bluuebunny/crossref_metadata_2025 huggingface dataset:
The online inverted classroom model (oICM). A blueprint to adapt the inverted classroom to an online learning setting in medical and health education
Authors: Tolks Daniel , Romeike Bernd FM , Ehlers Jan , Kuhn Sebastian , Kleinsorgen Christin , Huber Johanna , Fischer Martin R , Bohne Christoph , Hege Inga
Published: May 2020

This article was migrated. The article was marked as recommended. The idea of this paper is to offer a blueprint, with that facilitators have a guide to set up a complete digital teaching scenario according to the latest insights of didactical research. The corona pandemic forced higher education institutions all around the world to radically shift their curricula from a mix of face-to-face and remote teaching methods to a fully remote curriculum. Though challenging, this time provides opportunities to implement new educational methods and improve the quality of digital teaching. The classical concept of the inverted classroom was modified to meet the special needs of online settings. The proposed online Inverted Classroom Model (oICM) includes the following phases: (1) pre-phase, (2) self-learning-phase, (3) Synchronous online face-to-face phase, (4) transfer-phase, (5) evaluation. Recommendations and potential tools are provided for each phase. The oICM is an innovative and easy to use approach to shape digital teaching and learning processes during and after the CoVid19 pandemic. This blueprint is developed by the committee "Digitalization" of the German Association for Medical Education (GMA) for facilitators without any prior experience with the ICM, but also for those who already teach in a traditional ICM.
Volunteering in medical school during the pandemic: a solution for teaching
Authors: Mendes Chiloff Daniela , Muniz de Freitas Victor , Borges Cardin Natália , Bianchi Matiuzzi Camila , Juliano Perfeito João Aléssio , Inoue Sato Emilia , Malheiros Luzo Marcus Vinicius , Batista Castello Girão Manoel João , Flávio Teixeira Góis Aécio
Published: May 2020

This article was migrated. The article was marked as recommended. Introduction: On March 18, 2020, in face of COVID-19 pandemic and the suspension of in-person activities by the Board of the Paulista School of Medicine (EPM), students on clinical rotations (5th and 6th grades) organized themselves to support the local community and the Hospital São Paulo complex. Method: The construction of the Volunteering-EPM was, despite fast, progressive, following as required by the Hospital São Paulo-Escola Paulista de Medicina complex. Results: After one week, Volunteering-EPM added more than 100 students and the unconditional support of professors. The quantifiable results enable an adequate supply of resources to the hospital complex. However, the biggest impact was the moment of solidarity promoted by the initiative. Discussion: Volunteering enabled unique experiences for those involved, enhancing students and professor's skill sets otherwise not developed in medical school. Emphasizing the humanitarian view of medicine improved employee and community health access and welfare. Conclusion: The speed with which actions were implemented and their impact on the community shows the ability for transformation of the volunteers. The immediate demands have been solved. In medium and long term, the project continues to respond to the new demands of the hospital.
Desigualdades raciais em saúde e a pandemia da Covid-19
Authors: Goes Emanuelle Freitas , Ramos Dandara de Oliveira , Ferreira Andrea Jacqueline Fortes
Published: May 2020

Resumo O racismo é um sistema estruturante, gerador de comportamentos, práticas, crenças e preconceitos que fundamentam desigualdades evitáveis e injustas, baseadas na raça ou etnia. Na saúde o racismo pode se manifestar de diversas formas, como o institucional, que frequentemente ocorre de forma implícita. A pandemia do coronavírus tem sido um desafio para países que apresentam profundas desigualdades. No Brasil, em que pese a ausência das informações desagregadas por raça ou etnia ou que quando coletadas apresentam um preenchimento precário, sabe-se que negras e negros irão sofrer mais severamente os impactos da pandemia e seus vários desfechos negativos. No texto recuperamos aspectos históricos e sua relação com as condições de vulnerabilidade da população negra e apresentamos uma agenda de ações específicas para o combate ao racismo e suas devastadoras consequências no contexto da Covid-19.
Covid-19, causas fundamentais,classe social e território
Authors: Santos José Alcides Figueiredo
Published: May 2020

Resumo A teoria que considera as condições sociais como causas fundamentais da saúde, em articulação com as noções de classe social e território, é usada em reflexões acerca da trajetória e da distribuição dos efeitos da pandemia da Covid-19 no país. Parte-se de sínteses teóricas, abordagens e evidências de trabalhos do autor sobre desigualdade de saúde no Brasil. Entende-se que o ‘meio social’, de natureza relacional e estruturada, afeta a propagação e a distribuição da doença entre os grupos. As diferenças de classe em circunstâncias de trabalho, localização e moradia são referidas. No tocante às diferenças sociais no risco de desenlace fatal da doença, são consideradas a distribuição prévia de condições adversas e as diferenças no modo como as instituições de saúde processam as pessoas. Como proposto pela teoria, as desigualdades de recursos, informações, disposições e capacidade estariam afetando a distribuição social dos efeitos da pandemia no Brasil.
Proposta de aperfeiçoamento do processo de fiscalização tributária de ISS no setor portuário do município de Paranaguá - PR
Authors: Carneiro Amanda Maciel , Raupp Fabiano Maury , Secchi Leonardo
Published: May 2020

Essa pesquisa teve como objetivo propor alternativas para o aperfeiçoamento do processo de fiscalização tributária de ISS no setor portuário do município de Paranaguá (PR). Apresentou metodologia de característica qualitativa, em pesquisa exploratório-descritiva, enfoque analítico e prescritivo, e método de estudo de caso. Os dados foram coletados em entrevistas semiestruturadas com 12 auditores fiscais do município, apoiados em documentos e dados secundários, com posterior análise de conteúdo e documental e técnica de triangulação. Os resultados evidenciaram processos de fiscalização, dificuldades encontradas e sugestões de melhoria dos próprios entrevistados que, somados ao referencial teórico, permitiram a proposição de ações em atuação interna, investimentos e atuação externa com vistas ao aperfeiçoamento dos processos. As conclusões apontaram fomento à escassa literatura, resultados positivos de atuação técnica apesar das dificuldades encontradas, atuações distintas no início do processo, técnicas de fiscalização, experiências, teses, referências internas, uso de triangulação e informações de terceiros, ambiente portuário dinâmico e complexo, necessidades de capacitação e atualização constantes e de uso mais estratégico dos sistemas informatizados. Sobretudo, evidenciaram-se espaços para o aperfeiçoamento dos processos; coerência entre metodologia, achados e intervenções propostas; atingimento dos objetivos pela descrição do processo, diagnóstico das dificuldades encontradas e identificação de alternativas de aperfeiçoamento; e contribuições à comunidade acadêmica, à Prefeitura de Paranaguá, ao corpo técnico e à sociedade. Pode-se afirmar que o aperfeiçoamento desejado é possível e viável, e que, caso ocorra, apresenta grande potencial transformador e coaduna com a perseguição de excelência no serviço público, na constante busca pela satisfação dos anseios coletivos.
Adaptación cultural, validez y confiabilidad de la escala de Adopción del Rol Materno en Colombia
Authors: Vargas Porras Carolina , Roa-Díaz Zayne Milena , Hernández-Hincapié Hernán Guillermo , Ferré-Grau Carme , De Molina-Fernández María Inmaculada
Published: May 2020

Introducción: En la actualidad, se necesita un instrumento con sustento teórico disciplinar, válido, confiable y adaptado culturalmente, que mida el proceso de convertirse en madre en primerizas.

Métodos: Estudio de validación de escalas. En la adaptación cultural, la validez facial y de contenido participaron expertos de Colombia. Se utilizó el índice de validez de contenido y el análisis de factores. Un total de 282 madres participaron para establecer la validez de constructo y confiabilidad. La confiabilidad se estimó mediante el coeficiente alfa de Cronbach.

Resultados: Se realizaron adaptaciones culturales. La validez facial para las madres fue la siguiente: alta comprensión (97%); y para expertos: alta comprensión (95.50%), alta claridad (94.38%) y alta precisión (93.58%). En relevancia, el índice de validez de contenido fue de 0.97 (muy relevante) y en pertinencia, el índice de validez de contenido fue de 0.96 (muy pertinente). La validación de factores identificó diez factores que representaron el 66% de la varianza. El valor del alfa de Cronbach general fue 0.96 IC95% (0.95-0.97).

Conclusión: La escala de Adopción del Rol Materno adaptada culturalmente en Colombia, es válida y confiable para madres primerizas con bebés a término. Esta escala permite identificar el nivel: bajo, medio o alto del proceso de convertirse en madre y puede utilizarse para evaluar las intervenciones enfocadas a favorecer el proceso de convertirse en madre.
Propriocepção do joelho em indivíduos submetidos à menistectomia parcial e à sutura meniscal: estudo observacional
Authors: Da Silva Francklin Trindade , Stocco Thiago Domingues
Published: May 2020

INTRODUÇÃO: Os meniscos desempenham um papel fundamental na articulação, além de gerar estabilidade e congruência articular, influenciam na propriocepção do joelho. Lesões nesta estrutura muitas vezes só podem ser reparadas cirurgicamente, pelo fraco suprimento sanguíneo local, acarretando uma regeneração insatisfatória. A hipótese desse estudo é que possa existir menores déficits proprioceptivos em pacientes submetidos à sutura meniscal quando comparados aos submetidos à menistectomia parcial, devido a conservação da estrutura que tem importância proprioceptiva. OBJETIVO: Avaliar o déficit proprioceptivo do joelho em pacientes submetidos à menistectomia parcial e à sutura meniscal. METODOLOGIA: Estudo observacional transversal realizado na clínica de ortopedia e reumatologia da UNISA, em São Paulo. Participantes foram divididos em dois grupos. No Grupo I, indivíduos submetidos à menistectomia parcial, enquanto no Grupo II, a submetidos à sutura meniscal, sendo recrutados indivíduos de até 4 semanas de pós-operatório. Aprovado pelo comitê de ética seguido pelo CAAE 94144218.0.0000.0081. Para coleta dos dados foram realizados três testes: teste de senso de posicionamento ativo e passivo e teste de cinestesia. RESULTADOS: Participaram deste estudo uma amostra por conveniência de oito indivíduos (Grupo I, n=4 e Grupo 2, n=4), de ambos os gêneros, com média de idade de 33,4 anos (±11 anos). Os sujeitos do grupo I apresentaram maior déficit de proprioceptivo em comparação com o grupo II, nos testes realizados. Teste ativo do grupo I: 15°= 11,9° ±6,1; 30°= 11,6° ±5,0; 45°= 9,4° ±3,5 e do grupo II, 15°= 7,6° ±3,9; 30°= 6,9° ±2,8. Teste de Cinestesia: Grupo I 132ms ±51,5 vs Grupo II 96ms ±28,8). CONCLUSÃO: Os meniscos demonstraram ser estruturas influentes para a propriocepção do joelho, apresentando maiores déficits em indivíduos que retiraram a estrutura.
Oversee and Punish: Understanding the Fight Against Corruption Involving Government Workers in Brazil
Authors: Odilla Fernanda
Published: May 2020

This exploratory study leverages a major dataset of official penalties against Brazilian bureaucrats enforced between January 2003 and November 2014, when 5,005 expulsive sanctions were enforced, 68.5% of which concerned acts of corruption. The analysis and discussion also integrate qualitative data gathered through 24 semi-structured interviews with civil servants who were integrity enforcers. Despite the rapid increase in the number of penalties enforced over the years, the creation of a robust set of disciplinary norms and an anti-corruption agency have not secured a fully operational horizontal accountability system within the executive. A great variance of corruption control was observed across agencies, manifested through disproportionate enforcement, not only of overall sanctions but also of corruption and non-corruption-related penalties. In light of the self‐protective behaviour of civil servants, who openly say they do not feel comfortable in the role of corruption fighters, the article advances an argument on ‘convenient accountability’—a kind of institutional abdication combined with a reluctance for peer monitoring, with outcomes that can be described as satisficing for integrity agents. This institutional aspect poses a risk to internal disciplinary systems and increases dependence upon external actors of accountability, compromising the efficiency of both.
Implantação e consolidação de equipamentos para a educação ambiental
Authors: Correia Marques Margarida , Sorrentino Marcos , Serantes-Pazos Araceli
Published: May 2020

Os equipamentos para a educação ambiental (EqEA) têm potencial para serem eficazes dinamizadores sociais e promoverem um desenvolvimento comunitário sustentável. No presente trabalho pretende-se dar a conhecer o livro intitulado “Equipamentos para a Educação Ambiental”. Recorrendo a visitas in loco, a questionários, à fotografia profissional de António Borba e ao moderno e elegante design de Luís Gabriel, esta obra desvela dezasseis EqEA no interior Norte e Centro de Portugal Continental. Dirige-se a um público alargado, designadamente: educadores ambientais e responsáveis de EqEA, decisores, empreendedores, potenciais visitantes/utilizadores destes equipamentos. Objetiva contribuir para a premente reflexão e discussão sobre o papel deste recurso de educação ambiental –os EqEA–, no presente e num futuro próximo, bem como, no contexto da atual Estratégia Nacional de Educação Ambiental. Fruto do projeto “Equipamentos de educação ambiental para a sustentabilidade em prol de uma nova cultura da Terra”, envolveu na sua concretização as universidades: de Trás-os-Montes e Alto Douro (Portugal), de São Paulo (Brasil) e da Corunha (Galiza). Este livro aponta diretrizes, desafios e oportunidades, que podem impulsionar uma vivência socioambiental mais justa. Constata também que a existência de uma rede de EqEA é crucial na construção da equidade territorial, sobretudo em territórios de baixa densidade.
Expansão urbana nas zonas húmidas de Bissau
Authors: Abibe Tavares Habdel Karim
Published: May 2020

O presente artigo é fruto da minha monografia de fim de licenciatura em que fiz uma análise do fenómeno da expansão urbana em Bissau, também na perspetiva de refletir acerca do tipo de cidade que queremos. A educação ambiental pode ser uma ferramenta e um processo de ouvir e dar a voz às pessoas que vivem e têm uma relação direta com as zonas húmidas (bolanhas) como meio de subsistência (pesca e os arrozais). O estudo analisa a expansão urbana nas zonas húmidas de Bissaque-Djolo e perspetiva a educação ambiental face a esse desafio. O artigo sugere fundar uma perspetiva crítica da educação ambiental em que vai ser construída a partir das pessoas que vivem nas zonas húmidas e expandir o debate às entidades estatais e ao resto da sociedade.
Lixo marinho
Authors: Laranja Ana , Correia Marta , Morim Sílvia
Published: May 2020

O CMIA de Vila do Conde funciona como Centro Azul para o Programa Bandeira Azul, pelo oitavo ano consecutivo, promovendo diversas ações de sensibilização e educação ambiental durante a época balnear no concelho de Vila do Conde. Os plásticos são o grande flagelo e para ajudar a sensibilizar para esta causa, sob o mote de que todos os gestos são importantes, o CMIA dinamizou a atividade “Os Suspeitos do Costume”, que tem como objetivo a recolha e identificação dos resíduos mais frequentes em cada praia, e a reflexão sobre as suas origens, impactos e formas de os reduzir. Esta atividade, decorreu de abril a julho de 2018, com 10 ações de limpeza e cerca de 200 voluntários, tendo-se procedido à recolha de cerca de 95kg dos suspeitos do costume (resíduos). Os resultados mostraram que os principais suspeitos na nossa costa são: cotonetes, beatas, palhinhas, garrafas de plástico, tampas e plásticos fragmentados. A reflexão sobre possíveis contributos para a redução do lixo marinho aponta para a palavra de ordem RECUSAR.
Gestão Participativa dos Recursos Naturais no Arquipélago dos Bijagós
Authors: Madeira João Paulo
Published: May 2020

A sociedade Bijagó articula-se em torno de aldeias, unidades políticas e económicas de base que gozam de autonomia de decisão e de uma quase autossuficiência. Os clãs estão organizados por sexo e classes de idade, cada um desempenhando um papel e possuindo deveres na comunidade. Cada ilha ou aldeia possui as suas próprias formas de adoração que estão voltadas para ídolos ou deuses - irãs - entidades dotadas de poder para fazer o bem ou o mal e às quais as preces são dirigidas. Cada ilha é considerada propriedade do clã e do seu irã como guardião. Existem áreas consideradas sagradas, o que significa que ninguém se pode estabelecer nelas, sendo interdito o seu uso continuado. Este é o caso de certos espaços em Rubane, Enu, Orango e Carache. Estas áreas são particularmente importantes para a conservação da natureza, uma vez que misturam vários tipos de ambientes, desde as savanas e mangueirais até aos bancos de areia, entre os canais de mar. Pretende-se com este artigo compreender como se articula a gestão das terras e a divisão dos espaços e explicar como se processam as decisões relativamente à preservação do ambiente e dos recursos naturais.
Olhar para o lado
Authors: Mayr Luiz Roberto , De Oliveira Faria Salema Claudia
Published: May 2020

A equipe de Meio Ambiente e Educação Ambiental do Inmetro tem buscado sensibilizar a instituição, em especial a sua gestão, em favor da conservação da biodiversidade, com base na Agenda 2030. O seu campus de laboratórios ocupa posição central em relação a quatro unidades de conservação de Mata Atlântica e contribui para a conectividade entre remanescentes florestais na paisagem fragmentada da periferia do Rio de Janeiro. Por meio da Educação Ambiental, abre-se caminho para a introdução de práticas que minimizem os impactos ambientais negativos e promovam a recuperação de áreas ribeirinhas e encostas degradadas. A estratégia adotada é a de promover eventos no campus com a presença de alunos das escolas do entorno e com o engajamento de entidades que participam dos conselhos consultivos das unidades de conservação. A comunicação dos eventos, e de seus resultados, alcança a todos, abaixo e acima na hierarquia da instituição. Percebe-se que à centralidade do campus em relação à paisagem corresponde uma centralidade em relação às partes interessadas, a colocar a instituição como organização ponte, em condições de articular diferentes iniciativas pela sustentabilidade. Este trabalho apresenta a atuação recente da equipe no Inmetro e suas perspectivas para o futuro.
Alburnus caeruleus (Heckel, 1843) türünün Bazı Populasyon Dinamiği Parametreleri
Authors: SEÇER Burak , ÇİÇEK Erdogan , CELEPOĞLU Yasemin
Published: May 2020

Bu çalışmada 2013 yılında Merzimen Çayından örneklenen Alburnus caeruleus bireylerine ait populasyon dinamiği parametreleri belirlenmiştir. Toplam olarak 347 birey incelenmiş olup yaşlarının 0-III yaş grupları arasında değişim gösterdiği, en baskın II. yaş grubunun (%44.45) olduğu ve bunu sırayla I., III. ve 0. yaş gruplarının izlediği belirlenmiştir. İncelenen bireylerin 2,6-8,4cm boy ve 0,11-6,82g ağırlık dağılımına sahip olduğu ve ortalama boy ve ağırlık değerleri ise sırasıyla 5,53±1,12cm ve 1,83±1,23g olarak hesaplanmıştır. Merzimen populasyonuna ait boy-ağırlık ilişkisi W=0,0062*TL3,2205 olarak bulunmuştur. von Bertalanffy büyüme parametreleri ise L∞: 10,50 cm, k: 0,3665, to: -0,89, Büyüme katsayısı Φꞌ: 3,7 ve Kondisyon Faktörü ise K: 0,37 bulunmuştur. Toplam, doğal ve balıkçılık nedeniyle meydana gelen ölüm oranları ile stoktan yararlanma düzeyi Z: 0,79, M: 0,55, F: 0,24 ve E: 0,30 olarak hesaplanmıştır.
Factors Affecting Transfer of On-The-Job Training at Workplaces in Pakistan
Authors: Fatima Maham , Siddiqui Danish Ahmed
Published: May 2020

Purpose: This research is focused on examining the factors that influence transfer (effectiveness) of On-The-Job training at workplaces in Pakistan. The study identifies the factors that affect transfer of OJT training included independent variables such as motivation to learn, Perceived Organizational Support and Training Design and their impact on employees’ performance i.e. Transfer of Training. Methodology: The study adopted quantitative research and data was collected through well-structured questionnaire. The sample of 200 participants were selected throughout Pakistan using convenience sampling technique. Smart PLS software was used to analyse the data through descriptive statistics, structural equation modelling and Confirmatory factor analysis. Findings: The result revealed that there is a strong and significant impact of motivation to learn and training design on transfer of OJT training at workplaces in Pakistan. However, the results do not show any significant impact of Perceived Organizational Support in organizations on transfer of OJT training. Conclusions: This shows that even though, if the organization support is not present, the motivation to learn new things and to implement it to the workplace and effectively designed training programs can overcome the issues. Practical Implications: Organizations can use the result in favour of their organizational effectiveness, to consistently design effective training programs, and to consistently motivate their employees and to improve support and guidance by top management in the organizations.
A comparative study of Pap smear and colposcopy guided biopsy in the evaluation of unhealthy cervix
Authors: Venkatesh Meenakshi , . Ushadevi
Published: May 2020

Background: Cancer of cervix ranks as the third common malignancy in females worldwide. In developing countries like India, carcinoma cervix is the second commonest malignancy affecting females. In India, every year 1,26,000 new cases are identified and 67,477 deaths occur due to cervical carcinoma. Cervical carcinoma affects women of age 15-44 years and disease peaks at 55-66 years. On average, Indian women have a 2.5% risk of developing carcinoma cervix. It was estimated worldwide that every 5th woman, who suffer from cervical cancer belongs to India.Methods: A comparative study which included 110 married women of age 20 to 65 years. Women who presented with white discharge, lower abdominal pain, post coital bleeding and post-menopausal bleeding were subjected to Pap smear and colposcopy guided biopsy.Results: A total 53.6% women had inflammatory smear, followed by 34.5% women with normal Pap smear, 0.1% women had bacterial vaginosis, 6.4% women had LSIL and 4.5% women had HSIL. Authors found that 63.6% women had chronic cervicitis. 15.4% had chronic endo papillary cervicitis, 13.6% had CIN 1, 5.4% women had CIN 2 and 1.8% women had squamous cell carcinoma. Association of Pap smear with histopathology is statistically significant (p value <0.001).Conclusions: Pap smear can be used as screening test for detecting premalignant lesions of cervix. Colposcopy guided cervix biopsy has got better specificity than Pap smear, so all symptomatic women should be subjected to colposcopy guided cervix biopsy to detect carcinoma at early stage.
Neuro-imaging in severe hypertensive disorders of pregnancy: a study from North Indian tertiary health care institution
Authors: Dogra Rohit , Thakur Rama , Thakur Vijay , Pal Anita , Chamotra Shaina , Chaudhary Ankit
Published: May 2020

Background: Hypertensive disorders of pregnancy comprising of pre-eclampsia and eclampsia are a major cause of adverse pregnancy outcomes. Neurological manifestations of pregnancy induced hypertension are the most common cause of maternal and foetal morbidity and mortality. Cranial neuro-imaging reveals focal regions of symmetric hemispheric oedema; with parietal and occipital regions getting most commonly affected.Methods: The study was conducted among 65 antenatal women diagnosed with pre-eclampsia and eclampsia at gestational age >20 weeks in the department of obstetrics and gynecology, Kamla Nehru State Hospital for Mother and Child IGMC Shimla. Clinical signs and symptoms, neuroimaging findings were recorded for study purpose.Results: About 17.6% of severe pre-eclampsia and 100% of eclampsia had findings observed on cranial MRI. Headache and visual complaints were most frequently recorded. PRES was the predominant neuroradiographic finding in present study and occipital lobe was commonly affected region. No significant difference was observed regarding blood pressure parameters between MRI positive and negative subjects.Conclusions: Neuroimaging in antenatal with severe hypertensive disorders might aid in better understanding of the poorly explained phenomenon. In addition, this would be helpful in better management of the disorders along with their much-dreaded complications. Patients with hypertensive disorders of pregnancy should be subjected routinely to cranial imaging for the better perinatal outcomes.
Pregnancy outcome of external cephalic version in singleton pregnancy with breech presentation at term
Authors: Mishra Rajesh Kumar , Vardhan Shakti , Singh Sanjay , Panda Swati Sagarika
Published: May 2020

Background: Breech delivery is associated with poor perinatal outcomes irrespective of the route of delivery. External cephalic version can be a useful tool in management of breech presentation at term by converting it to a cephalic presentation. A study was conducted to evaluate maternal and neonatal outcome of external cephalic version in singleton pregnancies with breech presentation in third trimester.Methods: A prospective observational study was carried out at a tertiary care hospital over a period of 2 years. This study included a total of 65 uncomplicated cases of breech presentation who fulfilled the inclusion criteria. External cephalic version was carried out after 36 weeks of period of gestation in primigravida and after 37 weeks in multigravida women. These patients were followed up till delivery and data was collected and analysed regarding the mode of delivery, maternal and fetal outcome.Results: External cephalic version was successful in 41 patients with a success rate of 63%. Out of them, vaginal delivery could be achieved in 31 cases (75.6%) and LSCS was done for rest of the 10 cases. The success rate was higher in multigravida ladies compared to primigravida ladies. No major procedure related adverse event was noticed in our study.Conclusions: External cephalic version is a very safe and easy procedure which can reduce the rate of cesarean delivery in singleton pregnancies with breech presentation. The results of this study are in favor of wider practice of this procedure in selected cases.
Effect of antenatal retroviral therapy on feto-maternal outcome in human immunodeficiency virus seropositive patients
Authors: Trivedi Swati , Nagar Oby , Trivedi Shashank , Rastogi Prasoon
Published: May 2020

Background: To study the effect of HIV and duration of ART on term of delivery, newborn birth weight and adverse fetal outcomes.Methods: Prospective comparative study of 40 HIV seropositive pregnant females with varying duration of ART (tenofovir 300 mg + lamivudine 300 mg + efavirenz 600 mg) and HIV seronegative pregnant females attending ANC and delivering in department of obstetrics and gynecology at S. M. S. Medical College, Jaipur, Rajasthan, India.Results: Most HIV seropositive patients were in age group 25 to 30 years and more number were booked in comparison to unbooked. Adverse fetal outcomes were seen more in HIV seropositive patients and they were found to be statistically significant (p=0.029). No relationship could be derived of duration of ART on either the birth weight or term of delivery or adverse fetal outcomes.Conclusions: Maternal HIV infection was significantly found associated with adverse fetal outcome and this was not affected by the use of ART.
Study of endothelial function in pregnant women with gestational diabetes mellitus by flow mediated dilation of brachial artery
Authors: Pandey Nidhi , Goel Poonam , Malhotra Anita , Mehra Reeti , Kaur Navjot
Published: May 2020

Background: The objective of the study was to assess vascular function in normal pregnant women and women with gestational diabetes and to study its temporal relationship with gestational age at 24-28-week POG and at 36-38-week POG and changes in FMD in postpartum period.Methods: Assessment of vascular function was done at 24-28-week POG, 36-38-week POG and at 6-12-week postpartum by flow mediated dilation of brachial artery in 37 healthy pregnant women and 37 pregnant women with GDM.Results: In GDM group mean FMD at 24-28 weeks of POG, at 36-38 weeks POG was lower as compared to the control group (11.225±6.20,8.464±6.09 versus 14.49±5.21, 10.898±4.12) although the difference in mean FMD in two groups was not statistically significant. It was found that the decrease in FMD at 36-38-week POG as compared to 24-28 weeks POG was statistically significant in both the groups (p<0.001).Conclusions: This study revealed that when endothelial function as assessed by FMD was compared at different period of gestation, the mean decrease in FMD at 36-38-week POG as compared to 24-28-week POG and 6-week post-partum was statistically significant in patients with GDM and as well as the control group, however this trend of change was same in both the groups and was not statistically significant when compared between the two group (GDM versus control). A negative correlation of FMD was found with BMI, and HBA1c, that was stronger in GDM group.
The use of emergency contraception among female senior high students in the Ho municipality of the Volta Region, Ghana
Authors: Konlan Kennedy D. , Amoah Roberta M. , Saah Joel A. , Doat Abdul Razak , Konlan Kennedy Dodam , Japiong Milipaak , Abdulai Juliana A.
Published: May 2020

Background: Emergency contraception (EC) is one option for preventing unplanned pregnancy when it is available and properly used. Unsafe abortions are responsible for nearly one third of maternal deaths in sub-Saharan Africa and about quarter of unsafe abortions are among teenagers.Methods: A quantitative descriptive cross-sectional study. Data was collected using a pretested questionnaire. 260 senior high students were selected using a systematic sampling method in the Volta Region, Ghana. Data were cleaned and entered into SPSS version 22 and analysed into descriptive statistics.Results: Respondents acquired awareness about EC from friends (36.9%), family members (5.6%) and the mass media (41.6%). The required time for EC to be taken were stated as immediately after sex (57.9%), 24 hours after sex (1.2%) and (30.6%) did not know. 28.4% of participants indicated they would not use EC in the future as their faith was against it, 18.0% believed EC is ineffective and 24.9% consider it dangerous to their health. Reasons for use of EC included condom slipped (35.7%), inability to be on daily pill (33.7%), forced unprotected sex (8.2%) and miscalculation of the safe menstrual period (22.4%). There was a significant relationship between age and history of use of EC (p=0.000, c2=8.128, n=260).Conclusions: Strengthening education in Senior High Schools on sexual and reproductive health, with special emphasis on emergency contraceptives as a pregnancy preventive procedure will remain imperative to reducing the canker of maternal mortality attributed to adolescent abortions while improving understanding of the appropriate use of EC.
Evaluation of complication during third stage of labour at tertiary care center
Authors: Rangholiya Komal K. , Agrawal Saumya P. , Shah Sapana R. , Dodiya Hetal
Published: May 2020

Background: The objective of the present study was to determine the maternal outcome of complications of third stage of labour and to determine the risk factors and evaluate the management protocols for these complications.Methods: This is retrospective study of maternal outcome with complications of third stage of labour carried out at tertiary care centre from June 2016 to December 2019. Patients who developed any complications of third stage of labour after vaginal delivery or caesarean section were included.Results: Complications observed during third stage of labour were atonic PPH 0.82% (74 cases), traumatic PPH 0.55% (50 cases), retained placenta (including placenta accreta spectrum) 0.21% (19 cases), secondary PPH 0.03% (3 cases), uterine inversion 0.03% (3 cases) and amniotic fluid embolism 0.01% (1 case). Maximum cases were seen in 18-24 years of age group. Only 36% patients having atonic PPH responded to medical treatment, 46% patients having atonic PPH responded to conservative surgery, 18% of patients required radical surgery.Conclusions: Third stage complications are potentially life threatening. Associated conditions for third stage complication are high parity, anemia, hydramnios, multiple pregnancy, malpresentation, placenta previa, and adherent placenta. Early anticipation and early intervention with proper planning is required to reduce the maternal morbidity and mortality in third stage complication.
Association of polycystic ovarian syndrome and metabolic syndrome in Tripura, India
Authors: Batra Ipsita , Baidya Jahar Lal , Pradhan Mamata
Published: May 2020

Background: A total 4-11% of women in India are affected by PCOS. Studies show that incidence and prevalence is increasing. It is a constellation of metabolic and endocrine abnormalities with significant cost to quality and quantity of life. Aim of this study was to find out the association of metabolic syndrome with PCOS. Objectives of this study were identified subjects suffering from PCOS and measure strength of association of metabolic syndrome.Methods: Case-control study conducted in the department of Obstetrics and Gynaecology Agartala Government Medical College, Agartala, Tripura from January 2017 to June 2018. Fifty cases were diagnosed by Rotterdam criteria and 50 cases age matched controls were recruited. Hundred subjects underwent evaluation for metabolic syndrome according to ESHRE/ASRM criteria. Statistical analysis was done using SPSS 17.0.Results: Mean age was 19.4±3.5 years. Oligomenorrhea found in 42 out of 50 cases. Hirsutism found in 54% of cases. There is a statistically significant difference in weight, BMI and waist circumference among PCOS cases and controls. Hypertriglyceridemia was found to be significantly higher among PCOS cases. Fasting glucose and 2-hour OGTT were found to be statistically significantly different. No association was found between metabolic syndrome and clinical hyperandrogenism, but metabolic syndrome was significantly associated with higher BMI. BMI, Hip circumference and oral glucose tolerance test were independent predictors of polycystic ovarian syndrome. Metabolic syndrome was present in 34% of cases. The odds ratio of having metabolic syndrome in a case of PCOS is 5.92.Conclusions: Association between PCOS and metabolic syndrome is statistically significant. The two entities are intrinsically linked to each other and early identification of one may lead to the diagnosis and management of the other.
Acute kidney injury and its outcome in obstetrics
Authors: Shah Dipal C. , Patel Babulal S. , Shah Akshay C. , Jani Shashwat K. , Agrawal Saumya P. , Patel Vismay B. , Patel Adwait B.
Published: May 2020

Background: Acute kidney injury occurring during pregnancy, labour, delivery, and/or postpartum period. Proper management of AKI (acute kidney injury) is challenging because (i) both maternal and fetal health must be considered and (ii) the cardiovascular and renal adaptations of pregnancy add to the complexity for management.Methods: The objective of this study was to study association and contributing factors in AKI, a retrospective study of 20 cases of AKI complicating pregnancies carried out in department of obstetrics and gynecology, SVPIMSR over a period of 12 months and results were studied and analysed. Etiological factors, associated liver pathology, coagulation abnormality, thrombocytopenia, sepsis, recovery status and fetomaternal outcome were studied and tabulated. AKI was analysed in terms of maximal stage of renal injury attained as per risk, injury, failure, loss of function, and end-stage renal disease (RIFLE) criteria.Results: The incidence of ARF (acute renal failure) in pregnancy was about 0.3%. Hypertensive disorders were the major causative factor. Amongst the 20 cases, 8 cases were referred from outside and two of them died. Total 5 of 20 cases required hemodialysis and two of them had partial recovery.Conclusions: AKI complicating pregnancies are not uncommon. If recognized and treated promptly, recovery is assured in majority of cases. Early identification and prompt management of pre-eclampsia and sepsis can prevent majority of cases. Ultrasonography revelation of placenta previa or abruption helps in early management eventually decreases the chances of bleeding which is one of the causes of AKI (pre-renal cause).
A comparative study of vaginal misoprostol versus oral misoprostol for induction of labour
Authors: Mehta Raj M. , Patel Babulal S. , Shah Akshay C. , Jani Shashwat K. , Patel Vismay B. , Patel Adwait B. , Shah Jui Rakesh
Published: May 2020

Background: Induction of labour defined as artificial initiation of uterine contractions before the onset of spontaneous labour, after the period of viability, by any methods. The successful outcome depends on the Bishop Score, maternal age and parity. Authors compared the most preferred two routes; vaginal and oral for induction and outcome, adverse events and side effects were noted.Methods: This was a prospective comparative study carried out at SVPIMSR, Ahmedabad, from January 2019 to June 2019, Gujarat, 100 patients who required induction were randomly divided in two groups- Group A received 25µg oral misoprostol, Group B - received 25µg vaginal misoprostol repeated 4 hourly up to maximum five doses in both groups. The induction to delivery interval, mode of delivery, maternal and neonatal outcome and complications were observed.Results: The mean induction to delivery interval was less in vaginal group than oral (18.7 hours in vaginal versus 22.4 hours in oral). Vaginal delivery and caesarean section rates were comparable in both groups. 60% patients in Group A required more than two doses as compared to 36% in Group B. No major complications or adverse events were observed.Conclusions: Both oral misoprostol in a dose of 25μg and vaginal misoprostol 25μg every four hours, to a maximum of five doses, have safety and efficacy for induction. With The vaginal route, delivery occurs in less time and few doses required as compared to oral.
Recurrent ectopic pregnancies with secondary infertility: a case report
Authors: Jain Shivangi , Verma Indu
Published: May 2020

Infertility is defined as 1 year of unprotected sexual intercourse without pregnancy. It is further classified as primary and secondary. Secondary infertility is one in which prior pregnancy not necessarily live birth has occurred. Pelvic infections as a cause for infertility are seen in 12% cases while genital tuberculosis contribute 10-15%. Various studies have well established a relationship between subclinical infection and infertility with the two most potential pathogens being: Chlamydia trachomatis and mycoplasma species. Authors are presenting two cases one of a 30yr female, P0+5, with class 2 obesity with previous three ectopic pregnancies with LSO done 1 year back i/v/o left ruptured ectopic now presenting with secondary infertility for 1 year and another case of a 21 years female, P0+2, with previous two ectopic with LSO done 2 years back now presenting with infertility. These cases emphasize that infections are important causes for recurrent ectopic pregnancies and infertility.
Successful reduction of acute puerperal uterine inversion with use of Bakri postpartum balloon
Authors: Saha Divya , Singh Dipika , Verma Sarika
Published: May 2020

Acute puerperal inversion is rare but potentially fatal obstetric emergency and prompt recognition will enable immediate repositioning of uterus before it becomes edematous and incarcerated. Manual repositioning along with use of uterine balloon tamponade is simple and effective way for repositioning of inverted uterus as well as prevention of recurrence.
Anaesthetic management of a young primigravida with 8 months amenorrhea, rheumatic heart disease, hypothyroidism and met-hemoglobinimea schedule for cesarean section
Authors: Katyal Misha
Published: May 2020

A young patient, primigravida with rheumatic heart disease, hypothyroidism and met-hemoglobinemia had central and peripheral cyanosis was scheduled for caesarean section under general anesthesia in two days. Author managed met-hemoglobinemia with ascorbic acid keeping methylene blue as standby. Haemoglobin saturation was 89% at room air and 92% with supplemental oxygen. Initial met-haemoglobin levels were 31.54% (normal values <1%). After optimizing thyroid and RHD status (moderate MR and mild MS), she was given tablet ascorbic acid 2 gram thrice a day with methylene blue as standby. Conventional balanced general anesthesia technique was used and she was followed up in postoperative period with ICU care. A healthy live female baby was extracted and mother had stable vital parameters. Postoperative treatment with ascorbic acid was continued. Repeated methaemoglobin levels showed a drop from preoperative value of 31.54% to 11.39% by 3rd postoperative day and 8.05% at the end of 1st week. At the time of discharge, she did not have any cyanosis. Ascorbic acid is a good alternative drug with limited experience in met-hemoglobinemia. Author present a case of a met-hemoglobinemia treated with ascorbic acid successfully to emphasize the use of ascorbic acid as an alternative method without any adverse effects.
A rare case of lower segment scar pregnancy
Authors: Bhatu Jaydeep , Anand Nikhil A. , Chaudhari Ankita B.
Published: May 2020

Caesarean scar ectopic is one of the rarest of all ectopic pregnancies. The incidence of caesarean scar ectopic has increased due to increase in number of caesarean deliveries. A 31-year-old woman (G4P3003) presented from an outside facility to Sola Civil Hospital with vaginal bleeding and discharge with no abdominal pain or any discomfort. The gestational sac was located in an anterior position toward the anterior lower uterine segment at the level of prior caesarean scar with little visible myometrium noted anterior to the gestational sac in the lower uterine segment and Tissue was sent for histopathological examination and diagnosis of caesarean scar ectopic pregnancy was confirmed. Reports found that It is life threatening condition, causes excessive hemorrhage and risk of uterine rupture. The diagnosis of this type of ectopic pregnancy is very difficult and false negative diagnosis can lead to major complications.
Paediatric ovarian torsion: a case report and review of literature
Authors: . Umang , Cheema Harleen Kaur , Khullar Sidharth , Nagpal Madhu
Published: May 2020

Ovarian torsion is a surgical emergency, can result in ovarian loss, intra-abdominal infection and even death. Paediatric ovarian torsion is a rare condition, requires high clinical suspicion and prompt diagnosis. Diagnosis is a challenge since signs and symptoms are similar to those of other causes of acute abdominal pain such as appendicitis, gastroenteritis, urinary tract infection, renal colic or other conditions of acute abdominal and pelvic pain. Here, authors describe a case of a 4-year-old girl with a presentation of acute abdominal pain, treated empirically elsewhere. After investigations, a provisional diagnosis of ovarian torsion was made and patient was taken up for surgery. Intraoperatively, ovary was found to be necrosed. Detorsion was tried but ovary was unsalvageable. Right sided salpingectomy with oophorectomy was performed. Conservative surgery by laparoscopic detorsion can be tried in cases of ischemia but if necrosis has already set in, then salpingo-oophorectomy has to be performed.
A rare case of extragonadal immature teratoma mimicking as subserosal pedunculated myoma
Authors: Rai Aditi , Bettaiah Ramesh , Kumbhalwar Minal , Rani Isha , Garlapati Hema
Published: May 2020

Immature teratomas are usually derived from a malignant transformation of mature teratoma. The pure immature teratoma accounts for less than 1% of all ovarian cancers. It is the second most common germ cell malignancy and accounts for 10-20% of all ovarian malignancies seen in women younger than 20 years of age. Extragonadal origin are extremely rare and the most common extragonadal site of these teratomas is the omentum. We hereby describe a case report of a 29-year-old lady who presented with abdominal pain and her imaging with an ultrasound revealed a mass with features suggestive of a subserosal fibroid. She underwent a laproscopic myomectomy. A histopathologic diagnosis of Immature teratoma was made following her primary surgery. She subsequently underwent a staging laparotomy which was followed by chemotherapy. Immature teratomas predominantly occur in young patients, and preservation of fertility is an important factor in its management. Treatment should be initiated as soon as possible after surgery, preferably within 7-10 days, in those patients who require chemotherapy.
Leiomyoma in the space of Retzius: a rare location
Authors: . Shweta , Anjum Shaheen , Mohsin Zehra , Anees Afzal
Published: May 2020

Extrauterine locations of leiomyomas are extremely rare clinical conditions as in the case of space of Retzius. Space of Retzius is a small anatomical compartment located posterior to the pubic symphysis and anterior to the urinary bladder. Here authors report a very unique case of 22-year-old woman presented to the study hospital with complaints of inability to conceive and difficulty in urination. Clinical examination and imaging of pelvis suggest leiomyoma of uterus located between lower part of anterior uterine wall and bladder. An attempt to remove the tumour laparoscopically was taken but later it was converted into open laparotomy due to unusual location of leiomyoma. Histopathology revealed the tumour to be a leiomyoma.
Prevalence and associated risk factors of abnormal Pap smear in pregnant women
Authors: Venkatesh Meenakshi , . Ushadevi
Published: May 2020

Mohindroo N et al, conducted a prospective study  about the prevalence and risk factors associated with abnormal pap smear in pregnant women.1 This study is in need of the hour because carcinoma cervix is on increasing trend due to multiple sexual partners, HPV infection, and use of OCP in young women lead in increase in adenocarcinoma of cervix.2 Indian women face a 2.5% cumulative lifetime risk and 1.4% cumulative death risk from cervical cancer.1
Exploring the iceberg of gluten
Authors: Chaudhary Bhupendra , Chaudhary Ansh
Published: May 2020

Gluten, a protein present in wheat, rice or barley shares the reputation of common etiological agent for childhood disease ‘Coeliac Disease’ (CD) and adult ‘Non-Coeliac Gluten Sensitivity’ (NCGS).