bluuebunny/crossref_metadata_2025_split huggingface dataset:
One step versus two step screening for gestational diabetes mellitus
Authors: Hematbhai Satodiya Mohit 
Published: February 2021

Objective: To compare the incidence, maternal and fetal outcomes of gestational diabetes mellitus using one step vs. two step as a screening procedure.
Methodology: A prospective randomized trial involving screening of 1000 pregnant women for gestational diabetes mellitus was conducted. Women were divided in two groups (500 each). Group A comprised of patients screened with two step approach (ACOG recommendation), Group B comprised of women screened by one step method (IADPSG criteria). Women diagnosed with ‘gestational diabetes’ were followed in antenatal clinic and incidence of GDM, maternal and fetal outcome between two groups were analyzed using SPSS.
Results: The incidence of GDM was almost double using one step approach versus two step which was 19.2% and 11.8% respectively. Maternal outcomes were comparable in both the groups except the risk of preterm delivery which was 2.5 times more in group A than group B (odds ratio = 2.43 95% CI = 1.01-5.79). Further fetal outcomes were also comparable except neonatal hypoglycemia which was seen in 29.31% in group A vs. 7.4% in group B. In the group B 15 patients (15.8%) patients with GDM (based on FBS ≥92 mg/dl at 1st ANC visit) showed clinical symptoms & blood sugars in hypoglycemic range on MNT requiring resumption of normal diet.
Conclusion: The incidence of GDM using IADPSG criteria was almost double versus ACOG criteria. Maternal and fetal outcomes were comparable except in 15.8% women diagnosed as GDM (using FBS ≥92 mg/dl at 1st ANC visit as per IADPSG) suffered from hypoglycemia. A large trial is being proposed before these criteria are adopted.
R-veil in carcinoma vulva
Authors: Jain Vandana , Sekhon Rupinder , Giri Shveta , Rawal Sudhir 
Published: February 2021

Background: Vulvar cancer accounts for about 3-5% of gynaecologic malignancies. Prognosis is strongly dependent on presence of inguinofemoral lymph node metastases. Effective management of regional lymph nodes is the most important factor in the curative management of early vulvar cancer. Despite careful dissection and maintaining vascularity of skin, surgical morbidity is seen in 50% cases. Video – endoscopic inguinofemoral lymphadenectomy was developed by Bishoff in 2003 by dissecting two cadaveric models and in one patient with stage T3N1M0 penile carcinoma. VEIL is an alternative to reduce the morbidity without compromising the oncologic outcomes. VEIL has continued to evolve into single site and robotic variants. R-VEIL is a minimally invasive procedure duplicating the standard open procedure with less morbidity.
Aims and Objectives: A video presentation to describe the technique of R-VEIL in vulvar cancer and discuss the advantages and outcome.
Conclusions: R–VEIL is an attractive minimally invasive technique to do inguinal block dissection in a single sitting in patients with vulvar carcinoma as the surgeon does not get tired as happens in VEIL technique. R-VEIL allows the removal of inguinal lymph nodes within the same limits as in open procedure and potentially reduces surgical morbidity. It is better accepted cosmetically and reduces hospital stay. Long term oncological results are not available. Randomized multi-institutional studies are required to prove its efficacy over open counterpart.
Radical excision of a massive vulvo-vaginal mass
Authors: Meena J. , Parthasarathy A. , Vatsa R. , Singh N. , Kumar S. , Roy K. K. , Singhal S. 
Published: February 2021

Background: Vulvo-vaginal masses has a varied presentation and causes. The most common differential diagnosis are condylomata acuminata, vulvular abscess, vulvular/vaginal cysts, vulval carcinoma, vulval lipoma, angiomyofibroblastoma and aggressive angiomyxoma. Surgical excision of the mass is the main method of treatment and the outcome differs with the histological diagnosis. We present a video of excision of a massive Vulvo vaginal mass in toto.
Case: A 45 year old P3 L3 female, presented with complaint of mass in perineal area and discharge per vaginum for 2 years. The mass was growing progressively and reached the present size. On examination there was a 9 × 8 cm irregular firm to cystic mass, arising from posterior wall of vagina and protruding out of introitus with bossellated surface. The mass also extended into right ischiorectal fossa, 10 × 10 cm mass with cystic, smooth surface that was irreducible with no cough impulse. CECT abdomen and pelvis revealed a well-defined 12 × 10 × 8 cm mass in right perineum arising from right lower lateral vaginal wall with ischiorectal fossa extension. There was no extension into cervix, bladder or rectum. Biopsy taken from the mass was inconclusive. A wide local excision was done under general anesthesia wherein an ischiorectal and vaginal mass of size 30 × 10 cm with irregular margin was excised in toto. Histopathology was suggestive of aggressive angiomyxoma. The patient is under follow up.
Discussion: Aggressive Angiomyxoma is a rare slow growing locally invasive mesenchymal tumor and has a substantial potential for recurrence. It is often misdiagnosed. Pre-operative diagnosis is difficult due to rarity of this entity and absence of diagnostic features, but it should be considered in case of masses in genital, perianal and pelvic region in a woman of reproductive age. Radical surgical excision is the first line of management. A long term follow up of the case is necessary and MRI is preferred method for detecting recurrences.
Radical excision of a massive vulvo-vaginal mass
Authors: Meena J. , Parthasarathy A. , Vatsa R. , Singh N. , Kumar S. , Roy K. K. , Singhal S. 
Published: February 2021

Background: Vulvo-vaginal masses has a varied presentation and causes. The most common differential diagnosis are Condylomata acuminata, Vulvular abscess, Vulvular/vaginal cysts, Vulval carcinoma, Vulval lipoma, Angiomyofibroblastoma and Aggressive Angiomyxoma. Surgical excision of the mass is the main method of treatment and the outcome differs with the histological diagnosis. We present a video of excision of a massiveVulvo vaginal mass in toto.
Case: A 45 year old P3 L3female, presented with complaint of mass in perineal area & discharge per vaginum for 2 years. The mass was growing progressively and reached the present size. On examination there was a 9 X 8 cm irregular firm to cystic mass, arising from posterior wall of vagina and protruding out of introitus with bossellated surface. The mass also extended into right ischiorectal fossa, 10 X 10 cm mass with cystic, smooth surface that was irreducible with no cough impulse. CECT abdomen and pelvis revealed a well-defined 12 X 10 X 8 cm mass in right perineum arising from right lower lateral vaginal wall with ischiorectal fossa extension. There was no extension into cervix, bladder or rectum. Biopsy taken from the mass was inconclusive. A wide local excision was done under general anesthesia wherein an ischiorectal and vaginal mass of size 30 X 10 cm with irregular margin was excised in toto. Histopathology was suggestive of Aggressive Angiomyxoma. The patient is under follow up.
Discussion: Aggressive Angiomyxoma is a rare slow growing locally invasive mesenchymal tumor and has a substantial potential for recurrence. It is often misdiagnosed. Pre-operative diagnosis is difficult due to rarity of this entity and absence of diagnostic features, but it should be considered in case of masses in genital, perianal and pelvic region in a woman of reproductive age. Radical surgical excision is the first line of management. A long term follow up of the case is necessary and MRI is preferred method for detecting recurrences.
Dosimetric evaluation of sigmoidal and bowel doses in the treatment of carcinoma of cervix using CT based volumetric imaging technique
Authors: Bisht Jyoti , Kant Ravi , Gupta Meenu , Nautiyal Vipul , Bansal Saurabh , Saini Sunil , Ahmad Mushtaq 
Published: February 2021

Purpose: Radiation therapy is the main stray for the treatment of the cervical cancer. Normal organs such as bladder, rectum, sigmoid colon and bowel loops also get significant dose during treatment of carcinoma of cervix which often results late toxicity. The purpose of this study is evaluate CT image based volumetric doses of organ at risk and correlate the doses with the toxicity profile observed in cancer patients.
Materials and Methods: Sixty high dose rate intracavitary brachytherapy applications were performed in thirty patients of carcinoma of cervix. External beam therapy was planned for 46 Gy in 23 fractions followed by two brachytherapy sessions of 9 Gy/session. External beam radiotherapy was given by four field box technique to each patient. CT based treatment planning was done for each intracavitary brachytherapy application. Dose volume histogram was used for analysis of volumetric dose parameters and correlated with the RTOG defined normal organ toxicity profile of the patients.
Results: In the follow up of two years 2 (6.66%) patient had died, 12 (40%) patients had reported no significant problem, 3 (10%) patient got bladder toxicity of grade 2, 10 (33.33%) patients had reported small intestine toxicity of grade 1 and grade 2 while no information could be available for 3 (10%) patients. The average volume of rectum, sigmoid colon and bowel loops were 60.34 cc, 22.19 cc and 270.82 cc. The average, median and 2 cc volume doses for rectum 289 ± 121 cGy, 263 ± 113 cGy and 884 ± 444 cGy for sigmoid colon 409 ± 211 cGy, 366 ± 185 cGy and 693 ± 371 cGy resp. and for bowel loops 240 ± 169 cGy, 153 ± 59 cGy and 870 ± 222 cGy. The average and median sigmoid colon point doses were higher than rectum average (p= 0.000) and median doses (p =0.001) but 2cc volumetric doses of sigmoid colon are less than rectum 2cc volumetric doses (p = 0.013). For bowel loops the 2cc volumetric doses were much higher than average doses (p = 0.000) due to its large volume. The recto-sigmoidal toxicity profile were evaluated for sigmoidal max doses and rectum 2 cc volumetric dose profile. There was a poor correlation between rectum 2 cc volumetric dose and sigmoid 2 cc volumetric doses.
Conclusion: According to dose toxicity profile, sigmoidal doses represent an important role for dose constrains but till now no protocol has been formed for reporting the sigmoidal doses. This study attracts the attention for reporting the sigmoidal and bowl loop doses. This study demonstrates the possibility and role of volumetric imaging and dosimetry for improvement in dose constraints.
Primary signet ring cell mucinous carcinoma ovary: A very rare neoplasm
Authors: Mishra Amita , Pandit Archit , Kalra Namit , Narula Bhawna 
Published: February 2021

Introduction: Mucinous ovarian carcinomas are less common than serous and endometriod type, and are more frequently confined to the ovary at the time of diagnosis. But primary signet ring cell mucinous carcinomas of the ovary are extremely rare.
Case Presentation: A 40 yr old patient presented with extremely rare primary signet cell mucinous carcinoma of ovary. She presented with abdominal distension and frequency of urination for one month. She was evaluated and CECT whole abdomen was s/o large left ovarian mass. All the tumor markers were with in normal range. Laparotomy frozen section of left adnexal mass was done and was reported as malignant with sheets of signet ring cells seen. Hence complete staging laparotomy including TAH with RSO with bilateral pelvic lymph node dissection with total omentectomy with para aortic lymph node dissection. Final histopathology with IHC markers were S/O primary signet ring cell carcinoma of ovary with no extracapsular invasion, no lymph nodal involvement & no metastatic spread.
Conclusion: We present a very rare case of primary signet ring cell of ovary, confined to ovary itself. On literature review only 14 cases have been reported and of them very few are malignant.
Clinical presentation and management of malignant germ cell ovarian tumours in BPKMCH
Authors: Pariyar Jitendra , Shrestha Binuma 
Published: February 2021

Background: Germ cell malignancies account for about 5% of all ovarian cancers. These tumours grow rapidly and often produce symptoms quicker than the slow growing epithelial tumour. Commonly seen in the first two decades of life germ cell malignancies are highly chemosensitive and are potentially curable with surgery and chemotherapy. This study is the first of its kind regarding the epidemiology, management and outcome of patients with malignant germ cell tumour in Nepal.
Objective: To analyze the clinical presentation and management outcomes of malignant germ cell tumours managed in B.P. Koirala Memorial Cancer Hospital, Nepal.
Methodology: Descriptive study conducted in B.P. Koirala Memorial Cancer Hospital, Nepal. Case records of malignant germ cell tumours attending the hospital from January 1999 to December 2009 were analyzed regarding their illness history, clinical examination, investigations, treatment, follow-up and outcomes measured.
Observations: Total 65 cases of malignant germ cell tumours with age range from 2 to 58 years (mean 21.7 years) were received. 42% cases were Tibeto-Burmese; 30% were Indo-Aryans. There were 15 cases (23%) of dysgeminoma, 21 endodermal sinus tumor (32%), 16 Immature Cystic Teratoma (24.5%), 9 (14%) Mixed Germ Cell, 2 unclassified GCT (3.5%) and 2 malignant transformation in teratoma (3.5%). 33 (49.5%) patients had early stage disease, 37 (57%) underwent fertility preserving surgery. 4 cases (9%) due to disseminated disease, underwent neoadjuvant chemotherapy followed by debulking surgery. 51 cases (78.5%) received adjuvant chemotherapy (BEP or EP regimen). The overall survival was 70%.
Conclusion: Early stage germ cell malignancies can be safely managed by fertility preserving surgery followed by, chemotherapy if indicated. For advanced diseases, neoadjuvant chemotherapy followed by surgery can be undertaken with curable intent.
Clinicopathological correlates and need for adjuvant radiotherapy in early stage carcinoma cervix
Authors: Reddy Apoorva , Rajaram Shalini , Gupta Bindiya , Garg Shipra , Mishra Kiran , Goel Neerja , Radhakrishnan Gita , Vaid N. B. 
Published: February 2021

Objective: To analyse clinical-pathological findings in women undergoing surgery for early stage carcinoma cervix and to determine the need for adjuvant radiotherapy.
Methods: The study was a retrospective one done to analyse data of women who had been operated for carcinoma cervix in the last 10 years at a tertiary hospital in Delhi. Type II/III radical hysterectomy with pelvic lymphadenectomy was done depending on stage. Histopathological findings and need for adjuvant therapy based on presence of clinical and pathological criteria were studied.
Results: A total of 93 eligible patient records were included in the study. Mean age and parity was 48.09 ± 22.36 years and 4.29 ± 3.9 respectively. 47.31% (44) of the women had stage 1B1 carcinoma cervix; 31.18% (29) had stage 1B2 and 19.35% (18) had stage 2A disease. Average size of the tumour growth was 3.25 ± 2.46 cm with the largest being 7 cm. Keratinising squamous cell carcinoma was seen in 48.38% (45) of patients whereas the non-keratinising one was seen in 33.33% (31). Large cell variant was seen in 6.45% (6) whereas micro invasive cancer was seen in 4 women. Adenocarcinoma constituted only 3.2% (3) of the study group. Vaginal cuff involvement was present in 9.67% (9) of patients and an equal number had occult parametrial invasion. A significant number of these had stage 2A disease (16.66% and 22.22% respectively). Between 1B1 and 1B2 there was no significant difference in the incidence of vaginal cuff involvement and occult parametrial invasion (P equals to 0.206 and 1 respectively). Lymph nodes were positive in 24.73% with the obturator lymph node being the commonest involved (17). In stage 1b1 25% (11) had positive lymph nodes; in stage 1B2 34.48% (10) and in 2A only one woman had positive pelvic lymph nodes. This difference was also not significant (P = 0.434). About 50% (47) of patients were referred for adjuvant radiotherapy on the basis of the pathological findings. 61% (11) of patients with stage 2A disease, 51.7% (15) of patients with stage 1b2 and 45.45% (20) with stage 1B1 disease required adjuvant radiotherapy.
Conclusion: There was no significant difference in the pathological findings in patients of 1B1 and 1B2. Also the need for radiotherapy in both the groups was similar. Hence similar surgical approach to women with both 1B1 and 1B2 disease appears appropriate.
Cervical cancer management in Rural India: Are we really living in 21st century or need to focus on health education of our doctors
Authors: Mittal Sujata 
Published: February 2021

Objectives: To study cases of cervical cancer managed/unmanaged in rural India and to analyze the reasons for poor outcome.
Methods: This is a retrospective study of 218 cases of cervical cancers between 2008-2013 with resultant outcome in terms of treatment or absence of treatment in spite of diagnosis. Reasons for not taking the treatment have been analyzed. Also, analysis of 21 cases of simple hysterectomy with resultant complications like VVF, RVF has been done. Indications of surgery, operating surgeon, availability of preoperative/postoperative HPR, slides/blocks, discharge summary and disease status at the time of referral was done.
Results: 44% refused to take treatment in spite of stage III diagnosis citing financial constraints, distance to be traveled daily for RT and apathetic attitude of family towards females. 20.65% opted for other hospitals. 29.8% took complete treatment. 80% of females were illiterate and dependent. 9.7% had simple hysterectomy for invasive disease. 95% of simple hysterectomies were performed by general surgeons in private setups resulting in 19% of complications like VVF, RVF. 100% cases of simple Hysterectomy did not have pre-operative biopsy. Only 50% cases had post-operative biopsy report and in none of the cases were slide/blocks available for review as trained pathologists were not available. General surgeons who had performed surgery were neither trained in doing P/V examinations nor aware of staging of cervical cancer.
Conclusion: Illiteracy, poverty and absence of implementation of cancer control programs are the major hurdles in control of cervical cancer. The study highlights the absence of Government’s will to control cervical cancer in rural India. It emphasizes on the need of intensive training and health education of gynaecologists and surgeons at district/rural level, lack of which is a primary factor for violation of medical ethics by the doctors.
Effects of a 1-Year Physical Activity Intervention on Markers of Hemostasis among Breast Cancer Survivors: A Randomized Controlled Trial
Authors: Bøhn Siv Kjølsrud , Thune Inger , Flote Vidar Gordon , Frydenberg Hanne , Bertheussen Gro Falkenér , Husøy Anders , Fjeldheim Frøydis , Brunvoll Sonja Hjellegjerde , Hjartåker Anette , Mowinckel Marie-Christine , Sandset Per Morten , Iversen Per Ole 
Published: February 2021

Abstract
Introduction Physical activity may reduce the development of breast cancer. Whereas hypercoagulability has been linked to adverse outcomes in breast cancer patients, the effects of physical activity on their hemostatic factors are unknown. The study aimed to assess whether long-term (1 year) physical activity can affect hemostatic factors in breast cancer patients.
Methods Fifty-five women (35–75 years) with invasive breast cancer stage I/II were randomized to a physical activity intervention (n = 29) lasting 1 year or to a control group (n = 26), and analyzed as intention to treat. Fibrinogen, factor VII antigen, tissue factor pathway inhibitor, and von Willebrand factor (VWF) antigen as well as prothrombin fragment 1 + 2, the endogenous thrombin potential and D-dimer, were measured in plasma before intervention (baseline), and then after 6 and 12 months.
Results Maximal oxygen uptake (measure of cardiorespiratory fitness) decreased the first 6 months among the controls, but remained stable in the intervention group. We found no significant differences between the two study groups regarding any of the hemostatic factors, except a significantly higher increase in factor VII antigen in the intervention group. The effect of the intervention on VWF was, however, significantly affected by menopausal stage, and a significant effect of the intervention was found on VWF among postmenopausal women, even after adjustment for dietary intake.
Conclusion Long-term physical activity had no effect on the majority of the hemostatic factors measured, but led to increased plasma concentrations of factor VII antigen and prevented an increase in VWF concentration after breast cancer treatment in postmenopausal women. The clinical impact of these findings for risk of vascular thrombosis warrants further studies.
Evaluating the Right Ventricle in Acute and Chronic Pulmonary Embolism: Current and Future Considerations
Authors: Singh Siddharth , Lewis Michael I. 
Published: February 2021

AbstractThe right ventricle (RV), due to its morphologic and physiologic differences, is susceptible to sudden increase in RV afterload, as noted in patients with acute pulmonary embolism (PE). Functional impairment of RV function is a stronger presage of adverse outcomes in acute PE than the location or burden of emboli. While current iterations of most clinical prognostic scores do not incorporate RV dysfunction, advancements in imaging have enabled more granular and accurate assessment of RV dysfunction in acute PE. RV enlargement and dysfunction on imaging is noted only in a subset of patients with acute PE and is dependent on underlying cardiopulmonary reserve and clot burden. Specific signs like McConnell's and “60/60” sign are noted in less than 20% of patients with acute PE. About 2% of patients with acute PE develop chronic thromboembolic pulmonary hypertension, characterized by continued deterioration in RV function in a subset of patients with a continuum of RV function from preserved to overt right heart failure. Advances in molecular and other imaging will help better characterize RV dysfunction in this population and evaluate the response to therapies.
Risk Stratification in Acute Pulmonary Embolism: The Latest Algorithms
Authors: Triantafyllou Georgios A. , O'Corragain Oisin , Rivera-Lebron Belinda , Rali Parth 
Published: February 2021

AbstractPulmonary embolism (PE) is a common clinical entity, which most clinicians will encounter. Appropriate risk stratification of patients is key to identify those who may benefit from reperfusion therapy. The first step in risk assessment should be the identification of hemodynamic instability and, if present, urgent patient consideration for systemic thrombolytics. In the absence of shock, there is a plethora of imaging studies, biochemical markers, and clinical scores that can be used to further assess the patients' short-term mortality risk. Integrated prediction models incorporate more information toward an individualized and precise mortality prediction. Additionally, bleeding risk scores should be utilized prior to initiation of anticoagulation and/or reperfusion therapy administration. Here, we review the latest algorithms for a comprehensive risk stratification of the patient with acute PE.