bluuebunny/crossref_metadata_2025 huggingface dataset:
Una mirada hacia la Anafilaxia
Authors: Tello-Cajiao Maria Elena , Vásquez Laura del Mar
Published: March 2023

Introduction: Anaphylaxis is the most severe and potentially lethal presentation of acute systemic allergic reactions. Understanding its mechanisms provides a better diagnostic and therapeutic approach.
Objective: to present the key concepts of the mechanisms of anaphylaxis, its diagnosis, and its management in clinical practice.
Methods: a summary of the main concepts on the mechanisms, diagnosis, and management of anaphylaxis in clinical practice was made according to the review presented at the congress of the Asociación Colombiana de Medicina Interna (ACMI) Capítulo Valle, Universidad Libre: "A multidisciplinary approach with a Latin American vision" on May 13th and 14th, 2022.
Results: Anaphylaxis may affect 5% of people at some time in their lives. The main allergens are drugs, food, and Hymenoptera venom, but the cause may vary throughout the life cycle. The diagnosis is made according to the criteria of the World Allergy Organization and is confirmed by the determination of serum tryptase in case of doubt. Adrenaline intramuscular is the first line of treatment. Once the episode is over, evaluation by an allergy expert is always necessary.
Conclusion: identification and adequate treatment of anaphylaxis save lives. In the approach to the patient with anaphylaxis, it is important to identify the allergen and the factors associated with the episode to prevent a new one.
Reconociendo la Congestión en Insuficiencia Cardiaca Aguda, Terapéuticas del Primer Mundo Adaptadas Para el Tercer Mundo.
Authors: Aristizabal David , Hernández Torres Juan Manuel , Echeverri Natalia
Published: March 2023

About 90% of the Heart Failure patients are admitted due to congestive symptoms in the emergency departments, this is the leading cause of hospitalization and also a prognostic factor for cardiovascular death. The success of therapy in these patients comes from the proper use of the resources at our disposal.
Objective: Provide relevant knowledge to the clinician for the comprehensive approach to patients with heart failure and fluid overload.
Methodology: Narrative review.
Results: Loop diuretics continue to be the first line of management, reducing mortality rates, but there are also other pharmacological strategies when an adequate response is not achieved, among them we find thiazide diuretics, mineralocorticoid receptor antagonists and in cases of distribution vascular, the use of nitrates and hypertonic saline solution has been described.
Conclusions: The gradual and timely management of diuretic drugs decreases the cost and improves the prognosis of patients with heart failure and fluid overload.
Evaluating Burnout in the Emergency Departments: Methods, Results, and Lessons Learned
Authors: Vizer L. , Charguia N. , Adapa K. , Mazur L
Published: March 2023

Healthcare professionals practicing in the Emergency Department (ED) play a critical role in providing care in our societies. They interact with an assortment of sub-systems of the hospital and collaborate with various specialties across inpatient and outpatient settings. Research shows that >60% of ED physicians report burnout and, thus, it is important to understand the key factors contributing to their burnout. Over a ten-week period we used a mixed-method, theory-based, participatory, and data-driven approach based on survey, focus groups, and contextual inquiries to collect and analyze data and prioritize improvement efforts. Key areas of improvement were: i) workflows and patient monitoring that add to high cognitive load and stress levels; ii) low staffing, particularly among sitters, nurses, technicians, secretaries, and security staff; iii) suboptimal therapeutic atmosphere for psychiatric patients; iv) disrespectful and violent patients and visitors; v) communication issues, especially between the ED and other departments; and vi) frequent problems with the telecommunication system. We learned that EDs must take time to rigorously evaluate contributing factors to burnout while engaging their people who best know how to change systems to achieve positive and sustainable results.
Mobile Ad-Hoc network, Mobile application, aircraft performance, software development
Authors: Israr Amber , ANWAR ALI ZAIN , Salman Pathan Muhammad , aved Masood Rana J
Published: March 2023

In the past decade, a steady increase has been noticed in the number of mobile users and the use of mobile communication. In wireless communication links are stable. Duration of the link is the most important design by which the performance of the mobile Ad Hoc network (MANET) can be determined. In this research article, a derivative metric of graph theory attained from mobility model technique in Ad Hoc network of casually moving object, link duration of probability density function (PDF)been examined by using three mobility models namely random waypoint, random direction, and freeway model. The performance is based on the node speed, transmission range, the density of node, area of simulation, and computational complexity with time. By using Monte Carlo simulations, the reliability and robustness of models have been analyzed. The main advantage of the proposed scheme is implemented is an easy hardware platform because of the concept in mobility models and the easiness of code.
Guar sakızı ilaveli kitosan bazlı tutkalların bazı özelliklerinin belirlenmesi
Authors: ERGÜN Mehmet Emin , ÖZLÜSOYLU İsmail
Published: March 2023

Ahşap sektöründe kullanılan tutkalların büyük bir bölümü fosil yakıt temelli olup özellikle içerisindeki formaldehit nedeniyle çevre ve insan sağlığı açısından riskler oluşturmaktadır. Bu olumsuz durumu azaltmak amacıyla son yıllarda formaldehit emisyonunu azaltmaya yönelik farklı yöntemler üzerine araştırmalar yapılmaktadır. Bu araştırmalar içerisinde biyo bazlı tutkal kullanımı sağlık açısından sahip olduğu olumlu özellikler nedeniyle ilgi görmektedir. Bu çalışmada, doğal polimerlerden kitosan ve guar sakızı kullanılarak üretilen bağlayıcının ahşap tutkalı olarak kullanılabilme potansiyeli araştırılmıştır. Bu amaçla kitosan bazlı tutkalın içerisine 4 farklı oranda (%0.06, %0.2, %1 ve %2) guar sakızı ilave edilmiştir. Elde edilen tutkalın viskozitesi ölçülerek, farklı orandaki guar sakızı ilavesinin bağ kuvveti üzerindeki etkisi belirlenmiştir. Ayrıca kitosan bazlı tutkalların odun ile etkileşimini incelemek amacıyla Fourier transform kızılötesi spektroskopisi (FTIR) analizi yapılmıştır. Guar sakızı ilaveli kitosan bazlı tutkalın viskozitesi 1380 CP ile 5264 CP arasında bulunmuştur. %0.2 oranında guar sakızı ilave edilmiş kitosan bazlı tutkalın bağ kuvvet değerinin, guar sakızı ilave edilmeyen gruba göre %88 oranında iyileştiği tespit edilmiştir. Guar sakızı ilaveli kitosan bazlı tutkalın özellikle çevreci yapısı ile olumlu özelliklere sahip olduğu ve farklı alanlarda kullanılabileceği sonucuna varılmıştır.
Fesleğen (Ocimum basillicum L.)’nin mikro-morfolojik yapılarına ve sekonder metabolit içeriğine kuraklığın etkisi
Authors: KILIÇ Semra , KAYA Havva
Published: March 2023

Kuraklık stresinin fesleğenin (Ocimum basilicum L.) mikro-morfolojik ve fizyolojik parametrelerine etkisini değerlendirmek amacıyla bitkiler kontrollü ortam koşullarında 3 ay boyunca yetiştirilmiştir. Kuraklık uygulamaları 5 günde bir sulama (kontrol grubu), 10 günde bir sulama (1. grup: düşük derecede stres), 15 günde bir sulama (2. grup: orta derecede stres) ve 20 günde bir 100 ml sulama (3. grup: şiddetli stres) yapılmıştır. Stresin en belirgin etkisi olarak orta seviyedeki kuraklık uygulamasında stoma sayısının arttığı ve stomaların küçüldüğü belirlendi. Stresin şiddeti arttıkça bu parametrelerde herhangi bir değişim olmadı. Benzer etki yaprağın her iki yüzeyinde bulunan capitat ve peltat glandular tüylerde de tespit edildi. Kuraklık stresi fitokimyasal içeriğini de etkiledi. Kuraklık stresi uygulamaları arasında önemli farklılıklar gözlenmemesine rağmen, kuraklık uygulamaları ile kontrol grubu arasındaki farklılık önemliydi. Sonuç olarak, uygulamalar arasındaki farklılıklar ile oluşan mikro-morfolojik ve fizyolojik değişimler fesleğen bitkisinin sekonder metabolit üretimini maksimum tutacak sulama düzeyi olarak belirlenmesini sağlamıştır.
The Strategy of Mataram Tourism Services in Growing the Tourism Sector in The Era of COVID-19
Authors: Johari Muhamad , Lestari Sri Ayu , Hariono Hariono , Azizurrohman Muhammad
Published: March 2023

COVID-19 has caused numerous disasters in all sectors of the economy, including the tourism industry. Various regions continue to work to restore tourism activities to mitigate the impact that has occurred. This research aims to determine Mataram city tourism's economic recovery strategy during the COVID-19 pandemic. The descriptive qualitative research method was used in this study, with primary and secondary data obtained from the Mataram City Tourism Office, hotels, and restaurants. Data analysis techniques such as data reduction, presentation, and confirmation were used in this study. According to the study's findings, the Mataram City tourism office is attempting to mitigate the impact of COVID-19 through various programs involving tourism stakeholders. These programs include the implementation of CHSE, the creation of unique tours, digital tourism, promotions, and the provision of grants to tourism industry actors.
Analysis of Bank Soundness Before and After the Pandemic: The RGEC Approach
Authors: Arifin Alif Misbachul
Published: March 2023

The Covid-19 pandemic has affected activities in the financial services industry, especially the banking sector, due to a slowdown in the real sector and the corporate sector, which has not yet been able to operate thoroughly. Therefore, amid a pandemic like this, it is increasingly necessary for banks to maintain and improve their level of soundness so that they can minimize possible risks and identify problems earlier. Concerning the soundness of the banks, banks are required to conduct periodic self-assessments and take corrective measures effectively by using an assessment of several factors, including risk profile, good corporate governance (GCG), earnings, and capital, abbreviated as RGEC. This study aims to determine whether there are statistical differences in banking health conditions before and after the Covid-19 pandemic. The case studies used in this study were 13 banking companies listed on the Kompas 100 Index. Using the t-test and Wilcoxon test, no statistical differences were found in the level of bank soundness before and after the pandemic for each RGEC indicator except the loan to deposit ratio (LDR), return on earnings (ROE), return on assets (ROA), and operating costs of operating income (BOPO). This finding shows the lower liquidity capacity of banks after the pandemic.
The Impact of Cigarette Consumption on Poverty in Pohuwato District
Authors: Alkadri Aissyah Dien , Dai Sri Indriyani , Santoso Ivan Rahmat
Published: March 2023

This study aims to determine the impact of cigarette consumption on poverty levels in Pohuwato Regency by looking at how much influence and the chances of someone who smokes falling into poverty. The data used in this study are secondary data sourced from the results of SUSENAS KOR and KP in March 2021 at the Central Bureau of Statistics using the logit regression analysis method. The logit model aims to find the probability of an individual or household event falling into poverty or not. The analysis results show that the smoking variable has a significant effect with a greater chance of falling into poverty. This means that someone who smokes has a greater chance of falling into poverty than someone who does not smoke. More people who consume cigarettes will increase the likelihood of falling into poverty more than those who do not.
Corporate Social Responsibility dan Stabilitas Keuangan terhadap Financial Fraud: Peran Moderasi dari Kualitas Audit
Authors: Ashma' Fathin Ulfatul , Laksmi Ayu Chairina
Published: March 2023

Latar Belakang: Fraud telah menjadi pusat perhatian bagi sebagian besar perusahaan. Hasil survei yang dilakukan oleh Association of Certified Fraud Examiners (ACFE) menunjukkan bahwa fraud dengan kasus terbanyak secara berturut-turut adalah financial fraud. Hal ini menandakan bahwa masih banyak manajemen perusahaan yang melakukan perekayasaan laporan keuangan.Tujuan: Penelitian ini bertujuan untuk menguji peran dari moderasi kualitas audit pada hubungan antara Corporate Social Responsibility (CSR) dan stabilitas keuangan terhadap financial fraud.Metode Penelitian: Metode pengambilan sampel dalam penelitian ini adalah metode purposive sampling dan diperoleh sampel sejumlah 164 sampel. Data yang digunakan adalah data dari laporan tahunan dan laporan keuangan perusahaan perbankan tahun 2018-2021 yang berasal dari web Bursa Efek Indonesia (www.idx.co.id). Alat analisis penelitian ini menggunakan software SPSS versi 25.Hasil Penelitian: Berdasarkan analisis yang telah dilakukan diperoleh hasil penelitian bahwa CSR berpengaruh negatif terhadap financial fraud. Stabilitas keuangan berpengaruh positif terhadap financial fraud. Kualitas audit tidak mampu memoderasi hubungan antara CSR dan financial fraud. Kualitas audit mampu memoderasi hubungan antara stabilitas keuangan dan financial fraud.Keaslian/Kebaruan Penelitian: Penelitian ini mengembangkan penelitian dari Baten dkk., (2021) dengan menambahkan variabel independen yaitu Stabilitas keuangan dan variable kualitas audit sebagai variabel moderasi. Penelitian ini menguji peran kualitas audit sebagai variabel moderasi untuk menghubungkan variabel Corporate Social Rensposibility (CSR) dan stabilitas keuangan terhadap financial fraud yang diharapkan dapat membatasi penyalahgunaan tersebut.
Obstetric fistula and related factors: assessing pattern and quality of life among women in Southwest Nigeria
Authors: Afolabi Adebukunola O. , Bifarin Mary T. , Oluwasanmi Gladys O. , Oladokun Munirat O. , Fatoke Helen F. , Abioye Abigail A. , Daramola Lauretta S.
Published: March 2023

Background: Obstetric fistula remains major contributor to maternal morbidity in low resource countries. Study examined quality of life and related factors among women with obstetric fistula in Southwest Nigeria.
Methods: A cross-sectional study, involving 159 purposively selected women receiving care at the fistula centre, Wesley Guild Hospital, Ilesa, Southwest Nigeria. An adopted interviewer-administered World Health Organization Quality of Life Scale, WHOQOL-BREF was employed to examine quality of life. Data was processed and analyzed using IBM statistical product and service solutions (SPSS) software version 25. Analysis was done at univariate, bivariate and multivariate levels. Fisher’s exact, Analysis of Variance, Independent t-test and Regression analysis examined association and significance, p<0.05.
Results: Findings shows that 64.20% of the women had vesicovaginal fistula, 17.60% had rectovaginal fistula, 10.70% had uterovaginal fistula while 7.5% had ureterovaginal fistula. The mean scores for physical, psychological, social relationship and environmental health domains were 48.92 ±14.89, 39.91±17.42, 68.71±30.85, 42.75±18.60 respectively. Overall quality of life had mean score of 19.89 ±26.51 while 82.4% of the women had low quality of life, 2.5% had moderate and 15.1% had high quality of life overall. Regression analysis shows significant association between low quality of life and primipara (p=0.002, RRR=32.55, CI=3.73-284.19), multipara (p<0.001, RRR=23.20, CI=5.12-105.13), middle socio-economic status (p=0.02, RRR=4.62, CI=1.29-16.59).
Conclusions: Significant proportion of the women studied had low quality of life. Parity and socio-economic status were main predictors of quality of life. Holistic management of obstetric fistula should take cognizance of these variables for optimal outcomes.
Determinants and effects of sexual exploitation among female students of tertiary institutions in Rivers State
Authors: Gbaranor Barinua K. , Ohaka Justice , D. Famber Famber , Mube Williams A. , Amadi Ijeoma N. , Kinako Sam E. , Barinadaa Lebara L. , I. Austin-Asomeji , Oriji Eunice I. , Edward Felicia U. , E. Sokolo J. E.
Published: March 2023

Background: Labor induction methods are continuously evolving to ensure safer and more effective outcomes for both mother and neonate. The present study aimed to assess the effectiveness and safety of combined use of misoprostol with intracervical catheter for labor induction.
Methods: This single-blinded, parallel-group randomized control trial conducted at Shaheed Suhrawardy Medical College, Dhaka, Bangladesh, included 200 women with term gestation and Bishop score ≤6. Participants were divided into two groups: the intervention group (group B) received misoprostol juice and Foley’s catheter, while the control group (group A) received misoprostol in the posterior fornix.
Results: In Group A, 58% had vaginal deliveries, while in Group B, 65% had vaginal deliveries. Group B experienced a longer mean length of labor in the 1st stage (13.25±1.095) compared to Group A (12.98±1.982, p=0.008). The 3rd stage was shorter for Group B (10.00±0.000) than Group A (12.02±2.469, p<0.001). The most common induction reason was labor pain with an unfavorable cervix (31 in Group A and 33 in Group B). Group B had a higher percentage of inductions at less than 12 hours and a lower percentage at more than 24 hours. Neonatal outcomes were generally better for Group B. The Cox regression hazard model showed a lower likelihood of positive outcomes in Group B (hazard ratio 0.337, 95% CI 0.243-0.469, p=0.000), indicating a statistically significant difference between the groups.
Conclusions: The combined use of misoprostol with Foley’s catheter for labor induction is safe and effective, resulting in shorter labor duration and higher rates of vaginal delivery compared to misoprostol alone.
A study on the association of diabetes and semen quality in and around Chennai, Tamil Nadu, India
Authors: S. Kalaiselvi , Ali M. Syed , V. Anuradha , A. Subhashini
Published: March 2023

Background: Globally prevalence of diabetes is gradually increasing in individual at reproductive stage. Uncontrolled blood sugar affects biological systems including reproductive. Thus, this study was aimed to analyze the association of diabetes and male infertility in and around Chennai.
Methods: Fifty-four male participants who visited the fertility clinic was grouped in two based on the sugar value. An anthropometric measurement, clinical, blood, seminal parameters and life style behaviors was analyzed. All study variables was analyzed to examine the association of diabetes and semen quality.
Results: Study results shows that people with diabetes had abnormal semen parameters as compared to non- diabetic study participants. Pearson’s correlation between the semen parameters and blood sugar value of the study participants showed semen parameters: volume (r=-0.28, p<0.05), count (r=-0.22, p<0.05), and motility (r=-0.23, p<0.05), has a significantly week negative correlation with blood sugar level.  Scatter plots also showed semen parameters:  volume (r2=-0.079), count (r2=-0.048), and motility (r2=-0.053), had a significantly week negative linear correlation with blood sugar level.
Conclusions: From the study it was concluded that the uncontrolled blood sugar levels affect the reproductive health of the study participants.
Correlation between prolactin, thyroid, LH, FSH, estradiol and progesterone in the infertile women
Authors: Sharma Siddharth , Meena Kusum Lata , Tabiyad Aditi , Bhardwaj Manish Kumar , Jaiswal Aditi , Mehta Mili
Published: March 2023

Background: An important global health issue, infertility affects a couple’s social, psychological, economic, and sexual well-being. A variety of issues stemming from abnormal hypothalamus pituitary ovarian axis dysfunction make up the hormonal diseases of the female reproductive system. The aim of the study was to find correlation between prolactin, thyroid, LH, FSH, estradiol and progesterone in the infertile women.
Methods: Present study was hospital based descriptive, cross-sectional study. 150 infertile women were required in sample size. Serum LH, FSH, estradiol was measured on day 2 of menstrual cycle and also serum TSH and serum progesterone on day 21.
Results: Around one third (38%) of the cases was married since more than 10 years. Majority 108 (72%) had primary infertility and 50% of the women had history of irregular menstrual cycles. There was significant positive correlation between TSH and prolactin (p value <0.05) and significant negative correlation of TSH with FSH and LH (p value <0.05) and there was insignificant negative correlation of TSH with estrogen (D2) and progesterone (D21). The mean value of TSH in our study was 7.47±1.82 μIU/ml.
Conclusions: TSH has strong positive co-relation between prolactin, FSH and LH indicating role in female infertility. These hormonal evaluations allow a routine etiological approach to the diagnosis of infertility.
A retrospective study on ectopic pregnancy: incidence, clinical presentation, risk factors, treatment and morbidity and mortality associated with ectopic pregnancy- one year study
Authors: Godria Payal P. , Darda Medha G. , Modi Dipti A. , Rami Bijal D.
Published: March 2023

Background: Diagnosis of ectopic pregnancy was frequently missed and rising trend in incidence of ectopic pregnancies necessitates awareness about risk factors, resultant morbidity and mortality. to determine the incidence, clinical presentation, risk factors, treatment and morbidity and mortality associated with ectopic pregnancy. Aims and Objectives were to determine the incidence, clinical presentation, risk factors, treatment and morbidity and mortality associated with ectopic pregnancy.
Methods: Retrospective analysis of ectopic pregnancy was done in Government Medical College Baroda, from September 2021 to August 2022. The following parameters: age, parity, gestational age, risk factors, clinical presentation, diagnostic methods, mode of treatment and morbidity were noted.
Results: Out of 7521 deliveries, 74 were ectopic pregnancies (0.98 %). Women with age 20-30 years had highest incidence (62.16%) and with least below 20 years (4%). Ectopic pregnancies were common in multiparous women (78.3%) than primigravida (21.62%). Common symptoms: abdominal pain (82.4%), amennorhea (78.4%), bleeding per vaginum (63.3%), adenexal tenderness (46.2), asymptomatic (12%) patients. Urine pregnancy test positive in 96.4%. Etiology was pelvic infection (15.78%), infertility (7.01%), previous ectopic (8.33%), contraception failure (8.71%), surgeries including LSCS and tubal surgeries (4%). Right sided ectopic was more common. Site of ectopic was common in fallopian tube- ampullary region (88%), cornu (4%) followed by others (8%) then caesarean scar, rudimentary horn pregnancy. About 81.08% of ectopic was ruptured, 3/4th of these patients presented with shock at the time of presentation. Tubal abortions were seen in 4.01% of patients. Most of cases being ruptured ectopic pregnancies, salpingectomy in 72.9% and salpingo-opherectomy in 6.7%. Morbidity was blood transfusion (76.31%), wound complications 4.38 and no mortality.
Conclusions: Early diagnosis, identifying of underlying risk factors and timely intervention in the form of conservative or surgical treatment will help in reducing the morbidity and mortality associated with ectopic pregnancy.
A prospective study of simultaneous myomectomy with cesarean section at a tertiary care hospital
Authors: Sharma Medhavi , Sharma Gaurav , Varshney Shivangi
Published: March 2023

Background: Simultaneous surgical removal of a previously diagnosed myoma during cesarean section is preferred these days to reduce multiple operative procedures. The aim of present study was to determine the safety, cost effectiveness and complications of myomectomy at the time of cesarean delivery and its related peri-operative morbidity.
Methods: This prospective study was conducted in total 50 pregnant cases during the period of 6 months. The analysis focused on age and gender, the number, size and location of fibroids, the need for hysterectomy and blood transfusion.
Results: The mean age of patient was 28.2 years. Out of the 50 patients, 66% were primiparous and only 17% were multiparous. 56% patients underwent caesarean section for indications like primigravida head floating, IUGR, oligohydroaminos. 48% patients had myoma size 2-4 cm. Most of the myomas were located anteriorly (64%). The most common type of leiyomyoma found was subserosal (31%) and 17% with intramural fibroid. Only one patient required post operative blood transfusion whereas none of the patients underwent hysterectomy.
Conclusions: Cesarean myomectomy is a safe and effective procedure and it is a feasible undertaking in experienced hands.
Total laparoscopic hysterectomy in patients with previous caesarean section: experience at a tertiary care center in India
Authors: Minz Archana , Zangmo Rinchen , Deedwania Preeti , Roy Kallol Kumar , Sarkar Avir , Kashyap Deepika
Published: March 2023

Background: With a surge in the rate of caesarean deliveries, the number of patients undergoing hysterectomy with a previous caesarean section for gynecological complaints has also increased. The presence of intra-abdominal and bladder adhesions to the uterus is the main concern in such cases, resulting in higher complication rates. This study aimed to determine the challenges and complications encountered during TLH in patients with previous caesarean sections.
Methods: We conducted a retrospective study analysing data from the medical records of 243 patients who had undergone TLH for various gynecological conditions in a single tertiary care center from January 2018 to January 2021. Patients were categorized into two groups namely no previous CS (n=193) and previous CS (n=50). The surgical outcomes of those patients including major complications were measured.
Results: The clinical characteristics of the two groups were comparable except for the patient’s age with younger patients in the previous CS group (p=0.001). There was no difference in terms of surgical indications, intraoperative and postoperative complications, and hospital stay between the groups. Operating time was significantly more in the previous CS group (p=0.001). One patient sustained a bladder injury in a previous CS group. The conversion rates to laparotomy in the previous CS and no CS groups were not statistically significant. Significant hemorrhage requiring blood transfusion was noted in two patients (4%) in the previous CS group and one (0.51%) patient in the no CS group (p=0.108).
Conclusions: TLH can be safely performed with lower complication rates by an experienced surgeon in patients with prior history of caesarean section.
Analysis of caesarean sections with the Robson’s ten group classification system
Authors: Laya Meka Kamala , Sree M. Vijaya
Published: March 2023

Background: Caesarean section rates are increasing globally. For feedback and audit of the caesarean section rate and its optimization in clinical setups worldwide, there was a lack of a classification tool that can be used internationally for which WHO recommended the Robson classification as a tool for monitoring and auditing caesarean delivery rates in 2016.
Methods: All women who underwent caesarean section in our institute were included in our study. Exclusion criteria include all mothers who underwent vaginal delivery in our institute and those women with missing records. The study population included 82 women who underwent caesarean in our hospital during the January 2022 to December 2022 period.
Results: History of previous section was seen in 45 (54.88%) women. Distribution of all deliveries performed during the study period in accordance to Robsons criteria showed majority of women (29.7%) belonged to category 5a and category 10, followed 21 (25.61%) women in category 1. Data did not categorize any women in category 3 and 7. The most common indication for caesarean seen in our study was previous LSCS seen in 39 (47.56%) women.
Conclusions: According to Robsons criteria group 5 and group 10 were the groups found to be majorly contributing the most to the caesarean section in our study. There is a need to evaluate existing management protocols and further studies need to be conducted into the indications of CS and outcomes in our setting are needed to design tailored strategies and improve outcomes.
Advanced maternal age: maternal and perinatal outcomes
Authors: Sharma Pooja
Published: March 2023

Background: Advanced maternal age is significantly associated with adverse obstetrical outcomes like pregnancy-induced hypertension and preterm Delivery. Caesarean delivery is also increased in those mothers. Advanced maternal age pregnancy was also found to be a major risk factor for low birth-weight and perinatal death.
Methods: A hospital based observational study was conducted with 100 patients on attending antenatal-OPD patients at K. J. Somaiya Medical College and Research centre to evaluate the risks involved with advanced maternal age, the obstetric performance with neonatal outcomes of elderly gravidas aged 33 years or older.
Results: The most common maternal complication was gestational diabetes mellitus (16%), pregnancy induced hypertension (13%), pre-eclampsia (11%), malpresentation (8%), oligohydramnios (6%), placenta previa (2%) and post-partum haemorrhage (2%). Caesarean Section in 39% cases and vaginal delivery in 61% cases. (78%) were term deliveries, (22%) were preterm deliveries. (9%) neonates were very low birth weight [<1.5 kg, (34%) neonates were low birth weight (1.5-2.5 kg)] (36%) and (21%) neonates were in the range of 2.6-2.9 kg and ≥3 kg respectively.
Conclusions: Advanced maternal age is significantly associated with adverse obstetrical outcomes like pregnancy-induced hypertension and preterm delivery. Caesarean delivery was increased in those mothers. Advanced maternal age pregnancy was found to be a major risk factor for low birth-weight, perinatal death. Therefore, it is better for health care providers to counsel couples, who seek to have a child in their later ages, about the risks of advanced maternal age pregnancy.
A rare case of ruptured caesarean scar pregnancy
Authors: Bhatia Pooja , Gupta Radhika , Kaur Manjeet , Pandher Dilpreet K. , Tandon Rimpy , Goel Poonam
Published: March 2023

Caesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy. The incidence is approximately 1:2000 pregnancies and has potentially life-threatening complications. Ours is a rare case of scar ectopic pregnancy who had taken medical termination of pregnancy (MTP) kit while being unaware of her pregnancy location and presented with uterine rupture and hemoperitoneum. A 24-year-old female, P2L2A1, with previous two caesarean section (CS), presented with the complaint of bleeding per vaginum with acute pain abdomen and history of MTP kit intake at 7 weeks’ period of gestation (POG). She received symptomatic treatment at local hospital without any diagnosis being made but brought an ultrasound showing anterior myometrium defect with scar site hematoma and free fluid. She presented with moderate pallor, tachycardia and suprapubic tenderness. She was subsequently taken up for laparotomy in view of probable ruptured CSP. Intra-operatively, actively bleeding scar ectopic was seen with hemoperitoneum. The contents were scooped out and repair done with bilateral tubal ligation. She was resuscitated with adequate blood products. Embryo implantation in the region of a previous CS scar is rare and a delay in either diagnosis or treatment can have catastrophic complications like haemorrhage, rupture and significant maternal morbidity as seen in our case. Therefore, we should have a high index of suspicion of scar pregnancy especially in cases of previous CS so that timely intervention can be done preventing maternal morbidity. Unwarranted use of misoprostol can be deleterious when site of implantation is unknown, particularly in CSP.
Medical management of ovarian ectopic pregnancy- a case report
Authors: B. Ramesh  , Sreenivas Meghana , Madhu Raksha
Published: March 2023

Primary ovarian ectopic pregnancy is a rare type of ectopic pregnancy which has an estimated prevalence ranging from 1:7000 to 1:70,000 accounting for almost 3 % of all ectopic cases. A 37-year-old woman was referred to our hospital intermittent vaginal spotting, recurrent abdominal pain that was getting worse, and 3 days of vaginal bleeding with clot passage. Her general condition was good and her vital signs were normal. She felt tenderness in an abdominal examination and had a small amount of vaginal bleeding. Transvaginal ultrasonography showed an ectopic gestational sac, in her right ovary. Our final diagnosis was ectopic ovarian pregnancy and we successfully treated her with methotrexate. After 3 doses of methotrexate administration her beta human chorionic gonadotropin was negative and a sonographic examination was completely normal. Approximately 3% of all ectopic pregnancies are located in the ovaries. Preoperative diagnosis of this extremely rare condition is challenging, because the ectopic pregnancy often resembles cysts of the corpus luteum.
A drowning abdomen-a case report on acute urinary retention due to retroverted gravid uterus
Authors: Marimuthu Sangeetha , Ushadevi Gopalan  , Divya Ayyanar
Published: March 2023

Acute urinary retention due to retroverted gravid uterus is a rare condition, but serious complication of pregnancy. It usually occurs between 10 and 16 weeks of gestation. We report a case of 26 year old primigravida at 13 weeks of gestation presented to OPD with the complaints of abdominal distension for 30 days and lower abdominal pain associated with burning micturition for 10 days. On examination, abdomen is uniformly distended corresponding to 30 to 32 weeks of gestation which is tense and cystic, on per vaginal examination -features of retroverted uterus felt. Scan showed single intrauterine gestation corresponding to 13 weeks+5days with full bladder. Patient was catheterised and 2.5litre of urine drained. Patient was asked to lie in prone position at least 3-4 times a day. After 1 week patient was symptomatically better, on per vaginal examination uterus returned to midposition.
A case series of cholesteatoma spread in middle ear cleft
Authors: Mohanty Deeganty , Santhaiah Kakumanu , Soujanya Robba Rama
Published: March 2023

Background: This study aimed to describe the spread of cholesteatoma in middle ear cleft.
Methods: The 20 patients diagnosed with chronic otitis media, squamosal type (cholesteatoma) who underwent mastoidectomy exploration were included in this study. The main emphasis was to find out the extent and spread of cholesteatoma into the middle ear cleft.
Results: The result of the study showed 50% of cases spread to middle ear cavity (20% -meso tympanum, 15%-sinus tympani,15%-facial recess), 20% into the attic, 30% into adits, antrum and mastoid air cell system.
Conclusions: All of our patients underwent mastoid exploratory surgery. In half of the cases, the cholesteatoma was restricted to middle ear cavity, while in remaining 50% it has extended to attic, aditus mastoid antrum and mastoid air cells. Disease clearance was effective with no post-operative complication or recurrence in first 50% cases. Other 50% of cases required extensive surgery for disease clearance.
Fine needle aspiration cytology in head and neck masses, assessment of need for incision/excision biopsy
Authors: Yenkure Priyanka , Pore Shubhajyoti , Joshi Anil , Kaur Damandeep
Published: March 2023

Background: FNAC is a rapid, simple, cost-effective, and minimally invasive technique used to diagnose different types of swelling occurring in head and neck masses, and assess its need for biopsy.
Methods: The study included 650 patients, who presented with palpable head and neck swelling over a period of 18 months, at our hospital. FNAC procedure has been performed and smears are stained with Papanicolaou stain, Gemisa stain, and H and E stain. Cyto-histopathological correlations were done to evaluate the need for a biopsy.  
Results: Out of 650 cases, lymph node lesions constitute 370 cases (56.90%) most commonly involved. Thyroid gland lesions constitute 189 cases (29.10%) followed by salivary gland lesions 38 cases (5.80%), and other 53 cases (8.20%). Histo-pathological correlation of 116 cases were done out of 650.
Conclusions: FNAC serves as a guide to appropriate therapeutic management whether to locally excise a benign tumor or plan radical surgery and helps as an adjunct to histopathology.
A case series of rare sinonasal tumors
Authors: Jagtap Shruti Kishor , Nemade Sanjana Vijay
Published: March 2023

Sinonasal tumors often mimick inflammatory diseases. If misdiagnosed, results are life threatening. This article comprises of study done on 5 patients who presented with nasal mass. They underwent clinical examination, diagnostic nasal endoscopy, radiology and histopathological examination (HPE). Thorough evaluation helps the surgeon diagnose rare cases thus preventing detrimental outcomes. Herein we describe our experience with rare tumors like glomangiopericytoma, embryonal rhabdomyosarcoma, small cell sinonasal carcinoma, inverted papilloma and sinonasal undifferentiated carcinoma (SNUC).
Correlating condylar dimensions with growth pattern: A radiographicstudy
Authors: Ray Saugat , Datana Sanjeev , Singh RP
Published: March 2023

As lateral cephalograms are one of the mandatory pretreatment diagnostic radiographs for identifying the structural changes of the craniofacial skeleton including the mandibular condylar region, the present study attempts to evaluate the condylar dimensions in skeletal Class I cases with three different growth patterns using lateral cephalograms.

This study aimed to evaluate the dimensions of the mandibular condyle and to determine any correlation with growth patterns in skeletal Class I patients.

This retrospective study was conducted on the lateral cephalogram of the patients reported for orthodontic treatment. After applying inclusion and exclusion criteria 60 lateral cephalograms were selected and distributed in three groups. The measurements of condylar neck length, condylar neck inclination, condylar width, and ramal length were measured on lateral cephalograms.

The mean condylar dimensions were 12.18 ±1.44 mm of condylar width, condylar neck length of 16.82 ± 3.23 mm, and condylar inclination of 114.43⁰ ± 13.98⁰. The differences in condylar width among the three groups were not statistically significant. Pearson correlation reveals a statistically highly significant positive correlation between condylar neck length and ramal length. The condylar inclination was negatively correlated with the condylar neck length and ramal length but was not statistically significant.

Within the scope of this study, it can be concluded that condylar width does not have a significant correlation with growth patterns. With the increase in condylar neck length, the overall ramal length also increases. There exists a negative correlation of condylar inclination with ramal length and condylar neck length but it was statistically not significant.
Presurgical naso alveolar moulding in a bilateral cleft lip and palate patient- A case report
Authors: Bhatia Virag , Chauhan Jaideep Singh , Dwivedi Swati , Nanda Smruti Bhusan , Bhaxi Shalabh
Published: March 2023

One third of all craniofacial anamolies of head and neck region are of cleft lip and palate with an incidence of 1 in 700 worldwide. In Asian population the reported incidence is 2.0 per 1000 live births or higher. This case report presents the treatment of a 1-month old bilateral cleft lip and palate baby with Presurgical Nasoalveolar Molding, which was followed by chelioplasty.
Parasites observed in urine sediments: A learning from incidental rare species
Authors: Raj Swati , Yadav Alka
Published: March 2023

Parasitic infection becomes an unsolved problem in using of automated instruments for urinalysis. Most common parasitic infections described in literature are Trichomonas vaginalis, Schistosoma hematobium and Microfilaria. Other rare organisms are Balantidium coli and Paramecium. The main purpose of this article is to raise the awareness in pathologists and clinicians on the importance of cytological evaluation of urine. This study was done to find the associations between the age and point prevalence of organisms in our zone in the last 6 years. Identification of parasites in centrifuged deposits of urine sediment is a relatively rare occurrence in clinical practice. A fairly wide morphological spectrum of parasites may be diagnosed through microscopic examination of centrifuged urine sediment. They may present with symptoms like pyuria, hematuria, diarrhoea, burning micturition, itching and morphological awareness helps in prompt and effective management in most cases.
Análisis ergonómico de trabajo en una clínica de cuarto nivel para operarios de servicios integrales de aseo: un estudio de caso
Authors: Garzón Leal Diana Carolina , Giraldo Luna Clara Margarita , Cantor Melgarejo Héctor Andrés , Mora Monsalve Jossielyn Andrea , Yepes Boada Alexandra
Published: March 2023

La labor de limpieza es una tarea que se realiza a nivel mundial en diferentes ambientes y lugares, entre los cuales están los sectores privados y públicos en las diferentes industrias. De acuerdo con la Clasificación Nacional de Ocupaciones, las principales tareas de los aseadores están relacionadas con limpiar y preparar habitaciones para ser ocupadas; limpiar y desinfectar muebles y baños, recoger basura y vaciar los recipientes de desperdicios, lavar ventanas y paredes, barrer, trapear, lavar, encerar, sellar y brillar pisos, preparar los implementos de aseo requeridos en el desarrollo de sus actividades, entre otras. Por lo tanto, el objetivo de la limpieza puede describirse “como la contribución al mantenimiento de trabajo higiénico y ambientes públicos”. De acuerdo con la revisión de literatura, hay aproximadamente 3 millones de limpiadores en la Unión Europea, mientras que, en Estados Unidos, más de 4 millones de personas desempeñan esta labor. En ambos casos, esta tarea es realizada en su mayoría por mujeres. Los trabajadores quienes realizan la limpieza tienen un nivel educativo y estatus social bajo, las habilidades que se requieren para desempeñar dicha labor, son adquiridas durante el trabajo, evidenciando que son labores que no requieren educación o formación especializada. Los principales factores de riesgo en la labor de limpieza y aseo están relacionados con la carga física de la tarea, los movimientos repetitivos en miembro superior, posturas prolongadas, levantamiento y transporte de carga, lo que genera fatiga y desarrollo de desórdenes musculoesqueléticos.
Recent Increase in HIV cases in Oman
Authors: Elgalib Ali , Shah Samir , Al-Habsi Zeyana , Al-Fouri Maha , Lau Richard , Al-Rawahi Bader , Al-Abri Seif
Published: March 2023

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APPLIED IMPERATIVES FOR THE FORMATION OF AN EFFECTIVE MECHANISM FOR MAKING AND IMPLEMENTING MANAGEMENT DECISIONS AT ENTERPRISES IN THE CONDITIONS OF MARKET TRANSFORMATIONS
Authors: Vlasenko Valentyn
Published: March 2023

The methodological and practical recommendations for the formation of an effective mechanism for making and implementing management decisions at enterprises in the modern transformation period are substantiated. For this purpose, the author’s version of the stages of formation of the mechanism of development and management decision-making at the enterprise is recommended, with the allocation of four stages: diagnostic, research, selection of the final version of the decision, and evaluation of the adopted decision. Within the framework of the system approach, a plan for conducting a diagnostic study aimed at evaluating the effectiveness of the management system and the process of making management decisions were proposed. The stages of formation of the mechanism of implementation of management decisions at the enterprise were considered, which made it possible to distinguish five components in its structure: subjects of implementation of the management decision, target, methodological, functional, process and providing components.
SOCIAL ENTREPRENEURSHIP AS A TOOL TO ACHIEVE THE GOALS OF SUSTAINABLE DEVELOPMENT
Authors: Ilchenko Viktoriia
Published: March 2023

The purpose of the article is to position social entrepreneurship as a tool for achieving the goals of sustainable development. Modern realities position social entrepreneurship as one of the effective and important tools for finding innovative approaches to solving social problems of both civil society and small and medium-sized businesses. The research consists in the positioning of social entrepreneurship as an innovative form of business, in its ability to introduce innovations, economic and social solutions to social problems, including poverty, support of vulnerable sections of society, environmental protection, protection of human rights, energy security, preservation and restoration of land resources, uneven distribution of capital, etc. The lack of resources in the state budget and funding of the social sphere based on the residual principle encourages people and communities to become more active and look for innovative approaches to solving their problems. A socially oriented business is able to contribute to the solution of environmental, social and economic problems, which are targeted by the Sustainable Development Goals. Social enterprises develop and disseminate new approaches to achieving the Global Sustainable Development Goals at the local level, starting with the lowest link – each member of the community, using both traditional business practices and innovation. Implementation of the policy of socially responsible enterprises and business ensures the competitiveness of the national economy. Without the implementation of the policy of socially responsible enterprises and business as a whole, it is impossible to ensure the competitiveness of the national economy. Social responsibility in the context of the introduction of sustainable development is a necessary condition and quality of the system of social interaction between social subjects at all levels of management. The competitiveness and image of the enterprise are largely determined by the level of socially responsible relations both within the enterprise itself and in the system of external relations. The more social enterprises operate in the country’s economy, the higher is the overall result of economic activity in the economic system and the more tangible is its social effect.