Search results for: pregnant woman

Authors: Ujunma Nnenna Egbuawa

Abstract:

Rape or sexual assault is a hideous crime of violence done predominantly to women and occasionally to men. In institutions of higher learning, it’s mostly experienced within or outside the campus environment due to students who are from different backgrounds socially. These students also have been imbibed with conflicting ethical standards, thus act both morally and amoral with respect to their sexual urges. The most affected among these are the female students who live outside the campus environment that is suitable for any immoral activity. These female students that are victims of rape hardly would want to be identified and this has left them as habitual prey to the unsuspecting predators. The socio-cultural setting has also been a contributory factor to the psychological and physical damage these victims face throughout their time of study as female rape victims. This is an empirical study designed to elicit information from students of Federal Polytechnic Nekede Owerri Imo State Nigeria on whether they have been sexually assaulted or raped and how they handled it thereafter. This institution was used as a case study because the provost of this tertiary institution is a woman whose name is Dr( Mrs ) C.U Njoku who has made consented efforts to ensure these rape victims rise above the social stigma associated with it. This rector has also put in some measures to bring about a decline in cases of rape within and outside the campus environment. She also granted the researcher an oral interview on how she has been able to achieve these and the challenges she hitherto faced in the process. Three research questions and a hypothesis guided the study. Samples of 119 students were used and stratification was done for sex, age and the academic level of the students. 14 item questionnaires were used and data generated from the survey were analyzed using percentages. This workshop would engage the participants by investigating some courses that may help in declining the rate of rape cases within a campus. Also, necessary measures that would be taken to help in sensitizing the tertiary institutions in areas that can aid the healing procedures of these victims. The need also for guidance and counseling unit is also a necessity for the psychological survival of these rape victims. As a result, the participants would gain an increased awareness of the influence of rape and sexual assault on campus. There ought to be a paradigm shift in institutions of higher learning in policies, administrative decisions and introduction of courses that will uplift ethical standards in order to bring about a change both locally and globally.

Keywords: institutions, psychological, sexual assault, socio-cultural

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Authors: Ewa Kamarad

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Recent problems with adopting the EU Regulation on matrimonial property regimes have clearly proven that Member States are unable to agree on the scope of the Regulation and, therefore, on the definitions of matrimonial property and marriage itself. Taking into account that the Regulation on the law applicable to divorce and legal separation, as well as the Regulation on matrimonial property regimes, were adopted in the framework of enhanced cooperation, it is evident that lack of a unified definition of marriage has very wide-ranging consequences. The main problem with the unified definition of marriage is that the EU is not entitled to adopt measures in the domain of material family law, as this area remains under the exclusive competence of the Member States. Because of that, the legislation on marriage in domestic legal orders of the various Member States is very different. These differences concern not only issues such as form of marriage or capacity to enter into marriage, but also the most basic matter, namely the core of the institution of marriage itself. Within the 28 Member States, we have those that allow both different-sex and same-sex marriages, those that have adopted special, separate institutions for same-sex couples, and those that allow only marriage between a man and a woman (e.g. Hungary, Latvia, Lithuania, Poland, Slovakia). Because of the freedom of movement within the European Union, it seems necessary to somehow recognize the civil effects of a marriage that was concluded in another Member State. The most crucial issue is how far that recognition should go. The thesis presented in the presentation is that, at an absolute minimum, the authorities of all Member States must recognize the civil status of the persons who enter into marriage in another Member State. Lack of such recognition might cause serious problems, both for the spouses and for other individuals. The authorities of some Member States may treat the marriage as if it does not exist because it was concluded under foreign law that defines marriage differently. Because of that, it is possible for the spouse to obtain a certificate of civil status stating that he or she is single and thus eligible to enter into marriage – despite being legally married under the law of another Member State. Such certificate can then be used in another country to serve as a proof of civil status. Eventually the lack of recognition can lead to so-called “international bigamy”. The biggest obstacle to recognition of marriages concluded under the law of another Member State that defines marriage differently is the impossibility of transcription of a foreign civil certificate in the case of such a marriage. That is caused by the rule requiring that a civil certificate issued (or transcribed) under one country's law can contain only records of legal institutions recognized by that country's legal order. The presentation is going to provide possible solutions to this problem.

Keywords: civil status, recognition of marriage, conflict of laws, private international law

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Authors: Nivedita Paul

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The changing character of marriage be it arranged marriage, love marriage, polygamy, informal unions, all signify different gender relations in everyday lives. Marriages in India are part and parcel of the kinship and cultural practices. Arranged marriage is still the dominant form of marriage where spouse selection is the initiative and decision of the parents; but its form is changing, as women are now actively participating in spouse selection but with parental consent. Spouse selection related decision making is important because marriage as an institution brings social change and gender inequality; especially in a women’s life as marriages in India are mostly patrilocal. Moreover, the amount of say in spouse selection can affect a woman’s reproductive rights, domestic violence issues, household resource allocation, communication possibilities with the spouse/husband, marital life, etc. The present study uses data from Indian Human Development Survey II (2011-12) which is a nationally representative multitopic survey that covers 41,554 households. Currently, married women of age group 15-49 in their first marriage; whose year of marriage is from 1970s to 2000s have been taken for the study. Based on spouse selection experiences, the sample of women has been divided into three marriage categories-self, semi and family arranged. Women in self arranged or love marriage is the sole decision maker in choosing the partner, in semi arranged marriage or arranged marriage with consent both parents and women together take the decision, whereas in family arranged or arranged marriage without consent only parents take the decision. The main aim of the study is to find the relationship between spouse selection experiences and women’s autonomy in India. Decision making in economic matters, child and health related decision making, mobility and access to resources are taken to be proxies of autonomy. Method of ordinal regression has been used to find the relationship between spouse selection experiences and autonomy after marriage keeping other independent variables as control factors. Results show that women in semi arranged marriage have more decision making power regarding financial matters of the household, health related matters, mobility and accessibility to resources, when compared to women in family, arranged marriages. For freedom of movement and access to resources women in self arranged marriage have the highest say or exercise greatest power. Therefore, greater participation of women (even though not absolute control) in spouse selection may lead to greater autonomy after marriage.

Keywords: arranged marriage, autonomy, consent, spouse selection

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Authors: Roya Yumul, Chse, Ofelia Loani Elvir Lazo, David Chernobylsky, Omar Durra

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Background: Preoperative anxiety has been shown to be caused by the fear associated with surgical and anesthetic complications; however, the current gold standard for assessing patient anxiety, the STAI, is problematic to use in the preoperative setting given the duration and concentration required to complete the 40-item extensive questionnaire. Our primary aim in the study is to investigate the correlation of the Visual Facial Anxiety Scale (VFAS) and Numerical Verbal Rating Scale (NVRS) to State-Trait Anxiety Inventory (STAI) to determine the optimal anxiety scale to use in the perioperative setting. Methods: A clinical study of patients undergoing various surgeries was conducted utilizing each of the preoperative anxiety scales. Inclusion criteria included patients undergoing elective surgeries, while exclusion criteria included patients with anesthesia contraindications, inability to comprehend instructions, impaired judgement, substance abuse history, and those pregnant or lactating. 293 patients were analyzed in terms of demographics, anxiety scale survey results, and anesthesia data via Spearman Coefficients, Chi-Squared Analysis, and Fischer’s exact test utilized for comparison analysis. Results: Statistical analysis showed that VFAS had a higher correlation to STAI than NVRS (rs=0.66, p<0.0001 vs. rs=0.64, p<0.0001). The combined VFAS-Categorization Scores showed the highest correlation with the gold standard (rs=0.72, p<0.0001). Subgroup analysis showed similar results. STAI evaluation time (247.7 ± 54.81 sec) far exceeds VFAS (7.29 ± 1.61 sec), NVRS (7.23 ± 1.60 sec), and Categorization scales (7.29 ± 1.99 sec). Patients preferred VFAS (54.4%), Categorization (11.6%), and NVRS (8.8%). Anesthesiologists preferred VFAS (63.9%), NVRS (22.1%), and Categorization Scales (14.0%). Of note, the top five causes of preoperative anxiety were determined to be waiting (56.5%), pain (42.5%), family concerns (40.5%), no information about surgery (40.1%), or anesthesia (31.6%). Conclusions: Combined VFAS-Categorization Score (VCS) demonstrates the highest correlation to the gold standard, STAI. Both VFAS and Categorization tests also take significantly less time than STAI, which is critical in the preoperative setting. Among both patients and anesthesiologists, VFAS was the most preferred scale. This forms the basis of the Yumul FACES Anxiety Scale, designed for quick quantization and assessment in the preoperative setting while maintaining a high correlation to the golden standard. Additional studies using the formulated Yumul FACES Anxiety Scale are merited.

Keywords: numerical verbal anxiety scale, preoperative anxiety, state-trait anxiety inventory, visual facial anxiety scale

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Authors: Klazina T. Havinga, Hilde R. H. de Geus

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Introduction: Pre-operative coagulation management of Apixaban prescribed patients, a new oral anticoagulant (a factor Xa inhibitor), is difficult, especially when chronic kidney disease (CKD) causes drug overdose. Apixaban is not dialyzable due to its high level of protein binding. An antidote, Andexanet α, is available but expensive and has an unfavorable short half-life. We report the successful extracorporeal removal of Apixaban prior to emergency surgery with the CytoSorb® Hemoadsorption device. Methods: A 89-year-old woman with CKD, with an Apixaban prescription for atrial fibrillation, was presented at the ER with traumatic rib fractures, a flail chest, and an unstable spinal fracture (T12) for which emergency surgery was indicated. However, due to very high Apixaban levels, this surgery had to be postponed. Based on the Apixaban-specific anti-factor Xa activity (AFXaA) measurements at admission and 10 hours later, complete clearance was expected after 48 hours. In order to enhance the Apixaban removal and reduce the time to operation, and therefore reduce pulmonary complications, CRRT with CytoSorb® cartridge was initiated. Apixaban-specific anti-factor Xa activity (AFXaA) was measured frequently as a substitute for Apixaban drug concentrations, pre- and post adsorber, in order to calculate the adsorber-related clearance. Results: The admission AFXaA concentration, as a substitute for Apixaban drug levels, was 218 ng/ml, which decreased to 157 ng/ml after ten hours. Due to sustained anticoagulation effects, surgery was again postponed. However, the AFXaA levels decreased quickly to sub-therapeutic levels after CRRT (Multifiltrate Pro, Fresenius Medical Care, Blood flow 200 ml/min, Dialysate Flow 4000 ml/h, Prescribed renal dose 51 ml-kg-h) with Cytosorb® connected in series into the circuit was initiated (within 5 hours). The adsorber-related (indirect) Apixaban clearance was calculated every half hour (Cl=Qe * (AFXaA pre- AFXaA post/ AFXaA pre) with Qe=plasma flow rate calculated with Ht=0.38 and system blood flow rate 200 ml-min): 100 ml/min, 72 ml/min and 57 ml/min. Although, as expected, the adsorber-related clearance decreased quickly due to saturation of the beads, still the reduction rate achieved resulted in a very rapid decrease in AFXaA levels. Surgery was ordered and possible within 5 hours after Cytosorb initiation. Conclusion: The CytoSorb® Hemoadsorption device enabled rapid correction of Apixaban associated anticoagulation.

Keywords: Apixaban, CytoSorb, emergency surgery, Hemoadsorption

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Authors: Abdelkader Guendouz, Fatima Zohra Adel

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Even if both the economic and the human development are an axial pillar in its global policy, Algerian government seems to be more and more engaged in the international context aiming to reach of the so called millennium development goals, and this since its beginning. By looking closely at the Algerian economic policy, it is easy to mention the existence of several programs in which both economic and social realisations including among others, poverty reduction, enhancement of education level and conditions, woman statute and gender equity amelioration targets. The efforts of Algerian government in the field of these targets had been acheminated through three main plans, which are: -PSRE (Plan de Soutien à la Relance Economique), for the period of 2001 to 2004, initiated with about 7 billion US dollar, had been focused on three objectives, namely, poverty reduction, job creation and regional equilibrium with rural areas revitalization. -PCSC (le Programme complémentaire de soutien à la croissance économique), for the period of 2005 to 2009, with a starting funding of 114 billion US dollar. This program aims to develop public services and supporting public investments, especially in which concerns social infrastructures. Now, and at the end of the maturity of the MDGs agenda, an important question is to be asked: what are the main realizations regarding these MDGs? In order to answer this question, the present paper tries to examine the Algerian economic policy (but also the social one) by considering the MDGs challenges, for the period from 2000 to 2010, but also until 2015. This examination is focused on three main targets, namely poverty, education, and health. Firstly, statistical assessment for the Algerian economic and social situation shows that almost all MDGs had been reached during the period of 2000 to 2009 and it continues to maintain and improve them. This observation can be endorsed by invoking some achievements. Starting by the reduction of poverty, the proportion of population living with less than 1 US dollar per a day passed from 8.0 % in 2000 to 0.5 % in 2009, and 0.3 % in 2015. For education sphere, the enrolment ratio of six-year child, which is the most significant index for school attendance, is about 98 % for 2009 against 93 % in 1999, and only 43 % in 1966. Concluding with health care and relevant services; the Algerian government has accomplished big steps in providing easy access to this sector for the population. Moreover, the percentage of assisted accouchement had been raised from 91.2 % in 2000 to 97.2 % in 2009.

Keywords: Algerian economic policy, MDGs, poverty, education, health

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Authors: Amrit Vasdev, Edwin Rho, Gurinder Vasdev

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Robotic surgery has enabled a new spectrum of minimally invasive breast reconstruction by improving visualization, surgeon posturing, and improved patient outcomes.1 The DaVinci robot system can be utilized in nipple sparing mastectomies and reconstructions. The process involves the insufflation of the subglandular space and a dissection of the mammary gland with a combination of cautery and blunt dissection. This case outlines a 35-year-old woman who has a long-standing family history of breast cancer and a diagnosis of a deleterious BRCA2 genetic mutation. She has decided to proceed with bilateral nipple sparing mastectomies with implants. Her perioperative mammogram and MRI were negative for masses, however, her left internal mammary lymph node was enlarged. She has taken oral contraceptive pills for 3-5 years and denies DES exposure, radiation therapy, human replacement therapy, or prior breast surgery. She does not smoke and rarely consumes alcohol. During the procedure, the patient received a standardized anesthetic for out-patient surgery of propofol infusion, succinylcholine, sevoflurane, and fentanyl. Aprepitant was given as an antiemetic and preoperative Tylenol and gabapentin for pain management. Concerns for the patient during the procedure included CO2 insufflation into the subcutaneous space. With CO2 insufflation, there is a potential for rapid uptake leading to severe acidosis, embolism, and subcutaneous emphysema.2To mitigate this, it is important to hyperventilate the patient and reduce both the insufflation pressure and the CO2 flow rate to the minimal acceptable by the surgeon. For intraoperative monitoring during this 6-9 hour long procedure, it has been suggested to utilize an Arterial-Line for end-tidal CO2 monitoring. However, in this case, it was not necessary as the patient had excellent cardiovascular reserve, and end-tidal CO2 was within normal limits for the duration of the procedure. A BIS monitor was also utilized to reduce anesthesia burden and to facilitate a prompt discharge from the PACU. Minimal Invasive Robotic Surgery will continue to evolve, and anesthesiologists need to be prepared for the new challenges ahead. Based on our limit number of patients, robotic mastectomy appears to be a safe alternative to open surgery with the promise of clearer tissue demarcation and better cosmetic results.

Keywords: anesthesia, mastectomies, robotic, hypercarbia

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Authors: Kateryna Nykytchenko

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Modern fiction and non-fiction writers commonly use their own lexical and stylistic devices to capture a reader’s attention and bring certain thoughts and feelings to his reader. Among such devices is the appearance of one of the neologic notions – individual author’s formations: occasionalisms or nonce words. To a significant extent, the host of examples of new words occurs in chick lit genre which has experienced exponential growth in recent years. Chick Lit is a new-millennial postfeminist fiction which focuses primarily on twenty- to thirtysomething middle-class women. It brings into focus the image of 'a new woman' of the 21st century who is always fallible, funny. This paper aims to investigate different types of occasional word-formation which reflect cognitive mechanisms of conveying women’s perception of the world. Chick lit novels of Irish author Marian Keyes present genuinely innovative mixture of forms, both literary and nonliterary which is displayed in different types of occasional word-formation processes such as blending, compounding, creative respelling, etc. Crossing existing mental and linguistic boundaries, adopting herself to new and overlapping linguistic spaces, chick lit author creates new words which demonstrate the result of development and progress of language and the relationship between language, thought and new reality, ultimately resulting in hybrid word-formation (e.g. affixation or pseudoborrowing). Moreover, this article attempts to present the main characteristics of chick-lit fiction genre with the help of the Marian Keyes’s novels and their influence on occasionalisms. There has been a lack of research concerning cognitive nature of occasionalisms. The current paper intends to account for occasional word-formation as a set of interconnected cognitive mechanisms, operations and procedures meld together to create a new word. The results of the generalized analysis solidify arguments that the kind of new knowledge an occasionalism manifests is inextricably linked with cognitive procedure underlying it, which results in corresponding type of word-formation processes. In addition, the findings of the study reveal that the necessity of creating occasionalisms in postmodern fiction novels arises from the need to write in a new way keeping up with a perpetually developing world, and thus the evolution of the speaker herself and her perception of the world.

Keywords: Chick Lit, occasionalism, occasional word-formation, cognitive linguistics

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Authors: Pushp Lata Sankhwar

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INTRODUCTION: Maternal Hypothyroidism is the most frequent endocrine disorder in pregnancy and varies from 2.5% in the west to 11.0% in India. Maternal Hypothyroidism can have detrimental maternal effects like increased risk of preterm labor, PPROM leading to increased maternal morbidity and also on the neonate in the form of prematurity and its complications, prolonged hospital stay, neurological developmental problems, delayed milestones and mental retardation etc. Henceforth, the study was planned to evaluate the role of Hypothyroidism in preterm labor and its effect on neonates. AIMS AND OBJECTIVES: To Correlate Overt Hypothyroidism, Subclinical Hypothyroidism and Isolated Hypothyroxinemia With Preterm Labor and the neonatal outcome. Material and Methods: A case-control study of singleton pregnancy was performed over a year, in which a total of 500 patients presenting in the emergency with preterm labor were enrolled. The thyroid profile of these patients was sent at the time of admission, on the basis of which they were divided into Cases – Hypothyroidic mothers and Controls – Euthyroid mothers. The cases were further divided into subclinical, overt Hypothyroidism and isolated hypothyroxinemia. The neonatal outcome of these groups was also compared on the basis of the incidence and severity of neonatal morbidity, neonatal respiratory distress, the incidence of neonatal Hypothyroidism and early complications. The feto-maternal data was collected and analysed. RESULTS: In the study, a total of 500 antenatal patients with a history of preterm labor were enrolled, out of which 67 (13.8%) patients were found to be hypothyroid. The majority of the mothers had Subclinical Hypothyroidism (12.2%), followed by Overt Hypothyroidism seen in 1% of the mothers and isolated hypothyroxinemia in 0.6% of cases. The neonates of hypothyroid mothers had higher levels of cord blood TSH, and the mean cord blood TSH levels were highest in the case of neonates of mothers with Overt Hypothyroidism. The need for resuscitation of the neonates at the time of birth was higher in the case of neonates of hypothyroid mothers, especially with Subclinical Hypothyroidism. Also, it was found that the requirement of oxygen therapy in the form of oxygen by nasal prongs, oxygen by a hood, CPAP, CPAP along with surfactant therapy and mechanical ventilation along with surfactant therapy was significantly higher in the case of neonates of hypothyroid mothers. CONCLUSION: The results of our study imply that uncontrolled and untreated maternal Hypothyroidism may also lead to preterm delivery. The neonates of mothers with Hypothyroidism have higher cord blood TSH levels. The study also shows that there is an increased incidence and severity of respiratory distress in the neonates of hypothyroid mothers with untreated subclinical Hypothyroidism. Hence, we propose that routine screening for thyroid dysfunction in pregnant women should be done to prevent thyroid-related feto-maternal complications.

Keywords: high-risk pregnancy, thyroid, dysfunction, hypothyroidism, Preterm labor

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Authors: Ofelia Loani Elvir Lazo, Roya Yumul, David Chernobylsky, Omar Durra

Abstract:

Background: It is crucial to detect the patient’s existing anxiety to assist patients in a perioperative setting which is to be caused by the fear associated with surgical and anesthetic complications. However, the current gold standard for assessing patient anxiety, the STAI, is problematic to use in the preoperative setting, given the duration and concentration required to complete the 40-item questionnaire. Our primary aim in the study is to investigate the correlation of the Yumul Visual Facial Anxiety Scale (VFAS) and Numerical Verbal Rating Scale (NVRS) to State-Trait Anxiety Inventory (STAI) to determine the optimal anxiety scale to use in the perioperative setting. Methods: A clinical study of patients undergoing various surgeries was conducted utilizing each of the preoperative anxiety scales. Inclusion criteria included patients undergoing elective surgeries, while exclusion criteria included patients with anesthesia contraindications, inability to comprehend instructions, impaired judgement, substance abuse history, and those pregnant or lactating. 293 patients were analyzed in terms of demographics, anxiety scale survey results, and anesthesia data via Spearman Coefficients, Chi-Squared Analysis, and Fischer’s exact test utilized for comparative analysis. Results: Statistical analysis showed that VFAS had a higher correlation to STAI than NVRS (rs=0.66, p<0.0001 vs. rs=0.64, p<0.0001). The combined VFAS-Categorization Scores showed the highest correlation with the gold standard (rs=0.72, p<0.0001). Subgroup analysis showed similar results. STAI evaluation time (247.7 ± 54.81 sec) far exceeds VFAS (7.29 ± 1.61 sec), NVRS (7.23 ± 1.60 sec), and Categorization scales (7.29 ± 1.99 sec). Patients preferred VFAS (54.4%), Categorization (11.6%), and NVRS (8.8%). Anesthesiologists preferred VFAS (63.9%), NVRS (22.1%), and Categorization Scales (14.0%). Of note, the top five causes of preoperative anxiety were determined to be waiting (56.5%), pain (42.5%), family concerns (40.5%), no information about surgery (40.1%), or anesthesia (31.6%). Conclusıons: Both VFAS and Categorization tests also take significantly less time than STAI, which is critical in the preoperative setting. Combined VFAS-Categorization Score (VCS) demonstrates the highest correlation to the gold standard, STAI. Among both patients and anesthesiologists, VFAS was the most preferred scale. This forms the basis of the Yumul Faces Anxiety Scale, designed for quick quantization and assessment in the preoperative setting while maintaining a high correlation to the golden standard. Additional studies using the formulated Yumul Faces Anxiety Scale are merited.

Keywords: numerical verbal anxiety scale, preoperative anxiety, state-trait anxiety inventory, visual facial anxiety scale

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Authors: Lior B. Navon

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The objective of this study is to investigate how technology, such as social media, can influence the biopower hierarchy between the medical knowledge about the body and women’s bodily knowledge through the case study of the hashtag 'notpee'. In January 2015, the hashtag #notpee, relating to a feminine physiological phenomenon called female ejaculation (FE) or squirting (SQ) started circulating on twitter. This hashtag, born as a reaction to a medical study claiming that SQ is essentially involuntary emission of urine during sexual activity, sparked an unusual public discourse about FE, a phenomenon that is usually not discussed or referred to in socio-legitimate public spheres. This unusual backlash got the attention of women’s magazines and blogs, as well as more mainstream large and respected outlets such as The Guardian and CNN. Both the tweets on twitter, as well as the media coverage of them, were mainly aimed at rejecting the research’s findings. While not offering an alternative and choosing to define the phenomenon by negation, women argued that the fluid extracted was not pee based on their personal experiences. Based on a critical discourse analysis of 742 tweets with the hashtag 'notpee' between January 2015 and January 2016, and of 15 articles covering the backlash, this study suggests that the #notpee backlash challenged the power balance between the medical knowledge about the feminine body and the feminine bodily knowledge through two different, yet related, forms of resistance to biopower. The first resistance is to the authority over knowledge production — who has the power to produce 'true' statements when it comes to the body? Is it the women who experience the phenomenon, or is it the medical institution? The second resistance to biopower has to do with what we regard as facts or veracity. A critical discourse analysis reveals that while both the scientific field, as well as the women arguing against its findings, use empirical information, they, nevertheless, rely on two dichotomic databases- while the scientific research relies on samples from the 'dead like body', these woman are relying on their lived subjective senses as a source for fact making. Nevertheless, while #notpee is asking to change the power relations between the feminine subjective bodily knowledge and the seemingly objective masculine medical knowledge about the body, it by no means dismisses it. These women are essentially asking the medical institution to take into consideration the subjective body as well as the objective one while acknowledging and accepting the power of the latter over knowledge production.

Keywords: biopower, female ejaculation, new media, bodily knowledge

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Authors: Ioannis N. Sergentanis, Stavroula Papadodima, Maria Tsellou, Dimitrios Vlachodimitropoulos, Sotirios Athanaselis, Chara Spiliopoulou

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Introduction: The aim of this study is the investigation of characteristics of suicide, as documented in autopsies during a five-year interval in the greater area of Attica, including the city of Athens. This could reveal possible protective or aggravating factors for suicide risk during a period strongly associated with the Greek debt crisis. Materials and Methods: Data was obtained following registration of suicide cases among autopsies performed in the Forensic Medicine and Toxicology Department, School of Medicine, National and Kapodistrian University of Athens, Greece, during the time interval from January 2011 to December 2015. Anonymity and medical secret were respected. A series of demographic and social factors in addition to special characteristics of suicide were entered into a specially established pre-coded database. These factors include social data as well as psychiatric background and certain autopsy characteristics. Data analysis was performed using descriptive statistics and Fisher’s exact test. The software used was STATA/SE 13 (Stata Corp., College Station, TX, USA). Results: A total of 162 cases were studied, 128 men and 34 women. Age ranged from 14 to 97 years old with an average of 53 years, presenting two peaks around 40 and 60 years. A 56% of cases were single/ divorced/ widowed. 25% of cases occurred during the weekend, and 66% of cases occurred in the house. A predominance of hanging as the leading method of suicide (41.4%) followed by jumping from a height (22.8%) and firearms (19.1%) was noted. Statistical analysis showed an association was found between suicide method and gender (P < 0.001, Fisher’s exact test); specifically, no woman used a firearm while only one man used medication overdose (against four women). Discussion: Greece has historically been one of the countries with the lowest suicide rates in Europe. Given a possible change in suicide trends during the financial crisis, further research seems necessary in order to establish risk factors. According to our study, suicide is more frequent in men who are not married, inside their house. Gender seems to be a factor affecting the method of suicide. These results seem in accordance with the international literature. Stronger than expected predominance in male suicide can be associated with failure to live up to social and family expectations for financial reasons.

Keywords: autopsy, Greece, risk factors, suicide

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Authors: Carmela Nardelli, Laura Iaffaldano, Valentina Capobianco, Antonietta Tafuto, Maddalena Ferrigno, Angela Capone, Giuseppe Maria Maruotti, Maddalena Raia, Rosa Di Noto, Luigi Del Vecchio, Pasquale Martinelli, Lucio Pastore, Lucia Sacchetti

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Maternal obesity and nutrient excess in utero increase the risk of future metabolic diseases in the adult life. The mechanisms underlying this process are probably based on genetic, epigenetic alterations and changes in foetal nutrient supply. In mammals, the placenta is the main interface between foetus and mother, it regulates intrauterine development, modulates adaptive responses to sub optimal in uterus conditions and it is also an important source of human amniotic mesenchymal stem cells (hA-MSCs). We previously highlighted a specific microRNA (miRNA) profiling in amnion from obese (Ob) pregnant women, here we compared the miRNA expression profile of hA-MSCs isolated from (Ob) and control (Co) women, aimed to search for any alterations in metabolic pathways that could predispose the new-born to the obese phenotype. Methods: We isolated, at delivery, hA-MSCs from amnion of 16 Ob- and 7 Co-women with pre-pregnancy body mass index (mean/SEM) 40.3/1.8 and 22.4/1.0 kg/m2, respectively. hA-MSCs were phenotyped by flow cytometry. Globally, 384 miRNAs were evaluated by the TaqMan Array Human MicroRNA Panel v 1.0 (Applied Biosystems). By the TargetScan program we selected the target genes of the miRNAs differently expressed in Ob- vs Co-hA-MSCs; further, by KEGG database, we selected the statistical significant biological pathways. Results: The immunophenotype characterization confirmed the mesenchymal origin of the isolated hA-MSCs. A large percentage of the tested miRNAs, about 61.4% (232/378), was expressed in hA-MSCs, whereas 38.6% (146/378) was not. Most of the expressed miRNAs (89.2%, 207/232) did not differ between Ob- and Co-hA-MSCs and were not further investigated. Conversely, 4.8% of miRNAs (11/232) was higher and 6.0% (14/232) was lower in Ob- vs Co-hA-MSCs. Interestingly, 7/232 miRNAs were obesity-specific, being expressed only in hA-MSCs isolated from obese women. Bioinformatics showed that these miRNAs significantly regulated (P<0.001) genes belonging to several metabolic pathways, i.e. MAPK signalling, actin cytoskeleton, focal adhesion, axon guidance, insulin signaling, etc. Conclusions: Our preliminary data highlight an altered miRNA profile in Ob- vs Co-hA-MSCs and suggest that an epigenetic miRNA-based mechanism of gene regulation could affect pathways involved in placental growth and function, thereby potentially increasing the newborn’s risk of metabolic diseases in the adult life.

Keywords: hA-MSCs, obesity, miRNA, biosystem

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Authors: Abiola O. Temitayo-Oboh, Olugbenga L. Abodunrin, Wasiu O. Adebimpe, Micheal C. Asuzu

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Introduction: Many women who are sexually active would prefer to avoid becoming pregnant but are not using any method of contraception. These women are considered to have an unmet need for contraception. In an ideal situation, all women who want to space or limit their births and are exposed to the risk of conception would use some kind of conception; in practice, however, some women fail to use contraception which put them at risk of having mistimed or unwanted births, induced abortion, or maternal death. This study, therefore, aimed to assess the determinants of unmet need for contraception among currently married women in rural and urban communities of Osun State, South-West Nigeria. Methods: This was an analytical cross-sectional comparative study, which was carried out among currently married women. Three hundred and twenty respondents each were selected for the rural and urban groups from four Local Government Areas using multi-stage sampling technique. Data were collected using a pre-tested semi-structured interviewer-administered questionnaire and focus group discussion (FGD) guide; data analysis was done with Statistical Package for Social Sciences (SPSS) version 17.0 and detailed content analysis method respectively. Statistical analysis of the difference between proportions was done by the use of the Chi-square test and T-test was used to compare the means of the continuous variables. The study also utilized descriptive, bivariate and multivariate analytical techniques to examine the effect of some variables on unmet need. Level of statistical significance was set at p-value < 0.05 for all values. Results: Two hundred and ninety-six (92.5%) of the rural and 306 (95.6%) of the urban study population had heard of contraception, 365 (57.0 %) of the total respondents had good knowledge [162 (50.6 %) for rural respondents and 203 (63.4 %) for urban respondents]. This difference was statistically significant (p < 0.001). Five hundred and twenty-one (81.4%) respondents had a positive attitude towards contraception [243 (75.9%) in the rural and 278 (86.9%) in the urban area], and the difference was also statistically significant (p < 0.001). Only 47 (14.7%) and 59 (18.4%) of rural and urban women were current contraceptive users respectively. The total unmet need for contraception among rural women was 138 (43.1%) of which 82 (25.6%) was for spacing and 56 (17.5%), for limiting. While the total unmet need for contraception among urban women was 145 (45.3%) of which 96 (30.0%) was for spacing and 49 (15.3%) for limiting. Number of living children, knowledge of contraceptive methods, discussion with health workers about family planning, couples discussion about family planning and availability of family planning services were found to be predictors of women’s unmet need for contraception (p < 0.05). Conclusion: It is, therefore, recommended that there is need to intensify reproductive health education in bridging the knowledge gap, improving attitude and modifying practices regarding use of contraception in Nigeria. Hence, this will help to enhance the utilization of family planning services among Nigerian women.

Keywords: contraception, married women, Nigeria, rural, urban, unmet need

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Authors: Zeynep Altinkaya, Ugur Dal, Figen Dag, Dilan D. Koyuncu, Merve Turkegun

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Obesity is defined as abnormal fat-tissue accumulation as a result of imbalance between energy intake and expenditure. Since 50-70% daily energy expenditure of sedantary individuals is consumed as resting energy expenditure (REE), it takes an important place in the evaluation of new methods for obesity treatment. Also, it is known that walking is a prevalent activity in the prevention of obesity. The primary purpose of this study is to evaluate and compare the resting and walking energy expenditures of individuals with different body mass index (BMI). In this research, 4 groups are formed as underweight (BMI < 18,5 kg/m2), normal (BMI=18,5-24,9 kg/m2), overweight (BMI=25-29,9 kg/m2), and obese (BMI ≥ 30) according to BMI of individuals. 64 healthy young adults (8 man and 8 woman per group, age 18-30 years) with no known gait disabilities were recruited in this study. The body compositions of all participants were measured via bioelectric empedance analysis method. The energy expenditure of individuals was measured with indirect calorimeter method as inspired and expired gas samples are collected breath-by-breath through a special facemask. The preferred walking speed (PWS) of each subject was determined by using infrared sensors placed in 2nd and 12th meters of 14 m walkway. The REE was measured for 15 min while subjects were lying, and walking energy expenditure was measured during subjects walk in their PWS on treadmill. The gross REE was significantly higher in obese subjects compared to underweight and normal subjects (p < 0,0001). When REE was normalized to body weight, it was higher in underweight and normal groups than overweight and obese groups (p < 0,0001). However, when REE was normalized to fat-free mass, it did not differ significantly between groups. The gross walking energy expenditure in PWS was higher in obese and overweight groups than underweight and normal groups (p < 0,0001). The regression coefficient between gross walking energy expenditure and body weight was significiant among normal and obese groups (p < 0.05). It accounted for 70,5% of gross walking energy expenditure in normal group, and 57,9% of gross walking energy expenditure in obese group. It is known that obese individuals have more metabolically inactive fat-tissue compared to other groups. While excess fat-tissue increases total body weight, it does not contribute much to REE. Therefore, REE results normalized to body weight could lead to misleading results. In order to eliminate fat-mass effect on REE of obese individuals, REE normalized to fat-free mass should be used to acquire more accurate results. On the other hand, the fat-mass increasement raises energy requirement while walking to retain the body balance. Thus, gross walking energy expenditure should be taken into consideration for the evaluating energy expenditure of walking.

Keywords: body composition, obesity, resting energy expenditure, walking energy expenditure

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Authors: Parvez Sattar

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There are around 150,000 female sex workers in Bangladesh, and the country hosts one of the largest brothels in the world. There are 20 brothel-villages in the country, of which 14 are recognized to be ‘official’, and at least 11 are currently operational. Although the national Constitution adopts a preventive policy against prostitution, law does not, as such, prohibit commercial sex work by an adult woman working in a brothel having made an affidavit in this regard. But, at the same time, the law renders at least some forms of floating and hotel based sex work illegal, while sex between males has been termed as sodomy and made culpable offence even on its own. All forms of sex works by MSM and Hijra are thus branded as criminal acts. Observations and findings drawn in this article are based on both primary and secondary sources collecting data from a series of field-based empirical studies conducted by the author through questionnaire survey, FGDs, key informant consultations and other PRA/PLA tools. General and specific conclusions have been based on analysis guided by international standards of human and labour rights approaches. It has been noted that neither the community attitudes nor the cultural mind-sets, or the State's institutional set up is supportive of the causes of sex workers engaged in the most exploitative forms of labour. Lack of respect for fundamental rights continues to diminish any chances of sex workers' reintegration to the mainstream of the society, perpetuates poverty, and increases their vulnerability to HIV/AIDS. To aggravate the scenario, the endemic practice of a complex debt-bondage masked by the so-called 'entry-cost' and ‘legal license’ to the industry is considered to be a somewhat accepted 'open secret' and that the police and administration keep their eyes off from such practices treating these as 'their internal affairs'. Often these practices are used by the Sardarni/Khala (landlady) and other 'managing' actors as the tool for further exploitation of the sex workers as well as a 'control strategy'. The paper concludes with the observation that the tabooed truths of commercial sex and sex workers are inherently embedded in the very factors that compel them into this endemically ostracised profession itself. While denial of both recognition and enjoyment of the fundamental human rights of sex workers is widespread, it is the same cycle of social vulnerability and economic exclusion that often confines these people within a continuous process of servitude and modern day slavery.

Keywords: commercial sex work and human rights, Labor protection in sex industry, Prostitution Law in Bangladesh, Sex work as modern day slavery

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Authors: Nulu Nanono

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Background: The Ugandan national health policy and the national population policy all recognize the need to increase access to quality, affordable, acceptable and sustainable contraceptive services for all people but provision and utilization of quality services remains low. Two contraceptive methods are categorized as long-acting temporary methods: intrauterine contraceptive devices (IUCDs) and implants. Copper-containing IUCDs, generally available in Ministry of Health (MoH) family planning programs and is effective for at least 12 years while Implants, depending on the type, last for up to three to seven years. Uganda’s current policy and political environment are favorable towards achieving national access to quality and safe contraceptives for all people as evidenced by increasing government commitments and innovative family planning programs. Despite the increase of modern contraception use from 14% to 26%, long acting reversible contraceptive (LARC) utilization has relatively remained low with less than 5% using IUDs & Implants which in a way explains Uganda’s persistent high fertility rates. Main question/hypothesis: The purpose of the study was to examine relationship between the demographic, socio-economic characteristics of women, health facility factors and long acting reversible contraception utilization. Methodology: LARC utilization was investigated comprising of the two questions namely are you or your partner currently doing something or using any method to delay or avoid getting pregnant? And which method or methods are you using? Data for the study was sourced from the 2016 Uganda Performance Monitoring and Accountability 2020 Survey comprising of 3816 female respondents aged 15 to 49 years. The analysis was done using the Chi-squared tests and the probit regression at bivariate and multivariate levels respectively. The model was further tested for validity and normality of the residuals using the Sharipo wilks test and test for kurtosis and skewness. Results: The results showed the model the age, parity, marital status, region, knowledge of LARCs, availability of LARCs to be significantly associated with long acting contraceptive utilization with p value of less than 0.05. At the multivariate analysis level, women who had higher parities (0.000) tertiary education (0.013), no knowledge about LARCs (0.006) increases their probability of using LARCs. Furthermore while women age 45-49, those who live in the eastern region reduces their probability of using LARCs. Knowledge contribution: The findings of this study join the debate of prior research in this field and add to the body of knowledge related to long acting reversible contraception. An outstanding and queer finding from the study is the non-utilization of LARCs by women who are aware and have knowledge about them, this may be an opportunity for further research to investigate the attribution to this.

Keywords: contraception, long acting, utilization, women (15-49)

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Authors: Karolina Rutkowska, Hubert Pausch, Jolanta Oprzadek, Krzysztof Flisikowski

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The placenta is one of the most important organs that plays a crucial role in the fetal growth and development. Placenta dysfunction is one of the primary cause of the intrauterine growth restriction (IUGR). Cattle have the cotyledonary placenta which consists of two anatomical parts: fetal and maternal. In the case of cattle during the first months of pregnancy, it is very easy to separate maternal caruncle from fetal cotyledon tissue, easier in fact than removing an ordinary glove from one's hand. Which in fact make easier to conduct tissue-specific molecular studies. Typically, animal models for the study of IUGR are created using surgical methods and malnutrition of the pregnant mother or in the case of mice by genetic modifications. However, proposed cattle model with MIMT1Del/WT deletion is unique because it was created without any surgical methods what significantly distinguish it from the other animal models. The primary objective of the study was to identify differential expression of selected miRNAs in the placenta from normal and intrauterine growth restricted fetuses. There was examined the expression of miRNA in the fetal and maternal part of the placenta from 24 fetuses (12 samples from the fetal part of the placenta and 12 samples from maternal part of the placenta). In the study, there was done miRNAs sequencing in the placenta of MIMT1Del/WT fetuses and MIMT1WT/WT fetuses. Then, there were selected miRNAs that are involved in fetal growth and development. Analysis of miRNAs expression was conducted on ABI7500 machine. miRNAs expression was analyzed by reverse-transcription polymerase chain reaction (RT-PCR). As the reference gene was used SNORD47. The results were expressed as 2ΔΔCt: ΔΔCt = (Ctij − CtSNORD47j) − (Cti1 − CtSNORD471). Where Ctij and CtSNORD47j are the Ct values for gene i and for SNORD47 in a sample (named j); Cti1 and CtSNORD471 are the Ct values in sample 1. Differences between groups were evaluated with analysis of variance by using One-Way ANOVA. Bonferroni’s tests were used for interpretation of the data. All normalised miRNA expression values are expressed on a value of natural logarithm. The data were expressed as least squares mean with standard errors. Significance was declared when P < 0.05. The study shows that miRNAs expression depends on the part of the placenta where they origin (fetal or maternal) and on the genotype of the animal. miRNAs offer a particularly new approach to study IUGR. Corresponding tissue samples were collected according to the standard veterinary protocols according to the European Union Normative for Care and Use of Experimental Animals. All animal experiments were approved by the Animal Ethics Committee of the State Provincial Office of Southern Finland (ESAVI-2010-08583/YM-23).

Keywords: placenta, intrauterine growth restriction, miRNA, cattle

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Authors: Kavita Khoiwal, Vatsla Dadhwal, K. Aparna Sharma, Dipika Deka, Plabani Sarkar

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Introduction: About 2.4 million (1.93 - 3.04 million) people are living with HIV/AIDS in India. Of all HIV infections, 39% (9,30,000) are among women. 5.4% of infections are from mother to child transmission (MTCT), 25,000 infected children are born every year. Besides the risk of mother to child transmission of HIV, these women are at risk of the higher adverse pregnancy outcome. The objectives of the study were to compare the obstetric and neonatal outcome in women who are HIV positive with low-risk HIV negative women and effect of antiretroviral drugs on preterm birth and IUGR. Materials and Methods: This is a retrospective case record analysis of 212 HIV-positive women delivering between 2002 to 2015, in a tertiary health care centre which was compared with 238 HIV-negative controls. Women who underwent medical termination of pregnancy and abortion were excluded from the study. Obstetric outcome analyzed were pregnancy induced hypertension, HIV positive intrauterine growth restriction, preterm birth, anemia, gestational diabetes and intrahepatic cholestasis of pregnancy. Neonatal outcome analysed were birth weight, apgar score, NICU admission and perinatal transmission.HIV-positiveOut of 212 women, 204 received antiretroviral therapy (ART) to prevent MTCT, 27 women received single dose nevirapine (sdNVP) or sdNVP tailed with 7 days of zidovudine and lamivudine (ZDV + 3TC), 15 received ZDV, 82 women received duovir and 80 women received triple drug therapy depending upon the time period of presentation. Results: Mean age of 212 HIV positive women was 25.72+3.6 years, 101 women (47.6 %) were primigravida. HIV positive status was diagnosed during pregnancy in 200 women while 12 women were diagnosed prior to conception. Among 212 HIV positive women, 20 (9.4 %) women had preterm delivery (< 37 weeks), 194 women (91.5 %) delivered by cesarean section and 18 women (8.5 %) delivered vaginally. 178 neonates (83.9 %) received exclusive top feeding and 34 neonates (16.03 %) received exclusive breast feeding. When compared to low risk HIV negative women (n=238), HIV positive women were more likely to deliver preterm (OR 1.27), have anemia (OR 1.39) and intrauterine growth restriction (OR 2.07). Incidence of pregnancy induced hypertension, diabetes mellitus and ICP was not increased. Mean birth weight was significantly lower in HIV positive women (2593.60+499 gm) when compared to HIV negative women (2919+459 gm). Complete follow up is available for 148 neonates till date, rest are under evaluation. Out of these 7 neonates found to have HIV positive status. Risk of preterm birth (P value = 0.039) and IUGR (P value = 0.739) was higher in HIV positive women who did not receive any ART during pregnancy than women who received ART. Conclusion: HIV positive pregnant women are at increased risk of adverse pregnancy outcome. Multidisciplinary team approach and use of highly active antiretroviral therapy can optimize the maternal and perinatal outcome.

Keywords: antiretroviral therapy, HIV infection, IUGR, preterm birth

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Authors: Rahimi-Movaghar Vafa, Mansouri Pejman, Chardoli Mojtaba, Rezvani Samina

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Introduction: Blunt abdominal trauma is one of the leading causes of morbidity and mortality in all age groups, but diagnosis of serious intra-abdominal pathology is difficult and most of the damages are obscure in the initial investigation. There is still controversy about which patients should undergo abdomen/pelvis CT, which patients needs more observation and which patients can be discharged safely The aim of this study was to determine that is it safe to discharge patients with blunt abdominal trauma with normal initial findings. Methods: This non-randomized cross-sectional study was conducted from September 2013 to September 2014 at two levels I trauma centers, Sina hospital and Rasoul-e-Akram hospital (Tehran, Iran). Our inclusion criteria were all patients were admitted for suspicious BAT and our exclusion criteria were patients that have serious head and neck, chest, spine and limb injuries which need surgical intervention, those who have unstable vital signs, pregnant women with a gestational age over 3 months and homeless or without exact home address. 390 patients with blunt trauma abdomen examined and the necessary data, including demographic data, the abdominal examination, FAST result, patients’ lab test results (hematocrit, base deficit, urine analysis) on admission and at 6 and 12 hours after admission were recorded. Patients with normal physical examination, laboratory tests and FAST were discharged from the ED during 12 hours with the explanation of the alarm signs and were followed up after 24 hours and 1 week by a telephone call. Patients with abnormal findings in physical examination, laboratory tests, and FAST underwent abdomino-pelvic CT scan. Results: The study included 390 patients with blunt abdominal trauma between 12 and 80 years of age (mean age, 37.0 ± 13.7 years) and the mean duration of hospitalization in patients was 7.4 ± 4.1 hours. 88.6% of the patients were discharged from hospital before 12 hours. Odds ratio (OR) for having any symptoms for discharge after 6 hours was 0.160 and after 12 hours was 0.117 hours, which is statistically significant. Among the variables age, systolic and diastolic blood pressure, heart rate, respiratory rate, hematocrit and base deficit at admission, 6 hours and 12 hours after admission showed no significant statistical relationship with discharge time. From our 390 patients, 190 patients have normal initial physical examination, lab data and FAST findings that didn’t show any signs or symptoms in their next assessment and in their follow up by the phone call. Conclusion: It is recommended that patients with no symptoms at admission (completely normal physical examination, ultrasound, normal hematocrit and normal base deficit and lack of microscopic hematuria) and good family and social status can be safely discharged from the emergency department.

Keywords: blunt abdominal trauma, patient discharge, emergency department, FAST

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Authors: Dieudonne Uwizeye, Reuben Muhayiteto

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Teenage pregnancy is a challenging problem for sustainable development due to restrictions it poses to socioeconomic opportunities for young mothers, their children and families. Being unable to take appropriate economic and social responsibilities, teen mothers get trapped into poverty and become economic burden to their family and country. Besides, teenage pregnancy is also a health problem because children born to very young mothers are vulnerable with greater risk of illnesses and deaths, and teenage mothers are more likely to be exposed to greater risk of maternal mortality and to other health and psychological problems. In Kigali city, in Rwanda, teenage pregnancy rate is currently high and its increase in recent years is worrisome. However, only individual factors influencing the teenage pregnancy tend to be the basis of interventions. It is important to understand the important socioeconomic factors at the household level that are associated with teenage pregnancy to help government, parents, and other stakeholders to appropriately address the problem with sustainable measures. This study analyzed secondary data from the Fifth Rwanda Demographic and Health Survey (RDHS-V 2014-2015) conducted by the National Institute of Statistics of Rwanda (NISR). The aim was to examine household socio-economic factors that are associated with incidence of teenage pregnancies in Kigali city. In addition to descriptive analysis, Pearson’s Chi Square and Binary Logistic Regression were used in the analysis. Findings indicate that marital status and age of household head, number of members in a household, number of rooms used for sleeping, educational level of the household head and household's wealth are significantly associated with teenage pregnancy in Rwanda ( p< 0.05). It was found that teenagers living with parents, those having parents with higher education and those from richer families are less likely to become pregnant. Age of household head was pinpointed as factor to teenage pregnancy, with teenage-headed households being more vulnerable. The findings also revealed that household composition correlates with the probability of teenage pregnancy (p < 0.05) with teenagers from households with less number of members being more vulnerable. Regarding the size of the house, the study suggested that the more rooms available in households, the less incidences of teenage pregnancy are likely to be observed (p < 0.05). However, teenage pregnancy was not significantly associated with physical violence among parents (p = 0.65) and sex of household heads (p = 0.52), except in teen-headed households of which female are predominantly heads. The study concludes that teenage pregnancy remains a serious social, economic and health problem in Rwanda. The study informs government officials, parents and other stakeholders to take interventions and preventive measures through community sex education, policies and strategies to foster effective parental guidance, care and control of young girls through meeting their necessary social and financial needs within households.

Keywords: household socio-economic factors, Rwanda, Rwanda demographic and health survey, teenage pregnancy

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Authors: Sultan Çağırıcı, Arsida Bajrami, Beyza Aslan, Hacı Ali Erdoğan, Nejla Sözer Topçular, Dilek Bozkurt, Vildan Yayla

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Objective: Corticobasal syndrome (CBS) is phenotypically characterized by asymmetric rigidity, apraxia, alien-limb phenomenon, cortical sensory loss, dystonia and myoclonus. The underlying pathologies consists of corticobasal degeneration (CBD), progressive supra nuclear palsy, Alzheimer's, Creutzfeldt-Jakob and frontotemporal degeneration. CBD is a degenerative disease with clinical symptoms related to the prominent involvement of cerebral cortex and basal ganglia. CBD is a pathological diagnosis and antemortem clinical diagnosis may change many times. In this paper, we described the clinical features and discussed a cases diagnosed with symmetric CBS because of its rarity. Case: Seventy-five-year-old woman presented with a three years history of difficulty in speaking and reading. Involuntary hand jerks and slowness of movement also had began in the last six months. In the neurological examination the patient was alert but not fully oriented. The speech was non-fluent, word finding difficulties were present. Bilateral limited upgaze, bradimimia, bilateral positive cogwheel' rigidity but prominent in the right side, postural tremor and negative myoclonus during action on the left side were detected. Receptive language was normal but expressive language and repetition were impaired. Acalculia, alexia, agraphia and apraxia were also present. CSF findings were unremarkable except for elevated protein level (75 mg/dL). MRI revealed bilateral symmetric cortical atrophy prominent in the frontoparietal region. PET showed hypometabolism in the left caudate nucleus. Conclusion: The increase of data related to neurodegenerative disorders associated with dementia, movement disorders and other findings results in an expanded range of diagnosis and transitions between clinical diagnosis. When considered the age of onset, clinical symptoms, imaging findings and prognosis of this patient, clinical diagnosis was CBS and pathologic diagnosis as probable CBD. Imaging of CBD usually consist of typical asymmetry between hemispheres. Still few cases with clinical appearance of CBD may show symmetrical cortical cerebral atrophy. It is presented this case who was diagnosed with CBD although we found symmetrical cortical cerebral atrophy in MRI.

Keywords: symmetric cortical atrophy, corticobasal degeneration, corticobasal syndrome

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Authors: Avijit Dey, Antony Gomes, Subir Chandra Dasgupta

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Tea (Camellia sinensis) is the most popular beverages in the world and is ranked second after the water. Tea has been considered as a health promoting beverage since ancient times due to its health-promoting activity. Recently, immunomodulatory, anti-arthritic, antioxidant, anticancer and cardioprotective activity of tea has been established. Very few studies have demonstrated the effect of high dose of black tea on health. The aim of the present study was to evaluate the role of low & high dose of Black Tea Extract (BTE) on the different physiological parameters of mother and pups during prenatal and postnatal developmental period in the experimental rodent. BTE was orally administered in LD (50mg BTE/kg/day) and HD (100mg BTE/kg/day) except control groups of rats (n=6/group) throughout the prenatal (day 0-21) and postnatal (day 21-42) periods. During prenatal period (0, 7th, 14th, 20th days) body weight, urinary calcium, magnesium, urea and creatinine was measured. In postnatal period physical (0, 10th, 21th days) parameters of pups like body weight, cranial length, cranial diameter, neck width, tail length, craniosacral length of pups were analyzed. Liver and lungs from pups and kidney spleen, etc. from mothers were collected on day 42 for histopathological studies. The comparative urine strip and morphology of RBC was also analyzed by SEM from mothers of different groups on day 42. The level of cytokines like IL-1alpha, IL-1beta, IL-6, IL-10, TNF-alpha were analysed by enzyme-linked immunosorbent assay (ELISA) on day 0, day 20 and day 42. The body weight of LD and HD mothers were also significantly (P<0.05) less than control mothers at 20th day of pregnancy and there was also significant changes in urinary calcium, urea, creatinine. The bio morphometric analysis of pups showed significant alteration (P<0.05) in HD groups relative to control. Some histological alterations were also observed in pups and mothers. Comparative urine strip analysis and morphology of RBC showed significant changes in treated groups. LD and HD treated mothers showed an increase in proinflammatory cytokines like IL-1beta, TNF-alpha and decrease in anti-inflammatory cytokine-like IL-10 on day 20 compared to PC mothers. This study clearly indicated that high dose of BTE possesses detrimental effect on pregnant mother and the pup. Further studies are in progress to elucidate the molecular mechanism of actions. This project work has been sponsored by National Tea Research Foundation vide Project Sanction No.: 17 (305)/2013/4423 dated 11th March, 2014. All experimental protocols described in the study were approved by animal ethics committee.

Keywords: black tea extract, pregnancy, prenatal and postnatal development, inflammation

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Authors: Birtukan Atinkut Asmare, Bernhard Freyer, Jim Bingen

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Though it is possible to transform the farming system towards a healthy, sustainable, and toxic-free food system by reducing pesticide use both in the field and postharvest, pesticides, including those that have been banned or severely restricted from use in developed countries, are indiscriminately used in African agriculture. Drawing on social practice theory, this study is about pesticide use practices in smallholder farms and its adverse impacts on women’s health and the environment, with reference to Africa, with an empirical focus on Ethiopia. Data have been collected via integrating diverse quantitative and qualitative approaches such as household surveys (n= 318), focus group discussions (n=6), field observations (n=30), and key informant interviews (n=18), with people along the pesticide value chain, including sellers and extension workers up to women farmers. A binary logistic regression model was used to investigate the factors that influence the adoption of personal protective equipment among female headed households. The findings show that Female-headed households carried out risky and unsafe practices from pesticide purchasing up to disposal, largely motivated by material elements (such as labor, income, time, and the provisioning system) but were notably shaped by competences (skills and knowledge), and meanings (norms, values, rules, and shared ideas). The main meaning or material aspect for pesticide purchasing were the perceptions of efficacy on pests, diseases, and weeds (65%), cost and availability in smaller quantities (60.7%), and a woman’s available time and mobility (58.9%). Pesticide hazards to human health or the environment seem not to be relevant for most female headed households. Unsafe practices of pesticide use among women led to the loss of biodiversity and ecosystem degradation, let alone their and family’s health. As the regression results show, the significant factors that influenced PPE adoption among female headed households were age and retailer information (p < 0.05). In line with the empirical finding, in addition to changing individual competences through advisory services and training, a foundational shift is needed in the sociocultural environment (e.g., policy, advisory), or a change in the meanings (social norms), where women are living and working.

Keywords: biodiversity, competences, ecosystems, ethiopia, female headed households, materials, meanings, pesticide purchasing, pesticide using, social practice theory

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Authors: Umair Shoukat Ali, Rashna Hoshang Sukhia, Mubassar Fida

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Introduction: The objective of the study was to compare outcomes in terms of Bleeding index (BI), Gingival Index (GI), and Orthodontic Plaque Index (OPI) with video graphics and plaque disclosing tablets (PDT) versus verbal instructions in adult orthodontic patients undergoing fixed appliance treatment (FAT). Materials and Methods: Adult orthodontic patients have recruited from outpatient orthodontic clinics who fulfilled the inclusion criteria and were randomly allocated to three groups i.e., video, PDT, and verbal groups. We included patients undergoing FAT for six months of both genders with all teeth bonded mesial to first molars having no co-morbid conditions such as rheumatic fever and diabetes mellitus. Subjects who had gingivitis as assessed by Bleeding Index (BI), Gingival Index (GI), and Orthodontic Plaque Index (OPI) were recruited. We excluded subjects having > 2 mm of clinical attachment loss, pregnant and lactating females, any history of periodontal therapy within the last six months, and any consumption of antibiotics or anti-inflammatory drugs within the last one month. Pre- and post-interventional measurements were taken at two intervals only for BI, GI, and OPI. The primary outcome of this trial was to evaluate the mean change in the BI, GI, and OPI in the three study groups. A computer-generated randomization list was used to allocate subjects to one of the three study groups using a random permuted block sampling of 6 and 9 to randomize the samples. No blinding of the investigator or the participants was performed. Results: A total of 99 subjects were assessed for eligibility, out of which 96 participants were randomized as three of the participants declined to be part of this trial. This resulted in an equal number of participants (32) that were analyzed in all three groups. The mean change in the oral hygiene indices score was assessed, and we found no statistically significant difference among the three interventional groups. Pre- and post-interventional results showed statistically significant improvement in the oral hygiene indices for the video and PDT groups. No statistically significant difference for age, gender, and education level on oral hygiene indices were found. Simple linear regression showed that the video group produced significantly higher mean OPI change as compared to other groups. No harm was observed during the trial. Conclusions: Visual aids performed better as compared to the verbal group. Gender, age, and education level had no statistically significant impact on the oral hygiene indices. Longer follow-ups will be required to see the long-term effects of these interventions. Trial Registration: NCT04386421 Funding: Aga Khan University and Hospital (URC 183022)

Keywords: oral hygiene, orthodontic treatment, adults, randomized clinical trial

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Authors: Sadandaula Rose Muheriwa Matemba, Alexander Glazier, Natalie M. LeBlanc

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In the United States, up to 10% of girls and 22 % of boys 10-14 years have had sex, 5% of them had their first sex before 11 years, and the age of first sexual encounter is reported to be 8 years. Over 4,000 adolescent girls, 10-14 years, become pregnant every year, and 2.6% of the abortions in 2019 were among adolescents below 15 years. Despite these negative outcomes, little research has been conducted to understand the sexual health education offered to young adolescents ages 10-14. Early sexual health education is one of the most effective strategies to help lower the rate of early pregnancies, HIV infections, and other sexually transmitted. Such knowledge is necessary to inform best practices for supporting the healthy sexual development of young adolescents and prevent adverse outcomes. This qualitative descriptive study was conducted to explore the community stakeholders’ experiences in sexual health education for young adolescents ages 10-14 and ascertain the young adolescents’ sexual health support needs. Maximum variation purposive sampling was used to recruit a total sample of 13 community stakeholders, including health education teachers, members of youth-based organizations, and Adolescent Clinic providers in Rochester, New York State, in the United States of America from April to June 2022. Data were collected through semi-structured individual in-depth interviews and were analyzed using MAXQDA following a conventional content analysis approach. Triangulation, team analysis, and respondent validation to enhance rigor were also employed to enhance study rigor. The participants were predominantly female (92.3%) and comprised of Caucasians (53.8%), Black/African Americans (38.5%), and Indian-American (7.7%), with ages ranging from 23-59. Four themes emerged: the perceived need for early sexual health education, preferred timing to initiate sexual health conversations, perceived age-appropriate content for young adolescents, and initiating sexual health conversations with young adolescents. The participants described encouraging and concerning experiences. Most participants were concerned that young adolescents are living in a sexually driven environment and are not given the sexual health education they need, even though they are open to learning sexual health materials. There was consensus on the need to initiate sexual health conversations early at 4 years or younger, standardize sexual health education in schools and make age-appropriate sexual health education progressive. These results show that early sexual health education is essential if young adolescents are to delay sexual debut, prevent early pregnancies, and if the goal of ending the HIV epidemic is to be achieved. However, research is needed on a larger scale to understand how best to implement sexual health education among young adolescents and to inform interventions for implementing contextually-relevant sexuality education for this population. These findings call for increased multidisciplinary efforts in promoting early sexual health education for young adolescents.

Keywords: community stakeholders’ perspectives, sexual development, sexual health education, young adolescents

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Authors: Wegig Muwonugroho

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Subjectivity in advertisement is a ‘power’ possessed by advertisements to construct trend, concept, truth, and ideology through subconscious mind. Advertisements, in performing their functions as message conveyors, use such visual representation to inspire what’s ideal to the people. Ambient media is advertising medium making the best use of the environment where the advertisement is located. Miracle Aesthetic Clinic (Miracle) popularizes the visual representation of its ambient media advertisement through the omission of face-image of both female mannequins that function as its ambient media models. Usually, the face of a model in advertisement is an image commodity having selling values; however, the faces of ambient media models in Miracle advertisement campaign are suppressed over the table and wall. This face concealing aspect creates not only a paradox of subjectivity but also plurality of meaning. This research applies critical discourse analysis method to analyze subjectivity in obtaining the insight of ambient media’s meaning. First, in the stage of textual analysis, the embedding attributes upon female mannequins imply that the models are denoted as the representation of modern women, which are identical with the identities of their social milieus. The communication signs aimed to be constructed are the women who lose their subjectivities and ‘feel embarrassed’ to flaunt their faces to the public because of pimples on their faces. Second, in the stage of analysis of discourse practice, it points out that ambient media as communication media has been comprehensively responded by the targeted audiences. Ambient media has a role as an actor because of its eyes-catching setting, and taking space over the area where the public are wandering around. Indeed, when the public realize that the ambient media models are motionless -unlike human- stronger relation then appears, marked by several responses from targeted audiences. Third, in the stage of analysis of social practice, soap operas and celebrity gossip shows on the television become a dominant discourse influencing advertisement meaning. The subjectivity of Miracle Advertisement corners women by the absence of women participation in public space, the representation of women in isolation, and the portrayal of women as an anxious person in the social rank when their faces suffered from pimples. The Ambient media as the advertisement campaign of Miracle is quite success in constructing a new trend discourse of face beauty that is not limited on benchmarks of common beauty virtues, but the idea of beauty can be presented by ‘when woman doesn’t look good’ visualization.

Keywords: ambient media, advertisement, subjectivity, power

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Authors: Sijie Chen, Xiaofang Chen, Juan Wang, Yingying Zhang, Yu Hong, Wanyu Zhuang, Xinxin Huang, Ping Ou, Longsheng Huang

Abstract:

Purpose: Autistic symptom improvement can be observed in children treated with acupuncture, but the mechanism is still being explored. In the present study, we used scalp acupuncture to treat autism rat model, and then their improvement in the abnormal behaviors and specific mechanisms behind were revealed by detecting animal behaviors, analyzing the RNA sequencing of the prefrontal cortex(PFC), and observing the ultrastructure of PFC neurons under the transmission electron microscope. Methods: On gestational day 12.5, Wistar rats were given valproic acid (VPA) by intraperitoneal injection, and their offspring were considered to be reliable rat models of autism. They were randomized to VPA or VPA-acupuncture group (n=8). Offspring of Wistar pregnant rats that were simultaneously injected with saline were randomly selected as the wild-type group (WT). VPA_acupuncture group rats received acupuncture intervention at 23 days of age for 4 weeks, and the other two groups followed without intervention. After the intervention, all experimental rats underwent behavioral tests. Immediately afterward, they were euthanized by cervical dislocation, and their prefrontal cortex was isolated for RNA sequencing and transmission electron microscopy. Results: The main results are as follows: 1. Animal behavioural tests: VPA group rats showed more anxiety-like behaviour and repetitive, stereotyped behaviour than WT group rats. While VPA group rats showed less spatial exploration ability, activity level, social interaction, and social novelty preference than WT group rats. It was gratifying to observe that acupuncture indeed improved these abnormal behaviors of autism rat model. 2. RNA-sequencing: The three groups of rats differed in the expression and enrichment pathways of multiple genes related to synaptic function, neural signal transduction, and circadian rhythm regulation. Our experiments indicated that acupuncture can alleviate the major symptoms of ASD by improving these neurological abnormalities. 3. Under the transmission electron microscopy, several lysosomes and mitochondrial structural abnormalities were observed in the prefrontal neurons of VPA group rats, which were manifested as atrophy of the mitochondrial membran, blurring or disappearance of the mitochondrial cristae, and even vacuolization. Moreover, the number of synapses and synaptic vesicles was relatively small. Conversely, the mitochondrial structure of rats in the WT group and VPA_acupuncture was normal, and the number of synapses and synaptic vesicles was relatively large. Conclusion: Acupuncture effectively improved the abnormal behaviors of autism rat model and the ultrastructure of the PFC neurons, which might worked by improving their abnormal synaptic function, synaptic plasticity and promoting neuronal signal transduction.

Keywords: autism spectrum disorder, acupuncture, animal behavior, RNA sequencing, transmission electron microscope

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Authors: Priya Sepaha

Abstract:

Commercial Surrogacy refers to a contract in which a woman carries a pregnancy for intended parents. There are two types of surrogacy; first, Traditional Surrogacy, in which, sperm of the donor or father is artificially inseminated in the women and carries the fetus till birth. Second, Gestational Surrogacy, in which the egg and sperm of the intended parent are collected for artificial fertilization through In Vitro Fertilization (IVF) technique and after the embryo formation, it is transferred into the womb of a surrogate mother with the help of Assisted Reproductive Technique. Surrogacy has become so widespread in India that it has now been nicknamed the "rent-a-womb" capital of the world due to relatively low cost and lack of stringent regulatory legalisation. The legal aspects surrounding surrogacy are complex, diverse and mostly unsettled. Although this appears to be beneficial for the parties concerned, there are certain sensitive issues which need to be addressed to ensure ample protection to all stakeholders. Commercial surrogacy is an emerging business and a new means of human trafficking particularly in India. Poor and illiterate women are often lured in such deals by their spouse or broker for earning easy money. Traffickers also use force, fraud, or coercion at times to intimidate the probable surrogate mothers. A major chunk of money received from covert surrogacy agreement is taken away by the brokers. The Law Commission of India has specifically reviewed the issue as India is emerging as a major global surrogacy destination. The Supreme Court of India held in the Manji's case in 2008, that commercial surrogacy can be permitted with certain restrictions but had directed the Legislature to pass an appropriate Law for governing Surrogacy in India. The draft Assisted Reproductive Technique (ART) Bill, 2010 is still pending for approval. At present, the Surrogacy Contract between the parties and the ART Clinics Guidelines are perhaps the only guiding force. The Immoral Trafficking Prevention Act (ITPA), 1956 and Sections 366(A) and 372 of the Indian Penal Code, 1860 are perhaps the only existing laws, which deal with human trafficking. Yet, none of these provisions specifically deal with the serious issue of trafficking for the purpose of Commercial Surrogacy. India remains one of the few countries that still allow commercial surrogacy. International Surrogacy involves bilateral issues, where the laws of both the nations have to be at par in order to ensure that the concerns and interests of parties involved get amicably resolved. There is urgent need to pass a comprehensive law by incorporating the latest developments in this field in order to make it ethical on the one hand and to curb disguised human trafficking on the other.

Keywords: business, human trafficking, legal, surrogacy

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Authors: Paulina Ojeda, Damaris Estrella, Hector Rubio

Abstract:

Insomnia is a disorder characterized by difficulty falling asleep, staying asleep or both. It negatively affects the life quality of people, it hinders the concentration, attention, memory, motor skills, among other abilities that complicate work or learning. Some studies show that women are more susceptible to insomnia. Medicine curricula usually involve a great deal of theoretical and memory content, especially in the early years of the course. The way to accredit a university course is to demonstrate the level of competence or acquired knowledge. In Mexico the most widely used form of measurement is written exams, with numerical scales results. The prevalence of sleep disorders in university students is usually high, so it is important to know if insomnia has an effect on school performance in men and women. A cross-sectional study was designed that included a probabilistic sample of 118 regular students from the School of Medicine of the Autonomous University of Yucatan, Mexico. All on legally age. The project was authorized by the School of Medicine and all the ethical implications of the case were monitored. Participants completed anonymously the following questionnaires: Pittsburgh Sleep Quality Index, Insomnia Severity Index, AUDIT test, epidemiological and clinical data. Academic performance was assessed by the average number of official grades earned on written exams, as well as the number of approved or non-approved courses. These data were obtained officially through the corresponding school authorities. Students with at least one unapproved course or average less than 70 were considered to be poor performers. With all courses approved and average between 70-79 as regular performance and with an average of 80 or higher as a good performance. Statistical analysis: t-Student, difference of proportions and ANOVA. 65 men with a mean age of 19.15 ± 1.60 years and 53 women of 18.98 ± 1.23 years, were included. 96% of the women and 78.46% of the men sleep in the family home. 16.98% of women and 18.46% of men consume tobacco. Most students consume caffeinated beverages. 3.7% of the women and 10.76% of the men complete criteria of harmful consumption of alcohol. 98.11% of the women and 90.76% of the men are perceived with poor sleep quality. Insomnia was present in 73% of women and 66% of men. Women had higher levels of moderate insomnia (p=0.02) compared to men and only one woman had severe insomnia. 50.94% of the women and 44.61% of the men had poor academic performance. 18.86% of women and 27% of men performed well. Only in the group of women we found a significant association between poor performance with mild (p= 0.0035) and moderate (p=0.031) insomnia. The medical students reported poor sleep quality and insomnia. In women, levels of insomnia were associated with poor academic performance.

Keywords: scholar-average, sex, sleep, university

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