28 research outputs found
Interstitial Pregnancy Managed with Single-dose Systemic Methotrexate: A Case Report
No full textInterstitial pregnancy is a rare type of ectopic pregnancy with a high risk of massive hemorrhage on rupture as compared to ectopic on other sites. The mortality rate for the ruptured interstitial pregnancy is high. Therefore, early diagnosis of such pregnancy before the rupture occurs facilitates appropriate management and avoids life-threatening complications. With the advancement in diagnostic imaging modalities, early diagnosis and more conservative management for interstitial pregnancy have become possible. Here, we report a case of primigravida diagnosed with interstitial pregnancy with ultrasonography and successfully managed with a single dose of methotrexate
Evaluation of glucose challenge test using cut off values 130mg/dl and 140 mg/dl for gestational diabetes mellitus screening
No full textBackground: Gestational Diabetes Mellitus (GDM) is associated with several adverse maternal and perinatal outcomes. Thus, screening for early detection of GDM and its treatment is important.Methods: This was hospital based descriptive study done over one year in department of Obstetrics and Gynecology, TUTH, Nepal. Six hundred ninety-seven women fulfilling the inclusion criteria were enrolled at 18-22 weeks of gestation. High risk factors were assessed and GCT was performed in women with risk factors during enrollment. Diagnostic OGTT was performed in women who screened positive (GCT ≥130mg/dl). Screen negative high-risk women were re-screened at 24-28 weeks. In women without known risk factors, GCT was performed at 24-28 weeks and OGTT was performed when screen positive. The diagnosis of GDM was made according to Carpenter and Coustan criteria.Results: Out of 697 enrolled women, 12 were excluded for various reasons and 685 women were analyzed. Women having risk of GDM were 28.9%. The prevalence of GDM was 2.92% and 2.48% with GCT cut off 130 mg/dl and 140 mg/dl respectively. Lowering the threshold to 130 mg/dl identified three extra cases (p=0.010). The prevalence among high risk group was 8.58% and 7.07% with the cut off value 130 mg/dl and 140 mg/dl respectively with three extra cases detected on taking cut off value 130 mg/dl (p=0.014). Among low risk women the prevalence of GDM was same i.e. 0.61% with both the cut off values.Conclusions: Lowering threshold of GCT to 130 mg/dl could identify significant percentage of extra cases of GDM especially in high risk women.</jats:p
A Rare Case Study of Torsion of a Non-Gravid Uterus
No full textTorsion of a non gravid uterus is a rare but potentially fatal event. It may lead to rapid clinical deterioration causing irreversible ischemic damage to the uterus. The rarity of the condition and its non specific clinical presentation make the clinical diagnosis difficult. In this report we discuss a case of uterine torsion in a 55 year old postmenopausal lady who presented in emergency with acute abdomen. On examination a huge abdominal mass arising from pelvis was noted. The operative finding was huge fundal myoma with uterine torsion.Birat Journal of Health SciencesVol.2/No.3/Issue 4/Sep- Dec 2017, Page: 309-311 </jats:p
Induction of Labor in Post Dated Pregnancy with Intra-cervical Foley Catheter in Antenatal Ward
No full textIntroduction: Induction of labor is one of the commonest obstetric procedures done these days with the aim of normal vaginal delivery. Among the different methods, transcervical Foley catheter is one of them used with great success and less complications.Objective: This study assesses the effect of intra-cervical Foley catheter in induction of labor in post dated pregnancy.Methodology: This was a descriptive observational study. Patients admitted in antenatal ward of BP Koirala Institute of Health Sciences (BPKIHS) with period of gestation (POG) ≥ 41 weeks without any complications were taken. Patients were induced either with Foley catheter or directly with misoprostol. Patients induced with Foley catheter were included in the study. Sixteen French Gauge Foley catheter was inserted intracervically and bulb was inflated with 40- 60 ml of distilled water and observed for 24 hours. If patient didn't go into labor after 24 hours with or without Foley expulsion, patient was reassessed and prostaglandin was used for further induction. Structured Pro forma was used for data collection and collected data was analyzed using SPSS software 11.5.Results: During the study period 353 patients were induced with intracervical Foley catheter. Among them 97(27.48%) went to labor and 256 (72.52%) needed further prostaglandin. Among 97 patients who went to labor 80 had normal vaginal delivery, 16 underwent cesarean section and one patient had vacuum assisted vaginal delivery. There were nine patients who had delivered baby with meconium stained liquor. Four patients had postpartum hemorrhage and two patients had intrapartum fever. None of the patients had hyper stimulation syndrome but one patient had still birth.Conclusion: Intracervical Foley catheter is one of the options to induce the patient in postdatism for priming the cervix to increase the rate of normal vaginal delivery with less complications.BJHS 2018;3(1)5 : 338-341</jats:p
Assessment of the Required Subdivision Index for autonomous ships based on equivalent safety
No full textIn recent years, a significant amount of research has been conducted on autonomous ships. Since it is assumed that these ships will sail with a significantly reduced crew or even without people on board, the design of the ship needs reconsideration. The absence of people on board and the associated safety measures could result in a more efficient design. However, to achieve the required design freedom, the existing regulatory framework will have to be amended. In this article, we will focus on potential changes in the Convention for Safety Of Life At Sea (SOLAS) and in particular on the Required Subdivision Index. The evaluation is performed by using the principle of equivalent safety, which will ensure that unmanned ships will be at least as safe as manned ships. The index gives a requirement for the allowed probability of sinking when a ship is damaged due to collision or contact. The safety level is related to the safety of ship, cargo, environment and crew. If the crew is no longer present, the consequences of an incident will be less severe, since the probability of casualties is no longer present. If the principle of equivalent safety is applied, a lower subdivision index can be accepted for unmanned autonomous vessels. In this article, the level of risk that a manned ship is subjected to will be derived by means of a risk analysis. In this risk analysis all logical consequences of a collision will be taken into account, covering both the probability of losing the entire ship and the consequences of the cases where the ship will not sink. Thereafter, the Required Subdivision Index for unmanned ships, which ensures an equivalent safety level to an equivalent manned ship, is established. The sensitivity of the result to changes in the data is discussed as well.Ship Design, Production and Operation
Maternal and Perinatal Outcomes of Singleton Term Breech Vaginal Delivery at a Tertiary Care Center in Nepal: A Retrospective Analysis
No full textBackground. Breech presentation is associated with increased rates of maternal and perinatal morbidity regardless of mode of delivery. After the results of Term Breech Trial, most of the countries adopted the protocol of cesarean section for term breech delivery because of which breech vaginal delivery is becoming rare. The aim of this study is to evaluate short-term maternal and perinatal outcomes of breech vaginal delivery at a tertiary care hospital in Nepal. Methods. A retrospective review of case records of all women who had vaginal breech delivery from April 13, 2016, to April 12, 2018, was conducted, over a period of two years. Available demographic variables, obstetric characteristics, details of labor, postpartum complications, and perinatal complications were recorded and analyzed. Results. Out of 21,768 cases of deliveries during the study period, the incidence of term breech deliveries was 528 (2.4%) among which the mode of only 84 (17.8%) deliveries was vaginal. Most of the deliveries were unplanned and were conducted because emergency cesarean section could not be performed. Three (3.6%) women had postpartum hemorrhage, and four (4.8%) had entrapment of aftercoming head, two of them requiring Dührssen incisions. Adverse perinatal outcomes were seen in 23.8% of such deliveries with <7 APGAR score at 5 minutes in 20.2%, neonatal admission in 17.7%, and perinatal mortality in 8.3%. The perinatal mortality was significantly associated with birthweight less than 2500 grams as compared to birthweight ≥2500 grams (21.1% versus 4.6%; P=0.043). Conclusion. The perinatal outcomes for vaginal breech delivery are grave with our existing health facilities, especially when the deliveries are not well planned
OPTIMALISASI PERSEDIAAN BAHAN BAKU MULTI-ITEM MULTI-SUPPLIER DENGAN MENGGUNAKAN MODIFIED BASNET AND LEUNG FORMULATION (Studi Kasus: PT. Petrokimia Gresik)
No full textJika membutuhkan abstrak atau isi jurnal silahkan menghubungi author melalui email [email protected], [email protected], [email protected] Terima kasi
The measurement of internal supply chain integration
No full textPurpose: Internal supply chain refers to the chain of activities within a company that concludes with providing a product to the customer. This process involves multiple functions within companies such as sales, production, and distribution. It is obvious that a company's performance would be enhanced by the integration of these functions. However, there is no consensus yet on how integration is to be defined and measured. The purpose of this paper is to present research that was conducted with the goal of developing an instrument for the measurement of internal supply chain integration. Design/methodology/approach: Scale items were identified from current literature and the resulting survey instrument was sent out to a sample of New Zealand manufacturers. Statistical analysis was conducted to purify and validate the instrument. Findings: In total, three dimensions of integration were identified, labelled coordination, communication, and affective relationship. This paper makes a contribution towards developing a consensus in the understanding and measurement of the integration construct. Research limitations/implications: The selection and exclusion of measurement items for the survey have followed established principles of survey research, but may have been affected by the personal bias of the author. While every attempt has been made to comprehensively capture the state of the research up to the time of the study, there may be some omissions. The sample for the survey was drawn from a database of New Zealand businesses, thus the results are generalizable only to the extent that these businesses represent the population of all businesses. Another limitation is that no prior survey/case studies were carried out to collect practitioner's definitions/measures for integration. Practical implications: The authors hope to have made a contribution here towards building a consensus among practitioners and researchers in defining and measuring internal supply chain integration. For practitioners, the measurement instrument offers a self-assessment tool for internal supply chain integration. This should help them in identifying areas for improvement. Originality/value: The contribution of this paper consists of: development of an instrument for the measurement of integration, validating the instrument against a criterion, and the identification of three dimensions of integration - communication, coordination, and affective relationship. The unique contributions of this paper are the validation of the instrument against a criterion and the identification of "affective relationship" as a dimension of internal supply chain integration
Research on risk, safety, and reliability of autonomous ships: A bibliometric review
No full textThe safety and reliability of autonomous ships are critical for the successful realization of an autonomous maritime ecosystem. Research and collaboration between governments, industry, and academia are vital in achieving this goal. This paper conducts a bibliometric review of the research on the risk, safety, and reliability of autonomous ships aiming to provide researchers and maritime stakeholders with a structured overview of the topics, development trends, and collaboration networks in this research field. 417 papers published between 2011 and 2022 were identified covering 940 authors, 31 countries, and 227 journals. Three main themes were determined in this research domain: “safety engineering and risk assessment for decision making”, “navigation safety and collision avoidance”, and “cybersecurity risk analysis”. Meanwhile, it was identified that research on cybersecurity in autonomous shipping is moving to overlap with safety, which requires future co-analysis methods. Additionally, the analysis of the most cited 30 papers suggests that further research is needed in the topics of unmanned machinery operation risks, online risk tools, system-theoretic safety analysis, human factor, and the determination of suitable risk acceptance criteria for safety assessment of autonomous ships. Furthermore, the analysis revealed that the development of unambiguous COLREGs regulation is crucial for the development of safe collision avoidance algorithms for MASS. It was identified that the publication by Fan et al., (2020) is a key publication in this research field, while the journals of Ocean Engineering, Reliability Engineering & System Safety, and Safety Science are the key journals publishing on autonomous ship safety and reliability.Safety and Security Scienc
