bluuebunny/crossref_metadata_2025 huggingface dataset:
Influência do Risco de Litígio do Auditor nos Honorários de Auditoria e não Auditoria
Authors: Da Silva Giordani Mikaéli , Arruda de Souza Neto Justine Maria , Da Cunha Paulo Roberto
Published: December 2020

Objetivo: Analisar o impacto do risco de litígio do auditor nos honorários de auditoria e não auditoria.

Método: Realizou-se pesquisa descritiva, documental e com abordagem quantitativa. A população compreendeu as empresas listadas no Estados Unidos da América e a amostra correspondeu a 1.298 empresas para cada ano de análise, que abrangeu o período de 2013 a 2017. Os dados foram coletados e da base de dados da Thomson Reuters Eikon® e analisados por meio da estatística descritiva e de regressão linear múltipla.

Resultados: Os resultados do estudo demonstram que o risco de litígio influencia os honorários de auditoria e os honorários de não auditoria. As variáveis de controle, alavancagem, lucratividade, empresa de auditoria, endividamento, tamanho e Market-to-Book apresentaram relação significativa com ambos os honorários, entretanto, a variável alavancagem apresentou relação negativa. Na prática os resultados indicam, que a partir do momento em que o auditor percebe um alto risco de litígio da empresa auditada, estes são persuadidos a despender um maior esforço e tempo na aplicação de testes para realizar o trabalho de auditoria. Além disso, perante um alto risco de litígio, os auditores são motivados a realizar um trabalho especializado, como por exemplo, auditoria especial e verificação fiscal.

Contribuições: Este estudo contribui ao fornecer evidências explícitas sobre o risco de litígio específico do cliente, o qual afeta mais explicitamente a responsabilidade legal do auditor pela auditoria de um cliente específico, fato que consequentemente impacta nos honorários de auditoria e honorários de não auditoria, conforme evidenciado neste estudo.
Risk Intelligence Scale and its Relationship with Risk Readiness and Emotional Intelligence
Authors: Kornilova T.V. , Pavlova E.M.
Published: December 2020

We present the results of validating the Subjective Risk Intelligence Scale (Craparo et al., 2018) in the Russian sample. The study tested the hypotheses about the relationships between subjective risk intelligence, acceptance of uncertainty and risk, and emotional intelligence. The participants (N=588) included 473 women and 115 men (Mage=27.09, SD=10.35); 260 people were tested online, and the rest — face-to-face. We used the Subjective Risk Intelligence Scale (SRIS), New Questionnaire of Tolerance for Uncertainty, Personal Decision-Making Factors, and Emotional Intelligence Scale (EmIn). Exploratory and confirmatory factor analyzes established the four-factor structure of the questionnaire similar to the original. We found pairs of correlating scales that demonstrate emotional rejection of uncertainty and cognitive productive acceptance. Negative Attitude towards Uncertainty and Emotional Stress Vulnerability was higher in individuals with lower emotional intelligence, willingness to take risks, and tolerance for uncertainty. Problem Solving Self-Efficacy and Imaginative Capability correlated with emotional intelligence, willingness to take risks, and tolerance for uncertainty. The Russian version of SRIS has good psychometric characteristics, and we recommend it as a reliable tool to diagnose a person’s attitude towards uncertainty and risk; however, the understanding of subjective risk intelligence as a personal or cognitive characteristic is unclear.
Adaptation of the Bulgarian Version of the Social and Emotional Loneliness Scale (Short Form) for Adults and Older Adults
Authors: Strizhitskaya O.Y. , Petrash M.D. , Murtazina I.R. , Vartanyan G.A. , Manevsky F.S. , Alexandrova N.C. , Babakova L.V.
Published: December 2020

This study aims to adapt and validate the Bulgarian version of the Social and Emotional Loneliness Scale on adults and older adults. We present the results of the psychometric assessment of the questionnaire on a sample of adults aged 35—75 (N=332; Mage=49.45; SD=11.17). Exploratory factor analysis revealed four factors: two factors were identical to the first two sub-scales, the third sub-scale split into two separate factors. Reliability of the new sub-scales was assessed with Cronbach’s α coefficient that showed high levels of reliability for the general scale (α=0.875) and for all four sub-scales (α ranged from 0.843 to 0.873). Confirmatory factor analysis proved the four-factor structure of the adapted scale. The convergent validity of the Social and Emotional Loneliness Scale was proved by correlation analysis with the Differential Questionnaire of Loneliness Experience. Our study yielded the adequate psychometric characteristics of the Social and Emotional Loneliness Scale for adults and older adults in Russia. In future research, we plan to increase the sample to standardize the scores for the scales.
Cognitive Deficits in Patients with Gambling Disorder
Authors: Agibalova T.V. , Tuchina O.D. , Buzik O.Z. , Potapova R.K. , Potapov V.V.
Published: December 2020

The paper provides a narrative review of cognitive deficits in patients with gambling disorder. We discuss several types of these deficits, namely, cognitive impairments due to deficits in executive functioning, impulsive and risky decision-making, gambling-related cognitive distortions, and cognitive errors in cognitive-behavioral terms. These deficits are reviewed from the perspective of their relevance for psychotherapy and the development of differentiated psychotherapeutic interventions for gambling disorder treatment.
Gluttony during pregnancy. (On the issue of ovariotomy and conservative myomotomy during pregnancy)
Authors: Poroshin M. N.
Published: December 2020

Despite the fact that pregnancy is one of the physiological conditions of a woman, only about half of the cases, according to the studies of modern statistics, reach a happy end for the mother and fetus. Along with such reasons as constitutional diseases, acute infectious diseases, suffering of the respiratory and circulatory organs, contributing to premature termination of pregnancy and requiring purely therapeutic intervention, there are complications that require serious surgical care for a successful pregnancy outcome. These are mainly complications of pregnancy with tumors of the pelvic organs, for the removal of which one has to resort to the most serious operation - gluttony. And while earlier surgeons with extreme fear decided to open the abdominal cavity in non-pregnant women, risking always losing the patient from the seemingly inevitable septic peritonitis during this operation, while earlier surgeons talked about "happiness in surgery" and attributed the successful outcome of any often unimportant operation to a clean case, - now it is boldly performed on pregnant women with a certain certainty to save life not only existing, but also emerging life.
Case of uterine tuberculosis
Authors: Neyolov N. K.
Published: December 2020

On the tenth of September 1896 Mrs. K a, an old woman of 65 years, turned to me for advice; she complained of severe, debilitating pains and an extremely unpleasant constant sensation of moisture on the outer genitals. Anamnestic data of the patient are as follows.
Clinical case of pregnancy and preterm labor in a woman with stage III genital prolapse
Authors: Ziganshin Aydar M. , Mudrov Viktor A.
Published: December 2020

This article presents a clinical case of pregnancy and preterm labor at 31-32 weeks of pregnancy in a woman with stage III genital prolapse. This pregnancy occurred spontaneously within three years after a seven-year period of taking combined oral contraceptives. The birth was complicated by premature outpouring of amniotic fluid and ended with the birth of premature fetus.
Specific interactions between genes of the hemostasis system, folate cycle and background comorbid pathology in the prognosis of preeclampsia
Authors: Belotserkovtseva Larisa D. , Kovalenko Lyudmila V. , Kasparova Angelika E. , Mordovina Inna I. , Donnikov Maxim Yu. , Telitsyn Denis P.
Published: December 2020

Hypothesis/aims of study. The search for early predictors of preeclampsia currently remains relevant. There is still a need to study maternal factors affecting the development of preeclampsia such as intergenic interactions in a pregnant woman with single nucleotide polymorphisms (SNPs) in genes associated with hemostasis system and folate cycle, as well as predictors. The aim of this study was to assess the role of comorbid pathology and gene polymorphism associated with the hemostasis system and folate cycle in predicting preeclampsia in a pregnant woman.
Study design, materials and methods. We examined 158 pregnant women in two study groups, including 92 women with preeclampsia and 66 healthy subjects. Somatic anamnesis of the patients was studied, with the course and outcomes of pregnancy analyzed. The carriage of SNPs in genes involved in hemostasis and the folate cycle was studied once by the method of polymerase chain reaction in real time with amplification of polymorphic loci and restriction analysis using specific endonucleases. The analysis of intergenic interactions was performed using the MDR 3.0.2 program.
Results. Seven genes involved in hemostasis and three genes involved in the folate cycle were studied. The highest entropy of the case-control status for preeclampsia is associated with the locus of coagulation factor F7 10976GA 9.49% and that of methylenetetrahydrofolate reductase MTHFR 677CT (A223V) 5.35%. The combination of loci of the tissue plasminogen activator inhibitor-1 gene SERPINE1 (PAI-1) and the platelet glycoprotein integrin 1-2 gene ITGA2 (SERPINE1 (PAI-1) (5G4G) + ITGA2 (807C T)) account for 18.28%, and SERPINE1 (PAI1) (5G4G) + MTHFR (677CT) 14.26% of results. A three-locus synergy model SERPINE1 (PAI-1) (5G4G) + MTHFR (677CT) + ITGA2 (807CT) responsible for the development of preeclampsia was obtained, which has a reproducibility of 10/10 and an accuracy of predictions of 84.3%.
Conclusion. Our data indicate a high contribution of the ITGA2, SERPINE1 (PAI-1), and MTHFR mutations combination to the prediction of preeclampsia.
Blood serum and follicular fluid relaxin: a pilot study of the hormone effects on ovarian function and fertilization efficiency
Authors: Bespalova Olesya N. , Zagaynova Valeriya A. , Kosyakova Olga V. , Gzgzyan Alexander M. , Kogan Igor Yu. , Milyutina Yulia P. , Tkachenko Natalia N. , Borodina Valentina L. , Lesik Elena A. , Mekina Irina D. , Komarova Evgenia M.
Published: December 2020

Hypothesis/aims of study. To date, one of the most important avenues of research in the field of reproductive medicine is the searching for new biochemical markers of oocyte quality and the prediction of the effectiveness of in vitro fertilization (IVF) protocols. The aim of this study was to assess the effect of relaxin levels in blood serum and follicular fluid on the efficiency of ovulation stimulation, fertilization, and characteristics of the embryos.
Study design, materials and methods. This prospective randomized cohort study included 11 patients undergoing infertility treatment in a superovulation stimulation protocol using gonadotropin-releasing hormone antagonists. Age, body mass index, hormonal status, ovarian response, endometrial thickness and structure, the number and quality of oocytes and embryos, as well as fertilization efficiency were assessed. The level of relaxin in blood serum and follicular fluid samples was determined on the day of transvaginal follicle puncture using enzyme immunoassay.
Results. A correlation between follicular fluid relaxin levels and body mass index, age, the number of oocytes, and their fertilization efficiency (p 0.05) was established. Changes in follicular fluid relaxin level were revealed depending on the gonadotropin preparations (p 0.05) and triggers of final maturation of oocytes (p 0.05). The tendency of the effect of gonadotropin doses on circulating relaxin levels, and of the hormone itself on endometrial thickness and the quality of oocytes was determined.
Conclusion. Determination of the relaxin concentration can be considered as a promising method for predicting the result of ovarian stimulation and the efficiency of fertilization in IVF protocols.
Use of assisted reproductive technologies in euthyroid women with antibodies to the thyroid gland. A literature review
Authors: Gorelova Inga V. , Prikhodko Ksenia A. , Rulev Maxim V. , Zazerskaya Irina E.
Published: December 2020

The presence of antibodies to thyroid peroxidase and thyroglobulin of the thyroid gland in women with infertility is more common than in the population. Some studies describe the negative effect of autoantibodies on reproductive function and the results of assisted reproductive technology (ART) programs even in the absence of impaired thyroid function. This article presents a review of literature data on the possible mechanisms of this negative influence. To date, there are no data on a significant decrease in the quality of oocytes, embryos and pregnancy rates in ART cycles in such patients. The negative effect of autoantibodies on the frequency of live births can be realized through such complications of pregnancy as miscarriage and premature birth. Currently, the possibilities for preventing these complications are poorly understood. According to recent meta-analyses, the use of levothyroxine in euthyroid patients with autoantibodies who are treated for infertility using ART methods does not result in a decrease in the frequency of miscarriage and premature birth.
V. A. Bogoroditsky. - About the conduct of childbirth according to the Indian method. - (Channel. Tamb. Med. General, 1894, 1-12. Tambov, 1895, p. 157).
Authors: Kakushkin N.
Published: December 2020

The author calls the Indian method the method of delivery on his heels, on his knees, in general with the position of the body close to vertical. This method was practiced exclusively by the ancients, and now it is widespread among wild and uncultured peoples. The position of a woman in labor with this method, according to the author, is the most natural, because the act of childbirth by self-awareness approaches the act of defecation, the anatomical structure of the birth canal in an upright position favors the rapid passage of the fetus and less pressure of the presenting part on the perineum. The author adopted this method with success, and in the sense of speed and ease of childbirth and in the sense of preserving the integrity of the perineum, in 5 primiparous, of which one was 20 years old, the rest 30-40 years.
N.I. Kuskov. - A case of a teratoid tumor. - (Collection of Labor. Doctors of St. Petersburg. Maryinskaya Hospital. Issue II, St. Petersburg, 1893, p. 85).
Authors: Kakushkin N.
Published: December 2020

When a 28-year-old woman who had died of putrefactive peritonitis was opened, an opening was found in the small intestine (at the border of the lean and ileal), communicating with the abdominal cavity and with the cavity formed into the omentum. In the hole protruded a bone with teeth - the remains of a teratoma. The gland cavity is connected to a cord that goes directly into the left Fallopian tube. The author believes that at the known time of uterine life, the left tube with the ovary, in which the teratoma developed, did not descend into the pelvis, but grew to the omentum and overgrown with it; the bone of the teratoma with constant pressure ulcerated the wall of the adjacent intestine.
M.P. Ayzeshptadt. - Two cases of ovaryotomy. (Protok, sent by the General Minsk doctors for 1893/4, Minsk, 1894 p. 152).
Authors: Kakushkin N.
Published: December 2020

1st case. 50 years old, multiparous. 6 years ago, the climacteric period began. 3 months ago, the tumor covered up in the belly. Cystoma ovarii sinistri recognized. Gluttony on January 8, 1894. The cyst was opened with a knife. There are no splices. The cut surface of the leg is sheathed with a peritoneum. Recovery. The tumor turned out to be a multichamber colloid cyst of the left ovary.
V. V. Tipyakov. - A case of a hernia of a pregnant uterus; gluttony; safe end of pregnancy .— (Medical Review, 1895, No. 17, p. 409).
Authors: Kakushkin N.
Published: December 2020

Primigravid 23 years (5th month of pregnancy). Along the middle line of the abdominal wall, 4 fingers below the navel, annular, covered with integuments, a hole with a diameter of 8-9 cm. The uterus that had fallen into the ring did not adjust and showed signs of incipient infringement. Pains in the abdomen and back of a forced character appeared. During the womb, the uterus was repositioned, and the hernial ring was sutured. Pregnancy ended at the time of the birth of a living baby. The hernia did not return.
Dr. Albert Green. - A Case of Post-Mortem Parturition. - (Lancet., 1895, 5 / i, p. 27). - A case of childbirth after death (with eversion of the uterus and rupture of the perineum).
Authors: Ginzburg M.
Published: December 2020

A 20-year-old girl, so obese that her parents, with whom she lived, did not suppress her pregnancy, which had reached a normal term, suddenly fell ill with a headache; at night she had convulsions. The invited doctor found her in an unconscious state; seizures of convulsions were 3-4 times per hour, more tonic than clonic in nature, the tongue was bitten, the pupils were dilated. The doctor suspected poisoning with some kind of alkoloid. In the morning the patient died without being destroyed. Two women, who washed the deceased and laid her on the table, did not suppress her child's emergence; they covered her with a sheet, which there was no reason to reveal for two days, until the forensic medical examination of the corpse by Dr. Green. The last one, having removed the sheet, saw that between the legs of the deceased lay a dead newborn child, legs down, with the head at the mother's genitals, that is, with the buttocks presented; a fleshy round mass protruded from the genital organs of the deceased, which turned out to be the bottom of the uterus turned upside down and not separated from it after the house; the umbilical cord was very short. Traces of bleeding or clots were not detected. The perineum of the parturient woman was torn. Her belly was very swollen, and when she was punctured, a huge amount of gas came out of it. There were no pathological phenomena in the organs of the abdomen and chest. Strychnine was not found in the stomach and intestines sent to the chemical laboratory.
Dr. Theobald Smith. - On a local vascular Disturbance of the Fetus, probably due to the Injection of Tuberculin in the pregnant Cow. - From the Pathological Laboratory of the Bureau of Animal Industry of the United States Departament of Agriculture. - (New-Jork Medic. Journ., 1895, 23 / II, p. 233). - About local disorders of blood circulation in the embryo, caused by the injection of mother's tuberculin. - Experiments on animals, produced in the laboratory of the Department of Agriculture, Sv.-Am. Conn. States.
Authors: Ginzburg M.
Published: December 2020

The two observations described below are interesting in the sense of confirming the widespread in the public opinion of the reflection on the embryo of different impressions of the mother; these observations are more valuable than those produced on animals.
Flipped Classroom in Legal Education: Achievements and Challenges of Innovating the Teaching of a Basic Law Course
Authors:   Faculty of Law, Universidad de los Andes, Bogotá, Colombia, Castro Marcela , Aguirre Sandra
Published: December 2020

Unlike the traditional method of teaching, new educational trends focus on transforming learning environments into spaces where the teacher is a guide and not the provider of information. This article presents a proposal for a flipped classroom approach to teaching an entry level undergraduate law course. The implementation of the flipped approach, which was supported by ICT-based virtual learning environment, took place at the University of the Andes (Bogotá, Colombia). The qualitative and quantitative results of this methodology show its positive contribution to promoting student autonomy in the learning process, collaborative work and articulation between theory and practice (learning by doing) while strengthening lawyering skills.
A Systemic Approach to Design and Develop Online Programs—State of the Practice and Future Projections
Authors:   TCC Connect Campus - Tarrant County College, Fort Worth, Texas, United States, Morales Carlos R.
Published: December 2020

In the past 15 years, higher education institutions have worked diligently to increase students’ access to their educational offerings via distance education and, specifically, online learning. Despite the various administrative and academic structures needed to deliver the enterprise effectively, online programs continue to thrive. Yet, the benefits of a centralized versus a decentralized organization to manage distance education continue to be debated. This paper focuses on the merits of taking a systemic approach to online learning, which uses standardized procedures and practices while leveraging research data related to student learning preferences, student completion rates, workforce needs, and trends, along with statistical evidence from local, state and regional sources. From partial terms to accelerated terms to traditional semester-long courses, online programs benefit from using a systemic approach to design and delivery. This paper delves into these advantages and concludes with recommendations.
Differences in Self-Regulated Learning (SRL) and Online Learning Satisfaction Across Academic Disciplines: A Study of a Private University in Malaysia
Authors:   University Putra Malaysia, Serdang, Malaysia, Lim Chee Leong , Jalil Habibah Ab , Ma'rof Aini Marina , Saad Wan Zuhainis
Published: December 2020

Students’ online learning satisfaction is an important variable used to measure attainment of learning outcomes in blended learning courses. Previous studies found that learners who portray a high level of SRL contributed positively to online learning satisfaction. To date, research has also shown that students display different level of online learning satisfaction under different academic disciplines. Therefore, this quantitative research aims to investigate if students’ SRL abilities significantly influence their online learning satisfaction in blended learning courses and if differences exist in online learning satisfaction across multiple academic disciplines. A set of online self-reported questionnaire was posted through the official LMS of the university to collect data from 497 undergraduate students in a private university in Malaysia. The results from the multiple regression analysis revealed that SRL explained 40.2% of the variability in online learning satisfaction (OLS). In addition, the results from one-way ANOVA with Tukey Post Hoc analysis revealed that OLS level was significantly different statistically between students in Health & Medical science discipline and Innovation & Technology discipline. The outcomes of this research provide insights as to where future efforts need to be directed, especially in the areas related to the development of students’ self-regulated learning (SRL) abilities.
Vitamin D3 augments the antidepressant effect of agomelatine against repeated corticosterone-induced depressive-like behavior in rats
Authors: Emam Hanan Tawfeek , Abu-Raia Nashwa Hassan
Published: December 2020

Background: Depression is a highly complex psychiatric disorder that remains a major burden on society. The present study was aimed to detect the neuroprotective effect of agomelatine or/and vitamin D3 on the progression of depression induced by chronic administration of corticosterone.Methods: Rats were classified into 4 equal groups; corticosterone-untreated group, agomelatine-treated group, vitamin D3-treated group, and (agomelatine and vitamin D3)-treated group. Results: Agomelatine or/and vitamin D3 caused significant improvement of behavioral parameters of depression, increase in serotonin, dopamine, and brain-derived neurotrophic factor (BDNF) with a significant decrease in tumor necrosis factor (TNF)-alpha and caspase-3 levels of brain tissue with a more significant effect of combination therapy over the effect of each drug alone. Conclusions: Vitamin D3 augments the antidepressant effect of agomelatine against depressive-like behavior in rats.
Prescribing patterns of cardiovascular drugs in cardiology outpatient department in a tertiary care hospital in Western Odisha
Authors: Roy Ayan , Patel Nayan Kumar
Published: December 2020

Background: Cardiovascular morbidity plays a villainous role globally as well as countries like India. Additionally, irrational prescription incurs greater damage to health and wellbeing. Drug utilization studies scrutinize the appropriateness of treatment and provide favorable feedbacks to strengthen clinical practices. The objective of the study was to describe treatment practices in cardiology outpatient and drug utilization pattern using core prescribing indicators by World Health Organization (WHO).Methods: A cross-sectional, observational study of 4-month duration was undertaken for cardiology Outdoor patients at a tertiary care hospital. 615 prescriptions were screened and analyzed.Results: Males (59.84%) were more in number than females (40.16%). Average number of the prescribed drugs per patient were 4.32±2.7 and (3.73±1.1 for cardiovascular drugs). Generic prescription was 60.98%. Percentage encounters with antibiotics 4.11, injectables 2.92%, fixed-dose combinations (FDCs) (11.8%) were documented. Drugs from the National List of Essential Medicines were 75.89%. The most common diagnosis was ischemic heart disease (68.29%). Hypolipidemics (78.25%) followed by antiplatelets (71.14%) were toppers in cardiovascular drug. Antiulcer drugs (PPI/Antacids) comprised 58.54% of total prescriptions.Conclusions: Less adherence to EDL, less generic prescriptions, use of FDC are major shortcomings. Areas to further rationalization like optimal use of evidence based medication like beta-blockers, newer anticoagulants/anti-platelet agents and newer anti-anginal agents are identified.
Comparative evaluation of COVID-19 pandemic enforced online teaching versus traditional teaching from point of view of medical students
Authors: Vijay Radhika
Published: December 2020

Background: The current ongoing coronavirus-2019 (COVID-19) pandemic has brought a sea change in education teaching learning system, ways and methodologies. Online teaching has been enforced suddenly for students worldwide. It has become a substitute to traditional teaching. Aware of the fact that the Corona pandemic has changed the way of learning teaching, we want to find out what students think about their real predispositions. This study is to compare and evaluate the opinions, preferences, experiences of undergraduate medical students during continuous online classes since the onset of Pandemic times.Methods: A sample size of 115 undergraduate medical students of batch 2019 was taken for the study done in Sardar Patel Medical College of Bikaner, Rajasthan, India in October 2020.A questionnaire was prepared using Google forms application and was filled by students online.Results: Majority of students had a preference and interest for traditional mode of teaching, they agreed on better understanding of concepts and details of topic and grasping more of knowledge through it. But majority of students also agreed that they are getting more time to study now with online teaching.Conclusions: This study gives an in depth insight into the current ongoing online teaching methodologies and throws light on changing acceptance of students to the current COVID-19 pandemic ways of teaching and on welcoming a better “blended learning” pattern in the upcoming Post COVID-19 new normal times.
A randomized clinical study to compare pre-emptive analgesic efficacy of clonidine and diclofenac sodium in patients undergoing major surgeries at a tertiary care hospital
Authors: Jain Prachi , Bhosale Uma , Desai Shashank
Published: December 2020

Background: Pre-emptive analgesia is a method to achieve analgesia even before exposure to a noxious stimulus The purpose of pre-emptive analgesia is to reduce pain caused due to surgical incision triggered inflammatory mechanism activation; and to ensure a good post-operative pain control so that there is no development of chronic pain. Clonidine is an α2 adrenergic agonist thus it decreases the sympathetic outflow, while Diclofenac is a non-steroidal anti-inflammatory agent. Our literature review showed that both clonidine (150 μg) and diclofenac are efficacious pre-emptive analgesics. Literature review also revealed that there is no study available to compare pre-emptive analgesic efficacy as well as safety of oral clonidine with diclofenac, therefore present study was designed to compare pre emptive analgesic efficacy of these two drugs.Methods: This randomized clinical study included 100 patients from surgical departments, of either sex, between 18 to 70 years age and of American society of anesthesiologists (ASA) I/II grade. Patients were randomly allocated to two groups and received either of the treatments 30 minutes prior to induction of anesthesia. Pain scores were recorded using visual analog scale, facial rating scale and behavioral rating scale at awakening and at 1, 2, 4, 6 and 24 hours. Postoperative analgesic requirement over 24 hours was recorded. Data were analyzed using OpenEpi statistical softwares.Results: Significantly lower pain scores were observed in clonidine group as compared to Diclofenac at 4 and 6 hours (p<0.05) on all the pain scales. Clonidine group also required less postoperative analgesic as compared to diclofenac (p<0.05).Conclusions: Study results are strongly suggestive of greater pre-emptive analgesic efficacy of clonidine over diclofenac in major surgeries done under spinal anesthesia.
Comparative outcome analysis of hydroxychloroquine/chloroquine, remdesivir and standard of care treatment against COVID-19 infection
Authors: Kumar Vikas , Mahato Sumit Kumar
Published: December 2020

This study aimed to compare the efficacy and safety of hydroxychloroquine/chloroquine (HCQ/CQ), remdesivir and standard of care treatment (SOC) in patients with nCoV-19 based on the RCTs available in the literature. We conducted a cumulative review of all the RCTs published for the treatment of nCoV-19. Analysis for odds of patient recovery on HCQ/CQ, remdesivir and SOC treatment was accomplished and recovery was expressed as undetectable viral RNA levels. Total sample size in our analysis was 978 from six RCTs, in which nCoV-19 positive patients treated with HCQ/CQ, remdesivir and SOC were 166,560 and 252, respectively. SOC treatment showed increase in 2-fold of patients’ recovery as compared to the HCQ/CQ group (p=0.0006). Further, patients reported 1.5-3-fold increase in adverse events in remdesivir and HCQ/CQ group as compared to SOC group (p=0.0016 and p<0.0001). Our finding suggests remdesivir or HCQ/CQ ensures no benefit over SOC treatment, which may be attributed to the adverse events exhibited by remdesivir, or inefficacy of HCQ/CQ.
A case report on usage of rituximab on complicated steroid-dependent nephrotic syndrome
Authors: Jayachandran Shravan , Suwitha S. , Priya A. , Chander K. Arun
Published: December 2020

Nephrotic syndrome (NS) is one of the common yet challenging childhood disease. Treating NS with immunosuppressants like corticosteroids is typically effective. However, there are significant evidences which displayed resistance patterns to the former drugs. Here in this case, a male patient came to the nephrology department with the history of steroid dependant nephrotic syndrome with complaint of its infrequent relapse. The condition was complicated since, the patient was on multiple steroids even after which there were recurrent episodes of syndrome. Considering the status, Mycophenolate mofetil was added as a supportive treatment for the management of the disease along with steroids, still the outcome was unremarkable. Hence, rituximab was ordered (four cycles). The outcome this time was appreciable, rituximab administration produced a positive result. No events were recorded during the treatment duration.
Evaluation of outcome of early appendectomy in appendicular lump
Authors: Haque A. S. M. Rezbanul , Saha Bablu Kumar , Haque M. Mahfuzul , Sattar M. Abdus , Ray Upendra Nath , Rahman M. Anisur , Begum Most Arifa , Jesmin Miratul , Najma Shamima , Shorwer M. Golam
Published: December 2020

Background: Appendicular lump is a well-known sequalae of acute appendicitis encountered in 2-6% of patients. Successful management of appendicular lump is controversial with different approaches. This study aims to evaluate the outcome of early appendectomy in an appendicular lump.Methods: A total of 210 patients were admitted in surgery and pediatric surgery department of Rangpur medical college and hospital with the diagnosis of acute appendicitis and its sequalae over two years.Results: In this study, sixty patients were included who were presented with an appendicular lump. Maximum patients (50%) were found in the age group of 21-30 years. Males (66.67%) were more affected. Eighty percent of patients were coming from below-average socio-economic conditions. In group I, early appendicectomy had done and outcomes were satisfactory and favorable. In group II, eighteen patients were operated who were admitted at 6 to 8 days after an attack of acute appendicitis, and twelve patients were continued the conservative treatment. In group II, who had done surgery, among them, fourteen patients (77.78%) were found an appendicular abscess, and four patients (22.22%) were found perforated appendix per-operatively. In group I, the mean recovery period was less and they had minimum complications. In group II, the mean recovery period was more and they had more complications.Conclusions: Based on these findings, it can be concluded that early exploration in appendicular lump patients confirm the diagnosis, cures the problem, reduces the cost of management, and shortens the convalescence period and hospital stay with reasonably satisfactory outcomes.
Impact of Rashtriya Bal Swasthya Karyakram, in management of childhood cataract, at a tertiary eye care center of Eastern Uttar Pradesh
Authors: Bhardwaj Rahul , Sharma Sandeep , Tomar Vijay Pratap Singh , Singh Kunal Vikram , Singh Sindhuja , Chaudhary Prakhar , Jaiswal Nikita , Gaur Rachana
Published: December 2020

Background: Cataracts in children are rare, accounting 7.4-15.3% of pediatric blindness. Pediatric cataract is a treatable leading cause of childhood blindness. Rashtriya bal swasthya karyakram (RBSK) is an important initiative aiming at early identification and early intervention for children from birth to 18 years. The objective of our study was to know the impact of RBSK, in management of childhood cataract, at a tertiary eye care center.Methods: This was a hospital based retrospective study, done from December 2018 to December 2019. This study included all patients of congenital and developmental cataract during this study period. The patients aged less than or equal to 18 years were included. All statistical analyses were done at 5% (p<0.05) significance using Graph Pad instat version 3.0 and Microsoft excel 2019.Results: During a study period of thirteen months, 357 eyes of 210 patients with congenital or development cataract were included. There were 142 (67.61%) male patients and 68 (32.38%) were female. The maximum number of patients were seen in the age group of 4-6 years 52 (24.7%), followed by the age group of 7-9 years 48 (22.8%). Bilateral cataracts were seen in 148 (70.4%) patients and unilateral cataract in 61 (29.0%) patients. The most common type of cataract was lamellar cataract seen in 150 (42%) eyes.Conclusions: RBSK is changing the lives of children and their families by reducing the burden of childhood blindness due to cataract and improving the quality of the life, especially in financially underprivileged families.
A study of prevalence of abnormal EEG and its association between various clinical presentations of atypical febrile seizures
Authors: Priyavathani J. Bruntha , Pothapregada Sriram , Varadhan Anuradha , Thirunavukarasu Suresh C.
Published: December 2020

Background: Quantitative EEG is a rapidly emerging tool in the diagnosis and follow up of various neurological disorders and can act as predictive marker for subsequent epilepsy in children with complex febrile seizure. The present study aimed to estimate the prevalence of abnormal electroencephalogram (EEG) and to find the association between Quantitative EEG (qEEG) and various clinical features of atypical febrile seizures(AFS).Methods: EEG was recorded along with clinical features including the age at onset, duration of episode, number of episodes in a day, type of seizure and the recurrences from the children aged between 6-60 months with atypical febrile seizures. EEG recordings were classified into Normal and abnormal EEG with epileptiform changes by the expert interpretation and the distribution of above said clinical features in the both groups were analyzed. It is also attempted to find the association between qEEG and few of the clinical features.Results: Prevalence of abnormal EEG in atypical febrile seizures was 33.9%. There were no significant differences in the distribution of abnormal EEG and their association with various clinical features of AFS. Significantly increased absolute power of θ and α waves were recorded from the frontal montages in the children with epileptiform changes in the EEG.Conclusions: qEEG changes can be also considered as marker of severity of febrile seizure episodes. Many prospective studies with long-term follow up are required to establish the predictability of future epilepsy by qEEG.
Short term outcome of neonates born to mothers with SARS-CoV2 infection
Authors: Pathak Shweta , Lazarus Monica , Tiwari Asha
Published: December 2020

Background: Objectives of the study was to assess the clinical presentation and risk of mother-to-infant transmission of SARS-CoV2 in infants born to mothers with COVID-19 infection.Methods: This was a prospective observational study. This study was conducted in tertiary care centre and a dedicated covid hospital in central India. Infants born to mothers diagnosed to have COVID-19 at the time of delivery, born between 1 June and 25 September 2020 will be included in the study.Results: Total 60 infants were born to mothers with COVID-19 at the time of delivery. Three neonates tested positive for SARS-CoV2 after birth-one had mild respiratory symptoms and the other two infants remained well. A preterm baby who was negative for covid died due to extreme prematurity with sepsis (early onset) with respiratory failure on day 4 of life and another baby who was negative died due to hypoxic ischaemic encephalopathy stage 3 with Meconium aspiration syndrome with respiratory failure. Remaining 58 neonates and their mother roomed in while in hospital and all were breast fed. None of the other neonates developed any significant health issues or developed symptoms attributable to SARS CoV2.Conclusions: The risk of mother-to-infant transmission of SARS-CoV2, in the perinatal period is very low. Breast feeding and rooming in can be practiced safely with adequate infection control precautions with negligible clinical risk to the infant.
Clinical profile and aetiological factors of neonatal jaundice from a rural area of Kutch, Gujarat, India
Authors: Patel Avinash , Saradava Karan , Chauhan Hasmukh
Published: December 2020

Background: Etiology of hyperbilirubinemia is not only crucial for optimal management of the patient but also it may have implications for subsequent pregnancies. The objective of this study was to study the clinical profile and the underlying aetiological factors leading to neonatal jaundice in this rural setting of Kutch District, Gujarat, India.Methods: This prospective observational study was conducted in the neonatal intensive care unit (NICU) and Post Natal ward Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat. Total of 150 cases were enrolled for the study. Blood grouping and Rh typing of baby and mother were done. Cord blood bilirubin and haemoglobin, direct coomb's test (DCT) and bilirubin monitoring were done whenever there was a setting for Rh incompatibility.Results: Among 150 neonates studied, majority had birth weight between 2501g and 3000g. Only 21 babies had birth weight <2.5kg (14%) (Table 2). Of the 150 neonates 85 were males and 65 were females.Conclusions: This study concludes that physiological jaundice is the most common cause of neonatal jaundice in our hospital. This is followed by ABO incompatibility, sepsis, Rh incompatibility and idiopathic cases.
An unusual band causing intestinal obstruction: case report
Authors: Chelliah Suresh , Jayabalan Sathia Dev , Pachamuthu Meganathan , Veettil Nimisha Puthiya
Published: December 2020

We report an unusual case of intestinal obstruction. The child presented with intermittent abdominal pain. Initial USG abdomen and CT abdomen were inconclusive. Diagnostic laparoscopy followed by Laparotomy was done to remove bezoar made up of a rubber band and thread balls. Iron and zinc deficiencies are the preventable causes of pica. Plasticobezoars are rare and should be suspected when symptoms are not consistent with other common causes of obstruction.
Hereditary spastic paraplegia-a differential for spastic paraplegia in children
Authors: Shetty Niharika , Devadas Sahana , Kariappa Mallesh
Published: December 2020

Hereditary spastic paraplegia (HSP) is a group of neurodegenerative disorders with familial origin mainly affecting the lower limbs. It has a prevalence of 3-10/100,000. The diagnosis is by symptomatology, clinical examination and neuroimaging to rule out other causes of spastic paraplegia. The diagnosis is confirmed by genetic analysis. Since this disorder is slowly progressive with nonspecific MRI brain findings the diagnosis can be delayed with delay in the start of rehabilitation measures. This disorder is usually diagnosed in the adult life and the literature has very few cases of paediatric HSP and hence we are reporting a case of HSP. Here we present the case of two siblings who presented to us with progressive weakness of both the lower limbs.
Intussusception in an infant complicating dengue infection
Authors: . Fadila , Omair Md. Faraz , Kevlani Neeta
Published: December 2020

Intussusception is the most common abdominal emergency in children younger than 2 years of age. A 6-month-old child presented as dengue with gross abdominal distension to our hospital. Dengue was managed using standard therapy as per world health organization protocol, while abdominal pathology, later found out to be intussusception, required exploratory laprotomy. At the outset, abdominal distensions in the setting of a severe dengue infection, could be misdiagnosed as ascites due to capillary leakage, masking the clinical findings of acute abdomen on examination.  Although unusual, it is possible to find two concurrent illnesses simultaneously, one complicating the typical clinical course expected from the other, and this needs high index of suspicion due to different management strategies of both. We describe here the diagnostic dilemma of such a case.
Henoch-Schonlein purpura in child: a case report and review of the literature
Authors: Sonawane Vijay B. , Kotrashetti V. A. , Bainade Kapil S. , Nair Shweta , Yewale Sushil
Published: December 2020

Henoch-Schonlein purpura (HSP) is the most common vasculitis of childhood and is characterized by leukocytoclastic vasculitis and immunoglobulin A deposition in the small vessels in the skin, joints, gastrointestinal tract and kidney. We report a 6 year old female child presented with rashes over both legs and buttocks along with joint pain and abdominal pain and multiple episodes of vomiting. Patient was diagnosed with HSP and treated with oral prednisolone followed by methylprednisolone and other supportive care.
Infection associated hemophagocytic lymphohistiocytosis: a report of three cases
Authors: Kumar Magesh , . Dharmesh , Santra D. B. , Jain Chirag
Published: December 2020

HLH (Hemophagocytic lymphohistiocytosis) is not an uncommon disorder; it is an overreaction of the immune system. It can be familial or acquired and both share one common feature of a highly stimulated and ineffective immune response. Acquired HLH is commonly seen with infection (infection associated hemophagocytic syndrome-IAHS); malignancies and rheumatic disease where it is also known as (macrophage activating syndrome). Here we are reporting three cases of secondary HLH associated with dengue, typhoid and vivax malaria.
Determining COVID-19 disease severity and outcome using sequential chest radiograph in a new designated COVID-19 hospital
Authors: Munirathnam Mahendra , C. N. Mohan , Mohammadi Javeriya , Gowda Samarth S. , Ramaiah Madhumati
Published: December 2020

Background: COVID-19 pandemic to date has recorded around 37 million cases across the world. This study was done to appraise the prognostic importance of portable chest X-ray (CXR) and the Brixia scoring was then used to predict the outcome variables like hypoxia, non-invasive ventilation, intubation, sepsis, multiple organ dysfunction syndrome (MODS), recovery, death and post corona sequalae.Methods: A 100 reverse transcriptase-polymerase chain reaction (RT-PCR) confirmed COVID-19 infection were included in the study, based on the inclusion and exclusion criteria. A CXR was done on admission and on day 3 following admission. The CXR Brixia score was calculated and was correlated with lab parameters, hypoxia, need for mechanical ventilator and clinical outcome variables. P value of <0.05 was taken as significant.Results: The mean Brixia score on admission were 2.52±1.505, 6.18±2.969 and 12.05±3.251 in mild, moderate and severe category respectively and the scores that were calculated 3 days after admission were 2.52±1.505, 6.18±2.969 and 12.14±3.306 in mild, moderate and severe category respectively, it was found that mean Brixia scores were higher in patients with moderate and severe category compared to mild category. There was a statistically significant correlation between lymphopenia, lactate dehydrogenase (LDH), d-dimer, C-reactive protein (CRP) and serum ferritin with Brixia score on admission.Conclusions: The simple and a bedside Brixia CXR score has shown that the higher scores predict a need for monitoring and management to prevent poor clinical outcome and mitigate complications and death. When this score is used along with other easily available biochemical parameters is useful in predicting clinical outcome and prognosis.
A clinical and biochemical laboratory profile to measure the severity of dengue fever and their outcome
Authors: Sushma Maddipatla , Nagabhushana M. V. , Reddy M. Dharaneedhar
Published: December 2020

Background: To identify various manifestations of dengue fever, complications, and to measure their association with laboratory findings.Methods: 100 cases of suspected adults between 20-70 years of age with clinical features suggestive of dengue infection and patients presenting with fever of acute onset (<2 weeks), pain abdomen, vomiting, rash, flushed appearance and bleeding manifestation were studied. All cases were followed up for the clinical and laboratory parameters and treated according to WHO guidelines.Results: 36 were classified as classical dengue fever, 33 as dengue haemorrhagic fever (DHF), 15 as dengue shock syndrome (DSS), and 16 as dengue-like illness (DLI) and the common age group was 30-40 year (50%). Most (66%) of the patients were male. The common presenting symptoms was fever 65%, vomiting (40%), abdominal pain (40%), myalgia (7%), etc. Hepatomegaly (53%), ascites (1%), splenomegaly (8%) was noted. The mean platelet in the present study was 41870 cells/cu mm. Elevated liver enzymes and elevated serum creatinine was found in complicated forms of disease. The prothrombin time ranged from 11-60 sec with a mean of 19.5 sec.Conclusions: The treatment of dengue is mainly supportive, but early institution and meticulous monitoring are the important steps for positive outcome. Much more awareness, vigilance and research in the diagnostic modalities are further needed to avoid unnecessary panic and platelet transfusions.