute. The cross section of the weld was observed using an optical microscope and Scanning Electron Microscope (SEM). The results of the observations showed that there were macro defects and changes in the microstructure of the joints. This defect is influenced by the improper design of the pin so that the area of the mixture is uneven which results in an imperfect connection
Towards The Independence of The Propellant Industry for Munitions and Rocket
Authors: Rifai Akhmad - , Finalis Era Restu
Published: March 2023

Indonesia has not yet been able to generate propellants, which are crucial components of the country's defense system. Long-term reliance on imports for ammunition and rocket components can compromise the TNI's operational readiness. These issues and weaknesses include being susceptible to political pressure and having less independence and deterrence factor readiness. Because it affects national pride in national defense, the installation of a propellant factory should not be postponed. Nitrocellulose, the primary raw material of cellulose and nitroglycerin, whose primary raw material is glycerine, is used as the primary raw material in the production of propellants. Domestic industries have generated the two primary raw materials.
Tax Avoidance dan Tax Risk: Peran Moderasi dari Corporate Governance
Authors: Sihono Agus , Febyansyah Andar
Published: March 2023

Latar Belakang: Tax avoidance dianggap sebagai masalah utama, mengingat kompleksitas dan konsekuensi ekonominya. Tax avoidance yang dilakukan oleh wajib pajak, termasuk didalamnya Perusahaan, akan menyebabkan negara mengalami kerugian, karena pajak adalah sumber pendapatan negara, yang akan digunakan sebagai sumber pembiayaan atas pengeluaran negara. Jika banyak Perusahaan melakukan tax avoidance maka pendapatan negara yang bersumber dari pajak akan terpengaruh. Selain itu, tax avoidance mengakibatkan efek buruk terhadap reputasi suatu Perusahaan.Tujuan: Studi ini bertujuan mengisi kesenjangan yang ada dengan menguji pengaruh tax avoidance terhadap tax risk serta melakukan analisis dampak penerapan corporate governance pada pengaruh tax avoidance terhadap tax risk.Metode Penelitian: Data sekunder digunakan dalam penelitian ini yang diperoleh dari laporan keuangan Perusahaan yang bergerak dalam industry manufaktur yang terdafat di Bursa Efek Indonesia dari tahun 2016 sampai 2020. Analisis data yang digunakan adalah Moderating Regression Analysis.Hasil Penelitian: Hasil studi ini menunjukkan bahwa volatilitas dari effective tax rate dan effective tax rate memiliki pengaruh negatif dan signifikan. Studi ini memberikan bukti bahwa tax risk menurun ketika tingkat tax avoidance Perusahaan menurun, dan sebaliknya. Selain itu, kami menemukan bahwa semakin baik struktur corporate governance Perusahaan, semakin tinggi tingkat pengawasan dan pengendaliannya manajer, sehingga mengurangi dampak tax avoidance pada tax risk Perusahaan di masa depan. Temuan dari studi tentang tax avoidance dan corporate governance perusahaan ini penting bagi investor karena pajak merupakan risiko yang secara signifikan dapat mempengaruhi kesejahteraan investor.Keterbatasan Penelitian: Studi ini memiliki keterbatasan, diantaranya hanya berfokus pada industry manufaktur. Selain itu, studi ini hanya mempertimbangkan audit quality, komisaris independen serta komite audit sebagai pengukuran variabel corporate governance.Keaslian/Novetly Penelitian: Penelitian mengenai tax avoidance dan tax risk telah dilakukan, namun demikian terdapat inkonsistensi hasil penelitian-penelitian tersebut, oleh karena itu peneliti akan melakukan pengujian kembali terhadap variabel tersebut dalam kontek di Indonesia, yang diharapkan akan memberikan bukti baru apakah mendukung atau bertentangan dengan penelitian sebelumnya. Mengacu pada penelitian Choi dan Park (2022), pengukuran corporate governance yang digunakan adalah struktur komisaris independen, audit quality dan komite audit yang sebelumnya belum digunakan dan merupakan saran dari peneliti sebelumnya.
Determinan Opini Audit Going Concern: Studi Kasus Perusahaan Sektor Industri Barang Konsumsi
Authors: Caroline Helen Imelda , Minarso Bambang , Nurcahyono Nurcahyono
Published: March 2023

Latar Belakang: Laporan keuangan merupakan informasi utama bagi stakeholder dalam mengambil keputusan bisnis, sehingga informasi yang dilaporkan haruslah memberikan assurance. Auditor merupakan pihak yang memberikan assurance kepada stakeholder atas kinerja perusahaan, sehingga laporan keuangan menjadi sinyal kepada manajemen atas kesalahan dalam pengambilan keputusan karena akan mempengaruhi kelangsungan usaha. Investor akan menarik dananya jika perusahaan terindikasi bangkrut dan mendapatkan opini audit going concern.Tujuan: Penelitian ini bertujuan untuk membuktikan secara empiris faktor-faktor yang menyebabkan opini audit going concern diberikan oleh auditor.Metode Penelitian: Pendekatan penelitian ini adalah positivis dengan menguji variabel penelitian. Populasi yang dipilih adalah perusahaan sektor food and beverage yang listing BEI tahun 2019 sampai 2021. Serta, purposive sampling dipilih untuk menentukan unit analisis. Analisis data menggunakan regresi logistik dengan bantuan SPSS 26.Hasil Penelitian: Opini audit going concern dipengaruhi oleh debt ratio, ukuran perusahaan, audit lag. Sedangkan kualitas audit dan financial distress tidak mempengaruhi opini audit going concern yang diberikan auditor.Keaslian/Kebaruan Penelitian: Penelitian ini menggunakan prediktor financial distress yang tidak digunakan oleh peneliti sebelumnya. Alasan menggunakan variabel ini dimana perusahaan yang mengalami financial distress menjadi early warning system perusahaan akan bangkrut dan tidak memenuhi syarat sebagai perusahaan yang going concern.
Perkembangan Penelitian Carbon Disclosure di Indonesia
Authors: Almaeda Try Rizky , Pramuda Archangela Vitachristie Diva , Setiawan Doddy
Published: March 2023

Latar Belakang: Keberhasilan teknologi dan industri di dunia mengakibatkan perubahan iklim yang drastis. Hal tersebut meningkatkan pemerintah dunia, termasuk Indonesia, dalam berkontribusi untuk mengurangi tingkat perubahan iklim dengan mengurangi emisi gas. Salah satu upaya yang dilakukan adalah pengungkapan karbon oleh perusahaan di Indonesia. Fenomena pengungkapan karbon tersebut menarik perhatian para peneliti. Oleh sebab itu, penelitian ini dilakukan untuk mengkaji perkembangan penelitian pengungkapan karbon di Indonesia.Tujuan: Penelitian ini bertujuan untuk memberikan gambaran tentang perkembangan penelitian pengungkapan karbon di Indonesia yang dipublikasikan pada jurnal terakreditas SINTA 2 dan SINTA 3.Metode Penelitian: Metode yang digunakan dalam penelitian ini adalah Charting the Field, dengan sampel berupa 43 artikel yang membahas tentang pengungkapan karbon di Indonesia dari tahun 2013-2022. Pemetaan dilakukan dengan mengklasifikasikan artikel berdasarkan akreditasi jurnal, topik pembahasan, populasi dan sampel penelitian, metode, serta hasil penelitian.Hasil Penelitian: Penelitian ini menunjukkan bahwa variabel anteseden yang paling banyak ditemukan adalah profitabilitas, ukuran perusahaan, serta kinerja lingkungan. Variabel konsekuen yang paling banyak ditemukan adalah nilai perusahaan. Keaslian/Kebaruan Penelitian: Penelitian ini dibatasi oleh minimnya artikel terkait pengungkapan karbon yang diterbitkan pada jurnal terakreditasi SINTA 2 dan SINTA 3.
Determinan Kinerja Karyawan: Studi Kasus Pada Karyawan Perusahaan Leasing
Authors: Putuhena Hempry
Published: March 2023

Latar Belakang: Proses bisnis perusahaan jasa mengedepankan pelayanan secara langsung antara karyawan dengan konsumen yang nantinya konsumen dengan mudah mengidentifikasi dan menilai kualitas kinerja karyawan. Perusahaan leasing perlu untuk mengetahui penyebab kinerja karyawan yang dimiliki sehingga dapat melayani pelanggan secara baik, dan selain itu mampu menjaga kinerja menuju pencapaian tujuan.Tujuan: Penelitian ini untuk melihat apakah variabel kompensasi, work engagement, konflik kerja, dan motivasi memberikan dampak terhadap kinerja karyawan.Metode Penelitian: Penelitian ini merupakan penelitian kuantitatif. Responden yang digunakan adalah karyawan perusahaan leasing di kota Ambon dengan total data yang diperoleh sebanyak 80 karyawan. Pengelolaan data penelitian dan pengujian hipotesis menggunakan regresi linier berganda menggunakan aplikasi SPSS.Hasil Penelitian: Sesuai dengan proses pengujian dan hasil yang diperoleh terlihat bahwa secara parsial variabel kompensasi, work engagement, konflik kerja, dan motivasi berpengaruh positif terhadap kinerja karyawan. Variabel-variabel tersebut perlu menjadi perhatian penuh oleh perusahaan karena memberikan nilai koefesien determinasi sebesar 94,8% berpengaruh terhadap kinerja karyawan.Keaslian/Kebaruan Penelitian: Perusahaan jasa memberikan pelayanan yang dapat dilihat dan dinilai langsung oleh konsumen. perusahaan dapat meningkatkan kinerja karyawan dengan berbagai macam cara. penelitian ini membuktikan bahwa dengan Komponensasi, work engagement, konflik kerja, dan motivasi perlu menjadi perhatian pada perusahaan leasing yang berada di kota Ambon.
Risk factors and complications in pregnancies associated with placenta previa among admitted cases in FMCH
Authors: Ghosh Abanti , Rani Ghosh Suchita , Das Mita
Published: March 2023

Background: Placenta previa is a leading cause of antepartum haemorrhage. Placenta previa present a significant clinical problem and patients are at risk for significant haemorrhage, needing blood transfusion. The risks are increased in women with previous placenta previa, endometrial damage caused by DE and C, caesarean delivery, myomectomy, multiparity, alcohol cocaine use during pregnancy, smoking during pregnancy.
Methods: Admitted patients were selected with convenience sampling type of non-probability sampling type of non-probability sampling technique. The primary end point was to determine the risk factors of placenta previa and its complications. The secondary end point was to determine maternal morbidity and mortality of placenta previa.
Results: Incidence of placenta previa was 2.03% out of 2459 patients, 70% were associated with risk factors. Among them 42% had history of caesarean section, 14% had history of abortion, 10% had history of manual removal, 48% patients were more than 25% years old, 36% were more than 30 years. Placenta previa occurred in gravida 3rd or more. Forty two percent patients belonged to lower socioeconomics group. Only 12% patients had regular antenatal checkup. Malpresentations were present in 24% cases. In this study 50% patients were associated with central placenta previa. Eighty percent patients were in shock, only 2% patients were asymptomatic. Regarding management 76.34% patients were managed actively, 12% patients had expectant management. Only 2% patients delivered vaginally, 82% patients delivered by caesarean section. Maternal mortality rate was 02%. Regarding fetal outcome, 76% babies were alive and there were 20% perinatal deaths.
Conclusions: Although etiology of placenta previa largely remain obscure and speculative. There is a strong association between advanced maternal age, multiparity, history of caesarean section and abortion with subsequent development of placenta previa. Women aged >30 years, grand multipara, previa and must be monitored carefully. Hence the study advocates proper antenatal care early referral to hospital and prompt management of patients after proper selection can reduce maternal morbidity and mortality.
Effectiveness of combined use of misoprostol with intracervical catheter for induction of labour: a randomized control trial
Authors: Ferdausi Munira , Rahman Aurin , Geeti Shahreen , Shoma Chockroborty Shinthia , Zaman Nasreen , Siddika Ayesha
Published: March 2023

Background: Labor induction methods are continuously evolving to ensure safer and more effective outcomes for both mother and neonate. The present study aimed to assess the effectiveness and safety of combined use of misoprostol with intracervical catheter for labor induction.
Methods: This single-blinded, parallel-group randomized control trial conducted at Shaheed Suhrawardy Medical College, Dhaka, Bangladesh, included 200 women with term gestation and Bishop score ≤6. Participants were divided into two groups: the intervention group (group B) received misoprostol juice and Foley’s catheter, while the control group (group A) received misoprostol in the posterior fornix.
Results: In Group A, 58% had vaginal deliveries, while in Group B, 65% had vaginal deliveries. Group B experienced a longer mean length of labor in the 1st stage (13.25±1.095) compared to Group A (12.98±1.982, p=0.008). The 3rd stage was shorter for Group B (10.00±0.000) than Group A (12.02±2.469, p<0.001). The most common induction reason was labor pain with an unfavorable cervix (31 in Group A and 33 in Group B). Group B had a higher percentage of inductions at less than 12 hours and a lower percentage at more than 24 hours. Neonatal outcomes were generally better for Group B. The Cox regression hazard model showed a lower likelihood of positive outcomes in Group B (hazard ratio 0.337, 95% CI 0.243-0.469, p=0.000), indicating a statistically significant difference between the groups.
Conclusions: The combined use of misoprostol with Foley’s catheter for labor induction is safe and effective, resulting in shorter labor duration and higher rates of vaginal delivery compared to misoprostol alone.
A comparative study of insulin levels in lean versus obese polycystic ovarian syndrome patients
Authors: Sethi Nimrata , Puri Sapna , Malhotra Apoorva
Published: March 2023

Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age group. PCOS has been frequently associated with insulin resistance and obesity. Although most of the cases with PCOS are obese or overweight, a significant proportion of patients have normal body mass index (BMI≤25 kg/m2) that makes diagnostic work up and therapeutic approach more difficult. These cases are referred to as “lean PCOS.”
Methods: This hospital based prospective, comparative cross-sectional study was conducted to estimate the insulin levels and insulin resistance in lean versus over-weight or obese PCOS patients and to evaluate the correlation of BMI with clinical parameters, serum insulin levels, and hormone profile in these patients. Patients were grouped according to their BMI: Lean group-(n=46) BMI<25 kg/m2 and obese group-(n=40) BMI≥25 kg/m2.
Results: Serum insulin levels in obese PCOS patients were significantly higher than in lean PCOS patients (p<0.001). Overweight or obese PCOS women achieved significantly higher HOMA-IR than lean PCOS patients (p<0.001). The difference in fasting blood sugar levels in lean versus obese PCOS patients were not significantly different. Comparisons of the two groups showed no statistical differences in gonadotrophins (LH and FSH) values and LH/FSH ratio. The serum testosterone level was significantly higher in the obese group compared with the lean group (p=0.043).
Conclusions: We conclude that the overweight/obese PCOS patients had higher tendency to develop insulin resistance and elevated fasting insulin levels as compared to their lean counterparts. Thus, weight reduction and metformin therapy hold great potential in managing a patient with insulin resistance in PCOS but will not have much effect on hormonal profile of a patient with PCOS but will not have much effect on hormonal profile of a patient with PCOS.
Knowledge and Attitude regarding menstrual cups among young women
Authors: Thapa Tannu , Mary Roy Susha
Published: March 2023

Background: Menstruation is cyclic vaginal bleeding that occurs physiologically as a result of the shedding of the endometrium. The maintenance of adequate perineal hygiene during menstruation is very important. One product which is gaining quite a popularity over few years is a flexible, reusable cup that is inserted inside the vagina to collect blood during menstruation known as a menstrual cup. The benefits of a menstrual cup are numerous which include comfort, hygiene, cost-effectiveness and eco-friendliness. The acceptance of menstrual cups among women in India is varied due to personal and sociocultural factors. The objective of this study was to assess the knowledge and attitude regarding menstrual cups among young women.
Methods: A descriptive study design was adopted for the study. 200 young women were selected using non-probability convenient sampling technique. The study tool was administered to assess the knowledge and attitude regarding menstrual cups.
Results: Among 200 young women, 49% of young women had adequate knowledge, 43.5% had moderately adequate knowledge and 7.5% had inadequate knowledge regarding menstrual cups. 64.5% of young women had neutral attitude, 31% had positive attitude and 4.5% had negative attitude regarding menstrual cups.
Conclusions: Though young women are aware of menstrual cups but majority of them are skeptical towards its use. The findings suggests that mass in-depth awareness programmes for nurses and other health professionals should be organised and support groups need to be created to provide adequate information and counselling to the public regarding the use of menstrual cups.
Clinical study on the relationship of scar tenderness with scar integrity at repeat caesarean section
Authors: Rani Ghosh Suchita , Das Mita , Ghosh Abanti
Published: March 2023

Background: Caesarean section is an operative process whereby the fetuses after the end of 28th weeks are delivered through an incision on the abdominal and uterine wall. This excludes delivery through an abdominal incision where the fetus lying free in the abdominal cavity following uterine rupture or in secondary abdominal pregnancy. The first operation carried out on a patient is referred to as an primary caesarean section. When the operation is carried out in subsequent pregnancies, it is referred to as repeat caesarean section. Caesarean section is used in cases where vaginal delivery is not either feasible or would impose undue risks on mother or baby. The aim of the study to assess the Relationship of Scar Tenderness with Scar Integrity at repeat caesarean section.
Methods: This is an observational study. The study used to be carried out in the admitted patient’s Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh. The duration of the period from April 2017 to October 2017.
Results: This study shows that the according to age of 50 Patients aged 20 to 35 years. Here out of 50 mothers the highest 23(46%) mothers belonged to 21-25 years age group. Subsequently, 15(30%), 9(18%), 2(4%) and 1(2%) belonged to 26-30 years, ≤20 years, 31-35 years and >35 years respectively. The mean age of the respondents was 23.16±5.79 (age range: 17-38) years.
Conclusions: The scar complications are highly associated with the intensity of scar tenderness. Henceforth, it can be concluded here that scar tenderness is a vital factor responsible for scar complications.
Incidence and risk factors of post-molar gestational trophoblastic neoplasia: a prospective study
Authors: K. P. Shana Rahman , C. Sudhamani
Published: March 2023

Background: Gestational trophoblastic disease (GTD) is a group of disorders arising from abnormal trophoblastic cells. Gestational trophoblastic neoplasia (GTN) is a malignant counterpart of GTD. In the earlier era, morbidity and mortality associated with GTD was very high, 90-95% presenting with metastatic GTN in 1980’s.
Methods: This is a prospective study to analyze the incidence and to identify the risk factors of post-molar GTN and to evaluate the role of Beta-hCG level as a predictive factor of post-molar GTN, conducted in the department of Obstetrics and Gynecology, Institute of Maternal and Child Health (IMCH), Government Medical College, Kozhikode, on patients attending the vesicular mole(VM) clinic. Group A (remission group - was diagnosed after 6 months of follow-up with undetectable Beta-hCG values) and Group B (post-molar GTN). The two groups were compared for identifying risk factors.
Results: There were 79 cases of molar pregnancy registered in VM clinic with an incidence of 4.87/1000 deliveries. Of the 79 patients with GTD, 17 were diagnosed to have GTN during follow-up with an incidence of 21.51% of GTD. Incidence of post-molar GTN were significantly more among patients with history of previous molar pregnancy. The median Beta-hCG level at 2 weeks post-evacuation and the ratio of Beta-hCG levels at 1week to 2 weeks post-evacuation was found to be highly predictive of post-molar GTN.
Conclusions: Incidence of GTD was higher compared to international studies. The ratio of post-evacuation Beta-hCG at 1 week to Beta-hCG at 2 weeks is the most reliable predictor of post-molar GTN.
Transvaginal sonographic cervical length during mid-trimester in predicting preterm labour in asymptomatic singleton pregnancies
Authors: Mahammad Shamshad Begum , Sunkireddy Nagamani , M. Jayalakshmi
Published: March 2023

Background: Worldwide, preterm birth is the main contributor to perinatal mortality and morbidity. Preterm birth causes 50% of long-term morbidity, contributes 75% of neonatal deaths (after accounting for fatal abnormalities), and becomes 85% of newborn deaths. Cervical length measurement has been linked to predicting the preterm labour in mid-trimester by various studies.
Methods: This study was carried out to evaluate the strength of cervical length as a predictive factor for pre-term labour. This is a prospective observational study conducted at MIMS, Vizianagaram on 100 antenatal mothers. The cervical length is measured by transvaginal ultrasound. If the length was <25 mm, then the patients were advised a second scan during 28th week and follow-up was done till delivery.
Results: Out of the 100 patients, 21 were multigravida, whereas 79 were primigravida. 20 had pre-term delivery and 80 had term delivery. The mean age of the population was 25.2±4.5 years. 40% of cases with cervical length <25 mm had pre-term delivery, as compared to 33.33% in patients with cervical length 26-30 mm, 13.63% in 31-35 mm, 5.88% in 36-40 mm and 16.66% in patients with cervical length >40 mm. The p value<0.05. Area under ROC curve is 0.79. Sensitivity is 60%, specificity is 8.75%, positive predictive value is 57.14%, negative predictive value is 89.87%.
Conclusions: Transvaginal sonography is a reliable diagnostic test in mid-trimester in predicting pre-term delivery in singleton pregnancy.
Retrospective study on prevalence of severe anemia in pregnant women and its outcome
Authors: R. Sudha , Madenor Srushti
Published: March 2023

Background: Anemia is one of the most common nutritional deficiency disorders affecting the pregnant women in the developing countries. Anemia during pregnancy is commonly associated with poor pregnancy outcome and can result in complications that threaten the life of both mother and fetus. The study aimed at analyse the maternal and perinatal outcome of pregnant women with severe anemia (Hb <7 gm%) in pregnancy. Aim and objective were to study the prevalence of anemia among pregnant women and to determine its association with maternal and fetal outcomes.
Methods: A hospital-based retrospective study on the prevalence of anemia among the antenatal women for 6 months duration from February 2022 to July 2022 in department of obstetrics and gynecology Cheluvamba hospital, Mysore Medical College and Research Institute, Mysore.
Results: Out of 4291 deliveries during the study period 76 (1.7%) patients were severely anaemic. There were 55 (72.3%) multigravida. Maternal complications were preterm labour 15 (16.8%), pre-eclampsia and eclampsia 10(13.1%), abortions 22 (28%). Neonatal outcome was analysed in terms of prematurity (16.8%), LBW (22.4%), NICU admission (17.9%), still birth (0.03%), neonatal deaths (0.05%).
Conclusions: Severe anemia during pregnancy is associated with adverse maternal and perinatal outcome. It is one of the preventable indirect causes of maternal mortality. Education to adolescents, regular antenatal check-ups, early diagnosis and treatment, prevention of too late too early too frequent too many pregnancies. Educating the women regarding safe abortion services available thus avoiding unwanted pregnancies. Promotion of good nutrition practices thus reaching optimum haemoglobin before conception. Along with these active participation of health workers at grass-root level might help in bringing down the prevalence.
Retrograde study of patients with adenomyosis at tertiary health centre, a spectrum from clinical presentation to its final diagnosis and treatment
Authors: Patel Hemali , Kanani Kishankumar , Bhankhar Ronak , Dhameliya Priya
Published: March 2023

Background: Adenomyosis is a disease where ectopic endometrial glands affect the muscular wall of the uterus. It is considered a specific entity in the PALM-COEIN FIGO (polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; and not yet classified- International Federation of Gynaecology and Obstetrics). Aims and objectives were to diagnose adenomyosis accurately with help of data of clinical findings and imaging modalities.
Methods: It was a retrospective study done at tertiary hospital, Junagadh from June 2022 to November 2022. The HPE reports and case records of all the hysterectomy specimen were reviewed. Data regarding age, parity, symptoms, obstetric history, examinations, co-morbidities, investigation findings and treatment modalities were noted. They were tabulated and analysed.
Results: Out of the 50 patients, 30 patients (60%) were in the age group of 41-50 years. The prevalence of adenomyosis in our study was only 6% in post-menopausal women when compared to the age group 41-50 years (60%). Multiparous women had 92% incidence of adenomyosis. 62% had menstrual disturbances. Dysmenorrhea and dyspareunia were the next common symptoms. Fibroid was the commonest associated pathology 44%. 32% had endometrial hyperplasia, whereas 68% had no pathology. Imaging picked up only 36% of cases contrary to 28% of clinical diagnosis and was raised to 64% with gross examination of specimen and 100% with HPE.
Conclusions: Better modality to diagnose adenomyosis is clinical presentation. USG failed to diagnose all the cases. Gold standard modality is histopathological examination.
The association of pre-pregnancy body mass index and risk of pre-eclampsia
Authors: Nekkanti Dhanusha , Rani C. Kavya , Kumar S. Vasantha
Published: March 2023

Background: Preeclampsia is a pregnancy-related condition characterized by new-onset hypertension and proteinuria. Preeclampsia is responsible for 20% to 80% of mortality among pregnant in developing countries. Preeclampsia may cause prematurity and fetal growth restriction. It is the most serious complication affecting 2-8% of all pregnancies. The mortality and morbidity rates among the babies of pre-eclampsia mothers is five times higher than that among babies born to healthy mothers. Objective: To find the association between pre-pregnancy Body Mass Index (BMI) and gestational weight gain with incidence of pre-eclampsia.
Methods: Cross sectional Observational study was conducted among 140 cases. The study was conducted after obtaining approval from the ethics committee.
Results: In this study, in 27.9% of cases overweight, and in 12.1% of cases obesity were seen. In 60.7% of cases severe preeclampsia, and 39.3% of cases mild preeclampsia was reported. Preeclampsia had no significant association with age, marital life, parity, but had a significant association with liquor, birth weight, and NICU admission.
Conclusions: Pre pregnancy weight and Gestational weight gain were associated with high risk of preeclampsia.
Modified biophysical profile in high-risk pregnancy-association with neonatal APGAR score
Authors: Asgari Begum Vemala , Sruthi Reddygari , Sai Mamatha Sanikommu Venkata , Kameshwaramma K.
Published: March 2023

Background: MBPP is used for evaluating fetal health and predicting fetal outcomes, which can help to minimize perinatal morbidity and death. It combines the non-stress test, an indicator of acute fetal hypoxia, with AFI, the second indicator of persistent fetal problems. Each patient has a non-stress test and an ultrasonic examination of liquor volume. A non-stress test that is reactive will reveal a healthy fetus. Hence, an attempt has been made to study the MBPP in high-risk pregnancies in predicting fetal outcome.
Methods: Hospital-based prospective clinical study on 200 high-risk pregnant women more than 37weeks of gestation are screened using a modified biophysical profile. High-risk factors in the study include Gestational Hypertension, Preeclampsia, IUGR, Post-term pregnancy, Oligohydramnios, PROM, and Anemia. The study was conducted in the department of obstetrics and gynaecology, Narayana medical college and hospital, Nellore, Andhra Pradesh.
Results: In the present study, a total of 200 patients, 76.0% had both (NST, AFI) normal, 5.0% had both (NST, AFI) abnormal, 10.0% had Normal in NST and abnormal in AFI, 9.0% had abnormal in NST, and normal in AFI. The individual association between NST and AFI with the neonatal outcomes ie., APGAR at 1 min and 5min have been studied and have been found to be statistically significant.
Conclusions: In the present study, we concluded that MBPP is an effective antepartum fetal surveillance test in high-risk pregnancies in predicting perinatal outcome.
Knowledge and attitude towards contraceptive use among Juang men: a particularly vulnerable tribal group in Odisha, India
Authors: Kumar Mudi Prasanna , Pradhan Manas Ranjan
Published: March 2023

Background: Empirical evidence on knowledge and attitude toward contraception among particularly vulnerable tribal groups is rare in India. This study unearths the knowledge and attitude towards contraceptive methods among the Juang men, a PVTG in Odisha, India.
Methods: Data for the present study comes from a cross-sectional mixed-method study conducted in 2020-21, following a three-stage sampling design. The present analysis is based on the quantitative data of 100 men and the qualitative interviews (12 Focus group discussions and 12 Key informant interviews). The quantitative data were analyzed using Stata (V16), and we used NVivo (V12) to analyze the qualitative data. We calculated an attitude scale categorized into favorable, neutral, and unfavorable.
Results: Knowledge of contraceptive methods was found inadequate- 43% knew any modern spacing methods & 65% knew any modern limiting methods. About two-fifths (44%) of the men had a less favourable attitude towards contraception, 32% had a moderately favourable attitude, and 24% had a highly favourable attitude towards family planning. A higher percentage of educated men, exposed to mass media, do not consume alcohol and tobacco, and married after 18 years had a favourable attitude towards contraception. Qualitative data reveal that contraception was never perceived as an essential issue, and male involvement in family planning is culturally discouraging.
Conclusions: Contraceptive method knowledge is not universal among Juang men, and many have a negative attitude toward using family planning methods. Results indicate inadequate program outreach and suggest customized intervention for contraceptive knowledge and its benefits among Juang men.
Comparison of oral misoprostol versus intramuscular oxytocin for active management of third stage of labour: a single centre randomised controlled study
Authors: Garg Neha , Kulshreshtha Apoorva , Malhotra Sapna
Published: March 2023

Background: This study was conducted to compare the efficacy and safety of oral misoprostol against intramuscular oxytocin in the active management of the third stage of labour, so that it can be widely used in the areas of limited resources to contribute in preventing post-partum haemorrhage and thus decreasing maternal mortality ratio.
Methods: This was a prospective randomised controlled clinical study. Two hundred patients fulfilling inclusion criteria were randomized to receive either oral misoprostol (600 mcg) or intramuscular oxytocin (10 IU) in the active management of third stage of labour. Primary outcome measured was mean blood loss and incidence of primary PPH.
Results: The mean blood loss during third stage of labour in oral misoprostol group and oxytocin group was 239.16±22.78 ml and 240.19±19.70 ml respectively with p value-0.7331 which was insignificant. Similarly mean fall in haemoglobin was also not significant. There was no significant differences between the two groups with regard to the incidence of PPH (3% vs. 2% respectively; p=0.651). Women experiencing side effects like shivering and fever were significantly higher among misoprostol group than in oxytocin group.
Conclusions: In this study, oral misoprostol was found to be comparable to intramuscular oxytocin regimen, in terms of amount of blood loss, occurrence of postpartum hemorrhage, duration of third stage of labour, fall in hemoglobin and fall in blood pressure. However, shivering and fever were more common with misoprostol, but no other serious side effects were noted.
Maternal and fetal outcome among gestational diabetes mellitus mothers treated at a tertiary care maternity hospital
Authors: Sarimala S. Indra Priyadharsini , Venugopal Vinayagamoorthy
Published: March 2023

Background: Incidence of gestational diabetes mellitus (GDM) in India is alarming. The present study was designed to determine the association between the maternal and fetal outcome with the blood sugar control status at the time of delivery.
Methods: It was an analytical follow up study that included 180 antenatal women who met the criteria for GDM with singleton pregnancy irrespective of age, gestational period, parity were included into the study. Those with pre-existing diabetes mellitus, scarred uterus, multiple pregnancy, chronic medical disease and ante partum hemorrhage were excluded. Based on the blood sugar level at the time of delivery GDM mothers were classified into four groups excellent control, optimal control, poor control and no control group. The maternal and fetal outcomes were compared between groups.
Results: Nearly 7500 antenatal women were screened and 198 eligible GDM women were selected. Of which 180 cases were successfully completed the follow up. Among the 180 cases of GDM, 74 (41.1%) were in excellent control group, 40 (22.2%) under optimal control, 41 (22.8%) belonged to poor control and 25 (13.8%) were not controlled at the time of delivery. There was statistically significant positive association between poor glycemic control and bad maternal and fetal outcome.
Conclusions: Bad maternal and fetal outcomes were statistically higher among mothers with poor and no glycemic control. Strict glycemic control during antenatal period is mandate to avoid bad outcomes. Neonatal care center needs to be well equipped where GDM mothers seek care for delivery.
Salivary uric acid as a non-invasive marker of early onset preeclampsia
Authors: Agarwal Shaily , Dwivedi Divya , Gupta Renu , Gupta Garima , Lal Pavika , Neha
Published: March 2023

Background: Preeclampsia is one of the most common complications in pregnancy and is a major cause of maternal and perinatal morbidity and mortality. Early prediction of preeclampsia is crucial in proactive management of the patient. Uric acid is a biomarker of hypertension.
Methods: A prospective study was done on 200 pregnant females in their first or early second trimester of pregnancy and were followed till one week of delivery or termination of pregnancy. After taking socio-demographic details, detailed medical and obstetric history was taken. Blood pressure of the patients was routinely measured and mean arterial pressure was calculated. Blood and saliva samples were taken and were analysed following standard protocol for serum and salivary uric acid levels respectively. Participants were classified into normotensive and preeclampsia groups depending on the criteria met.
Results: Preeclampsia group participants had significantly more adverse and feto-maternal outcomes. Salivary uric acid is a promising diagnostic predictor of preeclampsia in pregnant women by the virtue of being a non-invasive investigation with cut off value 4.86 mg/dl having a sensitivity of 70.8%, specificity of 45.7% and a PPV of 81.3%. Salivary uric acid level and mean arterial pressure were found to be better predictors of preeclampsia as compared to salivary uric acid level.
Conclusions: Salivary uric acid is a reliable predictor of preeclampsia in pregnant females in first and early second trimester of pregnancy. Further largescale studies are warranted to establish an accurate cut off value with good diagnostic properties for Indian population.