Banking risk and regulation: Does one size fit all?

Using data for more than 200 banks from 21 OECD countries for the period 2002 to 2008, we examine the impact of bank regulation and supervision on banking risk. Supervisory control, and regulations on capital and market entry have a significant impact on 'capital and asset risk', while supervisory control and regulations on activities restrictions, private monitoring, market entry, and liquidity, have a significant effect on 'liquidity and market risk'. However, quantile regressions suggest that the effect of regulation and supervision differs across banks: most indicators of bank regulation and supervision do not have a significant effect on low-risk banks, while they do affect high-risk banks.

Functional outcomes of displaced midshaft clavicle fractures treated with precontoured locking compression plates. A prospective observational study.

Background:Displaced midshaft clavicle fractures are common injuries in active adults. Although conservative treatment has been the traditional approach, surgical fixation using precontoured locking compression plates (LCPs) offers potential benefits of anatomical reduction, stable fixation, and early rehabilitation. This study evaluated functional outcomes, union rates, and complications following open reduction and internal fixation with precontoured LCPs.  Methods: A prospective observational study was conducted on 30 patients aged >18 years with displaced midshaft clavicle fractures (Allman Group I) treated at a tertiary care center between April 2018 and September 2019. Open fractures, proximal or distal third fractures, pathological fractures, neurovascular injury, and nonunion cases were excluded. All patients underwent open reduction and internal fixation with precontoured LCPs. Functional outcomes were assessed using the Constant–Murley score at a minimum of 6 months follow-up. Radiological union was confirmed by callus formation and the absence of a fracture line. Data were analyzed descriptively.  Results: The mean age was 37.4 years; males comprised 73.3% of cases (male: female ratio 2.75:1). Road traffic accidents were the predominant cause (70%), and the right clavicle was more frequently involved (60%). The mean union time was 10.33 ± 1.2 weeks, with 90% achieving full shoulder range of motion by 6 months. Constant–Murley scores showed 73.3% excellent, 20.0% good, 3.3% fair, and 3.3% poor outcomes. Good-to-excellent results were achieved in 93.3% of cases. No nonunions or implant failures occurred; minor complications were limited to transient stiffness in 10% of patients.  Conclusion: Precontoured LCP fixation for displaced midshaft clavicle fractures provides high union rates, excellent functional outcomes, and minimal complications. Early mobilization and rigid fixation contribute to favorable results.  Recommendations: Precontoured LCP fixation should be considered in active adults with displaced midshaft clavicle fractures to optimize recovery and reduce disability

Comparison of the Effect of Simulated Gastric Juice on Surface Roughness and Flexural Strength of Three Different Computer Aided Designing Computer Aided Manufacturing Blocks: An In Vitro Study

Purpose: To evaluate the effect of simulated gastric juice on surface roughness and flexural strength of three different CAD/CAM blocks. Materials and Methods: Resin based ceramic (RBC Group), High impact polymer composite (HIPC Group) and Zirconia (Z Group) as 3 groups were considered for the study (90 samples, 30 samples per group). In each group, 10 samples were evaluated without immersion in gastric juice (Baseline). Remaining 20 samples were immersed for total of 24 hours in simulated gastric juice (pH 1.2). The surface roughness and flexural strength of samples was evaluated at the end of 6 hours and 24 hours. This was repeated for all groups. The data obtained was subjected to One way and Multivariate ANOVA and Tukey HSD tests. The significance level was fixed at 5% (p<0.05) Results: One way ANOVA showed surface roughness of Z group decreased significantly after acid immersion whereas RBC group and HIPC group showed significant increase in the surface roughness after acid immersion. One way multivariate ANOVA revealed statistically significant differences between the groups. Tukey HSD revealed a significant difference from base line to 24 hours across all groups.  The surface changes were not significant between 6 hours to 24 hours in Z (p=0.261), RBC (p=0.797), HIPC (p=0.401) and baseline to 6 hours in HIPC group (p=0.397). The flexural strength of all the groups decreased significantly after acid immersion. The change in flexural strength from baseline to 6 hours was not significant in RBC (p=0.123) and HIPC groups (p=0.126) and 6 hours to 24 hours in RBC group (p=0.096). Z group showed a significant reduction from baseline to 6, 6 to 24 and baseline to 24 hrs. RBC and HIPC showed significant reduction from baseline to 24 hrs; and HIPC from 6 to 24 hrs Conclusion: Resin based ceramic is a suitable material in terms of flexural strength and surface roughness in gastric acid regurgitation, followed by Zirconia as the surface roughness does not increase from the baseline. High impact polymer composite can be a suitable restorative material in severe abrasion and erosion cases as it is least affected by acid in terms of roughness

Study of effect of sildenafil citrate in pregnant women with intrauterine growth restriction/oligohydramnios

Background: Fetal growth restriction affects up to 8% of all pregnancies with early onset and late onset fetal growth restriction with increased perinatal mortality. The objective of the study was to evaluate the effectiveness of Sildenafil citrate, the type 5 phosphodiesterase inhibitor which dilates myometrial arteries and improves uterine blood flow.Methods: 100 pregnant women with severe early and late onset fetal growth restriction and oligohydramnios, from 2012 to 2015 at Hassan institute of medical sciences, Karnataka, India were selected for the study. Intervention included the administration of Sildenafil citrate 25mg three times daily until delivery and the major outcome variables were Doppler studies of Uterine artery, umbilical artery, MCA and ductus venosus, Amniotic fluid volume and gestational age. Pregnant women were in the age group of 18-36 years and between 22 -34 weeks of gestational age at the time of recruitment into the study. All the subjects were given intervention and monitored for primary outcome variables once in fifteen days with fetal Doppler and ultrasound techniques.Results: Among the subjects students 2% resulted in stillbirths, 98% retained in the study up to delivery and 80% followed up to three years following delivery. Majority of the women (60%) in the 30 weeks of gestational age and 10% among 22 weeks and 30% between 32-36 weeks of gestation age showed USG abnormalities respectively. Among the USG abnormalities IUGR was found among 70% of women and 30% were found with oligohydramnios before intervention and became 0% and 10% after intervention respectively (p<0.005).Conclusions: Study concludes that Sildenafil citrate would be useful to improve perinatal outcome in women with IUGR both early onset and late onset and Oligomnios

Testicular shielding in penile brachytherapy

Abstract Purpose: Penile cancer, although rare, is one of the common genitourinary cancers in India affecting mostly aged uncircumcised males. For patients presenting with small superficial lesions &lt; 3 cm restricted to glans, surgery, radical external radiation or brachytherapy may be offered, the latter being preferred as it allows organ and function preservation. In patients receiving brachytherapy, testicular morbidity is not commonly addressed. With an aim to minimize and document the doses to testis after adequate shielding during radical interstitial brachytherapy for penile cancers, we undertook this study in 2 patients undergoing brachytherapy and forms the basis of this report. Material and methods: Two patients with early stage penile cancer limited to the glans were treated with radical high-dose-rate (HDR) brachytherapy using interstitial implant. A total of 7-8 tubes were implanted in two planes, parallel to the penile shaft. A total dose of 44-48 Gy (55-60 Gy EQD2 doses with α/β = 10) was delivered in 11-12 fractions of 4 Gy each delivered twice daily. Lead sheets adding to 11 mm (4-5 half value layer) were interposed between the penile shaft and scrotum. The testicular dose was measured using thermoluminescent dosimeters. For each patient, dosimetry was done for 3 fractions and mean calculated. Results: The cumulative testicular dose to left and right testis was 31.68 cGy and 42.79 cGy for patient A, and 21.96 cGy and 23.28 cGy for patient B. For the same patients, the mean cumulative dose measured at the posterior aspect of penile shaft was 722.15 cGy and 807.72 cGy, amounting to 16.4% and 16.8% of the prescribed dose. Hence, the application of lead shield 11 mm thick reduced testicular dose from 722-808 cGy to 21.96-42.57 cGy, an &quot;absolute reduction&quot; of 95.99 ± 1.5%. Conclusions: With the use of a simple lead shield as described, we were able to effectively reduce testicular dose from &quot;spermicidal&quot; range to &quot;oligospermic&quot; range with possible reversibility

EVALUATING THE THERAPEUTIC POTENTIAL OF PRP THERAPY IN KNEE JOINT PAIN MANAGEMENT: A LARGE-SCALE STUDY

Background: Degenerative conditions are the primary causes of chronic knee joint pain and pose a major challenge for long-term management. Platelet-Rich Plasma (PRP) therapy, based on autologous growth factors, has attracted attention as an alternative to conventional treatments.Methods: This is a randomized controlled trial where the efficacy and safety of PRP therapy in 1,000 patients suffering from knee joint pain were assessed over a follow-up period of four to five years. Patients were divided into two groups: PRP and placebo (saline), with treatments administered at the initial visit and at one and two months.Results: The VAS and WOMAC score of the PRP group showed significant and sustained improvements over the placebo group, and the results were obvious to last longer. Even though minor adverse events like pain and swelling at the injection site were found to occur more in the PRP group, they have been manageable.Conclusion: With a long period, PRP therapy proved to be effective for reducing the pain and improving the functionality of the joints offering an upward, long-term benefit for chronic knee pain management. Strong results from the study support the wide clinical application of PRP, which can significantly enhance the quality of life in patients

Plasmodium vivax myocarditis in a child

We report the first documented case of myocarditis associated with Plasmodium vivax malaria in a child who presented with features of cerebral malaria. Clinical features of shock developing in a patient of severe Plasmodium vivax malaria, especially with stable haematocrit, should be investigated by electrocardiogram and/ or cardiac enzymes and echocardiogarphy to rule out myocarditis

Carbuncle in Diabetics-Our Experience

Abstract: Carbuncle is an uncommon skin and soft tissue infection, predominantly occurring in diabetics. It is quite surprising that there are very few series on carbuncle over last 2-3 decades. The aim of this study is to provide our experience on carbuncle in diabetics. Majority of the carbuncles occur over the nape of the neck (40%). Most patients present to the hospital 2 weeks after the onset of the symptoms. Our study shows that staphylococcus aureus continues to be the commonest bacteria isolated. There is no mortality in this series

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ABSTRACT. Objective. To put forward a new concept -Blau arteritis, a form of large-vessel vasculitis phenotypically related to Takayasu disease but genetically and clinically part of an expanded phenotype of Blau syndrome. Methods. We provide a clinical description of a new case and summarize previously published cases of arteritis associated with Blau syndrome. Genetic testing was performed by direct sequencing of exon 4 of the NOD2 gene. Results. The case described and those reviewed from the literature demonstrate the emerging phenotype of Takayasu-like arteritis in patients with Blau syndrome. Although most patients described to date depict an otherwise classic Blau syndrome phenotype, the current case was atypical in that the predominant features were arteritic. A novel substitution, G464W, in a highly conserved position near the nucleotide oligomerization domain of the NOD2 protein is also described. Blau syndrome is a monogenic granulomatous disease characterized in its most typical form by a triad of exuberant polyarthritis, uveitis, and granulomatous dermatitis 1 . It is caused by single amino acid substitutions at or near the NACHT domain of NOD2 2 . Although its systemic expression is well recognized after the descriptions of the expanded phenotype of Blau syndrome 3,4 , large-vessel vasculitis remains one of its serious and yet underrecognized manifestations if not actively sought by the treating physician. We describe an 8-year-old girl with symptomatic Takayasu-like arteritis and cardiomyopathy against the background of Blau syndrome with a G464W substitution in NOD2. We reported a similar case in 1989 5 , while others have observed arteritis among children with both sporadic and familial Blau phenotype before the mutation was known MATERIALS AND METHODS A girl, now 11 years old, from rural India, presented to us for the first time at 18 months of age, with bilateral knee effusions of a few months&apos; duration in the absence of rash, uveitis, or systemic features. From the age of 1 month she had had recurrent and unexplained episodes of fever. Her antinuclear antibody result was negative. With a working diagnosis of oligoarticular juvenile arthritis she was administered intraarticular steroids, to which she responded well. She was lost to followup for almost 6 years thereafter. At the age of 8 years, she presented with gradually progressive dyspnea and palpitations of 3 months&apos; duration. She had not thrived, and at this stage she weighed 17.2 kg and her height was 113 cm. There were no systemic features but joint examination showed &quot;boggy synovitis&quot; of the right elbow and knee. Cardiovascular examination showed an irregular pulse with a pulsatile precordium and evidence of congestive heart failure. A rhythm strip on electrocardiography showed ventricular extra beats. The echocardiogram revealed dilated ventricles, generalized hypokinesia with an ejection fraction of 20%, mild tricuspid and aortic regurgitation, and abnormal echogenicity within the wall of the left ventricle. With oligoarticular arthritis in a setting of dilated cardiomyopathy, elevated erythrocyte sedimentation rate, and family history of recurrent unexplained fevers in her mother, a diagnosis of early-onset sarcoidosis was considered. Her eye examination continued to be normal and all biopsies requiring sedation were deferred because of poor cardiac function. Oral methotrexate 10 mg/m 2 and corticosteroids 2 mg/kg were initiated in addition to decongestive treatment consisting of digitalis, diuretics, and captopril. She showed a gradual but steady improvement in effort tolerance, although her ejection fraction on electrocardiography did not mirror her clinical improvement. One and a half years later on a routine followup she was found to be hypertensive. Her carotid pulsations were decreased and a renal bruit was detected. Antihypertensive treatment was instituted and a compute