bluuebunny/crossref_metadata_2025 huggingface dataset:
A randomised controlled study for the prevention of post-partum haemorrhage with oxytocin plus methyl ergometrine versus oxytocin alone in the third stage of labour
Authors: Somanathan Rajani , Balu Mohanapriya , Jacob Elizabeth , Illickal Sr Marykutty
Published: April 2021

Background: Postpartum haemorrhage is the leading cause of maternal death. Uterine atony which is preventable, causes 80% of Post partum haemorrhage (PPH). Active management of third stage of labour (AMTSL) lowers maternal blood loss and reduces the risk of PPH. In this open labelled randomised controlled study we compared the combined use of oxytocin and methyl ergometrine vs oxytocin alone in prevention of PPH in the third stage of labour.Methods: 200 Women admitted for safe confinement and following the inclusion criteria were randomised immediately post delivery to receive either oxytocin +methyl ergometrine or oxytocin alone. The amount of blood loss was assessed objectively by weighing the mops and under sheets used during delivery. If bleeding could not be controlled, additional uterotonics were given. The incidence of PPH, amount of blood loss, use of additional uterotonics and side effects were recorded. The difference in pre natal and post natal haemoglobin (Hb) and the need for blood transfusion were assessed.Results: There was no statistically significant difference in the incidence of PPH between the groups. Post partum blood loss was significantly lesser in the combined group. Additional oxytocics were required more often in the oxytocin only group. The incidence of headache was significantly more in the combined group. The difference in haemoglobin levels post natally and the need for blood transfusion was comparable among both groups.Conclusions: The combined use of methyl ergometrine +oxytocin is not recommended over oxytocin alone in the third stage of labour for prevention of PPH.
Knowledge, attitude and practice of contraception among paramedical staff at tertiary care centre
Authors: Lamba Indira , Bhardwaj Manish Kumar
Published: April 2021

Background: To assess the knowledge, attitude and practice of contraception among female paramedical staff, who is already working in the tertiary care hospital and identify the factors that hinders the use of contraception.Methods: This cross-sectional study was done in the Dept. of obstetrics and gynecology, SMS Medical College and attached group of hospitals, Jaipur. The study group included 90 paramedical female staff of reproductive age group (20-45 years) working in this hospital. Their knowledge, attitude and practice on contraceptives were evaluated with the help of a predesigned questionnaire.Results: It was found that 93% of female paramedical staff were using contraceptive method, most of them (70%) using condom (barrier method) as contraceptive. since they were health worker about 88% has Contraceptive Information and 63% also has knowledge about post-partum lactational amenorrhea. 58 % using contraceptive to Preventing unwanted pregnancy. 39% staff discontinued methods due to abnormal uterine bleeding and 20% not adopted any method due to fear of its side effect.Conclusions: Although the level of knowledge, attitude and acceptance of contraception among female paramedical staff were very good but every health worker should teach the community on family planning holistically to increase the awareness so that family planning utilization will be enhanced. This study highlights that knowledge and awareness doesn’t always lead to the use of contraceptives. There is still a need to educate and motivate.
Effect of oral L- arginine versus intravenous hydration on maternal and fetal outcome in idiopathic oligohydramnios
Authors: Iqbal Suhail , Malik Mehak Ayub , Kaurani Heena , Chauhan Divya
Published: April 2021

Background: Adequate amount of amniotic fluid was required for normal growth of fetus. Oligohydramnios or reduced amount of amniotic fluid is associated with adverse maternal and perinatal outcome due to increase in induced labour and operative deliveries. Idiopathic oligohydramnios is a condition in which no other risk factors are associated with pregnancy. This study was done to compare the effect of L-arginine and IV hydration on improvement of amniotic fluid index and fetal growth.Methods: Total 50 patients were included in the study according to inclusion criteria and divided equally into two groups randomly. IV hydration was given to one group and other group received L- arginine sachet orally. The effect on AFI and fetal outcome was compared.Result: The result was compared with respect to age, gravidity, gestational age and AFI at the time of study and after giving treatment. Maternal and fetal outcome was compared which shows that L-arginine was more effective in increasing the AFI and thereby leading to favorable results in the form of increase in gestational age at time of delivery and fetal weight.Conclusion: This study shows that both IV hydration and L-arginine are useful in treatment of oligohydramnios. But L-arginine appears more advantageous over IV hydration in improving pregnancy outcome and reducing perinatal morbidity and mortality.
Rising trend in cesarean sections: a retrospective study at tertiary care hospital in Jammu
Authors: Zargar Shazia , Gandotra Nikita
Published: April 2021

Background: The uncontrolled wave of cesarean rates has increased globally which has resulted in a significant amount of maternal mortality and morbidity. The present study aims to evaluate the trend in cesarean section rates in Jammu, India. Methods: The present retrospective study was carried out at the department of Obstetrics and Gynecology, SMGS Hospital, Jammu, India. We collected data based on total number of deliveries and cesarean sections performed at the hospital during (March2015-Feb2020) along with indications for CS.Results: The percentage of cesarean sections has increased drastically from 39.4% during (2015-16) to 49.9% in (2019-20). The study shows that the most common indication for CS is post CS followed by NPOL, Fetal distress, breech, APH, CPD, PIH and others.Conclusions: There is a growing concern among public and health care providers regarding the escalating and uncontrolled trend of cesarean sections which needs to be curtailed within optimal limits recommended by WHO.
Seric status of vitamin D among nulligest women at the general reference hospital of Panzi in Democratic Republic of the Congo
Authors: Balungwe Sifa , Maroyi Raha , Joyeux Mpakanyi , Omari Mukango , Philémon Mulongo , Nyakiyo Olivier
Published: April 2021

Background: Vitamin D has both bony and extra bony implications. The objective of this study was to determine serum vitamin D levels in non-breastfeeding women aged 20 to 35 years.Methods: A cross-sectional study was conducted at the Panzi General Reference Hospital in the Democratic Republic of Congo (DRC) with an occasional sample of 412 nulligest women sensitized during gynecological consultations. A vitamin D test was performed using the immunofluorescence technique and a trans-abdominal ultrasound was routinely performed. Vitamin D deficiency was defined by a serum level ≤29 ng/dl. Data were collected using a pre-established survey questionnaire.Results: The mean age of the women was 25.23±4.54 years. The serum vitamin D level was 77.2% too high, indicating vitamin D deficiency in our context. The nulliparous, students and overweight women were the most encountered. Women who consumed more red meat, green vegetables and alcohol were more affected. Pelvic pain, pelvic pain and bleeding between periods dominated the clinical picture.Conclusions: The serum level was very high in nulligest women aged 20 to 35 years. The study recommends expanded screening and vitamin D supplementation for the prevention of myomas and other conditions in nulligest women.
Effect of body mass index on maternal outcome in pregnancy
Authors: Jindal Somya , Chaudhary Rachna , Singh Shakun , Dhama Vandana
Published: April 2021

Background: Maternal body mass index during pregnancy is one of the important parameter which gives us the clue regarding maternal complications. The objectives of this study were to study distribution of antenatal patients in underweight, normal, overweight (and obese) categories according to booking BMI, to examine the association of BMI with obstetric outcomes in singleton pregnancies.Methods: This prospective Study was conducted over a period of 1 year from July 2019 to June 2020 on antenatal women attending OPD in the Department of Obstetrics and Gynecology in LLRM Medical College. The enrolled patients were divided into three equal groups (n=50) according to their BMI. In all the groups obstetric outcome was assessed.Results: In normal BMI group 12% patients had preterm vaginal delivery. While In group of underweight patients 32% patients landed up in preterm delivery which has three times higher incidence. In overweight group 48% patients had caesarean section, while in normal BMI group it is only18% patients i.e. 3 times higher caesarean rate in high BMI group. 10% of patients belonging to normal BMI group needed induction of labor while 26% of patients in overweight group required induction .Thus incidence of induction of labor is more than double in overweight group. While only 16% patients had PPH in normal BMI group, 44% patients had PPH in overweight group i.e. three times higher. The frequency of preeclampsia was 22% in the overweight category and <1% in the normal group.Conclusions: Higher prevalence of complications to the mother when BMI is not in the recommended normal range.
A study on presentation and management of ectopic pregnancy at tertiary care hospital
Authors: Singh Tarini , Mohan Sanil , Aggarwal Shikha , Maji Debkalyan
Published: April 2021

Background: Ectopic pregnancy and its consequences are the most severe form of obstetric emergency during first trimester of pregnancy. It is a kind of life threatening emergency leading to significant maternal morbidity and even mortality.Methods: A prospective study was conducted at a tertiary care teaching hospital of Northern India from 01 Jan 2020 to 31 Mar 2020. All cases of ectopic pregnancy which were admitted and managed during this study period were included in the study. All collected data were analysed with Epitable 6.04 version and SPSS version 20 software.Results: During the study period total 32 cases of ectopic pregnancy were studied. Classical symptoms of amenorrhoea, pain abdomen and bleeding per vaginum were observed in 62.50% cases whereas 93.75% cases were associated with pain abdomen only and 71.88% cases had the symptoms of bleeding per vaginum only. All cases were managed surgically. The incidence of ectopic pregnancy was one in 200 delivered pregnancy. Most case were multiparas and common in 27 -32 yr age group (53.13%). Tubal ectopic pregnancy was common in right side (63%).   Approximately 81% cases presented with haemoperitoneum and 63% cases required blood transfusion.Conclusions: Ectopic pregnancy mostly presents as an obstetrics emergency in our hospital especially with rupture ectopic pregnancy with haemoperitoneum. Early diagnosis and intervention suited best for the situation is mainstay for favourable and successful outcome.
Magnitude of menstrual problems among young females of medical and paramedical college
Authors: Jaiswal Deepshikha , Kumar Rahul
Published: April 2021

Background: Menstruation is described as the exclusive sign of femininity. The age of menarche is determined by general health, genetic, socio-economic, nutritional factors, geographic location, exposure to light and psychological state. Objective of current study was to determine the magnitude of menstrual problem among young females of age group17-25 years of medical and paramedical college. Methods: The present study has been conducted on 300 young female students studying in the department of obstetrics and gynaecology in collaboration with paramedical and nursing college, RIMS and R. Saifai, Etawah over a period of 18 months January 2015 to July 2016, with an objective to determine the magnitude of menstrual problem among on young female students of age group 17-25 years.Results: Mean age of the study population was 21.98 years. The mean age of menarche was found to be 13.50 years with standard deviation of 1.315. This was also in accordance with the results of previous studies. The average duration of menstrual blood loss was found to be 4.28 days with standard deviation of 1.092. The average duration of normal blood flow for reproductive age group as estimated is 2-5 days. The mean of menstrual cycle length came out to be 29.79 days with a standard deviation of 4.87. The average amount of blood loss during each menstrual cycle was found to be 65.39 ml with a standard deviation of 11.81. Conclusions: It was concluded that the mean age of menarche was found to be 13.50 years with standard deviation of 1.315. The average duration of normal blood flow for reproductive age group as estimated is 2-5 days.
Unicornuate uterus with rudimentary horn, gynaecological and reproductive outcome
Authors: Anand Arti , Chandra Madhuri , Agarwal Meeta
Published: April 2021

Congenital malformations of the female genital tract occur in about 8-10% of all women. The unicornuate uterus is a result of partial or complete agenesis of one of the paired Mullerian ducts. It could be a true unicornuate uterus or along with a rudimentary horn, which may be functional. When the rudimentary functional horn is non-communicating, most patients become symptomatic after menarche or present with pregnancy related problems. Three clinical presentations of unicornuate uterus with non-communicating rudimentary horn encountered in last one year are described. The first case was of unruptured rudimentary horn pregnancy of 11-12 weeks. Second case had rudimentary horn removed as an adolescent due to intractable pain, but later main uterus harboured an uneventful pregnancy. Case three had two early abortions, followed by term caesarean section for fetal distress. With advent of ultrasonography and other imaging techniques, the diagnosis and management of unicornuate uterus and its variations is possible. The functional rudimentary horn if symptomatic must be removed along with ipsilateral tube. A unicornuate uterus is associated with obstetric problems and such women should be considered as high risk pregnancy.
A rare case of heterotopic pregnancy: case report
Authors: Patel Nisi , Patel Komal , Shah Bipin R.
Published: April 2021

Heterotopic pregnancy is defined as the coexistence of intrauterine and extrauterine gestation. The incidence is low and estimated to be 1 in 30,000 of spontaneous pregnancies though it is becoming commoner with assisted reproductive technique. It can be a life-threatening condition and can be easily missed with the diagnosis being overlooked. We present a rare case of spontaneous heterotopic pregnancy with intrauterine gestation without cardiac activity and unruptured tubal ectopic.
Successful deliveries in a case of spontaneous pregnancy in ‘uterus bicornis unicollis’ with dicavitory twin gestation: a rare case report
Authors: Sureddi Priyanka Koteswararao , Dalmia Rachana Deepak , Tambvekar Sunil Eknath , Athavale Umesh Vishnu
Published: April 2021

Congenital anomalies of the uterus cervix and vagina are caused by alterations in development or fusion of the Mullerian ducts and are associated with multiple obstetric problems. A 32-year-old primigravida presented with spontaneous conception of dichorionic diamniotic twin with one twin in the right horn and another in the left horn of a bicornuate uterus. At 31.4 weeks of gestation the patient presented with preterm premature rupture of membranes followed by preterm labour, and progressed to deliver vaginally, resulting in the successful delivery of a live twin male and female baby. Spontaneous twin pregnancies in case of uterus bicornis unicollis are reported rarely. Here we discuss an extremely rare occurrence of spontaneous dicavitatory twin pregnancy in uterus bicornis unicollis and its outcome.
Challenges with Takayasu arteritis in pregnancy: a case report
Authors: Dalal Monika , Malhotra Vani , Nanda Smiti , Chauhan Meenakshi , Rani Vandana , Gautam Sarika
Published: April 2021

Takayasu’s arteritis (TA) is a rare, chronic, inflammatory, large vessel vasculitis (LVV) of unknown etiology characterized by narrowing, occlusion, and aneurysms of systemic and pulmonary arteries affecting especially the aorta and its branches. Pregnant patients are at increased risk of cardiovascular complications, including hypertension and congestive heart failure, which may jeopardize both maternal and fetal outcomes, so one should pay special attention to these patients. We present a case of 30-year-old female G5P3L2A1 with 9 months of amenorrhea with previous 2 LSCS with chronic hypertension and superimposed pre-eclampsia with oligohydraminos. She was a known case of Takayasu arteritis, diagnosed since she was 16 years old. Her lower limb pulses were palpable with absent upper limb pulses. On Echocardiography there was dilated aortic root, moderate MR and LVEF was 55%. She proceeded to have emergency LSCS under spinal anesthesia in view of severe pre-eclampsia with previous 2 LSCS at 35 week and delivered alive healthy female baby weight 2.1 kg. A life-threatening maternal cardiovascular complication is observed in more than 5% of pregnant women with TA. Hypertension is present in 90% cases of Takayasu arteritis. A good control of TA disease activity and arterial hypertension before conception and during pregnancy is important to improve feto-maternal outcomes. Pregnancies in the setting of TA should be considered high-risk, requiring a close interdisciplinary collaboration of rheumatologists, nephrologists and obstetrician’s specialists involved in care of TA.
Coblation tonsillectomy: our experience as a day care procedure
Authors: Nath Kripamoy , Gupta Ritu
Published: April 2021

Background: A prospective study to cite our experience in adult and pediatric patients undergoing coblation tonsillectomy. We emphasised on the intra operative and post operative morbidity in coblation tonsillectomy and its feasibility as a day care procedure.

Methods: It is a prospective study done on both paediatric and adult cases presenting to our tertiary care centre between January 2018 to February 2020. Study was done to analyse operating time, intraoperative blood loss, post-operative pain, post-operative haemorrhage and post-operative return to home and normal diet.

Results: 114 cases were selected where bilateral tonsillectomy was performed using Coblation technique. 83 were adult patients and 31 paediatric. 56 were females and 58 males. 1 case presented with secondary haemorrhage, none with primary haemorrhage. No other complications were noted.

Conclusions: Coblation tonsillectomy yielded good results in reference to patient morbidity and low complication rate. It turned out to be a success as a day care procedure. Short operating time, minimal blood loss, less post-operative pain specially in the early post-operative period, minimal chance of complication and short stay at hospital as a day care surgery, Coblation tonsillectomy stood out as a hands down winner in our study. In this fast paced life, where consumerism demands everything instant, coblation tonsillectomy as a day care procedure provides good alternative to the patient requiring tonsillectomy. yroidectomies.
Treatment of tympanic membrane perforation with topical epidermal growth factor: progress towards clinical application
Authors: Nayak Puneeth S. , Harugop Anil S. , Patil Prashant H. , T. V. R. K. Prasad , Goswami Lakshmi
Published: April 2021

Background: Chronic otitis media is a widespread disease of developing countries, especially of the lower socio-economic group. Medical cost in hospitals associated with tympanoplasty for treating CSOM is very high. Our study investigates the efficacy of epidermal growth factor along with chemical cautery in healing of chronic tympanic membrane perforation on an outpatient department (OPD) basis. Hence providing a cheaper and cost effective treatment alternative to the patients.

Methods: A total number of 70 patients with signs of COM attending ENT OPD were selected. The patients were randomly assigned into 2 groups each with a sample size of 35. Otoendoscopy and pure tone audiometry was performed. Group A was treated with EGF with chemical cautery and group B was treated with only chemical cautery. Both groups were followed up after 15 days, one month and second month of the procedure in ENT outpatient clinic.

Results: The success rate of these non-healing perforation was found to be significantly higher in group A (29 [82.86%]) compared with group B (17 [65.71%]) with P value of 0.0070*.

Conclusions: This study shows a statistically significant result with topical application of epidermal growth factor in small to medium non-healing central tympanic membrane perforation. Due to the promising result of epidermal growth factor, it could be considered as office myringoplasty.  
Randomised controlled clinical study to evaluate the efficacy of IV injection of caroverine and intratympanic steroid injection in the treatment of cochlear synaptic tinnitus with sensorineural hearing loss
Authors: Dhulipalla Sharmila , Sodadasu Radhika
Published: April 2021

Background: Cochlear synaptic tinnitus with sensorineural hearing loss (SNHL) is the most common type of subjective tinnitus. Many therapies were tried, but nothing is well proven to cure this. Hence, our present study aims to assess the efficacy of intravenous (IV) injection of caroverine and intratympanic steroid injection in treatment of cochlear synaptic tinnitus with SNHL.

Methods: This study was carried out at the ear, nose and throat (ENT) department with 60 patients (22 male, 38 female) between the ages of 20 and 70 who had idiopathic tinnitus. Patients who met inclusion criteria were randomized by simple randomization and divided into two groups. The study group receives intratympanic dexamethasone, twice weekly for total three weeks and stat dose of IV caroverine. The control group receives an intratympanic isotonic solution with an IV caroverine placebo. Tinnitus handicap index (THI) score and pure tone averages (PTA) were done before treatment and in the first week, first month, and six months after completing the study protocol.  

Results: In the study group, pre-treatment results, and post-treatment first, sixth month THI scores, PTA results were different to a significant extent, whereas in the control group, the same scores were not different significantly. The THI scores between the groups revealed considerably lower scores in the first and six months for the study group. Successful treatment was defined as a decrease in PTA by 10 dB or more after six months.

Conclusions: The effect of the intratympanic injection of dexamethasone along with IV injection of caroverine on the efficacy of treatment of tinnitus severity and improving hearing was statistically significant.
A study to compare the outcomes of CO2 laser assisted myringoplasty versus conventional type1 tympanoplasty in small central tympanic perforations
Authors: Singh Inderdeep , Patil Basavaraj S. , Akhtar Mohammad Z.
Published: April 2021

Background: The standard treatment of tympanic membrane perforation is conventional surgical closure using myringoplasty or a tympanoplasty type 1. In this study the role of cabon dioxide (CO2)-laser-assisted de-epitheliazation of perforation margins and application of bioinert silastic sheet. Success rate was compared with conventional microscopic surgery.

Methods: This was a comparative study containing 60 patients with small dry tympanic membrane perforation (diameter 1-3 mm). The causes of tympanic membrane perforations were mainly traumatic or the eardrum did not heal after spontaneous perforation caused by an acute otitis media or after surgery. The procedure was performed under local anaesthesia. CO2 (acupulse) applied along the edge of the perforation until complete de-epitheliazation and application of bioinert silastic sheet in small dry perforation. Closure of eardrum perforation was monitored using an otoendoscope. Success rate of the CO2 laser myringoplasty was compared with conventional type 1 tympanoplasty.  

Results: Complete eardrum closure occurred in 24 cases (80%), 06 patients (20%) had a residual perforation. The success rate of this procedure is lower than conventional type 1 tympanoplasty, which is 90-94%. There were no complications during and after the treatment.

Conclusions: A closure rate of 80% (24/30) was achieved with a CO2-laser-assisted de-epitheliazation. This procedure can be offered carefully to selected cases with perforation size <3 mm, where the CO2 facility is available before they undergo formal conventional microscopic surgery.

 
Profile of allergic rhinitis patients in a tertiary care centre in Central Kerala
Authors: Thomas Ike , Mathew Geethu , Thomas Tina , Anilkumar Mahika , George Kalyan
Published: April 2021

Background: Allergic rhinitis (AR) is a major public health problem which has a significant impact on the quality of life. Around 20-30% of the Indian population suffers from AR. The objective was to study the clinical profile and find out the factors associated with severity.

Methods: This retrospective record-based study was conducted among 182 patients with AR who visited Department of otorhinolaryngology in a tertiary care hospital in central Kerala. Variables collected included age, gender, family history of allergy, duration of disease and details of symptoms. The visual analogue scale (VAS) was used in identifying the severity of symptoms.

Results: The mean age of participants was 39±19 years. Nearly 50% of them had positive family history and 77.5% were found to have severe symptoms. The mean total VAS score was 25±5.1. Sneezing and nasal block were the common symptoms reported. Among the participants who had family history, 77 (87.5%) of them reported severe symptoms (χ2=9.81, p=0.002). Almost all participants belonged to higher age group reported high severity (χ2=48.130, p<0.0001). More than 80% of the participants who reported a longer duration of disease had severe symptoms (χ2=7.28, p=0.007).

Conclusions: The study identified a significant proportion of sneezers and blockers among the study population. Older age group, family history and longer duration of disease were the factors associated with severity. Generating community awareness will help in early diagnosis, effective control with improvement in quality of life of these patients.
Noise induced hearing loss in low frequencies in employees in a hospital microbiology department
Authors: Chrysouli Konstantina , Kikidis Dimitrios
Published: April 2021

Noise induced hearing loss (NIHL) is regarded as a serious problem and one of the most recorded occupational disorders in Europe and in the rest of the world and amounts to between 7% and 21% of the hearing loss. Aim of this study is to explore the development and the prevalence of low frequency noise-induced hearing loss (NIHL) in a hospital, especially in microbiology laboratory workers. Generally it is known that 4 KHz is the main NIHL frequency. Despite current theories, our study suggests for the first time the impact of low frequency noise in hearing loss among laboratory workers. According to the results, the population examined, namely the employees at the Microbiology Department of the Hospital, showed lower hearing levels compared to the control group, who had no history of occupational exposure to noise. There are many other studies which suggest that prolonged exposures to high noise levels have negative physiological and psychological effects on workers. The finding of the correlation of noise frequency with the frequency of the generated hearing loss is involved in the controversy about the pathophysiology of noise effect.
Retropharyngeal abscess causing grisel’s syndrome secondary to tuberculosis of cervical spine, a rare form of torticollis: case report
Authors: Sivarajan Reegina , Mahfuz Mohammad Fuaz , Sanudin Siti Hajar
Published: April 2021

Grisel’s syndrome is a rare type of non-traumatic subluxation of an atlantoaxial joint characterized by torticollis, neck pain, and reduced neck movement. The common causes of Grisel’s syndrome are head and neck infection or post-otorhinolaryngology (ORL) procedures. We are reporting a case of a 3-year-old boy with a gradual worsening of neck stiffness, neck pain, and restricted neck movement for more than one month. The patient had no history of trauma. The computerized tomographic (CT) showed a retropharyngeal abscess with a bony erosion causing atlantoaxial subluxation. The management and progress of this patient are discussed. The objective of this case report is to emphasize that Grisel’s syndrome should be considered a differential in a painful torticollis to prompt an early diagnosis and treatment to prevent serious neurological complications.
Technique of neo-pharynx reconstruction with supra-clavicular artery island flap in a case of pharyngeal stricture
Authors: Arora Viresh , Kathuria Bhushan , Arora Madhuri
Published: April 2021

Pharyngeal stenosis frequently occurs after laryngectomy or laryngo-pharyngectomy, more commonly in patients complicated with a post-operative pharyngo-cutaneous fistula. Oral feeding becomes challenging, restricted to liquids. In such cases, dilatations can be futile if there is a complete stricture necessiating surgery. We present a case of 72 -year-old man who underwent total laryngectomy with partial pharyngectomy with pectoral major myocutaneous flap reconstruction for second primary of hypopharyngeal T3N0M0, after primary laryngeal T1N0M0 treated with RT presented with nearly 4 cm pharyngeal stricture causing him absolute dysphagia. Multiple dilations failed to create adequate passage, pharyngeal stricture was then excised, and a neopharynx was constructed with supraclavicular artery island flap. The outcome was uneventful with restoration of normal pharyngeal permeability and swallowing by 12th post-operative day. Post-operative follow-up after 8 months remained satisfactory. Resection of limited height pharyngeal stenosis can be successfully performed as end-to-end anastomosis whereas reconstruction of a long segment pharyngeal stricture utilizing a loco-regional flap gives satisfactory outcome.
Management of esophageal perforation with fistula formation in an 80 year old woman with multiple co-morbidities
Authors: Almarzooq Jalal , Alkhabbaz Ayman , Abdulla Nabeel
Published: April 2021

Esophageal perforation due to foreign body ingestion may lead to serious complications. Here we present a case of an 80 year old lady with multiple co-morbidities who presented with a proximal esophageal perforation with fistula formation following ingestion of a fish bone. Due to her age and co-morbidities the decision was made to manage her conservatively by IV antibiotics, NG tube feeds and observation. Follow up after 2 months showed resolution of the perforation and fistula, without the patient needing any surgical intervention. This case highlights conservative management of esophageal perforation with complications in patients with co-morbidities where open surgery is not favoured.
Rare case of intra-oral palatal (soft palate) fibro-lipoma
Authors: Mandal Manit M. , Panchal Ajay J. , Kumar Rakesh , Kapadia Parth B. , Parmar Neel
Published: April 2021

Amongst various differential diagnoses possible for intra-oral (palatal) mass, possibility of fibro-lipoma is extremely rare but documented in literature, and hence should be a consideration. Such patient requires thorough evaluation and step-wise approach to treat. This case study documents for a 30-year-old male patient presenting with such mass and chief complaints of post nasal drip, nasal obstruction (right side>left side) and intermittent headache for 3 years. After radiological and endoscopic examination, the mass was surgically removed in toto via dual route (trans-oral and endoscopic).  Lipomas are uncommon tumors in the oral cavity, and palate being the rarest amongst them as is our case. It would be strongly advocated to keep lipoma in the differential diagnosis when evaluating a palatal mass. Also, it is worth mentioning and recommending that a careful radiological examination of large lesions arising from the palate is a must before approaching for surgery.
Plasmablastic lymphoma of nose and para-nasal sinuses in an immunocompetent patient
Authors: Chakravati Arunabha , Mojahid Moazzam , Nair Rohini R. , Agarwal Shilpi
Published: April 2021

Plasmablastic lymphoma (PbL) is a rare and aggressive neoplasm with heterogeneous clinical, histological and genetic features. It has been reported in both immuno-compromised and immuno-competent patients and commonly presents in the extra-nodal regions, but it is more heterogeneous in immuno-competent patients. Its clinical course is aggressive with early dissemination and poor response to therapy. A 61 year old male presented with left sided nasal bleeding and nasal obstruction for last 6 months, snoring and disturbed sleep for last 2 months. On examination, there was fullness over left side of nose and obliteration of left naso-facial groove. A mass lesion was seen in the left nasal cavity on endoscopy. There was bulge in the soft palate and the mass extended into the oropharynx. CECT showed a locally aggressive sino-nasal mass. Histopathology and immuno-histo-chemistry (IHC) of the biopsy were suggestive of plasmablastic lymphoma. A debulking surgery was done to relieve his obstructive symptoms. The patient received 3 cycles of EPOCH chemotherapy and radiotherapy to local site. At 9 months of follow up he presented with recurrence of the mass. Plasmablastic lymphoma presents in patients other than those with HIV. Awareness about its unique characteristics is crucial for establishing a correct diagnosis. Currently available treatments are ineffective in achieving long term remission and prognosis remains unfavourable with high incidence of recurrence
Small cell neuroendocrine carcinoma of subglottis: a case report
Authors: C. Sunil K. , Kumar B. Y. Praveen , Hari Malavika , Ali Mir Arshad , Veenapani M. K.
Published: April 2021

Small cell carcinoma is an uncommon type of malignant epithelial neuroendocrine neoplasm. It is most commonly of pulmonary origin and only less than five percent of all tumours are extrapulmonary. Esophagus, stomach, colon and rectum, gall bladder, head and neck, urinary bladder, prostate, skin and cervix are the most common extrapulmonary sites. Small cell carcinoma of larynx accounts for less than one percent of all laryngeal neoplasms. It is a highly aggressive neoplasm with poor prognosis. It most commonly affects supraglottis in males who are heavy smokers in their sixth and seventh decades. Various paraneoplastic syndromes can also be associated with the neoplasm. More than 90% of small cell laryngeal neoplasms present with metastatic disease. Surgery is not considered the initial treatment of choice; concurrent chemo radiotherapy is proven to provide longer survival. We report the rare case of extrapulmonary small cell neuroendocrine tumour in subglottis in a non-smoker female patient.
Unusual case of congenital fistula between external auditory canal and nasopharynx
Authors: Mandal Manit M. , Panchal Ajay J. , Kher Shanu B. , Dudhani Harsh G. , Shah Vidhi D.
Published: April 2021

Defects in the development in the neck area of the embryo result in branchial cleft anomalies. Various first branchial cleft anomalies are described in literature including preauricular sinuses, cysts and collaural fistula. In our case study, we document a very unusual case of fistula between floor of external auditory canal and nasopharynx. Such patient requires thorough evaluation and step-wise approach to treat. After clinical examination and radiological evaluation, surgically the fistula was excised in toto via external approach using Modified Blair’s incision. In our case, fistulous tract was running from external auditory canal to nasopharynx, running superior and medial to the trunk of facial nerve. No such case is found to be reported in literature after extensive search. Hence, it would be strongly advocated to keep this presentation in the differential diagnosis during evaluation. Also, it is worth mentioning and recommending that a careful radiological examination is a must before approaching for surgery.
Synbiotics in oral immunity: a review
Authors: Mehta Kanishk , Mehta Heena
Published: April 2021

The oral cavity harbors numerous and varied microbial flora. The existence of probiotics in the indigenous oral micro flora of humans warrants exploration because these bacteria offer the advantage of being perfectly adapted to the oral ecosystem. The concept of probiotics probably dates back to 1908 when the long life of Bulgarian peasants was the result of their lifelong consumption of fermented milk products. The pursuit of original observation of the positive role played by some selected bacteria, as investigated by Elie Metchnikoff, the Ukrainian-born Nobel Prize winner working at the Pasteur Institute, at the beginning of the last century much still remains to be done to standardize the meaning of the term synbiotic and which strains actually fulfil the criteria of true synbiotic microorganisms. Since, there are established reports in its applicability, this opens up a new era of interest.
Modelo para armar: concepciones sobre desarrollo y autogestión en el sindicalismo latinoamericano de orientación socialcristiana en los años setenta
Authors: Scodeller Gabriela
Published: April 2021

El artículo se propone revisar la concepción sobre desarrollo y organización económica presente en el sindicalismo latinoamericano de orientación socialcristiana en las décadas en que, tensionados por la revolución cubana y la Alianza para el Progreso, los distintos actores sociales de la región no estuvieron al margen de los debates sobre el desarrollo. Nos interesa analizar la propuesta de autogestión que formula la Central Latinoamericana de Trabajadores (CLAT) como respuesta, donde conjuga en clave latinoamericana elementos de su tradición doctrinaria con la experiencia yugoslava, apelando además a otras experiencias europeas y de la región.
EŞİKTE DANS, PERFORMATİF İNŞA VE YIKICI-ARACI BİR KİMLİK OLARAK KÖÇEKLİK
Authors: BARUTÇU Atilla
Published: April 2021

Günümüzdeki köçek performansını yeniden okuma girişiminde bulunan bu makale, köçekliğin performatif olduğunu, cinsiyet kategorilerinden bağımsız bir toplumsal kategori inşa ettiğini ve yıkıcı- aracı olarak tanımlanabilecek geçici bir kimlik oluşumuna işaret ettiğini savunmaktadır. Makale, Türkiye’nin farklı şehirlerinde köçeklerle yapılan görüşmeleri, canlı köçek performansı gözlemlerini, video analizlerini ve film betimlemelerini içeren bir saha çalışmasına dayanmaktadır. Bu saha çalışmasının desteğiyle, köçek performansının ikili-karşıtlıkları yıkan ve kategorileri aşan bir uzam yarattığını öne sürmektedir. Bu uzamın eşikteliğe işaret ettiğini, eşikte gerçekleşen dansla köçeklerin normatif kategorileri sarstığını ve normatif olmayan yeni bir kimlik temsili aracılığıyla bütün kimliklerin toplumsal inşasını açık edecek ipuçları sunabildiğini tartışmaya açmaktadır.
RE-SEGMENTING OPPOSITION VOTES IN TURKEY USING A RELATIONAL APPROACH: THE BOXER, THE PRAGMATIST, AND THE VISIONARY
Authors: ÇEVİK Neslihan
Published: April 2021

This paper studies voting from a relational approach and builds a new model for voter segmentation using qualitative data from Turkey. To operationalize a relational approach in the field, I employed ‘switch interviews’ with 15 participants recruited from a randomly sampled national poll (March 2020), who in common opted for one of the recently founded parties in Turkey when asked “who they would vote for if there was an election tomorrow”. In this new model, the object of inquiry for voter segmentation is neither broad structural traits a voter has (ethnicity, religion, ideology, sexuality, etc) nor atomistic calculations. Instead, it is the actual needs and concerns voters are trying to meet in a system of relations. Drawing from these needs, I identify three relational voter profiles: the Boxer, the Pragmatist and the Visionary. These new relational segments help us better understand the causal drivers for support to the new parties in Turkey and give us clues into the future political debates and shifts in the country. The aim here is not to narrow voter segmentation to a single right approach. Nor the study claims to uncover all opinions /needs of the opposition electors who lean towards the new parties; it certainly does not claim to have scanned all opposition voters in Turkey. Rather, the paper aims to push the boundaries of the existing models by adopting a relational thinking and a new tool, switch interviewing, and build a new model for voter segmentation. Such a push is mandated in part by the changing nature of political engagement and citizenship. The paper makes two original contributions. It proposes a new model for voter segmentation using a relational approach and introduces a new methodological tool, switch interviews, to qualitative research.
MADDE BAĞIMLISI BİREYLERİN VE ÇOCUĞU BAĞIMLI OLAN AİLELERİN YAŞADIĞI SORUNLAR: VAN ÖRNEĞİ
Authors: DUMAN Zeki , GÜNGÖRMEZ AKOSMAN Bengül
Published: April 2021

Madde kullanımı ve bağımlılığı, birçok ülkede olduğu gibi Türkiye’de de özellikle de gençler arasında hızla artmaktadır. Zira Afganistan’da üretilip İran’a gönderilen maddelerin çoğu, Türkiye’nin de içinde yer aldığı “Balkan Rotası” üzerinden Avrupa’ya ve Avrupa’da üretilen sentetik opioidler de Türkiye üzerinden Ortadoğu ülkelerine sevk edilmektedir. Türkiye’de bu transferin gerçekleştiği illerin başında ise İran’dan gelen uyuşturucu maddelerin İstanbul’a sevkinde önemli bir rol oynayan Van ili gelmektedir. Dolayısıyla bu çalışma, madde kullanımının ve ticaretinin yoğun bir biçimde yapıldığı Van’da madde bağımlısı bireylerin ve çocuğu bağımlı olan ebeveynlerin yaşadığı sosyal, ekonomik ve psikolojik sorunlara odaklanmıştır. Toplamda 20 kişiyle yapılan mülakatlar ve bu mülakatlardan elde edilen bulgular, Van’da maddeye erişimin kolay, fiyatının ucuz, genç işsizliğin yüksek, istihdam ve yatırımım düşük, ailelerin çok çocuklu ve eğitimsiz olmasının ama daha da önemlisi bazı çevrelerin uyuşturucu ticaretini zenginleşmenin ve geçinmenin bir aracı olarak görmesinin, kentte hem madde kullanımını hem de kaçakçılığını artırdığını göstermiştir.
GAMMA KNIFE, BİR IŞINDAN FAZLASI: DOLAYIMLANMIŞ MÜDAHALENİN CERRAHİ ALANI YENİDEN YAPILANDIRICI ETKİSİ
Authors: ERGUR Ali , NUHOĞLU Şadiye
Published: April 2021

Bu çalışmanın temeli, teknolojinin tıp alanında hızla devam eden gelişiminin hekim ve hasta yönünden nasıl etkiler bıraktığını anlayabilmek için beyin cerrahisinde radyocerrahi alanında kullanılan Gamma Knife tekniğinin incelenmesidir. Yüksek teknoloji ürünlerinin hekimin mesleğini nasıl dönüştürdüğü, cerrahın kendi mesleki kimliği, hastayla ve ameliyathanedeki diğer ekip elemanlarıyla olan ilişkisi temel alınarak, cerrahın mesleki bir alışkanlığı olan dokunmanın ortadan kaybolması üzerinden açıklanmıştır. Geleneksel yöntemlerle yapılan cerrahi operasyonlardan çok farklı bir teknik olarak uzun yıllardır uygulanan Gamma Knife tedavilerinin hastalar üzerinde olumlu etkiler bırakmasının, beyin cerrahisinde bu tekniği kullanan-kullanmayan hekim ayrımını güçlendirdiği, bu tekniğin hasta ve hekimlerde çeşitli uyum ve direnç biçimleri ile karşılandığı, dokunmadan tedavinin mümkün olduğu bu teknikle hekim- ekibinin ve hekim-hasta ilişkisinin ciddi dönüşümler geçirdiği gözlemlenmiştir. Normal bir beyin cerrahisi operasyonuna göre çok daha kısa, kolay ve hasta için daha konforlu olduğu ileri sürülen bu teknikle sadece tedavi boyutunun değil, tedaviden sonraki sürecin de dönüştüğü tespit edilmiştir.
SAATLERİ AYARLAMA ENSTİTÜSÜ ROMANINDA AHMET HAMDİ TANPINAR’IN ZAMAN DÜŞÜNCESİ: NORBERT ELİAS PERSPEKTİFİNDEN BİR OKUMA
Authors: ERGÜÇ Veysel
Published: April 2021

Zaman kavramı sosyal bilimler alanında yaygın kullanılan bir kavramdır. Sosyal bilimler içerisinde yer alan çok sayıda düşünür zaman kavramı üzerine düşünce geliştirmiştir. Zaman kavramı Türkiye’deki düşünürler nezdinde de ilgi görmüştür. Türkiye’de zaman kavramı ile ilgilenen düşünürlerden birisi Ahmet Hamdi Tanpınar’dır. Tanpınar, kaleme aldığı roman ve deneme yazılarında zaman kavramını yorumlamıştır. Tanpınar, idealindeki zamanı yekpare zaman olarak tanımlar. Tanpınar, yekpare zaman görüşünü Saatleri Ayarlama Enstitüsü romanında kurgu biçiminde sunmuştur. Bu çalışmada Tanpınar’ın Saatleri Ayarlama Enstitüsü romanındaki zaman anlayışı Norbert Elias’ın perspektifinden yorumlanacaktır. Bu yorumlama çabası, Elias’ın Zaman Üzerine isimli eserinde yer verdiği zaman vicdanı kavramı çerçevesinde olacaktır. Elias, zaman vicdanı kavramını insanın anlam verdiği bir şey olarak tanımlar. Elias’a göre anlam inşası için gereken şey, kuşaklar arası aktarımdır. Elias açısından zaman vicdanı, kuşaklar arası aktarım ile inşa edilir. Elias, kuşaklar arası aktarımın olmadığı bir durumda zaman vicdanının olmayacağını ileri sürmektedir. Bu çalışmada Elias’ın zaman vicdanı kavramı ile Tanpınar’ın yekpare zaman kavramı arasında zamandaki süreklilik bağlamında ilişki kurulacaktır. Bu bağlantı ile Saatleri Ayarlama Enstitüsü adlı roman okunacaktır.
DELEUZE VE GUATTARİ’DE DRAMATİZASYONDAN ARZULAMA MAKİNELERİNE ÖZNELLİK ÜRETİMİ
Authors: ÖZCAN Emre , GÜNEŞ Fatime
Published: April 2021

Bu çalışma, Deleuze ve Guattari’nin yapı konusuna dair eleştirilerini “dramatizasyon” ve “arzulama- makineleri” kavramsallaştırmaları üzerinden ortaya koymaktadır. Buradaki amaç, her iki kavramsallaştırma aracılığıyla Deleuze ve Guattari’deki yapı eleştirisinin öznesiz bir öznellik üretimi fikrine kapı araladığını göstermektir.

Deleuze, dramatizasyon yöntemiyle ideayı kavramın dolayımından kurtarıp saf olayın sahasına çekerken, Guattari’yle birlikte geliştirdiği arzulama-makineleri teorisiyle de arzuyu başkasının ifade ettiği/başkası vasıtasıyla kazandığı olanaklı nesneden, bir bedenin dolayımından kurtararak saf bir nedenle ilişkiye sokmaktadır. Buradaki en önemli husus; özne-nesne, temsil-üretim vb. ikiliklerin yerinden edilmesinden ziyade gerek arzunun gerekse de ideanın bu tür düalizmlerden önce varolduğunun gösterilme çabasıdır. Deleuze ve Guattari açısından temel mesele, düalizmin kendisini reddetmek değildir. Düalizm, heterojen ilişkilerin dağılım modelleri olarak vücut bulmaktadır, yani ikincil bir etki (epifenomen) olarak vardır. Düşünürlerin derdi, her zaman için düalizmle kurulan temsili yıkmaktır ve böylelikle bu dağılımların kendisinin ikilik olarak görünmesini önlemektir. Yapı fikri için de aynı şey geçerlidir. Deleuze ve Guattari’de makinesel süreçler teorisi vasıtasıyla yapı, ancak ve ancak ikincil bir etki olarak ortaya çıkmakta, yani kurucu bir işlev üstlenmemektedir.