Search results for: Arab women pain

Authors: Ruth Green, Samantha Milton, Rinal Desai

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Background/Aims: Eye pain/swelling/redness is a common presentation to Barnet General Hospital (a district general hospital), pediatric emergency department, and is managed by both the pediatric and emergency teams. The management of each child differs dramatically depending on the healthcare professional who reviews them. There also appears to be confusion in diagnosis between periorbital cellulitis, pre-septal cellulitis, and orbital cellulitis. Pre septal cellulitis refers to an inflammation of the eyelids and soft tissue anterior to the orbital septum. In contrast, orbital cellulitis is a serious, rapidly progressive infection of soft tissues located posterior to the orbital septum. Pre-septal cellulitis is more prevalent and less serious than orbital cellulitis, although it may be part of a continuous spectrum if untreated. Pre-septal cellulitis should there be diagnosed and treated urgently to prevent spread to the septum. For the purpose of the audit, the term periorbital cellulitis has been used as an umbrella term for all spectrums of this infection. The audit aimed to look at, how as a whole, the department is diagnosing and managing orbital and pre-septal cellulitis. Gold Standard: Patients of the same age and diagnosis should be treated with the same medication, advice, and follow-up. Method: Data was collected retrospectively from pediatric patients ( < 18years) who attended the emergency department from June 2019 to February 2020 who had been coded as pre-septal cellulitis, periorbital cellulitis, orbital cellulitis, or eye pain/swelling/redness. Demographics, signs and symptoms, management, and follow-up were recorded for all patients with any of the diagnoses of pre-septal, periorbital, or orbital cellulitis. A Microsoft Excel spreadsheet was used to record the anonymised data. Results: There were vast discrepancies in the diagnosis, management, and follow-up of patients with periorbital cellulitis. Conclusion/Discussion: The audit concluded there is no uniform approach to managing periorbital cellulitis in Barnet General Hospital Paediatric Emergency Department. Healthcare professionals misdiagnosed conjunctivitis as periorbital cellulitis, and adequate steps did not appear to be documented on excluding red flag signs and symptoms of patients presenting. There was no consistency in follow-up, with some patients having timely phone reviews or clinical reviews for mild symptoms. Advice given by the staff was appropriate, and patients did return when symptoms got worse and were treated accordingly. Plan: Given the inconsistency, a gold standard care pathway or local easily accessible clinical guideline can be developed to help with the diagnosis and management of periorbital cellulitis. Along with this, a teaching session can be carried out for the staff of the pediatric team and emergency department to disseminate the teaching. Following the introduction of a guideline and teaching sessions, patients notes can be re-reviewed to check improvement in patient care.

Keywords: periorbital cellulitis, preseptal cellulitis, orbital cellulitis, erythematous eyelid

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Authors: Cherrie Lowe

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The TrendCare Patient Dependency System is currently utilized by a large number of Maternity Services across Australia, New Zealand and Singapore. In 2012, 2013, and 2014 validation studies were initiated in all three countries to validate the acuity tools used for Women in Labour, and Postnatal Mothers and Babies. This paper will present the findings of the validation study. Aim: The aim of this study was to; Identify if the care hours provided by the TrendCare Acuity System was an accurate reflection of the care required by Women and Babies. Obtain evidence of changes required to acuity indicators and/or category timings to ensure the TrendCare acuity system remains reliable and valid across a range of Maternity care models in three countries. Method: A non-experimental action research methodology was used across four District Health Boards in New Zealand, two large public Australian Maternity services and a large tertiary Maternity service in Singapore. Standardized data collection forms and timing devices were used to collect Midwife contact times with Women and Babies included in the study. Rejection processes excluded samples where care was not completed/rationed. The variances between actual timed Midwife/Mother/Baby contact and actual Trend Care acuity times were identified and investigated. Results: 87.5% (18) of TrendCare acuity category timings matched the actual timings recorded for Midwifery care. 12.5% (3) of TrendCare night duty categories provided less minutes of care than the actual timings. 100% of Labour Ward TrendCare categories matched actual timings for Midwifery care. The actual times given for assistance to New Zealand independent Midwives in Labour Ward showed a significant deviation to previous studies demonstrating the need for additional time allocations in Trend Care. Conclusion: The results demonstrated the importance of regularly validating the Trend Care category timings with the care hours required, as variances to models of care and length of stay in Maternity units have increased Midwifery workloads on the night shift. The level of assistance provided by the core labour ward staff to the Independent Midwife has increased substantially. Outcomes: As a consequence of this study changes were made to the night duty TrendCare Maternity categories, additional acuity indicators developed and times for assisting independent Midwives increased. The updated TrendCare version was delivered to Maternity services in 2014.

Keywords: maternity, acuity, research, nursing workloads

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Authors: Sayantika Biswas, Dipanshu Sur, Amitoj Athwal, Ratnabali Chakravorty

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Title: Impact of serum estrogen and progesterone levels in the outcome pregnancy rate in frozen embryo transfer cycles. A prospective cohort study Objective: The aim of the current study was to evaluate the effect of serum estradiol (E2) and progesterone (P4) levels at different time points on pregnancy outcomes in frozen embryo transfer (FET) cycles. Materials & Method: A prospective cohort study was performed in patients undergoing frozen embryo transfer. Patients under age 37 years of age with at least one good blastocyst or three good day 3 embryos were included in the study. For endometrial preparation, 14 days of oral estradiol use (2X2 mg for 5 days. 3X2 mg for 4 days, and 4X2 mg for 5 days) was followed by vaginal progesterone twice a day and 50 mg intramuscular progesterone twice a day. Embryo transfer was scheduled 72-76 hrs or 116-120hrs after the initiation of progesterone. Serum E2 and P4 levels were examined at 4 times a) at the start of the menstrual cycle prior to the hormone supplementation. b) on the day of P4 start. c) on the day of ET. d) on the third day after ET. Result: A total 41 women were included in this study (mean age 31.8; SD 2.8). Clinical pregnancy rate was 65.55%. Serum E2 levels on at the start of the menstrual cycle prior to the hormone supplementation and on the day of P4 start were high in patients who achieved pregnancy compared to who did not (P=0.005 and P=0.019 respectively). P4 levels on on the day of ET were also high in patients with clinical pregnancy. On the day of P4 start, a serum E2 threshold of 186.4 pg/ml had a sensitivity of 82%, and P4 had a sensitivity of 71% for the prediction of clinical pregnancy at the threshold value 16.00 ng/ml. Conclusion: In women undergoing FET with hormone replacement, serum E2 level >186.4 pg/ml on the day of the start of progesterone and serum P4 levels >16.00 ng/ml on embryo transfer day are associated with clinical pregnancy.

Keywords: serum estradiol, serum progesterone, clinical pregnancy, frozen embryo transfer

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Authors: Patrícia Pires, Renata Vaz, Bárbara Teles, Marco Pato, Pedro Beckert

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Introduction: The management of lateral third clavicle fractures can be challenging due to difficulty in distinguishing subtle variations in the fracture pattern, which may be suggestive of potential fracture instability. They occur most often in men between 30 and 50 years of age, and in individuals over 70 years of age, its distribution is equal between both men and women. These fractures account for 10%–30% of all clavicle fractures and roughly 30%–45% of all clavicle nonunion fractures. Lateral third clavicle fractures may be treated conservatively or surgically, and there is no gold standard, although the risk of nonunion or pseudoarthrosis impacts the recommendation of surgical treatment when these fractures are unstable. There are many strategies for surgical treatment, including locking plates, hook plates fixation, coracoclavicular fixation using suture anchors, devices or screws, tension band fixation with suture or wire, transacromial Kirschner wire fixation and arthroscopically assisted techniques. Whenever taking the hardware into consideration, we must not disregard that obtaining adequate lateral fixation of small fragments is a difficult task, and plates are more associated to local irritation. The aim of the appropriate treatment is to ensure fracture healing and a rapid return to preinjury activities of daily living but, as explained, definitive treatment strategies have not been established and the variety of techniques avalilable add up to the discussion of this topic. Methods and Results: We present a clinical case of a 43-year-old man with the diagnosis of a lateral third clavicle fracture (Neer IIC) in the sequence of a fall on his right shoulder after a bicycle fall. He was operated three days after the injury, and through K-wire temporary fixation and indirect reduction using a ZipTight, he underwent osteosynthesis with an interfragmentary figure-of-eight tension band with polydioxanone suture (PDS). Two weeks later, there was a good aligment. He kept the sling until 6 weeks pos-op, avoiding efforts. At 7-weeks pos-op, there was still a good aligment, starting the physiotherapy exercises. After 10 months, he had no limitation in mobility or pain and returned to work with complete recovery in strength. Conclusion: Some distal clavicle fractures may be conservatively treated, but it is widely accepted that unstable fractures require surgical treatment to obtain superior clinical outcomes. In the clinical case presented, the authors chose an osteosuture technique due to the fracture pattern, its location. Since there isn´t a consensus on the prefered fixation method, it is important for surgeons to be skilled in various techniques and decide with their patient which approach is most appropriate for them, weighting the risk-benefit of each method. For instance, with the suture technique used, there is no wire migration or breakage, and it doesn´t require a reoperation for hardware removal; there is also less tissue exposure since it requires a smaller approach in comparison to the plate fixation and avoids cuff tears like the hook plate. The good clinical outcome on this case report serves the purpose of expanding the consideration of this method has a therapeutic option.

Keywords: lateral third, clavicle, suture, fixation

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Authors: Lea Stein, Sabine Rösner, Alessandra Lo Giudice, Beate Ditzen, Tewes Wischmann

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For many couples bearing children is a consistent life goal; however, it cannot always be fulfilled. Undergoing infertility treatment does not guarantee pregnancies and live births. Couples have to deal with miscarriages and sometimes even discontinue infertility treatment. Significant medical predictors for the outcome of infertility treatment have yet to be fully identified. To further our understanding, a cross-sectional five-year follow-up survey was undertaken, in which 95 women and 82 men that have been treated at the Women’s Hospital of Heidelberg University participated. Binary logistic regressions, parametric and non-parametric methods were used for our sample to determine the relevance of biological (infertility diagnoses, maternal and paternal age) and lifestyle factors (smoking, drinking, over- and underweight) on the outcome of infertility treatment (clinical pregnancy, live birth, miscarriage, dropout rate). During infertility treatment, 72.6% of couples became pregnant and 69.5% were able to give birth. Suffering from miscarriages 27.5% of couples and 20.5% decided to discontinue an unsuccessful fertility treatment. The binary logistic regression models for clinical pregnancies, live births and dropouts were statistically significant for the maternal age, whereas the paternal age in addition to maternal and paternal BMI, smoking, infertility diagnoses and infections, showed no significant predicting effect on any of the outcome variables. The results confirm an effect of maternal age on infertility treatment, whereas the relevance of other medical predictors remains unclear. Further investigations should be considered to increase our knowledge of medical predictors.

Keywords: advanced maternal age, assisted reproductive technology, female factor, male factor, medical predictors, infertility treatment, reproductive medicine

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Authors: Omair Anas

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The Persian Gulf has been in turmoil for a long time since the colonial administration has handed over the role to the small and weak kings and emirs who were assured of protection in return of many economic and security promises to them. The regional order, Saudi Arabia evolved was a rentier regional order secured by an expansion of rentier economy and taking responsibility for much of the expenses of the regional order on behalf of relatively poor countries. The two oil booms helped the Saudi state to expand the 'rentier order' driven stability and bring the countries like Egypt, Jordan, Syria, and Palestine under its tutelage. The disruptive misadventure, however, came with Iran's proclamation of the Islamic Revolution in 1979 which it wanted to be exported to its 'un-Islamic and American puppet' Arab neighbours. For Saudi Arabia, even the challenge presented by the socialist-nationalist Arab dictators like Gamal Abdul Nasser and Hafez Al-Assad was not that much threatening to the Saudi Arabia’s then-defensive realism. In the Arab uprisings, the Gulf monarchies saw a wave of insecurity and Iran found it an opportune time to complete the revolutionary process it could not complete after 1979. An alliance of convenience and ideology between Iran and Islamist groups had the real potential to challenge both Saudi Arabia’s own security and its leadership in the region. The disruptive threat appeared at a time when the Saudi state had already sensed an impending crisis originating from the shifts in the energy markets. Low energy prices, declining global demands, and huge investments in alternative energy resources required Saudi Arabia to rationalize its economy according to changing the global political economy. The domestic Saudi reforms remained gradual until the death of King Abdullah in 2015. What is happening now in the region, the Qatar crisis, the Lebanon crisis and the Saudi-Iranian proxy war in Iraq, Syria, and Yemen has combined three immediate objectives, rationalising Saudi economy and most importantly, the resetting the Saudi royal power for Saudi Arabia’s longest-serving future King Mohammad bin Salman. The Saudi King perhaps has no time to wait and watch the power vacuum appearing because of Iran’s expansionist foreign policy. The Saudis appear to be employing an offensive realism by advancing a pro-active regional policy to counter Iran’s threatening influence amid disappearing Western security from the region. As the Syrian civil war is coming to a compromised end with ceding much ground to Iran-controlled militias, Hezbollah and Al-Hashad, the Saudi state has lost much ground in these years and the threat from Iranian proxies is more than a reality, more clearly in Bahrain, Iraq, Syria, and Yemen. This paper attempts to analyse the changing Saudi behaviour in the region, which, the author understands, is shaped by an offensive-realist approach towards finding a favourable security environment for the Saudi-led regional order, a post-rentier order perhaps.

Keywords: terrorism, Saudi Arabia, Rentier State, gulf crisis

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Authors: Palwinder Singh

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Beyond the conventional mode of working with anti-inflammatory agents through enzyme inhibition, herein, an alternate substrate of cyclooxygenase-2 was developed. Proline centered pentapeptide iso-conformational to arachidonic acid exhibited appreciable selectivity for COX-2 overcoming acetic acid and formalin induced pain in rats to almost 80% and was treated as a substrate by the enzyme. Remarkably, COX-2 metabolized the pentapeptide into small fragments consisting mainly of di- and tri-peptides that ensured the safe breakdown of the peptide under in-vivo conditions. The kinetic parameter Kcat/Km for COX-2 mediated metabolism of peptide 6.3 x 105 M-1 s-1 was quite similar to 9.5 x 105 M-1 s-1 for arachidonic acid. Evidenced by the dynamic molecular studies and the use of Y385F COX-2, it was observed that the breakage of the pentapeptide has probably taken place through H-bond activation of the peptide bond by the side chains of Y385 and S530.

Keywords: small peptides, anti-inflammatory agents, cyclooxygenase-2, unnatural substrates

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Authors: Ezinne K. Okoro, Takahiko Katoh, Yoko Kawamura, Stanley C. Meribe

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HIV infection in children is largely as a result of vertical transmission (mother to child transmission [MTCT]). Thus, elimination of mother to child transmission of HIV/AIDS is critical in eliminating HIV infection in children. In Nigeria, drawbacks such as; limited pediatric screening, limited human capital, insufficient advocacy and poor understanding of ART guidelines, have impacted efforts at combating the disease, even as treatment services are free. Prevention of Mother to Child Transmission (PMTCT) program relies on health workers who not only counsel pregnant women on first contact but can competently provide HIV-positive pregnant women with accurate information about the PMTCT program such as feeding techniques and drug adherence. In developing regions like Nigeria where health care delivery faces a lot of drawbacks, it becomes paramount to address these issues of poor PMTCT coverage by conducting a baseline assessment of the knowledge, practices and perceptions related to HIV prevention amongst healthcare workers in Nigeria. A descriptive cross-sectional study was conducted amongst 250 health workers currently employed in health facilities in Abuja, Nigeria where PMTCT services were offered with the capacity to carry out early infant diagnosis testing (EID). Data was collected using a self-administered, pretested, structured questionnaire. This study showed that the knowledge of PMTCT of HIV was poor (30%) among healthcare workers who offer this service day-to-day to pregnant women. When PMTCT practices were analyzed in keeping with National PMTCT guidelines, over 61% of the respondents reported observing standard practices and the majority (58%) had good attitudes towards caring for patients with HIV/AIDS. Although 61% of the respondents reported being satisfied with the quality of service being rendered, 63% reported not being satisfied with their level of knowledge. Predictors of good knowledge were job designation and level of educational attainment. Health workers who were more satisfied with their working conditions and those who had worked for a longer time in the PMTCT service were more likely to observe standard PMTCT practices. With over 62% of the healthcare workers suggesting that more training would improve the quality of service being rendered, this is a strong pointer to stakeholders to consider a ‘healthcare worker-oriented approach’ when planning and conducting PMTCT training for healthcare workers. This in turn will increase pediatric ARV coverage, the knowledge and effectiveness of the healthcare workers in carrying out appropriate PMTCT interventions and culminating in the reduction/elimination of HIV transmission to newborns.

Keywords: attitudes, HIV/AIDS, healthcare workers, knowledge, mother to child transmission, Nigeria, perceptions

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Authors: Yousef Abu Amrieh

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This paper explores how Arab American novelist Rabih Alameddine's recent novel The Angel of History (2016) appropriates certain motifs, tropes, and themes from Shakespeare's The Tempest. In particular, Alameddine's novel re-tells the story of Caliban and his mother from the perspective of a Yemeni bastard whose mis/fortunes take him to the US shores in the eighties of the previous century. The novel, specifically, re-writes the scene in which Caliban is gazed at by European travelers like Stephano and Trinculo whose first reaction to seeing him is to consider how to sell him or give him as a gift when they safely return to Europe. The novel contests Shakespeare's representation of Caliban as 'marketable' through depicting his daily experiences in modern day America.

Keywords: appropriation, Alameddine, Shakespeare, The Tempest

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Authors: Narjis Kahtoon

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The issue of the wage discrimination on the basis of gender and social problem has been a significant research problem for several decades. Whereas lots of have explored reasons for the persistence of an inequality in the wages of male and female, none has successfully explained away the entire differentiation. The wage discrimination on the basis of gender and social problem of working women is a global issue. Although inequality in political and economic and social make-up of countries all over the world, the gender wage discrimination, and social constraint is present. The aim of the research is to examine the gender wage discrimination and social constraint from an international perspective and to determine whether any pattern exists among cultural dimensions of a country and the man and women remuneration gap in Readymade Garment Sector of Pakistan. Population growth rate is significant indicator used to explain the change in population and play a crucial point in the economic development of a country. In Pakistan, readymade garment sector consists of small, medium and large sized firms. With an estimated 30 percent of the workforce in textile- Garment is females’. Readymade garment industry is a labor intensive industry and relies on the skills of individual workers and provides highest value addition in the textile sector. In the Garment sector, female workers are concentrated in poorly paid, labor-intensive down-stream production (readymade garments, linen, towels, etc.), while male workers dominate capital- intensive (ginning, spinning and weaving) processes. Gender wage discrimination and social constraint are reality in Pakistan Labor Market. This research allows us not only to properly detect the size of gender wage discrimination and social constraint but to also fully understand its consequences in readymade garment sector of Pakistan. Furthermore, research will evaluated this measure for the three main clusters like Lahore, Karachi, and Faisalabad. These data contain complete details of male and female workers and supervisors in the readymade garment sector of Pakistan. These sources of information provide a unique opportunity to reanalyze the previous finding in the literature. The regression analysis focused on the standard 'Mincerian' earning equation and estimates it separately by gender, the research will also imply the cultural dimensions developed by Hofstede (2001) to profile a country’s cultural status and compare those cultural dimensions to the wage inequalities. Readymade garment of Pakistan is one of the important sectors since its products have huge demand at home and abroad. These researches will a major influence on the measures undertaken to design a public policy regarding wage discrimination and social constraint in readymade garment sector of Pakistan.

Keywords: gender wage differentials, decomposition, garment, cultural

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Authors: J. S. P. Barbosa, L. C. Pereira, K. R. Garcia, P. C. P. Bouchardet, S. C. T. Vieira, A. O. Gomes, S. S. Funghetto, M. G. O. Kanikowski

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For this population, height seems to be a good predictor of strength and body composition. This increase in life expectancy of the Brazilian's population is associated with sociodemographic variables, but also to more access to health services in the prevention and better living conditions. With the growth of elderly population, a problem that has been a concern to health's professionals and public health at all is the use of psychoactive substances. The purpose of this study was to identify the sociodemographic profile of the elderly people who was attended at the Center of Psychosocial Care of alcohol and other drugs in the Federal District of Brazil. 408 medical records of people aged 60 years or over were evaluated, and it is possible to know that most of them were males (85.3%), with a mean age of 64 years (DP ± 4.16), 60 and 84 years and a mean age of 64 years (DP ± 4.42); 88.2% have some family ties, are married and have children, with relatives living in masonry housing. The educational level of drug users was considered low with more emphasis on those who had elementary education being the majority retired or unemployed. Regarding the street situation, there was no significance (p = 0.084), and the women (OR = 2.98) had few chances of street situations compared to men (OR = 0.89). As for substance consumption, the highest quantity of drug consumption bids in relation to the number of illicit. It did not present significant statistical value, and there is a greater probability of consumption/abuse of legal and/or illicit drugs for both sexes (OR = 0.96) for men and (OR = 1.32) for women. In relation to the use of multiple drugs, there was no significant difference between the sexes, (OR = 1.1) male sex and (OR = 0.74) female sex. Based on the results found in the present study, it was concluded that alcohol consumption is the main agent that causes vulnerability in the elderly and predisposes the latter to the consumption of other associated drugs.

Keywords: centers of attention psychosocial alcohol and drugs, elderly, mental disorder due to drug use, street situations

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Authors: Tan Hui Ying Renee, Stella Rizalina Sasha, Farah Safdar Husain

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Introduction: Menopause Hormone Therapy (MHT) is an effective drug indicated for the treatment of menopausal symptoms and as replacement therapy in women who undergo premature menopause. In 2020, less than 8.8% of perimenopausal Singaporean women are on hormonal therapy, as compared to the Western population, where up to 50% may be on MHT. Factors associated with MHT utilization have been studied from patient characteristics, but the impact of locally prescribing physicians resulting in low MHT utilization has yet to be evaluated. The aim of the study is to determine the level of knowledge physicians in the Obstetrics and Gynaecology specialty have and their attitudes toward MHT. We believe that knowledge of MHT is lacking and that negative attitudes towards MHT may influence its use and undermine the benefits MHT may have for women. This paper is a part of a larger study on Singaporean physicians’ knowledge and attitudes towards MHT. Methods: This is a cross-sectional study intended to assess the knowledge and attitudes of physicians toward Menopausal Hormone Therapy. An anonymous questionnaire was disseminated via institutional internal circulations to optimize reach to physicians who may prescribe MHT, particularly in the fields of Gynaecology, Family Medicine and Endocrinology. Responses were completed voluntarily. Physicians had the option for each question to declare that they were ‘unsure’ or that the question was ‘beyond their expertise’. 21 knowledge questions tested factual recall on indications, contraindications, and risks of MHT. The remaining 6 questions were clinical scenarios crafted with the intention of testing specific principles related to the use of MHT. These questions received face validation from experts in the field. 198 responses were collected, 79 of which were from physicians in the Obstetrics and Gynaecology specialty. The data will be statistically analyzed to investigate areas that can be improved to increase the overall benefits of MHT for the Singaporean population. Results: Preliminary results show that the prevailing factors that limit Singaporean gynecologists and obstetricians from prescribing MHT are a lack of knowledge of MHT and a lack of confidence in prescribing MHT. Risks and indications of MHT were not well known by many physicians, with the majority of the questions having more than 25% incorrect and ‘unsure’ as their reply. The clinical scenario questions revealed significant shortcomings in knowledge on how to navigate real-life challenges in MHT use, with 2 of 6 questions with more than 50% incorrect or ‘beyond their expertise’ as their reply. The portion of the questionnaire that investigated the attitudes of physicians showed that though a large majority believed MHT to be an effective drug, only 40.5% were confident in prescribing it. Conclusion: Physicians in the Obstetrics and Gynaecology specialty lack knowledge and confidence in MHT. Therefore, it is imperative to formulate solutions on both the individual and institutional levels to fill these gaps and ensure that MHT is used appropriately and prescribed to the patients who need it.

Keywords: menopause, menopause hormone therapy, physician factors, obstetrics and gynecology, menopausal symptoms, Singapore

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Authors: Aftab Ahmed, Ghulam Mehboob

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The object of presentation is to highlight the importance of condition which is a very rare genetic disorder although Paget’s disease is common but its juvenile type is very rare and a late presentation due to very slow onset and lack of earlier standard management. We present a case of 25 years old male with a chronic history of bone pain and a slow onset of mild swelling, later on diagnosed as juvenile Paget disease of bone. Rarity of this condition with inaccessibility for standard health treatment can lead to a significant delay in presentation and its management. There have been 50 reported cases worldwide according to Genetic Home Reference. There is increased osteoclastic activity along with osteoblastic activity related to gene alteration and osteoprotegrin deficiency. Morbidity of disease is very significant which lead children to become immobilize.

Keywords: juvenile, Paget’s disease, bone, Northern Area of Pakistan

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Authors: Margaret Denise P. Del Rosario, Geraldine Alcantara

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Background: The declaration of the COVID-19 pandemic has impacted hospital visits of child abuse cases with less consults but more severe injuries. Objective: The study aims to identify the clinical profiles of patients seen in the hospital ng Makati Women and Children Protection Unit before and during the pandemic. Design: A cross-sectional analytic study design through review of records that underwent quantitative analysis. Results: 264 cases pre-pandemic and 208 cases during the pandemic were reviewed. Most reported cases were neglect comprising of 47% of the pre-pandemic cases and 68% of cases during the pandemic. Supervisory neglect was most commonly reported. An equal distribution between males and females were seen among victims and alleged perpetrators. The age group of both victims and alleged perpetrators during the pandemic was significantly younger compared to the pre-pandemic period. Children belonging to larger family groups were commonly encountered with most of them being the eldest amongst siblings. Alleged perpetrators were mostly secondary graduates for both time periods. A significant increase of cases during the pandemic occurred at home. More patients required hospitalization during the pandemic period with 37% compared to the 23% of admissions prior to the pandemic. Furthermore, a three-fold increase of injuries sustained during the pandemic required intensive care. Conclusion: The study reflects increased severity of injuries related to abuse during the pandemic compared to pre-pandemic times. A significant increase in injuries requiring intensive care were also seen despite less reported cases.

Keywords: child abuse, COVID-19, violence against children, WCPU, neglect

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Authors: Nimasha Malalasekera

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Working with the indigenous Adivasi (Vedda) community of Dambana in the district of Badulla in Sri Lanka, this research documents linguistic data to address language and cultural endangerment. The ancestral language of Adivasi has undergone sustained restructuration over a long historical period due to its contact with Sinhala, an Indo-Aryan language spoken by the majority Sinhalese. The Vedda language is highly endangered today. At present, all speakers of the Vedda language spoken in Dambana are Adivasi men in the parent generation, who are Sinhala-Vedda bilinguals. Adivasi women and children do not speak the Vedda language but Sinhala in everyday life. Women can understand the Vedda language and would respond to a Vedda language utterance in Sinhala. The use of the Vedda language is largely restricted to self-ascribing Adivasi men who employ it in the context of cultural tourism in Dambana to index ethnolinguistic otherness. Adivasi of Dambana often refers to this distinct linguistic code that they speak as baasapojja or language. This research employs a cooperative model of ethnographic documentation to explore the interrelations between discursive practices, linguistic structures, and linguistic (and broader sociocultural) ideologies in this community. The Vedda language has been previously identified as a dialect of Sinhala or a creole emerging in the contact between Sinhala and the ancestral Vedda language. This paper analyzes the current language endangerment context of bilingual Adivasi members that allows the birth of a mixed language. The aim of this research is to preserve ongoing linguistic innovation among this endangered language speech community. It contributes to the appreciation of creative cultural and linguistic production of a stigmatized minuscule indigenous community of South Asia that strives to assert a distinct linguistic and cultural identity from the dominant populations.

Keywords: Vedda language, language endangerment, mixed languages, indigenous identity

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Authors: Emily Hamilton, Adiel Kahana, Ron Hauser, Shimi Barda

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BACKGROUND: In the male fertility and sperm bank unit of Tel Aviv Sourasky medical center, women are treated with intrauterine insemination (IUI) using washed sperm from their partner or thawed sperm from a selected donor. In most cases, the women perform the IUI treatment in Sourasky, but sometimes they ask to undergo the insemination procedure in another clinic with their own fertility doctor. In these cases, the sperm sample is prepared at the Sourasky lab and the patient is inseminated after arriving to her doctor. Our laboratory has previously found that time negatively affects several parameters of thawed sperm, and we estimate that it has more severe and significant effect than on washed sperm. AIM: To examine the effect of time on the quality of washed sperm versus thawed sperm. METHODS: Sperm samples were collected from men referred for semen analysis. Each ejaculate was allowed to liquefy for at least 20 min at 37°C and analyzed for sperm motility and vitality percentage and DNA fragmentation index (Time 0). Subsequently, 1ml of the sample was divided into two parts, 1st part was washed only and the 2nd part was washed, frozen and thawed. Time 1 analysis occurred immediately after sperm washing or thawing. Time 2 analysis occurred 75 minutes after time 1. Statistical analysis was performed using Student t-test. P values<0.05 were considered significant. RESULTS: Preliminary data showed that time had a greater impact on the average percentages of sperm motility and vitality in thawed compared to washed sperm samples (26%±10% vs. 21%±10% and 21%±9% vs. 9%±10%, respectively). An additional trend towards increased average DNA fragmentation percentage in thawed samples compared to washed samples was observed (46%±18% vs. 25%±24%). CONCLUSION: Time negatively effects sperm quality. The effect is greater in thawed samples compared to fresh samples.

Keywords: ART, male fertility, sperm cryopreservation, sperm quality

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Authors: Asem Bani Amer

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This study handles the linguistic fingerprint in judicial applications described in a law technicality that is recent and developing. It can be adopted to discover criminals by identifying their way of speaking and their special linguistic expressions. This is achieved by understanding the expression "linguistic fingerprint," its concept, and its extended domain, then revealing some of the linguistic fingerprint tools in Western judicial applications and deducing a technical imagination for a linguistic fingerprint in the Arabic language, which is needy for such judicial applications regarding this field, through dictionaries, language rhythm, and language structure.

Keywords: linguistic fingerprint, judicial, application, dictionary, picture, rhythm, structure

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Authors: Kamaljeet Kaur, Vinod Kumari, Jatesh Kathpalia, Bas Kaur

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A gender bias towards girl child is pervasive across the world. It is seen in all the strata of the society and manifests in various forms. However nature and extent of these inequalities are not uniform. Generally these inequalities are more prevalent in patriarchal society. Despite emerging and increasing opportunities for women, there are still inequalities between men and women in each and every sphere like education, health, economy, polity and social sphere. Patriarchal ideology as a cultural norm enforces gender construction which is oriented toward hierarchical relations between the sexes and neglect of women in Indian society. Discrimination to girls may also vary by their age and be restricted to the birth order and sex composition of her elder surviving siblings. The present study was conducted to know the gender discrimination among rural children in India. The respondents were selected from three generations as per AICRP age group viz, 18-30 years (3rd generation), 31-60 years (2nd generation) and above 60 years (1st generation). A total sample size was 600 respondents from different villages of two districts of Haryana state comprising of half males and half females. Data were collected using personal interview schedule and analysed by SPSS software. Among the total births 46.35 per cent were girl child and 53.64 % were male child. Dropout rate was more in female children as compared to male children i.e. near about one third (31.09%) female children dropped school followed by 21.17 % male children. It was quite surprising that near about two-third (61.16%) female children and more than half (59.22%) of the male children dropped school. Cooking was mainly performed by adult female with overall mean scores 2.0 and ranked first which was followed by female child (1.7 mean scores) clearly indicating that cooking was the activity performed mainly by females while activity related to purchase of fruits and vegetable, cereals and pulses was mainly done by adult male. First preference was given to male child for serving of costly and special food. Regarding professional aspiration of children of the respondents’ families, it was observed that 20.10% of the male children wanted to become engineer, whereas only 3.89 % female children wanted to become engineer. Ratio of male children was high in both generations irrespective of the districts. School dropouts were more in case of female in both the 1st and 2 nd generations. The main reasons of school dropout were lack of interest, lack of resources and early marriage in both the generations. Female enrolment was more in faculty of arts, whereas in case of male percentage it was more in faculty of non-medical and medical which showed that female children were getting traditional type of education. It is suggested to provide equal opportunities to girls and boys in home as well as outside the home for smooth functioning of society.

Keywords: gender biasness, male child, female child, education, home

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Authors: Nigar Sultanova

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Facial morphology is a constant topic of concern for clinicians. When anthropometric methods were introduced into clinical practice to quantify changes in the craniofacial framework, features distinguishing various ethnic group were discovered. Normative data of facial measurements are indispensable to precise determination of the degree of deviations from normal. Establish the reference range of facial proportions in Azerbaijan population by anthropometric measurements of craniofacial complex. The study group consisted of 350 healthy young subjects, 175 males and 175 females, 18 to 25 years of age, from 7 different regions of Azerbaijan. The anthropometric examination was performed according to L.Farkas's method with our modification. In order to determine the morphologic characteristics of seven regions of the craniofacial complex 42 anthropometric measurements were selected. The anthropometric examination. Included the usage of 33 anthropometric landmarks. The 80 indices of the facial proportions, suggested by Farkas and Munro, were calculated: head -10, face - 23, nose - 23, lips - 9, orbits - 11, ears - 4. The date base of the North American white population was used as a reference group. Anthropometric measurements of facial proportions in Azerbaijan population revealed a significant difference between mеn and womеn, according to sexual dimorphism. In comparison with North American whites, considerable differences of facial proportions were observed in the head, face, orbits, labio-oral, nose and ear region. However, in women of the Azerbaijani population, 29 out of 80 proportion indices were similar to the proportions of NAW women. In the men of the Azerbaijani population, 27 out of 80 proportion indices did not reveal a statistically significant difference from the proportions of NAW men. Estimation of the reference range of facial proportions in Azerbaijan population migth be helpful to formulate surgical plan in treatment of congenital or post-traumatic facial deformities successfully.

Keywords: facial morphology, anthropometry, indices of proportion, measurement

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Authors: Indu Poornima

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This paper aims at understanding the Socio-historical, political and economic dimensions of Female Genital Mutilation in Africa. After throwing light on the definition of FGM and scrutinizing the misconceptions associated with it, the paper progresses to analyze the following questions. a) How do communities performing FGM rationalize their act? b) Are the victims (women) themselves the strongest proponents of FGM ? and c) Are legislations against FGM by international organizations counter-productive?

Keywords: female genital mutilation, Africa, rationalizing the act, international legislations

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Authors: Maria E. V. Amarante, Carolina L. Cerdeira, Julia V. Cortes, Fiorita G. L. Mundim

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Basal cell carcinoma (BCC) is the most prevalent type of skin cancer in humans. It arises from the basal cells of the epidermis and cutaneous appendages. The role of sunlight exposure as a risk factor for BCC is very well defined due to its power to influence genetic mutations, in addition to having a suppressor effect on the skin immune system. Despite showing low metastasis and mortality rates, the tumor is locally infiltrative, aggressive, and destructive. Considering the high prevalence rate of this carcinoma and the importance of early detection, a retrospective study was carried out in order to correlate the clinical data available on BBC, characterize it epidemiologically, and thus enable effective prevention measures for the population. Data on the period from January 2015 to December 2019 were collected from the medical records of patients registered at one pathology service located in the southeast region of Brazil, known as SVO, which delivers skin biopsy results. The study was aimed at correlating the variables, sex, age, and subtypes found. Data analysis was performed using the chi-square test at a nominal significance level of 5% in order to verify the independence between the variables of interest. Fisher's exact test was applied in cases where the absolute frequency in the cells of the contingency table was less than or equal to five. The statistical analysis was performed using the R® software. Ninety-three basal cell carcinoma were analyzed, and its frequency in the 31-to 45-year-old age group was 5.8 times higher in men than in women, whereas, from 46 to 59 years, the frequency was found 2.4 times higher in women than in men. Between the ages of 46 to 59 years, it should be noted that the sclerodermiform subtype appears more than the solid one, with a difference of 7.26 percentage points. Reversely, the solid form appears more frequently in individuals aged 60 years or more, with a difference of 8.57 percentage points. Among women, the frequency of the solid subtype was 9.93 percentage points higher than the sclerodermiform frequency. In males, the same percentage difference is observed, but sclerodermiform is the most prevalent subtype. It is concluded in this study that, in general, there is a predominance of basal cell carcinoma in females and in individuals aged 60 years and over, which demonstrates the tendency of this tumor. However, when rarely found in younger individuals, the male gender prevailed. The most prevalent subtype was the solid one. It is worth mentioning that the sclerodermiform subtype, which is more aggressive, was seen more frequently in males and in the 46-to 59-year-old range.

Keywords: basal cell carcinoma, epidemiology, sclerodermiform basal cell carcinoma, skin cancer, solar radiation, solid basal cell carcinoma

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Authors: Tayebeh Jameh-Bozorgi, M. Soleymani

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In this research, the role of social networks in promoting ethics in Iranian sports was investigated. The research adopted a descriptive-analytic method, and the survey’s population consisted of all the athletes invited to the national football, volleyball, wrestling and taekwondo teams. Considering the limited population, the size of the society was considered as the sample size. After the distribution of the questionnaires, 167 respondents answered the questionnaires correctly. The data collection tool was chosen according to Hamid Ghasemi`s, standard questionnaire for social networking and mass media, which has 28 questions. Reliability of the questionnaire was calculated using Cronbach's alpha coefficient (94%). The content validity of the questionnaire was also approved by the professors. In this study, descriptive statistics and inferential statistical methods were used to analyze the data using statistical software. The benchmark tests used in this research included the following: Binomial test, Friedman test, Spearman correlation coefficient, Vermont Creamers, Good fit test and comparative prototypes. The results showed that athletes believed that social network has a significant role in promoting sport ethics in the community. Telegram has been known to play a big role than other social networks. Moreover, the respondents' view on the role of social networks in promoting sport ethics was significantly different in both men and women groups. In fact, women had a more positive attitude towards the role of social networks in promoting sport ethics than men. The respondents' view of the role of social networks in promoting the ethics of sports in the study groups also had a significant difference. Additionally, there was a significant and reverse relationship between the sports experience and the attitude of national athletes regarding the role of social networks in promoting ethics in sports.

Keywords: ethics, social networks, mass media, Iranian sports, internet

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Authors: Jessy Abouarab

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For more than half a century, international norms related to refugee security and protection have proliferated, yet their role in alleviating war’s negative impacts on human life remains limited. The impact of refugee-security processes often manifests asymmetrically within populations. Many issues and people get silenced due to narrow security policies that focus either on abstract threat containment and refugee control or refugee protection and humanitarian aid. (In)security practices are gendered and experienced. Examining the case study of Syrian refugees in Lebanon, this study explores the gendered impact of refugee security mechanisms on local realities. A transnational feminist approach will be used to position this research in relation to existing studies in the field of security and the refugee-protection regime, highlighting the social, cultural, legal, and political barriers to gender equality in the areas of violence, rights, and social inclusion. Through Photovoice methodology, the Syrian refugees’ (in)securities in Lebanon were given visibility by enabling local volunteers to record and reflect their realities through pictures, at the same time voice the participants’ anxieties and recommendations to reach normative policy change. This Participatory Action Research approach helped participants observe the structural barriers and lack of culturally inclusive refugee services that hinder security, increase discrimination, stigma, and poverty. The findings have implications for a shift of the refugee protection mechanisms to a community-based approach in ways that extend beyond narrow security policies that hinder women empowerment and raise vulnerabilities such as gendered exploitation, abuse, and neglect.

Keywords: gender, (in)security, Lebanon, refugee, Syrian refugees, women

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Authors: A. Venkatakrishnan, M. Juneja, S. Kapoor

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Background: Gastrointestinal dysfunction is an emerging co morbidity seen in autism and may further strengthen the association between autism and celiac disease. This is supported by increased rates (22-70%) of gastrointestinal symptoms like diarrhea, constipation, abdominal discomfort/pain, and gastrointestinal inflammation in children with the etiology of autism is still elusive. In addition to genetic factors, environmental factors such as toxin exposure, intrauterine exposure to certain teratogenic drugs, are being proposed as possible contributing factors in the etiology of Autism Spectrum Disorders (ASD) in cognizance with reports of increased gut permeability and high rates of gastrointestinal symptoms noted in children with ASD, celiac disease has also been proposed as a possible etiological factor. Despite insufficient evidence regarding the benefit of restricted diets in Autism, GFD has been promoted as an alternative treatment for ASD. This study attempts to discern any correlation between ASD and celiac disease. Objective: This cross sectional study aims to determine the proportion of celiac disease in children with ASD. Methods: Study included 155 participants aged 2-12 yrs, diagnosed as ASD as per DSM-5 attending the child development center at a tertiary care hospital in Northern India. Those on gluten free diet or having other autoimmune conditions were excluded. A detailed Performa was filled which included sociodemographic details, history of gastrointestinal symptoms, anthropometry, systemic examination, and pertinent psychological testing was done using was assessed using Developmental Profile-3(DP-3) for Developmental Quotient, Childhood Autism Rating Scale-2 (CARS-2) for severity of ASD, Vineland Adaptive Behavior Scales (VABS) for adaptive behavior, Child Behavior Checklist (CBCL) for behavioral problems and BAMBI (Brief Autism Mealtime Behavior Scales) for feeding problems. Screening for celiac was done by TTG-IgA levels, and total serum IgA levels were measured to exclude IgA deficiency. Those with positive screen were further planned for HLA typing and endoscopic biopsy. Results: A total of 155 cases were included, out of which 5 had low IgA levels and were hence excluded from the study. The rest 150 children had TTG levels below the ULN and normal total serum IgA level. History of Gastrointestinal symptoms was present in 51 (34%) cases abdominal pain was the most frequent complaint (16.6%), followed by constipation (12.6%). Diarrhea was seen in 8 %. Gastrointestinal symptoms were significantly more common in children with ASD above 5 yrs (p-value 0.006) and those who were verbal (p = 0.000). There was no significant association between socio-demographic factors, anthropometric data, or severity of autism with gastrointestinal symptoms. Conclusion: None of the150 patients with ASD had raised TTG levels; hence no association was found between ASD and celiac disease. There is no justification for routine screening for celiac disease in children with ASD. Further studies are warranted to evaluate association of Non Celiac Gluten Sensitivity with ASD and any role of gluten-free diet in such patients.

Keywords: autism, celiac, gastrointestinal, gluten

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Authors: Edeaghe Ehikhamenor, Jennifer Nnamdi

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Introduction: Gender-based violence (GBV) was a well-known global crisis before the COVID-19 pandemic. The pandemic burden only intensified the crisis. With prevailing lockdowns, increased poverty due to high unemployment, especially affecting females, and other mobility restrictions that have left many women trapped with their abusers, plus isolation from social contact and support networks, GBV cases spiraled out of control. Prevalence of economic with cultural disparity, which is greatly manifested in Nigeria, is a major contributory factor to GBV. This is made worst by religious adherents where the females are virtually relegated to the background. Our societal approaches to investigations and sanctions to culprits have not sufficiently applied forensic/DNA tools in combating these major vices. Violence against women or some rare cases against men can prevent them from carrying out their duties regardless of the position they hold. Objective: The main objective of this research is to highlight the origin of GBV, the victims, types, contributing factors, and the applications of forensics/DNA tools and remedies so as to minimize GBV in our society. Methods: Descriptive information was obtained through the search on our daily newspapers, electronic media, google scholar websites, other authors' observations and personal experiences, plus anecdotal reports. Results: Findings from our exploratory searches revealed a high incidence of GBV with very limited or no applications of Forensics/DNA tools as an intervening mechanism to reduce GBV in Nigeria. Conclusion: Nigeria needs to develop clear-cut policies on forensics/DNA tools in terms of institutional framework to develop a curriculum for the training of all stakeholders to fast-track justice for victims of GBV so as to serve as a deterrent to other culprits.

Keywords: gender-based violence, forensics, DNA, justice

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Authors: Hisham Mortada

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Transition in the urban configuration of Arab cities has never been as radical and visible as it has been since the turn of the last century. The emergence of new cities near historical settlements of Arabia has spawned a series of developments in and around the old city precincts. New developments are based on advanced technology and conform to globally prevalent standards of city planning, superseding the vernacular arrangements based on traditional norms that guided so-called ‘city planning’. Evidence to this fact are the extant Arab buildings present at the urban core of modern cities, which inform us about intricate spatial organization. Organization that subscribed to multiple norms such as, satisfying gender segregation and socialization, economic sustainability, and ensuring security and environmental coherence etc., within settlement compounds. Several participating factors achieved harmony in such an inclusive city—an organization that was challenged and apparently replaced by the new planning order in the face of growing needs of globalized, economy-centric and high-tech models of development. Communities found it difficult to acclimatize with the new western planning models that were implemented at a very large scale throughout the Kingdom, which later experienced spatial re-structuring to suit users’ needs. A closer look the ancient city of Yanbu, now flanked with such new developments, allows us to differentiate and track the beginnings of this unprecedented transition in settlement formations. This paper aims to elaborate the Arabian context offered to both the ‘traditional’ and ‘modern’ planning approaches, in order to understand challenges and solutions offered by both at different times. In the process it will also establish the inconsistencies and conflicts that arose with the shift in planning paradigm, from traditional-'cultural norms’, to modern-'physical planning', in the Arabian context. Thus, by distinguishing the two divergent planning philosophies, their impact of the Arabian morphology, relevance to lifestyle and suitability to the biophysical environment, it concludes with a perspective on sustainability particularly for in case of Yanbu.

Keywords: Yanbu, traditional architecture, Hijaz, coral building, Saudi Arabia

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Authors: M. J. Reis Lima, J. Oliveira, M. Brito, C. Lemos, A. Mascarenhas, E. Teixeira Lemos

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Hypertension is a common condition causing cardio and cerebrovascular complications. Portugal has one of the highest mortality rates from stroke and a high prevalence of hypertension. Systolic blood pressure (SBP) is an important risk factor for cardiovascular events (myocardial infarction and stroke) and premature mortality, particularly in the elderly population. The present study aims to estimate the prevalence of hypertension in a Portuguese population living in a coastal city and to identify some of its determinants (namely gender, age, the body mass index and physical activity frequency). A total of 91 adults who attended three pharmacies of a coastal city in the center of Portugal, between May and August of 2013 were evaluated. Attendants who reported to have diabetes or taking antihypertensive drugs in the 2 previous weeks were excluded from the study. Sociodemographic factors, BMI, habits of exercise and BP were assessed. Hypertension was defined as blood pressure ≥140/90 mmHg. The majority of the studied population was constituted by women (75.8%), with a mean age of 54.2±1.6 years old, married or living in civil union and that had completed secondary school or had higher education (40%). They presented a mean BMI of 26.2±4.76 Kg/m2. and were sedentary. The mean BP was 127.0±17.77mmHg- 74.69 ± 9.53. In this population, we found 4.3% of people with hypertension and 16.1% with normal high blood pressure. Men exhibit a tendency to present higher systolic blood pressure values than women. Of all the factors considered, SBP values also tended to be higher with age and higher BMI values. Despite the fact that the mean values of SBP did not present values higher than 140 mmHg we must be concerned because the studied population is undiagnosed for hypertension. Our study even with some limitations might be a prelude to the upcoming research about the underlying factors responsible for the occurrence of SBP.

Keywords: hypertension, age, exercise, obesity and gender

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Authors: Ravi Teja Mandapaka

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Literary assonance and lexical consonance have always put the readers pondering, shirking away, at times too, and beefing on the baffling question that hardly invited any answer. ‘Why should we read Fyodor Mikhailovich Dostoevsky today?’ Does he, during a surreal life beneath his bruised and broken soul, writhing in pain, toying with the affirmatives of pleasure in an innate way, draw the readers any sheath of support? Alexithymia has ruled the time and space for a quite a long time as many a reader spent more time than required on reading his works of art in literature. Do his swirling theories of deism and laconic gushiness when put in black and white push us towards reading the lost pieces of exuberant dilettantism? With a view of that, and a hallucinated panorama of another, its best to say, thoughts and droughts’ glorious uncertainties in literature have come forward towards putting the pen on the eloquent importance of knowing Fyodor Dostoevsky, the Socrates of Literature.

Keywords: Dostoyevsky, dilettantism, gushiness, hallucinations, puissance

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Authors: Rauha Salam

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In Pakistan, over the past decade, the notion of what counts as a true ‘masculine and feminine’ behaviour has become more complicated with the inspection of social media. Given its strong religious and socio-cultural norms, patriarchal values are entrenched in the local and cultural traditions of the Pakistani society and regulate the social value of gender. However, the increasing use of internet among Pakistani men and women, especially in the form of social media uses by the youth, is increasingly becoming disruptive and challenging to the strict modes of behavioural monitoring and control both at familial and state level. Facebook, being the prime social media communication platform in Pakistan, provide its users a relatively ‘safe’ place to embrace how they want to be perceived by their audience. Moreover, the availability of an array of semiotic resources (e.g. the videos, audios, visuals and gifs) on Facebook makes it possible for the users to create a virtual identity that allows them to describe themselves in detail. By making use of Multimodal Discourse Analysis, I aimed to investigate how men and women in Pakistan construct their gendered identities multimodally (visually and linguistically) through their Facebook posts and how these semiotic modes are interconnected to communicate specific meanings. In case of the female data, the analysis showed an ambivalence as females were found to be conforming to the existing socio-cultural norms of the society and they were also employing social media platforms to deviate from traditional gendered patterns and to voice their opinions simultaneously. Similarly, the male data highlighted the reproduction of the prevalent cultural models of masculinity. However, there were instances in the data that showed a digression from the standard norms and there is a (re)negotiation of the traditional patriarchal representations.

Keywords: Facebook, Gendered Identities, Multimodal Discourse Analysis, Pakistan

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Authors: Vanessa Bennemann, Gabriela Laste, Márcia Inês Goettert

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The gestational period is a phase in which the pregnant woman undergoes constant physiological and hormonal changes, which are part of the woman’s biological cycle, the development of the fetus, childbirth, and lactation. These are factors of response to the immunological adaptation of the human reproductive process that is directly related to the pregnancy’s well-being and development. Although most pregnancies occur without complications, about 15% of pregnant women will develop potentially fatal complications, implying maternal and fetal risk. Therefore, requiring specialized care for high-risk pregnant women (HRPW) with obstetric interventions for the survival of the mother and/or fetus. Among the risk factors that characterize HRPW are the women's age, gestational diabetes mellitus (GDM), autoimmune diseases, infectious diseases such as syphilis and HIV, hypertension (SAH), preeclampsia, eclampsia, HELLP syndrome, uterine contraction abnormalities, and premature placental detachment (PPD), thyroid disorders, among others. Thus, pregnancy has an impact on the thyroid gland causing changes in the functioning of the mother's thyroid gland, altering the thyroid hormone (TH) profiles and production as pregnancy progresses. Considering, throughout the gestational period, the interpretation of the results of the tests to evaluate the thyroid functioning depends on the stage in which the pregnancy is. Thyroid disorders are directly related to adverse obstetric outcomes and in child development. Therefore, the adequate release of TH is important for a pregnancy without complications and optimal fetal growth and development. Objective: Investigate the physiological effects caused by thyroid disorders in the gestational period. Methods: A search for articles indexed in PubMed, Scielo, and MDPI databases, was performed using the term “AND”, with the descriptors: Pregnancy, Thyroid. With several combinations that included: Melatonin, Thyroidopathy, Inflammatory processes, Cytokines, Anti-inflammatory, Antioxidant, High-risk pregnancy. Subsequently, the screening was performed through the analysis of titles and/or abstracts. The criteria were: including clinical studies in general, randomized or not, in the period of 10 years prior to the research, in the English literature; excluded: experimental studies, case reports, research in the development phase. Results: In the preliminary results, a total of studies (n=183) were found, (n=57) excluded, such as studies of cancer, diabetes, obesity, and skin diseases. Conclusion: To date, it has been identified that thyroid diseases can impair the fetus’s brain development. Further research is suggested on this matter to identify new substances that may have a potential therapeutic effect to aid the gestational period with thyroid diseases.

Keywords: pregnancy, thyroid, melatonin, high-risk pregnancy

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