bluuebunny/crossref_metadata_2025 huggingface dataset:
DIVERSIDAD DE ORQUÍDEAS DEL SISTEMA FLUVIO LAGUNAR DELTAICO PALIZADA-DEL ESTE, EN EL ÁREA DE PROTECCIÓN DE FLORA Y FAUNA LAGUNA DE TÉRMINOS, CAMPECHE, MÉXICO
Authors: Endañú-Huerta Esthela , López-Contreras José E. , Amador-Del Ángel Luis E , Carnevali Germán , Guevara-Carrió Emma , Duno de Stefano Rodrigo , Cetzal-Ix William
Published: August 2017

Se contribuye al conocimiento de la diversidad florística de la familia Orchidaceae presente en el sistema fluvio-lagunar-deltaico Palizada-del Este (SFLD-PE) a partir de los datos obtenidos de 15 recolectas realizadas en 10 sitios, durante agosto 2013 a febrero 2014. El listado incluye 27 especies en 17 géneros. Ocho especies son nuevos registros para el SFLD-PE: Bletia purpurea, Catasetum integerrimum, Habenaria pringlei, H. repens, Laelia rubescens, Myrmecophila tibicinis, Ornithocephalus inflexus y Rhetinantha friedrichsthalii. Los géneros con el mayor número de especies son Epidendrum (4) y Prosthechea (4). En lo que respecta al hábito de crecimiento, 23 especies son epífitas (85%), tres especies son terrestres o semiacuáticas (12%) y una especie es exclusivamente terrestre (3%). Las especies mejor representadas en los sitios son Brassavola grandiflora (8), Bletia purpurea (7) y Habenaria repens (6). Los hospederos con mayor número de especies son Pachira aquatica (20) y Zygia latifolia (7). Epidendrum isthmi fue la única especie que se encuentra en alguna categoría de riesgo, de acuerdo a la NOM-059-SEMARNAT-2010. Diversas acciones antrópicas inciden negativamente en el SFLD-PE: deforestación, incendios y apertura de canales de agua provocan el deterioro y fragmentación de los hábitats, lo que pone en peligro el futuro de este grupo taxonómico y de otros grupos de plantas, por lo que el conocimiento de la biodiversidad de esta área es necesario para establecer estrategias de conservación, restauración y manejo sustentable.
Análisis in silico y expresión génica del factor de transcripción TgNAC01 implicado en xilogénesis y estrés abiótico en Tectona grandis.
Authors: Camel Paucar Vladimir , Galeano Esteban , Carrer Helaine
Published: August 2017

El xilema secundario es el componente más abundante de la biomasa vegetal. Por tanto, conocer los genes que regulan su formación ayudaría a diseñar estrategias para el mejoramiento genético de la madera. Así, el objetivo de este trabajo fue realizar el análisis computacional de la estructura primaria y secundaria del factor de transcripción (FT) TgNAC01 de Tectona grandis, además de evaluar su historia evolutiva, dominios conservados y expresión génica en tejidos lignificados de árboles de 12 y 60 años. Para ello, se realizó una evaluación del potencial de interacción ion-electrón (PIIE), mediante el método del espectro de la información (MEI) utilizando la librería SFAPS de R-Project, seguido del modelamiento estructural utilizando el software MODELLER y visualizado mediante PyMol. Además, el análisis de alineamiento de secuencia múltiple y filogenia fue mediante el software Bioedit y MrBayes respectivamente. También se evaluó los niveles de síntesis del FT TgNAC01 mediante qRT-PCR. Como resultados, se evidencio que el FT mantiene una estructura β-hoja antiparalela retorcida, que se compacta contra una α-hélice en la región N-terminal, teniendo así tres dominios α hélice y siete dominios β plegada. Asimismo, mediante el MEI se demostró que tiene alrededor de cinco funciones biológicas y mutaciones sobre los aminoácidos con mayor PIIE, lo que conlleva a evoluciones sobre las redes de regulación genética. Finalmente, el FT TgNAC01 juega un papel fundamental en la organización y desarrollo de las partes que componen la albura, como las células radiales de la zona cambial, los vasos, fibras y los anillos de crecimiento.
MODELO DE CONECTIVIDAD ECOLÓGICA DE FRAGMENTOS DE BOSQUE ANDINO EN SANTA ELENA (MEDELLÍN, COLOMBIA)
Authors: Colorado Zuluaga Gabriel Jaime , Vásquez Muñoz Jorge Luis , Mazo Zuluaga Ingrid Natalia
Published: August 2017

La fragmentación de bosques y la potencial pérdida de calidad de hábitat asociada es una de las principales causas de pérdida de biodiversidad. Una de las estrategias para fomentar el mantenimiento de la misma a nivel de paisaje es el establecimiento de corredores biológicos que faciliten la conectividad estructural y funcional de los elementos bióticos. Sin embargo, la aplicabilidad y funcionalidad de esta herramienta está limitada por la falta de planeación al momento del diseño y establecimiento de corredores o redes de conectividad que obedezcan a métodos detallados y rigurosos. En esta investigación desarrollamos una propuesta teórica de conectividad ecológica para el corregimiento de Santa Elena, municipio de Medellín, Colombia, empleando herramientas de la ecología del paisaje. Inicialmente, se seleccionaron 21 fragmentos de bosque o núcleos a conectar a partir de su tamaño mínimo (mayores a 5 ha), área de interior (mayor a 1 ha) y sus índices de forma (redondeados o casi redondeados). Seguidamente, a partir de la creación de una matriz de fricción al desplazamiento, diseñamos una red potencial que permitiría conectar 1356,35 ha de nodos de bosques remanentes a través de 31 corredores ecológicos de 100 m de ancho con una extensión total de 208,33 ha. Finalmente, discutimos la importancia de fomentar este tipo de herramientas de planeación con herramientas de la ecología del paisaje que promueven la conservación de hábitats y la conectividad del paisaje en áreas cercanas a grandes urbes latinoamericanas.
Resident Peer-to-Peer Observation and Feedback in the Primary Care Setting
Authors: Overland Maryann K. , Levander Ximena , Black Marissa , Evans Ginger
Published: August 2017

This article was migrated. The article was not marked as recommended. Introduction: We performed a pilot study to improve self-efficacy with giving and receiving feedback among primary care Internal Medicine residents in the ambulatory setting. Methods: We trained Internal Medicine residents to give and receive feedback, scheduled observation sessions, and protected time for feedback and reflection on the process. This pilot took place over four month-long ambulatory blocks over a two-year period at the University of Washington's primary care continuity clinic sites. Twenty-eight residents participated each year. We developed a survey question to measure self-efficacy with feedback and compared means using the Wilcoxin Signed-Rank test. We also collected qualitative data that was analyzed using Grounded Theory. Results: The residents demonstrated a statistically significant and meaningful increase in their self-efficacy with giving feedback to peers. Conclusion: Peer-to-peer feedback is a low-cost, high-yield way to increase feedback and feedback-seeking behavior without undermining resident autonomy. This educational intervention could be easily translated across clinical settings and specialties. Based on the initial success of the program, the University of Washington internal medicine residency program will provide expanded opportunities for structured, longitudinal peer observation and feedback.
Uncertainty of dustfall monitoring results
Authors: Van Nierop MA , Van Staden E , Lodder J , Piketh SJ
Published: August 2017

Fugitive dust has the ability to cause a nuisance and pollute the ambient environment, particularly from human activities including construction and industrial sites and mining operations. As such, dustfall monitoring has occurred for many decades in South Africa little has been published on the repeatability, uncertainty, accuracy and precision of dustfall monitoring. Repeatability assesses the consistency associated with the results of a particular measurement under the same conditions; the consistency of the laboratory is assessed to determine the uncertainty associated with dustfall monitoring conducted by the laboratory. The aim of this study was to improve the understanding of the uncertainty in dustfall monitoring; thereby improving the confidence in dustfall monitoring. Uncertainty of dustfall monitoring was assessed through a 12-month study of 12 sites that were located on the boundary of the study area. Each site contained a directional dustfall sampler, which was modified by removing the rotating lid, with four buckets (A, B, C and D) installed. Having four buckets on one stand allows for each bucket to be exposed to the same conditions, for the same period of time; therefore, should have equal amounts of dust deposited in these buckets. The difference in the weight (mg) of the dust recorded from each bucket at each respective site was determined using the American Society for Testing and Materials method D1739 (ASTM D1739). The variability of the dust would provide the confidence level of dustfall monitoring when reporting to clients.
Air quality indicators from the Environmental Performance Index: potential use and limitations in South Africa
Authors: Garland RM , Naidoo M , Sibiya B , Oosthuizen R
Published: August 2017

In responding to deteriorating air quality, many countries, including South Africa, have implemented national programmes that aim to manage and regulate ambient air quality, and the emissions of air pollutants. One aspect within these management strategies is effective communication to stakeholders, including the general public, with regard to the state and trend of ambient air quality in South Africa. Currently, information on ambient air quality is communicated through ambient mass concentration values, as well as number of exceedances of South African National Ambient Standards. However, these do not directly communicate the potential impact on human health and the ecosystem. To this end, the use of air quality indicators is seen as a potential way to achieve communication to stakeholders in a simplified, yet scientifically defensible manner. Air quality indicators and their source data from the Environmental Performance Index (EPI) were interrogated to understand their potential use in South Africa. An assessment of four air quality indicators, together with their source data, showed improvements in air quality over the time period studied, though the input data do have uncertainties. The source data for the PM indicators, which came from a global dataset, underestimated the annual PM2.5 concentrations in the Highveld Priority Area and Vaal Triangle Airshed Priority Area over the time period studied (2009-2014) by ~3.7 times. This highlights a key limitation of national-scale indicators and input data, that while the data used by the EPI are a well-thought out estimate of a country’s air quality profile, they remain a generalised estimate. The assumptions and uncertainty inherent in such an ambitious global-wide attempt make the estimates inaccurate for countries without proper emissions tracking and accounting and few monitoring stations, such as South Africa. Thus, the inputs and resultant indicators should be used with caution until such a time that local and ground-truthed data and inputs can be utilised.
Air quality management in Botswana
Authors: Akinola MO , Lekonpane M , Dada EO
Published: August 2017

This paper examines air pollution situation and the history of air quality management in Botswana. The current air quality management in Botswana is still largely underpinned by the Atmospheric Pollution Prevention Act of 1971, supplemented by the more recently enacted legislations such as the Environmental Impact Assessment (EIA) Act of 2010 and the Ambient Air Quality - Limits for Common Pollutants of 2012 published by the Botswana Bureau of Standards. Though commendable efforts have been made toward legislating against air and other forms of pollution, these have not yielded expected results in view of the prevailing levels of air pollutants like sulphur dioxide and fine particulate matters in the country’s atmospheric environment. Legislation as a sole measure may not be effective in tackling this challenge. Rather, government should also address some root-causes of the problem by making policies and programmes that will reduce unemployment and increase the earning capacity of citizenry. This will, among other things, effectively check poverty-induced biomass burning in the country. The paper looks at some other challenges of air pollution management and suggestions are made to tackle the identified problems.
History of the study of hemorrhagic disease of newborns
Authors: Ivanov Dmitry O.
Published: August 2017

The article describes the main historical periods of the study of hemorrhagic disease of newborns. Clinical observations, describing bleeding of newborns, which occurs without visible damage, known since the seventeenth century and are found in the works of Francois Mauriceau and Georg Wolfgang Wedel. The role of the liver injury in the development of bleeding of infants noticed English physicians John Huxham (1672-1768) and John Cheyne (1777-1836). In 1871 Ludwig Grandidier conducted differential diagnosis between umbilical bleeding of neonates and the hemophilia clinic. Later I.P. Pavlov showed, that the clotting time of dog’s blood significantly prolongs when you turn off the liver from the blood circulation. In that way, partly began to understand the etiology of hemorrhagic syndrome, but the pathogenesis of this suffering, in diseases of the liver remained unknown. Charles Wendell Townsend in 1894, describing 50 cases of coagulopathy of newborns, at the first time paid attention to the connection between breastfeeding and development of bleeding and offered to call this nosological form as "hemorrhagic disease of newborns". In the late 20s of the last century Henrik Dam have identified the unknown substances from green lucerne leaves and described them as the fat-soluble vitamin K (coagulation). In 1943 H. Dam and E. Doisy received the Nobel prize for the discovery and establishment of the chemical structure of vitamin K. In 1943, a group of Soviet biochemists have synthesized a water-soluble analogue of vitamin K (K3, vicasolum), quickly introduced into clinical practice and showed their high efficiency in patients with hypovitaminosis K. In 1945 Yu.F. Dombrovskaya suggested that haemorrhagic disease of newborns caused by deficit of vitamin K. Further researching of the development of haemorrhagic disease of newborns is associated with the study of the biochemistry of the pathogenesis of the disease, identify its various forms and development of treatment techniques and prevention, depending on the identified features.
The modern methods of X-Ray based diagnostic in cases of ectopia cordis associated with pentalogy of Cantrell
Authors: Kosovtsova Elena V. , Pozdnyakov Alexandr V. , Pilyugov Nikolay G. , Naumov Alexey B. , Marchenko Sergey P.
Published: August 2017

Pentalogy of Cantrell with ectopia cordis is an extremely rare and lethal congenital anomaly included congenital hearth disease (CHD), midline supraumbilical abdominal wall defect, defect of lower sternum part, deficiency of the anterior diaphragm, a defect in the diaphragmatic pericardium. The complexity of this syndrome is usually incompatible with life. Depending on the location of the protruding heart and on the extent of the body wall defect, ectopia cordis may be grouped into cervical, thoracic, thoracoabdominal, or abdominal types. The heart mostly uncovered, covered with a serous membrane less often, and covered with skin rare. Depending on combination defects pentalogy of Cantrell classified for 3 different classes by Toyama (classified in 1972): 1 class – complete syndrome (all five defects), 2 class – probable syndrome (included intracardial defect and ventral abdominal wall defect) 3 class – incomplete syndrome (with various combinations of defects present, including a sternal abnormality). Presented clinical case newborn pentalogy of Cantrell first Toyama class. We used X-Ray for firstly diagnostic, for visualization CHD was performed CT. For postnatal diagnostic CHD are used Echo and CT. CT allows graphically to see the type of CHD and predict a surgical treatment. The strategy of surgical treatment and further prognose are depend on combination of anomalies within the framework of pentalogy of Cantrell. By CT we determined atresia of the pulmonary artery with major aorto-pulmonary collateral arteries (MAPCA), ventricular and atrial septal defects.
Evaluation of self medication practices in common illness among non health care professionals in a tertiary care hospital
Authors: Guduru Jyothsna , Singh T. Rohit , Motgi Somnath , Rani Jamuna
Published: August 2017

Background: Many studies have investigated the prevalence of self medication practices. World health organization promotes the practice of self medication for relief of symptoms without medical consultation to reduce the burden on health care services. Majority of the individuals in developing country like India have poor knowledge about appropriate use of self mediction, but still they practice taking it without knowing the benefits and risk factors.Methods: The present study was a cross sectional study aimed to gather information about prevalence of self medication in common illness among non health care professionals in a tertiary care hospital. The sample size comprised of 215 participants. Data was collected through an open ended semi structured questionnaire. All the descriptive data was coded, entered in micro soft excel and analysed with frequencies and proportions.Results: The prevelance of self medication was found to be 96%. Near about 30% of participants got information from pharmacist regarding self medication. 27% participants followed allopathy medicine.16% participants used becosules and mucaine gel for mouth and throat ulcers.26% participants used D-cold total for cough and cold.15% participants used dolo 650mg for fever and headache.41.7% participants used ciprofloxacin for ear and eye infections.26.6% participants used gelusil for GI infection .25.7% participants used calamine lotion for skin infections and 48% participants used turmeric for other minor ailments as self medication medicines.Conclusions: As the prevalence of self medication is high among educated participants. The present study suggest the growing trend of self medication has to be prevented by applying strong policies and prohibiting the supply of medicines without a valid prescription.
Comparative efficacy of visual inspection with acetic acid versus cytology for cervical cancer screening in Ogbomoso, Nigeria
Authors: Abiodun Afolabi B. , Durodola Aadewunmi O. , Ajani Mustapha A. , Amole Isaac O. , Abiodun Adejoke D. , Oluwasola Timothy A. O.
Published: August 2017

Background: Screening test for cervical cancer using visual inspection with acetic acid (VIA) has been advocated by World Health Organization as a suitable, low cost and feasible alternative modality for control of cervical cancer in resource-poor settings as compared to cytological and colposcopic screening. The need for reproducibility, accuracy and comparable efficacy will influence the acceptability of VIA as primary screening modalities for cervical cancer.Methods: A cross–sectional comparative study conducted at BUTH. Data were obtained from 318 consenting women aged 30–65 years using a systematic random sampling method and an interviewer–administered structured questionnaire. Pap smear samples were taken followed by visual inspection with acetic acid. Using Statistical Package for Social Sciences (SPSS) version 23.0, Frequencies were obtained and Chi-square test (X2) was used to compare rates and proportions with the level of statistical significance set at less than 0.05.Results: Positive results for premalignant cervical lesion was 1.3% and 4.1% for VIA and Pap smear respectively (X2=4.52; p=0.034). The sensitivity of VIA was 7.7% with positive predictive value of 25% while specificity was 99.0% with a negative predictive value of 96.2%. The prevalence of abnormal cervical lesion in the population studied was 4.1% (95% CI 2.2% – 6.9%).Conclusions: The detection rate for pre-cancerous lesions of the cervix using VIA was significantly lower than that of Pap smear in this study. There may be needed to exercise caution in adopting VIA as primary screening modality for cervical cancer.
Cellphone and media usage among adolescent girls of Bhopal city, Madhya Pradesh, India
Authors: Singh Purva , Jain Manisha
Published: August 2017

Background: Several researchers have reported that mobile phone uses are increasing among adolescents. Better understanding of cellphone and media usage by adolescents would help health care providers in guiding more responsible use of cellphone by teenagers. Aim of the study was to study the level and pattern of mobile phone usages among adolescent girls of Bhopal city, Madhya Pradesh.Methods: This cross-sectional study was conducted among adolescent girls between 14 to 19 years of age studying in schools of Bhopal city. Data was collected using a self-administered questionnaire. The questionnaire contains items related to demographic variables, cellular phone usage and patterns.Results: All the study subjects were using smart phones. Facebook was the most commonly surfed website. Maximum adolescent girls were using smartphones for 2-4 hours in a day. Seventy-eight (69.03%) study subjects preferred text messaging service for awareness about reproductive and sexual health.Conclusions: The cellphone usage can also be exploited to promote awareness about reproductive health among adolescents.
A comparative study of different route of administration of misoprostol in the management of third stage of labour
Authors: S. Sreelatha , H. S. Nethra , Nadagoudar Seema , Ambastha Vandana , . Rajeshwari
Published: August 2017

Background: Post partum haemorrhage is the most common cause of maternal morbidity and mortality.  Misoprostol is a prostaglandin analogue, used for management of post partum haemorrhage. It can be used by various routes with minimal side effects. This study is done to compare the different routes of administration of Misoprostol for the third stage management and their side effects. Objectives of present study were to estimate the amount of blood loss, to assess the maternal side effects of drug, to know the haemoglobin deficit, to know the duration of third stage of labour.Methods: This was a prospective hospital base study of 150 women delivery at obstetrics and gynaecology department at ESICMC Model Hospital, Rajajinagar. They were randomized into 3 groups of 50 patients each. They received 400 µg of misoprostol either orally or rectally or sublingually immediately after delivery of the fetus. The primary outcomes analysed were amount of blood loss duration of third stage of labour haemoglobin deficit and their side effectsResults: The amount of blood loss and haemoglobin deficit was least in sublingual group which was statistically significant. Need of additional oxytocics was less in sublingual and oral group, though it was not statistically significant.Conclusions: In the present study, sublingual Misoprostol was found to be more effective in reducing blood loss during third stage of labour.
Suture versus vessel sealer in vaginal hysterectomy: an observational study
Authors: Upadhyay Neha , Aditya Vani , Gupta Sudhir , Srivastava Reena , Sarkar Ruma , Tiwari Harish Chandra
Published: August 2017

Background: Vaginal route is considered to be the method of choice for removal of uterus and, in the absence of gross pelvic disease, can be carried out in most patients. Recent studies have shown that less than one-third of hysterectomies are performed vaginally. This could be due to technical difficulties occurring while operating in the narrow surgical field. This study was taken up to find out the easier alternatives in securing pedicles by using Electrosurgical Bipolar Vessel Sealer in Vaginal Hysterectomy.Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, BRD Medical College, Gorakhpur over a period of one year i.e. July 15 to June 16. A total of 62 patients posted for vaginal hysterectomy for benign conditions were enrolled after informed consent. Results were recorded under headings of procedure time (min), blood loss (ml), major intra-operative complications and post operative complications, post-operative pain (on VAS) and duration of hospital stay.Results: Mean procedure time in suture method was found to be 55.66min, whereas, in sealer group it was 27.75 min. Mean blood loss in the sealer group was 83.78ml, while, in suture group it was 156.62ml. Mean pain score on Visual Analogue Scale on POD 1 was 8.44±1.1522 for suture group and 6±1.325 for sealer group. Mean pain score on POD2 in sealer group was 3.48±1.325 and in the suture group it was 5.31±1.754 (P<0.0001). Mean pain score on POD3 in suture group 2.82±0.508, in sealer group it was 1.0909±0.608 (P<0.0001). Pain scores, thereafter, did not differ significantly. Mean length of stay in suture group is 10.71 days (suture group) versus 5.3 days (sealer group). Blood loss >200ml was observed in 29.03% of suture cases, none in the sealer group (P-value .0006). Labial burn occurred in 2 out of 32patients in sealer group.Conclusions: From above study, we conclude that bipolar vessel sealer has shown a significant reduction in intra-operative blood loss, procedure time, immediate post-operative pain (POD1,2&3), mean length of stay in hospital, major intra-operative blood loss>200ml which was found in significant number of cases in suture group.
Serum estradiol level and postmenopausal symptoms in surgical and natural menopause
Authors: Kaur Navdeep , Malla Veena G. , Gupta Sonal
Published: August 2017

Background: Menopause whether it occurs naturally or surgically is characterized by the reduced production of hormones by the ovaries. The study aimed at comparing the serum estradiol levels and postmenopausal symptoms in women with surgical and natural menopause.Methods: 50 women each of natural and surgical menopause were enrolled. Five ml of fasting blood sample was collected from each patient in both the groups by venepuncture in a plain tube, which was centrifuged and was analyzed for serum estradiol levels by chemiluminescence method. Levels of serum estradiol hormone for both the groups were compiled and the mean and standard deviation was calculated. Postmenopausal symptoms were also compared among two groups. Chi square and fisher exact test were used to analyze the qualitative data and t test were used to analyze the quantitative data.Results: The mean level of serum estradiol in women with surgical menopause was found to be 20.49 + 3.16 pg/ml while that in natural menopause, was 27.41 + 5.08pg/ml. The difference in mean estradiol level between the two groups was found to be statistically significant (p value <0.0001). Hot flushes and mood swings were observed in more number of women with surgical menopause.Conclusions: The statistically significant lower levels of serum estradiol in surgical menopausal group may be a reason behind increased presence of menopausal symptoms in this group. Thus, the women in this group may benefit from hormone replacement therapy, improving their quality of life, however further studies are needed to establish this role.
Ovarian sex cord stromal tumors: an institutional experience
Authors: Bhargava Shruti , Vyas Jyotsna , Bhargava Adarsh
Published: August 2017

Background: Sex cord stromal tumors are a heterogeneous group of rare neoplasms of ovary. These tumors arise from different cells of the ovary and have a fascinating variety of clinical presentations. They are mostly diagnosed on histopathology after surgical removal.Methods: Our study aims at discussing the clinical and histomorphological spectrum of these rare tumors at a tertiary care centre.Results: In our study 158 ovarian sex cord stromal tumors were received over a period of eight years at our institute. Out of these, the most common age group was 30 to 40 years and the chief complaint was abdominal pain and lump in majority of cases. Most common tumor histologically was Adult Granulosa cell tumor (42.4%). There were 8 (5.1%) Juvenile granulosa cell tumors, 31 (19.6%) fibromas, 6 (3.8%) thecomas, 14 (8.9%) fibrothecomas, 24 (15.2%) sertoli leydig cell tumors and 7 (4.4%) sclerosing stromal tumors. We encountered one case of sex cord tumor with annular tubules.Conclusions: Sex cord stromal tumors are uncommon ovarian tumors in Indians but have a wide range of distribution of age, clinical features and histopathological types. Since most of these have a relatively good prognosis, a high index of suspicion and thorough knowledge of clinicopathological findings is important for correct diagnosis and appropriate treatment.
A study of epidemiology of ectopic pregnancies in a tertiary care hospital of Mumbai, India
Authors: Kharat Deepali , Goswami Giri Prajakta , Fonseca Michelle
Published: August 2017

Background: Ectopic pregnancy is the result of a flaw in human reproductive physiology that allows the concept us to implant and mature outside the endometrial cavity which ultimately ends in the death of the fetus. Without timely diagnosis and treatment, ectopic pregnancy can become a life-threatening situation. Aim of the present study was to determine the incidence, clinical presentation, risk factors and immediate morbidity and mortality associated with ectopic pregnancy.Methods: The study was conducted among 194 patients with ectopic pregnancy in a tertiary care hospital, over a period of two year. The following parameters: age, parity, gestational age, risk factors, clinical presentation, need for blood transfusion and findings on ultra-sonogram and morbidity associated with ectopic pregnancy were noted.Results: The incidence of ectopic pregnancy was 0.76%. Etiological factors observed were pelvic inflammatory disease (13.9%), dilatation and curettage (8.8%), infertility (7.7%), previous abortions (7.2%), intrauterine contraceptive device (3.6%), previous ectopic pregnancy (2.6%) and history of sterilization (1.5%). The typical triad of amenorrhoea, pain in abdomen, and bleeding was observed in 76.5%. Surgery by open method in the form of salpingectomy (91.2%), salpingo-oophorectomy (5.7%) and salpingo-oophectomy ovarian cystectomy (4.1%) were the mainstay of management. Morbidity included anemia (24.2%) and blood transfusion (87.6%). No maternal mortality noted.Conclusions: Early diagnosis, proper assessment of principal risk factors and timely intervention in the form of conventional or surgical treatment will help in reducing the morbidity and mortality associated with ectopic pregnancy.
Thyroid screening in pregnancy
Authors: Wagh Reena Vijay , Mundra Mahavir Raghunath , Upadhye Jayshree Jayant , Telgote Deepa Baliram , Khillare Supriya Nivrutti , Ramteke Prafulkumar Suresh
Published: August 2017

Background: Thyroid hormone is critical to normal development of the baby’s brain and nervous system. During the first trimester, the fetus depends on the mother’s supply of thyroid hormone, which comes through the placenta. At around 12 weeks, the baby’s thyroid begins to function on its own. In our study, complete thyroid profile of all antenatal patients was done at the first antenatal visit along with routine investigations. Aim of the study was to study the prevalence of hypothyroidism and hyperthyroidism in low income, urban pregnant women.Methods: This is a retrospective study that includes 400 pregnant women attending the antenatal clinic at Government medical college and hospital, Nagpur in the month of April 2017. These patient’s data was randomly selected in the biochemistry department where samples come. Thyroid profile is being done as a routine test along with other antenatal profile tests in our hospital. Thyroid profile test includes serum T3, serum T4 and serum TSH.Results: A total of 400 pregnant women were included in this study. Results showed 34% prevalence of hypothyroidism of which 30% being subclinical hypothyroidism and 4% overt hypothyroidism. There was 9.5% prevalence of hyperthyroidism of which 5.5% being subclinical hyperthyroidism and 4% overt hyperthyroidism.Conclusions: The study shows a very high prevalence rate of hypothyroidism in the patients attending the antenatal outpatient department at Government medical college and hospital, Nagpur. This justifies the inclusion of thyroid profile test as a routine test in the antenatal profile.
Seroprevalence of HIV in pregnant women in tertiary care hospital Kota, India
Authors: Bala Suman
Published: August 2017

Background: As HIV infection in women occur primarily during reproductive years hence incidence of HIV infection specially in sexually active women is most sensitive marker to track course of HIV epidemics. It is easy to measure prevalence in pregnant women. This study was done to determine the seroprevalence of HIV in pregnant women in Medical College, Kota, India.Methods: The study was conducted over the year January2016 to April 2017 and included women either attending ANC or unbooked and referred cases came for delivery.Results: Only 5 out of 15250 ANC were found positive while total 13 cases were positive including unbooked and referred cases. Majority of women53.84% were in age group24-29 years and 61.54% were primigravida and 38.46% were multigravida. Seroprevalence of HIV infection was only 0.00055% in my study during 16months period.Conclusions: Appropriate antenatal screening, interventions during pregnancy, delivery and breastfeeding will bring down the mother to child transmission of HIV.
A study to evaluate and compare the expulsion and continuation rates of post placental insertion of Cu 375 and CuT 380A in Indian women at a premier hospital in New Delhi, India
Authors: Kumar Mansi , Kumar Mahesh , Aggarwal Parul , Gangania Archna , Dewan Rupali
Published: August 2017

Background: The Study was planned to evaluate and compare the expulsion and continuation rates of post placental insertion of Cu 375 and CuT380A in Indian women at Safdarjung Hospital New Delhi, after approval was obtained from Institutional Ethical committee.Methods: Study group consisted of 300 women, divided into two groups: Group A and Group B. The data was analysed by using ‘student “t” test/ non-parametric ‘Wilcoxon Mann Whitney’ for quantitative variables to evaluate the safety, efficacy and acceptability.Results: Mean age was 24.99 years (range: 19-35years), All women were married (off which 64% literate) and Mean parity in group A was 1.97 and 2.06 in group B. Mean pain score during intrauterine contraceptive device (IUCD) insertion on visual analogue scale was 2.93 in group A and 3 in group B and was not statistically different. 84% women completed 12 months follow up in group A and 83.33% women in group B. Strings were visible in 74% women in group A and in 34% women in group B at 1 month of IUCD insertion. Visibility of strings increased in successive follow up visits and was visible in >80% of women at the end of one year in the both groups. String visibility after intra-Caesarean insertion was delayed. Fifty one percent (n=77) subjects in group A and 54% (n=81) in group B experienced amenorrhea up to six months. Menorrhagia was reported in 7.33% in group A and women 8.66% in group B at the end of 1 year of follow up. Pain was complained by 26 out of 150 (17.3%) women in group A as compared to 36 out of 150 (24%) women in group B after 1 month of insertion. There was no case of PID in group A whereas there were 3 cases of PID in group B. There was no perforation/trauma and pregnancy in either group.Conclusions: Overall expulsion rate was 13% and removal rate was 5% in our study. Continuation rate was 83.3% in Cu 375 and 80.6% in CuT380A at 12 months. There was no significant difference between the IUCDs regarding the safety, efficacy and complications such as expulsion, bleeding etc.
Placental cord blood drainage after vaginal delivery as part of the management of third stage of labour: a systematic review of randomized controlled clinical trial
Authors: Meena S. A. , Bebincy D. S. , . Devika
Published: August 2017

Background: Present study was undertaken to evaluate the effectiveness of placental cord blood drainage after vaginal delivery in reducing the duration and blood loss during third stage of labour in Primi/Multigravida (up to G3) between the age group of 18-35 years, with term, singleton alive pregnancy with vertex presentation, adequate liqour, with average size (estimated foetal weight 2-4Kg) fetus, without any complications, expected to spontaneous vaginal delivery.Methods: It is a randomized clinical controlled trial on 400 pregnant women admitted in labour ward at KGMCH, Asaripallam, Kanyakumari district between January 2015 to December 2015. All women enrolled were subjected to history taking general and obstetric examination. In the study group, placental end of the previously clamped and cut umbilical cord was unclamped immediately after vaginal delivery, while remaining clamped in the control group.Results: Duration of third stage of labour blood loss during third stage postpartum hemorrhage and need for blood transfusion haemoglobin difference between antenatal and postnatal period was significantly reduced in the study group than control group.Conclusions: Placental Cord blood drainage is simple, safe, non-invasive method which reduces the duration and blood loss of third stage of Labour.
Anti-Mullerian hormone (AMH) as predictor of ovarian reserve
Authors: Shembekar Chaitanya Ashok , Upadhye Jayshree Jayant , Shembekar Manisha Chaitanya , Welekar Shravani H.
Published: August 2017

Background: Anti-Müllerian hormone (AMH) is produced by the granulosa cells of preantral and small antral follicles and its levels can be assessed in serum. Since the number of ovarian follicles declines with increasing age, AMH levels might be used as a marker for ovarian ageing. Therefore, we studied the relationship between AMH levels and ovarian response during ovarian stimulation for In vitro fertilization.Methods: A total of 100 patients who have undergone their ICSI treatment cycle using a GnRH antagonist protocol were retrospectively included. Co-relation between AMH and antral follicular count (AFC) was assessed.Results: In present study, 36% patients had normal AMH, 18% patients were in low normal range, 5% patients had low values and 2% patients had very low values. 41% of patients had values in high range suggestive of PCOS. Amongst this, 21% had values between 4 to 8 ng/ml where we got good AFC count and good result in terms of pregnancy. 80% were good responders while 20% were poor responders. When we evaluated the relationship of retrieved oocyte counts with the parameters included, we found that only basal AMH levels and the number of antral follicles were statistically correlated.Conclusions: High AMH levels correlated with low cancellation rates, retrieval of more eggs, higher live birth rates and a high chance for freezing of embryos. Low AMH levels (alone) do not predict low success rates in women under 35 years of age.
A study of the prevalence of gestational diabetes mellitus and its maternal and fetal outcomes in a tertiary care hospital
Authors: R. Gandhewar Manisha , R. Bhatiyani Binti , Singh Priyanka , R. Gaikwad Pradip
Published: August 2017

Background: The aim of this study was to study the prevalence of gestational diabetes mellitus (GDM) using Diabetes in Pregnancy Study group India (DIPSI) criteria to diagnose patients with GDM and to study the maternal and neonatal outcomes.Methods: 500 patients attending the antenatal clinic between January 2013 to September 2014 with singleton pregnancies between 24 and 28 weeks of gestation were evaluated by administering 75g glucose in a nonfasting state and diagnosing GDM if the 2-hour plasma glucose was more than 140 mg/ dl. Women with multiple pregnancies, pre-existing diabetes mellitus, cardiac or renal disease were excluded from the study.Results: 31 women were diagnosed with GDM (prevalence 6.2%). The prevalence of risk factors such as age more than 25, obesity, family history of Diabetes Mellitus, history of GDM or birth weight more than 4.5kg in previous pregnancy and history of perinatal loss were associated with a statistically significant risk of developing GDM. Though the incidence of Gestational hypertension, polyhydramnios and postpartum haemorrhage was higher in the GDM group, it did not reach statistical significance. More women in the GDM group were delivered by LSCS. There was no significant difference in the incidence of SGA or preterm delivery in the groups. The mean birth weight in GDM group was higher than in the non GDM group.Conclusions: Early detection helps in preventing both maternal and fetal complications. This method of screening is convenient to women as it does not require them to be fasting.
Study of cases of rupture uterus in a tertiary institute and its maternal and perinatal outcome
Authors: Gaikwad Rupali Atmaram , Chavan Niranjan N.
Published: August 2017

Background: Uterine rupture is undoubtedly one of the most tragic events that can occur in a women’s life and tragedy becomes more grim when she is young. In India, in advanced cities the incidence of rupture preceded by obstructed labour is decreasing, in rural parts where there is inadequate care, lack of communication and transport, home deliveries by untrained dais incidence of rupture uterus is still high. So, the study is to evaluate the etiological factors, incidence, management modalities and maternal and perinatal outcome.Methods: A prospective cross-sectional study of 46 cases of rupture uterus and maternal and Perinatal outcome, in the department of Obstetrics and Gynecology in government tertiary reference center.Results: Overall incidence of uterine rupture is 1 in 924. Out of 46 cases 07 (15.22%) were booked, and 39 (84.78%) were referred patients. The 20-30 years age group is the most vulnerable age group. Out of 44 rupture uterus during labor, 13 (22.72%) were spontaneous of intact uterus and 31(70.45%) were in scarred uterus. Subtotal abdominal hysterectomy was commonest modality of treatment used (28 out of 46 cases), followed by suturing of tear. There were 5 maternal deaths out of 46 patients, giving maternal mortality rate of 13.51%. Perinatal mortality rate still on higher side was 76.08%.Conclusions: Most cases of rupture uterus are preventable with good antenatal and intra-partum care. Our study shows that there has been a decline in the overall morbidity in cases of rupture uterus and so also the mortality rate (decreased from 24.3 to 13.51%).
Assisted delivery of mobile fetal head: a comparison of forceps, vaccum and assisted manual extraction of head at caesarean section
Authors: Swain Sujata , Sagarika N. , N. Satpathy Rabi , C. Mahapatra Purna
Published: August 2017

Background: Difficult fetal extraction occurs in 1-2% of caesarean deliveries. Either forceps or a vaccum device is often used to assist in delivery of the fetal head in cesarean section in high floating/mobile fetal head.  This study compare the safety (for mother and fetus) and efficacy of forceps and vacuum assisted delivery of high floating/mobile fetal head with the traditional method of manual extraction at caesarean section.Methods: The sample size included 100 cases of LSCS with manual extraction of fetal head, 100 cases of LSCS with forceps assisted extraction of fetal head and 100 cases of LSCS with vacuum assisted extraction of fetal head.Results: Application of fundal pressure was required in all cases of manual extraction group, in 51 cases of forceps extraction group. None of the cases of vacuum extraction group required application of fundal pressure. The U-D interval in manual extraction group was 90.56±4.91 seconds, in forceps extraction group was 70.2±5.02 seconds and in the vacuum extraction group it was 62.3±2.03 seconds. In the manual extraction group, there was an estimated blood loss of 428±69.38 ml, 579±97.22 ml of estimated blood loss was present in forceps extraction group and in the vacuum extraction group it was 454±66.92 ml.Conclusions: This study reveals that with use of vacuum in CS for delivery of floating head, is superior than application of forceps and manual delivery in relation to time, blood loss and fundal pressure without any adverse effect on neonates and maternal complication.
Comparison of clinical outcomes following CuT-380A insertion in postplacental period with interval insertion
Authors: Chauhan Divya , Gainder Shalini
Published: August 2017

Background: Postplacental intra-uterine device has many benefits like providing contraception immediately after childbirth, non-interference with lactation and high efficacy. However, concerns about its safety have led to decreased use of this method of contraception. Hence, this study aims to compare the complication rates following insertion of immediate postplacental IUCD (PPIUCD) with interval insertion.Methods: This is a prospective study conducted under the Department of Obstetrics and Gynaecology in PGIMER, Chandigarh. 196 women were included in the study. Women were divided in two groups, those who were inserted with immediate postplacental IUCD versus those who had IUCD insertion in interval period. The two groups were followed up for a period of 6 months and complications were recorded. The PPIUCD group was further subdivided into 2 subgroups based on mode of delivery, vaginal delivery and caesarean section. These PPIUCD subgroups were also compared.Results: There was no statistically significant difference in the incidence of pelvic pain, infection, abnormal uterine bleeding and expulsion between the PPIUCD and interval group. However, when the PPIUCD subgroups were compared, it was seen that no woman in caesarean section subgroup had expulsion of IUCD whereas 9.8% women had expulsion in the vaginal delivery PPIUCD subgroup.Conclusions: Postplacental and interval IUCD seem to be comparable for the incidence of various complications. However, intra-caesarean PPIUCD insertion seems to have a much lower expulsion rate as compared to vaginal delivery PPIUCD insertion.
Idiopathic spontaneous haemoperitoneum in pregnancy
Authors: M. A. Mazrin Nur , I. Rohana , H. Hamidah , H. Syauki , R. Roziana
Published: August 2017

We report a case of a 43-year-old grandmultipara at 26 weeks pregnancy with acute abdomen and in hypovolaemic shock. Urgent exploratory laparotomy revealed massive haemoperitoneum of 9 litres but the exact source of bleeding is obscured despite careful examination of the abdominal organs and vasculature. The patient recovered well post operation but the baby died in-utero.
A rare case of spontaneous posterior wall rupture in an unscarred uterus during labour
Authors: Nanda Kirty , Singh Shakun , Dhama Vandana , Choudhary Rachna , Azad Renu
Published: August 2017

Uterine rupture is a dreaded catastroph in obstetrics with a high incidence of maternal and fetal morbidity. In developing Country, the overall prevalence widely varies from 1 in 2,000 to 1 in 200 deliveries. Uterine rupture in an unscarred uterus is a rare event and only a finger countable cased have been reported on posterior rupture of uterus in unscarred uterus. We here presenting a case of spontaneous posterior rupture of an unscarred uterus. Our patient was 38 years old grand multipara, a 6th gravida female with 4 parity, 1 abortion last year and 3 live issues. She was 9 months of gestation with previous all normal vaginal deliveries. This time she had a uterine rupture in the lower segment of posterior wall of uterus during labour. The rupture was unrepeatable, so we have to do hysterectomy. This case points out to keep this catastroph in mind in multiparas with unscarred uterus and to be prepared for the same while assisting a normal vaginal delivery.
Isosexual precocious puberty with primary hypothyroidism: an interesting case report
Authors: Hymavathi Kaliki , Tadisetti Surekha , Pusarla Divya , Devi Gottipati Malini
Published: August 2017

Isosexual precocious puberty in a girl child is defined as thelarche before 6 years in African–Americans and 7 years in Caucasians and menarche before the age of 9 years. In 1960, Van Wyk and Grumbach first described a syndrome characterised by breast development, uterine bleeding and multicystic ovaries in the presence of long standing primary hypothyroidism. We describe an interesting case of 8 year old girl presented with the complaint of abdominal mass with history of premature menarche and breast development. She is found to have gross hypothyroidism, hyperprolactinemia, prepubertal LH levels, multicystic ovaries and delayed bone age. Thyroid replacement amazingly settled her problems bringing her to normalcy.