bluuebunny/crossref_metadata_2025 huggingface dataset:
Petrus und der singende Hahn: Eine zeitgeschichtliche Anspielung in der markinischen Verleugnungsperikope (Mk 14,54.66–72)
Authors: Lanzinger Daniel
Published: February 2018

A growing strand of scholarship assumes that Mark’s account of Peter’s denial should be understood within the context of the Neronian persecution. This paper strengthens this view by arguing that the cock whose crow reminds Peter of Jesus’ words is a hidden reference to Nero. Evidence comes from Suetonius, who testifies that a cock was indeed used as a derisive metaphor for Nero and alluded to his self-representation as an Apollo-like artist. The apparent tension between three denials and only two cock-crows in Mark 14,72 can then be taken as a proleptic allusion to a third “cock-crow”, i. e. to the Neronian persecution when Peter ultimately confessed his belonging to the disciples of Jesus instead of denying it. He is thus portrayed as a positive role model for those in the Marcan community who failed to remain steadfast during the persecution.
Hapax Legomena in Disputed Pauline Letters: A Reassessment
Authors: Nes Jermo van
Published: February 2018

To argue for the pseudonymity of disputed Pauline letters on the (partial) basis of their disproportional high number of hapax legomena continues to be common practice among New Testament scholars. By means of linear regression analysis, it is shown that only 1 and 2 Timothy use significantly more hapaxes than the undisputed Pauline letters. If, however, proper noun hapaxes, hapaxes taken from citations, and hapaxes which – upon removal of its preposition – have a common lexeme are not taken into consideration, it appears that none of the disputed Pauline letters use significantly more hapaxes than the undisputed Pauline letters.
The Vulnerable Spectator
Authors: Hastie Amelie
Published: February 2018

Amelie Hastie's column thinks through representations of the 1970s on film through an examination of two contemporary films: Battle of the Sexes (Jonathan Dayton and Valerie Faris, 2017) and The Center Will Not Hold (Griffin Dunne, 2017). She concludes that Somewhere between the jingle-jangle of nonsense and the sentimentality of a linear narrative lies the 1970s, the time of her childhood, the time to which she had never wanted to return but which she now finds herself trying to grasp, over and again. The films about and of this period implore her to continue.
A Bivariate Model based on Compound Negative Binomial Distribution
Authors: Omair Maha Ahmad , AlMuhayfith Fatimah E , Alzaid Abdulhamid A
Published: February 2018

A new bivariate model is introduced by compounding negative binomial and geometric distributions. Distributional properties, including joint, marginal and conditional distributions are discussed. Expressions for the product moments, covariance and correlation coefficient are obtained. Some properties such as ordering, unimodality, monotonicity and self-decomposability are studied. Parameter estimators using the method of moments and maximum likelihood are derived. Applications to traffic accidents data are illustrated.
Estimating the Gumbel-Barnett copula parameter of dependence
Authors: Portilla Yela Jennyfer , Tovar Cuevas José Rafael
Published: February 2018

In this paper, we developed an empirical evaluation of four estimation procedures for the dependence parameter of the Gumbel-Barnett copula obtained from a Gumbel type I distribution. We used the maximum likelihood, moments and Bayesian methods and studied the performance of the estimates, assuming three dependence levels and 20 different sample sizes. For each method and scenario, a simulation study was conducted with 1000 runs and the quality of the estimator was evaluated using four different criteria. A Bayesian estimator assuming a Beta(a,b) as prior distribution, showed the best performance regardless the sample size and the dependence structure.
Perspectivas sobre o uso das diretrizes de desenho instrucional para a simulação na saúde: revisão da literatura
Authors: Melo Brena Carvalho Pinto de , Falbo Ana Rodrigues , Bezerra Patricia Gomes de Mattos , Katz Leila
Published: February 2018

AIMS: This article had two main objectives: to present a brief summary of introductory cognitive concepts on learning and instruction for simulation, including instructional design guidelines; and provide an overview of the current available evidence on the instructional perspectives on healthcare simulation training effectiveness, in particular with regards to simulation formats, fidelity and simulation site.METHODS: We searched for articles at MEDLINE/PubMed, Embase, Cochrane, ERIC, LILACS and SciELO databases, using the keywords "instructional design guidelines", "healthcare simulation", "simulation training", "simulation effectiveness", "complex learning", and "transfer of learning". No specific beginning date of publication was specified and last date of search was September 19th 2017. All articles in English and Portuguese were considered for inclusion with no specific exclusion criteria. A few articles were purposefully selected in search of introductory concepts on learning and instruction.RESULTS: Our search retrieved 3196 articles in the different databases. After preliminary title, abstract and content analysis, we selected 56 articles. Additionally, nine traditional articles and one book were included to present the best available evidence, reviews, reflections and critiques on simulation instructional perspectives, resulting in 66 references consulted in detail for this review.CONCLUSIONS: Simulation offers the opportunity for active learning for health professionals by providing a complex learning environment with integration of knowledge, skills and attitudes. With potential impact on the different levels of learning, behavior and results, special attention should be given to the instructional format of the simulation. Among the instructional design guidelines, authenticity stands out as one of the elements of fundamental relevance for learning. Other instructional elements, such as increasing complexity, proper training location, debriefing, self-assessment opportunity, and other forms of assessment, also have positive influence and should be used in planning different simulation instructional designs.
Establecimiento y producción de raigrás y tréboles en dos regiones del trópico alto colombiano
Authors: Vargas- Martínez Juan De Jesús , Sierra-Alarcón Andrea , Benavidez-Cruz Juan , Avellaneda-Avellaneda Yesid , Ariza-Nieto Claudia
Published: February 2018

Colombian dairy systems are based on grasslands; therefore, it is necessary to define forages response under different environmental conditions. The objective of this study was to assess the establishment and production of five perennial ryegrass and three clovers into two regions of Colombian highlands (Tuta, Boyacá and Mosquera, Cundinamarca). Three 8 m2 plots of each species were established. Establishment variables were evaluated twice a month during the initial five months. The variables of production and nutritional quality were evaluated in rainy (April and May) and drought (June and July) season. The variables were analyzed through a randomized complete block with repeated measures, between November 2015 and July 2016. During the establishment period, ryegrass and clovers coverage and adaptation degree were greater between the days 45 and 60, and 105 and 150, in Tuta and Mosquera, respectively. Maturity increase reduced the lactation net energy (between 7% and 15%) and increased the daily dry matter production per hectare (between 20 and 78 kg). Evaluation day presented a greater influence regarding the variety and the rainy season on the evaluated establishment and regarding the production variables in ryegrass and clover forages, in the Colombian highlands.
If Not all Stones Are Alive…
Authors: Harvey Graham
Published: February 2018

Irving Hallowell’s conversation with an Anishinaabe (Ojibwa) elder in the early twentieth century has gained increasing attention in recent decades. It has been cited by many involved in the multi-disciplinary “turns” to ontology, materiality and relationality. In particular, it has inspired many researchers involved in the “new (approach to) animism”. This article considers efforts to rethink what “person” or “relation” might mean – in the light of Indigenous ontologies and of the ferment of reflection and analysis offered by many colleagues. It proposes that we have not yet sufficiently understood what the elder intended by telling Hallowell that only some stones are animate. A more radically relational understanding of personhood has implications for the ways in which we approach and engage with/in nature, culture, science and religion.
Special Issue Introduction
Authors: Johnston Lucas , Sideris Lisa , Witt Joseph
Published: February 2018

Special Issue Introduction: Religion, Science and the Future
Turismo de vinho: um catalisador do desenvolvimento rural, através de estratégias de coopetição
Authors: Salvado Josefina Olívia
Published: February 2018

As indústrias do vinho e do turismo são "os dois lados da mesma moeda", identificadas como parceiros naturais simbióticos, podendo ser classificados como um ecossistema catalisador do desenvolvimento rural. O turismo do vinho é um excelente veículo de resgate da memória e da construção de uma identidade cultural, garantindo a continuidade das tradições ao longo das gerações, resultante do processo de socialização, onde o indivíduo aprende e interioriza o sistema de valores, de normas e comportamentos de uma determinada cultura. Este tema valoriza as “velhas” atividades rurais e desenvolve outras, investigando oportunidades e fatores de competitividade que existem em cada região. O estudo identifica dinâmicas competitivas que possam moldar o ecossistema do enoturismo usando dados de uma amostra de conveniência de 51 empresas ligadas à indústria do vinho em Portugal. Para alcançar o sucesso empresarial e o desenvolvimento territorial, serão necessárias estratégias de coopetição, criar uma oferta de produtos inovadores e distintivos e promover os produtos endógenos de cada região. Os resultados mostram uma relação complexa entre os stakeholders dentro do ecossistema, com limitadas práticas de cooperação. Foi concluído que, para o enoturismo criar mais-valias sustentáveis nas regiões, é crucial reforçar as parcerias e fortalecer estratégias ganha-ganha de coopetição que envolvam todos os stakeholders e ainda garantir uma harmonização da visão e dos objectivos de cada parceiro, alinhados com a especialização inteligente das regiões e focados no crescimento e desenvolvimento sustentáveis dos territórios.
MELD Protocol 1 - Patient and Control Inclusion in the MELD Project v1
Authors: Adler Sophie , Whitaker Kirstie , Wagstyl Konrad
Published: February 2018

The MELD Project is an international collaboration aiming to create open-access, robust and generalisable tools for FCD detection. To this end, we will train a neural network classifier on MRI features from FCD patients from multiple centres worldwide. Protocol 1 details instructions for patient and control inclusion in the MELD Project as well as how to fill out the demographics csv file.
MELD Protocol 2 - Instructions for FreeSurfer Cortical Segmentations v1
Authors: Adler Sophie , Whitaker Kirstie , Wagstyl Konrad
Published: February 2018

The MELD Project is an international collaboration aiming to create open-access, robust and generalisable tools for FCD detection. To this end, we will train a neural network classifier on MRI features from FCD patients from multiple centres worldwide. Protocol 2provides instructionson how to create FreeSurfer cortical segmentations. These instructions are based on the freely available protocols on the ENIGMA-epilepsy websitehttp://enigma.ini.usc.edu We are very grateful to Derrek Hibar, Neda Jahanshad, Roberto Toro, Jerod Rasmussen, Theo van Erp who wrote the orginal ENIGMA protocols and offered them with an unlimited license without warranty! The main changes are the paths, which are now directed to the meld folder.
Responsabilidad social de la Psicología frente a la violencia
Authors: Vaca Vaca Patricia , Rodríguez Díaz María Clara
Published: February 2018

En este artículo se hace un análisis sobre la responsabilidad social de la Psicología frente al fenómeno de la violencia.  Se parte de su reconocimiento en este contexto como una de las problemáticas de mayor relevancia y de salud pública, que coincide con la valoración que de ella han hecho estudios realizados a nivel internacional.  Se destaca la importancia de la proyección social y la formación de futuros profesionales desde la universidad, así como algunos de los estudios sobre las diferentes expresiones de violencia en este medio. Se asumen como importantes las recomendaciones planteadas en el informe mundial de la OMS sobre violencia y  salud,  y  la comprensión  de  la realidad de la violencia más allá del ámbito privado e individual en el que priman criterios “curativos” o legales, para reconocerla como un hecho histórico social frente al cual la Psicología debe aportar elementos para la búsqueda de un proyecto ético/social de construcción de sujeto y comunidad. La investigación y praxis soportada en valores solidarios de respeto por el otro y formas diferentes de solucionar el conflicto, serán estrategias que deberán ser sustentadas.
A study on fetomaternal outcome in premature rupture of membranes
Authors: Mondal Arnab , Kanungo Sanhita
Published: February 2018

Background: Premature rupture of membranes (PROM) is a common obstetric complication. This condition may lead to maternal complications like puerperal hemorrhage, puerperal sepsis, chorioamnionitis, maternal death etc. due to increased risk of infections and operative interventions. It may also lead to neonatal complications like prematurity, respiratory distress syndrome (RDS), sepsis, low birth weight (LBW) and perinatal death. The aim of the study was to find out whether certain maternal and neonatal complications were significantly higher in PROM cases than controls.Methods: In the present study, the definition of PROM adopted is – rupture of fetal membranes before the onset of true labor pain. The lower limit of gestational age was taken to be 28 weeks. Diagnosis of PROM was mainly clinical. Culture sensitivity test of amniotic fluid was done. The mother was observed throughout labor and postnatal period till discharge and any complications were noted. The baby was also observed from birth till discharge and any complications and interventions were noted. Data obtained was analysed by appropriate statistical methods to obtain results and reach the conclusion.Results: The results of the study showed that the incidence of puerperal hemorrhage, LBW babies, prematurity, maternal morbidities, chorioamnionitis, perinatal mortality and neonatal morbidities were significantly higher in PROM cases. These results corroborated with the findings of other researchers most of the time.Conclusions: It was concluded that individualized management of PROM cases depending on the gestational age and risk of complications is the best way to achieve a good fetomaternal outcome in such cases.
Evaluation of causes of still birth in a tertiary care teaching hospital
Authors: Kothiyal Shivani , Agarwal Anjoo , Das Vinita , Pandey Amita , Agarwal Smriti
Published: February 2018

Background: Whenever pregnancy occurs there is an expectation that every pregnancy will end with the birth of a healthy baby, yet in a developing country like India 22 in every 1000 births are stillborn. The objective of this study was to evaluate the rate and causes of still birth in a tertiary care teaching hospital, Queen Mary, King George Medical college and university, Lucknow, Uttar Pradesh, India.Methods: Present study was an observational study in a tertiary care hospital. 7024 births occurred in the institution over a period of 1 year out of which 550 were stillbirths. Stillbirths which weighed over 500 grams were included in the study. After informed consent, details of history about epidemiological factors, obstetric history and medical history were obtained. Antenatal investigations including imaging, delivery details and stillborn morphological characteristics were analyzed to identify the cause of stillbirthResults: Out of 7024 deliveries, stillbirth rate was 78.30/1000 total births. Cause of intrapartum stillbirth showed statistically significant correlation with patient’s place of residence (rural>urban), distance of health centre from her house, time taken to reach first point of contact and her parity. The major obstetrical causes of stillbirth identified were APH 22.36%, hypertensive disorders of pregnancy 19.27%, IUGR 15.27%, unexplained causes 11.09%, mal-presentations 9.64%, rupture uterus 9.09% and obstructed labour 6.36%. Severe anemia was found in 24.91% as an associated obstetrical cause of stillbirth.Conclusions: The rate of stillbirth is higher as compared to the Indian data (22/1000 total births). Antepartum obstetric complications (APH, hypertensive disorder of pregnancy, IUGR) were the most common. 15.45% cases showed intrapartum causes of stillbirth (obstructed labour and rupture uterus) which was significantly higher than developed countries where such cases are negligible. The higher number of intrapartum deaths indicate that better healthcare services can drastically reduce stillbirth rates in developing countries.
A comparative study of ADA and WHO criteria for screening of gestational diabetes mellitus
Authors: Baskaran Jeyamani , Sengodan Subha Sivagami , Pandian Anbarasi
Published: February 2018

Background: Gestational diabetes mellitus is defined as carbohydrate intolerance with its onset or first recognition during present pregnancy. Objective of present study was to compare screening accuracy of ADA and WHO criteria for screening of gestational DM.Methods: This is a prospective comparative study using ADA and WHO criteria for the screening of GDM. Our objective was to study the implication of implementing the ADA guidelines and WHO guidelines for screening and diagnosis of GDM in 200 antenatal patients at Government Mohankumaramangalam Medical College, Salem during a period of one year from July 2015 to June 2016. All antenatal women attending AN OP between 24-28 weeks of gestation are subjected to fasting blood glucose measurement followed by an oral OGTT using 75 gms of glucose load. Venous blood samples are collected at the end of 1hr and 2hr. The ADA and WHO criteria were applied separately for each subject to diagnose GDMResults: As per ADA criteria presence of any one of either, Fasting blood sugar- 92 mg (5.1 mmol/L),1 hour postprandial-180mg (10.00mmol/L), 2 hour postprandial: 153 mg (8.5 mmol/L) was used for the diagnosis of GDM.As per WHO criteria presence of any one of either, Fasting blood sugar- 126mg/dl (7 mmol/dl) or 2 hour postprandial- 140 mg/dl (7.8 mmol/dl) for diagnosis of GDM. The 2hr value has the statistical significance in the diagnosis of GDM. The 1hr value done in ADA criteria does not have statistical significance when compared to 2hr value.Conclusions: Universal screening for GDM is necessary to diagnose Gestational Diabetes Mellitus. Universal screening may not be feasible in resource poor settings, but it definitely improves the pregnancy outcomes considering the high prevalence of gestational diabetes in India.
Surgical site infection among gynecological group: risk factors and postoperative effect
Authors: Bharatnur Sunanda , Agarwal Vandana
Published: February 2018

Background: This study was carried out to evaluate the preoperative and intraoperative risk factors associated with surgical site infection amongst gynecology patients and its impact on postoperative recovery.Methods: A prospective, observational study was conducted among 285 patientsWho underwent surgery over a period of two years. Diagnosis of SSI was made as per CDC criteria. Various risk factors and impact of SSI on postoperative recovery were analysed. Statistical analysis was carried out with SPSS version 16.0. Range and mean was calculated for continuous variables and overall incidence rate of SSI is also calculated. Pearson Chi-square test was used to test risk factor association with SSI. Odds ratios and 95% confidence intervals (CI) was calculated. Significance was assumed at a p value of less than 0.05.Results: The incidence of SSI was found to be 52 out of 285 women (46%). Majority of SSI, i.e. 49 out of 52 (94%) were superficial in nature. Deep SSI was seen in 3 patients (6%). No organ/space infection was noted in any patient. Women who were over 50 years had higher risk of developing SSI than women between 36 to 50 years (OR 0.519 Vs 0.214). The risk of SSI was 4 times in case of clean contaminated wounds as compared to clean wounds (OR 3.877). The risk further increased to 7 times in case of dirty wounds (OR 6.753). Other risk factors which are significantly associated with SSI were BMI (p value <0.001), midline incisions (p <0.001) and Mattress suture (p <0.001). Presence of previous scar had intraoperative adhesions, weaker scar and poor healing which predispose to development of SSI. Comorbidities which influence SSI’s in the present study are diabetes mellitus (OR 5.49, 95% CI 2.506-12.066, P <0.001), anaemia (OR 4.63, Cl 2.458-8.756) and hypertension (OR 2.46, Cl 0.994-6.117). Wound swab was sterile in 33(63%) cases and 18(35%) cases showed growth of the organism. Most common organism noted was E. coli 9 (50%) followed by Klebsiella and Staph aureus.Conclusions: SSIs are increasing in the current scenario due to increase in the number of surgeries, however they can be prevented by early identification and optimization of medical comorbidities and BMI. Meticulous preoperative workup and intraoperative surgical steps are important in reducing the risk of developing SSI.  A decrease in infection rate can lead to substantial reduction in the burden of disease.
Clinical outcome of unilateral versus bilateral laparoscopic ovarian drilling in clomiphene citrate resistant cases of polycystic ovarian syndrome: a comparative study
Authors: Laul Poonam , Saxena Pinkee , Kurrey Sonali , Kadam Vijay K. , Migalani Urvashi
Published: February 2018

Background: The aim of the current study is to compare the efficacy of laparoscopic unilateral ovarian drilling with bilateral ovarian drilling in clomiphene citrate resistant cases of polycystic ovarian syndrome in terms of clinical response, change in biochemical parameters, ovulation rate, pregnancy rate and miscarriage rate.Methods: The study was conducted on 45 women with anovulatory infertility due to PCOS with clomiphene citrate resistance. By random selection, all patients were divided in two groups. In group 1, unilateral ovarian drilling was done and in group 2, bilateral ovarian drilling was done. A maximum of 5 drills were performed using insulated unipolar diathermy needle. Patients were followed up for one year and the clinical outcome in two groups were recorded and compared.Results: Post ovarian drilling it was seen that no major differences were noted between the two groups in return of spontaneous menstruation at 6 weeks (65% vs 60%), overall ovulation rate (55% vs 65%) and pregnancy rate (45% vs 40%). The mean fall in serum LH, serum FSH and serum testosterone were also similar in the two groups.Conclusions: Unilateral laparoscopic ovarian drilling had similar efficacy as bilateral laparoscopic ovarian drilling in terms of restoration of normal menstrual pattern, ovulation and achieving pregnancy. It is an effective alternative minimally invasive procedure for patients with resistant PCOS.
Prevalence and determinants of high risk human papilloma virus in Hyderabad, India
Authors: V. Chandana , Gaguturu Rasheeda Begum
Published: February 2018

Background: Cervical cancer is the most common cancer among india women and age standardized mortality rate are the highest in south central Asia. In the past decade an among aetiologic association between infection with high risk human papilloma virus and development of cervical cancer has been increased. The study was aimed at studying the prevalence and determinants of high risk human papilloma virus in these patients.Methods: This study was conducted for a period of one year to know the prevalence and determinants of high risk human papilloma virus in the patients attending gynaec out patient department. A total of 266 married women between 15-75 were randomly selected for the study.Results: There is high prevalence of HPV in low (43.3%)/mid (37.4%) socio economic class (17.6%). But the result was not statistically significant (p=0.149). higher prevalence of HPV was found in multiparas (39.4%) compared to multiparas (33.3%) which was not statistically significant (p=0.233). Husbands of 252 women were circumcised out of which 96 wives were positive for HPV DNA (38.1%). Among 14 women with no history of circumcision in their husband HPV DNA positive (28.6%). Correlation of cytology with HPV DNA among different age groups showed increasing prevalence with age but the result was not statistically significant (p=0.115). the result showed that age at marriage, higher the prevalence of HPV DNA. The result was statistically significant (p=0.017). with increasing state of education, the prevalence of HPV infection decreased, but the result was not statically significant (p=0.142).51.3% of women of who were not education were positive for HPV as against only 25% of graduates were HPV positive.Conclusions: Genital hygiene, genetic polymorphisms and other environmental cofactors among HPV DNA positive women, which prevent oncogenesis.
Comparative study of pap smear and microbiological pattern in bacterial vaginosis
Authors: J. Girishma , M. Rupakala B. , Chavan Sunil
Published: February 2018

Background: Bacterial vaginosis is the most common cause of vaginal discharge among women in reproductive age group. It is characterized by an increased vaginal pH and loss of normal lactobacilli and overgrowth of anaerobes like Gardnerella vaginalis and other gram-negative rods. Purpose of this study is to compare the characteristics of pap smear and microbiological pattern in patients with abnormal vaginal discharge.Methods: The study was conducted in the Department of Gynecology and Obstetrics of Rajarajeswari Medical College and Hospital (RRMCH) Bangalore, India. All patients with vaginal discharge were included in the study. Vaginal discharge samples were sent to gram staining, culture and pap smear examination.Results: Of the 52 patients, 18 patients (34.6%) showed positive for bacterial vaginosis according to Nugent’s score. Of the 18 patients with positive Gram stains, 8 of them were positive for bacterial vaginosis according to pap’s smear (44%) and 10 had negative pap smears. In our study, of the 18 patients with positive Gram stains, 14 (77%) of them were positive for bacterial vaginosis according to culture.Conclusions: In the present study we found out that correlation of gram stain and pap smear was 44% whereas correlation of gram stain and culture was 77%. Hence, we conclude that gram stain and culture are preferred for the diagnosis of bacterial vaginosis rather than the pap smear evaluation.
Role of bilateral internal iliac artery ligation in severe obstetric and gynaecological hemorrhage
Authors: Maheshwari Shashi Lata Kabra , Kumari Nisha , Ahmad Syed N.
Published: February 2018

Background: Massive pelvic haemorrhage is a potentially lethal complication while undergoing obstetric and gynaecological surgery. The objective of this study was to study of role of bilateral internal iliac artery ligation in severe obstetric and gynaecological haemorrhage. It was a prospective interventional study carried out in a multi-speciality tertiary care hospital in New Delhi.Methods: Thirty-five patients (31 obstetric and 4 gynaecological) fulfilling the inclusion criteria over a period of 2 years were included in the study cohort after informed consent. After laparotomy, internal iliac arteries were exposed by incising the peritoneal fold between the infundibulo-pelvic and round ligaments. A number 1 silk suture and right-angled artery forceps were used to tie the internal iliac arteries approximately 1 inch below their origin. The success and complications of the procedure were analysed.Results: In the present study 31 out of 35 cases underwent BIIAL for obstetrical cause of haemorrhage and rest 4 for gynaecological cause. In 19 out of 31 patients, hysterectomy preceded or followed BILAL depending upon the clinical situation making a uterine salvation rate of 38.7%. The success rate of BIIAL was 67.7% in 31 obstetric cases. In the 4 gynaecological cases BILAL was done to arrest post-hysterectomy haemorrhage and success rate was 100%. Among 35 patients one patient died of haemorrhagic shock and 4 other died of full blown sepsis and MODS in surgical ICU. No significant procedure related complications were encountered.Conclusions: BILAL is a very effective procedure to control PPH and pelvic haemorrhage due to other causes and helps save the much precious lives and uteri. This procedure can always be tried where procedures like embolization are unavailable.
A rare case report: heterotopic pregnancy with ovarian ectopic pregnancy
Authors: N. Manuja , Devoor Ashok , . Umashankar
Published: February 2018

Heterotopic Pregnancy(HP) is defined as the occurrence of intrauterine and extrauterine pregnancy simultaneously. Incidence varies from 1 in 8000 to 30,000 natural conceptions. HP is common with artificial reproductive techniques and is very rare in natural conception. A high index of suspicion is helpful in diagnosis and appropriate management. We report a case of HP in a 28-year-old woman presented with 2 and half months amenorrhoea, pain abdomen and bleeding per vagina with TAS showing intra uterine single missed abortion and ovarian ectopic pregnancy.
Leiomyoma of the vulva: a diagnostic challenge
Authors: Saxena Shilpi , Goel Suyash , Sen Alok D.
Published: February 2018

Smooth muscle tumours of vulva are rare and therefore can be missed clinically. Our patient, 48-year-old lady presented with lump in the left vulva that was clinically diagnosed as Bartholin duct cyst. The lumpectomy was done under local anaesthesia and the lesion was sent for pathological examination. On gross examination the mass was 3.5 cm in diameter. The microscopic examination revealed the lump to be leiomyoma and no necrosis or atypia was present. The final diagnosis of “vulval leiomyoma” was given. Postoperative period was uneventful, and the patient is on regular follow up and there has been no recurrence. Leiomyoma should be kept as a differential diagnosis when a lady presents in late reproductive age group with unilateral swelling in vulvar region which is firm in consistency and the lump must be sent for histopathological examination for definitive diagnosis and rule out malignancy. The pathologists play a critical role in recognition and management of smooth muscle tumors of the vulva and to rule out leiomyosarcoma.
Ruptured caesarean scar ectopic pregnancy
Authors: Saiyyed Anjum
Published: February 2018

Caesarean scar ectopic is a rare form of ectopic whose incidence has been on rise recently due to increase in incidence of caesarean section. In 1972 the first report of scar ectopic was reported in medical literature. It is a type of abnormal implantation in a scarred uterus following surgery most commonly caesarean section. Early diagnosis and management is the key to prevent morbidity and mortality. Here we present a case of gravida 3 para 2 with previous 2 LSCS with ruptured caesarean scar ectopic with massive haemorrhage. Timely resuscitation and laparotomy helped prevent morbidity and mortality in this patient.
Evaluation of chronic pain after transabdominal preperitoneal hernia repair
Authors: Hamada Takashi , Adachi Tomohiko , Matsushima Hajime , Moriuchi Hiroki , Iwata Toru , Eguchi Susumu
Published: February 2018

Background: Early postoperative pain after transabdominal preperitoneal hernia repair (TAPP) has been frequently reported. However, the incidence and degree of chronic pain after TAPP have not been evaluated. Therefore, author aimed to examine chronic pain after TAPP.Methods: A total of 256 who underwent TAPP between November 2008 and March 2015 at the institute were enrolled. Original questionnaires focusing on the current state of pain were sent to the enrolled patients by mail. The incidence, body location, and degree of chronic pain occurring at least 6 months after the initial surgery were evaluated. In addition, a medical chart review of patients with and without chronic pain was performed to determine the predictive factors of chronic pain.Results: The survey response rate was 43.8% (112/256). The median follow-up period after the initial surgery was 44.3 months (range, 9.7-80.3 months). Sixty percent of patients experienced pain after TAPP; however, in 56.2% of the patients, the pain had mitigated 1 week after TAPP. Ten percent (12/112) of the patients had chronic pain 6 months after TAPP. Pain in the inguinal region was more frequently reported than any other wound region (67% vs 25%, p =0.0009). Although most of the patients with pain felt the pain occasionally, three of twelve patients (25%) complained of daily pain and had high VAS score. No significant predictive factors of chronic pain were identified.Conclusions: Ten percent of patients experienced chronic pain after TAPP. Large scale prospective trials are needed to identify the predictive factors of chronic pain.
Effectivity of injection sclerotherapy with sodium tetra decyl sulphate in the management of first and second-degree hemorrhoids
Authors: Rohit Dushyant Kumar , Thakur Omkar , Verma R. S. , Pandey Grishmraj
Published: February 2018

Background: Haemorrhoids are one of the common surgical conditions affecting anorectal region with prevalence of 4% of the population. It is usually defined as increase in size as well as downward disruption of normal functional architecture known as anal cushions. Injection sclerotherapy is time honoured outpatient’s procedure that is widely practised globally to treat first and second-degree haemorrhoids.Methods: This prospective study includes 52 patients who were underwent injection sclerotherapy at Bundelkhand Medical College and Associated Hospital Sagar from August 2015 to September 2016. Patients above the age of 18 years of both sexes with Ist and IInd degree hemorrhoids were included in the study. Pregnant patients, patients with diabetes mellitus and with third and fourth degree hemorrhoids were excluded from the study. A detailed history, clinical presentation, digital rectal examination, proctoscopy and routine investigation were done in all cases.Results: In the present study most of the patients were male. Patients with age group ranging from 20-40 year were found of high incidence of haemorrhoids (86.53%). In present study after three doses of injection 94.23% had satisfactory result. After the first dose injection 71.15% patients had satisfactory results rest 15 patients were given second dose of injection of which 60% patients had satisfactory results. Third dose of injection given to the remaining 06 patients proved satisfactory results in only 03 cases. After three doses of injection 03 cases (5.76%) failed to show any response.Conclusions: Sclerotherapy as a safe, easy, cheap and effective method of treatment of 1st and 2nd degree haemorrhoid devoid of any significant complication.
Prophylactic ilioinguinal neurectomy in open inguinal hernia repair: a randomized control trial
Authors: Belagali Hareesh , Manjunath Darshan A. , Devani Ravindra , Radhakrishna Veerabhadra
Published: February 2018

Background: Inguinal neuralgia is one of the important complications of hernia repair which occurs due to entrapment, neuroma or fibrotic reactions involving the ilioinguinal nerve. Hence the excision of ilioinguinal nerve should theoretically eliminate the possibility of inguinal neuralgia. But routine ilioinguinal neurectomy is still controversial and is not widely accepted. Hence a study was conducted to evaluate the effect of prophylactic ilioinguinal neurectomy in open inguinal hernia repair.Methods: A prospective study was conducted in the General Surgery Department in a tertiary center for a period of 20 months, from December 2011 to July 2013. The patients were randomly allocated to either group A or group B by block randomized technique. Group ‘A’ patients underwent neurectomy of ilioinguinal nerve whereas the ilioinguinal nerve in group ‘B’ patients was safeguarded.Results: A total of 60 patients were studied with 30 patients each in group A and group B. During vigorous activities, more group B patients had pain compared to group A patients at 4-month [15 (50%) vs. five (17%); p=0.006; Chi-square test] and 8-month follow-up [15 (50%) vs. five (17%); p=0.006; Chi-square test].Conclusions: Inguinal neuralgia is a significant and debilitating complication following hernia repair. The prophylactic neurectomy can be an appropriate solution in the prevention of chronic groin pain following inguinal hernia repair and can be considered as an ideal inclusion into the standard hernia repair procedures.
A study on peripheral neuropathy in patients with diabetic foot ulcers
Authors: M. H. Siddesh Kumar , M. S. Moosabba , Koppad Sanjay N.
Published: February 2018

Background: Diabetic neuropathies are nerve disorders associated with diabetes. The most common complication of diabetes is caused by hyperglycemia which can damage nerve fibers throughout the body. Depending on the types of nerves involved, diabetic neuropathies can be categorized as peripheral, autonomic, proximal, focal neuropathies.Methods: A total of 62 diabetic foot patients admitted in general surgery department of Yenepoya medical college and hospital undergo neurological examination. Patients who were having peripheral neuropathy with diabetic foot ulcer between 18 and 85 years of age were included in the study.Results: On 62 patients with diabetic foot ulcers, 50 were unilateral and 12 were bilateral among which 8 patients had undergone toe amputation prior to examination. Patients were predominantly male 48 (77.4%). There were 14 women and 48 men with an average duration of diabetics being 15.6 and 14.8 years respectively. Women   were older than male patient (58.2 v/s 51.7 years). Study of motor and sensory signs men and women patients, abnormal deep tendon reflex and deep sensory loss was high. Abnormal deep tendon reflex was 38 (79.1%) and 11 (78.5%), atrophy was 24 (50%) and 2 (14.2%), loss of pain was 18 (37%) and 4 (28.5%), loss of touch was 32 (66%) and 8 (57%), and deep sensory loss was 42 (87.5%) and 12 (85.7%) in men and women respectively.Conclusions: Diabetes mellitus leads to neuropathies of more than one type and all contribute to diabetic foot pathogenesis. Clinical symptoms and signs, as well as nerve conduction studies may be different between men and women with diabetic foot. Motor neuropathies may constitute an important prognostic parameter in men. Mononeuropathies sometimes reflect more severe involvement and peroneal and ulnar neuropathy is remarkable among these.
Impact of battery-powered orthopedic drills on the practice of orthopedic surgery in a resource limited country
Authors: Baidoo Paa K. , Ocloo Agbeko , Ansu Velarie , Baidoo Joojo N.
Published: February 2018

Background: The study aimed at assessing the impact of the availability of battery-powered drills on the management of orthopedic cases presenting to the orthopedic unit of the department of surgery at a major teaching hospital serving the southern part of Ghana.Methods: This study was a single center retrospective study. Authors examined the total number of cases, average time spent on cases in the operating room, and the average patient waiting time for surgery between January 2012 and December 2014. A paired sample t-test was used to evaluate the effectiveness of the orthopedic drills for the pre-and post-intervention periods.Results: There were statistical significant differences in the total number of cases (p<0.01), the average time spent on cases in the operating room (p<0.01), and the average waiting time for surgery (p<0.05) between January 2012 to June 2013 when manual hand drills were in use and July 2013 to December 2014 when the battery-powered drills were introduced.Conclusions: The introduction of the battery-powered drills led to a significant improvement in the total number of cases done. There was a reduction in time spent per case in the operating room as well as the average waiting time to having surgery.
Clinical study of pain after inguinal hernia repair
Authors: Ainapure Ramesh , Singaraddi Ramesh
Published: February 2018

Background: Chronic severe pain following inguinal hernia repair is a significant post-operative problem. Pain is a complex study subject, mostly defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage.Methods: Patients undergoing elective inguinal hernioplasty in the Hospital from March 2016 to March 2017 were included in the study. Seventy-eight patients were present for follow up for a period of 6 months. Patients presenting with obstructed/strangulated inguinal hernia were excluded from study.Results: Majority of our patients were male 97.43% with mean age 49.1 years (range 16-78 years). Table 8 shows the VAS scores of patients at six months following surgery. When patients were divided into groups of mild (1-3), moderate (4-7), and severe pain (>7) on basis of VAS score, it was found that majority, 34.61%, had mild pain, 8.97% had moderate pain, and less than 1% had severe pain.Conclusions: In the present study, author found that chronic pain following inguinal hernia repair causes significant morbidity to patients and should not be ignored. All measures must be taken to suppress early postoperative pain and prevent complications as these lead to development of chronic pain.
Outcome of over-sewing reinforcement of gastric staple line during laparoscopic sleeve gastrectomy in morbid obese patients: single center experience
Authors: Abdallah Adel M.
Published: February 2018

Background: During laparoscopic sleeve gastrectomy (LSG), different staple line reinforcement techniques are adopted by many bariatric surgeons, aiming at reducing the incidence of bleeding and leakage from the staple line.Methods: Fifty patients suffering from morbid obesity with body mass index above 35kg/m2 were prepared for LSG. The patients were enrolled in a prospective, randomized controlled study comparing the effect of staple line reinforcement by suture over-sewing versus non-reinforcement. Patients were classified randomly into two groups. In group I, after gastric stapling, the staple line was reinforced by suture over-sewing using continuous extra-serosal invaginating absorbable polyglycol sutures. In group II (non-reinforcement group), staple line over clipping by 10 mm clips was used when needed.Results: Three cases (12%) in group II presented with collected hematomas and staple line bleeding necessitated laparoscopic evacuation and staple line bleeding control by suture over-sewing or additional clipping. In group I, one case (4%) of hematoma responded well to per-cutaneous drainage. There were 2 cases of leakage (8%) in group II versus no detectable cases in group I. Stenosis was detected in one case (4%) in group II while no detected cases in group I. The operative duration was 135 minutes in group II versus 110 minutes in group I.Conclusions: Reinforcement by suture over-sewing of the staple line as a step in LSG is a safe, technically easy, of low cost and can reduce the incidence of postoperative complications as bleeding and leakage although it significantly prolongs the operative time.
Lymphoedema: non-operative management
Authors: Sukhadia Mukta , Sethi Deepak , Sethi Anjali
Published: February 2018

Background: Lymphoedema is one of the most undesirable complication that is anticipated in patients of cancer breast post mastectomy. A comprehensive care of patient of lymphoedema is required which includes, prevention, early diagnosis and treatment. In the study conducted, efficacy of non-operative management of lymphoedema is observed.Methods: A descriptive study was conducted on women who presented with lymphoedema post-mastectomy. Thirty-three patients were studied for non-operative management. Treatment of patients was carried out with physiotherapy, massage, compression bandages and stockings and Intermittent pneumatic compression by pneumatic compression pump.Results: Patients were categorized according to the grades, duration of lymphoedema, type of treatment they received and effect of the treatment.Conclusions: Lymphoedema being dreaded complication, much attention needs to be given on its prevention post mastectomy. But in country like India, compliance and regular follow up is not possible for every patient, especially for the patients of the rural background. The same pattern of dearth in compliance follows in management of lymphoedema. Non-operative management is an effective mode of treatment in cases of post-mastectomy lymphoedema.
Appendicular agenesis: a case report
Authors: Sedik Alaa , Al-Dawoodi Tarek , Elhoushy Salwa
Published: February 2018

Congenital agenesis or absence of vermiform appendix is very rare. Herein, author reported a case of a 28 years old Vietnamese lady who presented with a picture of acute appendicitis. During surgery, author failed to find the appendix. Postoperatively, she made uneventful recovery and she was diagnosed as a case of nonspecific abdominal pain (NSAP) with appendicular agenesis.
Huge carbuncle of the neck with intracranial extension: a case report
Authors: Sedik Alaa , Rauf Muhammad Y. , Makhdoom Mahmood , Abdo Ihab , Harga Abdelhamid , Suliman Amir , Hussein Abrar , Ali Hamza , Altwiher Rasheed , Alrashidi Abdullah , Alanazi Wael , Elhoushy Salwa , Osman Alaa , Mostafa Mohamed
Published: February 2018

A carbuncle is a coalescence of several inflamed follicles into a single inflammatory mass with purulent drainage from multiple sinuses. They can develop in healthy individuals with no predisposing conditions or in immune-compromised ones. Author are presenting a case report of 57 years old Saudi presented with neglected huge carbuncle of the neck that was found complicated with intracranial extension in the posterior cranial fossa. He underwent successful simultaneous excision of the carbuncle and debridement of gross necrotic tissues; together with evacuation of the intracranial abscess. Both general and neurosurgical teams were involved. Patient made uneventful recovery and discharged home in good condition.