bluuebunny/crossref_metadata_2025 huggingface dataset:
Didáctica y estudio del cómic-ensayo, de Gustav Doré a Fréderic Pajak / Didactics and Study of the Comic-Essay, from Gustav Doré to Frédéric Pajak
Authors: Pintor Iranzo Ivan
Published: September 2024

This paper serves as an introduction to the study of the graphic essay or comic essay, tracing its evolution from its self-aware inception to the present day. With the intention of establishing a genealogy of significant works, the article emphasizes formal aspects related to montage strategies that are relevant to the essay form, drawing from research developments in the field of cinema. Furthermore, at its core, it proposes a methodology primarily based on Aby Warburg's iconology for the examination of the essay as a didactic formula and a means of transmitting tradition within the context of non-fiction forms in comics.
O modelo espacial multicritérios para implantação de aerogeradores visando a redução de impactos ambientais
Authors: Paula Yara Lemos de , Silva Paulo César Moura da
Published: September 2024

A energia eólica é uma fonte de energia renovável para incrementar a matriz energética brasileira e mundial. Diante do cenário de crescimento da demanda energética somada ao potencial eólico do litoral do Oeste Potiguar, este trabalho objetivou obter um modelo espacial para predição de áreas potenciais, visando a implantação destes empreendimentos em cinco municípios da Costa Branca, no estado do Rio Grande do Norte, nordeste do Brasil, com o intuito de prevenir impactos ambientais. Os dados foram obtidos das bases do Instituto Brasileiro de Geografia e Estatística, OpenStreetMap, Google Earth Pro, Topodata e Infraestrutura Nacional de Dados Espaciais, foram, ainda, tratados no software QGIS 3.16 com ferramentas do GRASS e SAGA. Para isto, 35 pontos inseridos aleatoriamente na área de estudo foram avaliados através de indicadores ambientais como vegetação, uso e ocupação do solo, recursos hídricos, solo e geologia, analisados através do método de interpolação espacial IDW. Observou-se que o modelo se adequou ao uso proposto, e identificou que 77,14% (N=27) dos pontos, com área total de 1.381,07 ha, apresentaram entre 60% e 85% de potencial para evitar os impactos ambientais provenientes de aerogeradores. Onde, Tibau (25,93%) apresenta-se como o município mais promissor para a implantação de empreendimentos eólicos, seguido dos municípios de Serra do Mel (22,22%), Areia Branca (18,52%), Porto do Mangue (18,52%) e Grossos (14,81%), totalizando 1.281,07 ha.
Influência da adubação foliar na cultura da cana-de-açúcar no Brejo Paraibano
Authors: Batista Antônio Marcos Azevedo , Silva João Henrique Barbosa da , Marciano Luany Emanuella Araújo , Nascimento Mayra Alves do , Silva Antônio Veimar da , Mielezrski Fábio
Published: September 2024

A cana-de-açúcar é uma gramínea caracterizada pelo alto rendimento e se destaca como uma das principais culturas plantadas no Brasil, sendo assim, há uma necessidade de adubação das plantas para otimizar a produção principalmente de macro e micronutrientes, sendo assim, objetivou-se avaliar a resposta da adubação foliar com doses de micronutrientes, em dois ciclos do genótipo (RB92579) na cultura da cana-de-açúcar em condições sequeiro no Brejo Paraibano. A pesquisa foi conduzida na fazenda experimental Chã de Jardim durante os anos de 2019 a 2021, no município de Areia, PB. O delineamento experimental adotado foi o de blocos ao acaso, constituídos por sete tratamentos com quatro repetições: T1-Controle (Sem aplicação), T2-100, T3-180 e T4-240 dias após o plantio (DAP) com doses únicas e os tratamentos T5-100/180, T6-100/240, T7-180/240 DAP com aplicação fracionada, avaliando altura de planta, número de plantas por metro linear, diâmetro de colmo, número de entrenós, toneladas de colmos por hectares e teor sólidos solúveis. Os dados foram submetidos a análise da variância e teste de Scott-Knott (p
Respostas morfofisiológicas de plantas de milho e jiló ao estresse hídrico induzido
Authors: Ferreira João Cleber Cavalcante , Cruz Jozângelo Fernandes da , Negreiros Tassia Michelli Nogueira , Brito Wildson Benedito Mendes , Lima Alan Ferreira Leite , Souza Aline Ellen Duarte de
Published: September 2024

O déficit hídrico é um dos fatores mais impactantes que alteram seriamente a fisiologia das plantas, levando finalmente ao declínio da produtividade das culturas. Dessa maneira, é fundamental a compreensão do comportamento morfofisiológico das plantas com metabolismo C3 e C4 em relação a diferentes níveis de déficit hídrico para que estratégias de manejo sejam desenvolvidas. Portanto, avaliamos o impacto do estresse hídrico induzido nas características morfofisiológicas de plantas de milho (Zea mays L.) e jiló (Solanum gilo Raddi). O experimento foi conduzido em delineamento inteiramente casualizado, sendo os tratamentos constituídos por combinação fatorial de duas espécies de plantas, milho (C4) e Jiló (C3), e três níveis de umidade do solo T1 (50%), T2 (65%) e T3 (90%) com quatro repetições. Foram avaliadas as variáveis de crescimento, relações alométricas e aspectos fotossintéticos. Verificamos que o regime hídrico induzido severo afetou significativamente a germinação, emergência, crescimento e estádios fenológicos, além de causar decréscimo na taxa fotossintética nas duas espécies estudadas, no entanto, com maior impacto no jiló. O milho (C4) desempenhou maior eficiência fotossintética em relação ao jiló (C3), mesmo em condições de regime hídrico severo.
Implantação e análise da conformidade à produção integrada de morango em Alfredo Vasconcelos – MG
Authors: Melo Bruno Almeida de , Carvalho Lívia Mendes de , Oliveira José Emílio Zanzirolani de , Silveira Luís Cláudio Paterno , Baungartem Stein Humberto
Published: September 2024

Minas Gerais é o maior produtor de morango no país. A adoção da certificação de produção integrada de morango (PIMo) resultaria na comercialização de produtos seguros e de qualidade. O objetivo deste trabalho foi implantar e analisar o nível de conformidade de agricultores familiares vinculados à Cooperativa Agropecuária de Alfredo Vasconcelos - MG (COOPRAV) ao sistema da PIMo, visando à certificação e à obtenção do selo de qualidade. Para isso foi elaborado um projeto: “Produção Integrada de Morango: rumo à certificação” para adequar as propriedades às Normas Técnicas Específicas para Produção Integrada de Morango. O projeto foi conduzido em três etapas: 1) oficinas de capacitação teórico/prática; 2) acompanhamento técnico mensal e 3) auditorias participativas. Durante as oficinas, observou-se grande demanda por conhecimentos sobre manejo de pragas e doenças e tecnologia de aplicação de agrotóxicos. No acompanhamento técnico mensal foi possível adequar as estruturas da propriedade às normas da PIMo, assim como propor o uso do caderno de campo e das boas práticas agrícolas que permitiram ganhos em produtividade. Durante as auditorias participativas foram identificadas dez não conformidades, as quais foram adequadas para o atendimento às normas. Seis propriedades foram consideradas aptas a utilizarem o selo da PIMo e a cooperativa alcançou potencial produtivo de 121.700 kg de morangos certificados, com redução de 80% no uso de fungicidas, 70% no uso de inseticidas, além de ganhos substanciais relacionados à organização das propriedades, como locais para armazenamento de agrotóxicos e de embalagem do morango.
Informações sobre os serviços de saneamento básico: a realidade do déficit no Brasil
Authors: Marcon Adriano Marcos , Wesz Junior Valdemar João
Published: September 2024

O saneamento básico é um componente de suma importância para o desenvolvimento local e regional, urbano ou rural, para a melhoria da qualidade de vida das pessoas e na garantia de inúmeros direitos fundamentais correlatos, tal como o meio ambiente equilibrado. Visando à universalização dos serviços, foram promovidas sensíveis alterações no atual Marco Legal do Saneamento Básico, com o objetivo de sanar as enormes deficiências ainda existentes. Entretanto, o sucesso da política pública correspondente, assim como a consequente garantia dos direitos que estão relacionados, depende do correto dimensionamento da cobertura e das carências dos serviços de saneamento. Assim, este artigo analisa os principais bancos de dados disponíveis, para discutir suas eventuais limitações e a confiabilidade das informações apresentadas, por meio de um estudo descritivo e explicativo, de abordagem predominantemente qualitativa, a partir de pesquisa bibliográfica e documental. Os resultados indicam a existência de diversas inconsistências e lacunas nos bancos de dados acerca do saneamento básico no Brasil, que acabam por produzir informações distorcidas, possivelmente subdimensionadas, acerca das deficiências existentes.
Análise dos casos de AVC durante a pandemia de COVID-19 em um município da região sul do Brasil
Authors: Karsten Luciana Ferreira , Safanelli Juliana , Lucca Leticia Fernandes , Lopes Milena
Published: September 2024

Analisar se os dados dos óbitos de casos de AVC ocorridos em Joinville sofreram influência no período da pandemia da COVID-19. Método: estudo analítico documental, quantitativo, utilizando dados do Registro Epidemiológico de AVC. A amostra foi de 362 óbitos hospitalares. Os dados foram analisados no programa de estatística Jamovi, utilizando valor de p
Atendimento de urgência e emergência na atenção primária: percepções de profissionais de saúde
Authors: Alves de Melo Rosana , Coelho Guimarães Millena , Rodrigues dos Santos Costa Dhessika Riviery , Henrique de Souza Sueleen Thaísa , Cavalcante Valença Fernandes Flávia Emília
Published: September 2024

Analisar a percepção de profissionais de saúde da atenção primária referente aos desafios vivenciados diante das demandas de urgência e emergência nas Unidades Básicas de Saúde. Pesquisa qualitativa, realizada com 23 profissionais de saúde, de julho a novembro de 2021, por entrevista semiestruturada e analisadas por Análise de Conteúdo Temática. Identificou-se que os profissionais possuem conhecimento relativo sobre a temática, apresentando como perfil de atendimento crises hipertensivas e asmáticas, convulsões, hipoglicemias e outras. Quanto ao fluxo de assistência, perpassa desde o acolhimento até a regulação, não obtendo contrarreferência do paciente e apresentando como dificuldades para a assistência a falta de recursos básicos e educação permanente. A atenção básica se mostra importante na rede de atenção às urgências e emergências e seu papel nos atendimentos à população carece de melhoria de infraestrutura, capacitação profissional, planejamento estratégico das ações e avaliação das atividades desenvolvidas.
Uso de Canabidiol em pacientes terminais com dor refratária: conhecimento entre estudantes de Maringá
Authors: Barduco Kovaltchuk Hellen , Bonsere Ana Carolina , De Oliveira Simone Martins , Cardoso Bruna Muller
Published: September 2024

A cannabis surge como alternativa no tratamento de condições crônicas, especialmente em casos de dor refratária aos medicamentos convencionais. Seu uso em conjunto com opióides possibilita a redução das doses do mesmo, preservando a eficácia e minimizando efeitos colaterais. Apesar do respaldo científico, a abordagem desse tema na graduação em medicina é limitada. Diante disso, foi realizada uma pesquisa exploratório-descritiva na UniCesumar (Universidade Cesumar), Maringá-PR, com o objetivo de identificar lacunas no conhecimento dos estudantes sobre o uso da cannabis no tratamento de pacientes terminais com dor refratária. Os resultados revelaram déficits de conhecimento, evidenciando a necessidade de maior aprofundamento durante a graduação. Dentre os resultados esperados, destaca-se a falta de informação sobre benefícios, efeitos adversos e uso do canabidiol. Este estudo enfatiza a importância de uma abordagem mais abrangente na formação médica com o intuito de desmistificar preconceitos e estigmas acerca do tema, assegurando um atendimento humanizado e melhor qualidade de vida aos pacientes.
Tecnologias educacionais para insulinoterapia em adultos com diabetes melitus tipo 2: revisão de escopo
Authors: Izidório Rodrigues de Araújo Ana Danúsia , Vilarouca da Silva Ana Roberta
Published: September 2024

O presente estudo objetiva mapear as tecnologias educacionais para administração da terapia insulínica em adultos com diabetes mellitus tipo 2 atendidos pelos serviços de saúde. Trata-se de uma revisão de escopo, baseada na estrutura metodológica desenvolvida pelo JBI e no checklist do Preferred Reporting Items for Systematic reviews and Meta Analyses extension for Scoping Reviews. Foi realizada busca em bases de dados e literatura cinza. Os artigos foram avaliados de forma pareada e independente por dois revisores. Para seleção e triagem dos estudos foi utilizado o gerenciador de referências Rayyan®. A síntese dos dados ocorreu por meio de tabela e discussão em categorias temáticas. Embora existam diferentes tipos de tecnologias educacionais que abordem a temática de insulinoterapia, faz-se necessário a realização de mais estudos no que tange a avaliação de efeitos e viabilidade do uso de tal tecnologia no âmbito da insulinoterapia.
Demandas de educação permanente para o cuidado centrado na pessoa na atenção psicossocial
Authors: Martins Sousa Johnatan , Gonçalves Farinha Marciana , Soares Silva Landim Joyce , Costa Nunes Fernanda , Queiroz Bezerra Ana Lúcia
Published: September 2024

Descrever sugestões de profissionais de serviços comunitários de saúde mental para a construção de uma intervenção formativa sobre o cuidado centrado na pessoa na atenção psicossocial. Pesquisa social, modalidade estratégica, de abordagem qualitativa realizada com 17 profissionais de dois Centros de Atenção Psicossocial da região central do Brasil em 2021. Para coleta de dados utilizou-se questionário de perfil profissiográfico, roteiro semiestruturado para entrevista individual online e anotações em diário de campo. Os dados foram submetidos à análise de conteúdo temática, com auxílio do software ATLAS.ti para a organização do corpus. A partir dos relatos dos participantes, foi construída a categoria temática Intervenção formativa que contemplou duas categorias: 1. Temas de interesse ao cuidado centrado na pessoa; 2. Estratégias atrativas aos olhos na percepção dos profissionais de saúde. Apesar da importância dos temas e estratégias levantados pelos profissionais, ficou evidente que as equipes não se referiram de forma direta às temáticas específicas do cuidado centrado na pessoa.
Desenvolvimento de uma máscara facial antiacne a base de álcool polivinílico
Authors: Luiz Dias Nathalia , Macedo Brito Luciana
Published: September 2024

O objetivo do presente trabalho foi desenvolver uma máscara facial utilizando o álcool polivinílico como agente formador de filme com um princípio ativo antiacne (extrato de Punica granatum/romã). Foram obtidas formulações com diferentes concentrações de álcool polivinílico utilizando glicerina e sorbitol como agentes umectantes. Foram realizados testes organolépticos, teste de secagem, formação de filme, medição de pH, estresse de temperatura e ciclos de congelamento-descongelamento. A formulação com álcool polivinílico a 10% e mistura de glicerina e sorbitol apresentou melhor resultado, sendo a escolhida para incorporar o princípio ativo. As formulações apresentaram-se estáveis em temperatura ambiente durante 60 dias, todas secaram em tempo hábil e foram capazes de formar filme removível; o pH das máscaras faciais foi compatível com o pH cutâneo. Ao final do trabalho se obteve uma formulação de máscara facial antiacne ideal sendo recomendado a realização de testes de eficácia e segurança para a posterior comercialização do cosmético.
Saúde bucal de populações rurais ribeirinhas de um município do Amazonas, Brasil: avaliação do índice CPO-D e autopercepção
Authors: Moraes Lima Adriano , Gatto Pereira Junior Jairo , Tadeu do Nascimento Borges Alberto , Silva Cardoso Caio , Dos Santos Gonçalves Júnior Fernando
Published: September 2024

O presente estudo teve como objetivo conhecer a autopercepção em saúde bucal e avaliar o índice de CPO-D dos pacientes ribeirinhos localizados no município Careiro da Várzea no Estado do Amazonas atendidos em ação voluntária. Utilizando uma metodologia exploratória e descritiva, com amostragem não-probabilística, foram avaliados 84 participantes, predominantemente do sexo feminino (57%) e com idades entre 12 e 80 anos. Embora a maioria participe de programas de saúde bucal, cerca de metade enfrenta dificuldades de acesso. Ainda assim, a maioria considera essencial visitar o dentista duas vezes ao ano, sendo a dor de dente o motivo mais comum. A autopercepção variou, com 35,7% classificando como "regular" e 40,5% como "boa". Entretanto, a média elevada (8,4) no exame CPO-D revela uma discrepância na saúde bucal dos pacientes ribeirinhos.
A study of cognitive functions in elderly men from the Arctic region of the Russian Federation with arterial hypertension using the auditory event-related potentials P300
Authors: Krivonogova Olga V. , Krivonogova Elena V. , Poskotinova Lilia V.
Published: September 2024

AIM: To study the effect of arterial hypertension on cognitive functions by evaluating the auditory event-related potentials (ERP) Р300 in men aged 60–74 years from the Arctic region of the Russian Federation with the special emphasis on men receiving antihypertensive therapy with controlled arterial hypertension and those who either do not take antihypertensive drugs or take them both regularly and irregularly without controlling blood pressure.
MATERIAL AND METHODS: The study included 64 men with arterial hypertension and 19 men without hypertension (n=19) in Arkhangelsk. Registration of the Р300 and N2 components was performed using the Neuron-Spektr-4/VPM electroencephalograph (Neurosoft, Russia), utilizing the oddball paradigm. Blood pressure (BP) was measured with an automatic tonometer AD Medical UA-668 (Japan).
RESULTS: In men without arterial hypertension and in those with controlled arterial hypertension, where the median values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were within normal ranges, there were no differences in the latency (LT) of N2 and P300, nor in the magnitude of the P300 amplitude between these groups. In contrast, men who do not take antihypertensive drugs or receive antihypertensive therapy both regularly and irregularly without controlling their blood pressure, and who have SBP and DBP above normal values, showed an elongation of LT N2 in the parietal (P3), central (C3), and middle temporal (T3) sections on the left, and in the frontal section on the right (F4). There was also an elongation of LT P300 in the middle temporal region on the right (T4) and frontal regions on the right (F4), along with a decrease in the median values of the P300 amplitude in the anterior-temporal (F8, F7) parts of the brain. This indicates a deficit in attention, an increase in the time required for primary recognition and differentiation of signals, and a reduction in the speed of information processing and decision-making.
CONCLUSION: In older men, SBP above 140 mmHg and DBP above 90 mmHg are associated with cognitive impairment as determined by the auditory event-related potentials P300.
Diagnostic criteria for optimizing treatment tactics for children with traumatic splenic ruptures
Authors: Pikalo Ilia A. , Podkamenev Vladimir V. , Karabinskaya Olga  A. , Novozhilov Vladimir A. , Milyukova Lalita P.
Published: September 2024

BACKGROUND: Damage to the spleen is the leading cause of abdominal trauma in children. This often becomes the main indication for splenectomy. This article addresses concerns on the safety of conservative treatment of these injuries in children. Most studies have found that asplenization results in the complete loss of the immunological and hematological functions of the spleen. Thus, spleen-preserving surgeries are crucial to prevent post-splenectomy hyposplenism and associated life-threatening complications.
AIM: This study aimed to develop a mathematical model using logistic regression to determine aggregate variables associated with the possibility of surgical treatment and identify safe shock index parameters for the conservative treatment of traumatic splenic ruptures in children.
MATERIALS AND METHODS: This prospective study included 91 patients with traumatic splenic rupture: 80 (87.9%) children received conservative treatment and 11 (12.1%) underwent surgical treatment. The age of the children was 11 (8; 13) years; there were 3.3 times more boys (70 versus 21). To assess the need for surgical treatment, an analysis of categorical variables was conducted using a mathematical model using logistic regression.
RESULTS: Increased shock index (β = −0.264 ± 0.083; t(86) = −3.191; p = 0.002) and the need for blood transfusion (β = 0.464 ± 0.089; t(86) = 5.218; p = 0.001) were cumulative factors associated with a high possibility of surgical treatment of splenic ruptures in children. With the combination of parameters of increased shock index and blood transfusion for surgical treatment, moderate sensitivity was determined at 85.7% (95% CI: 52.1–99.6; p = 0.001) and a positive predictive value at 75% (95% CI: 34.9–96.8). In the absence of these factors, the probability of conservative treatment of children with splenic ruptures reached 100% (specificity: 97.5%; 95% CI: 91.1–99.7; p = 0.001). When summarizing the identified parameters, the area under the curve was 0.941 ± 0.026 (95% CI: 0.872–0.980), and the assessment of the model’s suitability showed a positive test (χ2 = 32.7; p = 0.264). In nonoperative treatment, the frequency of identified cumulative factors was 2.5% (n = 2). Safe shock index parameters for successful conservative treatment of splenic ruptures in children have been determined: SIPA 1.1 (age up to 6 years), 0.85 (7–12 years), and 0.83 (over 13 years).
CONCLUSIONS: An increased shock index and the need for blood transfusion are combined factors that determine the high probability of surgical treatment for traumatic ruptures of the spleen in children. In nonoperative treatment, the frequency of identified cumulative factors was 2.5%, which indicates a strong argument for justifying the safety of conservative therapy.
Comment on the article “Multiple recurrences of adnexal torsion in a 9-year-old girl: a clinical observation”
Authors: Chundokova Madina A. , Petlakh Vladimir I.
Published: September 2024

Commentary on the article by N.S. Bakaeva, D.A. Baranov, V.A. Vecherkin, V.A. Ptitsyn, P.V. Koryashkin, V.M. Gagloeva “Multiple recurrences of adnexal detorsion in a 9-year-old girl: case report”, published in the journal Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2024;14(3):441–449. DOI: https://doi.org/psaic1781
Extending the Modified Square-Root-Impedance Method for the Development of Site Amplifications Consistent with the Full-Resonance Approach to a Range of VS30 Values
Authors: Al Atik Linda , Boore David M.
Published: September 2024

The square-root-impedance (SRI) method is commonly used to approximate the seismic site amplifications computed using the full-resonance (FR) method for gradient shear-wave velocity (VS) profiles that are smoothly varying with depth. The SRI site amplifications have been observed to systematically underpredict the FR site amplifications by a ratio of FR/SRI amplifications around 1.05 to 1.3 across a wide frequency range (Boore, 2013). Recently, Boore and Abrahamson (2023; hereafter, BA23) related this difference in the SRI and FR methods to differences in the exponent η of the ratio of seismic impedances between the two methods. They proposed the implementation of a modified frequency-dependent η in the SRI method to improve its match to the FR site amplifications. This modified η was derived using only five VS profiles. We investigate the performance of the BA23 η for a wide range of realistic gradient VS profiles with VS30 ranging from 180 to 1500 m/s. These gradient VS profiles are constructed using two power-law functions of depth and are constrained by the assigned VS30 value, the depth and velocity of the half-space, and depths to shear-wave velocity horizons of 1.0 and 2.5 km/s (Z1.0 and Z2.5) based on western United States sites. Despite observing a VS30 dependence of η, we find that the BA23 η generally works reasonably well for the range of VS profiles analyzed. Using the VS30-dependent η derived in this study results in improvements in matching the FR site amplification compared to using the BA23 η. These improvements are more pronounced for the soft-site conditions and become modest to negligible for the stiff site conditions.
Big Data en la gestión de destinos turísticos españoles
Authors: Jorge Naranjo Moises
Published: September 2024

Desde el año 2014 España experimentó un crecimiento constante del turismo demostrado en la trayectoria que muestra su aporte en el PIB total y el PIB turístico. Sin embargo, la pandemia generada por el Covid-19 supuso una caída estrepitosa de los ingresos generados por este sector económico, el cual comenzó su recuperación en el segundo semestre del año 2021. Teniendo en cuenta este gran potencial del sector, se propuso elaborar un modelo de análisis de Big Data que fuera útil para el logro de los objetivos del sector turístico de español. Para ello se realizó una revisión de información objetiva por parte de 12 agentes de destinos turísticos, tomados como muestra elegida al azar, y a partir de esta información se determinaron objetivos SMART que fueron la base para realizar el modelo Big Data. Como consecuencia de esta investigación se elaboró un modelo de Análisis de Big Data el cual se compone de cuatro fases; recolección de los datos, almacenamiento, procesamiento y visualización. Como conclusión se llega a que el Big Data es un amplio registro de información que puede brindar gran ayuda en la personalización del marketing, toma decisiones, satisfacción al cliente entre otros, por esta razón es de gran relevancia enfocar la solución Big Data en función de unos objetivos determinados y sobre todo como herramienta fundamental en la toma de decisiones de los órganos gestores de destinos turísticos tanto nacionales como internacionales.
A comparison of buccal versus vaginal misoprostol for induction of labour at term to correlate maternal and foetal outcome
Authors: Kaur Jasvir , Kaur Satwant
Published: September 2024

Background: Induction of labour with prostaglandins offers the advantage of promoting cervical ripening with stimulation of myometrial contractility. The use of prostaglandin preparations with or without oxytocin infusion, widely recognized and accepted as a standard method of labour induction, has been shown to reduce induction time and the risk of failed induction.
Methods: The present study was a prospective observational study undertaken in the obstetrics and gynaecology department of Adesh Medical College and Hospital, Kurushetra, Haryana, India from 01 June 2023 to 30 November 2023. Total 100 patents were randomly allocated to either group A (n=50) who receive 25 µg misoprostol buccally four hourly upto maximum of four doses, group B (n=50) who receive 25 µg misoprostol vaginally four hourly upto maximum of four doses. Various parameters noted were time interval from induction to vaginally delivery, mode of delivery, maternal adverse effect, and neonatal outcome.
Results: The mean induction delivery interval in group I was 14.17 hours and 12.9 hours in group II. The mean number of doses in group I was 1.58±0.36 and 1.26±0.28 in group II. The mode of delivery in group I (buccal) patients was full-term vaginal delivery (FTVD) in 33 of patients, instrumental (forceps) 2 of patients and lower segment caesarean section (LSCS) in 15 of patients. While as in group II (vaginal) patients 35 of patients had FTVD, 1 had instrumental (forceps) and 14 had LSCS. The results of present study were indicated that participants who were treated with buccal misoprostol were suffering from gastrointestinal experiences and tachysystole which was the result of misoprostol dosage.
Conclusions: Misoprostol in either buccal or vaginal route has proven to be equally effective for inducing labour in women at term pregnancy. This study found that the women who are treated with buccal misoprostol are suffering from gastrointestinal experiences more than vaginal misoprostol. However, easy intake is observed if the drug is administered buccally outweighs its advantages over the vaginal misoprostol.
Clinical outcomes of COMOC-MG modified B-lynch stitch technique for preventing postpartum haemorrhage in a tertiary care teaching hospital
Authors: Chaudhary Haresh A. , R. Shah Bipinchandra
Published: September 2024

Background: Postpartum haemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide. Effective management often involves uterotonic drugs, but surgical interventions like the B-Lynch suture are crucial when medical treatments fail. The COMOC-MG modified B-Lynch stitch technique offers promising improvements in controlling atonic PPH. This study aimed to evaluate the clinical outcomes of the COMOC-MG modified B-Lynch stitch technique in managing PPH among high-risk obstetric patients undergoing caesarean sections at a tertiary care teaching hospital.
Methods: A prospective study was conducted from January 2021 to June 2022 at C.U. Shah Medical College and Hospital, Surendra Nagar. Fifty antenatal women undergoing emergency or elective lower segment caesarean section (LSCS) with identified high-risk factors for PPH were included.
Results: Participants were predominantly aged 26-30 years (52%), with 40% primigravidae and 60% multigravida. The majority of patients (94%) experienced no maternal complications, and only 6% required ICU admission. Fetal distress (36%) was the leading indication for LSCS. Anaemia was the most prevalent high-risk factor (22%). However, 88% did not require postoperative blood transfusions. Haemoglobin levels decreased significantly from a mean of 9.90 g/dl preoperatively to 8.70 g/dl postoperatively (p<0.05). The prophylactic COMOC-MG modified B-Lynch suture alone was successful in 82% of cases, with only 2% requiring hysterectomy.
Conclusion: The COMOC-MG modified B-Lynch stitch technique is effective in preventing PPH in high-risk caesarean section patients, demonstrating low complication rates and favourable maternal outcomes. These findings support the technique's use in managing atonic PPH and highlight the importance of comprehensive obstetric care.
An assessment of knowledge regarding hospital acquired infection prevention among health care workers in a government medical college, UP, India
Authors: Gupta Rashmi
Published: September 2024

Background: This study aimed to assess the status of knowledge and practice aspects regarding infection control and prevention among Health care workers in a tertiary health care facility of Uttar Pradesh.
Methods: It was an observational cross section study conducted between April 2023 to June 2023 in a government medical college involving 179 health care workers. Data was collected on the basis of pre tested questionnaire through interview of health care workers. Questionnaire was divided into three-part, first part containing question related to demographic parameter of study participants and second and third part contained questions regarding knowledge and practice of standard infection control measures respectively.
Results: Majority of participants were above 34 years (66.66%) female health worker (73.6%).72% participants were in the category of faculty member and nursing staff with average experience of more than 9 year. Study shows that100% of faculty members, resident doctors, and nursing staff were having the knowledge regarding steps of hand wash before surgical procedure and hand hygiene procedure before and after patient care. 100% of faculty members, resident doctors and nursing staff said that they perform all steps of hand wash before surgical procedure, perform hand hygiene before and after patient care.
Conclusion: This study demonstrates a commendable level of adherence to infection control measures among healthcare workers. The high levels of compliance observed in our study may be attributed to institutional policies, ongoing training, or other factors unique to our setting.
Acarbose is as effective as metformin in reducing central obesity in infertile women with polycystic ovary syndrome
Authors: Islam Tahmida , Akter Asma , Laila Rawnok , Renu Rafikunnahar , Khatun Sumyara , Ishrat Shakeela
Published: September 2024

Background: Polycystic ovary syndrome (PCOS) in infertile women is frequently associated with insulin resistance and obesity. Optimization of the patient by reducing weight and insulin resistance improves clinical, biochemical & endocrine parameters and consequently increases the chance of successful ovulation and pregnancy. Acarbose is an alpha-glucosidase inhibitor which acts by reducing and slowing down intestinal absorption of glucose, with a reduction of the postprandial glucose wave and a consequent reduction of insulin secretion. The objective of this study was to evaluate the efficacy of acarbose compared to metformin, in reducing central obesity in infertile women with PCOS.
Methods: This randomized controlled trial study was conducted on a total 60 infertile, overweight and obese women with PCOS. The women were allocated randomly to two treatment arms: one group receiving acarbose 100 mg three times daily with meal for 3 months and another group receiving metformin 500 mg three times daily after meal for 3 months. The main outcome variables were changes in central obesity and insulin resistance.
Results: Mean weight, BMI, waist circumference and waist hip ratio was significantly decreased in both acarbose and metformin group. Reduction of fasting blood sugar, fasting insulin and HOMA-IR were also significant. The reduction was more in acarbose group, but the difference was not statistically significant. Gastrointestinal side effects were more in the women given metformin.
Conclusion: There is significant reduction in central obesity or insulin resistance parameters in infertile PCOS women given acarbose or metformin over three months. However, there is no statistically significant difference between the two groups. Acarbose has less gastrointestinal side effects, so can be a suitable alternative to metformin in those who are intolerant to metformin.
Dydrogesterone use in recurrent pregnancy loss and luteal phase insufficiency: a knowledge, attitude, and practice survey amongst Indian obstetricians and gynaecologists
Authors: Tank Jaydeep , Gupte Sanjay , Mahapatra Purna Chandra , Reddy Jayanthi , Mittal Pratima , Mukhopadhyay Ashish Kumar , Vyas Lila , Batra Achla , Gupta Mahesh , Tandulwadkar Sunita , Chandra Sunita , Bhat Vidya , Bapat Kawita , Tank Parikshit , Kulkarni Ketan , Suryawanshi Sachin , Gundu Shridevi
Published: September 2024

Background: Oral dydrogesterone is effective in treating reproductive disorders such as recurrent pregnancy loss (RPL) and is a better option than progesterone for luteal phase support (LPS) after in-vitro fertilization (IVF). This study aimed to assess the attitude, knowledge, and practice of obstetricians and gynecologists (ObGyns) across India towards the usage of dydrogesterone in RPL and LPS in real-life setting.
Methods: A validated questionnaire-based survey was conducted among Indian ObGyns and results were expressed in percentages.
Results: 393 ObGyns participated in the survey. 61.3% of ObGyns agreed RPL is the three consecutive pregnancy losses prior to 20 weeks from the last menstrual period. With the use of dydrogesterone in RPL patients, 82.6% of ObGyns found ˃40% of patients having successful pregnancy outcomes. 37.2% of ObGyns mentioned that dydrogesterone is useful in ongoing pregnancy rates while 33% reported benefits in the live birth rate. At the risk for preterm delivery before 34 gestational weeks, 57% of ObGyns see benefits of dydrogesterone. More than 95% of ObGyns observed benefits of dydrogesterone over micronized progesterone such as good efficacy, fewer side effects, better tolerability, and improved patient compliance. 51.9% of ObGyns reported that they used dydrogesterone in combination with progesterone in LPS.
Conclusions: The present KAP survey highlights the observation, perception, and practicing behaviour of ObGyns on RPL and LPS. It also highlights the usage of dydrogesterone in aforesaid indications.
Development of new localised formula basis for birthweight estimation: single variable and single constant coefficient based clinical formula
Authors: Kantharia Preet S. , Patel Rutwa
Published: September 2024

Introduction: The OBGY professionals’ primary goal is the well - being of fetal and mother. And, to achieve this, accurate fetal weight assessment is of prime importance. The prevalent fetal weight assessment formulas are of western origin and developed several decades ago, and hence its applicability throughout the world is always under debate.
Methods: Present study of analytical formula basis development was carried out at the OBGY Department of a semi-urban cum rural tertiary care hospital, Dhiraj Hospital, SBKS MRC, at Gujarat. The study was undertaken over total of 50 pregnant women at full term pregnancy, till delivery. The actual localised birthweight data of these cases were collected and analysed, to derive a new formula basis and named as ‘SHF as singular kinematic’ (SSK). Same is verified, validated and compared using prevalent Johnson’s formula, for its significance, accuracy / error and positive predictive value. The Microsoft office, excel was used for the calculations and analysis and for graphs.
Results: The new linear formula basis for birthweight estimation is BW(e-ssk)=(SFH-5.8)/8.588, is developed and got validated for its accuracy and predictive value. In comparison to prevalent clinical method Johnson and Toshach formula (JT), it was derived that new SSK formula has identical p value and higher PPV. Also, weighted average PPV % of the study using new SSK formula has resulted higher than, that of PPV % of Similar studies using prevalent formula.
Conclusion: This study concludes that for clinical birthweight estimation, for pregnancy at term, using the newly derived formula basis “SFH as Singular Kinematic–SSK”, provides better accuracy for birthweight estimation over prevalent formula, while simultaneously solving the purpose of easy to learn and easy to use method for all concerned, even including non-medical persons and expecting mothers, at their own with basic training.
Improving outcomes by effective communication with would-be mothers with gestational diabetes at tertiary care center
Authors: Baradia Pooja , Patel Narmada Prasad
Published: September 2024

Background: Gestational diabetes mellitus (GDM) is a metabolic disorder characterized by carbohydrate intolerance detected for the first-time during pregnancy. It may result in various complications in both the mother and child. The purpose of this study was to assess their knowledge about diabetes, doubts about safe pregnancy and misconceptions regarding treatment. It helped us in creating awareness amongst patients, their caregivers and of fellow doctors involved in patient care.
Methods: Each patient was started on a treatment protocol and compliance of medical nutrition therapy (MNT) in patients and calorie requirement were recorded. They were counselled regarding the care they need to execute and provided sample diet chart modified according to their needs, as per the guidelines laid down by ministry of health and family welfare, government of India 2018.
Results: Majority of the GDM women were obese (65%). Majority of the patients had calorie requirement of 2080 (37.50%) followed by 1750 (25%) and 2580 (22.50%). The compliance of MNT in present study was 68.33%.
Conclusions: Patients were unaware about diabetes, had fear for their unborn child, of a safe pregnancy and delivery. Patients were educated about gestational diabetes, its consequences, and how we can together prevent them. The guidelines for gestational diabetes care and assessment during ANC checkup has to be inculcated at grass root level. Patients, their care takers, nursing staff, doctors have to be involved as a team in providing care and implementing these guidelines.
Scar endometriosis: a rare case report
Authors: Somaiya Hetvi , Palve Tushar , Thatikonda Rajashree , Kumari Ankita
Published: September 2024

Endometriosis is a challenging topic in gynaecology, and its diagnosis necessitates a high level of suspicion, particularly when it presents at extra-pelvic sites. Extra-pelvic endometriosis, though relatively rare, can manifest in various forms, with cutaneous endometriosis being the most common. Scar endometriosis is an uncommon manifestation of endometriosis where endometrial tissue is located within the abdominal wall following a caesarean section. This case report details a 30-year-old female with scar endometriosis and reviews the current literature on its management. Scar endometriosis often poses a diagnostic challenge due to its ability to mimic other conditions, including malignancy. Accurate diagnosis requires a combination of clinical evaluation, imaging studies, and histopathological examination. Multidisciplinary approaches are crucial for effective management. This case underscores the importance of considering scar endometriosis in patients with post-caesarean section abdominal wall masses. A thorough diagnostic workup and surgical intervention are key to resolving symptoms and preventing recurrence.
Giant cervical fibroid in a perimenopausal women: a rare case report
Authors: K. Jaya Rakini , Ravichandran Vidhya
Published: September 2024

Uterine leiomyomas, are smooth muscle neoplasms and the most common benign gynaecological tumour prevailing in 70-80% of women reaching 50 years.  Fibroids contribute to 40-60% of hysterectomies performed all over the world. Most of the fibroids are situated in the body of the uterus, but only 1 to 2% of cases, they are confined to cervix. Most of the patients remain asymptomatic but in patients with large fibroids mostly present with pressure symptoms depends upon location of fibroid. Cervical leiomyoma is mostly single and are subserous or interstitial in origin. They arise either from vaginal or supra-vaginal portion of cervix. We report a case of cervical fibroid in perimenopausal parous women with anaemia proceeded with laparotomy after anaemia correction. It showed a huge fibroid arising from the posterior cervix with uterus pushed anteriorly. Enucleation followed by abdominal hysterectomy was done. Large cervical fibroids are rare, presenting with surgical difficulties. Careful dissection by expert hands is needed in the management of such cases. Patient had an uneventful post-operative recovery.
A rare case of twin fetal papyraceous in triplet pregnancy: clinical challenges and insights
Authors: Agarwal Mamta , Jindal Saurabh
Published: September 2024

The occurrence of twin papyraceous foetuses in triplet pregnancy is rare. A papyraceous foetus is found almost exclusively in multiple gestation. Twin fetal papyraceous occurs when one or more fetuses die in utero with retention of the fetus for a minimum of 10 weeks resulting in mechanical compression of the small fetus and loss of fluid such that it resembles parchment paper. This condition can have serious implications for the remaining fetuses and the overall pregnancy. Understanding the causes, potential complications, and management strategies for triplet pregnancies complicated by twin fetal papyraceous is crucial for ensuring the best possible outcomes for both mother and babies. We report here a case of a 24 year female with triplet pregnancy with two foetus papyracei who delivered a healthy baby at 34 weeks.
A novel approach - letrozole in the management of retained products of conception: a case report
Authors: Chandran Ishwarya Chandran , Gopalan Ushadevi , Mayilvahanan Karthika
Published: September 2024

Miscarriage affects 15-20% of pregnancies, often in the first trimester, with 1-5% involving retained products of conception (RPOC). Traditional management includes misoprostol or surgical evacuation. WHO guidelines suggest oral letrozole, an aromatase inhibitor, as an alternative for first-trimester medical termination of pregnancy (MTP). This case reports on the effectiveness of letrozole in treating RPOC.A 20-year-old primigravida with persistent vaginal bleeding post-MTP presented with RPOC. Despite prior misoprostol treatment, bleeding continued. Ultrasound revealed RPOC (3.20×2.57 cm) with vascularity. Letrozole 5 mg daily for 5 days was administered after informed consent. Follow-up ultrasound showed complete resolution of RPOC, with no significant side effects. Letrozole, a third-generation aromatase inhibitor, has shown potential in managing RPOC by inhibiting estrogen production, thus facilitating expulsion. This case supports its efficacy and tolerability as an alternative to surgical intervention or traditional medical treatments. Letrozole effectively resolved RPOC in this case, highlighting its potential as a non-invasive treatment option. Further research is needed to validate its standard use for RPOC.
Strategies for managing epithelial ovarian cancer in elderly patients: a comprehensive review
Authors: Gupta Sumedha , Kalwaniya Dheer Singh
Published: September 2024

The management of epithelial ovarian cancer in elderly patients presents distinct challenges due to age-related factors and comorbidities. Developing optimal strategies requires a careful balance between treatment efficacy and the potential side effects. This review aims to evaluate current management approaches specifically tailored to elderly patients with epithelial ovarian cancer. It focuses on the effectiveness and safety of various treatments, including surgery, chemotherapy, and targeted therapies, and considers how age-related factors influence treatment decisions and outcomes. Additionally, the review explores the importance of geriatric assessment and supportive care in optimizing treatment for this demographic. The findings suggest that managing epithelial ovarian cancer in elderly patients demands a multifaceted approach that considers both the effectiveness of the treatment and the patient's overall health and quality of life. By recognizing and addressing the unique needs of elderly patients, clinicians can refine treatment strategies, thereby improving outcomes for this vulnerable population. This approach emphasises the importance of individualized care that is responsive to the specific challenges posed by ageing and associated comorbidities, ultimately leading to better health outcomes for elderly patients with epithelial ovarian cancer.