bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role and the Place of the Speeches in the Work of Theophylact Simocatta
Authors: Kotłowska Anna , Różycki Łukasz
Published: June 2020

Powyższy artykuł poświęcony został analizie mów (tzn. wypowiedzi w ora­tio recta) w Historii powszechnej Teofilakta Symokatty, najważniejszym dziele historiografii bizantyńskiej pierwszej połowy VII w. Przeprowadzony przegląd pozwolił na dokonanie konkretnych ustaleń. Mianowicie, Teofilakt w pełni akcep­tuje rolę kompozycyjną mów (zgodnie z tradycją klasyczną) w aspekcie a) mowy jako możliwość wypowiedzi własnej autora, b) mowy jako środek wzmocnienia płaszczyzny aksjologicznej, tzn. to, co mówione posiada wiarygodność wyższą od tego, co przekazane w mowie pośredniej (oratio obliqua itp.). Niemniej, uważna lektura pozwoliła wyodrębnić cechy szczególne stylu Teofilakta. Są nimi: nadmierna afektacja, brak dobrego smaku w doborze egzemplów i, niestety, nadużywanie argumentacji religijnej, zbliżające się do fanatyzmu (chociaż w tym ostatnim wypadku należy przeprowadzić badania, by stwierdzić, czy jest to kwes­tia osobista, czy ‘duch czasów’, tzn. polityka religijna Herakliusza). To, co zasługuje na uznanie, to dbanie o aspekt formalny. Teofilakt bardzo wyraźnie zaznacza te partie tekstu w mowie niezależnej, których nie stworzył, lecz wiernie cytował z dostępnej mu dokumentacji. Używa przy tym ścisłej i jed­noznacznej terminologii filologicznej. Zabieg ten świadczy o rozumieniu, zarów­no przezeń, jak i jego odbiorców, konwencji związanej z komponowaniem mów. Podsumowując, w zakresie przedmiotowym poddanym badaniu, Historia powszechna Teofilakta Symokatty spełnia standardy historiografii późnoantycznej.
Effects of Frozen Storage on the Physical Properties and Sensory Acceptability of Goat’s Milk Yoghurt
Authors: Doan Nguyen Duc , Solah Vicky Ann
Published: June 2020

The effects of frozen storage of goat’s milk on the physicochemical, physical properties, and sensory attributes of goat’s milk yoghurts were evaluated. Four yoghurts were made from goat’s milk stored at 4℃ overnight, and at -6, -20, or -35℃ for 1 month. Goat’s milk yoghurts were stored at 6℃ for 21 days. Protein and lipid contents in all the yoghurts were insignificantly different, however, the total solids content, including the added sugar in the yoghurts made from frozen goat’s milk, significantly increased in comparison with that in the yoghurt made from chilling goat’s milk. The water holding capacity (WHC) and viscosity for all the yoghurts at any period of cold storage were statistically different. No significant differences in pH or titratable acidity for all the yoghurts were observed after 1 day of cold storage; however, these physicochemical properties for the yoghurts after 7 days of storage were significantly different. All the yoghurts after 21 days of storage received similar scores for appearance and texture, but significantly different scores for color, odor, flavor, and overall acceptability.
What is zettelkasten and how to write "papers" using zettelkasten?
Authors: Basu Arindam
Published: June 2020

Zettelkasten is a system of maintaining interlinked notes in a repository and developing themes and knowledge artifacts from such interconnected notes that have identity codes, and connectors. We will describe here how to set up a Zettelkasten method of knowledge base for your own purpose and use such a system to rapidly develop reviews and publish knowledge artifacts from such collections.
Essentially, these are the steps to follow: first, set up a Zettelkasten (slip-file) system for the research papers and research data you want to work with; next, use the zettels (or notes or slips) to identify clusters and patterns, and the final step is to write research documents using information contained in the "slips".
MEWUJUDKAN KEMANDIRIAN BELAJAR MELALUI PEMBELAJARAN BERBASIS DARING DIPERGURUAN TINGGI PADA ERA INDUSTRI 4.0
Authors: Sobri Muhammad , Nursaptini Nursaptini , Novitasari Setiani
Published: June 2020

Tulisan ini bertujuan hendak mengelaborasi sejumlah pemikiran dan konsep yang meyakini pentingnya pembelajaran berbasis daring dalam rangka mewujudkan kemandirian belajar dan sebagai respon perkembangan informasi dan teknologi yang cepat pada era industri 4.0. metode penelitian yang digunakan adalah studi literatur dengan cara mengumpulkan literatur (bahan-bahan materi) yang bersumber dari buku, jurnal, dan sumber lainnya terkait dengan pembelajaran daring dan kemandirian belajar. Hasil kajian menyimpulkan bahwa model pelaksanaan pembelajaran berbasis daring terdiri atas: (1) model daring yang hanya melibatkan dosen dan mahasiswa sebagai peserta; (2) model daring yang melibatkan tiga pihak, yaitu mahasiswa, mentor, dan dosen. Pada kedua model tersebut dapat terjadi interaksi secara synchronous, yakni  interaksi belajar pada waktu yang bersamaan seperti dengan menggunakan video call, telepon atau live chat. Interaksi juga dapat terlaksana dengan cara asynchronous, yakni interaksi belajar pada waktu yang tidak bersamaan melalui kegiatan pembelajaran yang telah disediakan secara elektronik dengan menggunakan forum atau message. Dengan adanya pembelajaran berbasis daring, nmahasiswa atau peserta lebih mandiri belajar dengan kata lain senantiasa tidak tergantung kepada orang lain, menetapkan tujuan belajar, mendiagno­sis kebutuhan belajar, memiliki rasa percaya diri dan tanggung jawab serta mel­akukan evaluasi diri
STRATEGI PENGELOLAAN KELAS DI SEKOLAH DASAR
Authors: Isnanto Isnanto , Pomalingo Samsi , Harun Meldiana N
Published: June 2020

The Objective of this research was to explore teacher’s role in maximizing the potency of the class; factors inhibiting classroom management; teacher’s efforts in coping with issues of classroom management; and classroom management strategies. This case study was conducted at elementary school of SDN 83 Kota Tengah Gorontalo City, and employed a qualitative approach. The data were collected from technical and source triangulations. The result shows that in classroom management, the teacher serves as a counselor, motivator, facilitator, demonstrator, and evaluator. Therefore, the teacher was able to analyze issues revolving around the students, teachers, as well as the physical and socio-emotional environment in the classroom. Regarding this, the teacher endeavors to apply preventive and corrective acts with the involvement of the school and the committee. Teacher tends to apply eclectic or pluralistic approach in which two or more approaches were applied at the same time. Accordingly, it was expected that the eclectic approach helps teachers improve their capacity in selecting approaches that allow them to cope with problems regarding classroom management
KORELASI ANTARA KEKUATAN OTOT LENGAN DAN KELENTUKAN TOGOK TERHADAP KEMAMPUAN GULING DEPAN PADA MAHASISWA PENJASKESREK UNISMUH LUWUK BANGGAI
Authors: Salahuddin Muhammad
Published: June 2020

Penelitian ini  bertujuan   untuk  1). mengetahui ada hubungan antara kekuatan otot lengan dengan kemampuan guling depan Mahasiswa Penjaskesrek Universitas Muhammadiyah Luwuk. 2). Mengetahui  ada hubungan antara kelentukan togok dengan kemampuan guling depan Mahasiswa Penjaskesrek Universitas Muhammadiyah Luwuk. 3). Mengetahui ada hubungan saling ketergantungan antara kekuatan otot lengan dan kelentukan togok terhadap kemampuan guling depan Mahasiswa Penjaskesrek Universitas Muhammadiyah Luwuk. Penelitian ini terdiri dua variabel bebas dan satu variabel terikat. Populasi dan sampel adalah Mahasiswa Penjaskesrek Universitas Muhammadiyah Luwuk, dipilih secara random sampling diperoleh sampel sebanyak 37 peserta didik.Berdasarkan hasil analisis data dapat disimpulkan sebagai berikut: 1). Ada hubungan yang signitifkan antara kekuatan otot lengan dengan kemampuan guling depan pada siswa Mahasiswa Penjaskesrek Universitas Muhammadiyah Luwuk 2). Ada hubungan yang signitifkan antara kelentukan togok dengan kemampuan guling depan pada Mahasiswa Penjaskesrek Universitas Muhammadiyah Luwuk. Ada hubungan yang signitifkan memiliki kekuatan otot tangan dan kelentukan togok secara bersama-sama dengan kemampuan guling depan Mahasiswa Penjaskesrek Universitas Muhammadiyah Luwuk
PENGEMBANGAN PERANGKAT PEMBELAJARAN BERBASIS PENDEKATAN REALISTIK UNTUK MENINGKATKAN KEMAMPUAN BERFIKIR KREATIF DAN SELF-EFFICACY SISWA SMP
Authors: Siregar Rama Nida , Karnasih Ida , Hasratuddin Hasratuddin
Published: June 2020

Penelitian ini bertujuan untuk: 1) Mendeskripsikan perangkat pembelajaran berbasis pendekatan realistik yang memenuhi kriteria valid dan praktis; 2) Mengembangkan perangkat pembelajaran berbasis pendekatan realistik yang efektif; 3) Mendeskripsikan peningkatan kemampuan berfikir kreatif matematis dan perubahanself-efficacy siswa dengan menggunakan perangkat pembelajaran berbasis pendekatan realistik yang dikembangkan. Penelitian ini merupakan penelitian pengembangan yang dilakukan dengan dua tahap. Perangkat pembelajaran yang dihasilkan dalam penelitian ini adalah: Rencana Pelaksanaan Pembelajaran (RPP), Lembar Aktivitas Siswa (LAS), Buku Guru (BG), dan Buku Siswa (BS) dengan instrumen yaitu Tes Kemampuan Berfikir Kreatif Matematis dan Angket Self-Efficacy. Dari hasil uji coba I dan II diperoleh: 1) perangkat pembelajaran berbasis pendekatan realistik yang dikembangkan telah memenuhi kriteria valid, praktis, dan efektif; 2) terdapat peningkatan kemampuan berfikir kreatif matematis siswa dengan menggunakan perangkat pembelajaran berbasis pendekatan realistik yang dikembangkan pada hasil uji coba I dengan uji coba II yaitu sebesar 2,12%; 3) terdapat perubahan kemampuan self-efficacy kearah yang positif dengan menggunakan perangkat pembelajaran berbasis pendekatan realistik yang dikembangkan pada uji coba I dan uji coba II yaitu sebesar 1,92%. Berdasarkan hasil penelitian yang telah dilakukan, disarankan agar guru matematika mengembangkan perangkat pembelajaran menggunakan pendekatan realistik dan menggunakan perangkat pembelajaran yang telah dikembangkan.
PROFIL. PERSEPSI DAN MOTIVASI MAHASISWA BARU UNIVERSITAS MUHAMMADIYAH LUWUK
Authors: Haluti Farid , Layoo Nurhidayah
Published: June 2020

Tujuan penelitian in adalah mendeskripsikan profil mahasiswa baru UML, mengidentifikasi persepsi mahasiswa baru terhadap UML, mengidentifikasi motivasi mahaisiswa baru dan media promosi yang efektif mendorong mahasiswa baru untuk mengenal dan memilih UML,. Sampel penelitian sebanyak 725 mahasiswa baru angkatan 2018/2019 yang mengikuti ta’aruf, data dikumpulkan dengan menggunakan kuesioner, lalu data tersebut dianalisisa secara deskriptif kuantitatif. Hasil penelitian menunjukkan bahwa profil mahasiswa baru UML yakni 58% perempuan, sebagian besar (67%) berumur 18-19 tahun , 94% tidak bekerja, 3% telah menikah, 43% dari orangtua mahasiswa memiliki pekerjaan sebagai petani, Lebih dari separuh (51%) Sedangkan persepsi mahasiswa tentang UML adalah 44,1% beranggapan program studi yang ada sangat sesuai dengan minat mahasiswa, dan 41% beranggapan UML termasuk perguruan tinggi yang Islami. Motivasi sebagian besar mahasiswa (36%) masuk UML karena adanya keinginan menjadi Aparatur Sipil Negara, 25% ingin menjadi wirausahawan, dan 16% termotivasi ingin menjadi karyawan BUMN. Media promosi yang efektif mendorong mahasiswa mengenal dan memilih UML adalah melalui cerita keluarga atau teman yang sedang/pernah kuliah di UML.
Risk correlates of acute respiratory infections in children under five years of age in slums of Bankura, West Bengal
Authors: Gupta Avisek , Sarker Gautam , Pal Ranabir
Published: June 2020

Background: Acute respiratory infections (ARI) are the leading cause of mortality and morbidity globally inchildren under five years of age. Objective: To find out prevalence and risk factors of ARI among under fivechildren. Methods: A population based analytical cross-sectional study was conducted in the urban slums ofBankura, West Bengal on the prevalence of ARI and feeding practices, nutrition and immunization among 152children under five years of age. Results: Overall prevalence of ARI was 44.73 percent; 43.47 percent male and45.78 percent female were affected with ARI; half of the infants suffered from ARI (51.21%), it was 45.71percent in 13- 24 months age groups; with increasing age, prevalence of ARI gradually decreased. ARI was seenin 45.76 percent of exclusively breast fed children and 57.89 percent in children with breast feeding less than sixmonths; in bottle fed children ARI prevalence was 47.82 compared to 44.18 percent in breast-fed. Risk of ARIis almost equal in normal participants and undernourished children. ARI cases were seen among 38.73 percentof completely immunization in comparison to 80.00 percent of partially-immunized children (X2=4.97,p=0.026). Conclusion: The present study had identified a high prevalence of ARI in children less than fiveyears of age. In our study population, ARI was significantly associated with immunization status, but not withfeeding practices and nutritional status of the child.
Analysis of phlebotomy blood losses in neonates in a tertiary care hospital
Authors: Agrawal Amit , Goyal Shweta
Published: June 2020

Introduction: Blood loss due to laboratory testing is greatest for the most premature neonates with very low birth weight who require many weeks of intensive support and monitoring. Objective: The purpose of this study was to find out the volume of blood withdrawn for analytical purposes in neonates. Design: Retrospective chart analysis Setting: Neonatal intensive care unit (NICU) of a tertiary care teaching hospital of central India Participants: Neonates admitted to NICU over a period of three months. All medical records of recruited patients were reviewed and amount of blood withdrawn for analytical purposes was recorded. Intervention: None Main Outcome Measures: The amount of blood overdrawn per test and blood overdrawn per newborn. Results: A total of 153 neonates were admitted to the NICU during the study period. A total of 684 samples were performed, corresponding to 4.47±3.36 (range 1-17) per neonate. The mean volume of blood removed was 9.38 ml ± 8.8 ml per newborn (range 1 -51 ml). The amount of blood withdrawn was inversely proportional to the gestational age and birth weight i.e., neonates less than 32 weeks gestation and those with birth weight <1500 gm had statistically significant more phlebotomy loss (p<0.0001). The amount of blood withdrawn per test was significantly more than required by laboratory. Conclusion: The volume of blood sampled in our NICU was higher in neonates with low birth weight and lesser gestational age. The amount of blood overdrawn per test was much higher than required by laboratory.
Tuberculous Aortic Root Abscess in a child: A case report
Authors: Meena Jagdish Prasad , Jose Josmy , Juneja Monica , Mishra Devendra , Dixit Rashmi , Vyas Aniruddha
Published: June 2020

Although tuberculous aortitis is fairly common in adults, tuberculous mycotic aneurysm of aorta is rare withinvolvement of aortic root being very uncommon. The diagnosis depends on a combination of clinical criteria,including persistent fever and bacteraemia and echocardiographic confirmation. Because of the rarity of aorticroot abscess in children, there is no consensus on a treatment strategy. We describe a 10-year-old male whopresented with fever, abdominal pain and headache, and was found to have disseminated tuberculosis and aortic root abscess with mycotic aneurysm. Due to the presence of evidence of tuberculosis elsewhere in the body (multiple tuberculomas in brain, granulomas in liver, lichen scrofulosorum over abdomen), therapy with antituberculous drugs was started to which the patient responded partially, but later died suddenly at home.
Familial Congenital Digital Clubbing - Report of Two Siblings
Authors: Das Dillip Kumar , Shukla Suprabha
Published: June 2020

Digital clubbing can be a striking physical finding. Etiology of clubbing in most of the time is secondary to somesystemic illness. Familial clubbing is a rare occurrence and incidence or prevalence of such occurrence is notknown. We are presenting two cases (brother and sister) with digital clubbing in all the four limbs. Systemicexamination and laboratory investigation were normal. Parents were assured about the benign nature of the disease and the children were kept under regular follow up.
Hyperimmunoglobulin E syndrome and multiple brain abscesses
Authors: Sahoo Sushama , Ganguly Tusti
Published: June 2020

Hyperimmunoglobulin E (HyperIgE) syndrome is a rare primary immunodeficiency disease characterizedby recurrent skin and pulmonary infections and an elevated serum IgE level. We report a female neonatewith hyperIgE syndrome who presented with multiple brain abscesses and superficial cold abscesses causedby Staphylococcus aureus and also developed pneumonia later on. On follow-up, she developed pneumoniatwice and cold abscess once. She responded well to conservative management.
Instructions to Authors
Authors: Agrawal Amit
Published: June 2020

An abstract (not exceeding 300 words) should be provided on a separate sheet. Abstract should be structured (except for case reports) and include objective, methods, results and conclusion.
Peak expiratory flow rate nomogram in relation to anthropometric determinants of South Indian school children
Authors: Abraham Binu , Baburaj Stephenson , Patil Rahul Bhimrao , Mohandas M K , Ruhman Shibily , Raj Sunil
Published: June 2020

Background: The predictive normal value of peak expiratory flow rate (PEFR), used in monitoring of healthy and asthmatic children, is correlated with height, but it may vary with other anthropometric measurements and ethnic differences. Purpose: To study the correlation of PEFR with age, sex, body mass index (BMI), chest circumference (CC), and MUAC and to formulate PEFR nomograms in relation to these anthropometric variables in a rural school going children of age group 6-12 years in southern India. Methods: A descriptive cross-sectional study was conducted in 2000 children consist of 993 boys and 1007 girls who fulfilled the selection criteria from eight randomly selected government schools from a rural area. PEFR was measured age wise using Mini-Wright peak flow meter and the highest among the three values was taken. PEFR nomograms were formulated, and its correlation with BMI, height, weight, CC, and MUAC were estimated using linear regression analysis. Results: PEFR has strong (p < 0.001) positive correlation with age, height, weight, MUAC, and CC, but it has poor correlation with BMI (p = 0.985) which showed flat regression line with narrow 95% confidence limits. Conclusion: In this study, PEFR has nonsignificant correlation with BMI but has strong positive correlation with other anthropometric measurements. This underlines the need of a local reference nomogram as anthropometric measurements affect the PEFR reference values.
Lung functions in children with Type 1 diabetes mellitus: A cross sectional study
Authors: Somashekhar A R , Nagarajan S A , - Saketh , Mallikarjuna H B , Kumar B M Sunil
Published: June 2020

Background: Diabetes mellitus (DM) is a metabolic disorder precipitating micro and macro vascular complications and peripheral vascular diseases. Normal lung mechanism and gas exchange are influenced by integrity of pulmonary connective tissues and microvasculature. Abnormality in either of these two structural components of lung leads to variations in lung functions. Objective: This study was conducted to document lung function patterns by spirometry in patients with Type 1 DM. Materials and Methods: This cross-sectional study was conducted in Bangalore, India. Patients in the age group of 1-18 years diagnosed with Type 1 DM between December 2009, and January 2011 were included. Data regarding respiratory symptoms, age, height and weight of each patient with Type 1 DM was collected. The children were trained to use spirometers. Multiple readings of forced expiratory volume in one second and forced vital capacity were obtained until consistent, and the best reading was recorded and analyzed for any association. Results: A total of 51 children with Type 1 DM were studied, of whom 24 children were males, with a mean age of 14.06 ± 3.25 years, the minimum age being 5 years and a maximum being 18 years. 25 children (49%) with Type 1 DM were found to have pulmonary dysfunction, of which 19 children (76%) had restrictive lung pattern, and six children (24%) had obstructive pattern. Conclusion: Spirometry evaluation showed that restrictive lung pattern was very common in children with Type 1 DM, and there is scope for further study.
Effect of counseling on breast feeding practices
Authors: Rai Preeti Lata , Sharma Neetu , Gaur Ajay , Shingwekar A G
Published: June 2020

Background: National Family Health Survey-3 data show that the initiation of breastfeeding within 1 h is only24.5%, whereas the exclusive breastfeeding rates in children <6 month is only 46.4%. Objective: The present study was planned to assess the effect of counseling on breast feeding practices, especially early initiation and sustained exclusive breast feeding (EBF). Method: Cases were pregnant mothers attending antenatal clinic of Kamla Raja Hospital (KRH) (n = 154). Control group comprises of mothers who delivered at government maternity hospital other than KRH (n = 140). The cases were enrolled using structured proforma with written consent. All mothers in case group were counseled antenataly for advantages of early initiation of breastfeeding and helped to initiate breast feeding immediately after birth and again counseled at discharge, on follow-up at the end of 1st month and 3rd month for EBF. The effect was evaluated at end of 1st, 3rd and 6th month in terms of breast feeding practices. Counseling skills used were according to infant and young child feeding practice guidelines. At the end of 3rd month, group and individual counseling was done in case group. In control group, the breast feeding practices were recorded at 1, 3 and 6 month after delivery without any counseling. Results: There was significant increase in early initiation and EBF since birth in case group than in control group with odds ratio of 26. On follow-up at the end of 1st month, 83% (p = 0.001) mothers were practicing EBF in case group, which increased to 86% (p = 0.01) and to 97% (p = 0.006) at the end of 3rd and 6th month, respectively. Effect of counseling in case group for EBF was more in primiparous (78%, 81%, 91%) than in multiparous (48%, 55%, 61%) (p = 0.001, 0.006 and 0.0004 at end of 1st, 3rd and 6th month respectively). On comparing group and individual counseling given at end of 3rd month, the effect evident at 6th month shows, respectively; group counseling was more effective (99%) than individual counseling (95%, p = 0.002). Conclusion: Counseling before delivery and at regular intervals was of utmost importance for early initiation and sustained exclusive breastfeeding. This influenced primiparous mothers more. Group counseling had more impact than individual counseling.
Progressive cavitating leukoencephalopathy: Case report of a rare childhood onset neurodegenerative disease
Authors: Kekatpure Minal V , Karthik G A , Bhat Venkatraman
Published: June 2020

The leukoencephalopathies with cystic changes form a distinct subtype of childhood onset neurodegenerativedisorders. This group has heterogeneous etiological differentials that primarily include mitochondrial disorders, some leukodystrophies and central nervous system infections. We report this case of a 17-month old girl who presented with seizures, episodic encephalopathy, elevated blood lactate level and lactate peak on magnetic resonance spectroscopy, a typical imaging picture noted on cranial magnetic resonance imaging and absence of deletions or duplications of mitochondrial deoxyribonucleic acid. Progressive cavitating leukoencephalopathy (PCL) is a recently described entity with only a few cases reported so far. We report the first case of PCL from India. Accurate diagnosis can be made, not only, by the presence of typical clinicoradiological findings of PCL, but also by the awareness of, and, ruling out of, the various other differential diagnoses that are discussed in detail below.
Hirayama Disease – A case report
Authors: Sharma Bharat B , Sharma Shashi , Sharma Sandeep , Oberoi Nitin , KSV Abhinetri
Published: June 2020

Hirayama Disease is a non-progressive juvenile spinal muscular atrophy of the distal upper limb. The flexionmovement results in cervical myelopathy which affects the dorsal aspect of the cervical cord. It is a benign motor neuron disorder and its initial course is progressive which subsequently becomes stationary. These findings are quite sensitive to magnetic resonance imaging in flexion position which sometimes may be missed in neutral position. We hereby report a case an adolescent boy who presented with asymmetrical weakness of both hands and his magnetic resonance imaging in flexion revealed changes suggestive of Hirayama disease.
Dyke-Davidoff-Masson syndrome as sequelae of typhoid encephalitis?
Authors: Agarwal Sheetal , Yadav Dinesh Kumar , Beniwal Mukesh Kumar , Singh Archana
Published: June 2020

Dyke-Davidoff-Masson syndrome (DDMS) is characterized by cerebral hemiatrophy with homolateral hypertrophy of the skull and sinuses in association with contralateral hemiplegia, seizures, mental retardation, difficulty, and impairment of speech development. Among the various complications of typhoid fever, neuropsychiatric manifestations constitute a major portion. However, DDMS post typhoid encephalitis has not been reported in the literature. We report a case of DDMS in an 8-year-old boy who presented with multiple seizures, impaired speech, behavioral changes, and mental retardation following typhoid encephalitis.
Hypertrophic pyloric stenosis: Early presentation with hyperbilirubinemia
Authors: Mishra Rajeeva , Maji Prabir
Published: June 2020

Hypertrophic Pyloric Stenosis commonly presents with non-bilious progressive vomiting usually after a feed. The vomiting usually starts after third week with a range of symptoms onset from first week to fifth month of life. Less commonly it is associated with hyperbilirubinemia (unconjugated > conjugated) which subsides after surgical correction. We report a case of Hypertrophic Pyloric Stenosis who presented early in fifth day of life with repeated vomiting after each feed and unconjugated hyperbilirubinemia. Ultrasonography revealed Hypertrophic Pyloric Stenosis without any evidence of other cause of jaundice. Patient was treated conservatively, prepared for surgery, surgical correction done with Ramstedt’s Pyloromyotomy following that vomiting and jaundice both subsided. Early presentation of HPS may suggest congenital etiology and association of unconjugated hyperbilirubinemia should alert clinician for future Gilbert Syndrome.
Secondary infection in immuno-competent children with dengue: Case series
Authors: Pandey Mukul , Mittal Hema
Published: June 2020

The occurrence of bacterial superinfection, or coinfection, in patients with dengue, has been previously reported,but the available information comes from anecdotic reports. We report clinical and pathological data of immunocompetent children diagnosed with dengue and had evidence of concurrent bacterial infections.
Acute disseminated encephalomyelitis in a child with enteric fever: A case report
Authors: Pazare Pradeep , Dandge V P , Girish Meenakshi , Gaikwad Kiran
Published: June 2020

The central nervous system is involved in 5-35% children suffering from typhoid fever and manifest asneuropsychiatric features such as confusion, encephalopathy, meningismus, convulsion and focal neurologicaldeficit. However, only few cases of acute disseminated encephalomyelitis (ADEM) have been reported along withenteric fever. ADEM is a monophasic immune-mediated demyelination disorder, which commonly follows viralinfections and vaccination. We here report a case of typhoid fever who later developed ADEM.
Langerhans’ cell histiocytosis (histiocytosis X): A rare and diverse group of disorder in children
Authors: Sonawane Vijay B , Prajapati Snehal , Kotrashetti V
Published: June 2020

Langerhans cell histiocytosis is a rare disorder of unknown etiology with proliferation of Langerhans’ cells which may infiltrate a single or multiple organs. We report a case of 5-year-old child presented with skin lesions since the age of 4 months and fever for 10 days where skin biopsy revealed histiocytosis.
Type I Takayasu’s arteritis: An unusual presentation in young female child
Authors: Sharma B B , Sharma Shashi , Sharma Sandeep , Atwal Swapndeep Singh , Sharma Shweta
Published: June 2020

Takayasu’s arteritis is a rare type of vasculitis of unknown origin in which aorta and its branches are affected.Aortoarteritis causes narrowing of vessel lumen due to inflammatory changes in the vessel wall which in turn leads to thrombus formation, occlusion, or both. However, very rarely these may present exclusively with facial palsy at the time of onset. We present such a rare case of young female child who reported to the outpatient department with unusual findings of facial palsy followed by stroke and was diagnosed as Type I Takayasu’s arteritis on the basis of various investigations. Magnetic resonance imaging and magnetic resonance angiography play a significant role in making the diagnosis.
Juvenile recurrent parotitis: Report of two cases
Authors: Sawant Sangeeta Priyadarshi
Published: June 2020

Juvenile recurrent parotitis is a recurrent, nonobstructive, and nonsuppurative inflammatory condition of theparotid gland of uncertain etiology in young children. It is characterized by multiple episodes of unilateral orbilateral parotid inflammation over a period of years. Two cases of juvenile recurrent parotitis in a 3-year-oldgirl and a 6-year-old boy are reported. Both presented with multiple episodes of the parotid gland swelling.Investigations for infective etiology, an autoimmune disorder, Sjogren’s syndrome, and immunodeficiency werenegative. Diagnosis was established clinically and confirmed by ultrasound. They were managed symptomatically and recovered in 6-7 days. The parents were counseled about the benign nature of the condition and its resolution by puberty.
Incidental finding of cleidocranial dysplasia in an adolescent with head trauma
Authors: Sandhu Gurpreet Singh , Lakhkar B N , Nagrale H R
Published: June 2020

Cleidocranial dysplasia (CCD) is a rare autosomal dominant skeletal disease. It is characterized by partial or complete absence of clavicles, late closure of fontanels, presence of open skull sutures and multiple wormian bones and various craniofacial and dental abnormalities. The majority of craniofacial abnormalities become obvious during adolescence. Early diagnosis with preventive measures for various associated complications helps improve the quality-of-life of the patient. We hereby report an incidental finding of CCD in a 16-year-old young adolescent male with blunt head trauma and review the clinical and radiological features and associated orthopedic, dental and ENT complications of this rare disorder.
Addressing the public health challenge of birth defects in India
Authors: Khurmi Manpreet Singh , Gupta Medhavi , Chaudhari Gaurav
Published: June 2020

Birth defects consisted of a group of diverse clinical conditions categorized on the basis of a congenital presentation and a partly or wholly genetic etiology. Although individually rare, birth defects affect 2-3% of all births in India. As India has the largest global annual births, in absolute numbers, India may harbor the largest number of affected children worldwide. There is a need of strategic research and interventions to bring down the rate of birth defects and associated economic burden and also a need to actively screen and identifythem at early stage so necessary intervention (medical or surgical) could be initiated so as to reduce lifelong disability as a result of such defects. The recent child health screening and early intervention service initiative by the Government of India, the Rashtriya Bal Swasthya Karyakram under the National Health Mission is the first attempt in the direction toward providing services for some of the more prevalent birth defects and has the potential to alleviate suffering of affected children especially from rural areas. The data collected from this program could help policy makers to allocate sufficient funds aimed at treatment of birth defects and also develop behavior change communication strategies for prevention of the same.
Diagnostic utility of fecal calprotectin as a biomarker of gut inflammation in neonates to predict necrotizing enterocolitis: A prospective study
Authors: Shenoy Mohan T , Shenoy K T , Roseth A , Geir Larsson , Keshavamurthy S R
Published: June 2020

Background: Necrotizing enterocolitis (NEC) is a neonatal emergency that affects preterm newborns during the 1st weeks of life. Diagnosis is made mainly by clinical criteria since no specific diagnostic tests are available. Objective: The objective was to evaluate fecal calprotectin (fCal) as a biomarker of gut inflammation to predict NEC in preterm neonates. Methods: Design: Diagnostic test evaluation. Inclusion criteria: 102 preterm neonates <36 weeks gestation and within 7 days of birth admitted in Level III neonatal intensive care unit (NICU) were recruited from January 2010 to May 2011. Exclusion criteria: Congenital anomalies and overt infection. Paired stool samples at day 3 and 7 were analyzed by lateral quantum blue rapid calprotectin assay. Cut-off values of fCal were determined among 30 term healthy infants. A structured questionnaire which included gestational age, symptoms at admission, and modified Bell’s staging was used to record NEC episodes on day 3 and 7 of admission. Septic screen and radiological tools were done as per NICU protocol. Results: 48% were above 34 weeks gestation; 31.3% were of very low birth weight. As per modified Bell’s staging on day 3 and 7, 22 and 11 neonates had 1a or above stage, respectively. 15 had features of NEC; of these, 12 were managed appropriately and discharged and 3 died. In the receiver-operated curve with fCal >279 ?g/g as cutoff, the area under the curve was 0.652 (95% confidence interval: 0.516-0.789). Day 3 fCal levels were high in 65.7% neonates. Using NEC as outcome, sensitivity of the test was 93.3%; specificity was 39%; positive predictive value was 20.8% and negative predictive value was 97.14%. Conclusion: fCal has high sensitivity for diagnosing NEC in preterm neonates. However, further research is needed to establish its clinical usefulness.
Validity of pediatric risk of mortality score in prediction of mortality in North Indian pediatric intensive care unit
Authors: Madaan Gautam , Bhardwaj Anand Kumar , Sharma P D , Dhanjal Gurdeep Singh
Published: June 2020

Background: The pediatric risk of mortality (PRISM) score allows assessment of the severity of illness and mortality risk adjustment in heterogeneous groups of the patients in an objective manner. It has been developed and validated mostly at pediatric intensive care unit (PICUs) of developed countries with very few reports from India. Objectives: This study was planned to evaluate the usefulness of the PRISM score and to correlate it with the mortality in patients admitted to PICU of a northern Indian PICU. Material and Methods: A prospective, observational study was conducted between January 2012 and June 2013, during which a totalof 150 consecutive cases were enrolled for the study. PRISM score was calculated within 24 h of their admission and receiver operating characteristic (ROC) curve was used to establishing the validity of the PRISM score for predicting the mortality. Results: Overall mortality was 12.5%, and the PRISM score for survivors versus non-survivors was 7.5878 ± 5.032 versus 20.63 ± 3.41, respectively. No difference was seen between the observed and expected value of mortality calculated from PRISM score (Z = 0.467-1.521, p = 0.291– 0.64), thereby establishing the validity of the PRISM score in predicting the mortality in our PICU (ROC curve - area under the curve 0.934). The observed and expected values of the mortality were more comparable for lower PRISM scores (0-15) and a PRISM score of 13.5 has the highest sensitivity and specificity. Conclusion: We concluded that PRISM score is a valid parameter to predict the mortality among the ICU patients in Indian set ups.
Determinants of retinopathy of prematurity: A prospective observational study from Tertiary Care Teaching Hospital from North India
Authors: Gupta Ashok K , Pandita Neerul , Gupta Surbhi , Sharma Ashok K
Published: June 2020

Objective: This prospective observational study was designed to evaluate the point prevalence as well as various risk factors associated with retinopathy of prematurity (ROP) in preterm/low birth weight (LBW) babies <32 weeks of gestation and or birth weight ?1500 g on both inborn and outborn babies. Materials and Methods: Binocular opthalmological examination was performed 4-6 weeks postnataly under local eye anesthesia in 200 newborns who qualified the above criteria. If ROP was detected, the 2nd evaluation was done after 1 week, 3rd evaluation after 2 weeks and 4th after 4 weeks. The examination was carried out by the same ophthalmologist. Results: 25 (12.5%) out of 200 babies developed ROP. 23 were in Stage 1 and 2 in Stage 2 at first evaluation. All showed regression, i.e., they had completed temporal vascularization on repeat follow-up evaluations. No baby showed progression to threshold stage at any time of follow-up examinations. On multiple logistic regression analysis, factors having significant association with development of ROP werebirth weight (p = 0.0028), oxygen therapy (p = 0.0059), septicemia (p = 0.0062), and blood transfusion (p = 0.0013). Conclusion: In our study, point prevalence of ROP was 12.5 % (25/200) which is substantially high among preterm/LBW babies. Thus, evaluation for ROP should be done mandatorily in all preterm/LBW babies, particularly with gestation <32 weeks and or weight ?1500 g and when risk factors are present, so as to prevent the long-term morbidity which ranges from mild myopia to blindness.
Clinico biochemical profile of birth asphyxia in neonates of western Odisha
Authors: Shah Seema , Mishra Pramila Kumari , Goel Anil Kumar
Published: June 2020

Background: Perinatal asphyxia contributes to almost 29% of neonatal deaths in developing countries as most of the deliveries occur in rural areas and are unattended. The outcome of most of the deliveries is not encouraging in spite of standard guidelines. Objectives: To study the different spectrum of clinical presentation of birth asphyxia and its biochemical derangements. Materials and Methods: This was a prospective, hospital-based study conducted from September 2005 to March 2008 comprising of 58 term neonates admitted to neonatal intensive care unit with definite history suggestive of perinatal hypoxic insult. Compilation of history, clinical features, and relevant investigations (random blood sugar, serum creatinine, blood urea and serum electrolytes) were done, and the results were analyzed by using Medcalc software version 12. Results: Vaginal delivery was more common across all the stages. Abnormal neonatal reflex was a common feature in all babies except hypoxic-ischemic encephalopathy (HIE) I. Convulsion, mostly multifocal seizures was present in allHIE II babies where as only 22.2% babies had seizure in HIE III. Congestive heart failure (55.17%) and Oliguria was present in HIE III (77.8%) and 22 cases (37.9%) developed acute kidney injury. Hypoglycemia was observed with increasing severity of asphyxia (HIE III 26.67 ± 2.78). Serum urea, creatinine and potassium increased significantly in HIE III whereas calcium and sodium were decreased. Conclusion: The combination of clinical and supportive laboratory parameters can be used for monitoring of patients to guide early intervention to decreases morbidity and mortality.
Knowledge attitude and practices of pneumococcal vaccines in India
Authors: Kumar R Kishore , Suma A R
Published: June 2020

Introduction: Pneumococcal conjugate vaccines (PCV) have revolutionized the prevention of invasive pneumococcal disease (IPD) globally. The initial 7-valent (PCV7) vaccine has gradually been replaced by higher valency vaccines such as PCV10 and PCV13, as these cover additional serotypes causing increased immunization. Objective: The purpose of this study was to determine the overall attitude and practices of the Indian public toward PCV for their infants. Materials and Methods: Data were collected over a period of 18 months from a tertiary perinatal center. Pneumococcal vaccine leaflets with current, unbiased information on PCV10 and PCV13 were circulated to parents, who were then asked to opt for either one or none of the vaccines for their infants at their 6 weeks immunization check-up. Results: A total of 3406 infants came for follow-up. Among them, 84% chose to give the PCV while the remaining 16% opted out. Among the parents that opted for the vaccines, 90% chose PCV13 over PCV10. This may be attributable to its increased immunogenicity and broader serotype coverage as understood by the parents - who seem to want the best for their children. Conclusion: PCV13 was a preferred vaccine of choice for infants by majority of the parents, as compared to PCV10. Such information is of valuable importance in deciding which vaccine to go for if and when India goes for PCV in the future with Global Alliance for Vaccines and Immunization and United Nations Children’s Fund funding.
Acquired demyelinating disorders of central nervous system
Authors: Dekate Parag Shankarrao
Published: June 2020

Acquired demyelinating disorders of central nervous system (CNS) are rare disorders in the pediatric age group and are characterized by demyelination occurring at various sites in the nervous system. Demyelination can involve an isolated CNS site such as brain, spinal cord (transverse myelitis) and optic nerves (optic neuritis) or can involve multiple areas of the nervous system. This group of disorders includes transient single-time events like acute demyelinating encephalomyelitis (ADEM) to life-long conditions like multiple sclerosis (MS). Repeated acute episodes of demyelination may be a harbinger to the development of chronic demyelinating disorders. Early and accurate distinction between transient acute single-time demyelinating events and chronic relapsing conditions like MS is of paramount importance as treatment protocols and prognosis are widely different. Early disease modifying therapy may be beneficial in MS to suppress the ongoing and future relapses, whereas in ADEM, only short-term steroid therapy is all that is needed with an overall good prognosis.
The effects of stimulant medications on children’s growth velocity
Authors: Siddiqi Siraj , Dedlow E Rosellen , Saliba Heidi , Black Erik W , Giordano Beverly P
Published: June 2020

Objective: This study sought to determine whether relationships exist between stimulant medications and children’s growth velocity. Methods: The investigators conducted a retrospective review of 280 charts of pre-pubertal children with attention-deficit hyperactivity disorder (ADHD) who were prescribed stimulant medications for a minimum of 1 year. The children were patients in a university child development/ADHD clinic. Results: The average growth velocity across all genders and ages was 5.72 cm/year (females 5.53 cm/year,males 5.28 cm/year). The majority of the children had growth velocities in the 25-50th percentiles for age. Conclusion: This study did not find evidence of significant effect on growth velocity in children with ADHD treated with stimulant medications. Our results concur with the majority of other studies of growth in children taking stimulant medications for ADHD management. It supports our continued prescription of stimulant medications without concern for slowed or stunted growth in our patients with ADHD.
Prevalence of thrombocytopenia and its relation with WHO clinical and immunological staging among human immunodeficiency virus-infected children
Authors: Kumar Durgesh , Kumar Dinesh , Singh Dharmendra Kumar , Rai Ruchi
Published: June 2020

Objective: The aim was to study the thrombocytopenia in human immunodeficiency virus (HIV) infected children and its relation with WHO clinical and immunological HIV/AIDS staging. Study Design: Observational analytic cross-sectional study. Materials and Methods: 47 ambulatory and clinically stable HIV-infected children (confirmed by enzyme-linked immunosorbent assay for HIV-1 and HIV-2) aged 18 months-18 years attending the out-patient Department of anti-retroviral therapy center at tertiary care setting, were included in this study. Detailed history was taken, and thorough clinical examination was done in all cases. Blood samplefor complete blood count and CD4 count was taken. Primary Outcome: Thrombocytopenia in HIV-infected children. Secondary Outcome: WHO clinical and immunological HIV/AIDS staging in HIV-infected children and its relation to thrombocytopenia. Results: Of 47 studied children, thrombocytopenia was found in 14 (29.78%) cases. Patients with thrombocytopenia were found in all stages of the disease; however, it was strongly associated with increasing immunological stages (correlation coefficient, r = 0.948). Conclusion: Thrombocytopenia commonly occurs in children with HIV and its occurrence increases with an increase in WHO clinical and immunological HIV/AIDS staging.
Tuberous sclerosis complex: Role of radiology as an invaluable tool in management and follow-up
Authors: Sharma Shashi , Sharma Sandeep , Ramchandran Priya , Sharma B B
Published: June 2020

Tuberous sclerosis complex is a genetic disorder, which affects many organs in the body manifesting spectrum of symptomatology. The severity of the disease can be gauged from the extent of involvement of a particular system. Since the disease runs a long course from its presentation at childhood till adulthood and hence the monitoring is very important to have some qualitative life. Other than the common symptomatology and a few laboratory tests, radiological investigations viz. ultrasound, color Doppler sonography, computedtomography and magnetic resonance imaging play a major role in follow-up for the management map road and associated complications. We present a case where a female child had a follow-up from the age of 8 years till 20 years of age. The follow-up and the management were designed mainly as per the radiological findings. The radiological findings have indicated the time for the patient to undergo surgical intervention in addition to the ongoing medical management.
A rare cause of recurrent pneumonia: Scimitar syndrome
Authors: Murthy Srinivas , Raghavendra K , Pejaver Rajath , Basavanthappa S P , Kumar Naveen
Published: June 2020

Scimitar syndrome is characterized by partial or total anomalous pulmonary venous return from the right lung along with hypoplasia of the lung. This syndrome has varied presentations, from an asymptomatic state to severe pulmonary hypertension and/or heart failure. Newer diagnostic modalities have improved our understanding of this rare syndrome and hence providing newer treatment options to be tried. Here, we present a case of a 4-year-old child with recurrent pneumonia with Scimitar syndrome. We are reporting this case in view of the rarity of this syndrome and its presentation as recurrent pneumonia.
Mongolian spot with involvement of the frontal area
Authors: Leung Alexander K C , Barankin Benjamin , Hon Kam Lun
Published: June 2020

Mongolian spots are congenital hyperpigmented macules of varying size and shape and are usually grayish in color. They occur commonly in the sacrococcygeal area, followed by the gluteal and lumbar areas. We report a Chinese infant with a Mongolian spot in the frontal area; the occurrence of a Mongolian spot in this location is considered exceptional. Awareness of such an occurrence is important, and hence that a false accusation of child abuse is not made.