bluuebunny/crossref_metadata_2025 huggingface dataset:
ЯКІСНИЙ АНАЛІЗ РИЗИКІВ ВІТЧИЗНЯНИХ ПІДПРИЄМСТВ В УМОВАХ ВОЄННОГО СТАНУ
Authors: Макалюк Ірина , Кривда Олена , Лайкова Аліна
Published: June 2024

Статтю присвячено дослідженню ризиків вітчизняних підприємств в умовах воєнного стану. Визначено етапи управління ризиками діяльності суб’єктів господарювання. Охарактеризовано основні групи ризиків виробничих підприємств (фінансових, техніко-виробничих, комерційних та інших). Обгрунтовано специфіку найбільш суттєвих ризиків діяльності підприємств в контексті умов воєнного стану в Україні, а саме: ризиків припинення діяльності та втрати майна підприємства, регуляторного, кадрового, репутаційного, енергетичного ризиків, ризику взаємовідносин з контрагентами, а також групи фінансових ризиків (валютного, інфляційного, податкового, інвестиційного, кредитного, процентного та інших). Визначено сутність та етапи здійснення якісного аналізу ризиків на підприємстві. Проведено практичну апробацію якісного аналізу ризиків на прикладі ПрАТ «Оболонь» – здійснено ідентифікацію та обгрунтування ризиків, а також визначено шляхи їх мінімізації. Проаналізовано динаміку зміни фінансового стану досліджуваного підприємства воєнного періоду відносно довоєнного. Виокремлено стратегії та методи управління ризиками з метою їх нейтралізації.
ОСОБЛИВОСТІ АНАЛІЗУВАННЯ БІЗНЕС-ПРОЦЕСІВ ПІДПРИЄМСТВ У СУЧАСНИХ УМОВАХ
Authors: Мірошник Роман , Дереворіз Михайло
Published: June 2024

В статті розглядаються особливості аналізування бізнес-процесів підприємств у сучасних умовах. Досліджено складові аналізування бізнес-процесів: дизайн нових та виправлення несправних бізнес-процесів; усунення неефективних бізнес-процесів; тренування та підвищення кваліфікації персоналу; стандартизація операцій бізнес-процесів; автоматизація та діджиталізація; розвиток нових моделей бізнес-процесів. Визначено, що на проведення аналізування бізнес-процесів підприємства впливають умови: внутрішнє відчуття керівництва підприємства; період активного зростання чи розширення сфери діяльності; погіршення продуктивності діяльності підприємства; ступінь розвитку діджиталізації та цифрової трансформації; процес злиття та процес вдосконалення діяльності. Авторами визначено переваги від покращення бізнес-процесів: економія витрат; підвищення задоволеності та лояльності споживачів; оптимізація бізнес-процесів, надання високоякісних продуктів та послуг; покращення мотивації праці персоналу.
УДОСКОНАЛЕННЯ ПЕРСОНАЛІЗОВАНОГО ПІДХОДУ ДО ОБСЛУГОВУВАННЯ ГОСТЕЙ В БАРАХ ГОТЕЛЬНИХ ПІДПРИЄМСТВ
Authors: Пушка Ольга , Шаран Лариса
Published: June 2024

Стаття присвячена питанням, пов'язаним з вдосконаленням та впровадженням персоналізованого підходу до обслуговування гостей у барах готельного підприємства. В роботі висвітлено аналітичний огляд різноманітного спектру стратегій, методів та технік, спрямованих на оптимізацію процесів обслуговування та підвищення ефективності комунікації з гостями в закладах ресторанного господарства. В даній праці розглядаються сучасні тенденції в галузі барного обслуговування, включаючи використання інноваційних методів та підходів для персоналізації взаємодії з гостями. На основі комплексного аналізу різноманітних підходів до оптимізації обслуговування гостей, публікація висуває конкретні рекомендації щодо покращення загального досвіду відвідування барів при готелях та збільшення рівня їхнього задоволення.
НЕГАТИВНИЙ ВПЛИВ ПАНДЕМІЇ COVID-19 НА СІЛЬСЬКЕ ГОСПОДАРСТВО
Authors: Хмелевський Денис
Published: June 2024

Пандемія Covid-19 надала багато негативних наслідків для світової економіки та людей у всьому світі. Covid-19 створює багато загроз для стійкості сільського господарства, який є дуже чутливим через потреби в безпеці продовольства. Перш за все, необхідно проаналізувати та усвідомити безпосередні наслідки нинішньої пандемії для сільськогосподарської та продовольчої систем, щоб розробити необхідні дії. Ризики, вразливість, стійкість і системні зміни сільськогосподарських систем необхідно краще зрозуміти, щоб адаптуватися до пандемії Covid-19. Основним внеском у цю роботу є систематизація та групування основних заходів щодо підвищення стійкості систем сільського господарства проти пандемії Сovid-19 на основі останніх наукових досліджень, опублікованих у 2020 році. Також надані рекомендації щодо майбутніх досліджень на основі проведеного систематичного огляду літератури.
EDUKASI TENTANG PENERAPAN GIZI SEIMBANG PADA 1000 HPK REMAJA PUTRI UPAYA UNTUK MENCEGAH STUNTING
Authors: Laraeni Yuli , Sulendri Ni Ketut Sri , Wahyuningsih Retno , Darni Joyeti , Pratiwi Intan Gumilang
Published: June 2024

Timbulnya masalah gizi pada remaja pada dasarnya dikarenakan perilaku gizi yang salah, yaitu ketidak seimbangan antara konsumsi gizi dengan kecukupan gizi yang dianjurkan. Bila konsumsi gizi selalu kurang dari kecukupan maka seseorang akan mengalami gizi kurang. Sebaliknya jika konsumsi melebihi kecukupan akan menderita gizi lebih. Adapun tujuan pelasanaan kegiatan meningkatkan pengetahuan tentang gizi seimbang pada remaja putri dan mempersiapkan dan memotivasi remaja puteri untuk mengkonsumsi makanan dengan gizi seimbang pada periode 1000 HPK untuk mencegah stunting. Remaja Puteri di Dusun Bengkel Selatan 1  Desa Bengkel Kecamatan Labuapi. Metode kegiatan pemberian konsultasi gizi tentang edukasi dalam penerapan gizi seimbang pada 1000 HPK pada kelompok sasaran dengan menggunakan metode secara langsung yaitu assessment masalah gizi dan pemberian konsultasi gizi dan metode yang digunakan adalah pemberian contoh makanan bergizi  yang sesuai dengan prinsip-prinsip gizi seimbang. Pengukuran antropometri. Pada akhir kegiatan dilkukan evaluasi hasil terjadinya peningkatan pegetahuan tentang makanan gizi seimbang sebelum edukasi pengetahuan yang baik sebesar 46,7% setelah edukasi menjadi 80 %, untuk pengetahuan sedang sebelumnya 46,7 % menjadi 20% dan pengetahuan kurang 6,6 % setelah penyuluhan dan pemberian contoh makanan semua menjadi katagori baik dan sedang. Saran: Koordinasi dengan pihak aparat dan puskesmas terkait lebih ditingkatkan mengingat masih terdapat sasaran yang perlu mendapatkan tindak lanjut karena mengalami anemia dan mengalami KEK.
Виконавче провадження : навч.-метод. посіб. для здобу вачів денної та заочної форми навч. Нац. ун-ту «Одес. юрид. академія», галузь знань – 08 «Право», спец.– 081 «Право» [Електронне видання]
Authors:   Національний університет «Одеська юридична академія», Голубєва Неллі , Волкова Наталія , Іліопол Інна , Полуніна Ольга , Притуляк Валерій , Яніцька Інна
Published: June 2024

Видання визначає обсяг знань, що повинен опанувати здобувач, відповідно до вимог освітньо-кваліфікаційної програми майбутнього правознавця з дисципліни «Виконавче провадження», послідовність опанування навчальним матеріалом дисципліни з урахуванням міждисциплінарних зв’язків, методичні рекомендації щодо проведення практичних занять, завдання для самостійної роботи, складові оцінювання знань здобувачів, список рекомендованої літератури. Навчально-методичний посібник розрахований на здобувачів і науковопедагогічних працівників вищих юридичних навчальних закладів
PHẪU THUẬT CHUYỂN THẦN KINH PHỤ ĐẾN THẦN KINH TRÊN VAI PHỤC HỒI DẠNG VAI BẰNG ĐƯỜNG SAU, MỘT PHẪU THUẬT HỨA HẸN TRONG ĐIỀU TRỊ TỔN THƯƠNG ĐÁM RỐI THẦN KINH CÁNH TAY: BÁO CÁO CA LÂM SÀNG
Authors: Trương Trọng Tín , Tăng Ngọc Đạt
Published: June 2024

Đặt vấn đề: Ổn định và phục hồi dạng vai trong tổn thương đám rối thần kinh cánh tay bằng phương pháp phẫu thuật chuyển thần kinh phụ đến thần kinh trên vai theo đường kinh điển phía trước có thể làm yếu một phần cơ thang. Phương pháp phẫu thuật qua đường mổ phía sau do Guan SB và Bahm J khởi xướng từ năm 2004 được mong đợi là khắc phục được một số nhược điểm của phẫu thuật đường phía trước. Đường mổ này bảo tồn chức năng phần trên cơ thang và chuyển thần kinh gần cơ mục tiêu hơn giúp tái phân bố sớm cơ trên gai.

Mục tiêu: Áp dụng phương pháp chuyển thần kinh phụ đến thần kinh trên vai bằng đường sau phục hồi dạng vai trong điều trị tổn thương mức độ rễ đám rối thần kinh cánh tay (ĐRTKCT) để có nhận định bước đầu về ưu điểm và nhược điểm của phương pháp trước khi triển khai rộng rãi hơn.

Đối tượng và Phương pháp nghiên cứu: Báo cáo hàng loạt ca. Năm bệnh nhân tổn thương ĐRTKCT mức độ rễ, không phục hồi với điều trị bảo tồn.

Kết quả: Thời gian theo dõi ngắn nhất 3,5 tháng dài nhất 14 tháng với sức cơ trên gai M3-4, tầm vận động chủ động dạng vai từ 200 đến 400. Bắt đầu có dấu hiệu phục hồi vận động dạng vai lúc 2,5 tháng (sức cơ M2). Luôn tìm được thần kinh trên vai, có một trường hợp biến chứng chảy máu. Sức cơ thang hầu như không bị ảnh hưởng đạt sức cơ M4-5.

Kết luận: Phẫu thuật chuyển thần kinh phụ tới thần kinh trên vai bằng đường sau hứa hẹn là phương pháp hiệu quả trong việc giúp phục hồi chức năng dạng vai trên bệnh nhân tổn thương ĐRTKCT mức độ rễ.
Testing for efficacy in four measures of demographic buffering
Authors: Gascoigne Samuel , Kajin Maja , Sepil Irem , Salguero-Gomez Rob
Published: June 2024

Understanding population responses to variable environments is central to much of current research in population ecology and conservation biology. Environmental variability, a key component of global climate change, increases the extinction risk of species across the tree of life. Therefore, quantifying the sensitivity of populations to environmental variability is timely in the face of global climate change. A common approach to measure the impact of environmental variability on a population is by quantifying the population’s capacity towards demographic buffering specifically, the population’s ability to reduce the impact of environmental variability on its own growth rate. This line of work has, over the past 25 years, resulted in multiple, heterogeneous methods to quantify demographic buffering. To date, we lack clarity on which method is most appropriate, and under what conditions. To identify the best method to quantify demographic buffering, we test four methods – one correlational method, two methods using terms from Tuljapurkar’s approximation and the summation of stochastic elasticities of variance – for their efficacy to inform conservation strategies. We compare and contrast these methods via three different tests to determine the efficacy of the methods across four integral projection models for plants representing different life histories. In the first test, we determine if the measures, structured by ontogeny, are similar or distinct by analyzing their covariance structure across the four species. In the second and third tests, we perform two counterfactual simulations to test if the measures offer insights about the populations’ responses to variable environments that are better than chance. We find that the four methods significantly differ in their ability to identify and quantify demographic buffering. Furthermore, our simulations identify the summation of stochastic elasticity of variance as the most effective method to quantify demographic buffering. This work represents a clear example of how and why to test the metrics we infer from structured systems prior to their applications in systems of interest (e.g., endangered populations). In addition, our finding that commonly used approaches to quantify demographic buffering are ineffective has broad implications for our current understanding of how natural populations are responding to climate change, and thus for effective conservation practices.
(ANTİK) YUNAN-ROMA DÖNEMİ ANADOLU’SUNDA BEBEK/ÇOCUK SAĞLIĞI
Authors: Mutlu Gülseren
Published: June 2024

Bebek/çocuk sağlığı ve ölüm oranları günümüzde olduğu gibi antik çağ toplumlarının da yaşam kalitesini, yaşam düzeyini, ekonomisini ve toplum sağlığını yansıtan en önemli veridir. Literatür tarama yöntemi kullanılarak hazırlanan bu çalışma, antik kaynaklarda bebek/çocuk sağlığı ve hastalıkları üzerine aktarılan bilgileri ve 1995-2020 yılları arası Arkeometri Sonuçları Toplantısı’nda sunulan, Anadolu’da yürütülen kazılarda elde edilen iskelet bulguları üzerinde saptanmış sağlık problemlerini içermektedir. Bu problemler modern kaynaklar ışığında değerlendirilerek bölgenin ve toplumun ekonomik, kültürel ve coğrafi dağılımı ile ilişkilendirilmeye çalışılmıştır. Ayrıca, antik çağ bebek/çocuk hastalıkları ile günümüz modern tıp literatüründe yer alan problemler arasında anolojik bağlantılar tespit edilmiştir. Antik çağ toplumlarında bebek/çocuk ölümlerinin sebebi, ortaya çıkartılan osteolojik bulgular üzerinde saptanabildiği gibi, kemikler üzerinde iz bırakmayan rahatsızlıklardan kaynaklı da olabilmektedir. Bu konudaki eksik bilgiler yazılı kaynakların aktardığı bilgilerle tamamlanmıştır. Antik Yunan-Roma toplumunda bebek/çocuk sağlığı hususunda folklorik izlere dikkat çekilmiştir. Toplumların çocuğa karşı tutumları ve geleneksel farklılıklarında, bebek/çocuk sağlığı konusundaki değer yargılarının ne derece önemli olduğu fark edilmiştir. Antik çağ toplumlarının sağlığı üzerinde beslenme ve beslenme dışı hijyen alışkanlıklarının, yaralanma, parazitoz, kötü yaşam koşullarına bağlı enfeksiyonların etkili olduğu anlaşılmıştır. Tedavi yöntemi olarak mineral ve bitkisel kaynaklı sıvılar, nadir durumlarda ise cerrahi yöntem kullanılmıştır. Genellikle semptomları ortadan kaldırmaya yönelik prosedürler tercih edilmiştir.
READING NOËL COWARD’S CAVALCADE AS A PROBLEM PLAY
Authors: Şensoy Ayşe
Published: June 2024

Sir Noël Peirce Coward (1899-1973) was a prolific English playwright, actor, director, writer, composer, songwriter, and screenwriter who produced numerous works of plays, musicals, songs, short stories, poetry and a novel. However, Coward is most admired for his drama. He is acknowledged to be a playwright of comedy of manners, musical comedy, and light comedy. The 1930s showed the peak of his theatrical success. Coward stages the realities of the twentieth century life in Britain by means of intellectual, psychological and witty discussion of the sociopolitical issues in everyday life. Although he is known for his comedies, he became successful with one of his noncomic plays: Cavalcade (1931). Coward reveals his sense of the theatre and his stagecraft in the play to thrill, distress and puzzle the audience. The play presents the changes in nation’s spirit and society with the coming of the new age, which bring about domestic, social, political, economic and moral problems for English people. It discusses such problems as the conflict between patriotism and jingoism, Englishness, futility of war, human cost of war, breakdown of the social class system, tension between the lower and upper classes, social mobility, modernisation in life and society, generation gap, maintenance of peace, honour and dignity, and political partisanship. Although the play presents conflicting opinions or situations at the same time, it does not suggest any formula to resolve the contradiction. In this respect, this article aims to analyse Coward’s serious and realistic play as a problem play both in form and content by interpreting the historical events and topical sociopolitical issues of Coward’s time.
TATAR TÜRKÇESİ DİLBİLGİSİ KAYNAKLARINDA DERECE-USUL KATEGORİSİ
Authors: Çimen Gamze
Published: June 2024

Türk dilinde ve bunların içinde Tatar Türkçesinde fiillerin kılınış-görünüş özelliklerinin sınırları henüz tam olarak belirlenememiştir. Genel dilbilimde fiillerin kılınış-görünüş özellikleri Tatar Türkçesi dilbilgisi kaynaklarında, Rus dilindeki vid terimiyle adlandırılan kavramla karşılaştırılarak yapısal yönden oluşturulma biçimleri ve işlevleri bakımından sözlüksel-dilbilgisel kategoride incelenen derece-usul kategorisi adı altında ele alınan yapılar üzerinden açıklanmaya çalışılmıştır. Tatar Türkçesi dilbilgisi kaynaklarına göre derece-usul kategorisini oluşturmanın ekleme yöntemi, çözümleme yöntemi, tekrar yöntemi ve -(I)rg(A) biçimbirimli fiile totın-, kéréş- ve mataş fiillerinin birleşmesi yöntemi olmak üzere dört yöntemi vardır. Ekleme yöntemi fiile belirli biçimbirimler getirilmesi yoluyla kurulur. En yaygın kullanılan çözümleme yöntemiyle kendi anlamını tamamen ya da kısmen kaybedip yardımcı fiil rolünde gelip ana fiille -A /-y ya da -(I)p zarf fiil biçimbirimi aracılığıyla birleşen fiilin kullanılmasıyla oluşan birleşik fiiller oluşturur. Bu yöntemlerle oluşturulan yapılar bağlam bağlantılı olarak fiilin adlandırdığı hareketin başlama, yönelme, devamlılık, teklanma, anilik, kısmen gerçekleşme ya da tamamlanma ve sonucu gibi gerçekleşme özelliğiyle ilgili çeşitli ilave anlamlar bildirirler. Fiilin adlandırdığı harekette temel olarak bir değişikliğe yol açmayıp onun gerçekleşme derecesi ve usulüyle ilgili birtakım nüanslar bildiren böyle yapılar, kurulumlarında sözlüksel ve dilbigisel unsurlar bulunduğundan sözlüksel-dilbilgisel kategori esasında değerlendirilir.
Bu çalışma Tatar Türkçesi dilbilgisi kaynaklarında derece-usul kategorisi ve bu kategorinin Rusça vid ile karşılaştırılmasıyla ilgili verilerin toplanması, bu veriler esasında derece-usul kategorisini oluşturma yöntemlerinin analiz edilmesi ve çeşitli yöntemlerle oluşturulan yapıların ortaya konan çeşitli işlevlerinin bağlam bağlantılı olarak örnek cümlelerle açıklanması yöntemleriyle oluşturulmuştur. Bu sayede Tatar Türkçesindeki derece-usul kategorisinin anlaşılmasına katkı sağlamak hedeflenmiştir.
RUSÇADA ÖTÜMLÜLEŞME VE ÖTÜMSÜZLEŞME SÜREÇLERİ
Authors: Şahin Zulfiya
Published: June 2024

Her dil özgün bir ses yapısına sahiptir. Sesler sözcükte yan yana gelerek birbirini etkiler ve bu etkileşim sonucu sesbilimsel süreçler meydana gelir. Yapılan çalışma, Rusçanın ünsüzler dizgesinin belirgin özelliklerinden olan ötümlüleşme ve ötümsüzleşme süreçlerinin kapsamlı bir analizini sunmaktadır. Araştırma, literatür incelemesi, betimleme, sesbilimsel veri analizi ve karşılaştırmalı dilbilimsel yöntemleri kullanarak, Rusçadaki ötümlü ve ötümsüz ünsüzler arasındaki etkileşimi derinlemesine incelemektedir. Çalışmada ötümlü/ötümsüz ünsüz sınıflandırması, konumsal ötümsüzleşmenin, benzeşme sonucu ötümlüleşmenin ve ötümsüzleşmenin yanı sıra sesbilimsel süreçlerin düzensizliklerine de odaklanılmaktadır. Özellikle ötümsüzleşme süreci üzerindeki yan boğumlanmanın ve Eski Rusçada var olan gırtlak patlamalı [ʔ] ünsüzünün etkisi incelenmektedir. Bununla beraber çalışmada Rusça ve Türkçe arasındaki ötümlü/ötümsüz ünsüz özelliklerinin karşılaştırmalı analizi yapılarak iki dizge arasındaki benzerlikler ve farklılıklar tespit edilmektedir. Çalışma, her iki dilin sesbilimsel özelliklerinin dil öğrenim sürecine nasıl etki ettiğine dikkat çekerek Rusça öğrenenler için potansiyel seslendirme zorluklarının daha kolay aşılması için tavsiyeler içermektedir. Çalışmadaki bilgiler hem kuramsal hem uygulamalı kullanıma uygun olup hem Rusça Sesbilgisi derslerinde hem öğrencilerin sessel yetilerini geliştirmesine odaklanan uygulamalı derslerde kullanılabilmektedir. Sonuç olarak sunulan çalışma Rusçada ötümsüzleşme ve ötümlüleşme süreçlerini ayrıntılı bir biçimde ele alarak konuyu dizgeleştirmeyi hedefleyen mütevazı bir denemedir. Çalışmada ötümsüzleşme ve ötümlüleşme süreçleri, Rus sesbilimsel geleneği ve günümüze değin ilgili alanda geliştirilen kuramlar çerçevesinde ele alınmaktadır.
OSMANLI İSTANBUL’UNDA CENEVRELİ SAATÇİLER (1600-1763)
Authors: Gürer Ahmet Şamil
Published: June 2024

Bu makalede incelenen belge grubu on yedinci yüzyıl başlarından itibaren İstanbul-Pera’da yerleşmiş olan küçük bir İsviçreli Protestan topluluğunun mevcudiyetine işaret etmektedir. Muhtemelen aralarında çok sayıda Fransız Protestanlarının da bulunduğu bu topluluk 1725 yılı itibarıyla seksen beş kişiden oluşmaktaydı. Dönemin Hollanda ve İsveç elçilerinin himayesi altında bir Protestan kilisesi kurmuşlardır. Bu kişiler Pera’da açmış oldukları dükkanlarda saat montajı ve ticareti yapmaktaydılar. İsviçre ile yaptıkları yazışmalarda topluluğun örgütlenme biçimi, açmış oldukları okullar ve hukuki meseleleri ile ilgili önemli bilgiler bulunmaktadır.
POLİFONİK ÜSLUPTA BİR KÖY DESTANI: TAŞ TAŞ ÜSTÜNDE
Authors: Vardal Atak Nevra
Published: June 2024

Polonya edebiyatında köy akımının önemli örneklerinden birini oluşturan, Wiesław Myśliwski’nin Taş Taş Üstünde (Kamień na kamieniu) başlıklı romanı, Polonya köy yaşamına tutulan bir ayna gibidir. Yazarın günlük köy yaşamına detaylıca değinmesi, doğanın köy yaşamı üzerindeki etkisini ele alması, köy gelenekleri ve ritüellerini yansıtması ve köylünün inanç konusundaki eğilimlerini ortaya koyması bağlamında, yapıt bazı edebiyat eleştirmenleri tarafından bir köy destanı olarak adlandırılır. Bu açıdan da Polonya edebiyatında köy sorunsalını en iyi şekilde yansıtan Nobelli yazar Władysław Reymont’un Köylüler (Chłopi) adlı romanıyla benzerlik gösterir. Destansı özellikleri aynı zamanda onu Adam Mickiewicz’in Bay Tadeusz (Pan Tadeusz) başlıklı epik poematına da yaklaştırır. Bu iki yapıt da Polanya edebiyatı için oldukça önemli, mihenk taşı kabul edilen yapıtlardandır.
Romanın destan türüne yakıştırılmasındaki önemli nedenlerden biri de üslubudur. Başkahraman Szymon Pietruszka’nın dilinden bir monolog biçiminde anlatılan olaylarda, bilinç akışı ve iç monolog teknikleri kullanılarak üç kuşak geriye dek uzanılır. Bu yöntemler sayesinde de Polonya siyasi tarihindeki önemli dönüm noktalarına değinilir. Ayrıca okur Polonya köyünde zaman içerisinde yaşanan değişimlere de tanıklık yapmış olur.
Kronolojik bir sıra olmaksızın, geçmişle şimdinin iç içe geçerek ilerleyen romanın içeriği Szymon’un köy jargonuyla zenginleşmiş, mizah dolu, ironik ve coşkulu diliyle, gerçekçi ve hatta natüralist betimlemeleriyle şekillenir. Ayrıca yazar, günlük konuşma tarzını, retorik bir stille beslemiş, zaman zaman şiirsel betimlemelere yer vermiştir. Felsefi ve politik propaganda tonun da içinde bulunduğu bu polifonik üslup, romanın anlatımındaki zenginliği ortaya koymaktadır.
GÖÇER ÜRETİM TARZINDAN FEODAL ÜRETİM TARZINA GEÇİŞ SÜRECİNDE İKİLİ SINIF DURUMU VE SINIF MÜCADELELERİ KARAHANLILAR ÖRNEĞİ
Authors: Şahin Ozan Giray
Published: June 2024

Karahanlı dönemi göçebe Türk boylarının göçer üretim tarzından feodal üretim tarzına geçiş dönemindeki önemli duraklardan biridir. Göçer üretim tarzı düzeninden feodal üretim tarzı düzenine geçiş, geçiş sürecine özgü belirli yapısal formasyonları beraberinde getirmektedir. Feodal üretim tarzına özgü üretim ilişkileri ve pratiklerinin göçer üretim tarzı dairesinde örgütlenmiş topluluklar içerisinde yayılması süreci karşımıza ikili sınıf ve ikili üretim tarzı durumunu çıkarır. Karşımızda bir yanda göçer üretim tarzı içerisinde yaşamakta ısrarcı kara budun diğer yandan ise feodal üretim ilişkilerinin hâkim olduğu bir düzende egemen sınıf işlevlerini üstlenmeye başlamış olan ak budun fraksiyonlarının olduğu bir çelişki düzlemi vardır. Ak budun ve kara budun feodal üretim ilişkileri içerisinde yaşayan yerleşik toplulukların artı emeğinin paylaşılması ve göçer üretim tarzı düzenine iç sömürü ilişkilerinin eklemlenmesi düzleminde karşı karşıya gelirler. Söz konusu karşılaşma göçer üretim tarzına özgü kurum ve pratiklerin feodal üretim ilişkilerine uygun formlara tercüme edilmesi ile neticelendiği ölçüde üretim tarzlarının feodal üretim tarzı hakimiyetinde birbirlerine eklemlenmesi söz konusu olur. Eklemlenme ise sınıf mücadelelerinin sonucuna bağlıdır. Sınıf mücadeleleri sonucunda eklemlenme gerçekleşmiyorsa yapı siyasal varlığını feodal üretim ilişkilerine dayanarak sürdüremez hale gelir ve göçer üretim tarzı düzenine doğru geri çekilir ya da siyasal varlığı sona erer. Karahanlılar dönemi de eklemlenme ve çelişme dinamikleri ile ikili sınıf ve üretim tarzı durumunun izlerini bünyesinde taşımaktadır. Yerleşik feodal topluluklar üzerinde egemen sınıf işlevlerini üstlenmekte olan ak budun fraksiyonları feodalleşme sürecinde feodal üretim tarzına özgü pratikleri göçer üretim tarzı dairesinde yaşayan göçer kitlelerine kabul ettirmeye çalışırken kara budun ile karşı karşıya gelmişlerdir. Ak budunun egemen sınıf işlevlerini üstlenmeye başlayan fraksiyonları ile kara budun arasındaki bu çelişki, Karahanlı siyasal sistemi içerisinde göçer kökenli isyanlar ve yapısal istikrarsızlık eğilimlerinin temelinde yatmaktadır.
LOZAN KONFERANSI’NDA MISIR DELEGASYONU: MISIR’IN BAĞIMSIZLIĞININ TANINMASI VE SÜVEYŞ KANALI HAKKINDA ÖZEL NOTA
Authors: Uygur Fatma
Published: June 2024

Birinci Dünya Savaşı’nın etkileri henüz devam ederken Doğu Akdeniz ve Orta Doğu’da taşlar yerine oturmamıştı. Kağıt üzerinde Osmanlı Kuzey Afrika’nın bazı bölgelerinde nominal bir egemenliğe sahipti. Yavuz Sultan Selim tarafından fethedilen, bir Osmanlı vilayeti olarak 16. ile 19. yüzyıl arasında Osmanlı egemenliği altında kalan Mısır buna örnektir. Mısır, 1806 yılında Fransa tarafından büyük reformatör olarak kabul edilen Kavalalı Mehmet Ali Paşa döneminde özerklik kazanmış fakat daha sonra fiilen1882’de İngiliz işgaline uğramıştır. Böylece Mısır Osmanlının “savaşsız” kaybettiği hukuken egemenliği altındaki topraklarından biri olmuştur.
Birinci Dünya Savaşı sırasında ülke, 1922'de krallık olarak bağımsızlığını kazanmadan önce kısa süreliğine İngiliz himayesi altına girmişti. İşte bu süreçte Mısır’ın bağımsızlığının tanınması ayrıca jeopolitik ve jeostratejik bir suyolu projesi olarak görülen, Akdeniz ile Kızıldeniz’i birbirine bağlayan Süveyş Kanalı ile ilgili çeşitli argümanların bulunduğu bir dosyayı 19 Aralık 1922 tarihinde Lozan Konferans Başkanlığına sunan Mısır Delegasyonu düveli muazzama karşısında diplomatik bir mücadele vermiştir.
BONDAGE OF ‘INDEPENDENT’ NATIONS: NEO-IMPERIALISM IN NGUGI WA THIONG’O’S PETALS OF BLOOD AND INDRA SINHA’S ANIMAL’S PEOPLE
Authors: Degirmencioglu Nesrin
Published: June 2024

Both Ngugi wa Thiong’o’s Petals of Blood and Indra Sinha’s Animal’s People are mirrors reflecting the trajectories of neo-imperialism from the point of view of the victims suffering from the system. After independence, the colonialists are replaced by a national bourgeoisie who, without capital and economic power, become dependent on foreign investment. In both novels, the unprivileged poor are the victims of the neo-imperialist system which attracts multinational corporations to take advantage of low-cost land and cheap labour. Ngugi explores the subjectivity of African history as reflected by Westerners by the dual narration of his novel, from a subjective and a relatively objective but complementary narrative voice. Neither the previous colonial domination nor the national bourgeoisie which replaces them represents the victims of the system. The narration of the novel from the perspective of Munira, who refuses the familial capitalist wealth by escaping to live in Ilmorog, successfully reflects the contradictory concerns of the capitalists and the victims. In Animal’s People, Sinha gives voice to the subaltern victims of the system by the first-person narrative of Animal, who is one of the worst victims of the system. Sinha emphasizes the reality of his story by indicating each chapter as a tape recording and using a sharp, slangy, and witty language for Animal. Both novels give voice to the subaltern victims of the society, and they are milestones in the freeing of the unprivileged classes from the bondage of the dominating national and foreign powers.
OSMANLI REJİ İDARESİ ÇATISI ALTINDA HAK ARAYIŞ MÜCADELESİ: KASAPYAN NAZMİ EFENDİ’NİN ZİMMET MESELESİ (1904-1910)
Authors: Tanık İbrahim Halil , Dağ Mustafa
Published: June 2024

Reji Şirketi, Osmanlı İmparatorluğu genelinde tütünün üretim, tüketim, ticaret ve imalatını denetim altına almak amacıyla çokuluslu yabancı sermaye eli ile kurulmuş bir müessesesidir. Tütünün her türlü faaliyetini denetlemek amacıyla Düyûn-ı Umûmiyye İdaresi bünyesinde 1883 yılında kurulan şirket, 1884 yılında imparatorluk genelinde teşkilatlanmıştır. Teşkilatlandırıldığı vilayetlerden biri de Ankara’dır. 1925 yılına kadar vilayette faaliyette olan idare; politikalarından dolayı üretici, tüketici ve tüccar ile birtakım sorunlar yaşamıştır. İdarenin bu kesimlerle yaşamış olduğu sorunların yanı sıra kendi bünyesinde istihdam etmiş olduğu görevlilerle ilgili usulsüzlükler meydana gelmiştir. Ankara Reji İdaresi’nde bu problemlerin temel kaynağı idare kasasından memurların zimmetlerine para geçirmeleridir. Bu bağlamda, Ankara Reji İdaresi’nde ambar memuru Kasapyan Nazmi Efendi’nin yolsuzluk davası çalışmanın ana temasını oluşturmuştur. Bu konu kapsamında elde edilen bilgiler incelenerek dava sürecinin ne şekilde cereyan ettiği ve neticelendiğini tespit etmek çalışmanın temel amacını oluşturmuştur. Nazmi Efendi ile idare arasında 1904 ile 1910 seneleri arasında cereyan eden zimmet davası arşiv belgeleri ve telif eserler ışığında incelenmiştir. Bilhassa şirketin teşkilat yapısı, iddiaların Ankara Vilayeti Meclis-i İdaresi Bidayet Mahkemesi’nde tahkik edilmesi ve kararın Şûrâ-yı Devlet Muhakemat Dairesi İstînâf Mahkemesi’nde temyiz edilmesi süreci ayrı başlıklar halinde ele alınmıştır. Kasapyan Nazmi Efendi’nin hukuki sürecinde farklı makamların işletildiği, gayrimüslim bir vatandaşın üst mahkemeye müracaat edebildiği, özerk yapısı olmasına rağmen devlet adli makamlarının nihai karar mevkii olduğu gibi sonuçlar, çalışmanın bulguları arasındadır.
Asciminib stands out as the superior tyrosine kinase inhibitor to combine with anti-CD20 monoclonal antibodies for the treatment of CD20+ Philadelphia-positive B-cell precursor acute lymphoblastic leukemia in preclinical models
Authors: Domka Krzysztof , Dąbkowska Agnieszka , Janowska Martyna , Urbańska Zuzanna , Pastorczak Agata , Winiarska Magdalena , Fidyt Klaudyna , Lachota Mieszko , Patkowska Elżbieta , Sędek Łukasz , Perkowski Bartosz , Hunia Jaromir , Jakubowska Justyna , Krzymieniewska Beata , Lech-Marańda Ewa , Młynarski Wojciech , Szczepański Tomasz , Firczuk Małgorzata
Published: June 2024

Philadelphia chromosome-positive B-cell precursor acute lymphoblastic leukemia (Ph+ BCPALL) is a high-risk acute lymphoblastic leukemia subtype characterized by the presence of BCR::ABL1 fusion gene. Tyrosine kinase inhibitors (TKIs) combined with chemotherapy are established as the first-line treatment. Additionally, rituximab (RTX), an anti-CD20 monoclonal antibody (mAb) is administered in adult BCP-ALL patients with ≥20% of CD20+ blasts. In this study, we observed a marked prevalence of CD20 expression in patients diagnosed with Ph+ BCP-ALL, indicating a potential widespread clinical application of RTX in combination with TKIs. Consequently, we examined the influence of TKIs on the antitumor effectiveness of anti-CD20 mAbs by evaluating CD20 surface levels and conducting in vitro functional assays. All tested TKIs were found to uniformly downregulate CD20 on leukemic cells, diminishing the efficacy of RTX-mediated complement-dependent cytotoxicity. Interestingly, these TKIs displayed varied effects on NK cell-mediated antibody-dependent cytotoxicity and macrophage phagocytic function. While asciminib demonstrated no inhibition of effector cell functions, dasatinib notably suppressed the anti-CD20-mAb-mediated NK cell cytotoxicity and macrophage phagocytosis of BCP-ALL cells. Dasatinib and ponatinib also decreased NK cell degranulation in vitro. Importantly, oral administration of dasatinib, but not asciminib, compromised NK cell activity within patients' blood, determined by ex vivo degranulation assay. Our results indicate that asciminib might be preferred over other TKIs for combination therapy with anti-CD20 mAbs.
Frequency of Positive Antinuclear Antibody in People with Active Tuberculosis and its Changes with Antitubercular Therapy.
Authors: Naher Naznin
Published: June 2024

Background: Antinuclear antibodies (ANAs) are frequently detected in individuals with a variety of conditions, but they are also commonly used in the diagnosis of autoimmune diseases. According to reports, Mycobacterium TB infection is thought to cause the development of autoantibodies, and they often regress following antitubercular therapy. In order to prevent autoimmune diseases from being misdiagnosed, we want to investigate the prevalence of ANA in people with active tuberculosis in our community. Methods: The longitudinal study was carried out at BSMMU in Dhaka, Bangladesh, in the Department of Internal Medicine. A total of 150 male and female adult patients with active tuberculosis (age e”18) were recruited from the DMCH, KMSS, and BSMMU DOT corners, as well as the inpatient and outpatient departments. Initially, 150 patients with active tuberculosis had their serum samples taken in order to ascertain the frequency of ANA test results from patients who had not started antitubercular therapy or who had been on anti-TB therapy for fewer than seven days. The patient who had initially tested positive for antinuclear antibody (ANA) was thereafter monitored to see any changes in ANA test results at the end of the third and sixth months of anti-TB therapy. Results: Antinuclear antibody was found in 8.7% (13/150) of patients with active tuberculosis; pulmonary TB patients had a higher frequency of ANA positive test results (11.3% (6/53) than extrapulmonary TB patients (7.2%/7/97). The coarse speckled pattern 61.5% (8/13) was the most frequently seen ANA pattern in patients with active tuberculosis. After six months of antitubercular medication, 92.3% (12/13) of the majority of ANA positive patients became negative. There was no significant association found between ANA positivity and clinic demographic characteristics. Conclusion: A certain percentage of patients (8.7%) with tuberculosis may have a positive antinuclear antibody. Mycobacterial studies should be performed in patients with positive antinuclear antibodies (ANA) but without the typical or multiple manifestations of autoimmune diseases.
Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 158-160
Biomarkers in sepsis: the present and the future
Authors: Chowdhury Fazle Rabbi
Published: June 2024

Sepsis is a complex and potentially life-threatening condition characterized by a dysregulated host response to infection and leading to organ dysfunction. Adult sepsis is neglected, and we are still looking for an effective biomarker which can predict and diagnose sepsis. In low-middle-income countries, where access to diagnostics is difficult and cost is a considerable issue, clinicians often treat a case on an empirical basis. Clinicians often rely on different scores such as SOFA, qSOFA, SIRS, NEWS, and MEWS which are not comprehensive and have many limitations. Identifying biomarkers that can aid in the diagnosis, prognosis, and management of sepsis is an area of active research. WBC count and C-reactive protein are probably the most used markers to predict sepsis. Although not a new biomarker, procalcitonin, serum albumin and lactate have gained significant attention for their role in guiding antibiotic therapy in sepsis. Its levels correlate with the severity of infection and response to treatment. Inflammatory cytokines such as interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), and tumour necrosis factor-alpha (TNF-alpha) play crucial roles in the immune response during sepsis. Monitoring their levels may provide insights into the inflammatory state and prognosis of septic patients. Heparin-binding protein 1 (hbp-1), serum calprotectin, Micro-RNAs (miRNAs), presepsin, endothelial markers, sepsis index (SI) and others are on the pipeline with promises. It's important to note that while these biomarkers hold promise, further validation and standardization are needed before their widespread clinical use in the management of sepsis. The cost of those markers, access for impoverished populations, requirement of logistics will be the other challenging factors.
Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 140-141
Growth Retardation in Children: How to Face?
Authors: Islam Mohammad Imnul
Published: June 2024

Growth is an irreversible constant increase in the size of organs and the body from fetal to adulthood. It is positively influenced by parental health, genetic, nutrition, hormonal, and environmental factors.1-3 Growth can be assessed by proper history taking, accurate measurement of growth parameters, determination of growth percentile and trajectory for age and sex.4 According to WHO, weight, height, and head circumference are used for growth assessment of children < 2 years, whereas weight, height, and BMI are used for children>2 years. 4,5 Growth of children will be retarded if their height is more than 2 standard deviations below the mean (3rd percentile) or marked decrease in growth velocity.7 Growth retardation is a burning issue of global health and stunting acts as the most prevalent indicator of child growth failure.In South Asia, the higher prevalence of growth failure was evidenced by 28.6% of global stunting in India and 6.8% in Pakistan.8 In 2017, the prevalence of stunting in Bangladeshi children was 31%, which become 24% in 2022.9 Like other lower middle-income countries, Bangladesh faces a great challenge to achieve growth due to poor socioeconomic conditions, malnutrition, inadequate health care access, poor maternal education, and poor ability of care giving.10 Delayed evaluation and detection of underlying causes make an obstacle in achieving targeted growth in adulthood, increase morbidity, and have far-reaching effects on psychological well-being. Lack of caregivers' knowledge, the disparity between necessity and financial support, less prioritization, and the communication gap between the health service providers and users still become principal issues in the early assessment and detection of growth failure in children of Bangladesh.11 Timely action is now required to combat this challenge and ensure the proper growth of future generations of this nation.
Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 145
Immunoglobulin G4-related disease -related Disease: What a Clinician Needs to Know
Authors: Azad Azizul Haque
Published: June 2024

Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory condition that can affect multiple organs, including salivary glands, pancreas, biliary tree, lymph nodes, orbital and periorbital tissues, retroperitoneal tissues, blood vessels, thyroid, lung, kidney, and some other structures. In the late 19th century, the first accounts of organ manifestations associated with IgG4-related disease were published. Johann von Mikulicz first described a patient with an inflammatory disease of the salivary glands (Mikulicz’ syndrome). IgG4-RD should be suspected in individuals with any of the following: pancreatitis of unknown origin, sclerosing cholangitis, bilateral salivary and/or lacrimal gland enlargement, retroperitoneal fibrosis, orbital pseudotumor/proptosis, and development of an otherwise unexplained mass lesion in any of the following organs: pancreas, biliary tree, orbits, lungs, kidneys, major salivary gland, or lacrimal gland. The combination of biliary tract and pancreatic disease, or isolated involvement of the bilateral submandibular glands, is highly suggestive of IgG4-RD. Serum IgG4 levels should be measured in all patients with suspected IgG4-RD. In roughly two-thirds of patients with IgG4-RD, serum IgG4 levels are above the upper limit of normal. A CT scan or ultrasound may be used to image the involved organs. A biopsy of the affected organ is needed to confirm IgG4-RD. The biopsy may reveal lymphoplasmacytic tissue infiltration and storiform fibrosis. Glucocorticoid therapy is recommended for all patients with symptomatic disease or asymptomatic disease affecting a vital organ (e.g., aorta, retroperitoneal fibrosis causing hydronephrosis). In refractory cases, either rituximab, azathioprine, methotrexate, or mycophenolatemofetil can used. Most patients respond well to glucocorticoid at first, although relapses are common after stopping therapy. Uncontrolled, progressive inflammatory and fibrotic changes in affeced tissues can cause significant organ dysfunction. Early diagnosis and treatment improve the prognosis of IgG4-RD.
Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 133
Challenges in Diagnosing Gallbladder Tuberculosis Mimicking Acute Calculus Cholecystitis: A Case Report of an Uncommon Presentation
Authors: Munira Sirajam , Hasan Mehedi , Jolil Rukshana , Sarwar Jahangir Md
Published: June 2024

Gall bladder tuberculosis (TB) represents a highly uncommon form of extrapulmonary TB, even within endemic regions, presenting a considerable diagnostic challenge. Limited pre-operative diagnostic tools lead to cholecystectomy and tissue analysis to initiate definitive treatment, thereby prolonging patient suffering and delaying diagnosis. A 50-year-old menopausal lady presented with history of prolonged fever, significant weight loss, and subsequent upper abdominal pain. Serological and blood biochemistry tests revealed normal findings, except for moderate anemia. Abdominal ultrasound detected cystitis, while MRCP revealed a distal common bile duct stricture concomitant with gallstones. However, ERCP failed to confirm the biliary stricture, instead revealing papillary stenosis. The initial diagnosis was cholelithiasis, leading to laparoscopic cholecystectomy. The histopathological examination of the specimen indicated the presence of granulomas consisting of epithelioid cells and multinucleated giant cells. Additionally, areas of necrosis and chronic inflammatory cell infiltration were observed within the gallbladder wall. Histopathology of Lymph node biopsy showed granulomas, multinucleated giant cells, and areas of necrosis. Category-1 Anti-Tubercular Therapy was initiated postoperatively, resulting in favorable clinical and operative outcomes. Although gall bladder TB is a rare entity, clinicians should raise a high index of suspicion for TB in patients presenting with prolonged fever, weight loss, and features suggestive of calculus cholecystitis in endemic areas, aiming to mitigate unnecessary investigations and treatments, particularly in resource-limited settings such as Bangladesh.
Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 168-169.
Low Bone Mineral Density in Chronic Pancreatitis
Authors: Paul Sanjoy Kumar , Aftab Hafeza
Published: June 2024

Background: Chronic pancreatitis (CP) is associated with irreversible pancreatic dysfunction which lowers the bone mineral density. Bone disease is an under-recognized cause of morbidity in chronic pancreatitis. The aim of the study was to evaluate the changes found in bone mineral density and serum vitamin D level in patients with chronic pancreatitis. Methods: This cross-sectional study was carried out in the department of Gastroenterology, Dhaka Medical College Hospital from April 2022 to June 2023. Thirty-five eligible patients diagnosed with chronic pancreatitis in different stages were enrolled. Bone Mineral Density (BMD) was estimated by Dual Energy X-ray Absorptiometry (DXA) and serum vitamin D level was measured by radioimmunoassay (RIA). Results: The study participants (22 males; 13 females) had mean age of 37.69 ± 12.79 years, duration of illness was 6.90 ± 3.82 years, and mean Body Mass Index (BMI) of 20.58 ± 3.47 kg/m2. Half of the patients (48.6%) were smoker. Most of the patients 25(71.4%) had tropical chronic pancreatitis. Seventeen (48.6%) patients had normal BMD, 14(40%) patients had osteopenia and 04 (11.4%) patients had osteoporosis according to WHO criteria. Serum vitamin D deficiency was found in 80% of patients with mean value of 15.92 ± 7.21 ng/ml. Significant differences were observed in body mass index, smoking status and disease duration between normal and low BMD group. Multiple linear regression showed only smoking was independently negative predictive of low bone mineral density. Conclusion: Low BMD reflecting osteopenia is more common in chronic pancreatitis patients in course of disease progression. It demands physician’s attention to bone health in chronic pancreatitis patients.
Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 171
A 60 year old female with redness of eye turns to periorbital swelling with nasal bleeding
Authors: Akter Sharmin
Published: June 2024

Mrs. X, 60 year old hypertensive , diabetic, known case of CKD, non-asthmatic patient came to PMCH with the complaints of redness left eye with left sided orbital swelling. She was reasonably well 15 days back, then suddenly she developed headache followed by redness, swelling with pain on left eye . She went for an eye consultation and took antibiotic eye drop and Oral antibiotic . But after taking medication she didn’t improved at all, eventually swelling and redness extended into right eye as well .She got admitted on NIKDU with orbital complaints. But she had an episode of tinge bleeding per nose and no improvement on orbital complaints . At late night she got admission on PMCH and had an another episode of severe epistaxis which was sudden onset and the amount was about 2-3 tea spoon full . On next day amount was profuse, about ½ cup full. At the same time, she developed bluish to whitish discoloration of skin over nasal area.On examination, she was ill looking, mildly anaemic, tinge bleeding per nose. Her vitais normal. Examination of nervous system reveled partial ptosis of left eye with 3,4,6 nerve palsy with mild ophthalmoplegia, movement of eyes were mildly restricted and No sign of papilledema present. Normal higher psychic function and intact other cranial nerves. Motor function and sensory function was normal and all reflexes were intact .Examination of other system was unremarkable.Histopathology report : Nasal tissue Aspergillosis ª% Sino-nasal tissue Mucormycosis.
Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 171-172
Disseminated Melioidosis with multiorgan failure in a Diabetic and Chronic Kidney Disease patient with a sad outcome
Authors: Saha Lima , Azad Md Abul Kalam , Aftab Kazi Ali , Monira Shirajum , Murshed Khaled Mahbub , Ikhtaire Shapur
Published: June 2024

Melioidosis is caused by Burkholderiapseudomallei. It has recently gained importance as emerging pathogen in Bangladesh. It causes various clinical manifestations like pneumonia, septicemia, arthritis, subcutaneous and deep seated abscess associated with high morbidity and mortality. Few cases have been reported mainly from southeast asia. Such wide range of presentation & mimicry with other infection leads to misdiagnosis or underdiagnosis. This case report outlines a 58-year-old male’s progression from melioidosis to septicemia with multiple organ failure leading to death. Initial presentation was fever, bilateral leg swelling including right knee joint with subcutaneous abscess over both leg and foot. This case emphasizes the need of timely identification & tailored intervention to prevent devastating complication & mortality.
Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 177
Three cases of hypopituitarism with variable presentation
Authors: Hossain Moumita , Ahasanul Haque , Afrozrafiya  , Bin Bashar Fuad , Abdur Rahim , Rafiqul Islam Mohammad
Published: June 2024

Patients with hypopituitarism often experience a delay in diagnosis. Symptoms which maybe life threatening are nonspecific and often attributed to aging and/or related morbidities. We have diagnosed three patients with hypopituitarism. We treated them accordingly and they dramatically improved. Our first case 60 years old female came to us with sudden onset of vomiting for several times and generalized weakness. She is known case of diabetes mellitus, hypertension and IHD with HF (EF 40%). In routine investigation we found unusual hyponatremia and hyperkalemia. We did pituitary function test as well as other necessary investigation. We found hypopituitarism and pituitary microadenoma in MRI of brain with pituitary protocol.Our second case 43years old female presented to us with vomiting for four months for several times with features of anemia. We did routine investigation and found hypomagnesemia, hypocalcemia, hypokalemia and hypernatremia. In search of previous document, we found hyponatremia, hypokalemia and hypochloremia. For these she admitted into tertiary care hospital and treated as acute gastroenteritis. We did pituitary function along with other possibilities. We found hypopituitarism with multiple endocrine neoplasia. Imaging showed pituitary microadenoma involving left half of anterior pituitary.Our third case 68 years elderly female known to have hypertension and diabetes mellitus came to us with features of meningo-encephalitis. We searched for features of meningo-encephalitis in MRI of brain. We found empty Sella. Pituitary function tests revealed hypopituitarism. Lactational failure and pre mature amenorrhea was absent in all three cases. So, suspicion about hypopituitarism should be kept in mind though clear-cut features are absent to save lives of our patients.
Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation:178