bluuebunny/crossref_metadata_2025 huggingface dataset:
A re-look into intra-operative impediments and post-operative morbidities in repeat caesarean section
Authors: Subramanian Supraja , Chugh Amey , Bal Himadri
Published: July 2023

Background: Repeat caesarean sections are known to be a cause of significant morbidity in both intra and post-operative period. The challenges faced by the surgeon may include adhesions, difficulty in delivery of foetus, visceral injury and bleeding. The post-operative recovery may be marred by problems such as post-partum haemorrhage, febrile morbidity, wound infections and the after effects of intra-operative visceral injury. It is these issues that often make repeat caesarean section a cause for concern and delay the recovery of the mother.
Methods: At random, hundred ante-natal patients visiting the obstetric OPD, meeting the inclusion criteria of previous caesarean section and planned for repeat caesarean section were selected and all the data were collected and tabulated.
Results: After careful analysis of the data, it is observed that the intra-operative findings of adhesions, placenta praevia and excessive blood loss were encountered in relook caesarean sections. Similarly post operative morbidity in the form of wound infection and fever were observed in the same study population.
Conclusions: If we are more vigilant and restrict the number of primary caesarean sections to evidence based appropriate indications, we may be successful in reducing the number of repeat caesarean sections and thereby mitigating the subsequent hardships for the mother.
Ultrasonographic placental localisation and extent of invasion in scarred versus non-scarred uterus and its correlation with obstetrical outcomes: a prospective study
Authors: Pathak Anu , Gupta Ayushi , Singh Saroj , Agarwal Neha
Published: July 2023

Background: The site of implantation and resultant location of the placenta within the uterus are likely important determinants of placental blood flow and therefore pregnancy success. Abnormal placental implantation or ‘placental invasion’ is a rare, but potentially life‐threatening, complication in the third stage of labour. Currently massive obstetric haemorrhage remains one of the leading causes of maternal mortality.
Methods: 140 antenatal women at ≥34 weeks of gestation were selected, out of which 70 had the history of previous caesarean section and 70 had the history of previous vaginal delivery. Detailed USG was done with special emphasis on edge to os distance (EOD), extent and depth of invasion of placenta. All cases were followed till delivery and their intraoperative assessment done and correlated with sonographic findings and obstetrical outcomes.
Results: With increasing number of previous caesarean section, depth and extent of invasion of placenta increases and edge to os distance (EOD) decreases. 8.5% cases with previous 1 caesarean section, 22.22% cases with previous 2 caesarean section and 50% cases with previous >2 caesarean section had some adherence of placenta.
Conclusions: Uterine scar increases chances of low implantation of placenta as well as its adherence as compared with unscarred uterus. This risk increases with number of caesarean sections. These high-risk cases of scarred uterus especially those with multiple scars should be subjected to detailed sonographic scan by expert radiologist.
Neonatal outcome in early term and late term pregnancy
Authors: Gupta Garima , Dwivedi Seema , Agarwal Rijul , Rajput Anand , Sharma Karishma , Dwivedi Divya
Published: July 2023

Background: Full-term neonates born between 37- and 41-weeks’ gestational age have been considered a homogeneous, low-risk group. However, recent evidence from studies has pointed toward increased NICU admissions and morbidity associated with births (37-38 weeks) compared with term neonates (39-41 weeks). The objective of this study was to compare the short-term morbidity of early-term vs term neonates in a county-based birth cohort using the primary objective of admission to a neonatal intensive care unit (NICU) or neonatology service.
Methods: Retrospective observational population-based 2 year birth cohort study at Department of Obstetrics and Gynecology GSVM Medical College, Kanpur. All full-term live births comprised the birth cohort; this information was obtained from the hospitals’ perinatal databases, and data pertaining to NICU, or neonatology service admissions were extracted from individual medical records.  Gestational age of early term (37 0/7-38 6/7 weeks) verses term (39 0/7-4 10/7 weeks). Admission to the NICU or neonatology service.
Results: There were 17,132 live births during the 2 year period, of which 13679 had a gestational age between 37 and 41 weeks. Of all live births, 6204 (45.3%) were early term. Compared with term infants, early-term neonates had significantly higher risks for the following: hypoglycaemia (29.9% verses 14.7%), NICU or neonatology service admission (20.9% vs12.05 %), need for respiratory support (36.8% verses 29.9%), treatment with intravenous antibiotics [39.4% verses 25. Delivery by caesarean section was common among early-term births (45.9%)].
Conclusions: Early-term births are associated with high neonatal morbidity and with NICU or neonatology service admission. Evaluation of local prevalence data will assist in implementation of specific preventive measures and plans, as well as prioritize limited health care resources.
A study on lactate dehydrogenase levels in hypertensive disorders of pregnancy and its correlation with feto-maternal outcome
Authors: Preet Adarsh , Anand Ashok R.
Published: July 2023

Background: Hypertensive disorders of pregnancy are one of the most common medical disorders seen during pregnancy. Lactate dehydrogenase (LDH) is an intracellular enzyme. The objective of this study was to compare lactate dehydrogenase levels in women with hypertensive disorders of pregnancy and normal pregnant women, to correlate lactate dehydrogenase levels with complications of hypertensive disorders of pregnancy and role of lactate dehydrogenase as an early predictor of hypertensive disorders of pregnancy.
Methods: A study was conducted in the department of obstetrics and gynecology at JJ group of hospitals, Mumbai, India for a duration of 18 months from January 2020 to June 2021. This study has a sample size of 500 antenatal patients. Necessary information such as their detailed clinical, and obstetric history, clinical examination, investigations was noted. LDH were measured at 12-16 weeks of pregnancy and at the time of delivery.
Results: In our study, the incidence of hypertensive disorders of pregnancy was 10.2% There was no association between LDH levels at 12-16 weeks of gestation and development of hypertensive disorders of pregnancy. There was association between levels of lactate dehydrogenase levels at time of delivery and severity of hypertensive disorders in our study. Higher serum LDH levels were associated with increased incidence of maternal and fetal complications like abruption placenta, HELLP syndrome, IUGR, IUFD, prematurity and oligohydramnios in our study.
Conclusions: Hypertensive disorders of pregnancy are one of the medical conditions affecting pregnancy. Lactate dehydrogenase levels at 12-16 weeks of gestation is not early predictor of hypertensive disorders of pregnancy. Serum lactate dehydrogenase levels at time of delivery helps in prediction of severity of disease, adverse outcomes and complications of hypertensive disorders of pregnancy. Hence lactate dehydrogenase acts as prognostic factor in hypertensive disorders of pregnancy.
Antenatal screening for thalassemia carrier at tertiary care centre
Authors: Kumari Sarita , Seth Princee , Gehlot Hanslata
Published: July 2023

Background: Thalassemia syndromes are the commonest genetic disorders of blood and constitute a vast public health problem with 2.78 to 4% prevalence in India. The most effective and feasible approach to reduce the incidence of thalassemia major is implementation of carrier screening program to screen the antenatal women in early pregnancy.
Methods: Institutional based cross sectional observational study was conducted. We screened 400 antenatal women by performing preliminary test red cell indices, Mentzer index and confirmatory test by high performance liquid chromatography. Husbands of positive women were also tested to find out couples on risk.
Results: Out of 400 antenatal women screened, 46 required HbA2 estimation, and 11 (2.8%) were diagnosed as β-thalassemia minor positive. Most of thalassemia minor positive women were primigravida and mean (SD) age and gestational age of these women was 23.8 (3.1) years and 11.8 (1.7) weeks, respectively. Amongst thalassemia minor positive women most were mild to moderately anemic and these women had significantly greater mean TRBC count. Ninety one percent of thalassemia minor positive women had MCV<77. All of thalassemia minor positive women had MCH<27. Eighty two percent of thalassemia minor positive women had MI<13. None of couple at-risk was detected. So, prevalence of thalassemia carrier was 2.8%.
Conclusions: Thalassemia is a monogenetic disorder with autosomal recessive streak. Universal screening in antenatal window by complete blood counts, hematological indices (MCV, MCH, TRBC), Mentzer index and HPLC may lead to non-pyrrhic victory over this odious entity.
Knowledge, attitudes, and practices regarding HIV/AIDS among pregnant females attending the antenatal clinic: a study at Dr. S. N. Medical College in Jodhpur, India
Authors: Manisha  , Yadav Ritu , Shaheen Rizwana
Published: July 2023

Background: AIDS, caused by HIV, is a global health threat that weakens the immune system and leads to life-threatening infections. India has been heavily affected by the HIV/AIDS epidemic due to a lack of accurate information and prevention efforts. Mother-to-child transmission (MTCT) is a significant factor in HIV spread. Knowledge of HIV status through voluntary counseling and testing (VCT) is crucial. Despite efforts, HIV/AIDS remains a major public health challenge in India.
Methods: A study at Dr. S.N. Medical College focused on pregnant women in the antenatal clinic. Using a questionnaire, data was collected from 100 participants on socio-demographics, HIV/AIDS knowledge, attitudes, and practices.
Results: Most participants were aged 21-30, with 48 having 6-10 years of education. The majority identified as Hindu, and 89 were housewives. The study revealed gaps in HIV/AIDS knowledge, with many participants lacking awareness and having misconceptions. Stigma and fear were also prevalent, but recognition of abstinence as a preventive measure was observed.
Conclusions: Targeted interventions, education, and awareness campaigns are necessary to enhance knowledge, dispel misconceptions, and reduce HIV/AIDS stigma among pregnant women in antenatal clinics. Policies, programs, and preventive strategies should be developed to reduce HIV/AIDS incidence and prevalence. Future research should address knowledge gaps, promote understanding of HIV/AIDS, and focus on preventing mother-to-child transmission, ultimately working towards ending AIDS as a public health threat.
A cross sectional study of pregnancy outcome in women with recurrent pregnancy loss
Authors: Priyadarshinee Lipsa , Meetei Laishram Trinity , Singh Leimapokpam Roshan , Longjam Nirmala , Singh M. Rameswar , Devi Phurailatpam Rupabati , Sen Sayan , G. Rakshita , Bharathi S. Dhivya
Published: July 2023

Background: Recurrent pregnancy loss occurs in approximately 1-2% of reproductive aged women. Aetiology is unknown in approximately 50% of RPL. Common established causes include uterine anomalies, antiphospholipid syndrome, hormonal and metabolic disorders, and cytogenetic abnormalities. Maternal age and number of previous miscarriages are two independent risk factors. The study was conducted to determine the pregnancy outcomes in women with history of recurrent pregnancy loss.
Methods: A hospital based cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Regional Institute of Medical Sciences, Imphal. The study was carried out during a period of 2 years with effect from September 2019 to August 2021.
Results: A total of 116 pregnant women with history of recurrent pregnancy loss were included in the study. The mean age among participants was 30.28±5.48 years. The average number of abortions prior to this pregnancy was 2.53±1.02. About 85.34% had spontaneous onset of labour and nearly equal proportion of (48.27% and 46.56%) of the participants delivered by NVD and CS. Maternal complications were present in 51.72%. Most common were hypertensive disorder (12.06%) and preterm labour (12.06%). Fetal complications were observed in 22.4% of newborn, commonest being low birth weight.
Conclusions: Women with history of recurrent pregnancy loss encountered increased adverse maternal complications however fetal complications were similar to that of the general population. The definition, diagnosis and treatment of patients with a history of RPL remains difficult. Increased antenatal surveillance to reduce the risk of pregnancy complications with better screening of the obstetrical history and the necessary investigations to identify a treatable cause associated with previous miscarriages can lead to early prophylactic interventions for a better outcome.
Spectrum of rudimentary horn pregnancy: a case series
Authors: Arvindar  , Sen Sangeeta , Bilwal Bharat
Published: July 2023

Uterine malformations are the results of abnormal mullerian duct development -fusion, canalization, and septal defects. A unicornuate uterus with a rudimentary horn is one such anomaly of the uterus occurring due to fusion defects. It is associated with a high rate of spontaneous abortion, preterm labor, intrauterine growth retardation, intra-peritoneal haemorrhage, and uterine rupture. We have three cases of rudimentary horn pregnancy of which: the first one was in the first trimester and diagnosed before rupture and managed by excision of the rudimentary horn; the second one was diagnosed after a rupture in the first trimester and managed by surgical excision; and the third one was diagnosed as an obstetric emergency as a second-trimester rupture of rudimentary horn pregnancy. It was managed by initial resuscitation followed by complete excision of the rudimentary horn. Despite advances in ultrasound technology, the antenatal diagnosis of a rudimentary horn pregnancy remains difficult for inexperienced physicians. A high index of clinical suspicion for uterine malformations early in gestation can reduce the mortality rate, along with early intervention. When a rudimentary horn pregnancy is diagnosed, the excision of the horn with ipsilateral salpingectomy is the recommended surgical treatment for the best prognosis. This case series highlights the need for high clinical suspicion of this rare condition.
Post-partum right ovarian vein thrombosis mimicking acute appendicitis: a rare entity
Authors: Talreja Deep Parkash , Talreja Rani Bai , Elsayed Ahamed M. , Albatanony Ayman A.
Published: July 2023

Postpartum ovarian vein thrombosis (OVT) is a rare condition that must be distinguished from other causes of acute abdominal pain because it presents with non-specific, predominantly lower abdominal pain. If the right ovarian vein is involved, pain would be predominantly right-sided and may be missed for acute appendicitis. OVT has been reported to occur in 0.05% to 0.18% in the postpartum period following normal vaginal deliveries, and in up to 2% following caesarean sections. Untreated, postpartum OVT can lead to serious consequences such as sepsis, pulmonary embolism, and even death. We share a case that was admitted to our hospital with symptoms of acute appendicitis that proved later to be due to postpartum ovarian thrombosis. A 28-year-old woman was admitted to our hospital on her 4th postpartum day, following a spontaneous vaginal delivery of a live born full term female baby, complaining of anorexia, nausea, and abdominal pain in her right lower quadrant accompanied by low grade fever. On examination, she appeared ill and had a significant tenderness in her right lower quadrant. An ultrasonography did not reveal any abnormality and did not visualize her appendix. Patient was referred to a consultant gynecologist and was discharged as having no obstetric nor gynaecological cause of her complaint. Patient was admitted to general surgery department where a venography CT of her abdomen confirmed a thrombus in the right ovarian vein with a normal appendix. Blood tests were positive for anticardiolipin. Patient was treated conservatively and responded well to treatment with low molecular weight heparin and antibiotics. OVT is a rare disease, occurring mostly in the postpartum period. Rapid diagnosis is needed to prevent serious consequences and unnecessary surgical procedures, especially when mimicking an acute abdomen.
A rare case report of intraoperative diagnosis of ovarian ectopic pregnancy, managed surgically
Authors: Tambe Saylee , Dalmia Rachana
Published: July 2023

Ovarian ectopic pregnancy (OEP) accounts for <1% of ectopic pregnancies. Its underlying etiology is likely secondary to fertilized oocyte reflux to ovary. The study represents left adnexa mass query ectopic. The patient was successfully treated by exploratory laparotomy with intraoperative findings suggestive of left ovarian ectopic with resection of gestational sac and left oopherotomy.
Spontaneous heterotopic pregnancy: a rare possibility
Authors: Chavan Komal N. , Mayadeo Lalita N. , Sontakke Priya N. , Rathod Heena V.
Published: July 2023

Heterotopic pregnancy is defined as a condition when intrauterine and extrauterine pregnancy occur simultaneously. It is a life-threatening condition that requires immediate and accurate diagnostics and treatment. We present the case of a 34-year-old multigravida in her 7 weeks of gestation came to emergency ward with complains of pain in abdomen for 3 days. Ultrasonographic examination showed a live intrauterine pregnancy and mild to moderate free fluid in abdomen with moving internal echoes. An emergency exploratory laparotomy done and left sided tubal ectopic removed along with right salpingectomy as patient was willing for family planning. A high index of suspicion is required to diagnose Heterotopic pregnancy as clinical as well as radiological findings may be insufficient for diagnosis.
Acute abdomen in pregnancy, not to forget twisted ovarian cyst: a case report
Authors: Gadre Sandhya , Chaudhary Gunjan , Khurrum Fareena
Published: July 2023

Aim of the study was to present a case of acute abdomen in pregnancy with twisted ovarian cyst which is a rare entity. A primigravida with period of gestation 25 weeks presented to casualty with acute abdomen. Her USG Doppler revealed findings of ovarian mass of around 9 by 6 cm which underwent torsion. Patient was taken up for emergency laparatomy. Per operatively right sided tubo-ovarian mass-9×8×5 cm, dumbell shaped, fleshy, hemorrhagic and necrosed with one twist over the pedicle seen separate from the uterus. Left side tubes and ovaries seen normal, uterus-26-week size. Frozen section revealed benign pathology. Postoperatively patient was done well and delivered a healthy baby at term via cesarean section. High index of suspicion, regular antenatal follow up and analysis of related risk factors, early and prompt diagnosis and timely intervention in cases of ovarian torsion in pregnancy can change feto-maternal outcome. Meticulous planning and timely intervention under multidisciplinary care team at a tertiary care centre reduces feto-maternal morbidity and mortality.
Pregnancy in rudimentary horn
Authors: Gadekar Madhura S. , Arrawatia Aakanksha , Yadav Ojaswini
Published: July 2023

Pregnancy in rudimentary horn is rare occurrence with incidence of less than 1 in 150,000. Pregnant rudimentary horn can present with wide range of symptoms that may be similar to ectopic pregnancy or may remain silent with features of normal pregnancy. Management is typically resection of the rudimentary horn and the ipsilateral fallopian tube by either laparotomy or laparoscopy.
Caesarean scar ectopic pregnancy and laparoscopy: a rendezvous
Authors: Dutta Annesha , Koley Murari Mohan , Kumaradasan Sunanda , Alam Mahfooz
Published: July 2023

Caesarean scar pregnancy (CSP) is defined as an implantation of pregnancy in a fibrous tissue scar of a previous caesarean section, one of the rarest forms of ectopic pregnancy which can be life threatening. The incidence of CSP is steadily rising in view of increasing caesarean section rates. A very high index of clinical suspicion is required for the diagnosis and further management. As with other ectopic pregnancies, caesarean scar ectopic pregnancy pose a greater risk for maternal haemorrhage and ultimately maternal mortality. Through this case report, we demonstrated the laparoscopic management of a CSP.
Shifting paradigms in uterine fibroids treatment: insights from current therapeutic approaches
Authors: Vázquez Ruvalcaba Aranza , García Aurora Guadalupe García , Cornejo Morelia Yunuen López , Palacios Avhril Alejandra Morales , Vespero Fernando Hernández
Published: July 2023

This review examined the effectiveness of ulipristal acetate (UPA) compared to leuprolide acetate (LEU) in the treatment of symptomatic uterine fibroids. The primary objective was to analyze relevant studies that investigated the improvement of symptoms, complications, alternative treatment options, and surgical outcomes for fibroids. Using the PICO format as a research approach, various aspects were compared for each treatment, including diagnostic accuracy, side effects, quality of life, and patient satisfaction measured through the Uterine fibroid symptoms and quality of life scale. UPA proved to be a safe, well-tolerated, and effective treatment option for symptomatic uterine fibroids, leading to amenorrhea and reduced heavy menstrual bleeding. On the other hand, LEU also effectively reduced fibroid size but had a higher incidence of adverse events such as hot flashes, vaginal dryness, and decreased bone density. It is crucial to consider all the aforementioned factors when selecting the most suitable treatment option for individual patients, as each treatment has its own advantages and disadvantages, including dosing requirements, side effects, endometrial changes, and their impact on treatment adherence and outcomes. Currently, there is limited evidence supporting the superiority of UPA over other drugs like LEU in short-term therapy for symptomatic uterine fibroids. Further research is necessary to establish UPA as a reliable and promising alternative. Treatment decisions should be individualized, taking into account patient comorbidities and considering both surgical and conservative approaches.
Early outcome of surgery, triamcinolone and silicone gel combination therapy for earlobe keloid: our local experience
Authors: Aigbonoga Oshiozimede Quincy , Awe Oluwafemi Olasupo , Okomayin Andrew Akarutu
Published: July 2023

Background: Earlobe keloids cause facial disfigurement, physical, emotional and psychological burden to patients, while posing an intriguing treatment challenge to the plastic surgeon. Different options of combination therapy have been used in the treatment of earlobe keloids with varied success rates.    
Methods: This interventional prospective hospital-based study was carried out in Irrua Specialist Teaching Hospital, Irrua, Edo State, over a 15-month period (October 2017 to December 2018). Forty-two patients with earlobe keloids who met the inclusion criteria were serially recruited into the study. Forty-eight earlobe keloids in 41 patients had the intralesional excision biopsy, intralesional triamcinolone injection and silicone gel combination therapy. A modified Sharquie et al’s scar grading system was applied pre-intervention to record the baseline scores and post-intervention to evaluate the patients’ rate of response. Post treatment complications were identified, and the patients were followed up for six months.
Results: Most of the patients with earlobe keloids fell in the age group 21-30 years and the male-female ratio was 1:19.5. Multiple earlobe piercing had significant association with the development of earlobe keloids. 95.8% of treated lesions had complete response to therapy. Two (4.2%) patients had dyschromia following treatment.
Conclusions: The triple therapy combination of intralesional excision biopsy, postoperative intralesional triamcinolone injection and topical silicone gel application is a readily available, safe and efficacious treatment modality for earlobe keloids. Thus, it can be used as a first-line treatment modality.
Comparing clinical outcomes between patients receiving non-absorbable and delayed absorbable sutures for abdominal wound closure after laparotomy
Authors: Shah Rabin Pratap , Sah Lakhan Lal , Pandit Rakesh Kumar
Published: July 2023

Background: There is a lot of debate about the best suture for repairing the abdominal fascia post-laparotomy. This research compared the clinical results of patients who received non-absorbable versus delayed absorbable sutures for abdominal wound closure after laparotomy.
Methods: We conducted a prospective non-randomized clinical trial in the Department of General Surgery, Janaki Medical College and Teaching Hospital, Janakpur, Nepal. We included patients aged more than 18 years who underwent an elective laparotomy surgery with midline vertical incision for any indication between April 2020 till March 2022 in our department. Two study groups were formed: non-absorbable suture (polypropylene suture) and delayed absorbable suture (polydiaxanone suture).
Results: The two study groups were similar with respect to indication of surgery (p value = 0.52). Bowel was opened in 81% in non-absorbable group and in 85% in delayed absorbable suture group. Mean duration of surgery was found to be significantly lower in the delayed absorbable suture group as compared to non-absorbable suture group (185±21.8 vs. 232±27.3 minutes, p value < 0.05). Post-operative complications included surgical site infection, burst abdomen, incisional hernia and sinus formation. It was observed that surgical site infection rate was significantly higher among non-absorbable suture group patients as compared to delayed absorbable suture group (25% vs. 13%, p value <0.05).
Conclusions: Comparing early and late post-operative complications, there was no statistically significant difference between non-absorbable suture group and delayed absorbable suture group.
Comparative study of outcomes between application of negative pressure wound therapy to split skin graft versus split skin graft immobilized by traditional bolster dressing
Authors: Agrawal Naveen
Published: July 2023

Background: SSG is a versatile technique used for the reconstruction of wounds. The conventional techniques like traditional bolster dressing (TBD) to secure graft have been in use since the long time for the management of these wounds. NPWT is an effective advanced therapy which increase graft take by providing negative pressure to seal the space and provide persistent and uniform pressure.
Methods: 60 patients were enrolled in the study. In the TBD group (30 patients) a bolster was placed on the graft which was made using a nonadherent dressing. In the NPWT group (30 patients) the SSG was secured using circumferential staples, followed by placement of VAC dressing with continuous negative pressure. Percentage of graft take assessed on 5th, 7th and 9th postop day.
Results: Graft take on day 5th with NPWT group was 83.16±4.1% and in TBD group was 78.12±3.76%. On day 7th with NPWT group was 89.83±4.12% and in TBD group was 84.33±4.66%. On Day 9th with NPWT group was 96.33±5.3% and in TBD group was 92.67±5.24%. In NPWT group, mean Post SSG days were 9.9±0.61days. In TBD group, mean Post SSG days were 13.03±1.4 days.
Conclusions: Our study suggest that Application of NPWT on SSG is beneficial in terms of better graft take, lesser infection, shortened post graft hospital stays and less no who needs for redo SSG and it is particularly useful anatomically challenging sites.
Management of cutaneous melanoma: update on current treatment from surgical perspective
Authors: Salman Muhammad , Meccano Christina , Salman Mehwish
Published: July 2023

Incidence and mortality rate of cutaneous melanoma substantially varies across the globe depending upon early detection and management. Therapeutic developments have revolutionized the treatment. The aim of this paper is to discuss the treatment options for localized and advanced disease in the context of surgery, adjuvant, and neoadjuvant treatment. PubMed, Medline, Guidelines of European Society of Medical Oncology, National Institute of Clinical Excellence, American Joint Committee on Cancer on Melanoma, publications from 2012-2022 were searched. Low risk node negative disease (stage I and IIA) melanoma patients should have curative surgical wide local excision along with SLNB with no adjuvant therapy. High risk node negative disease (stage IIB and IIC) should be treated with curative surgery and SLNB followed by adjuvant immunotherapy. Low risk node positive disease (stage IIIA) surgical resection with SLNB followed by adjuvant systemic therapy, depending upon BRAF mutation status of tumour. High risk node positive microscopic disease (stage IIIB, IIIC, IIID) BRAF V600 mutation, primary resection with SLNB followed by nivolumab or combination of BRAF + MEK inhibitors. For BRAF wild-type tumours, adjuvant immunotherapy with programmed cell death-1 (PD-1) inhibitor. Patient with macroscopic disease that is resectable neoadjuvant combination immunotherapy followed by surgery with lymph node dissection. Metastatic disease (stage IV) regardless, adjuvant combination immunotherapy followed by maintenance nivolumab. Surgical excision is the treatment of choice for most patients with loco regional cutaneous melanoma and is curative in most cases. Checkpoint inhibitors and targeted therapies are important advances in adjuvant, neo adjuvant settings. Despite all the progress, melanoma remains challenging to treat.
Aesthetic outcomes of oncoplastic surgical techniques in large benign lump of breast using breast Q tool
Authors: Singh Manju , Shrimor Prachi , Sharma Sweta
Published: July 2023

Large benign breast tumors encompass an array of conditions resulting in breast asymmetry with significant physical and mental morbidities. Breast oncoplasty, in these conditions have better aesthetic outcomes. Here, as the opinion of the patient is superior when compared to subjective opinion of the surgeon, breast Q tool, can be a tool to assess outcomes after using oncoplastic techniques. The following case series includes 20 patients admitted with large benign lesions of breast undergoing oncoplastic surgery, who were assessed to evaluate their satisfaction with breast, nipples, information surgeon and medical team, before and after breast oncoplasty, using breast Q tool version 2.0 reduction mastopexy module, where pre-operative and post operative scores are noted and also converted into equivalent RASCH scores (statistical analysis used: statistical package for the social sciences (SPSS) v.20 software). From the case series it was found that the average pre-operative scores for satisfaction with breasts was 21.95 and post-operative score was 42.95 (p value of 0.0001). Majority of patients had maximum scores for satisfaction with nipples (47% with breast Q score of 20 out of 20), satisfaction with outcome (45% with RASCH score of 100 and 55% with RASCH score of 92), satisfaction with information (55% with RASCH score of 100) and satisfaction with medical team (75% with RASCH score of 100). It was clearly noted that from breast Q tool for reduction mammoplasty, there was excellent post-operative satisfaction among patients across various domains, when oncoplasty is employed for large benign breast diseases.
A rare case presentation of combined enteric duplication cyst both tubular and cystic
Authors: Kamble Pavan , Shah Darshi , Vasavada Dharmesh P.
Published: July 2023

Enteric duplication cyst are rare congenital malformations of children and can develop anywhere along the gastrointestinal (GI) tract being ileum the most frequent location, they don’t communicate with GI lumen. They are usually detected prenatally or in first years of life. The size, location, type, mucosal pattern produces varied clinical presentation and different imaging findings. Ultrasonography (USG) is the most commonly used imaging method for diagnosis. A 4-year-old boy was admitted in our hospital for recurrent on and off abdominal pain, on getting USG he has diagnosed has having tubular enteric duplication cyst on both USG and computed tomography (CT) scan. Surgery performed and resection and anastomosis done. Macroscopic and histologic findings confirmed the diagnosis of enteric duplication cyst arising from ileum. Although intestinal duplications are considered to be benign lesions, they may result in significant morbidity and mortality if left untreated.
Successful laparoscopic cholecystectomy in a patient with ventriculoperitoneal shunt: a case report
Authors: Thakral Ajay Kumar , Aggarwal Atul , Farooq Aamir , Sinha Anklesh
Published: July 2023

With advances in medical care there is a significant increase in life expectancy of patients with hydrocephalus. Many patients survive and live a meaningful life even after a decade of ventriculoperitoneal (VP) shunt placement. In this scenario, there are all the chances that these patients may need abdominal surgeries for pathologies unrelated to VP shunt. Laparoscopic cholecystectomy is one of the most common abdominal surgeries being performed. In patients with VP shunt in situ, before performing laparoscopic cholecystectomy factors such as type of shunt, shunt function, presence of shunt infection and possibility of shunt malfunction needs to be assessed. Laparoscopic cholecystectomy in a patient with previous VP shunt is not a well answered question. Some authors favor this while the others disagree. With proper anesthetic management and monitoring it is safe to perform laparoscopic cholecystectomy in these patients, even though literature gives little information about it. So, this case report is our sincere effort to strengthen the available data and stabilize a ground that can we can safely perform laparoscopic cholecystectomy in patient with VP shunt.
Peculiar challenges of a glass object retained in rectum: review of current options
Authors: Kesiezie Khriethonuo , Meena Sanjay , Goel Mahak , Sharma Deborshi
Published: July 2023

Rectal foreign bodies are rare and often challenging. It can vary from soft toys to hard glass or wooden objects. Patients are mostly habitual offenders who generally present to emergency due to retained foreign body or complications like perforation or bleeding. Proper history with a plain X-ray is often enough for the diagnosis and position of the foreign body. However, management can be varied from a simple trans-anal retrieval to an exploratory laparotomy. Minimal invasive techniques also have a role in current scenario. We report an unusual glass foreign body with its opening placed caudally.
An unusual case of basal cell carcinoma in the scrotum
Authors: Rajarathinam Manivannan , Gandhirajan Keshavrajan , Karthigayan Narendran , Murali Sowmya
Published: July 2023

Basal cell carcinoma (BCC) is one of the most common cutaneous malignancies worldwide. Reports of BCC on non-exposed areas are relatively uncommon. In our study we present the case of a male patient with BCC in the scrotum, since 3 years, successfully treated with wide local excision. Histopathological examination confirms infiltrating BCC. Our objective is to remind specialists of the possibility of scrotal BCC when encountering scrotal lesions not responding to treatment.
Factors influencing the selection of liver resection for adult patients with colorectal cancer liver metastases
Authors: Vespero Fernando Hernández , Pacheco Luis Eduardo Gamboa , Cornejo Morelia Yunuen López , Graciano Dulce Carolina Lopez , Sandoval Vania Bárbara Escobedo
Published: July 2023

The selection of liver resection surgery for adult patients with colorectal cancer liver metastases is a complex process influenced by various patient, tumor, and surgical factors. A systematic review was conducted with the PICO model research question, "are hepatectomy surgeries more effective than non-surgical treatment or alternative surgical treatments in improving survival and quality of life in adult patients?". A comprehensive scientific literature search was conducted using recognized medical and scientific databases. A narrative-question-answer synthesis was used to provide a comprehensive overview of the factors influencing the choice of hepatic recession surgery in adult patients with liver metastatic liver cancer. Concluding, the choice of liver surgery in adults with liver cancer metastasis depends on a wide range of factors such as the patient's age, characteristics of the tumor, peri and postoperative complications, and the number of metastases. Considering this is essential to the decision-making process and should be individualized for each patient.
Opportunities for professional development in nursing-Indian nurses
Authors: Sangati Chetan R , Rosario Rosita Martha
Published: July 2023

In accordance with the State of the World's Nursing (SOWN) 2020 study, there were 27.9 million nursing staff members as of 2018, including 19.3 2.6 million (9%) unclassified nurses, million (69%) professional nurses, 6.0 million (22%) associate professionals, and million (69%) professional nurses. The research also notes that there was a 5.9 million nurse deficit worldwide in 2018. There would be 35.9 million nurses worldwide, according to the study. As a result, just an estimated 5.7 nurses would be required. Million, with 89% of those needed in low- and middle-income nations. By 2030, it is predicted that 10.6 million more nurses would be required worldwide to meet the demand. The International Council of Nurses (ICN) reports that 74% of countries want to recruit more nurses, and 54% have pledged to enhance the working conditions for those who are already employed. because the COVID-19 pandemic temporarily disrupted the supply of nurses internationally, it was anticipated that the destination nations would move towards self-sufficiency by strengthening their domestic training. To overcome the shortage by 2030, it would be necessary to hire an additional 8% of nursing graduates year and keep the current workforce of nurses in all nations.
Copious teaching methodology in nursing-quality improvement
Authors: Rosario Rosita Martha
Published: July 2023

The concepts and techniques for instruction that teachers will use to help students learn the things they need to know make up a teaching method. These tactics are influenced by the subject matter to be taught and the learner in different ways. Nursing is a multifaceted technique that combines science and art. Teaching new nurses the finest patient care techniques as well as critical medical terms for diagnosis, sickness treatment, and medication administration are part of the job of a nurse educator or Nursing lecturer. Nursing students can be taught using a variety of methods both in the classroom and in a clinical setting. You may enhance student engagement, retention, and skill-building as a nurse educator or nurse lecturer by reviewing the tried-and-true teaching techniques.
Knowledge and attitude towards handling medical-legal records among nurses
Authors: Jose Edwin , Saraswathi D
Published: July 2023

Knowledge and attitude are essential for the proper handling of medico-legal records. A healthcare professional with a good understanding of the law and the proper procedures for documenting and preserving records will be better equipped to protect themselves and their patients in the event of a legal dispute. A positive attitude towards medico-legal records will also help to ensure that they are handled in a timely and accurate manner. The study aims to assess the knowledge and attitude towards handling medical-legal records among nurses.

A cross-sectional study was conducted with 150 nurses from various government hospitals in South India. Convenient sampling was used to select the participants. A sociodemographic scale, knowledge questionnaires, and a Likert scale were used to collect data. Data was coded in Excel and analyzed using IBM SPSS version 26.

The results of the study indicate that a significant portion of the nurses had average knowledge (64%) and a considerable number had poor knowledge (36%) regarding the handling of medical-legal records. None of the participants showed a good level of knowledge. In terms of attitude, 68% of the nurses displayed a moderate attitude, 26% had a low attitude, and only 6% exhibited a high level of attitude towards the subject.

The study found that nurses had average knowledge and moderate attitude towards handling medico-legal records. However, there were gaps in knowledge and low attitude, which highlights the need for interventions and educational programs.
Human lactoferrin modulates gene expression of the cytokine IL4 and the receptor TLR4 in the rat spleen under stress and upon the lipopolysaccharide administration
Authors: Yankelevich Irina A. , Filatenkova Tatiana A. , Aleshina Galina M.
Published: July 2023

Lactoferrin is a multifunctional glycoprotein of the transferrin family with a molecular mass of about 80 kDa. We studied the effect of human lactoferrin on stress- and lipopolysaccharide-induced changes in blood corticosterone levels, as well as on the gene expression of the cytokine IL4 and the pattern-recognition receptor TLR4 in rat splenocytes. Stress in rats was modeled by swimming in cold water (1-4°C) for 2 min. Lactoferrin and lipopolysaccharide (LPS) were administered intraperitoneally before the stress exposure. Corticosterone level in the plasma was determined by enzyme immunoassay, and changes in gene expression were assessed by real-time polymerase chain reaction (PCR) with reverse transcription. We showed that preventive intraperitoneal administration of lactoferrin reduced the stress and LPS-induced increase in the gene expression of both IL4 and TLR4 in rat splenocytes but did not change the concentration of corticosterone in the blood.
The Importance of Knowledge Management in Secondary Vocational Education Organizations in Greece
Authors: Zygouris Fotios , Papadopoulou Sofia
Published: July 2023

In recent years, knowledge management has increased in popularity as a management tool, as well as a new research field. Most organizations realize that "knowledge" is a strategic resource that can provide them with a sustainable competitive advantage and help them to achieve long-term organizational goals. Based on this, organizations attempt to use knowledge management to promote innovation, to improve organizational efficiency also to accelerate the creation and exchange of knowledge. The purpose of this paper is to present the importance of knowledge management in Greek vocational education. Essentially, it will study and try to highlight the way Vocational High Schools (VΗC), which are being secondary vocational education organizations, to attempt to manage knowledge in an effective way, also the knowledge management practices that can be useful in such an environment. The conclusions highlight the important elements of knowledge management in technical vocational education organizations.
Origin of Militants
Authors: Abdul Khaleak Mohammad
Published: July 2023

I know about the top most secret matter of the militants. All militants are exceptional clone. The process of cloning will never be disclosed by the militants. Jinn and Fay (Fairy) is one kind of species. I have seen the Jinn and Fay (Fairy) many times. A some number of people have seen Jinn and Fairy (Fay). Jinn is male and Fay (Fairy) is female. Jinn Fay (Fairy) can take shape of any men. Then he/she can’t see in the light of day, and there are no teeth in the mouth, no nails in the fingers and toes. The thumb of the hand is one bone (phalanges). Then there are 204 bones in the whole body. They can speak like any human voice. Jinn and fairy have to do special training before becoming militant people. Then the clone creates the clone man in the factory. For this a few operations have to done. The first operation is to attach the teeth in mouth of the Jinn/Fairy. Then can’t change after attaching teeth. The second operation is to attach the collected human retina to the eye of the clone. The man-collected nails are then surgically attached to the fingers of the clone. With the help of the machine, the bones of the thumbs of both hands are made into two phalanges. Then number of bones stands at 206 pieces. This is how cloning is performed. Then it looks like human (Insun/Adam race). Realizing the opportunity, militants kills Adam (Insun man) and hide his death body. The clone came to house and occupied the place. This clone system makes militants. So their secret matter is violation of Human Rights. So all militants is not Adam /Insan race (Not Homo sapiens).
Finitude e angústia existencial entre estudantes de ensino médio de uma escola pública: agravantes da covid-19
Authors: Kepler Rosilei dos Santos Rodrigues , Nogaro Arnaldo
Published: July 2023

Este artigo abriga resultados de uma pesquisa que busca identificar nos depoimentos de professoras de ensino médio como os temas relacionados à finitude humana e angústia existencial estão presentes na vida de seus estudantes. São trazidos aqui dados oriundos da coleta em grupo focal sobre aspectos relacionados ao sofrimento psíquico de jovens e adolescentes que frequentam o ensino médio de uma escola pública da região Oeste de Santa Catarina. A metodologia de coleta dos dados envolveu atividades em 5 encontros com 10 professoras que atuam no ensino médio, com duração aproximada de 60 minutos cada encontro. A pesquisa possui enfoque qualitativo e a interpretação dos dados seguiu o enfoque teórico hermenêutico. É inevitável que o profissional educador, ao longo de sua carreira, em algum momento se defronte com situações cotidianas que envolvem a angústia existencial vividas por seus alunos, necessitando de preparação para lidar com elas. No entanto, nem sempre o educador a possui, o que revela lacunas no seu processo formativo. Em um cenário normal, já há barreiras a transpor, e com a Covid-19, muito mais caótico ficou o espaço escolar e a vida dos adolescentes. A pandemia demonstrou nossas fragilidades e expôs nossa vulnerabilidade humana e profissional para dar conta das questões existenciais e da finitude. Também revelou aspectos de nossa impotência para ouvir e auxiliar os adolescentes em suas crises existenciais e sofrimento psíquico.
The Effect of Planting Arrangement, Phosphorus and Nitrogen on Physiological Traits and Guar Yield (Cyamopsis tetragonoloba L.)
Authors: Toghrekan Zahra Ghorabaei , Aien Ahmad , Afsharmanesh Gholamreza , Alavi-Siney Seyed Mohammad , Shirzadi Mohammad Hasan
Published: July 2023

Background: The guar, known as Cyamopsis tetragonoloba L., is an annual, summer plant of the legume family and importance of guar as a food, industrial and medicinal product is new in the cultivation pattern. Methods: This combined experiment was conducted as factorial based on a randomized complete block design with three replications during two consecutive years (2020-2021) under the climatic conditions of Jiroft area (Kerman province, Iran) in the farm of research center and agricultural and natural resources education. Three levels of Nitrogen (20, 60 and 100 kg pure nitrogen per hectare) from a source of urea and phosphorus fertilizer at two levels (zero and 75 kg P2O5 source per hectare) and a source of monopotassium phosphate fertilizer and three levels of planting row spacing (30, 45 and 60 cm) equivalent to 47, 31 and 24 plants per square meter, plant density was taken into account. Result: The highest chlorophyll a (2.69 mg/fresh weight), chlorophyll b (1.97 mg/fresh weight) and carotenoid (2.64 mg/fresh weight) was measured for guar in treatment N3P2D3 under application nitrogen 100 kg/ha-1 + phosphorus 75 kg/ha-1 + planting row distance 60 cm, while the lowest chlorophyll a (1.85 mg/fresh weight), chlorophyll b (1.25 mg/fresh weight) and carotenoid (1.72 mg/fresh weight)was observed in treatment N1P1D1 under nitrogen 20 kg/ha-1 + phosphorus zero kg/ha-1 + planting row distance 30 cm.