bluuebunny/crossref_metadata_2025 huggingface dataset:
THE INVESTMENT IN THE MEAT SECTOR IN THE CONTEXT OF FOOD SECURITY IN UKRAINE
Authors: Shebanina Olena , Golubeva Oksana , Burkovska Anna , Radzevičius Gediminas
Published: September 2018

In the agricultural sector, it is important to identify the main directions of investment in order to ensure the food supply for the country's population. One of the most important cases in this sector is ensuring the secure supply of meat and meat products. The state has to choose the most effective tools for supporting the development of indigenous producers and the industry in this sector. The security of the country's food supply is influenced by a large amount of quantitative and qualitative factors. Interaction of these factors and the necessary state support instruments in the meat sector is unevenly treated in the researches of the scientists and varies depending on the specifics of the development of the food sector in a country. The problem of the research is to find out and evaluate the main financial demands and investment directions of the state’s support programs for the support of Ukrainian meat’s sector, which could help secure the state’s demand for the food supply. The purpose of the research is to find out effective mechanisms for the state support and financing of the long-term projects aimed to ensuring the food security in the country. The methodology of research: analysis of research results of Ukrainian and foreign scientists and statistical information (2006–2018 m.). The information is grouped and structured to determine the forecast of meat consumption in Ukraine for 2020, the expected number of population and the determination of the missing quantities of this product in the country. The study provides a model for identifying the volume of long-term investments to ensure the food the security of the country’s supply of meat, identifying the main directions of these investments. The research was based on economic analysis and synthesis models, correlation-regression analysis, mathematic modeling method, etc. The results of research demonstrate the indicators of the food security in the country and determine the adequacy of the food consumption; also the estimation of the investment need for meat production by 2020 is carried out.
Projeto BGV Rolezinho: uma estratégia digital biopolítica para gerência da juventude na cidade do Rio Grande-RS
Authors: Nunes Evandro Dos Santos , Hecktheuer Luiz Felipe Alcantara
Published: September 2018

Resumo Este texto dedica-se a problematizar o projeto denominado BGV Rolezinhos e suas estratégias digitais, tomando-as como artifícios para governar as crianças e jovens do bairro Getúlio Vargas da cidade do Rio Grande - RS. O projeto faz parte do Programa BGV na Paz e se constitui por meio do funcionamento de oficinas. Além das oficinas, o projeto traz como estratégia as mídias sociais para acessar e dialogar com indivíduos da periferia, com vistas a gerir homicídios na cidade e no bairro. O projeto é tratado por nós como uma biopolítica que investe na vida da população local para fazê-los viver e evitar que os mesmos venham a se interessar pela drogadição e criminalidade.
Analysing Activities in a Classroom - Remembrances of Professor John Aitchison in Hong Kong with Applications to a Service Provider
Authors: Coleman Shirley Yvonne
Published: September 2018

Compositional data analysis formed a main focus of statistical activities at Hong Kong University when Professor John Aitchison was head of the Statistics department. It was part of a new Master's degree in Statistics that he set up, and as this was the first such post graduate degree to be offered in Hong Kong, it attracted many gifted statisticians from the Government Statistical Service and other employments making it a very lively program.

Acknowledging the constrained nature of many types of data led to a new way of looking at proportions and percentages of components making up data items. Professor Aitchison's seminal book The statistical analysis of compositional data contains background theory and many examples of data arising from a wide variety of applications such as geology, economics and human behaviour. One example was an analysis of the daily activities of a statistician. This prompted an analysis of classroom activities in a range of classes and schools encountered during teacher training within the Professional Educational Studies department of Hong Kong University. It was found that the nature of the target class and the school level affected the pattern of lesson activities with more listening carried out in the higher target classes and higher level schools. More time was spent dealing with educational equipment in lower level schools.

Data analytics is increasingly popular in all walks of life and many small and medium enterprises are realising the benefits. Compositional data forms a large part of internal company operational data and its analysis can provide useful insights. For example, the change in proportions of different activities undertaken over time is important information for a service provider. In addition to biplots and coordinate representations of isometric log ratios, using ternary diagrams to illustrate proportions is an informative way to share findings with company staff.
Dimensionamento das Entradas Ambulatoriais em uma Maternidade em Função do Número de Leitos Disponíveis no Alojamento Conjunto
Authors: Picchia Djair , Costa Rafaela Alkmin da
Published: September 2018

Esse estudo teve por objetivo dimensionar a entrada ambulatorial de pacientes na Divisão de Clínica Obstétrica - DCO do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, em função do número de leitos disponíveis. Utilizou-se a metodologia de estudo de caso quantitativo com acesso ao banco de dados do serviço, referentes aos meses de julho de 2015 a abril de 2016. Utilizou-se a Equação de Erlang-B para calcular, a partir da taxa de ocupação, da média de permanência das pacientes, do número de leitos disponíveis, da taxa de recusa desejada e do histórico de entradas das gestantes, qual seria o redimensionamento necessário no ambulatório da DCO. Nos 10 meses de análise, a taxa de ocupação média foi de 84,2%, a média de permanência foi de 2,8 dias. Para 13 leitos disponíveis, taxa de recusa de até 5% seria atingida com uma demanda calculada de 3,2 chegadas/dia no serviço. Conclui-se que para se atingir taxa de recusa de até 5% na DCO seria necessária uma redução de 9 a 35% na entrada mensal ambulatorial, de acordo com o percentual de redução de entradas de pacientes “externas”, via pronto-socorro, para parto no serviço.Palavras-chave: Dimensionamento. Leitos. Maternidade.AbstractThis study was designed to measure the outpatient entrance patients in the Division of Obstetric Clinic (DCO), Hospital das Clinicas, Medicine School, University of São Paulo in the number of beds available.  The quantitative case study methodology was used with access to service database, for the months from  July 2015 to April 2016. Erlang-B equation was used to calculate, from the occupancy rate, the average of the patients stay, the number of beds available, the desired rate of refusal and history entries of pregnant women, which would be necessary to resize the outpatient clinic of  DCO. In the 10 months of analysis, the average occupancy rate was 84.2%, the average stay was 2.8 days. For 13 beds available, refusal rate of up to 5% would be reached with an estimated demand of 3.2 arrivals / day service.Is is concluded that to achieve up to 5% rejection rate in the DCO a reduction from  9 to 35% would be required on an outpatient monthly input according to the percentage of entries reduction of patients 'external', ER pathway, for labor in the service.Keywords: Design. Hospital Beds. Maternity.
A Eficácia da Eletroestimulação Funcional Associada à Facilitação Neuromuscular Proprioceptiva em um Paciente com Lesão Medular
Authors: De Sousa Samer Augusto , Quilice Consuelo Volpato , Franzoni Lucas Renato , Alves Sandra Leite , Bezzan Marluci Benini , Andrade Ellen Cristina , Bonito Diane Lucce
Published: September 2018

A lesão medular é uma alteração incapacitante, caracterizada por interrupção parcial ou total dos estímulos neurológicos através da medula. No processo de reabilitação, o fisioterapeuta pode se utilizar de vários recursos para melhora funcional do paciente, como as técnicas conhecidas de eletroestimulação funcional e a facilitação neuromuscular proprioceptiva (FNP). O objetivo deste trabalho foi verificar a eficácia da eletroestimulação funcional (FES) associada à FNP na melhora funcional dos membros superiores de um paciente tetraplégico. Para tal, um paciente com lesão medular foi submetido a 20 sessões de tratamento com FES, associado à FNP nos membros superiores, duas vezes por semana, com duração de 40 minutos. Para a obtenção dos resultados, o paciente foi avaliado, inicialmente, pela escala da Ásia para determinar o nível neurológico da lesão, e pela escala Wolf Motor Function Test (WMFT). Como resultado, observou-se uma melhora bilateral da capacidade de realizar atividades funcionais, destacando assim as tarefas que exigiram movimentos mais precisos, como dobrar toalhas e levantar cesta. Conclui-se que, no caso do paciente estudado, a FES associada à FNP proporcionou melhora funcional dos membros superiores de um paciente com lesão medular.Palavras-chave: Lesão Medular. FES. FNP. Fisioterapia.AbstractSpinal cord injury is a disabling alteration, characterized by partial or total disruption of neurological stimuli through the medulla. In the rehabilitation process the physiotherapist may use several resources for the patient’s functional improvement, such as the so-called techniques of electrostimulation functional and proprioceptive neuromuscular facilitation (PNF). The objective of this work was to verify the influence of the association of functional electrostimulation (FES) with the PNF in the functional improvement of the upper members of a tetraplegic patient. For such, a patient with spinal cord injury was submitted to 20 sessions of treatment with FES associated to the PNF in the upper limbs, twice a week, with duration of 40 minutes. For obtaining the results, the patient was assessed initially by the scale of Asia to determine the neurological level of the lesion, and by scale Wolf Motor Function Test (WMFT). As results a bilaterally improvement in the ability to perform functional activities was observed, thus highlighting the tasks that demanded more precise movements, such as to fold towels and raise basket, where the patient obtained 2 in pre treatment and 4 evaluation in the post-treatment bilaterally. It is concluded that, in the case of the studied patient, FES associated with PNF gave functional improvements of the patient’s upper members with spinal cord injuries.Keywords: Spinal Cord Injury. FES. PNF. Physical Therapy.
Centro Educacional Teodoro Sampaio: os Saberes Matemáticos na Formação dos Professores das Séries Iniciais em Santo Amaro (1954-1971)
Authors: Lima Eliene Barbosa , Nery Wesley Ferreira , Freire Inês Angélica Andrade
Published: September 2018

Neste artigo, analisamos os saberes matemáticos na formação dos professores primário no Centro Educacional Teodoro Sampaio no período de 1954 – ano de sua inauguração como centro formador de professor primário – a 1971 – o ano em que foi sancionada a Lei 5.692, a qual reformou a Lei de Diretrizes e Bases da Educação Nacional de 1961 ao estabelecer uma nova classificação serial para a educação básica e ampliar a sua obrigatoriedade. Neste sentido, além de termos nos apoiado nas categorizações de saberes a ensinar e saberes para ensinar, apropriadas, recentemente, por Valente (2016), fizemos uso de documentos históricos pertencentes a esse centro de ensino e de uma historiografia da educação e da própria história. A partir dessa análise, argumentamos que pelo menos ao longo da década de 1960, nesse centro santamarense, os saberes a ensinar, dados nas disciplinas escolares continuavam tendo domínio na formação dos professores primários. Essa realidade permanecia mesmo após os saberes para ensinar, ainda que oscilando de um ano para outro, terem ganhado paulatinamente mais espaço na formação dos professores que ensinariam nas séries iniciais.Palavras-chave: Saberes Matemáticos. Formação de Professores. Centro Educacional Teodoro Sampaio. Bahia.AbstractIn this article, we analyze the mathematical knowledge in the formation of primary teachers in Teodoro Sampaio Educational Centre in the period from 1954 - the year of its inauguration as a primary teacher centre - to 1971 - the year in which the Law 5.692 was sanctioned, which reformed the 1961 Lei de Diretrizes e Bases da Educação Nacional establishing a new serial classification for a basic education and extending its obligatoriness. In this sense, in addition to having been supported in the categories of knowledge to be taught and knowledge to teach, recently adapted by Valente (2016), we have used historical documents belonging to this teaching centre and a historiography of education and history itself. From this analysis, we argue that, at least during the 1960s, in the santamarense centre, the knowledge to be taught provided in the school subjects continued to dominate the formation of primary teachers. This reality remained even after the knowledge to teach, even though they oscillated from one year to another, they gradually gained more space in the formation of the teachers who would teach in the initial grades.Keywords: mathematical knowledge. Teacher Formation. Teodoro Sampaio Educational Centre. Bahia.
Significance of timely reference on maternal morbidity and mortality
Authors: Chandrayan Piyusha , Merawat Rohit K. , Parekh Usha P.
Published: September 2018

Background: The objective is to evaluate the effectiveness of the timely maternal referral system to a tertiary care centre in reducing maternal morbidity and mortality. Well known causes of maternal mortality are delays at three levels: in seeking care, in referring/reaching health facility in time and in receiving adequate treatment. In this study, authors have made an attempt to focus mainly on the referral system in improving maternal morbidity and mortality.Methods: This was an observational study, conducted at Dhiraj General Hospital, a rural tertiary health care facility, affiliated to SBKSMC and RC located in Waghodia district,16 kms away from the Vadodara city. It covers an area of around 7,550 sq kms of rural areas. All the patients referred from any centre and admitted to emergency obstetrical ward were included under the study within the study time period.Results: The total incidence of referred patients in this study accounted for 7.49%. 70% of the patients under study were unbooked. 65% of the referrals were multigravida. 35% of the patients were of age group 24-29 yrs. Hemorrhage, accounting 39% was the most common cause of referral. The bulk of referrals,70% were within the 50km circumference. 65% of present referred cases reached within 5 hours from the referring centre due to timely referral and easy accessibility of the transport system like - availability of 108.Conclusions: Timely referrals of women have significantly reduced the maternal morbidity and mortality as patients from remote area can avail tertiary medical health facilities. A proper referral letter with primary care from the referring centre can further enhance the functioning of this system.
Caesarean section on demand: a hospital-based study
Authors: Qazi Mahvish , Saqib Najmus
Published: September 2018

Background: The aim of the study was to find out the reasons behind healthy women preferring cesarean section (CS) in the absence of obstetric and medical indications.Methods: This was a prospective study among women who came for delivery at ASCOMS, Jammu (Jammu and Kashmir), India a tertiary level teaching hospital. All women who underwent caesarean delivery for maternal request were included in this study.Results: The total number of deliveries during the study period (9 months) were 889. There were 636 (71.54%) vaginal deliveries and 253 (28.46%) CSs. Among 253 CSs, 25 (9.88%) had maternal request as their indication. Majority 13 (52%) of them were in the age group of 20 - 25 years. Multigravida opted for CS more than primigravida (17 versus 8). Most 10 (40%) of them were Graduates and 15 (60%) were working. Majority of them 13 (52%) were in class II socioeconomic status of Kuppuswamy’s scale. The various reasons for women requesting cesarean delivery were refusal of vaginal birth after cesarean section (VBAC), simultaneous tubectomy, painless delivery, prolonged infertility, afraid of neonatal outcome and astrological concerns.Conclusions: Most of the women who opted for cesarean delivery in our study was for preventable reasons like painless labor, previous negative birth experience and simultaneous tubectomy which would have been avoided by prior counseling starting from antenatal period and by providing labor analgesia. Proper education of the patient and personal involvement of the treating obstetrician in counselling the patient and her supporters can reduce cesarean delivery for maternal request.
Surveillance of surgical site infections to determine incidence, risk factors and microbiologic spectrum following obstetric and gynaecological surgeries
Authors: Panicker Seetha , Chitra T. V.
Published: September 2018

Background: Surgical site infections (SSI) are one of the major health problems throughout the world with an incidence of 3%-16%. Hospital acquired surgical site infection is further complicated by the emergence of multi drug resistant strains. SSI surveillance is an established monitoring tool and has been shown to reduce infection rates. The importance of preventing surgical site infections is well recognized since they lead to increased morbidity, prolonged hospital stay, need for readmission, high end antibiotic treatment and re-surgery. This study was undertaken to determine the incidence, risk factors, and microbiological spectrum of surgical site infections and to identify the multidrug resistant strains.  Analysis of the effectiveness of the existing surveillance methods was also done.Methods: This retrospective study was done for a period of 1-year form Jan 2016 to Dec 2016. All patients with infection following caesarean section and abdominal and vaginal hysterectomy were included. Laparoscopic surgery and patients with preexisting infection were excluded.Results: Incidence of SSI in present study is 5.27%. The major risk factors identified were obesity, diabetes and prolonged operating time.  The commonest infective organism was Klebsiella Pneumoniae in 37% of which 19% were ESBL producing and 3.8% were carbapenemase producing. E. coli was identified in 20% of isolates. The incidence of ESBL in both isolates was higher.Conclusions: Regular audit of SSIs is a very effective tool to analyse risk factors, identify causes and plan strategies to prevent infection.
The study of meconium staining of amniotic fluid and foetal outcome
Authors: Gavhane Bhagyashri , Thakare Sarika , Wankhede Sachin
Published: September 2018

Background: This study was carried out to determine the effect of meconium stained amniotic fluid on mode of delivery and correlation of thick and thin meconium with foetal outcome.Methods: This prospective observational study was carried out in the Department of obstetrics and gynecology, IGGMC Nagpur from September 2015 to August 2017. All pregnant women in labor with cephalic presentation with singleton pregnancy with meconium stained liquor irrespective of age, parity and stage of labor were enrolled in this study. 200 consecutive study subjects who fulfilled inclusion criteria were included in the study.Results: Out of 200 cases of MSAF, thick meconium was seen in 53.5% cases and thin meconium constituted 46.5% of the cases. The mean gestational age in present study was 39.31 ± 0.89 weeks. Overall incidence of LSCS in meconium stained amniotic fluid is 65.5%. The thick Meconium stained grades had significantly higher NICU admissions when compared to the thin meconium grades (p<0.05). In present study, the total perinatal mortality was 4%.Conclusions: MSAF were associated with higher rate of caesarean delivery. It causes birth asphyxia, MAS, increases NICU admissions and perinatal mortality.
Fetal and neonatal outcomes in intrahepatic cholestasis of pregnancy
Authors: Sharma Parul , Sarkar Bani , Majhi Bangali
Published: September 2018

Background: Intrahepatic cholestasis of pregnancy has been associated with adverse fetal and neonatal outcomes. The objective of this study was to assess the improvement in fetal and neonatal outcomes with timely intervention in pregnant females with intrahepatic cholestasis of pregnancyMethods: This prospective observational study included 50 patients attending antenatal clinic of the Department of Obstetrics and Gynecology of Dr. RML Hospital, from 1st November 2015 to 31st March 2017, using inclusion and exclusion criteria. History, examination, blood investigations, with ultrasound upper abdomen was done for all the patients. Diagnosed patients were treated accordingly and fetal and neonatal outcomes were studied. The data was analyzed using STATA (version 13.1, Stata Corp 4905 Lakeway Drive College Station, Texas 77845 USA). Comparisons were analyzed using Chi-Square, Student’s t-tests.Results: In the present study, in view of timely diagnosis and intervention, 82% of the neonates had birth weight >2.5kg. 94% of the total neonates had >7 APGAR at 1min, and 100% of the neonates had >7 APGAR at 5min. No stillbirth was observed in present study group. No NICU admission was observed in the present study.Conclusions: Patients with intrahepatic cholestasis of pregnancy should be taken with utmost care. With early intervention, the adverse effects on fetus and neonates can be reduced to a significant amount.
Comparison of fetal outcome in spontaneous versus induced labor in postdated pregnancy: a study in a tertiary care centre
Authors: Anand Nikhil , Shah Hardik
Published: September 2018

Background: Pregnancy lasting beyond 40 weeks is a known complication of normal delivery. Various studies have found incidence between 2-14%. Post-dated pregnancy carries specific hazards to both mother and fetus. While mothers are faced with problems like increased incidences of induced labour, instrumental delivery and LSCS with associated morbidities, fetuses are faced with morbidities ranging from IUGR to macrosomia. Authors tried to study fetal outcome in post-dated pregnancy present study. The objective is to compare fetal outcome in spontaneous versus induced labour in post-dated pregnancy.Methods: This is a prospective cross-sectional study done at a tertiary care hospital in obstetrics and gynecology in duration of 18 months. After screening according to inclusion criteria, all patients who were admitted in labour wards are selected and two groups were created according to clinical examination. First group consists of patients with spontaneous onset of labour and second group consists of patients with induction of labour. In each group USG, NST and BPP were performed, and labor monitored according to standard partograph. Fetal outcomes in both groups were studied.Results: Fetal outcomes were nearly same in both groups, induced and spontaneous onset of labour, except a few like thick meconium which was common in spontaneous onset group while rate of LSCS was more in induced group.Conclusions: Women with uncomplicated pregnancies should be offered induction of labour, while women with any complicating factors LSCS should be considered.
Pap smear in antepartum women: an opportunity to screen and create awareness
Authors: Ethirajan Shanthi , R. Srinidhi , K. Jayashree
Published: September 2018

Background: Cervical and breast cancers are the leading malignancies in females in India. Cancer cervix is preventable and treatable if detected at premalignant stage. Pap smear is a recommended screening method for cancer cervix and its precursors. Pap smear screening in antenatal period presents an opportunity to screen for premalignant cervical lesions and genital infections. This study was undertaken to determine the prevalence of abnormal cervical smears and genital infections among antenatal women.Methods: It is a prospective study in which, 200 antenatal mothers at booking visit, were included in the study. Details on their demographic characteristics, obstetric profile, and past history of Pap test were collected. Liquid based cytology was used for the test. The cytological results were reported based on the Bethesda classification system 2001.Results: Among 200 antenatal women 57% were between 21-25 yrs of age and 18% were less than 20 years. 38% of women were less than 20 years of age at the time of beginning of sexual activity. 56% were primi gravida and others were multi gravida. 95.5 % of women were literate. 89% of women were unaware of Pap smear test. Among the 200 Pap smear reports, 23% were normal, 55.5% nonspecific inflammatory changes, 8.5% Candida infection and 13% bacterial vaginosis. None were reported with premalignant changes.Conclusions: In a population where people do not undergo Pap test due to varied reasons, antenatal Pap test not only provides an excellent opportunity to screen and create awareness for further screening, also helps detect genital infections.
Delivery by repeat caesarean section today: an overview
Authors: Christe D. M. , Gunasingh Shaanthy T. K. , Bharani V.
Published: September 2018

Background: To find out the maternal and neonatal outcome and background characteristics of women delivering by repeat caesarean section in a tertiary care centre in Chennai, South India.Methods: Parturition records for the year 2017, were accessed and case records, for the calculated sample size were selected. Demographic features, obstetric history, gestational age and antenatal complications were recorded. Maternal outcome and baby details including sex of the baby, birth weight, APGAR and admission to New born Intensive Care Unit (NICU) data and acceptance of postpartum contraception was noted.Results: In the study group, 156 women delivered by repeat caesarean section.  The age group of women ranged from 20 years to 38 years.  Majority of 83.4% of women were Para one.  Threatening rupture was recorded in 2.6% of women. The risk of previous two CS scars was noted in 3.2% of women. More than 41% of women had other complications. Most often observed complications were Gestational hypertension, Gestational diabetes, preeclampsia and eclampsia. Pregnancy complications of oligohydramnios, twins, breech and abnormal presentation, were significant. 1% of women had associated medical complications of anaemia and hypothyroidism.  Maternal and Fetal causes were the most important indication for caesarean section in 74% of women. There were no maternal deaths in present study group. Postpartum contraception was accepted by 55 % of women.Conclusions: Majority of repeat caesarean section was observed most commonly in para one women in the age group of 26-30 years More than 41% of women had associated medical and obstetric complications. There were no maternal deaths in this study. Neonatal deaths were 2.5%.
A clinico-histopathological review of ovarian masses at a tertiary care centre
Authors: Fonseca Michelle N. , J. Madhavi
Published: September 2018

Background: Ovarian tumours can be seen at all stages of life but they differ in type, being mostly germ cell tumours in childhood, functional cysts in the reproductive age group (up to 45 years) and becoming increasingly malignant towards and after menopause. It also accounts for most prevalent cause of hospital admissions.Methods: This is a retrospective study conducted in the Department of Obstetrics and Gynaecology at a tertiary care hospital in Mumbai from August 2017 to August 2018. All patients with ovarian masses who were surgically managed were included in the study. The data of 30 patients was collected in excel sheet and analyzed by descriptive statistics.Results: Out of the 30 ovarian masses, 50 % were functional cysts, 46.6% were benign ovarian masses and 3.3% were borderline malignant. 46% of tumours were seen in the age group 21-30 years. More than 50 % tumours were seen in parous women. Most common presenting clinical symptom was pain in abdomen irrespective of the type of tumour. Most common complication was haemorrhage in the cyst. Laparoscopy was done in 4 patients and 26 required exploratory laparotomy. Most common surgery performed was unilateral cystectomy for functional ovarian cysts and benign ovarian tumours. Mucinous cystadenoma was the most common benign ovarian tumour, followed by dermoid cyst.Conclusions: Pre-operative diagnostic approach to a patient with ovarian mass includes careful history taking, thorough clinical examination, ultrasound and tumour marker assays in selected cases. Conservative surgery should be the goal to preserve fertility in young patients with ovarian tumours.
Non-acceptance of permanent methods of contraception-a threat to small family norm: a cross-sectional study from the Northern state of India
Authors: Singh Rajesh Kumar , Kaur Amandeep
Published: September 2018

Background: India is second most populous country of the world after China and is expected to surpass China by 2024. In order to balance the population growth, replacement-level fertility – total fertility rate of 2.1 – needs to be achieved and sustained even at sub-national level. Acceptance of permanent family planning methods by young couples can be an effective way of eliminating risk of future pregnancies. The objective of the present study was to assess acceptance and determinants of acceptance of permanent methods of contraception among couples with two or more living children.Methods: A community based cross-sectional study was conducted during September 2017-April 2018 in Haldwani block of Nainital District of Uttarakhand, India. The study participants were selected by multi-stage sampling and were interviewed using semi-structured and pretested questionnaire. The statistical analysis was done using the software R. Chi-square test was used to test association between variables.Results: Among 221 interviewed study subjects, only 34.39% were using permanent method of contraception and out of these, 96.05% were acceptors of tubectomy while only 3.95% preferred vasectomy. One in four couples were not using any contraceptive method and rest chose temporary contraceptive techniques. Non-acceptors were especially high in case of couples with women belonging to lower age-group, living in joint families, having only one or no male child and with formal schooling.Conclusions: Non-acceptance of permanent method of contraception for limiting the family after two children was very high in the community and desire for male child being its important determinant.
A comparative study of safety and efficacy of vaginal isosorbide mononitrate (40mg) with dinoprostone gel (0.5mg)
Authors: T. M. Malathi , K. Kanchanamalai
Published: September 2018

Background: It is essential to intervene pregnancy for safety of mother, fetus or both. Successful labor induction is clearly related to the state of the cervix. Women with an unfavorable cervix who have not experienced cervical ripening phase before labor present the greatest challenge with regard to labor induction. Therefore, it is necessary to use optimal technique for cervical ripening and safe confinement. One of the common methods includes use of PGE2 gel for cervical ripening. The rationale of this study is to compare the safety and efficacy of Iso-sorbide mononitrate as pre-induction cervical ripening with PGE2 gel induction.Methods: After attaining ethics approval [PSG IHEC], a prospective randomised, case-controlled study was conducted on 182 women undergoing elective induction of labour. They were allocated to either Study or Control group by computer generated random number table method. ISMN was used vaginally prior to labour induction in the study group whereas PGE2 gel induction was used in the control group. Change in bishop score and Induction to delivery interval was assessed in both the groups.Results: There was a significant reduction in induction to delivery interval in the study group (ISMN) 15.2 hours when compared to 23.2 hours in the control group (PGE2 gel) with p=0.000. Need for augmentation of labour was reduced in the study group significantly with p=0.003. Cost of induction was less when compared to the control group. ISMN had less side effects hence can be used as OP basis.Conclusions: Vaginal Isosorbide mononitrate when used as a cervical ripening agent significantly reduces induction to delivery interval. Use of Isosorbide mononitrate was associated with very less side effects and it is a cost-effective drug. Thus, ISMN can be used safely and effectively in term patients for pre-induction cervical ripening when compared to PGE2 gel.
Evaluation of preventable causes and risk factors of maternal mortality
Authors: Bhatia Ruby , Mohi Manjit Kaur , Singh Neeraj
Published: September 2018

Background: The primary objective was to evaluate preventable causes of maternal deaths at tertiary, second and primary care in Patiala district, Punjab. Secondary objective was to determine impact of socio-demographic characteristics, anemia and three delays on maternal death.Methods: This is a retrospective observational study carried out between 1. 7. 2013 till 30. 6. 2014, for period of one year in department of a tertiary care hospital and district health authorities catering to secondary and primary care deaths for evaluation of preventable causes and risk factors for maternal deaths at tertiary, secondary and primary level.Results: A total of 54 maternal deaths with MMR of 170.42/100000 live births, occurred in stipulated period, 87.03% at tertiary care, one at second care, 7.41% at home and 3.7% on the way to tertiary care. Majority of maternal deaths (92.6%) were unbooked, between 21-30 years (64.82%) of age, primi or second gravida (35.18%), para 1 or 2 (37.03%), illiterate (40.74%), low income group (57.41%) with rural background (59.26%). Majority of maternal deaths (77.7%) occurred in postpartum period. Most of maternal deaths (75.93%) were due to direct causes, pre-eclampsia 25.93% followed by sepsis (22.2%) and haemorrhage (20.3%). Anemia was contributory factor in 79.63% maternal deaths. 7.4% maternal deaths occurred at home with delay in seeking care while 29.62% died due to delay in reaching care. In 40.42% maternal deaths, it took more than two hours to reach tertiary care hospital.Conclusions: Skilled antenatal, intranatal and postnatal care, women empowerment, counseling, early diagnosis and referral of pre-eclampsia and other high-risk cases with curbing anemia at grass root level is need of millennium. Preventing delay in seeking care or reaching care-a step towards sustainable development goals (SDG) to reduce MMR.
The study of eclampsia as a cause of severe acute maternal morbidity
Authors: Lakshmi S. K. Yoga , R. Suvarna
Published: September 2018

Background: “SAMM” refers to the morbidity a woman actually suffers1. The identification of Eclampsia as a cause of severe maternal morbidity has emerged as a promising complement or alternative to the investigation of maternal deaths. The most common tool used to identify SAMM is by WHO criteria. Incorporation of near-misses into maternal death enquiries would improve the quality of care and its standardization.Methods: A descriptive study of SAMM in the department of OBG in KIMS hospital done between Jan 2013 to June 2014. The total number of deliveries during this period were 2786. There were 43 cases of Eclampsia as a cause of SAMM. Among this, 1 case was admitted in ICU due to peripartum cardiomyopathy, MODS, HELLP syndrome. Data were collected as per Performa (facility based Maternal Near Miss Review Form [MNM-R FORM] and statistical analysis was performed.Results: The cases of near miss have 2 or more factors responsible for it. In this study,23% of SAMM are due to lack of resources and Lack of transport from home to health care facility. 20% due to lack of human resources.11% due to lack of awareness. Other responsible for minor contributory factors.Conclusions: SAMM can be decreased by identifying factors responsible for it and steps taken to resolve them. Step by step improvement to be done as all the factors are modifiable.
Urothelial bladder carcinoma with major clinical presentation as overactive bladder, without hematuria: case report and literature review
Authors: M. Alexander de J. Rafaelano , Navarro Junior J. Araiza , Sosa María Isabel Tolentino , Reyes Fernando López , Gutiérrez Marlene De la Peña
Published: September 2018

The urothelial carcinoma is the most common type of bladder cancer, comprising approximately 90% of cases in the United States. The most common symptom of bladder cancer is macroscopic hematuria, increased urinary frequency, urgency, or irritative symptoms may occur. Generally, occurs in elderly people, about 9 out of 10 people are over 55 years old, with the average age at diagnosis of 73 years. Males are more likely than women to have this neoplasm with a probability of 1 in 27 (for women the probability is 1 in 89). Most bladder cancers begin in the inner layer, also called the urothelium or transitional epithelium. As it advances, it invades the layers of the bladder and can invade adjacent structures, often metastasizing to distant lymph nodes, bones, lungs or the liver. Among the cancers that originate in the bladder authors have: Urothelial carcinoma (transitional cell carcinoma), squamous cell carcinoma, adenocarcinoma, small cell carcinoma, sarcoma. Hematuria occurs in the majority of patients with urothelial carcinoma. Symptoms such as dysuria, frequency, urgency and pain may also occur, or it may also be asymptomatic.  In this case report, an atypical presentation of bladder cancer is shown, simulating the symptomatology of a Hyperactive Bladder Syndrome.
Reproductive outcome of a patient with congenital adrenal hyperplasia: case report
Authors: A. Bhagyashree , S. Shylaja A. , Srikonda Yashaswini
Published: September 2018

Congenital Adrenal Hyperplasia are a group of inherited autosomal recessive enzymatic defects of adrenal steroid biosynthesis. Low pregnancy rate has been reported in women with CAH. Several factors have been suggested to contribute to this subfertility such as androgen excess, adrenal progesterone hyper secretion, consequences of genital reconstructive surgery, secondary PCOS and psychosexual factors. In contrast to this subfertility, pregnancies are normal and uneventful. During pregnancy, maternal & fetal problems are confined to these deficiencies. Adequate glucocorticoid therapy and improvement of surgical and psychological management could contribute to optimize fertility in CAH. The interposition of the placenta on the HPA axis & other endocrine changes during pregnancy impact considerably on the clinical evaluation of CAH. A 21 years old Primigravida presented to us at 13 weeks of gestation with history of CAH on treatment and vaginoplasty done in the childhood. Endocrinologist opinion was taken, and steroids continued. Advised to meet genetist and follow up for prenatal testing. But patient denied. Antenatal period was uneventful. Patient underwent Emergency LSCS in view of CPD in labour at 36+6 weeks of gestation. Pre-op stress dose of steroid given. A girl baby of birth weight 2.13 kg was born with good Apgar scores. Perioperative period uneventful. Preconception health, including hormonal, psychosexual and anatomical barriers to fertility should be addressed early in women with CAH. This review provides fertility outcome and pregnancy issues of a woman with CAH.
Second trimester rupture of an unscarred uterus following blunt trauma: a case report
Authors: Mathews Basil , T. Chitra
Published: September 2018

Uterine rupture is a life-threatening emergency in obstetrics carrying an increased risk of maternal and foetal morbidity and mortality. Often, uterus ruptures during labour; however, scarred uterus may rupture before the onset of contractions in the late third trimester. Uterine rupture in an unscarred uterus occurs extremely rare. Various aetiology has been described in literature from anomalous uterus, uterine manoeuvres, and abnormal placentation to congenital exposure to Diethylstilbestrol.  Maternal outcome depends greatly on the early diagnosis, prompt management and availability of emergency expert care and blood transfusion. However, the diagnosis is not always obvious with its varied non-specific presentation. Most common presentation of rupture uterus is acute abdomen, which is often mistaken for other causes like acute pancreatitis, appendicitis, cholecystitis, especially in the early pregnancy. Authors report a case of grand multipara at 19 weeks of gestation presented as acute abdomen. She was referred as incomplete abortion in need of blood transfusion, later diagnosed to be rupture of uterus. She had abdominal pain and vaginal bleeding for 14hours duration prior to admission. On further inquiry, history of blunt trauma to abdomen, the day prior was revealed.
PRES, a diagnostic dilemma in pregnancy: three case series with unusual presentation
Authors: Mansingh Sudhir , Rai Gunjan , Bhardwaj Bikram
Published: September 2018

Authors report a series of three cases of unusual presentation of posterior reversible encephalopathy syndrome in pregnancy. First patient, 29 years old G2P1L1, who was a booked case at our hospital, presented with complain of no fetal movement perception for 3 days at 27 weeks of period of gestation. No history of hypertension and even no record of hypertension after admission. On USG detected to have severe early onset IUGR and AEDF in Umbilical artery doppler. Went in to spontaneous labor and delivered vaginally a preterm neonate of birth weight of 740 gms at 27 weeks 06 days of period of gestation. Postpartum period was uneventful till day four and on day five of postpartum she developed severe headache and seizure. MRI done which was suggestive of PRES. Second patient 27 years old primi gravida with 37 weeks 01 day, booked at our hospital with regular ANC visit brought with history of headache, vomiting with semi-conscious state with diminution of vision till finger count only. She developed seizure thrice while examination. Antenatal period was uneventful with no history of hypertension. Underwent emergency LSCS on same day and delivered a 2.8 kg healthy female neonate. Patient treated as a case of eclampsia and later MRI findings were suggestive of PRES. Third patient 19 years old primigravida booked ANC case at another hospital. She underwent emergency LSCS at 39 weeks POG for fetal distress at same hospital. Antenataly no history of hypertension or any other co-morbidity. On fourth post-op day, she developed headache and vomiting followed by one episode of seizure and after initial management she transferred to our hospital for further management. When we received patient, she was on Magsulph infusion considering postnatal eclampsia. We managed with Inj Lorazepam 2 mg intravenous and later with Inj Levetiracitam. Final diagnosis has been made as PRES after MRI and MRV brain. We found very atypical presentation of all three cases with difficulty in diagnosis and challenging management, so we are reporting these cases.
Yolk sac tumor in an antenatal patient: a challenging case
Authors: Namgyal Anu , Soni Anjali , Verma Suresh , Chauhan Indu , Sharma Shikha , Purbia Charu
Published: September 2018

Pregnancy complicated with adnexal masses is a very common occurrence. However, most of these adnexal masses encountered in pregnancy are benign in nature and are found incidentally during routine antenatal ultrasound. Malignant ovarian neoplasms account for 1%-8% of all persistent adnexal masses diagnosed during pregnancy. Yolk sac tumor (YST) complicating pregnancy is very rare and has no proper guidelines for its diagnosis and management hence causing a therapeutic dilemma for the clinicians. Therefore, an individualised approach is preferred in such cases. It is very important to report such cases for better understanding and management of these cases. Here we present a case report of a 23-year-old primigravida at 30 weeks gestation with yolk sac tumor of right ovary, surgical stage IIIc who responded well to fertility sparing surgery with cisplatin-based combination chemotherapy. She has no evidence of disease post treatment and has been put on regular follow up.
Awareness of medical students towards cancer
Authors: S. Radhika , Kareem Hana Abdul , A. Najma R. , Bharadwaj Ira
Published: September 2018

Background: Cancer is the second leading cause of mortality worldwide. Amongst the cancers, the three leading cancers in India which causes high mortality and morbidity includes cervical cancer, breast cancer and upper aerodigestive tract carcinoma. High mortality and morbidity due to cancers can be reduced by preventive measures and early diagnosis of cancer, which can be achieved by creating awareness.Methods: A total of 337 medical students from 1st year to 4th year (1st year students-preclinical, 2nd year students-paraclinical and 3rd and 4th year students- clinical students) were included in this study and the results were analysed by descriptive statistics, Pearson’s Chi square test and paired ‘t’ test.Results: Out of 337 students, 120 were males, 204 were females and 13 students have not mentioned their gender. There was significant difference in knowledge of the students between pretest and posttest (following a short lecture) and amongst the preclinical, paraclinical and clinical students. Clinical students were found be more aware about the cancer compared to the preclinical and paraclinical students.Conclusions: Creating awareness to the medical students who are future doctors is the need of the hour. A short talk on cancer awareness can create a great impact on the awareness.
Role of frequency volume chart for the assessment of urinary incontinence in men
Authors: Samaddar Debasis , Pal Dilip Kumar
Published: September 2018

Background: This study was conducted to evaluate the role of FVC (frequency volume chart) in the male patient with urinary incontinence. That will definitely help to evaluate patient’s objective lower urinary tract symptoms including incontinence and guide to manage those symptoms. But there are less number of reported studies showing role of FVC in men with urinary incontinence.Methods: Male patient (19-60 years) presenting with incontinence symptoms from 1st February 2018 to 30th July 2018, were enrolled in the study. They were asked to record the time and volume of each oral fluid intake, voided volume for 3 consecutive days and put tick in the column of incontinence in the FVC if present.Results: Total 205 male patients presented with incontinence symptoms were evaluated, they were divided into 3 age groups (19-32, 33-46 and 47-60 years). Mean incontinence were found 2.65 (19-32 years). 2.99 (33-46 years) and 3.13 (47-60 years). In 47-60 years group total oral fluid intake is positively correlated with frequency (p <0.05) but not in other groups. Correlation of Nocturia with incontinence (p >0.05) and frequency with incontinence (p >0.05) were not statistically significant in any age groups.Conclusions: The FVC is the registration of voiding parameters by patient in his own environment. Assessment of lower urinary tract symptoms based on a history alone is not accurate, value of FVC are found to be consistent and accurate, so it will guide us to initiate management in male with urinary incontinence and also help to assess treatment responsiveness.