bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhancement of Hybrid SPEEK Based Polymer–Cyclodextrin-Silica Inorganic Membrane for Direct Methanol Fuel Cell Application
Authors: Kusworo Tutuk Djoko , Hakim Muhammad Fahmi , Hadiyanto H
Published: June 2017

Direct methanol fuel cell (DMFC) is one of several types of fuel cells that use proton exchange membrane  (PEM) as a liaison between the reaction at the cathode and anode. Polyether-ether ketone (PEEK) is one of the aromatic polymer that can be applied in DMFC because of its characteristics that are resistant to DMFC environment. The polymer is also quite easy in the sulfonation process using concentrated sulfuric acid. However the role of polyether-ether ketone as DMFC membrane material is still lack of advantage due to its low conductivity and therefore the modification is required to increase the value of proton conductivity of the membrane. The purpose of this experiment is to modify the membrane (sPEEK) with the addition of cyclodextrins-silica, additive variation charge of 2%, 6% and 10%, time and temperature were fixed at 4 hours and 65oC. The results showed the best results of membrane sPEEK was obtained at the addition of -cyclodextrin -silica 10% with the membrane characteristics of ion exchange capacity of 2.19 meq / g polymer, the degree of sulfonation of 81%, methanol permeability of 3.09 x 10-9 cm2 / s and water uptake membrane of 64%. Keywords: Direct Methanol Fuel Cell, Poly(ether ether ketone), cyclodextrin-silica, sulfonation, ionic conductivity.Article History: Received January 18th 2017; Received in revised form April 21st 2017; Accepted June 22nd 2017; Available onlineHow to Cite This Article: Kusworo, T.D., Hakim, M.F. and Hadiyanto, H. (2017) Enhancement of Hybrid SPEEK Based Polymer–Cyclodextrin-Silica Inorganic Membrane for Direct Methanol Fuel Cell Application. International Journal of Renewable Energy Development, 6(2), 165-170.https://doi.org/10.14710/ijred.6.2.165-170
Optimization of Lipid Extraction from Municipal Scum Sludge for Biodiesel Production Using Statistical Approach
Authors: Ibrahim Samir Hag , Hamza Emad
Published: June 2017

Design of Experiment (DoE) as a statistical method was applied for optimizing lipid extraction conditions from scum sludge. Four different extraction variables were optimized namely methanol to hexane ratio (%), solvent to sludge ratio (ml/g), temperature (oC), and extraction time (h). Process optimization was conducted through three main steps: 1) 2k factorial screening design; 2) Steepest ascent method; and 3) Box-Behnken design and response surface method. Based on 2k factorial screening design, methanol to hexane ratio, solvent to sludge ratio and temperature were identified as highly significant variables affecting lipid extraction from scum sludge. Based on screening results, the steepest ascent method was used followed by Box-Behnken design and Response Surface Method (RSM) were then applied for optimization. The maximum extracted lipid of 29.4% (wt lipid/wt dry sludge- %) was achieved at 40% methanol to hexane ratio (%), 40 solvent to sludge ratio (ml/g), 90oC and 6 hours extraction time. The results revealed that lipid extraction increases with reducing the methanol to hexane ratio, increasing solvent to sludge ratio and increasing temperature The results demonstrated the potentiality of scum sludge for biodiesel production from scum sludge compared with the amount of lipid extracted from primary and secondary sludge reported by other studies.Article History: Received Feb 16th 2017; Received in revised form May 5th 2017; Accepted June 4th 2017; Available onlineHow to Cite This Article: Ibrahim, S.N.H, and Hamza, E.A. (2017). Optimization of Lipid Extraction from Municipal Scum Sludge for Biodiesel Production Using Statistical Approach. International Journal of Renewable Energy Development, 6(2), 171-179.https://doi.org/10.14710/ijred.6.2.171-179
The structure of the tetanus toxin reveals pH‐mediated domain dynamics
Authors: Masuyer Geoffrey , Conrad Julian , Stenmark Pål
Published: June 2017

The tetanus neurotoxin (TeNT) is a highly potent toxin produced by Clostridium tetani that inhibits neurotransmission of inhibitory interneurons, causing spastic paralysis in the tetanus disease. TeNT differs from the other clostridial neurotoxins by its unique ability to target the central nervous system by retrograde axonal transport. The crystal structure of the tetanus toxin reveals a “closed” domain arrangement stabilised by two disulphide bridges, and the molecular details of the toxin's interaction with its polysaccharide receptor. An integrative analysis combining X‐ray crystallography, solution scattering and single particle electron cryo‐microscopy reveals pH‐mediated domain rearrangements that may give TeNT the ability to adapt to the multiple environments encountered during intoxication, and facilitate binding to distinct receptors.
An Efficient FLP-Based Toolkit for Spatiotemporal Control of Gene Expression in Caenorhabditis elegans
Authors: Muñoz-Jiménez Celia , Ayuso Cristina , Dobrzynska Agnieszka , Torres-Mendéz Antonio , Ruiz Patricia de la Cruz , Askjaer Peter
Published: June 2017

Site-specific recombinases are potent tools to regulate gene expression. In particular, the Cre (cyclization recombination) and FLP (flipase) enzymes are widely used to either activate or inactivate genes in a precise spatiotemporal manner. Both recombinases work efficiently in the popular model organism Caenorhabditis elegans, but their use in this nematode is still only sporadic. To increase the utility of the FLP system in C. elegans, we have generated a series of single-copy transgenic strains that stably express an optimized version of FLP in specific tissues or by heat induction. We show that recombination efficiencies reach 100% in several cell types, such as muscles, intestine, and serotonin-producing neurons. Moreover, we demonstrate that most promoters drive recombination exclusively in the expected tissues. As examples of the potentials of the FLP lines, we describe novel tools for induced cell ablation by expression of the PEEL-1 toxin and a versatile FLP-out cassette for generation of GFP-tagged conditional knockout alleles. Together with other recombinase-based reagents created by the C. elegans community, this toolkit increases the possibilities for detailed analyses of specific biological processes at developmental stages inside intact animals.
A Whole-of-Society Approach to Wildlife Crime in South Africa
Authors: Gonçalves Duarte
Published: June 2017

The recent and rapid increase in wildlife crime not only threatens the survival of significant populations of endangered species in South Africa, but also threatens regional security, the sustainability of the tourism sector and social stability of local communities. Many interventions and actions in addressing wildlife crime fail to achieve sustained impact mainly due to the complexity of the problem and the resulting multiple and simultaneous interventions needed along the short, medium and long term. Factors that contribute to the complexity of the problem are, the number of role players involved, the framing of the problem through different worldviews, the high stakes, the number of simultaneous aspects of interventions, the problem dynamics and the huge number of interactions. Different aspects of the problem are interconnected, but stakeholders are tempted to address the problem in parts (fragmentation), thus creating new problems. This dynamic facilitates situations in which decision makers find the problem too big and complex to address and they remain in a state of crisis management. Addressing the current wildlife crisis requires harmonised efforts incorporating on-the-ground cross-border cooperation and a strategic environment that balances conserving wildlife with stakeholder needs for economic growth and local, national, and regional stability. This paper explores innovative and integrated ways in mitigating the complexity of the wildlife crime problem. The approach is problem focused as opposed to discipline focused or organisation-centric. The paper also discusses the lessons learnt and the resulting preliminary set of “principles”: inclusivity of actors, different ways of being and knowing as ways of addressing fragmentation; foresight; governance, as dynamic problem solving to build capabilities; and the transforming organisational narratives as part of implementing new strategies. These “principles” form the basis of the whole-of-society approach in dealing with complexity and can be applied in future interventions that concentrate on combining operational and scientific expertise with local knowledge, through participatory learning and governance.
Organized environmental crimes: Trends, theory, impact and responses
Authors: Hübschle Annette , Faull Andrew
Published: June 2017

Once considered peripheral and a green matter, wildlife crimes have moved up global security and policy agendas. The UN General Assembly, for example, adopted two resolutions to tackle wildlife crimes in 2015 and 2016. Meanwhile the South Africa and the Southern African Development (SADC) have declared wildlife trafficking a priority crime issue. Rhino poaching, in particular, has captured the attention of the public, international community and our national government. Less charismatic plant and wildlife species are also harvested and trafficked across the globe. The lesser-known pangolin is considered the most trafficked species while cycads constitute the most threatened plant species on the planet.   The illegal or irregular extraction of natural resources, logging, mining, overfishing, trafficking of toxic, nuclear or electronic waste, and industrial dumping have all become areas of concern.
Determinants of utilisation of traditional birth attendant services by pregnant women in Ogbomoso, Nigeria
Authors: T. Awotunde O. , T. A. Awotunde , F. O. Fehintola , Adesina S. A. Adesina , O. A. Oladeji , A. O. Fehintola , D. E. Ajala
Published: June 2017

Background: This study was designed to assess the determinants of utilization of Traditional Birth Attendants (TBAs) services by pregnant women in different communities in Ogbomoso, Nigeria.Methods: This was a community- based cross-sectional study. Fisher's formula was used to calculate the sample size and a total of 270 eligible pregnant women were enrolled for the study using multistage sampling technique. Data was collected using pretested structured interviewer-administered questionnaire. Data analysis was done using SPSS version 20 and results were presented in frequencies and percentages.Results: Factors found to have a significant influence on the utilization of TBA services in this study include: low educational status (p <0.001), lower socioeconomic status (p <0.001), and compassionate care given by the TBAs (p=0.004). Other factors include service proximity and lower cost of TBA services.Conclusions: The impact of TBAs and their services cannot be overemphasized in the present state of maternal and child health in Nigeria.  Lower educational status among others has been found to be a strong predictor of utilization of TBA services. There is, therefore, the need to improve the educational and socioeconomic status of women in order to allow them to access quality health care services that will safeguard their well-being. Inculcating compassionate care into orthodox healthcare delivery will go a long way to improve patronage and discourage TBA utilization.
Uterine artery Doppler study for the prediction and the severity of the hypertensive disorders during pregnancy
Authors: Chakraborty Saptarshi , Saharan Surabhi
Published: June 2017

Background: Hypertensive disorder in pregnancy is one of the major cause of maternal and perinatal mortality and morbidity worldwide particularly in developing countries. In developed countries, maternal mortality rate varies from 4-40 per 1 lakh live birth. In developing countries, it varies from 100-700 with India having 178 per 1 lakh live birth. Objectives were to study of uterine artery Doppler for the prediction of hypertensive disorders and its severity, Sensitivity and Specificity of Uterine Artery Doppler and their comparison for the prediction and the severity of hypertensive disorders during pregnancy.Methods: This is a prospective study. Approximately hundred patients with hypertensive disorders during pregnancy attending the OPD and IPD in Obstetrics and Gynecology Department will be included. All the patients in this study group will be subjected to Ultrasonographic evaluation of the pregnancy along with the Arterial Doppler of both the Uterine Artery and Umbilical Artery will be done.Results: Using uterine artery Doppler Study in combination is significantly useful in early prediction of PIH having specificity and sensitivity of Uterine artery Doppler study – Pi Index as 91.67% and 85.71 %, Ri Index as 87.5% and 71.43% and diastolic notch as 94.44% and 92.85 % respectively. The use of uterine artery Doppler Study as an important tool for early prediction of PIH and has a lot of prognostic value.Conclusions: The predictive accuracy of uterine artery Doppler study using Pi Index and Ri Index is better in the detection of early-onset PIH, than the late-onset disease. Thereby, it will help in the long run to prevent the increasing maternal and fetal morbidity and mortality.
Role of transvaginal sonography in gynecological diagnosis at a tertiary care hospital
Authors: V. Sitalakshmi , Bansal Alpana
Published: June 2017

Background: Transvaginal sonography (TVS) is very useful to assess the abnormalities in the anatomical structure of the uterus as well as endometrium. Not only this, it is capable of finding out any abnormalities of ovary, fallopian tubes, cervical structures as well as myometrium. The objective of the study was the role of transvaginal sonography in gynecological diagnosis at a tertiary care hospital.Methods: Present hospital based prospective study was carried out among 31 randomly selected eligible patients as per inclusion and exclusion criteria of the study for a period of one year at Department of Obstetrics and Gynecology of S. V. Medical College, Tirupati. All ethical guidelines were followed. A pre-designed and semi structured pre-tested questionnaire was prepared for entry of patient data.Results: Transvaginal sonography was more accurate in terms of evaluation of both tubes. Overall diagnostic accuracy of transvaginal sonography was 90.9%. It was found that the accuracy of clinical diagnosis was 100% in comparison to diagnosis by scan. In five cases, the clinical diagnosis of infertility was made as ovarian cyst and in all those cases it was confirmed. In three cases, the clinical diagnosis of infertility was made as fibroids and in all those cases it was confirmed. It was found that in cases of ectopic pregnancy, copper T missing loop and missed abortion, the clinical diagnosis was 100% accurate in comparison to scan diagnosis. Only in case of pelvic inflammatory disease, the accuracy of clinical diagnosis was 66% in comparison to scan diagnosis.Conclusions: Despite the few disadvantages of transvaginal sonography in measuring large pelvic masses, the smallest details of the masses yield valuable preoperative information. The more accurate delineation of internal echo characteristics scores the benefit over transvaginal sonography has its rightful place in gynecological practice has diagnostic and minimally invasive therapeutic tool.
The predictive value of amniotic fluid index for adverse perinatal outcome and suggested plan of action
Authors: Bawa Ritu , Neerja .
Published: June 2017

Background: Modern obstetrics and perinatal medicine is concerned with recognition of a fetus at risk for death or damage in utero: quantifying the risk and determining the optimal time and mode of intervention. Objective of present study was to determine whether an antepartum amniotic fluid index (AFI) of 5.0cm or less is a predictor of adverse perinatal outcome.Methods: This was a prospective study of 400 antenatal women booked at Muzaffarnagar Medical College during the year 2015-16 with gestational age between 36 and 41 weeks AFI was determined using the Phelan’s technique within 7 days of delivery or at the onset of labour. Perinatal outcome was compared between two groups i.e. AFI ≤5 and >5.Results: An AFI of 5.0cm or less was significantly associated with higher cesarean section rate for fetal distress and low birth weight babies. There was no significant difference in APGAR score at 5 min. <7 between the two groups.Conclusions: Determination of AFI is valuable for predicting fetal distress in labour requiring cesarean section. It can be used as an adjacent to other fetal surveillance methods. An AFI <5 detected after 36 weeks of gestation is an indicator of poor perinatal outcome.
Closure of Pfannenstiel skin incisions in cesarean sections: comparison of wound outcomes with interrupted mattress vs. subcuticular suture
Authors: Choudhary Anjali , Bansal Neeta , Chaudhari Priyanka
Published: June 2017

Background: Cesarean section is by far the commonest surgery performed worldwide. Most of these surgeries are performed by Pfannenstiel incision. Various techniques and material have been tried for skin closure in these surgeries. Each method has its own advantages and disadvantages. The objective of the study was to compare wound outcomes in Pfannenstiel incisions closed in interrupted mattress sutures and subcuticular suture with absorbable material, in a prospective study of cesarean deliveries.Methods: It was studied that 104 women who had cesarean sections with Pfannenstiel incision prospectively for wound outcomes in terms of wound complications (hematoma formation, infection, nonunion, dehiscence and need for resuturing), pain and cosmetic appearance in two groups. One with absorbable subcuticular sutures, another with interrupted mattress suture.Results: Women who had subcuticular stitches had less postoperative pain, better wound outcomes, faster recovery, early discharge from hospital and cosmetically superior scars as compared with interrupted mattress sutures.Conclusions: While search for the best method and material for skin closure continues, the subcuticular suture with an absorbable material seems to leave a cosmetically better scar with lesser wound complications.
Knowledge, attitude, and practice of resident doctors about medical research in BJ Medical College, Pune, Maharashtra
Authors: Satav Pranav J. , Wankhede Uma N.
Published: June 2017

Background: Every doctor should strive to contribute to the generation of evidence by conducting research. A review of literature showed that the data regarding knowledge, attitude, practice towards medical research among resident doctors pursuing post graduate studies in India is lacking. The objective of the study was to assess medical research related knowledge, attitude and practice of resident doctors in BJ Medical college, Pune, Maharashtra.Methods: With written informed consent of the participant, a cross-sectional survey was conducted at BJ Medical College, Pune, Maharashtra using structured and pre-validated questionnaire. We enrolled all 102 resident doctors pursuing their second and third year residency in various subjects. Two residents have not given written consent and excluded from the study (N=100). All participants were provided with sufficient time of 7 days to fill the KAP questionnaire. In case of more than 5 unanswered questions, the participant was excluded from the study. The data was expressed in percentage and analyzed by Microsoft Office Excel 2007.Results: The concept of research hypothesis was known to 48% of the residents. 85% of the residents were aware of the procedure to obtain informed consent. 82% of the residents agreed that patient outcome improves with continued medical research. Although 56% of the residents were interested in conducting research in future, 60% had made paper/poster presentations and only 15% had publications. 'Lack of time' (60%), 'lack of research curriculum' (26%) and 'inadequate facilities' (30%) were stated as major obstacles for pursuing research.Conclusions: Our study finds that residents have a fair knowledge about research. They also showed a positive attitude toward research, but they fail to transform their knowledge and attitude into actual practices.
Clinical course of ectopic pregnancy:a tertiary centre experience
Authors: J. C. Spandana , D. Tejaswini , Bai G. Sunanda
Published: June 2017

Background: Ectopic pregnancy (EP) is one of the causes of maternal mortality and morbidity in the first trimester. EP is still a major challenge and its incidence is on the rise due to changes in lifestyle and advances in medical practice. The early diagnosis and treatment of this condition over the past two decades has allowed a definitive medical management of unruptured ectopic pregnancies even before there were clinical symptoms in these high-risk women.Methods: It was a retrospective study of 100 cases of EP conducted in the Department of Obstetrics and Gynecology, Bowring and Lady Curzon Hospital, attached to Bangalore medical college, Bengaluru for a period of 3 years. The aim of the study was to study the incidence, risk factors, clinical profile and management of EP cases.Results: Incidence of EP was 1.3% of all deliveries and 5.6% of gynecological surgeries. Peak age group was between 25-30 years (37%). Most of them were multiparous (83%), 58% of the patients had identifiable risk factors. 95% had amenorrhea, followed by pain abdomen in 81%, bleeding PV in 43%. 17% presented with shock. 91% patients presented with ruptured ectopic, 9% were unruptured. Unruptured cases were treated medically using Methotrexate. Laparotomy was done for ruptured cases. Commonest site of Ectopic was ampulla (81%). Salpingectomy was done for most cases (86%). No maternal mortality observed.Conclusions: All high-risk women should be screened at the earliest with serum β-hCG and TVS. The impact on future fertility can be improved by focusing on primary prevention and early diagnosis before rupture.
Acute kidney injury requiring dialysis in obstetric patients: management and clinical outcome in case series of 30 patients in a tertiary care centre
Authors: Patel Molina U. , Jadeja Yuvraj , Patel Niket , Patel Nayana , Vaishnav Smruti , Bhadarka Harsha
Published: June 2017

Background: Acute Kidney Injury is a common medical problem affecting approximately 5% of all hospitalized and 30% of critically ill patients. The incidence in obstetric patients ranges from 1 in 2000 to 1 in 25000 pregnancies. In India till date, the impact of AKI on fetomaternal outcome and pertaining therapeutic interventions is only sparsely studied.Methods: It is a retrospective cross-sectional study. All obstetric patients with AKI on dialysis, admitted to Shree Krishna Hospital, a tertiary care hospital in Karamsad village in Gujarat from January 2013 to August 2015. Multivariate statistical analysis of clinical and laboratory parameters was performed using SPSS program to obtain the results.Results: The incidence of dialysis was 1.6%. HELLP syndrome and pre-eclampsia (80%) was found to be the most common etiology of AKI followed by Congestive cardiac failure (34.5%), hemorrhage and sepsis in 30% resp. All patients were admitted to ICU care. No significant difference was found between SAP II and SOFA monitoring system. Mechanical ventilation was done to support 53.3% and inotropic support was needed by 56.7% patients. According to the RIFLE criteria, majority of the patients fall under risk category followed by injury. 18% of the patients developed End Stage Renal Disease.Conclusions: In view of the multifaceted etiologies and complexity of management of AKI, a multi-disciplinary approach involving nephrologist, intensivists, obstetricians and neonatologists is extremely important.
Tablet misoprostol as a cervical priming agent prior to surgical abortion
Authors: Revankar Vijaya Manohar , T. N. Harsha
Published: June 2017

Background: Every effort to promote effective contraceptive methods as well as emergency contraception is being made, still there would be a need and place for termination of pregnancy. Objective of present study was to evaluate and to know the efficacy and adverse effects of tablet misoprostol 400 micro gram as a cervical priming agent administered either by oral or vaginal route, 3 hours before MTP.Methods: Prospective randomized not blinded study carried out for two years at Government Tertiary care level hospital, OBG Department, Mangalore on 100 women with gestational age up to 12 weeks requesting for surgical abortion.Results: In both the groups there was no significant statistical difference with respect to age (p=0.44), parity and gestational age (p=0.59). With respect to baseline cervical dilatation significant statistical difference was not observed in both the groups. Baseline dilatation of the cervix was 8.0 mm versus 8.2 mm (p value=0.55). Baseline cervical dilatation was ≥7mm in 90% of women when tab misoprostol was given by oral route and 94% with vaginal route. There was no significant statistical difference with respect to side effects (p value>0.05) except nausea (p=0.01) found in both the groups. Gastro Intestinal side effects were more in oral misoprostol group, but it was not statistically significant.Conclusions: Oral route is an effective alternative to vaginal route. Oral route is preferred over vaginal route because women can do self-administration at home and there was no internal examination discomfort.
Comparison of sublingual versus vaginal routes of misoprostol in induction of labor
Authors: Jadai swamy Madhu , Hangaraga U. S.
Published: June 2017

Background: Induction of labor can be defined as an intervention intended to artificially initiate uterine contractions resulting in progressive effacement and dilatation of cervix. Present study was under taken to compare the efficacy of sublingual versus vaginal routes of administration of misoprostol for induction of labor.Methods: Prospective observational study conducted from January 2010 to January 2011 in the Department of Obstetrics and Gynecology at Karnataka Institute of Medical Sciences, Hubli, Karnataka, India. The patients were selected from either antenatal ward or emergency admission to labor room. 100 women were selected for the study. 50 women in sublingual group and 50 in vaginal group. Main outcome measured were the number of doses of misoprostol administered, induction to delivery interval, incidence of cesarean sections, uterine hyperstimulation, meconium stained liquor and admission to NICU.Results: Mean number of misoprostol doses required in sublingual group was significantly less compared to vaginal group (p=0.0001). Mean induction to delivery time interval was significantly less in sublingual group (p=0.008). The incidence of cesarean sections, major side effects and vaginal delivery were similar in both the group. Neonatal outcomes of both groups were comparable.Conclusions: Misoprostol was effective in induction of labor when administered by either sublingual or vaginal route. Sublingual route had significantly less induction to delivery time interval and less doses were required. Sublingual route seems to have better efficacy than vaginal route. Misoprostol seems to be acceptable to the patients and is an option to be considered to induce labor at term.
Tranexamic acid for the treatment of postpartum hemorrhage: placebo controlled study
Authors: Nagangouda Rashmi , G. Vinaya
Published: June 2017

Background: Each year, worldwide about 530,000 women die from causes related to pregnancy and child birth. Obstetric hemorrhage is the leading cause of maternal mortality accounting for between one quarter and one third of deaths, most of which occur in postpartum period. The objective of the study was to study the effectiveness of tranexamic acid in reducing the blood loss in women with PPH.Methods: Study done on 100 adult women with clinically diagnosed postpartum hemorrhage, satisfying inclusion and exclusion criteria, following vaginal delivery of baby; women may have delivered their babies at Obstetrics and Gynecology department, Karnataka Institute of Medical Sciences (KIMS), Hubli or outside, with hospital admission following delivery. 50 patients will receive standard protocol with placebo for the treatment of PPH and 50 women will receive standard protocol with tranexamic acid (1 gm slow IV, if after 30 min bleeding continues after the first dose, a second dose may be given approximate rate of 1 ml/min).Results: Mean blood loss in the control group was 744±102 ml, whereas in Tranexamic acid group blood loss was 626±113ml. There was no patient requiring surgical intervention or hysterectomy in either group & there was no maternal mortality in either group and no thrombogenic side effect seen either in mother or baby in both the groups.Conclusions: It was concluded that Tranexamic acid is effective in reducing blood loss in women clinically diagnosed with PPH.
Comparison of metformin and N-acetylcysteine on metabolic parameters in women with polycystic ovarian syndrome
Authors: Ali Hina , Radhakrishnan Gita , Singh Alpana
Published: June 2017

Background: Polycystic ovary syndrome (PCOS) is a common disease that affects up to 10% of women of reproductive age, in which hyperandrogenism (HA), enlarged cystic ovaries, and chronic anovulation often co-exist with obesity, dyslipidemia and insulin resistance (IR). There is a need for an alternative to metformin with minimal side effects to improve insulin sensitivity and correct dyslipidemia in PCOS patients.Methods: It was a prospective, Randomized controlled clinical trial. 116 PCOS patients, 58 each in two groups received either Metformin 500 mg TDS or N-acetylcysteine (NAC) 600 mg TDS for 3 months. Clinical and biochemical parameters contributing to metabolic syndrome (MS) and insulin resistance (fasting blood sugar (FBS), fasting insulin (FI), FBS:FI, HOMA-IR and QUICKI) were assessed at the start and end of the study. Results were compared between the two groups.Results: Both treatment modalities resulted in a significant reduction in number of cases with IR (p=0.001) and MS. Fasting hyperinsulinemia improved in 15 % (p=0.12) and 30% (p=0.001) of patients while 12% (p=0.23) and 18% (p=0.049) improvement was seen in FBS:FI in MET and NAC group respectively. Similarly, improvement in HOMA-IR was 12% (p=0.30) and 32% (p=0.001) in MET and NAC group which is significant with NAC. QUICKI and impaired glucose tolerance showed significant improvement in both the groups with a p-value of 0.04 and 0.006, 0.035 and 0.046 respectively. Significant reduction was seen in triglycerides (p=0.048) in NAC group.Conclusions: NAC is equally efficacious as metformin in improving parameters of insulin resistance and metabolic syndrome with minimal occasional side effects ensuring better compliance for a long-term therapy.
Estimation of serum 25 hydroxy vitamin D level and its correlation with metabolic and endocrine dysregulation in women with PCOS
Authors: Solanki Vandana , Chaurasia Amrita , Singh Shalini , Sachan Shikha , Varma Kachnar , Devi Rekha
Published: June 2017

Background: Polycystic ovarian syndrome is the most common hormonal disturbance in the reproductive age women, with prevalence of 5-10%. Vitamin D deficiency is common in women with or without PCOS. The aim of this study was to assess association of serum vitamin D level with metabolic and endocrine dysregulation in women with PCOS.Methods: This cross-sectional study was done over a period of one year. 100 women of age group 20-40 years were divided in group A 30 (BMI >30 mg/m2) with PCOS, group B 20 (BMI <25 mg/m2) with PCOS, group C 50 controls and were investigated for serum FSH, LH, LH/FSH ratio, S. total testosterone, S. postprandial insulin level, glucose insulin ratio, 25 hydroxy vitamin D level.Results: LH/FSH ratio >2 (33.33% in obese and 50% in non-obese), serum total testosterone level >0.8ng/ml (80% in obese and 75% in non-obese) (p value was significant between study group as well as between study and control group). Serum fasting, postprandial blood glucose, postprandial serum insulin level was elevated in obese than non-obese PCOS. 25 (OH) vitamin D deficiency <20 ng/ml (56.675% in obese and 45% in non-obese). So, vitamin D deficiency was more common in obese PCOS.Conclusions: PCOS is more common in age group of 20-40 years. There is more Insulin resistance in obese PCOS as compared to non-obese PCOS. Vitamin D deficiency is comparatively more common in obese PCOS population than in non-obese PCOS.
Assessment of anaemia in adolescent girls
Authors: Upadhye Jayant V. , Upadhye Jayshree J.
Published: June 2017

Background: The world’s adolescent population is facing a series of serious nutritional challenges which are not only affecting their growth and development but also their livelihood as adults. Yet, adolescents remain a largely neglected, difficult to measure and hard to reach population, in which the needs of adolescent girls in particular, are often ignored. Anemia in adolescent girls contributes to maternal and foetal mortality and morbidity in future. The objective of the study was to estimate the frequency of anemia among adolescent girls, to study the socio-demographic factors associated with anemia and to evaluate the cause and type of anaemia.Methods: A cross-sectional survey was conducted in an urban area in a school. A total of 300 girls (12-18 years) were included in this study. Statistical analysis was done using percentage, standard error of proportion, Chi-square test and student’s t-test.Results: The prevalence of anemia was found to be 90%. A significant association of anemia was found with socio-economic status and literacy status of parents. Mean height and weight of subjects with anemia was significantly less than subjects without anemia. A high prevalence of anemia among adolescent females was found, among those whose parents were less educated.Conclusions: The overall prevalence of anemia among adolescent females was found to be 90%. There is significant association of anemia with socio-economic status and parents' educational status. There is need to increase awareness of anemia in adolescent girls and parents.
Study on factors influencing caesarean section delivery in urban field practice area of Kamineni Institute of Medical Sciences, Narketpally, Nalgonda, India
Authors: Sarala Kumari Balmur , Visweswara Rao Guthi
Published: June 2017

Background: Caesarean section is one of the most commonly performed major surgeries in obstetric practice intended to save the mother and child in turn reducing maternal and perinatal mortality. The steadily increasing global rate of caesarean section has become one of the most debated topics in maternity care. The objective of this study is to identify the factors influencing caesarean section delivery in the study area.Methods: This is a community based cross sectional study conducted among 66 women who underwent caesarean section in urban slum of field practice area of KIMS Nalgonda from January 2017 to February 2017. Information regarding socio demographic factors, indication of caesarean section, maternal and neonatal outcome was recorded in pre-designed pretested questionnaire.Results: The rate of caesarean section (CS) in this study was 55.9%. The commonest indication for elective caesarean was previous caesarean section (59.5%) and for emergence caesarean section the commonest indication was fetal distress (50%). 47.6% in elective group and 62.5% in emergency underwent caesarean section in government hospitals, 52.38% in elective group and 37.5% in emergency underwent caesarean section in private nursing homes.Conclusions: Elective caesarean sections are more common than emergency sections. Most of the caesarian sections were in the age group of 18-25 years, Hindus, BC community, house wives, who have studied up to intermediate and above, below poverty line group and in multigravida women. Common indication for elective CS was previous CS and for emergency CS was fetal distress.
Study of posterior vaginal wall prolapses and correlation with bowel function
Authors: Bijwe Smita Anand , Rajbhara Pooja
Published: June 2017

Background: This study’s objectives were to describe symptoms related to bowel symptoms in women with prolapse and to compare these symptoms as per the grading of posterior vaginal prolapse.Methods: Descriptive study, 63 women answered questionnaire for assessment of bowel function and were subjected to physical examination according to the International Continence Society’s system for grading uterovaginal prolapse.Results: The distribution of pelvic organ support by overall POPQ stage was 6.4%stage 1,21%stage 2, 50% stage 3, and 23% stage 4. Women were asked to rate the extent to which they were bothered by their bowel function on a scale of 1 to 10, with 1 being not at all and 10 being extremely. Thirty-six women (58%) reported 1 to 4, 18 (29%) reported 5 to 7, and 8 (13%) reported greater than 8. According to the furthest extent of posterior vaginal prolapse at point Bp, 22 (15.5%) were in stage 0, 46 (32.4%) were in stage I, 50 (35.2%) were in stage II, 23 (16.2%) were in stage III, and 1 (0.7%) was in stage IV. Ninety-two percent of women reported having bowel movements at least every day. When asked whether straining was required for them to have a bowel movement, 67% reported never or rarely,3% reported sometimes,1.6%) reported always. When asked whether they ever needed to help stool come out by pushing with a finger in the vagina or rectum, 77.0% reported never or rarely, 15.1% reported sometimes, (5.6%) reported usually, and (1.6%) reported always. No women had fecal incontinence, there were no clinically significant associations between any of the questions related to bowel function and severity of posterior vaginal prolapse.Conclusions: Women with uterovaginal prolapse frequently have symptoms related to bowel dysfunction but this is not associated with the severity of posterior vaginal prolapse.
Study of correlation between symptoms and signs in women with anterior vaginal wall prolapse
Authors: Bijwe Smita Anand , Rajbhara Pooja
Published: June 2017

Background: Pelvic organ prolapse is a common, distressing and disabling condition affecting up to 30% of the women, 20- 60 years of age, attending Gynaecology outpatient clinics. Objective of present work was to know the effect of Pelvic Organ Prolapse (POP) on micturition symptoms.Methods: Descriptive study including 64 women presenting with POP symptoms. Subjects were evaluated using POP-Quantification system, Urinary Distress Inventory.Results: Women were asked to rate the extent to which they were bothered by their urinary function on a scale of 1 to 10, with 1 being not at all and 10 being extremely. Ten women (16%) reported 1 to 4, 23 (37%) reported 5 to 7, and 29 (47%) reported and gt;8.Conclusions: Strong association does exist between POP and micturition symptoms which are obstructive in nature and those causing urge incontinence.
Pregnancy and lactation associated osteoporosis: unrecognized cause of musculoskeletal pain syndrome during the peri-pregnancy period
Authors: Kornete Anna , Rasa Ingvars , Mukane Maija
Published: June 2017

Pregnancy- and lactation-associated osteoporosis (PLO) is a rare disorder, usually occurring in late pregnancy and the early post-partum period. The prevalence, etiology, pathogenesis and therapy remains unclear. Three clinical cases of PLO present patients with multiple severe osteoporotic fractures during the peri-pregnancy period and different treatment strategies.
Uterine myxoid leiomyosarcoma: a diagnostic challenge
Authors: Durairaj Jayalakshmi , Chandrasekaran Swaramya
Published: June 2017

Uterine sarcomas are histologically diverse tumours which comprise about 3-7% of uterine malignancies. Myxoid leiomyosarcoma (MLMS) is an extremely uncommon variant of uterine leiomyosarcoma. This report is of a 35 year old woman who presented with urinary retention and abnormal vaginal bleeding, who underwent a total abdominal hysterectomy for cervical fibroid. A diagnosis of leiomyoma with myxomatous degeneration was made. The woman subsequently developed a recurrence within 5 months of the surgery and was diagnosed with MLMS following biopsy. This case reiterates the uncertainties associated with the diagnosis of MLMS and the need for heightened vigilance in women with myxomatous degeneration of leiomyoma.
Rarest variations of ectopic pregnancy: an obstetrician's dilemma
Authors: Chaudhari Kamlesh R. , Sakhalkar Ashwini , Khyade Rajeshwari
Published: June 2017

Ectopic pregnancy is an important cause of morbidity and mortality which has always proven to be a challenge to obstetricians. Increased usage of artificial reproductive techniques has not only increased tubal ectopic pregnancies but also other rarer forms of ectopic pregnancies. With newer diagnostic and therapeutic tools, chance of early detection and intervention has increased many fold. Conservative treatment options have also gained importance. Here we discuss 3 peculiar types of rare ectopic pregnancies-heterotopic pregnancy, caesarean scar ectopic pregnancy and rudimentary horn ectopic pregnancy- and their treatment options.
Comparison of diagnostic yield of GeneXpert MTB/RIF assay and ZN (Ziehl-Neelsen) staining in serosal fluids from HIV and non-HIV patients with extra-pulmonary tuberculosis
Authors: Mittal Mahim , Kumar Ritesh
Published: June 2017

Background: India accounts for 23% of the global TB burden and of these 15-20% are extrapulmonary tuberculosis(EPTB). EPTB has diverse clinical presentation and often is over diagnosed because of lack of standardised diagnostic means. Yield of acid fast bacilli (AFB) from EPTB settings is very low and alternate facilities are nearly non-existent routinely. GeneXpert MTB/RIF has been recommended as a diagnostic tool for sputum samples. It has been also recommended for serosal fluids from HIV patients only. This study was done to compare the yield of GeneXpert MTB/RIF assay and ZN (Ziehl Neelsen) staining among HIV and non-HIV patients with suspected serosal TB.Methods: GeneXpert MTB/RIF assay and ZN staining was done in all serosal fluid samples in which a clinical diagnosis of serosal TB had been made by conventional methods.Results: A total of 81 extra pulmonary samples (21 from HIV and 60 from non-HIV patients) were processed in this study, which included 48 CSF, 19 pleural fluids and 14 ascitic fluid. Out of these, 34.5% (28/81) patients were both GeneXpert MTB/RIF as well as ZN stain positive whereas only 13.58%(11/81) patients were ZN stain positive. 4/21 (19.05%) samples from HIV patients were ZN stain positive and 9/21(42.85%) were GeneXpert positive. 7/60 (11.66%) samples from non-HIV patients were ZN stain positive and 19/60 (31.66%) were GeneXpert positive.Conclusions: GeneXpert MTB/RIF is more sensitive than ZN staining in EPTB. The yield in both HIV and non-HIV patients is the same.
Monteggia fracture dislocation in adults: study of functional outcome following surgical treatment in patients attending a tertiary care center in North India
Authors: Khan Shameem A.
Published: June 2017

Background: Monteggia fracture dislocations are rare injuries that comprise less than five percent of all forearm fractures. Good results in monteggia fractures depend on early and accurate diagnosis, rigid fixation of ulna, accurate reduction of radial head and post-operative immobilization to allow ligamentous healing about the dislocated radial head. The objectives of the study were to assess the mean time taken for union of fracture, complication encountered during treatment, to assess the functional outcome and to present conclusions based on the results of plate osteosynthesis of monteggia fracture dislocation in adults.Methods: In a prospective study from September 2013 to August 2016, twenty adult patients of monteggia fracture were admitted and treated by closed reduction/excision of radial head and compression plate fixation of ulna. The results were evaluated by assessing union on serial x-rays at follow-up (6-18 months) and functional outcome using Anderson’s criteria.Results: Most of the cases were type-1 fracture-dislocation according to Bado's classification. Mean time taken for union was 4.1 months. Using Anderson scoring system, we achieved 65% excellent results, 30% satisfactory result and 5% failure in study case. The complication encountered were superficial infection and non-union.Conclusions: The technique of early closed reduction of radial head and open reduction and internal fixation of ulna using compression plate is a simple and effective means of treating monteggia fracture dislocation in adults with excellent functional outcome. Upper limb should be immobilized in 110-120 degrees of elbow flexion and forearm in supination to prevent radial head redislocation.
Effect of oral clonidine premedication on hemodynamic responses during laparoscopic cholecystectomy
Authors: Mali Anshu , Asthana Unnati , Prakash Jai , Londhe Nandini , Bandey Suhail , Arya Gaurav
Published: June 2017

Background: Laparoscopic cholecystectomy has rapidly revolutionized gall bladder surgeries and has now become the gold standard for the treatment of cholelithiasis. Even though it has several advantages, creation of pneumoperitoneum for the surgical procedure can have several adverse haemodynamic and respiratory consequences. Thus, the present study was designed to evaluate the type and extent of haemodynamic changes associated with laparoscopic surgery and also to find out the efficacy of oral clonidine premedication in attenuation of such haemodynamic changes.Methods: In this prospective, randomized, double blinded comparative study, 60 patients between 18-60 years age group, belonging to ASA 1 and ASA 2 categories scheduled for elective laparoscopic cholecystectomy under general anaesthesia were categorized into 2 groups as Group C and Group P with 30 patients in each group. Patients in Group C received premedication with oral clonidine 150μg and Group P received Tab. Vitamin C, 90 minutes prior to surgery. The two groups were compared with respect to haemodynamic parameters and sedation scores.Results: There was significant increase in all the haemodynamic variables in group P as compared to group C where the variables remained close to baseline values and patients in Group C had mild to moderate sedation without causing respiratory depression.Conclusions:Oral premedication with clonidine effectively attenuates the haemodynamic response to pneumoperitoneum and also provides sedation without respiratory depression, thus reducing anaesthetic requirement.
Mother's experience in managing labor pain in central java Indonesia
Authors: Rahayu Heni Setyowati Esti
Published: June 2017

Background: Maternal mortality ratio in Indonesia is still high compared to other ASEAN countries. One of the causes of maternal death is obstructed labor associated with anxiety, stress and pain. In some areas of Indonesia have the traditional ways to cope with pain during childbirth. This tradition is inherited from one generation to the next generations. The objective of this study was to explore the experience of mothers on coping with pain which are influenced by culture, values and beliefs of the Java community.Methods: This study used a phenomenological qualitative approach. A total of five people in Magelang regency, Central Java participated in this study, selected by using purposive sampling and data was analyzed by thematic content analysis,Results: The result of this study consist of four themes, namely mules (uncomforted feeling in stomach) and stiffness in stomach’s muscle because the baby would be born which is a mother's perception of pain during childbirth, mothers perform actions in the physical, psychological and spiritual for pain, parents teach in eating and drinking, attitudes and actions in reducing labor pain, the parents and provider are source who convinced her to take action to manage labor pain.Conclusions: Culture affects maternal in managing pain, so nurses need to notice to the cultural aspects of nursing care adjusted to the patient's beliefs and culture.