bluuebunny/crossref_metadata_2025 huggingface dataset:
Intrauterine Condom Tamponade in Management of Post Partum Hemorrhage
Authors: Joshi Rijuta , Baral Gehanath
Published: November 2018

Aims: To analyze the outcome of intrauterine balloon tamponade using fluid filled latex condom attached to Foley’s catheter (condom tamponade) in the management of postpartum hemorrhage. Methods: This is a retrospective descriptive study of 29 women with postpartum hemorrhage unresponsive to pharmacological agents and managed with condom tamponade in Paropakar Maternity and Women’s Hospital, Nepal from 13th February 2015 to 12th February 2016. Data were entered in Microsoft office excel (2007). Results: Majority (n=20) of women were 20-29 years and 52% of them (n=15) were primipara. Seventy percent women (n=20) delivered at term and vaginal delivery was the most common mode of delivery (72.41%, n=21). Sixty-two percent (n=18) had blood loss of <1000ml and condom tamponade was successful in 27 out of 29 women. One woman each needed internal iliac artery ligation and peri-partum hysterectomy.                                                                              Conclusions: Intrauterine condom tamponade is the effective method of arresting postpartum hemorrhage due to a wide variety of causes.
Cervical Cancer Screening with VIA in Eastern Nepal - 3 Years Analysis
Authors: Rijal Pappu , Chhetri S , Agrawal A , Pradhan T , Bhatta R
Published: November 2018

Aims: To estimate the VIA positivity rate and to see the efficacy of the treatment with cryotherapy during follow up.Methods: A retrospective analysis of all VIA test from March 2012 to April 2015 were analyzed to estimate the VIA positivity rate of the screened population. Guideline for screening, treatment and follow up was as per the national guideline for cervical cancer screening and treatment 2010 of Nepal.Results: A total of 12,444 clients were screened, the VIA positivity rate was 5.9%, repeat VIA positivity rate at the end of one year during follow up was 1.2%, more than 98% had been screened for cervical cancer for the first time and the complication following cryotherapy was low.Conclusions: The VIA positivity rate of our population is comparable to the global magnitude. Screening for cervical cancer with VIA and treatment with cryotherapy is a feasible and acceptable form of screening in our setup. The recommendation would be scaling up of the facility up to grass root level that is linked to appropriate referral system.
Oligohydraminos in Low Risk Pregnancies at Western Regional Hospital Pokhara
Authors: Regmi Rabi , Singh Dela , Joshi Rijuta , Baral Gehanath
Published: November 2018

Aims: This study is done to see the maternal and fetal factors associated with isolated oligohydraminos.Methods: It is a retrospective observational study done at Western Regional Hospital Pokhara.   All cases of oligohydraminos except those with diabetes mellitus, hypertension, premature rupture of membranes, preterm labour and fetal congenital anomalies were included in the study.  SPSS 16 and MS-Excel were used for data entry and analysis. Results were presented as graphs and tables.Results: Sixty cases were enrolled in the study and the mean age was 25.6 years. Oligohydraminos was more prevalent among primigravida compared to multigravida (62% vs. 38%). Half of the women (n=30) delivered in between 37 to 40 weeks of gestation while 47% (n=28) of the women were post dates and two were post term. LSCS was the most common mode of delivery in this study (n=48). Anhydraminos was detected in seven women (12%) during caesarean section and rest had scanty liquor (41 in LSCS and 12 in vaginal delivery). One fifth of them (n=12) had low birth weight and there were no cases of growth retardation. Eighty two percent of women (n=49) had scanty clear liquor while only seven percent (n=4) had meconium stained scanty liquor. One had stillbirth and the rest had Apgar score of six or more including anhydramnios.Conclusions: There were seven cases of anhydraminos and four cases of meconium stained liquor. All the live births had Apgar score of six or more. There was one stillbirth and neonatal admission each while no neonatal death in this study.
Histopathological Pattern of Gynecological Malignancy at Tribhuvan University Teaching Hospital, Nepal
Authors: Subedi Kirtipal , Singh Meeta , Ojha Neebha
Published: November 2018

Aims: This study aims to find out histopathological diagnosis and stage at presentation during the diagnosis of female genital tumors.Methodology: This is hospital based prospective observational study of histopathologically confirmed gynecological malignancies conducted in the Department of Obstetrics and Gynecology, TUTH, Maharajgunj, Kathmandu for one year from 2014 to 2015Results: Among 102 cases enrolled in the study, the most common gynecological malignancy was of ovary (48%) followed by cervix (31%), endometrium (11%), vulval (6%), gestational trophoblastic neoplasia (3%) and fallopian tube (1%). Patients presented in early stage in 66.6% of cases. Seventy-nine percent of ovarian cancer, 96.8% cases of cervical carcinoma, 66.6% cases of gestational trophoblastic neoplasia and all the cases of the endometrial, vulval fallopian tube carcinoma presented in early stage of the disease. The most common histopathological diagnosis of ovarian cancer was serous cyst adenocarcinoma (49.4%), cervical cancer was squamous cell nonkeratinising type (72%), endometrial carcinoma was endometroid adenocarcinoma (82%), vulval carcinoma were squamous cell carcinoma (100%) and fallopian tube carcinoma was adenocarcinoma (100%). The mean age of gynecological malignancy was 49.6±14.5 years.Conclusions: Screening of gynecological malignancy in women with suggestive symptoms is necessary to identify this disease in early stage and decrease the incidence, morbidity and mortality from this common public health problem.
Management of Adnexal Mass During Cesarean Section
Authors: Gurung Monica , Baral Gehanath
Published: November 2018

Aims: To find out the prevalence of adnexal mass during Cesarean Section, its management and histological profile.Methods: This is a retrospective study conducted for 4 years from 2013 to 2017 at Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal. There were 18993 Cesarean Sections out of 72263 total births screened for adnexal masses from operation theatre register and record section.Results: The incidence of adnexal mass during cesarean section was 0.31% (58 out of 18993). Among them 15.52 % diagnosed antenatally and 84.48 % were incidentally diagnosed during cesarean section. Among 58 cases, 6 (10%) were bilateral amounting to 64 adnexal masses among which 35 (54.69%) masses had cystectomy, 20 (31.25%) masses had oophorectomy, 6 (9.37%) had aspiration/ drilling done and 3(4.69 %) masses were left without intervention. Among those cases only 48 histopathological reports were available. All the masses were benign and the most common was benign mature cystic teratoma (34; 69.38 %) and the least common was fibroma (1; 2.04%).Conclusions:  Adnexal masses during cesarean section should undergo surgical removal.
Factors Effecting Intimate Partner Violence among Pregnant Women at a Centre in Karnataka
Authors: Ramalingappa Padmasri , Somya KP , Akhila MV
Published: November 2018

Aims: To determine the prevalence of intimate partner violence among pregnant women and to evaluate associated sociodemographic factors.Methods: This is a prospective cohort study which was carried out in the outpatient department, antenatal and labour wards among 635 antenatal women above 34 weeks of gestation. A pretested questionnaire was used and women were divided into two groups based on presence or absence of intimate partner violence. The sociodemographic details of the women were taken in both groups and data were analyzed for statistical significance using SPSS version 16.Results: The incidence of intimate partner violence was 52.8% out of which 30.7% were positive for physical violence, 23.4% for sexual violence and 46.3% for emotional violence. Sociodemographic factors like lower socioeconomic status, Hindu religion, economically not independent, unemployed husband, problems with in-laws, dowry at marriage, alcoholic and smoker spouse was associated with significantly more domestic violence (p<0.05).Conclusions: Iintimate partner violence is not uncommon and under reported.
Repeat Spinal Anaesthesia for Caesarean section: An Experience at Paropakar Maternity and Women’s Hospital
Authors: Pradhan Ritu , Shrestha Sangeeta , Gurung Tara , Shrestha Amirbabu
Published: November 2018

Aims: This study aims to review the haemodynamic effects of the repeat spinal anaesthesia and to identify the different doses of Bupivacaine heavy used for the repeat spinal anaesthesia for the failed spinal in caesarean section.Methods: This study was conducted by reviewing medical anaesthesia records of the cases of the repeat spinal anesthesia regarding any adverse haemodynamic effects. The second dose of bupivacaine heavy, maximum sensory blockade and intraoperative events like bradycardia, hypotension, high spinal, nausea vomiting, conversion to general anaesthesia and inadequate block were also reviewed.Results: Out of 8040 caesarean section under subarachnoid block, 51(0.63%) cases were conducted under repeat spinal anaesthesia from April 2014 to December2016. All the cases had complete spinal failure with no sensory and motor effects even after 10 minutes of the intrathecal injection. The second dose of bupivacaine heavy used was variable but reduced than the first dose. The most common adverse effect was hypotension (27.5%). 50% of cases were uneventful. One case was converted to general anaesthesia even after repeat spinal anaesthesia and 9.8% cases had high spinal above T4.Conclusions: Repeat administration of Bupivacaine heavy in reduced dose and volume can be used in complete failure of administration of first spinal anaesthesia. However, it always requires careful assessment and the judicious monitoring.
Comparative Evaluation of Pre-Induction Changes in Bishop’s Score with Insertion of Intra-Cervical Foley Catheter and Vaginal Misoprostol
Authors: Mandal Anju
Published: November 2018

Aim: The aim of this study was to compare changes in pre-induction Bishop’s Score with insertion of intra-cervical Foley catheter and vaginal Misoprostol administration for cervical ripening.Methods: It is a comparative study done among 50 patients at term that had Bishop’s score <5 in College of Medical Science in Bharatpur. Intra-cervical Foley catheter was used in half of the women and intra-vaginal insertion of 50 microgram Misoprostol tablet was used in the rest. After 24 hours of post ripening, Bishop’s score was noted and labour was induced with inj. oxytocin if required.Results: Both groups showed significant changes in the mean Bishop’s score after ripening agents, 7.64 and 7.25 for Foley catheter group and Misoprostol group respectively. Eighty four percent patients from Foley catheter group and 72% patient from Misoprostol had normal delivery.Conclusion: Post ripening mean Bishop’s score was significantly better in Foley catheter group as compared to Misoprostol group.The induction to labour interval, induction to delivery interval and labour to delivery interval were less in Foley’s catheter group than Misoprostol group.
Thyroid function test in abnormal uterine bleeding
Authors: Kattel Pramod
Published: November 2018

Aims: To evaluate and detect the thyroid dysfunction in patients with abnormal uterine bleeding (AUB) from puberty to menopause.Methods: This is an observational descriptive study of 90 patients of abnormal uterine bleeding at Paropakar Maternity and Women’s Hospital, Kathmandu from 17th January 2016 to 16th January 2017. Besides thyroid function test Pap smear, endometrial biopsy and histo-pathological examination of uterus following hysterectomy was done in selected cases.Results: The incidence of AUB was 6.2 % with mean age of 37 years. The most common presenting complaint was menorrhagia (36.7%) followed by metrorrhagia (23.3%). Thyroid dysfunction accounted for 20% of AUB with major share occupied by subclinical hypothyroidism (11%) and least by hyperthyroidism (1%). The most common association of thyroid dysfunction with AUB was overt hypothyroidism (27.3%) with menorrhagia. Non-structural cases of AUB accounted for 30.4% of thyroid dysfunction.Conclusions: This study shows that thyroid dysfunction plays significant role for AUB so it is wise enough to perform TFT on routine basis in order to avoid unnecessary hormonal treatment with Estrogen, Progesterone or their combination and even the hysterectomies.
Induction of labor in Mid-Western Hospital in Nepal: Practice and Solution
Authors: Dhakal Keshar Bahadur , Dhakal S , Shrestha S , Bhandari S
Published: November 2018

IntroductionInduction of labour has been common intervention in modern obstetrics. This study is aimed to determine the distribution of practice and outcomes related to induction of labour in Mid-Western Regional Hospital in Nepal. MethodsThis is a retrospective cross-sectional study conducted at Mid-Western Regional Hospital in Surkhet, Nepal. Secondary data were collected from patients’ records of the hospital dating from 16 July 2016 to 15 July 2017. All women who underwent induction of labour with oral misoprostol were included in this study. For induction of labour, maximum five doses of 50 microgram oral misoprostol was administered in every four hours. Descriptive summary statistics such as frequency and percentages were calculated.ResultsOut of total 3,694 pregnant women who delivered in MWRH, 10.5% (n = 387) were induced by oral misoprostol. Majority of labour induced women were in the age group of 20 – 24 years (52.9%), 37 – 42 weeks of gestation (69.5%), and multi-gravida (49.9%). Majority (77.0%) who underwent induction of labour had vaginal delivery. Among total induction of labour, 88.9% had healthy babies. Majority of new borns had APGAR score of six or more in both one minute (87.9%) and five minutes (93.6%). More than half of the new borns (54.5%) had birth weight of 3000 – 3500 grams. Most of the induced cases (97.4%) were free of complications. Only 1.3% of cases had post-partum haemorrhage. ConclusionsInduction of labour using oral misoprostol is a common practice in Mid-Western Regional hospital in Nepal and majority (77.0%) who underwent induction of labour had vaginal delivery.
A Successful Pregnancy in Women with Uterine Didelphys
Authors: Khadka Sailaja , Lama Poonam
Published: November 2018

We report a didelphys uterus in 36 years female diagnosed intra-operatively who underwent Cesarean Section for fetal distress. The fetus was found in one uterus while another uterus was empty.
Serum β-hCG Levels Between 13-20 Weeks Gestation Can Predict Development of Pregnancy Induced Hypertension
Authors: Kour Gurpreet , Kour Sandeep
Published: November 2018

Aims: To find out predictive value of Serum β Human Chorionic Gonadotropin (β HCG) levels between 13-20 weeks of gestation in predicting the development of pregnancy induced hypertension (PIH) or pre-eclampsia, eclampsia.Methods: Serum β HCG level was estimated in 200 normotensive patients between 13-20 weeks of gestation. The median value of Serum β HCG was calculated and patients were divided into two groups as per two times Multiple of Median (2MOM) values of Serum β HCG i.e. those above and below the 2MOM values. The patients were followed up to delivery and were evaluated for the development of PIH, pre-eclampsia and eclampsia.Results: As per the median score of Serum β HCG in studied patients, the determined value of 2MOM was 30845 mIU/ml.  Out of 200 patients, 23 (11.5%) patients were found to have values of Serum β HCG ≥ 2MOM. Twelve (52%) patients in Serum β HCG ≥ 2MOM group developed hypertension on follow up as compared to 13 (7.3%) patients in < 2MOM group (p< 0.0001). Also patients in the ≥ 2MOM group had higher prevalence of maternal and fetal complications.Conclusion: Serum β HCG levels between 13-20 weeks of gestation can predict development of PIH  in pregnant females
Profile of Fetal Echocardiography in a Tertiary Cardiac Centre of Nepal
Authors: Sharma Poonam , Shrestha Manish , Shrestha Pragati , Sharma Diwakar
Published: November 2018

Aims: To analyze the fetal echocardiographic diagnosis.Methods: A descriptive study of fetal echocardiographic diagnosis at Shahid Gangalal National Heart Centre between October 2016 to September 2017.  Results: Total of 615 fetal echocardiography was performed in 607 pregnancies. Intrauterine heart disease noted in 79 cases. Echogenic intracardiac foci was the most common abnormality (6%) followed by VSD (1.3%), fetal arrhythmia (1.1%), pericardial effusion (1.6%), cardiomyopathy (0.3%), hypoplastic left ventricle (0.6%), DORV (0.3%) and tricuspid atresia (0.4%).  Similarly the most common referral for fetal echocardiography was for maternal disorder mostly diabetes mellitus.Conclusion: Fetal echocardiography is an important tool for the antenatal diagnosis of congenital heart defects. Appropriate timing and judicious use increases the sensitivity and improves the perinatal outcome of newborns with congenital heart disease
Awareness with Recall in General Anesthesia undergoing Cesarean Section
Authors: Gurung Tara , Shrestha Sangeeta , Basnet Ujjwal , Shrestha Amirbabu
Published: November 2018

Aims: To determine the incidence of awareness with recall in parturient undergoing cesarean section under general anesthesia in Paropakar Maternity and Women’s Hospital.Methods: Retrospective observational cohort study of the patients who underwent cesarean section under general anesthesia from April mid 2014 to April mid 2017 (Baishakh 2071 to Chaitra 2073 BS).  Awareness questionnaires filled up through the modified Brice interview.Results: A total of 162 patients underwent Cesarean Section under general anesthesia and138 were included in the study.  None of them had awareness and six patients had a dream.Conclusion: No awareness with recall found and prospective study is required to determine the condition.
Maternal and perinatal outcome of teenage pregnancy in a tertiary care centre
Authors: Subedi Anjali , Shrestha Junu , Shrestha Aashika , Gurung Sangeeta
Published: November 2018

Aims: To evaluate the maternal and perinatal outcome in adolescent pregnancy,Method: This was a cross-sectional study conducted in Department of Obstetrics and Gynecology, Manipal Teaching Hospital, Pokhara from October 2017 to March 2018 for duration of 6 months.Results: There were total 82 cases of teenage pregnancy in the study duration with incidence of  6% among total deliveries. Majority of cases were of age 19 and were primigravida. Fifty five percent of the cases had normal vaginal delivery and cesarean section accounted for 39% of cases. The major indication for cesarean section was meconium stained liquor (52%) followed by oligohydraminos (15%) and cephalopelvic disproportion (11%). The maternal complication accounted for 59% of total cases. Among them, anaemia was highly prevalent comprising 11% of cases followed by PPROM (9.8%) and hypertensive disorders in pregnancy (8.5%). In perinatal outcome, the incidence of preterm birth was 15.9% and low birth weight was 13.4%. The rate of NICU admission was 2.4% and there was one case of still birth.Conclusion: The study showed that teenage pregnancy is at increased risk of adverse maternal and perinatal outcome. So if we lay an effort for reducing the incidence of teenage pregnancy, we can bring in positive changes in the indicators of maternal and perinatal morbidities.
Risk Factors for Adverse Outcome in Pregnant Women with Obstructed Labor
Authors: Thapa Baburam Dixit , Regmi Mohan Chandra , Rai R
Published: November 2018

Aims: The aim of the study was to assess the risk factors for adverse outcomes in pregnancy with obstructed labor.Methods: It was a prospective descriptive study conducted at BP Koirala Institute of Health sciences (BPKIHS).The patients with obstructed labour were managed and followed up until delivery and six weeks postpartum from Jan to Dec 2012.Results: There were 57 (0.6%) cases of obstructed labour out of 9500 deliveries. The main cause was cephalopelvic disproportion in 36 (63.2%). The majority of the cases were from rural areas, low socioeconomic status, non salaried and illiterate. Risk for maternal mortality, peripartum hysterectomy and perinatal mortality as adverse outcomes was significantly associated with low socioeconomic status (AOR 12.5, P=0.02) and literacy status (AOR 21.9, P=0.001). If only the risk of perinatal mortality is taken as an adverse outcome, it is significantly associated with booking status (AOR 7, P=0.001), low socioeconomic status (AOR 9.62, P=0.037) and literacy of the patient (AOR 15, P=0.001). Perinatal mortality rate was 100 per 1000 live births in women with obstructed labour. The case fatality rate was 1.2%.
A Comparative study of intrathecal hyperbaric Bupivacaine with or without Morphine for Post-Operative Analgesia in Hysterectomy
Authors: Basnet Ujjwal
Published: November 2018

Aims: The aim of the study is to compare the effect of addition of morphine with bupivacaine and bupivacaine alone in intrathecal anesthesia for the quality and the duration of analgesia in hysterectomy.Methods: Prospective randomized analytical study was conducted in patients undergoing hysterectomy under spinal anesthesia over period of one year. Patients were randomized into two groups: hyperbaric bupivacaine (15mg) only or hyperbaric Bupivacaine (15mg) plus Morphine (0.2mg). The mean duration for the request of first analgesia in post-operative period, mean visual analogue scale (VAS) score at the time of request of analgesia and common adverse effects were compared.Results: The post-operative analgesia was prolonged (260.32 Vs. 154.34 minutes) along with low VAS pain scale (5 vs. 7.5) in combination group but the respiratory depression was significantly high.Conclusions: The addition of morphine to hyperbaric bupivacaine prolongs the total duration of sensory analgesia, causes significantly greater frequencies of respiratory depression and causes no significant increase in other complications like hypotension, bradycardia, nausea and vomiting and pruritus, in comparison to patients receiving intrathecal hyperbaric bupivacaine only.
Evaluation for Screening of Cervical Cancer by Visual Inspection with Acetic Acid (VIA) Method
Authors: Thapa Kalpana Kumari , Parajuli Urmila
Published: November 2018

Aims: To evaluate pre-cancer lesion and presence of risk factors by visual inspection with acetic acid.Methods: A retrospective study was done to evaluate VIA positive women by demographic and reproductive history and presence of risk factors from the period 16th March, 2016 to 15th March, 2017.Results: A total of 605 women were included and counseled for screening mean age of patient in year's was 39.46±9.4 years and VIA positive rate was 4.63% (28/605).Conclusions: Cervical pre-cancer and cervical cancers were detected by VIA testing.
Isolation of Organism and its Drug Sensitivity Pattern in Patients with Urinary Tract Infection at Kathmandu Model Hospital
Authors: Joshi Rajesh Dhoj , Khadka Sachin , Joshi Deepak Man , Shrestha Basudha , Dangal Ganesh , Dahal Abhinav
Published: November 2018

Introduction: Lack of compliance and unjustified antibiotic prescriptions has resulted in increasing bacterial resistance and is proving as a major challenge in the management of infections. Knowing the commonly isolated uropathogens and their antimicrobial susceptibility is beneficial in planning treatment protocols.Methods: A retrospective review of records of patients with urinary tract infection from January 2012 to December 2016 was conducted at Kathmandu Model Hospital. All patients who were diagnosed as having culture positive urinary tract infection in medical ward of Kathmandu Model Hospital during 5 years period were analyzed for demographic data, prevalence of organism and antibiotic susceptibility patterns.Results: A total of 315 samples were culture positive. The majority of bugs were gram negative E.coli (48.57%) followed  by multi-drug resistant E.coli (28.89%).  The other major pathogens were E. faecalis (6.03%), S. epidermidis (4.44%), K. pneumoniae (4.13%), respectively. The highest level of sensitivity in first line antibiotics was seen in nitrofurantoin (84.9%), whereas least sensitivity was shown by amoxicillin/clavulanic acid (21%). Similarly, in second line antibiotics, highest sensitivity was seen in tetracycline (100%), imipenem (91.9%) and least to meropenem (49.2%). Ceftazidime is mostly (93.3%) resistant antibiotics among uropathogens. All the third line antibiotics such as polymyxin B, tigecycline and colistin were 100% sensitive to all our isolates.Conclusions: Nitrofurantoin may be an appropriate choice for initial empirical therapy of urinary tract infection. Similarly, the multi-drug resistant E.coli is increasing but it can be tailored if antibiotics are used appropriately on the basis of susceptibility data.
Ruptured Right Cornual Pregnancy
Authors: Pokhrel Shreesiya , Dangal Ganesh , Karki Aruna , Pradhan Hema Kumari , Shrestha Ranjana , Bhattachan Kabin , Thapa Shekhar , Paudel Rekha , Bajracharya Nishma
Published: November 2018

The ectopic implantation is implantation of fertilized ovum outside the uterine cavity, ampulla of fallopian tube being the most common site. A cornual or interstitial pregnancy is an ectopic pregnancy that develops in the interstitial portion of the fallopian tube which is one of the most hazardous type of ectopic gestation. Treatment depends on the week of gestation at the time of diagnosis, level of serum β HCG, findings of ultrasonography, hemodynamic stability of the patient and the choice of future fertility. In this case report, we present a case which was previously misdiagnosed as a case of missed abortion at 8 weeks of gestation by transabdominal ultrasound and patient underwent medical abortion with  mefipristione and  misoprostolandafter 1 month presented with pain abdomen and was confirmed as extrauterine pregnancy by transabdominal ultrasound followed by surgical management.
Creation of Functional Neo-vagina in Vaginal Atresia
Authors: Paudel Rekha , Dangal Ganesh , Karki Aruna , Pradhan Hema , Shrestha Ranjana , Bhattachan Kabin , Bajracharya Nishma
Published: November 2018

Vaginal atresia is one of the common congenital anomalies of the female lower genital tract due to incomplete canalization of Mullerian ducts. It mostly presents as primary amenorrhoea with attacks of severe lower abdominal pain at monthly interval in presence of appropriate Tanner staging secondary sex characteristics. It is diagnosed by clinical presentation, examination and imaging, usually Ultrasound scan and Magnetic Resonance Imaging. There are conservative non-surgical as well as surgical methods to correct it. A 13 years pubertal girl presented at Kathmandu Model Hospital with complaints of cyclic severe lower abdominal pain since one year with presence of appropriate secondary sexual characteristics. Ultrasound showed features suggestive of hematometra. She underwent drainage of hematocolpos with neo-vaginoplasty followed by intravaginal mould placement. She also underwent dilatation of neovagina thrice under IVA to maintain the vaginal length and function. We present here a case of isolated vaginal atresia, who underwent Mc Indoe Vaginoplasty followed by serial dilatation.
Izazovi istraživanja otpornosti obitelji
Authors: Ferić Martina , Maurović Ivana , Žižak Antonija
Published: November 2018

Otpornost je koncept koji se sve više istražuje u području psihosocijalnih znanosti. Time se ujedno i rasvjetljavaju brojne nejasnoće u konceptualiziranju i operacionaliziranju ovog fenomena. Kroz pedesetogodišnji razvoj, koncept je prošao put od usmjerenosti na pojedinca ka usmjerenosti na sve šira okruženja pojedinca (obitelj, zajednica, kultura). U skladu s time, nejasnoće nastale u području istraživanja individualne otpornosti selile su se u područja istraživanja otpornosti u sustavima poput obitelji ili zajednice. Cilj ovog rada je dati pregled različitih načina konceptualizacije otpornosti obitelji te navesti operacionalizaciju otpornosti obitelji u projektu Specifična obilježja obitelji u riziku: doprinos razvoju kompleksnih intervencija koje se provodi na Edukacijsko-rehabilitacijskom fakultetu Sveučilišta u Zagrebu.
Turkish Undergraduate Veterinary Students’ Attitudes to Use of Animals and Other Teaching Alternatives for Learning Anatomy
Authors: Küçükaslan Özgül , Erdoğan Serkan , Bulut İlhami
Published: November 2018

This study aimed to investigate the views of first-year veterinary students in Turkey from six veterinary faculties on their anatomy courses and to evaluate their perceptions of the uses of animals and other teaching alternatives from an ethical perspective. The study sample included a total of 293 veterinary students studying in the provinces of Ankara, Burdur, Diyarbakır, Kars, Konya, and Tekirdağ. The 38-item instrument tool developed by the researchers consisted of three sections and was administered to volunteer student participants. All the data were statistically analyzed, and normal distribution of the scores obtained in the attitude scales was determined using the Kolmogorov–Smirnov Z test (KSZ). The 20 items in the Anatomy Scale had an arithmetic mean of 3.48 and thus indicated an average rating of agree. The most challenging topic was found by 40.9% to be “the nervous system.” The most useful material in facilitating the learning process was rated by 24.1% to be “the anatomy book.” The 11 items in the Cadaver Scale had an arithmetic mean of 3.77, indicating an average rating of agree. The highest arithmetic mean score was for the item “Using cadavers is a must for the anatomy course” with a mean of 4.66, indicating their strong agreement with this view. The veterinary students’ perspective emphasized that the combination of cadavers and the anatomy book contributed to their learning of anatomy.
Exploring the Effects of Participation in a Shelter Medicine Externship on Student Knowledge and Self-Confidence
Authors: Hedge Zarah N. , Bossong Frank , Gordon-Ross Paul N. , Kovacs Suzie J.
Published: November 2018

With the recognition of shelter medicine as a sub-discipline of veterinary medicine, many veterinary programs are including clinical shelter experiences in their curricula. A concurrent mixed-methods study was designed with the aim to determine the effectiveness of a 4-week clinical shelter medicine program on students’ perception of canine and feline surgical proficiency and shelter medicine knowledge as well as gain information on student attitudes toward shelter medicine and interest in pursuing this career path. Year 4 veterinary students at Western University of Health Sciences who were enrolled in a shelter medicine externship from 2014 to 2016 were invited to complete pre- and post-course online surveys. Of the 168 enrolled students, 77.4% were invited to participate, and 114 completed the survey. There was no statistically significant difference in student veterinary career interest before and after completing the externship. There was an overall increase in student rating of their ability to perform six shelter medicine tasks as well as ovariohysterectomy/ovariectomy (OVH/OE) and castration surgeries after completing their externship; all were statistically significant ( p < .001). There was a statistically significant difference in the proportion of students who were familiar with the Asilomar Accords and the Association of Shelter Veterinarians (ASV) Guidelines for Standards of Care in Animal Shelters after completion of their externship ( p < .001). Students largely supported pediatric spay and neuter, stating it was an effective means of population control. Based on the themes that emerged from the qualitative analysis, it appeared most students had an accurate understanding of the term no-kill.
Flipped Classroom Use in Veterinary Education: A Multinational Survey of Faculty Experiences
Authors: Matthew Susan M. , Schoenfeld-Tacher Regina M. , Danielson Jared A. , Warman Sheena M.
Published: November 2018

Active teaching approaches such as the flipped classroom are linked to better quality student learning outcomes across health care disciplines, with the potential to support students’ preparedness for practice. In the flipped classroom instructional approach, students engage in significant pre-class preparation to learn foundational knowledge and skills, then undertake instructional activities in the classroom that require them to integrate, apply and extend their learning to new contexts. This study reports the results of a multinational survey of flipped classroom use in veterinary education. Participants’ ( n = 165) familiarity with and extent of use of the flipped classroom technique were investigated, together with the teaching strategies used and the perceived benefits and barriers to implementation. Relationships between respondent characteristics and flipped classroom use were also explored. The results indicated that 95% of participants were familiar with the flipped classroom technique, although fewer (64%) used it in their teaching. Pre-class activities included reviewing online and printed material, and engaging in preparatory learning activities such as quizzes, case analyses, reflective assignments and group activities. A variety of active learning strategies were used in class, including discussions, presentations, quizzes, group activities, problem solving and laboratory/practical exercises. Most participants perceived that the flipped classroom technique benefited student learning, with some also identifying benefits for the faculty involved. A range of student-, faculty- and institution-related barriers to implementing the flipped classroom technique were identified. These barriers need to be considered and addressed by teachers and administrators seeking to improve students’ preparedness for practice by implementing flipped classrooms in veterinary education.
Challenges and Issues Surrounding Promotion and Tenure of Faculty with Clinical Service Responsibilities in Veterinary Medicine
Authors: San Miguel Sandra F.
Published: November 2018

Mentoring, assessing, and rewarding faculty who have clinical service responsibilities with promotion and tenure can be challenging in many respects. Clinical service responsibilities can limit the time that faculty have available to participate in scholarly activities, especially if the scholarship required for promotion is restricted to traditional research efforts where an individual faculty member is assessed in terms of the number of scientific publications in high-tiered journals with senior authorship and the amount of extramural funding garnered. Even if other forms of scholarship are recognized, metrics used to evaluate research efforts are often inappropriately applied to other scholarly activities. This challenge is not unique to veterinary medicine. This literature review reveals information regarding barriers and recommended solutions from other healthcare and service professions as recognizing scholarly engagement in academic veterinary medicine is just beginning. Opportunities and examples of how faculty can derive scholarship from their clinical service activities are provided. In addition, an approach for mentoring faculty in the prospective planning and documenting of scholarly engagement efforts is suggested. Lastly, challenges and guidance for assessing such scholarship in academic veterinary medicine are recommended as one step toward encouraging colleges of veterinary medicine to develop methods to assess scholarly engagement within their promotion and tenure processes. A change in approach to the promotion and tenure process can result in more faculty being rewarded for their clinical, diagnostic, and scholarly excellence, which positively impacts patient care, career fulfillment, institutional reputation, the veterinary profession, and society as a whole.
Innovative, Simple Models for Teaching Neuroanatomy Using the Elnady Technique
Authors: Elnady Fawzy A.
Published: November 2018

Plastination is a valuable tool for the teaching of neuroanatomy. However, the high cost of the process and the complexity of sheet plastination for brain slices remains a challenge. This article describes an innovative, simple, and inexpensive method, called the Elnady Technique, to develop brain slices of various domestic animals. The slices are either enveloped in lamination sheets using an electric iron, or enveloped in transparent plastic using an impulse sealer. This fast, effortless process results in realistic, durable, odorless, soft, flexible slices. The models provide accurate three-dimensional (3D) reference guides for demonstration of neuroanatomical structures that show soft tissue contrast between the gray and white matter. This makes them invaluable for interpretation of clinical imaging modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI). These ethically sourced models can provide a replacement for the killing of animals for practical classes.
Use of Three-Dimensional Printing Models for Veterinary Medical Education: Impact on Learning How to Identify Canine Vertebral Fractures
Authors: Suñol Anna , Aige Vicente , Morales Carles , López-Beltran Marta , Feliu-Pascual Alejandro Luján , Puig Jordi
Published: November 2018

Vertebral fractures and luxations are common causes of neurological emergencies in small-animal patients. The objective of this study was to evaluate the impact of three-dimensional printing (3Dp) models on how veterinary students understand and learn to identify canine spinal fractures and to compare 3Dp models to computed tomography (CT) images and three-dimensional CT (3D-CT) reconstructions. Three spinal fracture models were generated by 3Dp. Sixty first-year veterinary students were randomized into three teaching module groups (CT, 3D-CT, or 3Dp) and asked to answer a multiple-choice questionnaire with 12 questions that covered normal spinal anatomy and the identification of vertebral fractures. We used four additional questions to evaluate the overall learning experience and knowledge acquisition. Results showed that students in the 3Dp group performed significantly better than those in the CT ( p < .001) and the 3D-CT ( p < .001) groups. Students in the 3Dp and 3D-CT groups answered all questions more quickly than the CT group (3Dp versus CT, p < .001; 3D-CTversus CT, p < .001), with no significant differences between the 3Dp and 3D-CT groups ( p = .051). Only the degree of knowledge acquisition that the students considered they had acquired during the session showed significant differences between groups ( p = .01). In conclusion, across first-year veterinary students, 3Dp models facilitated learning about normal canine vertebral anatomy and markedly improved the identification of canine spinal fractures. Three-dimensional printing models are an easy and inexpensive teaching method that could be incorporated into veterinary neuroanatomy classes to improve learning in undergraduate students.
AN ‘ANONYMOUS’ REVIEW IN LITERATURNAYA GAZETA
Authors: Batyuto S.
Published: November 2018

The article renders the contents of the review by the bibliographer Ferapont Vityazev published in Literaturnaya Gazeta in 1934. In his review, the author lashed out at the first volume of Selected works by P. Lavrov, printed by The Publishing House of Political Prisoners [Izdatelstvo politkatorzhan]. The biographical essay, introduction, comments and biography for this publication were written by I. Knizhnik-Vetrov, whose view of P. Lavrov’s output and method of work stood in stark contrast with Vityazev’s own concept, the main point of dispute being Lavrov’s growing ties with the Sovremennik’s editorial board as early as the early 1860s. Having dwelt on Knizhnik’s several errors in text interpretation, Vityazev takes issue with him on the authorship of the article entitled On the popularizer type of journalists and natural sciences [O publitsistakh-populyarizatorakh i o estestvoznanii]. While Knizhnik names Lavrov as the author, Vityazev argues that it was penned by A. Zhuk, and cites payment records of the journal Sovremennik, kept in the Pushkin House archives, as proof. As for the book’s bibliography, Vityazev points out a number of omissions and debatable mentions stemming from the complexity of attribution of articles to Lavrov, who chose to publish his work either anonymously or under a pseudonym.
ON THE NUANCES OF ANDREY BELY’S DECLAMATORY STYLE AND S. BERNSTEIN’S STUDIES OF HIS POETIC RECITALS
Authors: Glukhova E. , Torshilov D.
Published: November 2018

The paper offers a detailed analysis of Andrey Bely’s (melo)declamatory style in the context of his poetic and theoretical experimentations. Bely’s contemporaries described his recitals as adhering to the typically ‘decadent’ manner of declamation: with the poem’s meter emphasized by monotonous melodization. On examining the written mentions of his recitals, one is moved to agree with Bernstein’s statement that the poet had undergone a change in his declamatory manner, confirmed by Bely himself. And indeed, a first-ever digital analysis of the audio recordings made by Bernstein in chronological order sheds light on the inner causes of Bely’s poetic experimentation (‘melodism’) in his later years, and, together with the printed version of the poetry, points to the connection between the poet’s declamatory style and the general direction in which he went with his work as a poet and a theorist. Bely’s later poetry called for two distinctive manners of recital: one, relatively stable in terms of pauses and melodization, for traditional meters, and the other, more elaborate, for his ‘melodic’ verses. The latter is more in affinity with the poet’s manner of reciting his rhythmical prose. The two declamatory styles originate in the voiceless recital during composition, as described by Bely to Bernstein.
STUDY OF PHYSICAL AND CHEMICAL, SORPTION PROPERTIES OF NATURAL SORBENTS (ZEOLITES)
Authors:   Cand. Tech. Sci. Institute of Metallurgy and Ore Benefication. Almaty, the Republic of Kazakhstan. Е-mail: ainur_kbk@mail.ru, Berkinbayeva Ainur Nurkalievna
Published: November 2018

The article considers a comparative assessment of the chemical and phase composition of natural zeolites obtained at different horizons of ore bodies. It has been established that the main phases of zeolites are quartz, clinoptilolite, albite, diopside, hematite, lomontite, ernite. The sorption properties of the initial natural ion-exchange materials - a calcium type zeolite - in relation to uranium have been studied.
FEATURES OF THE HUMAN CAPITAL MODEL IN THE FIELD OF MEDICINE AND THE FACTORS INFLUENCING ITS FORMATION
Authors:   Master’s Degree student Voronezh Institute of High Technologies. E-mail: malika_92.art@mail.ru, Akhmetkul Malika
Published: November 2018

This article is devoted to a research of the informative characteristic of the human capital model in the field of medicine. Optimal formation of the human capital model in the conditions of digital transformation is possible only at interaction of personal, professional and moral qualities of the employee. At the same time, exact definition of the factors influencing quality of the human capital will allow to develop the development strategy more competently and increase effectiveness of activity of the company, its competitiveness, and satisfaction of personnel.
TRANSFORMATION OF CARGO FLOWS AT TERMINAL AND LOGISTICS COMPLEXES AS PART OF THE LOGISTICS CHAIN OF CARGO DELIVERY
Authors:   senior lecturer Kazakh university ways of communications Almaty, the Republic of Kazakhstan. E-mail: nurlantoleuov@gmail.com, Toleuov Nurlan , Kasenbaeva Zarina ,   senior lecturer Kazakh university ways of communications Almaty, the Republic of Kazakhstan. E-mail: kasenbaevaz@bk.ru
Published: November 2018

This article describes the main ways to solve problems, developed a classification of indicators of freight traffic, which allowed to determine the list of indicators that affect the process of loading containers, securing cargo in them and information support. The article analyzes the operational technology, which includes PRR, fastening of cargo in containers, selection of technological documentation for the transfer of cargo from road to rail, which allowed to determine the subject of research to solve the problems set in the article.
THE RECEIVING AN ACTIVATED ADSORBENT ON THE BASIS OF COAL THE «SHOPTYKOL» FIELD OF THE MAYKUBEN BASIN
Authors:   Doctor of Chemistry, Professor, Director. E-mail: coaltech@bk.ru, Yermagambet Bolat Toleukhanuly , Kazankapova Maira Kuttybayevna ,   PhD, Leading Researcher Institute of Coal Chemistry and Technology. E-mail: maira_1986@mail.ru, Zhenisova Akmaral Kamzievna ,   Master’s Degree student Kazakh University of Technology and Business Junior Researcher of LLP "Institute of Coal Chemistry and Technology" Astana, the Republic of Kazakhstan. E-mail: ms.tanabaeva95@mail.ru
Published: November 2018

The article shows experiments on heat treatment of coal at the Shoptykol deposit of the Maikuben basin by means of its carbonization and activation. First, carbonization of coal was carried out in an inert atmosphere of argon in the temperature range of 25-700 ° C and then the activation of coal with water vapor at a temperature of 700-800 ° C. With the help of energy dispersive X-ray spectroscopy on an SEM instrument (Quanta 3D 200i) with an attachment for energy dispersive analysis from EDAX, its chemical composition and surface morphology of the samples were determined. The BET method is used to determine the adsorption characteristics of the samples. It was found that the specific surface area and specific pore volume significantly increased as a result of high-temperature coal. Tests on approbation of the obtained activated carbon as an adsorbent for the purification of gas and water.
Correlates of Body Mass Index in Moderate to Severe Irritable Bowel Syndrome Patients
Authors: Brown Abbey C. , Firth Rebecca
Published: November 2018

SII es un trastorno gastrointestinal común y potencialmente incapacitante, susceptible a las influencias psicológicas fuertes, especialmente entre los pacientes más graves. Se sabe poco sobre el papel de los factores del estilo de vida (p.ej. obesidad) que influyen en la trayectoria de otras enfermedades crónicas. Este estudio ha examinado la correlación entre la obesidad y los diferentes aspectos de la experiencia de enfermedad en los pacientes más graves con el SII. Nuestra hipótesis fue que el SII se podría correlacionar positivamente con peores resultados de salud, incluyendo síntomas más graves del SII, molestias extraintestinales y angustia emocional. Durante el pretratamiento, en una prueba de comportamiento basada en NIH, 448 pacientes con el SII diagnosticados mediante los criterios de Roma (MEDAD = 41, MIMC = 26, F = 8%) fueron sometidos a una batería de prueba
que incluía una variedad de variables clínicas (gravedad del SII, miedo
de síntomas gastrointestinales, IMC etc.) y sociodemográficas (p. ej. edad etc.) El IMC fue positiva y significativamente correlacionado con la somatización (molestias somáticas inexplicadas), pero no con la gravedad de los síntomas del SII o angustia emocional. Una serie de múltiples análisis regresivos moderados demostró que la relación entre el IMC y la somatización fue moderada por la interacción entre el IMC, la edad y el miedo de los síntomas gastrointestinales. Los pacientes mayores con el IMC más alto mostraron niveles de somatización más altos,
y los pacientes que tenían más miedo de los síntomas gastrointestinales
tenían más posibilidad de sufrir la somatización si tenían también el IMC alto. Estos datos subrayan la relación entre los factores de estilo de vida y los síntomas extraintestinales entre los pacientes más graves con el SII, tanto como el impacto que tienen factores sociodemográficos (edad) y psicosociales (miedo de los síntomas gastrointestinales) en su relación.