bluuebunny/crossref_metadata_2025 huggingface dataset:
A clinical study of diphtheria cases in a pediatric population in tertiary care hospital in western Maharashtra
Authors: Bandichhode Sachin T , Jatti Gajanan M , Anita M S , Nandimath Viresh A
Published: June 2020

Background: Although DPT immunization has been a part of universal immunization program since its inception, still diphtheria continues to be endemic in India and also leading to morbidity in children, especially in areas in the border of the two states. Cases coming to tertiary care level are only tip of iceberg. Objectives: To study the clinical profile, morbidity, and mortality of the diphtheria cases admitted to the Pediatrics Department of a tertiary care hospital and to study their immunization status. Materials and Methods: A hospital-based cross-sectional study was conducted from 1 January, 2012, to 31 June, 2013, on clinically suspected diphtheria cases. Detailed history and clinical examination were done, and their immunization status was recorded. Results: Total 36 clinically suspected children of diphtheria were studied. Sex ratio was 1:1. 12 cases were from 1 to 5 years age group, whereas 15 cases were between 6 and 10 years and remaining 9 cases aged more than 10 years. Among 36 cases, 4 (11.11%) were fully, 11 (30.55%) were partially immunized, and 21 (58.33%) were not immunized. The most common symptom observed was fever in 34 (94.44%) cases followed by throat pain in 25 (69.44%) cases and difficulty in swallowing in 23 (63.88%) cases. Case fatality rate was 13.88%. Maximum numbers of cases were observed during the rainy season. Conclusion: High prevalence of diphtheria in the age group of 5-15 years suggests the need for completing immunization schedule specially booster doses. Immunization activity needs to be strengthened in borderline districts as most of the cases in the present study were from the areas in the border between states.
Acute kidney injury in asphyxiated neonates and its correlation to hypoxic ischemic encephalopathy staging
Authors: Agrawal Sumit , Chaudhuri Partha Kumar , Chaudhary Anil Kumar , Kumar Deepak
Published: June 2020

Background: Acute kidney injury (AKI) is a common consequence of perinatal asphyxia, occurring in up to 56% of these neonates. It is important to recognize AKI in asphyxiated neonates to facilitate administration of appropriate fluids and electrolytes to improve their outcome. Objectives: To determine the incidence of AKI in asphyxiated neonates and its correlation with severity of hypoxic-ischemic encephalopathy (HIE). Methods: 135 term neonates were enrolled - 90 asphyxiated and 45 healthy neonates. AKI was diagnosed when serum creatinine was >1.5 mg/dl regardless of the rate of urine output (UOP). Neonates with AKI were managed as per standard protocol. Results: Of the 90 asphyxiated neonates, 68 (75.6%) had AKI including 58 (85.3%) neonates with pre-renal AKI and 10 (14.7%) with intrinsic AKI. Out of the 68 AKI, 22 (32.36%) had oliguric AKI and 46 (67.64%) had non-oliguric AKI. Levels of blood urea and serum creatinine were significantly higher in asphyxiated neonates as compared to healthy controls (p<0.001). There was no significant difference in UOP in control and study groups. Sonographic abnormalities were seen mostly in oliguric babies and indicated bad prognosis. Mortality was higher in babies with oliguric AKI. Conclusions: Perinatal asphyxia is an important cause of neonatal AKI. The majority had non-oliguric AKI and responded well to fluid challenge. Abnormalities in the renal function correlate well with the severity of HIE. Intrinsic AKI, oliguria, hyponatremia, reduced creatinine clearance, and abnormal sonographic scan suggest bad prognosis in neonatal AKI secondary to perinatal asphyxia.
Thalassemia carrier screening in siblings of thalassemia major patients by HbA2 estimation
Authors: Sharma Gopikishan , Sharma Dipendra , Gulati R K
Published: June 2020

Objective: Thalassemia carrier screening in siblings of thalassemia major patients by HbA2 estimation. Methods: This prospective, cross-sectional study was conducted at thalassemia welfare society of JK Lon Hospital, Kota. Siblings of thalassemia major patients registered at our hospital were investigated for chemically bonded ceramics and HbA2 estimation by high performance liquid chromatography (HPLC) method. Results: A total of 121 cases were screened for carrier by HPLC method for HbA2 estimation. Total 59 (48.76%) cases had HbA2 level ?3.5%, and considered as carrier while 62 (51.24%) cases were non-carrier. Mean HbA2 value in carrier was 5.24% ± 1.14% and in non-carrier was 2.69% ± 0.51%. Conclusion: It was concluded that ? thalassemia carriers are more prevalent in siblings of thalassemia major than the normal population.
Blood glucose as a predictor of diarrheal dehydration in children
Authors: Chandra Surabhi , Singh D K , Ansari Mohd Ayub , Pareek Prince
Published: June 2020

Background: Diarrhea remains the second leading cause of death globally among under 5 children. Historical clinical characteristics may not correlate to dehydration severity. Objectives: This study was done to evaluate the glycemic status of children having acute diarrhea with dehydration, at presentation, and to analyze the blood glucose as a predictor of the severity of diarrheal dehydration. Materials and Methods: Blood glucose levels were assessed in 150 children with acute diarrhea with dehydration, on admission. Results: Blood glucose levels showed statistically significant association with the degree of dehydration (p<0.05). Receiver operating characteristic curve analysis showed that blood glucose was a poor predictor of the severity of dehydration (area under curve [AUC] 0.240, 95% confidence interval [CI] = 0.050-0.429, standard error [SE] = 0.097) for some dehydration; and (AUC = 0.760, 95% CI = 0.571-0.950, SE = 0.097) for severe dehydration. Conclusion: Blood glucose is a poor predictor of the severity of diarrheal dehydration.
Scrub typhus in India: Whether increased reporting or expanding geographies?
Authors: Kumar Chandra Mohan , Sharma Preeti , Patwari A K
Published: June 2020

Scrub typhus is a potentially fatal disease with serious complications in untreated cases or where there is delay in starting treatment. It has been considered to be limited to certain geographic areas with vegetations and cattle grazing fields like Jammu. Scrub typhus cases/outbreaks have been reported in the recent past from South India, Mumbai, Goa, Himachal Pradesh, and Haryana. Recently, we had a case of scrub typhus in a child residing in Delhi with no history of travel outside. A 10-year-old girl admitted with high-grade fever, abdominal pain, myalgia, and erythematous rash with hepatomegaly but without lymphadenopathy and developed splenomegaly in the 2nd week of illness. She was confirmed to be a case of scrub typhus after immunoglobulin M enzyme-linked immunosorbent assay for the disease. Scrub typhus is a matter of great public health importance that all medical practitioners should be sensitized about this disease and its varying presentations and complications.
Congenital dislocation of knee: A correctable deformity
Authors: Rahiman M Hisham Abdu , Nair P M C , James Jemila
Published: June 2020

We report the case of a late preterm small for gestational age baby girl presenting with deformities of both knees at birth. Diagnosis by radiologic investigation revealed bilateral knee joint dislocation and ultrasonography revealed developmental dysplasia of the hip. Concomitant treatment of the congenital dislocation of the knee with serial casting and the hip with Pavlik harness provided satisfactory results. Cases with delayed presentation or which do not respond to conservative treatment need surgery. Delay in treatment may lead to long-term instability and stiffness. Emphasis should be laid on the immediate recognition and treatment of the condition.
Budd-Chairi syndrome with intussusception a unique and rare presentation of celiac disease
Authors: Temani Kuldeep , Bairwa A L
Published: June 2020

The association of Budd-Chiari syndrome (BCS) and celiac disease is rare, reported in only 15 cases. None of the case of Budd-Chiari with transient intussusception in celiac disease (in same patient) reported in literature till now. We, hereby, report a 5-year-old male, known case of celiac disease, who presented with pain and distention of abdomen, and failure to thrive for last 2 years. The child had hepatomegaly with fluid thrill. Ultrasonography abdomen showed caudate lobe hypertrophy, transient intussusception with dilated vascular channel and on contrast enhanced computed tomography scan; features suggestive of BCS were found.
Glucose levels in first 3 days and neurodevelopmental outcome at 1 year in low birth weight infants: A cohort study
Authors: Chandrasekaran Ashok , Rao P N Suman , Raman Vijaya , Nesargi Saudamini , Shekharappa Chandrakala Bada , Sahoo Jagdish Prasad , Ranjit Thomas , Chico Marie Shalini , Bhat Swarnarekha
Published: June 2020

Background: Definition of neonatal hypoglycemia is still controversial. Objective: To find the effect of blood glucose (BG) levels in the first 3 days of life, on developmental outcome at 1 year in low birth weight neonates <2000 g. Methods: A prospective cohort study was conducted in tertiary level neonatal intensive care unit and follow-up clinic in south India. Intramural neonates admitted from September 2009 to August 2010 were enrolled. Perinatal and neonatal variables were recorded. Respiratory support, fluids, and feeding management were based on the standard protocols. BG was measured within 2 h, then 6 hourly for 72 h by glucometerand BG <50 mg% was analyzed by hexokinase method. Infants were followed until 1 year corrected age and development age (DA) assessed by Developmental Assessment Scales for Indian Infants (DASII). Motor and mental DA at various BG levels were compared. Composite outcome of motor or mental developmental delay; or cerebral palsy or hearing impairment or visual impairment was analyzed, and logistic regression analysis was performed. Results: The mean birth weight and gestation of the study group (n=129) was 1493 g and 32.5 weeks. The 10th centile of BG in the first 72 h was 51 mg%. BG below 10th centile was seen in 60 infants. The mean motor and mental DA of the infants by DASII assessment at 1 year was 11.3 and 11.5 months, respectively. The motor DA and mental DA were significantly higher until 50 mg% lowest BG level, and positive correlation was seen (r=0.26 motor, 0.2 mental DA). Mean BG level, the presence of symptoms; number of episodes or small for gestation did not influence the DA. The adjusted odds for poor composite outcome when BG was below 51 mg% is 2.83 (0.65-12.3). Conclusion: Even though high-risk neonates with BG <51 mg% have a lower motor DA and mental DA at 1 year, than neonates with BG >50 mg%; other morbidities do determine their composite outcome.
Survey and mapping of the leading causes of childhood mortality in Nigerian tertiary hospitals
Authors: Smith Stella I , Nwaokorie Francisca O , Adagbada Ajoke O , Yisau Jacob I , David Nkiru A , Adeboye Muhammed A N , Adesida Solayide A , Bamidele Moses , Adeneye Adeniyi , Fowora Muinah A , Musa Zaidat A , Adedeji M A , Omonigbehin Emmanuel A , Iroha Edna , Adedoyin Olanrewaju T , Eneh Augusta , Ibeziako Ngozi , Jiya Nma , Oguche Stephen , Bello Mustapha , Olowu Adebiyi O , Ujah Innocent A O
Published: June 2020

Background: Despite the modest gains made under the millennium development goals, indices of child health for Nigeria remain poor. Improvement on these indices requires mitigating the causes of childhood mortality. Objective: We undertook this study to determine the leading cause(s) of childhood mortality in Nigeria from 2005 to 2009. Methods: Using stratified random sampling techniques, data on demographics and cause(s) of death of under-five children, who had died between 2005 and 2009, were collected from the patients’ records of seven teaching hospitals. Data were analyzed using IBM SPSS version 20.0. Results: The leading causes of childhood mortality from this survey were neonatal sepsis (30.1%), asphyxia (27.2%), preterm complications (25.8%), and acute respiratory illness (15.3%). Analysis of causes of death by geopolitical zones did not indicate any definite pattern, although the North-Central and South-West had the highest deaths due to respiratory tract infections. The highest death records from human immunodeficiency virus/acquired immune deficiency syndrome came from North-East. In addition, Lagos in South-West was the most likely to have recorded death due to malaria (p<0.05). Preterm complications and neonatal sepsis accounted for the majority of the causes of death in low birth weight babies, whereas neonatal sepsis and asphyxia accounted for the majority of the causes of death in the appropriate birth weight group. Conclusions: This study supports the results of previous ones that childhood mortality was due to illnesses that were preventable and treatable. Knowledge of the causes and pattern of childhood mortality is essential to enable the health authorities to scale up appropriate interventions to reduce the burden. This will help the country to meet the target of reducing under-five mortality by two-thirds, few years after 2015.
Microbiological profile of early-onset neonatal sepsis in a tertiary care hospital in South India
Authors: Gupta Ankur , Philip Prijo , Madhava Kamath K
Published: June 2020

Aims: To identify the microbiological profile of neonatal sepsis and antibiotic sensitivity patterns of various isolates in the Newborn Intensive Care Unit at a Tertiary Care Hospital in Karnataka. Materials and Methods: In this retrospective study, the laboratory data of primary blood culture reports of 240 neonates admitted with clinical suspicion of early-onset sepsis, from April 2014 to March 2016, were analyzed. Results: Total 240 samples were received during the study period, of which 40, (16%) were found to be positive. Out of these, 18 (7.5%), 18 (7.5%), and 4 (1%) had Gram-positive, Gram-negative, and Candida infection, respectively. The most common organism noted among Gram-positive isolates was Staphylococcus aureus (22.5%), followed bycoagulase-negative staphylococci (12.5%) and Enterococcus (10%). Among Gram-negative isolates, Acinetobacter was the most commonly implicated organism (20%), followed by Klebsiella pneumoniae (12.5%), Escherichia coli (7.5%), and Pseudomonas aeruginosa (5%). Conclusion: This study emphasizes the need for close observation to be carried  out at regular intervals to describe the various pathogens causing early-onset neonatal sepsis and their ever changing antibiotic sensitivity pattern which will provide useful data to guide practice and policies on rational use of antibiotics.
Clinico-etiological pattern of lower gastrointestinal bleeding in children (5-18 years age group) at a tertiary care center in central India
Authors: Bhadauria Neha , Dubey Shiv Ram Krishna , Mittal Purvi , Arya A K , Singh R P
Published: June 2020

Background: Lower gastrointestinal bleeding (LGIB), defined as bleeding occurring distal to the ligament of Treitz, is a common presenting symptom in pediatric patients. Objective: To understand the clinico-etiological pattern of LGIB in children in the age group 5-18 years. Materials and Methods: This prospective study was carried out at a tertiary health-care center in central India between January 2011 and August 2012. We consecutively enrolled all patients in the age group 5-18 years who came to our center with gross LGIB or two consecutive positive occult blood tests with at least 1-week interval between tests. All patients underwent colonoscopy (small, flexible Olympus PCF-20 colonoscope) and the findings were recorded. The procedure was done only after proper informed consent from the parents. Results: Total 38 patients were included in the study with above-mentioned inclusion and exclusion criteria, during the study period. Male to female ratio in LGIB was 2.16:1. LGIB was most common in children aged 5-10 years (63.1%), followed by 10-14 years (26.3%). Hematochezia was the most common presenting symptom (78.9%) followed by melena (21.1%). The most common causes of LGIB were colitis and colorectal polyp (31.6% each) followed by anal fissures (21.1%). Anemia was present in 68.4% patients at the time of presentation. Recurrence of LGIB was noted in 18 (47.4%) patients. Conclusion: We conclude that LGIB is most common in 5-10 years of children (school age) with hematochezia as the most common presenting symptom. Causes of LGIB in children in developing countries are same as developed countries (polyps and colitis being most common, followed by anal fissure), but further studies are required to determine the significant correlation between findings.
Factors determining poor prognosis in scorpion sting in coastal Andhra Pradesh
Authors: Kumar Chandra Mohan , Prasad Naveen S V
Published: June 2020

Introduction: Scorpion stings are a major public health problem and a common emergency in India and other tropical countries. In India, red scorpions are more prevalent, and their venom is more likely to cause cardiovascular complications and mortality. Objective: There are very few studies regarding predictors of poor prognosis. Hence, this study was designed which aimed to identify these factors. Materials and Methods: In this hospital-based, prospective study, children admitted to scorpion sting between December 2009 and November 2010 were included. Relevant information was collected and analyzed. Results: Scorpion stings account for 1 in every 36 admissions. Maximum cases were in 0-3 and 7-9 years age groups with mean of 6.78 years. Red scorpion stings were more common and are associated with more severe presentations. There was considerable variation in sting-prazosin interval (SPI) ranging from 2 to 28 h. If the child’s age was below 6 years, red scorpion sting and SPI >8 h were very significantly associated with a higher incidence of complications such as peripheral circulatory failure, congestive cardiac failure, myocarditis, and acute pulmonary edema. Conclusion: Younger age, red scorpion, and delay in administration of prazosin are predictors of poor prognosis in scorpion stings in children, a common and fatal medical emergency in India.
Nonfatal agriculture injuries in children - A retrospective study
Authors: Huda Farhanul , Wasim Sanober
Published: June 2020

Introduction: A larger proportion of the population in the world is involved in agriculture. Agricultural injuries are a major cause of morbidity and mortality both in developed as well as developing countries. These injuries can occur in all age groups. Objective: Since India is a predominantly agricultural country, we undertook this study to find out the pattern of agricultural injuries in children. Materials and Methods: This is a retrospective hospital-based study. Children <18 years of age, who presented to the hospital with agriculture-related injury from January 2009 to January 2013, were included in the study. The following data were recovered for each case - age, sex, type and cause of injury, and the body part involved. All fatalities were excluded from the study. Simple frequencies and percentages were obtained for various variables. Results: A total of 146 patients were included in the study. 94 (64.4%) were males and 52 (35.6%) were females. The most common age group involved was 7-13 years. Fractures and dislocation were the most common injuries (29.7%). Most of the injuries were to the upper extremities (57.3%). There was a wide variety of causes of agricultural injury in our study, falls and slips being the most common cause. Conclusion: Our study shows that males in the age group of 7-13 years were the most frequent victims of agricultural injuries. Falls and slips were the most common mechanism of injury with fracture and dislocations being the most common type of injury. The results from this study will help in identifying the risk factors for agriculture injuries in children and also to look for the prevention measures to be applied.
Clinico-hematological profile of paediatric patient admitted with acute leukemia in tertiary care centre of central India
Authors: Kumar Saurabh , Anand Shweta , Sahu T P
Published: June 2020

Background: Leukemia is the most prevalent childhood cancer. Acute lymphoblastic leukemia (ALL) constitutes 75% of all cases. Objective: To find out the most common clinical and hematological findings of pediatric patients with acute leukemia at a tertiary care center of central India. Materials and Methods: This retrospective study was done on 30 pediatric patients diagnosed with acute leukemia in the Department of Pediatrics and Oncology at Chirayu Medical College and Hospital, Bhopal. This study included children aged from 6 months to 15 years, who were admitted from June 2014 to June 2015. Data were retrospectivelycollected by reviewing medical records of these patients. Clinical history, physical examination, hematological, and radiological data were analyzed. Results: ALL was the most common hematological malignancy observed at our hospital. In addition, it was found to be more prevalent in males and fever was the most common presenting symptoms followed by fatigue and anorexia. Hepatosplenomegaly and pallor were the most common findings on clinical examination. Among patients with ALL, subtype L1 was the most common type. Among patients with acute myeloid leukemia, M2 and M3 subtypes were most commonly documented.
Drug compliance in children with epilepsy: Cross-sectional study, New Delhi
Authors: Verma Neha , Tripathi Smita , Sharma Suvasini
Published: June 2020

Background: For individuals with epilepsy, adherence to medication is crucial in preventing or minimizing seizures and their cumulative impact on everyday life. Compliance studies in adult patients are many, but few in children with epilepsy. Objective: This study tries to find the prevalence of noncompliance in children with epilepsy and causes leading to it. Method: The study was conducted in a tertiary care super specialty children hospital of New Delhi. Children, age 1-12 years, who were already diagnosed cases of epilepsy and were all on drug therapy for at least 3 months were included in the study. After obtaining clearance from the hospital’s Ethical Committee, a total of 100 parents of epileptic children were interviewed as per the prepared questionnaire. Results: Out of 100 children (63 males, 37 females) with epilepsy, 71% were compliant. Most of the noncompliant parents (82.7%) felt that there is the harmful effect of long-term anti-epileptic drugs. They believed in stopping medications on their own once signs and symptoms disappear and did not like to give medication to their child in public place. No significant association of noncompliance could be seen with etiology of epilepsy, monotherapy versus polytherapy, and duration of disease, mother’s age and parental education (p>0.05). Conclusion: Compliance in this study group of children with epilepsy was 71%. Further improvement of health and well-being of children with epilepsy can be attempted by education of parents, distribution of written instructions in the form of pamphlets, counseling, group discussions, and exchange of personal experience. Public awareness drive should help in reducing the associated taboos.
Postnatal predictors for outcome in congenital diaphragmatic hernia: A singlecenter retrospective cohort study from India
Authors: Chandrasekaran Ashok , Rathnavelu Ezhilarasan , Mulage Lingaraja , Ninan Binu , Balakrishnan Umamaheswari , Amboiram Prakash , Shaik Shafi Jan Mohammad , Ramaswamy Sarvanan
Published: June 2020

Background: Congenital diaphragmatic hernia (CDH) has high morbidity and mortality. Many outcome predictors have been tried. Objective: To assess the short-term outcomes of neonates with isolated CDH and find the predictors of outcome. Methods: Neonates with isolated CDH managed over 12-year period from June 2004 were analyzed. Antenatal counseling, delayed surgery after stabilization, primary conventional ventilation and rescue high frequency ventilation if needed is the unit protocol. Details on baseline characteristics, delivery room management, clinical details, ventilation details, management of pulmonary hypertension, inhaled nitric oxide usage, operative details, and post-operative period were noted. Oxygenation index (OI) was calculated, and echocardiography findings on pulmonary hypertension were noted. Outcome predictors were assessed. Results: 40 neonates with isolated CDH were managed during the study period. The mean birth weight and gestation were 37.7±1.55 weeks and 2830±480 g, respectively. The majority of them were intramural and had an antenatal diagnosis. Definitive sepsis, pneumothorax, and severe pulmonary hypertension were seen in 10, 9, and 17 neonates, respectively. In 32 neonates, surgical repair was done and 31 (78%) survived at discharge. Median (range) of maximum OI on day 1 was 6 (2.2-39) and 59.9 (7.65-96) for survivors and non-survivors,respectively. Area under the curve (AUC) for OI prediction of survival was 0.94 (confidence interval 0.86-0.99). The adjusted odds ratio for survival, when maximum OI was below 15, was 36.2 (4.6-142). Receiver operating curve showed AUC for OI in predicting survival was 0.95 (0.86-0.99). Conclusion: We found 78% survival for isolated CDH neonates using standard protocol and OI is a good predictor for survival.
Comparison of clinical outcomes in patients with congenital anorectal malformation treated with posterior sagittal anorectoplasty and laparoscopically assisted anorectal pull through
Authors: Kunnur Vijaymahantesh S , Singh Chandra Shekhar , Kunnur Shanthala V , Kunnur Anil Kumar S
Published: June 2020

Aim: To compare the complications and outcomes of laparoscopic-assisted anorectoplasty (LAARP) for anorectal malformation (ARM) with that of posterior sagittal anorectoplasty (PSARP) using Kelly’s score. Materials and Methods: This was a single-center study conducted over a period of 4-year. A total of 95 male ARM patients were included in the study, of which 25 patients underwent LAARP, whereas 70 patients underwent PSARP. Result: Superficial wound infection was seen in 2 (2.85%) cases of the PSARP group while in 1 (4%) case in LAARP group. 12 (17.14%) cases of PSARP group had wound dehiscence at the neo-anal site, of which 6 (8.57%) had complete wound dehiscence and the remaining 6 (8.57%) had partial dehiscence, whereas 4 (16%) cases had wounddehiscence in LAARP group of which 3 (12%) had partial and 1 (4%) had complete dehiscence. Retraction of the neo-anus was seen in 6 (8.57%) cases of PSARP group while in 2 (8%) cases of LAARP group. Ectopically placed neo-anus was seen in 3 (4.28%) patients of PSARP group while in none of the cases in LAARP group. None of the patients in LAARP group had anal stenosis, whereas 2 (2.85%) patients underwent redoanoplasty in PSARP group for anal stenosis. Mucosal prolapse was seen in 8 (11.42%) cases of PSARP group, as compared to 3 (12%) patients of LAARP group. The net average Kelly’s score in LAARP group was 4.56, whereas, in PSARP group, it was 4.10. Conclusion: This study emphasizes the emerging laparoscopic technique for the managementof ARMs. Using this approach, it is possible to achieve better continence rates as the extent of perineal dissection is minimal.
Tubularized parameatal based dartos-spongiosum flap urethroplasty in distal hypospadias with flat glans, shallow meatal groove, and severe glans tilt
Authors: Singh Chandra Shekhar , Kunnur Vijaymahantesh S , Kunnur Shanthala V , Kunnur Anil Kumar S
Published: June 2020

Objective: To report the technique and results of single stage tubularized parameatal based dartos-spongiosum flap urethroplasty for distal hypospadias with flat glans, shallow meatal groove, and severe glans tilt. Materials and Methods: The study was conducted over a period of 2-year from October 2013 to October 2015, and 19 patients with distal hypospadias were included in the study with flat glans, poor urethral groove, and severe glans tilt, who otherwise would have been subjected to transection of urethral plate and a two-stage procedure. In this technique, bilateral flaps were fashioned along the preputial edge beginning from the hypospadiac meatus with intact dartos, keeping the base of the flaps attached to the bifurcated spongiosum. The urethral plate was transected. Glans was split wide open. Bilateral flaps joined at ventral midline creating new urethral plate which was tubularized with the creation of slit like wide meatus at the tip of glans. Neourethral coverage was provided with double dartos flap. Complications and aesthetic appearance on a score of 1-10 were outcome measures. Results: There was no urethral stricture, residual chordee, penile rotation, or asymmetrical penis. The average aesthetic score was 8.5. Meatus was at the tip of glans with adequate caliber in all patients. Two (10.5%) out of 19 patients developed subcoronal fistula that required surgical closure. Conclusion: Tubularized parameatal-based dartos-spongiosum flap urethroplasty is viable and easy to reproduce option for management of a specific group of patients with distal hypospadias (with flat glans, poor urethral plate, and glans tilt) and is associated with very low complication rate.
Transient hyperphosphatasemia: A case report
Authors: Sahu Vinay Kumar
Published: June 2020

Transient hyperphosphatasemia (THP) is characterized by temporary elevation of serum alkaline phosphatase (AP). We report a case of a 26-month-old girl referred for slow growth and found to have THP as AP levels returned to normal without active treatment. THP is a benign condition in healthy children, which resolves spontaneously without any intervention. In the absence of signs and symptoms of any underlying liver, bone or gastrointestinal disease, isolated elevation of AP levels should alert the clinician to a diagnosis of THP to avoid expensive, extensive, and unnecessary investigations.
Pain abdomen in a child - An uncommon cause
Authors: Alwadhi Varun , Dabas Aashima , Aggarwal Anju , Faridi M M A
Published: June 2020

Diagnosis, identification of underlying etiology and management of pain abdomen, remains difficult. Tumors presenting as abdominal pain are rare in children. We report a case of 11-year old boy presenting with pain abdomen. On examination, he had a lump in left hypochondrium. Gastrointestinal tumors constitute about 12% of abdominal masses, 2% of which are pancreatic tumors. He underwent laparotomy was diagnosed as desmoplastic small round cell tumor in the pancreas. This report presents an uncommon cause of a common pediatric problem.
Gastric lactobezoar - Ultrasound diagnosis: A case report
Authors: Sharma Bharat Bhushan , Sharma Shashi , Bhardwaj Naveen , Aziz Mir Rizwan
Published: June 2020

Gastric lactobezoars are found in neonates and diagnosed with the help of imaging modalities in the background of clinically presenting features.Inspissated milk mixes with the mucous and leads to ball like semisolid mass formation. The preterm infants are usually brought with abdominal swelling with or without features of intestinal obstruction. The condition is comparatively rare in children of higher age group. We present a 3-year-old male child who had a history of abdominal pain and swelling with occasional episodes of vomiting. Ultrasonography abdomen had shown some mass in stomach which was confirmed on subsequent barium and computerized tomography studies. He was fully recovered after the endoscopic conservative management with N-acetylcystein.The present case gains little more importance because of different age and sex group.
Kikuchi-Fujimoto disease with multisystem involvement: A case report
Authors: Sahu Vinay Kumar
Published: June 2020

Kikuchi-Fujimoto disease (KFD) is a self-limited, usually benign condition of unknown etiology characterized by fever and cervical lymphadenitis. Multisystem involvement is not very common. We report a case of a 14-year-old Chinese boy who presented with prolonged fever, rashes, cervical lymphadenitis, oral ulcers, and weight loss eventually diagnosed with Kikuchi’s disease. This case is interesting as the child subsequently developed multisystem involvement secondary to Kikuchi disease. The child recovered and remains well on follow-up clinic visits. KFD may have to be differentiated from many other infective, inflammatory, and malignant disorders. Diagnosis is confirmed by characteristic histopathological findings on excision lymph node biopsy. Long-term careful monitoring of these patients for signs and symptoms of evolving systemic lupus erythematosus or other autoimmune disorders is required.
Generalized erythroderma in a neonate: Rare presentation of nosocomial candidemia with Candida tropicalis
Authors: Dipak Niraj Kumar , Sheikh Samir Sultanbhai , Madhusudhan D S , Kikani Kishore Kanajibhai , Gandhi Prachi , Shetty Deepa
Published: June 2020

Candida species are currently one of the most common causes of nosocomial infection in neonatal intensive care units with Candida tropicalis emerging as a frequent offending agent. Colonization precedes systemic invasive fungal infections in neonates. It generally manifests with lethargy, increased apneic episodes, feeding intolerance, late-onset thrombocytopenia, hypoglycemia, unexplained hyperglycemia, poor perfusion, and need for increased ventilator requirement. We report a 10-day-old neonate, with late-onset sepsis by C. tropicalis, presenting as generalized erythroderma. We present this case to highlight that nosocomial candidemia with C. tropicalis can present as generalized erythroderma in neonates. Maintaining adequate oral or parenteral fluidintake with monitoring of serum electrolytes is mandatory.
Acute respiratory infection in under five children
Authors: Mandal Anirban , Singh Amitabh
Published: June 2020

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Türkiye’de Banka Kredi Kanalının Etkinliği
Authors: ŞAHBAZ KILINÇ Nazan , KILINÇ Efe Can
Published: June 2020

Parasal otoritenin yürütmüş olduğu para politikası, reel ekonomiyi; geleneksel faiz kanalı, varlık fiyatları kanalı, döviz kuru kanalı, kredi kanalı ve beklenti kanalı olmak üzere parasal aktarım kanalları aracılığıyla etkilemektedir. Bu çalışmanın esas konusunu oluşturan kredi kanalı, banka kredileri kanalı ve bilanço kanalı olarak iki alt kanala ayrılmaktadır. Bu çalışmanın amacı, 2003Ç1-2018Ç4 döneminde Türkiye’de banka kredi kanalının etkinliğinin VAR modeli kullanılarak araştırılmasıdır. Analizde para politikası göstergesi olarak kısa vadeli faiz oranları kullanılmış ve faiz oranındaki değişikliklerin özel sektörün (finansal olmayan) kredi hacmine olan etkileri araştırılmıştır. Etki-tepki fonksiyonlarının sonuçları Türkiye’de banka kredi kanalı mekanizmasının çalıştığını göstermiştir.
Güncel Pazarlama Yaklaşımlarının Sağlık Hizmetlerinde Uygulanabilirliği
Authors: ŞANTAŞ Gülcan , ŞANTAŞ Fatih
Published: June 2020

Sağlık hizmetlerinin kendine özgü özellikleri nedeniyle sağlık hizmetlerinde pazarlama faaliyetleri diğer hizmet sektörlerinden farklılaşmaktadır. Sağlık hizmeti pazarlaması; sağlık hizmeti sunucularının sayısının artması, artan tıbbi maliyetler ve tıbbi odakların değişmesi gibi zorluklarla rekabetçi bir şekilde nasıl başa çıkılabileceğine dair bir anlayış sağlamaktadır. Sağlık hizmetleri pazarlamasına yönelik eleştiriler olmakla birlikte, her türlü hizmette olduğu gibi sağlık hizmetlerinde de memnuniyeti yaratma ve sadakat oluşturmada hizmet pazarlamasının temel ilkeleri ve yönleri katkı sağlayabilmektedir. Bu çalışmada güncel pazarlama yaklaşımlarından nöropazarlama, viral pazarlama, gerilla pazarlama ve dijital pazarlama stratejilerine yer verilmektedir. Ayrıca çalışmada güncel pazarlama yaklaşımlarının sağlıkta uygulanabilirliği örnekler üzerinden tartışılmaktadır. Hastalıkların erken teşhisinde ve sağlığın geliştirilmesi hizmetlerinde bu çalışmada bahsedilen güncel pazarlama yaklaşımlarından daha fazla yararlanılabileceği söylenebilir.
Ortaokul Öğrencilerinin Okul Tükenmişliği, Öğrenme Sürecinde Yardım İstemeleri ve Akademik Başarıları Arasındaki İlişkinin İncelenmesi
Authors: ÇELİK Abdülaziz , PESEN Ata
Published: June 2020

Bu araştırma 6. 7. ve 8. sınıf öğrencilerinin okul tükenmişliği ve öğrenme sürecinde yardım istemeleri ile genel akademik başarı düzeyleri arasındaki ilişkinin belirlenmesi amacıyla yapılmıştır. Araştırma ilişkisel tarama modelinde desenlenmiştir. Araştırma Siirt il merkezinde okuyan 990 ortaokul öğrencisi ile gerçekleştirilmiştir. Verilerin analizinde Pearson korelasyon katsayısı analizleri uygulanmıştır. Araştırmada öğrencilerin okul tükenmişliği ve tüm alt boyutları ile akademik başarı arasında negatif yönde ve düşük düzeyde anlamlı bir ilişki olduğu belirlenmiştir. Ayrıca öğrencilerin öğrenme sürecinde yardım isteme ve bütün alt boyutları ile akademik başarı arasında anlamlı bir ilişki olduğu belirlenmiştir. Son olarak öğrencilerin okul tükenmişliği ölçeğinin tüm alt boyutları ile öğrenme sürecinde yardım isteme ölçeğinin tüm alt boyutları arasında anlamlı bir ilişki olduğu tespit edilmiştir.
Sanal Kaytarma ve İşgören Performansı İlişkisinde İş Stresinin Düzenleyici Etkisinin İncelenmesi: Sağlık Sektöründe Bir Araştırma
Authors: ÖZÜDOĞRU Mesut , YILDIRIM Yavuz Tansoy
Published: June 2020

Bu araştırmanın amacı iş stresinin, sanal kaytarma ve işgören performansı ilişkisi üzerinde anlamlı bir etkisinin olup olmadığını belirlemektir. Bu amacı gerçekleştirmek için “Sanal Kaytarma”, “İşgören Performansı” ve “İş Stresi Ölçekleri” Balıkesir ilinde kamuda görevli 402 sağlık çalışanına uygulanmıştır. Toplanan veriler üzerinde frekans analizi, faktör analizi, güvenilirlik analizi, normallik testi, korelasyon analizi ve regresyon analizi testleri uygulanmıştır. Korelasyon analizi sonucuna göre sanal kaytarma, işgören performansı ve iş stresi arasında anlamlı ilişkilerin olduğu tespit edilmiştir. Regresyon analizi sonucunda iş stresinin, sanal kaytarma ve işgören performansı ilişkisi üzerinde düzenleyici etkisinin olduğu tespit edilmiştir. Yöneticiler ve yapılacak araştırmalar için önerilerde bulunulmuştur. Araştırmanın bulgularının literatüre ve uygulayıcılara katkı sağlayacağı düşünülmektedir.
Rehberli Araştırma Sorgulama Öğretim Yönteminin 7. Sınıf Öğrencilerinin FeTeMM Tutumları Üzerindeki Etkisi
Authors: SAĞDIÇ Müge , BAKIRCI Hasan
Published: June 2020

Bu çalışmanın amacı, rehberli araştırma sorgulama öğretim yöntemine dayalı fen öğretiminin yedinci sınıf öğrencilerinin Fen-Teknoloji-Mühendislik-Matematik (FeTeMM) tutumlarına etkisini araştırmaktır. Çalışmada, yarı deneysel yöntem kullanılmıştır. Çalışma grubu, 2017-2018 eğitim-öğretim yılının güz döneminde Van ilinin Başkale ilçe merkezindeki bir ortaokulda 45'i deney (23 kız, 22 erkek) ve 40'ı kontrol grubunda (17 kız, 23 erkek) olmak üzere toplam 85 öğrenciden oluşmaktadır. Veri toplama araçları olarak; FeTeMM Tutum Ölçeği kullanılmıştır. Çalışmada elde edilen veriler, Wilcoxon İşaretli Sıralar Testi ve Mann Whitney U-testi kullanılarak analiz edilmiştir. Çalışmanın sonunda, deney grubunda uygulanan rehberli araştırma sorgulama öğretim yönteminin ve kontrol grubunda uygulanan 5E öğrenme modelinin yedinci sınıf öğrencilerinin FeTeMM tutumları üzerinde etkili olduğu bulunmuştur. Deney ve kontrol grubunda yapılan öğretim kıyaslandığında; deney grubunda yapılan öğretimin, ortaokul yedinci sınıf öğrencilerinin FeTeMM tutumları üzerinde daha etkili olduğu sonucuna varılmıştır. Ayrıca rehberli araştırma sorgulama öğretim yöntemine dayalı fen öğretimi, FeTeMM Tutum Ölçeği’nde yer alan özellikle fen ve 21. yüzyıl becerileri üzerinde daha etkili olduğu tespit edilmiştir. Çalışmadan elde edilen sonuçlara bağlı olarak, rehberli sorgulama öğretim modelinin ortaokul öğrencilerinin FeTeMM tutumları üzerinde etkisinin daha net görülebilmesi için Fen Bilimleri dersinin farklı ünitelerinde kullanılması önerilmektedir.
Hastanelerde Performans Değerleme Sisteminin Çalışan Motivasyonuna Etkileri Hakkında Çalışan Görüşleri (Çankaya İlçesi Örneği)
Authors: ÖZTÜRK Zekai , DOĞUÇ Ece
Published: June 2020

Günümüzde rekabet avantajını elde etmeyi hedefleyen işletmeler, en önemli girdi olan insan kaynaklarını en verimli şekilde kullanmalıdır. İnsan kaynaklarının ne kadar verimli ve etkin kullanıldığını açıklayan performans değerlendirme sistemi ve performansı etkileyen motivasyon işletmeler için hayati önem arz etmektedir. Bu nedenlerden dolayı bu araştırma insan kaynaklarının belki de en önemli unsur olduğu hastanelerde performans değerleme sisteminin işgören motivasyonuna etkisini açıklamayı amaçlamaktadır. Araştırmanın örneklemini Ankara Çankaya Bölgesinde hizmet vermekte olan bir üniversite, devlet ve özel hastanesinde görev yapan 462 çalışan oluşturmaktadır. Veri toplama aracı olarak performans değerlendirme sistemi ile motivasyonu ölçen iki ölçek kullanılmıştır. Elde edilen veriler analiz edilip yorumlanarak çalışma tamamlanmıştır. Çalışmada elde edilen veriler frekans, yüzde dağılımları, keşifsel faktör analizi, Kolmogorov Smirnov, Mann Whitney-U ve Kruskal Wallis testleri kullanılarak değerlendirilmiş ve yorumlanmıştır. Performans değerleme sistemi ve motivasyona analizler sonucunda iş görenlerin yaş grupları, unvan, çalışılan departman ve yöneticilik pozisyonunda olup olmama durumları ile performans değerleme sistemi ve motivasyona ilişkin görüşleri arasında farklılık bulunduğu görülmüştür. Aynı şekilde özel, kamu ve üniversite hastaneleri arasında hem performans hem de motivasyon açısından istatistiksel olarak anlamlı farklılığın bulunduğu sonucuna varılmıştır. Son olarak performans değerleme ile motivasyon arasında pozitif yönlü ve doğrusal bir ilişkinin olduğu tespit edilmiştir.
Ortaokul Öğrencilerinin Bilişim Teknolojilerinden Yararlanma Düzeyleri ile Toplumsal Değerlere Yönelik Algıları Arasındaki İlişkinin İncelenmesi
Authors: KOÇOĞLU Ayhan , YANPAR YELKEN Tuğba , KANADLI Sedat
Published: June 2020

Bu araştırma, ortaokul öğrencilerinin bilişim teknolojilerinden yararlanma düzeyleri ile toplumsal değerlere yönelik algıları arasındaki ilişkinin incelenmesi amacıyla gerçekleştirilmiştir. Araştırma, karma yöntem araştırma desenlerinden açımlayıcı sıralı desen yaklaşımıyla yürütülmüştür. Araştırmanın nicel aşamasında ilişkisel tarama yöntemi kullanılmıştır. Nitel aşamasında ise veriler açık uçlu sorular ile toplanmıştır. Araştırmada nicel veri toplama aracı olarak Özmusul (2011) tarafından geliştirilen “Bilişim Teknolojilerinden Yararlanma Ölçeği” ve Bakaç (2013) tarafından geliştirilen “Toplumsal Değerlere Yönelik Algı Ölçeği” kullanılmıştır. Nitel veri aracı olarak araştırmacılar tarafından geliştirilen “Bilişim Teknolojileri ve Toplumsal Değerlere Yönelik Öğrenci Görüşme Formu” kullanılmıştır. Araştırmanın örneklemini Mersin ili merkez ilçelerinde öğrenim gören 424 ortaokul öğrencisi oluşturmaktadır. Nicel verilerin analizinde betimsel istatistiklerden yararlanılmış ve korelasyon analizi yapılmıştır. Araştırmanın nitel verileri ise betimsel analiz yöntemi kullanılarak çözümlenmiştir. Nicel verilerin analizi sonucunda ortaokul öğrencilerinin bilişim teknolojilerinden daha çok iletişim kurma ve araştırma yapma amaçlı faydalandıkları ortaya çıkmıştır. Bununla birlikte öğrencilerin toplumsal değerlere yönelik algılarının ise daha çok olumlu yönde olduğu belirlenmiştir. Ayrıca öğrencilerin bilişim teknolojilerinden yararlanma düzeyleri ile toplumsal değerlere yönelik algıları arasında anlamlı bir ilişki bulunamamıştır. Nitel veri analizi sonucunda ise öğrencilerin bilişim teknolojilerinden bilgi edinme, araştırma-inceleme yapma ve oyun-eğlence amaçlı yararlanırken toplumsal değerleri dikkate almadıkları belirlenmiştir.
Porto Alegre, Paris ve Seul Katılımcı Bütçe Modelleri
Authors: GÜNEŞ İsmail
Published: June 2020

Bundan 30 yıl önce Brezilya'nın Porto Alegre ‘de başlayan katılımcı bütçeleme demokratik bir süreçtir ve vatandaşlar doğrudan bir kamu bütçesinin belirli bir bölümünün tahsisine katılmaktadırlar. Katılımcı Bütçeleme vatandaşlara yatırım teklifleri sunma ve ardından açık oylama yoluyla hangi projelerin finanse edilmesi ve uygulanması gerektiğini seçmelerini sağlar. Uygulamada tek bir katılımcı bütçe modelinden bahsetme olanağına sahip değiliz. Her ülkenin kendi özgün koşullarından hareketle farklı modeller geliştirmeye çalıştıkları görülmektedir. Bu çalışmada uygulamanın ilk ortaya çıktığı Porto Alegre modeli yanı sıra büyük ölçekli kentlerden Seul ve Paris’te katılımcı bütçeleme örnekleri analiz edilecektir. Seul, 10 milyonu aşan nüfusu ile daha çok küçük ölçekli yerlerde başarılı örneklerini gördüğümüz katılımcı bütçe uygulamalarının büyük bir ölçekte nasıl işleyeceğini göstermesi açısından incelenmesi gereken bir kenttir.
Değişen Eczacı Rolleri Bağlamında Hastaların Eczacılık Hizmetleri ile İlgili Memnuniyetlerinin Değerlendirilmesi
Authors: DEMİR Muazez , EKE Erdal
Published: June 2020

Eczacılık mesleğinin dönüşümü paralelinde değişen eczacı rolleri, sunulan eczacılık hizmetlerinin çeşitlenmesine ve eczacıların sorumluluklarının artmasına yol açmıştır. Sağlık sektörünün bir paydaşı olan eczacıların rollerini değerlendirme noktasında hasta memnuniyeti önemli bir parametredir. Ayrıca hasta memnuniyeti değerlendirme sonuçları, sağlık hizmetlerinin tasarım ve yönetiminde hizmet sağlayıcılara ve politika yapıcılara yol göstermede önemlidir. Bu çalışmada bireylerin eczacılık hizmetinden memnuniyetleri değerlendirilmiştir. Araştırma evrenini Isparta il merkezinde yaşayan 18 yaş üzeri bireyler oluşturmaktadır. Araştırmada kolayda örnekleme yöntemi kullanılarak 411 katılımcıya ulaşılmıştır. Araştırmada veri toplama aracı olarak, araştırmacı tarafından geliştirilen “Eczacılık Hizmetlerinin Değerlendirilmesi Anketi” kullanılmıştır. Bireylerin eczacıların danışmanlıklarından (2,928) orta derecede, eczanenin fiziki şartlarından ve eczacı ile olan iletişim boyutundan (3,929) iyi düzeyde ve ilaç kullanımı bilgilendirme boyutundan (4,092) iyi düzeyde memnun oldukları sonucuna varılmıştır. Eczacıların klasik görevlerini yerine getirdikleri ancak değişen eczacılık rollerini henüz tam olarak yerine getirmedikleri sonucuna ulaşılmıştır.
Çağdaş Sanat Yapıtının Göstergebilimsel İncelenmesi: Joseph Kosuth’un “Bir ve Üç Sandalye” Adlı Çalışması
Authors: İNCİRKUŞ Buşra
Published: June 2020

Sanat ve dille ilişkilendirilen bir sanatçı olan Joseph Kosuth, bir sanatçı olmanın sanatın doğasını sorgulamak anlamına geldiğini iddia etmektedir. Sanatçının “sandalye nedir?” sorusundan yola çıkarak oluşturduğu çalışmada, merak duygusunun sanat eserini çözümlemede kavramın rolünü ortaya koymaktadır. Sanatın bir soru olarak işlevini ele alarak, kavramın temellerini ortaya çıkarmaya çalışmaktadır. Araştırmanın amacı, görselliğin ön planda olduğu bir sanat ortamında göstergelerin, gösterilen imgelerin bilhassa çağdaş sanat yapıtlarında nasıl yorumlanması gerektiğini ortaya koymak, bu gibi çalışmaların yorumlanmasında yol gösterici olarak katkıda bulunmaktır. Çalışmada, üç ayrı bölüm, tek bir göstergeyle ilişkilidir. Sanatçı böylece gerçek sandalyenin hangisi olduğu sorusunu izleyicisine sormakta, sanat eseri-izleyici etkileşimini oluşturmaktadır. Çalışmanın sağında yer alan sandalyenin fotoğrafı, geçmişle bağlantılıdır. Çalışmanın ortasında duran sandalyenin kendisi de bugüne gönderme yapmaktadır. Sol tarafta yer alan sandalye kavramının tanımı ise hem geçmişe hem de geleceğe gönderme yapmaktadır. Böylelikle çalışma, soyut ve somut kavramların gösterge olarak kullanıldığı Kavramsal sanatın Göstergebilim ile ilişkisini gösteren son derece etkili bir eser olmaktadır.