bluuebunny/crossref_metadata_2025 huggingface dataset:
Profile of Hirschsprung’s disease cases diagnosed in tertiary care teaching hospital: a retrospective observational study
Authors: Prabakaran S. , Thilagam K. Kasthuri
Published: February 2020

Background: To date, there are very few studies of Hirschsprung’s disease. Hence, the study was conducted to profile Hirschsprung’s disease in a tertiary care setting.Methods: This is a retrospective observational study that evaluated the admitted patients with Hirschsprung’s disease in the pediatric surgery department. Biopsy was taken from the patient in the form of the full thickness of intestine, seromuscular biopsy, resection from the colostomy site when doing closure and or appendix was taken and subjected to histopathological study with routine eosin and haematoxylin stain.Results: Among the study population, 21(28.8%) children were aged less than one month, and only 10(13.7%) were aged 11 years and above. There were 45(61.6%) participants were male and 28(38.4%) female. Most common biopsy site was appendix in 33(46.2%), followed by Ileum full-thickness biopsy in 6(8.2%) , Ileum Seromuscular biopsy in 5(6.8%%) ,Colon full-thickness biopsy in 4(5.6%) subjects. Among the 73 participants, 46(63%) were clinically suspected cases, and the remaining 27(36.9%) were clinically established cases. Among clinically suspected, the majority (50.7%) had ganglionic cells only in proximal segments.Conclusions: the Hirschsprung's disease diagnosis was established mostly in younger males.
Adolescents: a paediatrician’s or an adult physician’s domain? clinical profile of Indian adolescents admitted in pediatric ward and those admitted in other than pediatric ward
Authors: Patel Snehal V. , Vasavada Halak J. , Patel Purvi R. , Rathod Nirav B.
Published: February 2020

Background: Study of the clinical profile and no. of admissions of adolescents admitted in pediatric ward and other than Pediatric ward.Methods: A Prospective Study, conducted during August 2018 to March 2019, at a tertiary care teaching hospital, including age group 10-19 years.Results: Out of 1645, highest adolescents’ admissions   749 (46.37%) were to medical ward, 2nd highest in the Pediatric ward which was 317 (19.6%), followed by general surgical ward which was 312(19.3%).                               Highest among late adolescents, infectious diseases were still the leading cause of hospitalization of adolescents as it constituted 68.4% (902) of admissions to other than pediatric ward followed by surgical cause[135(10.2%)] followed by accidents [5%(66)].Conclusions: Infectious diseases are more common in adolescents compared to developed countries. The shift in hospitalisation of adolescents from pediatrics to general medicine at about 14 years is illustrated in present study and reflects the need of better implementation of clinical policy on the age divide.
Incidence of hyponatremia and its utility as an indicator of morbidity in children hospitalised with community acquired pneumonia
Authors: Natarajan Thrilok , Sahubar Sadique Thahsheen Nilofar , Shanmugham Kabilan
Published: February 2020

Background: The aims of the study were to determine the incidence of hyponatremia associated with pneumonia and to assess its utility as an indicator of morbidity in children hospitalized with community acquired pneumonia between 2 months and 5 years of age.Methods: This was a prospective study of children aged 2 months to 5 years hospitalized with community acquired pneumonia. 120 children aged 2 months to 5 years with symptoms of lower respiratory tract infection and had radiological evidence of pneumonia were recruited into the study. Children with chronic diseases, previously treated with intravenous fluids and those with chronic drug intake were excluded from study.Results: Of the 120 children, 40.8% (49/120) had hyponatremia at admission. The relationship of hyponatremia to different clinical and laboratory parameters was analyzed. Sixty-one percent (31/51) of children under 1 year and 26% (18/69) of children between 1 to 5 years of age had hyponatremia (p=0.001). Hyponatremia was seen more commonly in children with severe pneumonia, with initial high temperature(p=0.001), with tachycardia (p=0.001), leukocytosis (p=0.001), increased neutrophils (p=0.001) and reactive thrombocytosis (p<0.001) and in children who had hemodynamic instability on admission (p<0.001). All 11(9.2%) children who required mechanical ventilation had hyponatremia (p<0.001). Consolidation was significantly associated with hyponatremia (p<0.001). Hyponatremia also showed a significant association with prolonged hospital stay (p<0.001).Conclusion: The incidence of hyponatremia in children hospitalised with pneumonia is 40.8%. This study concludes that the hyponatremia shows a significant association with the morbidity of the disease like requirement of intensive care and mechanical ventilation, hemodynamic instability and prolonged hospital stay. Hence the presence of hyponatremia at admission can be used as an indicator of morbidity.
Usefulness of serum albumin as a prognostic factor in dengue
Authors: H. Murali B. , Lysander Shilpa Deborah , Nannapaneni Meghana
Published: February 2020

Background: Dengue is a major public health problem throughout subtropical and tropical regions. In more severe or complicated dengue, patients present with a severe febrile illness characterized by abnormalities of hemostasis and increased vascular permeability, which in some instances results in a hypovolemic shock. Dengue is endemic in more than 100 countries in tropical and subtropical regions with an estimated 390 million infections occurring worldwide, among which 96 million infections are clinically apparent. The objective of this study is to assess the usefulness of serum albumin as a prognostic factor in dengue.Method: This observational study enrolled 100 patients who were admitted in KIMS Hospital from June 2017 to June 2018 without any co morbidities as mentioned in the exclusion criteria. On day 4 of illness hemoglobin, packed cell volume, platelet and serum albumin were done, and the participants were classified into 3 groups based on clinical manifestationResults: In this study, hemoglobin was elevated on day 4 in group 3 when compared to other groups and it was statistically significant. Hemoconcentration and low platelet values were also seen in group 3 when compared to other groups showing statistical significance.Serum albumin was also low in group 3 when compared to other groups, which was strongly significant.Conclusion: Hence serum albumin can be used as a prognostic factor in dengue.
Correlation between umbilical cord blood pH and meconium stained deliveries
Authors: Lysander Shilpa Deborah , P. Chandrakala , . Jayalalitha
Published: February 2020

Background: Among all live births approximately 13% neonates are born through meconium-stained amniotic fluid and out of these 5-10% developed MAS, which increases neonatal morbidity and mortality. The incidence increases as the gestational age advances with reported frequencies at 37, 40, and >42 weeks being 3%, 13%, and 18% respectively. Although there is a significant decrease in the occurrence of MAS and associated mortality in developed countries, MAS remains a major problem in developing countries. The objective was to study the correlation between umbilical cord blood PH and Meconium stained amniotic fluid.Methods: Observational study done in KIMS hospital Bangalore, Karnataka, India in a study period of 18 months on a sample size of 100. Within 30 sec of delivery a segment of umbilical cord was clamped at both ends. Cord blood was collected in heparinised syringe. It was then transported with cold ice packs and blood pH, pCO2, pO2 were measured.Results: In present study population, among those with MSAF, 72% had acidemia and 28% did not have acidemia. The mean (SD) of pH in the group with MSAF was 7.16 (0.10). The median (IQR) of pH in the group with MSAF was 7.14 (0.12). There was no significant difference between the groups (those with MSAF and those without MSAF but other risk factors) in terms of pH (W = 867.500, p = 0.580).Conclusions: The presence of acidosis in the umbilical cord blood, used as a biochemical marker for perinatal asphyxia can be used to evaluate the significance of intrauterine passage of meconium. But a normal acid-base status at delivery present in many cases of MSAF, suggests that either a pre-existing injury or a non-hypoxic mechanism is often involved. MSAF is not always secondary to an acute hypoxic event.
Analysis of predictors in outcome of fever with thrombocytopenia of pediatric age upto 12 years
Authors: Gowd Kagitha Pratap , Ram Guntur Sai , Belavadi Gangadhar B.
Published: February 2020

Background: It is well recognized that many fetomaternal and neonatal conditions are associated with thrombocytopenia. Study aimed to establish the possible etiology of children presenting with thrombocytopenia.Methods: The study was carried out in 100 children 1 month-12 years, admitted at department of paediatrics, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India with fever and thrombocytopenia. A thorough history was obtained and a general and systemic examination done. Routine investigations were done in all cases and specific investigations as and when required.Results: Total 100 cases were studied. Among them, 65% developed only fever, 10% developed fever with bleeding and 25% developed fever with shock. In total admissions 55% of children admitted with warning symptoms including abdominal pain, vomiting, reduced urine output and black colored stools. There is a significant influence of warning symptoms in predicting the outcome of fever with thrombocytopenia. 30% of children admitted with respiratory distress. 30% of children admitted with abdominal distension. 60% children admitted with hepatomegaly. In these children, 20% of them developed fever with shock and 13% of them developed fever with bleeding, 52% children admitted with platelet count less than 1 lakh. In these patients, 19% of them developed fever with shock and 9% of them developed fever with bleeding. 60% had dengue serology positive, 12% had positive Widal test, 8% children had positive urine culture and sensitivity. There was a significant influence of etiology in predicting the morbidity as 15% of children having positive serology for dengue developed fever with shock. 10% of children having positive serology for dengue developed fever with bleeding. Bleeding manifestations were seen most commonly in children with a platelet count less than 50000/μl.Conclusions: The commonest cause of febrile thrombocytopenia in this study was dengue fever in Children. Platelet count was the predictive of bleeding manifestations.
Clinical profile of patients with chronic obstructive pulmonary disease at a tertiary care hospital
Authors: R. Prasuna K. , Ratnam Praveena Korani , R. Pramod Kumar K. , K. Krishna Kumar T. V.
Published: February 2020

Background: Chronic obstructive pulmonary disease progresses if the exposure to aggravating factors continues. As lung function is declined, even after exposure is reduced or totally stopped, the COPD continues to progress though may be at a slower pace and as an effect of increasing age. Objective of the study was to study the clinical profile of patients with chronic obstructive pulmonary disease at a tertiary care hospital.Methods: A hospital based cross sectional study was carried out among 30 patients as decided by inclusion and exclusion criteria at MediCiti Institute of Medical Sciences, Medchal from November 2012 to June 2014. Detailed history, detailed clinical examination, Systemic examination and Forced expiratory volume (FEV1) was done for all patients included. Pack years of smoking was calculated. Data was entered in Excel worksheet and analyzed using proportions.Results: Maximum number of patients was in age group of 60-69 years (36.67%). Majority were males i.e. 83.34%. Smoking was major risk factor. Maximum number of patients (90%) had symptoms of less than one year of duration. Maximum number of patients (80%) had moderate to severe airflow obstruction at time of presentation and only 13.34% had mild disease. Four patients had mild form of the disease. Majority of patients with severe to very severe disease had more than 20 pack years. All patients in the study had breathlessness at the time of presentation. Wheeze and Crepitations were present in 96.66% of patients.Conclusions: Smoking has been found to be the major risk factor and it was positively correlated with the severity of COPD.
An adaptive clinical trial on patients with non variceal upper gastrointestinal bleed with the help of endoscopy
Authors: Singh Prem , Singh Gaurav , Kumar Vinay , Chawla Gaurav
Published: February 2020

Background: Acute upper gastrointestinal hemorrhage (UGIH) is a common condition worldwide frequently leads to hospital admission also has a significant associated morbidity and mortality, especially in the elderly. A systematic diagnostic and definite therapeutic approach is essential to establish a diagnosis, relevant to specific investigations for appropriate treatment in tertiary medical care center.Methods: A comparative trial was done on n=109 cases with an objective to find out the different causes of UGI bleed in population, to assess the requirement of blood transfusion in patients with massive GI Bleed and to compare the treatment outcome of Proton pump inhibitors over Tranexamic acid and  Octreotide in non-variceal UGI bleed. The cases were assigned to three different groups by lottery system. Proton pump inhibitors (Omeprazole), Somatostatin (Octreotide), Anti-fibrinolytic (Tranexamic acid), outcome was assessed after complete treatment and follow up.Results: Out of 150 cases, 109 were diagnosed with non-variceal GI bleed, 35 cases were treated with Omeprazole out of which 11.42% cases received blood   transfusion, and 4 had history of re bleeding, Mean Duration of stay in hospital was 4.4±1.75, when compared to the other two group the duration of hospitalization was least as the P value was <0.0001.Conclusions: In this study it was demonstrated the use of PPI in case of Non-Variceal Bleeding significantly reduces the need of blood transfusion. Even it reduces the cases of re bleeding and duration of hospital stay.
Adult nephrotic syndrome in the Niger delta sub region: a single centre study at the university of Port Harcourt teaching hospital
Authors: Chioma Pedro C. Emem , Wokoma Friday S.
Published: February 2020

Background: Adult nephrotic syndrome is a common cause of chronic kidney disease globally and in Sub-Saharan Africa.  In Nigeria there are only few studies on adult nephrotic syndrome, mostly from the south-western Nigeria and rarely from the Niger delta sub-region of Nigeria. This study aims at contributing to the National data on adult nephrotic syndrome, from the perspective of the Niger delta sub-region.Methods: Retrospective analysis of five-year clinical data (January 2007 to December 2011) of adult nephrotic syndrome patients in the University of Port Harcourt teaching hospital was conducted.Results: Forty-four patients, representing 1% of medical admissions and 7.3% of adult renal cases were seen during the period, with mean age of 27.7±8.5 years. There were 32 males (72.7%). Mean duration of illness was 25.3±30.3months. Peak age group was the 20-29 year age group, accounting for 52.3% of cases.  Hypertension was seen in 45.5%. Mean e-GFR was 73.5±33.8 ml/min/1.73m2 with CKD 1-3 constituting 93.2% of cases. Mean 24-hour urinary protein excretion was 13.6±8.4 grams/day. Protein excretion >10grams/day was observed in 65.8% of the patients.  Mean total serum protein, albumin and total cholesterol were 51.4±11.7g/dl, 22.5±9.9 g/dl and 8.1±3.0 mmol/L, respectively. Anemia was common (68%) and histology showed MCGN (52.6%), MCD (21.1%), membranous (15.8%) and FSGS (10.5%). Though response to therapy was generally poor, immunosuppressive therapy showed better outcomes.Conclusions: The prevalence and pattern of adult nephrotic syndrome in the Niger delta sub-region is similar to that in other parts of Nigeria.  It is predominantly a disease of young adult males with high prevalence of hypertension, and poor histologic categories.
Role of electrocardiogram in identifying the infarct related artery in acute myocardial infarction and to correlate it with 2D echo and coronary angiogram
Authors: Ruram Jacob Abraham , Ganta Rami Reddy , Arunachalam P.
Published: February 2020

Background: The Electrocardiogram remains a crucial tool in the identification and management of acute myocardial infarction. A detailed analysis of patterns of ST segment elevation may influence decisions regarding the perfusion therapy. This study was undertaken to study the role of ECG in identifying the infarct related artery in acute ST elevation MI and to correlate its findings with 2 D ECHO and Coronary angiogram.Methods: A total of 100 patients who presented with acute ST elevation MI were randomly selected for the study. After admission all the patients underwent ECG, CPK, CK-MB levels, 2D ECHO and CAG. Patients with ST segment elevation from ECG was evaluated to identify culprit vessel and the ECG findings were then correlated with 2D ECHO and CAG to identify the Sensitivity, Specificity, Positive predictive value and Negative predictive value of ECG in identifying the infarct related artery.Results: Fifty-two (52%) patients had an Anterior wall MI, forty-two patients (42%) had an evidence of Inferior wall MI and Six patients (6%) were found to have Antero inferior wall MI in the study group. Thirty-eight (38%) had evidence of SVD, forty-six patients (46%) had DVD and Sixteen patients (16%) had TVD. Sensitivity, Specificity, PPV and NPV of the ECG in identifying the LAD artery occlusion were 60.5%, 100%, 100% and 44.4% respectively. Sensitivity, Specificity, PPV and NPV of ECG in identifying the RCA artery occlusion were 78.5%, 100%, 100% and 78.5% respectively. Sensitivity, Specificity, PPV and NPV of the ECG in identifying the LCx artery occlusion were 26%, 96%, 86% and 60% respectively.Conclusions: ECG was found to be a sensitive and specific tool in identifying the infarct related Coronary artery in acute ST elevation MI.
Assessment of plasma blood sugar level in first degree relatives of known type 2 diabetes patients: a descriptive study from Maharashtra, India
Authors: Deshmukh J. K. , Mulay P. Y. , Naghate Amit G. , Takalkar Anant A.
Published: February 2020

Background: There is steady increase in the prevalence of diabetes mellitus from 0.73% to current 2.4% in rural and 4.0% to 11.6% in urban areas. Familial clustering of diabetes may support a genetic predisposition to diabetes. With increase in the prevalence of diabetes there is increase in number of first degree relative as well, thus an increased risk of developing diabetes, will also increase. To study the plasma glucose levels in First-degree relatives of family member of type 2 diabetic patients was the objective of the present study.Methods: It is a descriptive observational study with 1020 individuals serially coming to our outpatient Department for Pre-employment Medical Health Check Up Annual Health Check Up were selected. These individuals have been enrolled for the study and their family history of diabetes was noted, their sugar levels and their lipid levels were estimated and their body mass index was calculated. The data thus collected and analyzed with excel.Results: 184 (18%) individuals were FDRs, were as 836 (82%) individuals were Non-FDRs. There were 754 (74%) males [131(17%) FDR and 623(83%) Non-FDR], were as 213 (26%) females [53(20%) FDR and 213(80%) Non-FDR], 61(6%) individuals were having Diabetic Mother, 91(9%) individuals had Diabetic Father and 32(3%) were those in whom both the Parents were Diabetic. It was found that maternal history has strong association for getting abnormal BSL levels as compared to a diabetic father as the RR of 9.82 (95% 4.84 to 19.95) in individuals with mother being diabetic, and RR of 1.54(95% 0.68 to 3.87) of father being diabetic.Conclusions: Family history of diabetes, maternal history of diabetes and history of both the parents having diabetes are risk factors for diabetes in FDRs.
A prospective evaluation of microvascular complications in diabetes mellitus patients at time of diagnosis
Authors: Prasad Ramadhenu Rajendra , Sekhar Valluri Some , Rajyalakshmi M.
Published: February 2020

Background: The microvascular complication is also showing increasing trend. This is because of lack of awareness and lack of regular screening programme. Early diagnosis and Intensive glycemic control has been the most effective approach to prevent the progress of microvascular complication.Methods: Based on exclusion and inclusion criteria 100 patients were enrolled for this study. For diagnosis of diabetes mellitus, we used American Diabetes Association (ADA) guidelines was followed. Detail history of patient was taken related to microvascular complication and they underwent extensive medical examination for the assessment of microvascular complications.Results: Mean age of patient with microangiopathy was 59.942±7.18 years and without microangiopathy was 54.31±13.15years. Microangiopathy was common in patient whose HbA1c was more than 10.7. Out of 26 patient 20 patient having microangiopathy. Neuropathy was present in 31 patients and absent in 69 patients.Conclusions: It was observed that a continuous linear association between HbA1c and microvascular complications. This is more common in patient in patient with higher HbA1c. Neuropathy is most common which is followed by nephropathy and retinopathy least among all.
Role of bronchoscopy in pleural effusion bacterial infection
Authors: G. Gomathi R. , Koganti Sindhura , . Dhanasekhar , . Chandrasekar , . Rajagopalan
Published: February 2020

Background: In the present study was to investigate that the role of Bronchoscopy in pleural effusion in bacterial growth condition. Pleural effusion is one of the commonest problems with which patients present to the hospital. Pleural effusion is always abnormal and indicates the presence of an underlying disease. Despite the fact that there are many causes of pleural effusion, it is estimated that 90% of all pleural effusions are the result of only 5 disease processes: malignancy, pneumonia, pulmonary embolism viral infection, congestive heart failure.Methods: This is a Prospective and Observational Study. All patients diagnosed to have pleural effusion by x-ray, clinical examination and ultrasound examination of pleura if needed will undergo informed.Results: All 80 patients were included of whom 60(70%) were males and 20(30%) were females. Out of 80 patients, 5 patients are having bacterial growth (6.3%). All 5 patients who had exudative effusion, 4 were males and 1 female, 4 cases were right side effusion and 1 left sided effusion.Conclusions: Authors conclude that bronchoscopy has a definite role in the etiological diagnosis of pleural effusion in bacterial infection.
Multivariate analysis of correlates of children nutritional status in Harar region, Ethiopia
Authors: Kebede Dufera Tejjeba , Bekalo Daniel Biftu , Mekuriaw Daniel Mesele
Published: February 2020

Background: Malnutrition is defined as deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients. In Ethiopia malnutrition is one of the most serious health and welfare problems among infants and young children. Malnutrition among children under five years of age is a chronic problem in most regions of Ethiopia, including the Harari region. The main objective of this study was to assess risk factors attributed to nutritional status of children in Harari region.

Methods: Data was obtained from Ethiopian Demographic Health Survey, 2016. Different factors were considered as determinants of nutritional status of a child. The study used Multivariate Multiple Linear Regression model to identify significant correlates of children nutritional status.  

Results: The descriptive statistics in the study revealed that out of a total of 233 children included in the study 21% are underweighted, 19.3% are stunted and 11.2% are wasted in the study area. From Multivariate multiple linear regression, breast feeding factors, health status of child and child vaccination status significantly affect nutritional status of the under five children.

Conclusions: The factor analyses conducted in this study indicated that only two factors (instead of 5 original observed variables or items) were sufficient to explain 78.605% of the total variation in PCFA of observed items related to child nutritional status. Factors duration of breast feeding, birth order of a child, current age of child is statistically significant in affecting child malnutrition.
A review on insulin presence and function in brain
Authors: Sedaghat Katayoun
Published: February 2020

Hormones have major role in maintaining the homeostasis of the body and mental functions. One of the crucial hormones that act to regulate the metabolism and growth is insulin. Insulin activity in the periphery has been the subject of study since long time ago, though, beginning to understand the central activity of insulin is rather recent and because of complexity of actions and interference with neurodegenerative diseases such as Alzheimer’s and Parkinson’s and mood disorders, like anxiety and depression, it is considered very crucial hormone in the maintenance of the mental health. This mini-review will discuss briefly the recent main aspects of insulin transfer to the brain, receptor and mediators, signaling pathways with particular attention to neural system and its role in cognitive and emotional processing in brain. Insulin is an endocrine hormone with receptor distribution in different parts of brain and has role in various neural functions such as; growth factor, modulating learning or memory, mood, neural growth and survival, also controlling neurotransmitters functions in different brain regions. Insulin regulates metabolic homeostasis in brain through complex routes, which inevitably makes it involved with some neurodegenerative or affective disorders, that raises its importance for more serious studies.
Is antibiotic prophylaxis really needed in thyroid surgery?
Authors: Mehta Rachna B. , Yadav Rajesh , Jain Akansha , Ashwathy K. P.
Published: February 2020

Background: Thyroid surgery is considered under clean surgical procedures and antibiotics are not routinely recommended for such clean surgical procedures. However, many hospitals in India still give post-operative antibiotics to thyroidectomy patients. Our aim was to find out if administering antibiotics in thyroid surgeries really helpful?

Methods: A retrospective study was conducted for a period of one year with total number of 30 participants, 15 of which were given antibiotic prophylaxis and remaining 15 weren’t given. The patients were observed for signs of infection and hence need for antibiotics till one month postoperatively.

Results: None of the patients in both the groups with and without antibiotics developed post-operative surgical site infection necessitating the need for antibiotics.

Conclusions: Thyroid surgery being classified as clean surgical procedure with small incision and short duration and given that strict aseptic precautions are followed in surgery, then antibiotic prophylaxis may not be needed. However, our study should be considered as only a preliminary case control study and a larger prolonged study is needed to provide statistically significant data.
Early intra-treatment diffusion weighted magnetic resonance imaging in patients with recurrent nasopharyngeal carcinoma treated with nivolumab
Authors: So Tiffany Y. , Ai Qi-Yong , Ma Brigette B.Y. , King Ann D.
Published: February 2020

Immune check point inhibitors have demonstrated promising efficacy in patients with recurrent or metastatic nasopharyngeal carcinoma (NPC) in phase I and phase II trials. Early identification of treatment response is important in these patients. This report aimed to document the early intratreatment diffusion weighted magnetic resonance imaging (DW-MRI) findings in NPC patients following treatment with the programmed cell death-1 inhibitor, nivolumab. Two consecutive patients with histologically confirmed recurrent undifferentiated NPC treated with nivolumab were prospectively recruited. Nivolumab was administered at a dosage of 3 mg/kg intravenously every 2 weeks. Patients underwent magnetic resonance imaging examinations at baseline, and at 3 and 5 weeks after commencement of treatment. Intratreatment changes in tumour volume and apparent diffusion coefficient (ADCmean)were calculated. The endpoints were objective response by response evaluation criteria in solid tumors and survival. In patient 1, an intratreatment ADC increase at 5 weeks corresponded with anatomical tumour volume reduction and a better long-term survival outcome (progression free survival 1.3 years, overall survival 2.9 years). In patient 2, an intratreatment ADC decrease at 5 weeks corresponded to progressive disease and worse outcome (progression free survival 0.0 years, overall survival 0.9 years). Intratreatment ADC changes at 3 weeks were not associated with response outcome. These cases suggest that intratreatment changes in ADC at 5 weeks may potentially predict tumour response in patients treated with nivolumab. Dedicated studies are needed to clarify these findings and fully characterise patterns of treatment related ADC change.
Case report on hereditary haemorrhagic telangiectasia
Authors: Mathur Stuti , Saberwal Akanksha , Dabholkar Yogesh , Verma Bhavika
Published: February 2020

Osler Weber Rendu disease also known as hereditary haemorrhagic telangiectasia (HHT) is a rare autosomal dominant disorder by the presence of multiple arteriovenous malformations (AVMs) that lack intervening capillaries resulting in direct connections between arteries and veins. A 70-year-old male patient known case of hypertension; Indian origin was brought to the emergency department of our hospital with complaints of severe epistaxis. An attempt was made initially to control bleeding by ice compressions and finally anterior and posterior nasal packing was done. He gave history of similar episodes in the past often accompanied with hemetemesis and malena on and off since childhood gastroduodenoscopy was done to rule out cause for hemetemesis which showed multiple telangiectasia in fundus, body and antrum of stomach and first part of duodenum establishing the diagnosis of HHT. Patient with Osler-Weber–Rendu disease may present with uncontrolled bleeding. Resuscitation along with hemostasis is the main stay of treatment. As the bleeding occurs from malformed vessels coagulation tests are normal. Management include blood transfusion, antifibrolytics and surgical hemostasis.
Rhinoscleroma with laryngotracheal involvement: a case report
Authors: Singh Saroo , Gupta Ankur , Sharma Nishi
Published: February 2020

Rhinoscleroma is a chronic, slowly progressive, granulomatous inflammatory disease of the upper respiratory tract. It is more common in developing countries and rural areas and endemic in Asia, Africa and South and Latin America. We report a case of rhinoscleroma in a young male presented to our Outpatient Department with complaint of hoarseness since one and half years. He had history of dyspnoea on exertion. Patient also had history of bilateral nasal discharge and obstruction. A nasal specimen was taken for histological diagnosis which confirmed rhinoscleroma. Patient was put on medical management and was assessed weekly for improvement by nasal endoscopy and laryngeal examination for one year. A high degree of suspicion is required by clinician to diagnose the disease and prompt treatment should be given to avoid the progression of disease and complications. Patient requires long term follow up for proper management.
Comparison of functional outcomes between cemented and uncemented bipolar hemiarthroplasty for intracapsular neck femur fractures
Authors: Singh Harpreet , Rudani Tej S. , Gandhi Malay P. , Rampurwala Aliasgar J.
Published: February 2020

Background: The neck of femoral fracture is common and leading fracture in orthopaedic practice. The older age group and female are more to prone to develop this fracture.

Methods: A prospective, clinical observational, analytical comparative study was undertaken in the department of Orthopaedics of Geetanjali Medical College and Hospital in Udaipur, Rajasthan from January 2018 to June 2019. 52 adult patients with neck of femur fracture, 26 patients in each group.

Results: In our study, the mean age was 77.72 years. Female preponderance was seen in our study. In our study mean duration of surgery in uncemented group was 65.78 minutes and mean duration of surgery in cemented group was 79.89 minutes. The mean total HHS in our patient was 86.63 with standard deviation of 6.18. Mean HHS for cemented group was 86 and for uncemented group was 87.23. We found 20 excellent result and 27 good results (35.71% and 51.92% respectively). We also found 5 fair result (12.37%). There were 2 complications, both in cemented group, one had post-operative dislocation and other had a cement reaction.

Conclusions: Both cemented and uncemented hemiarthroplasty are equally good options in the treatment of femoral neck fractures in the elderly. However, it is to be noted that the duration of surgery & complications, were both less in the uncemented group as compared to cemented hemiarthroplasty group in our study. 
Shearing osteochondral humerus fragment fixed with bio-pins
Authors: Narayanan Subramaian Kanthalu , Sellappan Rajesh , . Dharmaraj
Published: February 2020

The fractures associated with an anterior dislocation generally reported in the literature have been Hill-Sachs lesions, avulsions of the greater tuberosity and glenoid fractures. Although literature presents many sequels of posterior shoulder subluxations, we have not come across any shearing type osteochondral fracture in the literature. In this case report we present a 24year-old male following a fall from a motorcycle, sustaining a shearing type of osteochondral fracture likely from dislocation and relocation, which we fixed using absorbable biopins.
Hepatitis C seropositivity in lichen planus: a case control study in a tertiary care hospital
Authors: Narendra Gangaiah , Ahmed Mowazaffin , Amruthavalli Potlapati , Shivanna Raghunatha
Published: February 2020

Background: Lichen planus (LP), an immune-mediated disorder, has been reported as an extra-hepatic manifestation of Hepatitis C virus (HCV) infection, especially in HCV hyper endemic areas such as southern Europe and Japan. In India, the association between LP and HCV is documented in many studies. The aim of this study was to investigate hepatitis C virus infection in patients with lichen planus from an epidemiological standpoint and determine the sero-positivity of hepatitis C virus in patients with lichen planus and also to describe clinical profile of lichen planus in patients with hepatitis C virus infection.

Methods: This hospital-based case control study was conducted over 167 patients and 167 controls, evaluation included detailed history, cutaneous examination, routine blood tests and ELISA test for seropositivity.

Results: In this case control study 5.4% of the total study population presented with hepatitis c infection. Hepatitis C infection was more common in oral LP out of all the HCV positivity obtained in LP patients. Male to female ratio was 1:2.2. Prevalence of HCV infection was found to be slightly more in cases (6.6%) than controls (4.2%) but there is no statistically significant difference in the prevalence of HCV infection among cases and controls.

Conclusions: In conclusion, from the evaluation of our epidemiological data, any etiological link between LP and HCV could not be found in our population and an etiological link between LP and HCV cannot be inferred solely by epidemiological data.
Clinical pattern of papulosquamous dermatoses: an observational study conducted at tertiary care center, Ujjain, Madhya Pradesh, India
Authors: Varma Krishnendra , Kumar Ujjwal , Kumar Varun
Published: February 2020

Background: Papulosquamous dermatoses is a complex group of disorder characterized by scaly papules and plaques. There is a need to study the exact, pattern and prevalence of this disorder in different age groups and their line of treatment. Objective of the study was to observe the clinical pattern of various papulosquamous dermatoses and their prevalence at tertiary care center, Ujjain.

Methods: This was an observational study done in R.D. Gardi Medical college, Ujjain over a period of one year. A total of 229 cases including male and female of papulosquamous dermatoses were enrolled from the outpatient department. All patients were studied clinically and relevant data was recorded. Microsoft excel was used for data entry and analysis was done using SPSS version 23.

Results: There were 139 (60.7%) males and 90(39.3%) females with overall male to female ratio was 1.54:1. Most common age group affected with papulosquamous dermatoses was 31-50 years. The clinical pattern observed was psoriasis 49.3%, lichen planus 24.5% followed by pityriasis rosea 10.5%. The least common papulosquamous diseases were pityriasis rubra pilaris (1.3%) and lichen nitidus (1.3%). Most common variant of psoriasis and lichen planus was chronic plaque and classical respectively. Classical juvenile variant of pityriasis rubra pilaris was seen in our study. A single rare case of lymphomatoid papulosis was noted in our study.

Conclusions: Psoriasis, lichen planus and pityriasis rosea were commonest papulosquamous diseases were observed but still we need more longer duration of observational studies on papulosquamous dermatoses to understand the morphological features for the effective management of these diseases.
КОНЦЕПТУАЛЬНІ ПІДХОДИ ДО ЗАБЕЗПЕЧЕННЯ ЗБАЛАНСОВАНОСТІ ФІНАНСОВИХ РЕСУРСІВ ДЕРЖАВИ
Authors: Колодій Сергій , Гаряга Леся , Кочума Інна
Published: February 2020

Запропоновано концептуальні підходи до забезпечення збалансованості фінансових ресурсів держави. Досліджено сутність і класифікацію збалансованості фінансових ресурсів держави. Збалансованість фінансових ресурсів держави пропонується трактувати як відповідність між сукупністю грошових засобів, що надійшли в розпорядження центральних і місцевих органів виконавчої влади у процесі формування фінансових ресурсів держави, і сукупністю грошових засобів, що направляються на різні цілі під час їхнього використання. Індикаторами збалансованості фінансових ресурсів держави визначено: баланс зведеного бюджету; обсяг державного боргу; залишок коштів на Єдиному казначейському рахунку (ЄКР). Обґрунтовано основні загальні та спеціальні положення концепції інституціонального регулювання збалансованості фінансових ресурсів держави. Детально  охарактеризовано окремі аспекти спеціальних положень концепції інституціонального регулювання збалансованості фінансових ресурсів держави. Виділено ключові проблеми формування, виконання, збалансування і забезпечення безперебійного фінансування фінансових ресурсів держави. Розроблено пропозиції щодо вжиття заходів і використання відповідних інструментів для вдосконалення управління фінансовими ресурсами держави.
ТЕОРІЇ КУРСОУТВОРЕННЯ ЯК ОСНОВА ПОЛІТИКИ ОБМІННОГО КУРСУ
Authors: Швець Наталія , Полагнин Дмитро
Published: February 2020

Проблеми визначення оптимального валютного курсу і прогнозування його впливу на економічні процеси вимагають пошуку нових підходів до дослідження фундаментальних і прикладних моделей курсоутворення в умовах сфери впливу різних інтересів суб’єктів економічних відносин. З методологічного погляду, для вивчення теорій валютного курсу в процесі реалізації валютно-курсової політики можна використовувати різні підходи. Розглянуто політичний та емпіричний підходи до використання теорій курсоутворення. Зазначено переваги і недоліки кожного окремого підходу і його вплив на політику обмінного курсу. Описано теоретичні моделі формування валютного курсу, його прогнозування в короткостроковому і довгостроковому періодах. Окремо зазначено покоління моделей, які пояснюють валютні кризи. Означено проблеми дослідження курсоутворення в контексті виникнення взаємовиключних ідей. Доведено, що на практиці можуть втілюватись ті підходи до курсоутворення, які формуються під певні цілі економічної політики і реалізуються відповідно до умов та інтересів.
ЗАСТОСУВАННЯ ВЕНЧУРНОГО ІНСТРУМЕНТАРІЮ БЕТТИНГОВИХ СТАРТАПІВ В ІНВЕСТУВАННІ ГАЛУЗЕЙ ІННОВАЦІЙНОГО ЕНЕРГОПОСТАЧАННЯ
Authors: Паньків Олег
Published: February 2020

Розглянуто теоретико-методологічні засади перспективних управлінських рішень щодо ефективності залучень фінансових ресурсів, а також щодо ініціювання i безпосереднього створення принципово нових джерел фінансування розвитку енергоорієнтованих стартапів. Визначено роль і місце галузей інноваційного енергозбереження та альтернативних джерел енергопостачання у складній системі енергонезалежності країни. Окреслено шлях та основні напрями дослідження і розробки моделей вирішення вищезазначеної задачі. У рамках пошуку оптимізаційних рішень запропоновано використовувати принципи наявного статистично-математичного апарату, маркетингових досягнень і досягнень у мережевому розвитку, які мають місце у прогнозно-ігровому (букмекерсько-біржовому) бізнесі. Проведено аналогове порівняння принципових моделей, у ході якого визначено наявні типи енергоорієнтованих стартапів. Запропоновано також окремий напрям у рамках економічного пошуку, сформульовано його профільні ознаки. Розглянуто тип моделі, властивої для умов України. В основі пошуку і дослідження покладено запропонований автором метод порівняння стратегій із залучення фінансових ресурсів у ігровий бізнес, природа якого має подібний процес щодо математичного дослідження операцій. Для розв’язання досліджуваної задачі запропоновано застосувати властивість закону емерджентності. Аналіз проведено на конкретному прикладі функціонування тендерної процедури, а саме організації державних закупівель. За принципом аукціонно-змагального характеру «на пониження» з обов’язковим дотриманням емерджентно-орієнтованих вимог розглянуто імітаційну модель вирішення досліджуваної теми. Ціллю статті є розгляд і аналіз пропозиції автора щодо звернення окремої уваги на таке важливе явище, як постійне утворення різниці між очікуваною ціною та кінцевою договірною ціною. В основу моделі розв’язку покладено системне поєднання цього явища з адміністративним стимулюванням упроваджень і реалізацій виключно енергоінноваційних проєктів. Поєднанняцих двох моментів покладено в основу оптимізаційної політики потенційного формування і ведення державної програми щодо пошуку та стимулювання джерел фінансування енергостартапів.
УДОСКОНАЛЕННЯ ІННОВАЦІЙНИХ СТРАТЕГІЙ РОЗВИТКУ БАНКУ
Authors: Ковальчук Вероніка , Орліков Дмитро , Орлікова Вікторія
Published: February 2020

Для побудови банку майбутнього важливим є забезпечення ефективної інноваційної діяльності банків. Метою статті є дослідження теоретико-методичних засад системи управління стратегічним розвитком банку і формування науково-практичних рекомендацій щодо підвищення ефективності інноваційної діяльності сучасного банку. Проаналізовано види і напрями застосування цифрових технологій, готовність персоналу ефективно реалізовувати цифрову модель розвитку банку. Установлено, що банки переживають революцію в галузі продуктів, послуг і способів їх надання, технологій ідентифікації клієнтів і зв’язку, біометричних технологій для підвищення рівня безпеки і надійності ідентифікації. Тому банк майбутнього — це такий банк, який добре розуміє потреби своїх клієнтів, активно розробляє і впроваджує технології безконтактного локально орієнтованого сервісу і має бездоганну організацію служби бек-офісу, пропонуючи своїм клієнтам обслуговування дистанційно та через інноваційні філії / відділення. Запропоновано формування інноваційної стратегії в напрямі Банк 3.0 як найефективніший спосіб досягнення максимального розвитку банківської установи в сучасних умовах.
ОСНОВНІ ПІДХОДИ ДО ОРГАНІЗАЦІЇ СИСТЕМИ ВНУТРІШНЬОГО КОНТРОЛЮ У БАНКАХ УКРАЇНИ
Authors: Швець Наталія , Омельчук Ярослав
Published: February 2020

Досліджено передумови для посилення внутрішніх контрольних процедур у банках України. Визначено основні підходи до організації системи внутрішнього контролю в банках України з урахуванням регуляторних вимог Національного банку України. Проаналізовано основні способи і напрями впровадження внутрішніх контрольних процедур у діяльності банківських установ України. Класифіковано основні види внутрішнього контролю, що мають бути регламентовані та впроваджені у діяльності банківських установ. Наведено критерії для оцінки системи внутрішнього контролю банківськими установами і Національним банком України. Розглянуто основні вимоги Положення про організацію системи внутрішнього контролю в банках України і банківських групах, затвердженого Національним банком України 2019 року, зокрема визначено десять основних змін щодо організації внутрішнього контролю, які суттєво вплинуть на діяльність банківських установ України. Проаналізовано компоненти системи внутрішнього контролю і запропоновано основні критерії, що можуть  використовуватись банківськими установами для оцінки якості та ефективності системи внутрішнього контролю.
ПЕРСПЕКТИВИ РОЗВИТКУ СОЦІАЛЬНОГО ІНВЕСТУВАННЯ В БАНКІВСЬКОМУ СЕКТОРІ
Authors: Тяжкороб Ірина , Марканич Тетяна
Published: February 2020

Виділено напрями розвитку соціального інвестування у вітчизняних банках з урахуванням зарубіжного досвіду, які полягають у вдосконаленні механізму державного регулювання процесу соціального інвестування; удосконаленні механізму взаємодії державних, регіональних органів влади і бізнес-структур, зокрема банків, а також удосконаленні механізму соціального інвестування в банківській структурі. Акцентовано увагу на доцільності вдосконалення податкового законодавства, яке регулює благодійництво; ухвалення проєкт-документа «Концепція національної стратегії соціальної відповідальності бізнесу в Україні» та єдиних стандартів нефінансової звітності суб’єктів господарювання; організації ринку зелених облігацій. Наголошено, що для підвищення ефективності менеджменту корпоративної соціальної відповідальності банків доцільними є подальша імплементація принципівкорпоративної соціальної відповідальності, підвищення рівня інформаційної відкритості банків; розширення переліку фінансових послуг банків, обумовлених соціальними та екологічними чинниками.
La heterogeneidad de los agentes inversores en las series de la Bolsa Mexicana de Valores
Authors: Rebollo Catalán David , Vázquez Guillén Xiomara
Published: February 2020

Los agentes que intervienen en un mercado construyen el mercado a su medida, los estudios previos han constatado cómo ciertas características aisladas de los agentes inversores impactan de forma directa en sus decisiones e indirectamente en los precios de las compañías. Desde este punto de vista, el presente trabajo se enfoca en combinar indicadores de los agentes que previamente han demostrado dicho efecto, con el objetivo primordial de caracterizar de forma compleja a las series. Un segundo propósito fue identificar cuáles de estos indicadores intervienen en la volatilidad de los rendimientos de los títulos. Se consideró una muestra de 1116 agentes inversores participantes en 84 series de la Bolsa Mexicana de Valores (BMV); los resultados mostraron tres tipos diferentes de series, y tres indicadores con impacto significativo en la volatilidad de los rendimientos de las series: el nivel de participación de los agentes en las series la tipología de agentes familiares y la proximidad cultural del agente. Los resultados del estudio aportan información relevante sobre cómo la estructura y composición compleja de los agentes inversores participantes impacta en el comportamiento de las series de la BMV.