Sensitivity analysis of scenario models for operational risk Advanced Measurement Approach

Scenario Analysis (SA) plays a key role in determination of operational risk capital under Basel II Advanced Measurement Approach. However, operational risk capital based on scenario data may exhibit high sensitivity or wrong-way sensitivity to scenario inputs. In this paper, we first discuss scenario generation using quantile approach and parameter estimation using quantile matching. Then we use single-loss approximation (SLA) to examine sensitivity of scenario based capital to scenario inputs

The study of thyroid profile in abnormal uterine bleeding at tertiary care center, Rajasthan, India

Background: Hypothyroidism and Hyperthyroidism leads to menstrual irregularities. Females with thyroid gland abnormality have chances of reproductive abnormalities ranging from abnormal sexual development, menstrual irregularities, infertility and premature menopause. The objectives were to study the association between thyroid dysfunction and AUB in the reproductive age group (18-45 years), To study the thyroid abnormalities in different types of AUB in the reproductive age group, to establish if screening for thyroid abnormalities is justified using T3, T4 and TSH.Methods: This cross-sectional study conducted among 250 women with ‘abnormal uterine bleeding’ (AUB). Inclusion criteria for participants were females in the age group of 18-45 years, females presenting with abnormal uterine bleeding, with thyroid dysfunction, females who do not have signs of demonstrable pelvic pathologyincluding PID.Results: Majority of the patients belonged to the age group of 24 - 32 years i.e.56.8%, 9.2% cases were nullipara, 44.0% cases have menorrhagia, 32.2% have oliogomennorrhea, 19.6% have amenorrhea. Around 3.6% had Thyromegaly, 12.4% have weight gain in hypothyroidism, 28.4% have fatigue in hyperthyroidism, 6.8% cases have higher T4 level, 18.0% cases have higher TSH level.Conclusions: The risk of progression to overt hypothyroidism (about 5% per year) in patients with subclinical disease and the cost-benefit ratio also emphasises the need for selective screening. Early detection of subclinical disease by selective screening facilitates appropriate therapy early in the course of the disease

Carbamazepine-induced Stevens Johnson syndrome: a case series of three case reports

Carbamazepine is an iminostilbene derivative that was initially used as an antiepileptic but has been used with increased frequency for different indications including chronic pain, trigeminal neuralgia, and herpetic neuralgias. This has resulted in increased incidence of carbamazepine related adverse effects such as nausea, vomiting, and serious hematological toxicities such as aplastic anemia, agranulocytosis, eosinophilia, lymphadenopathy, and splenomegaly. Life-threatening hypersensitivity reactions such as Steven Johnson syndrome (SJS) and toxic epidermal necrolysis can also occur. We hereby present a series of three cases that were prescribed carbamazepine for different indications and presented with SJS

Allopurinol inappropriate use in case of asymptomatic hyperuricemic patient causes fatal Allopurinol hypersensitive syndrome: lesson to all

Allopurinol is used to treat hyperuricemia (HU) in a patient of gout. It is also used to prevent HU in a patient of hematological malignancies who are about to undergo chemotherapy. Allopurinol is usually well-tolerated but it occasionally induces hypersensitivity reactions that manifest after few months of therapy. Cutaneous reactions are pruritic, erythematous, or maculopapular eruptions. Rarely fatal toxic epidermal necrolysis or Stevens-Johnson syndrome may occur. Transient leukopenia or leukocytosis, eosinophilia and elevated transaminases may also occur. HU is not a disease in itself. Its level is highly variable in the general population. Uric acid level is influenced by many factors such as dietary intake of proteins, hypertension, and obesity. Only very rarely patients of AHU may progress to gout and renal stones. Not much data is available that support HU alone in an asymptomatic patient in later life shows the diseases which are associated with HU. Sometimes only lifestyle changes, diet restrictions, alcohol restrictions, and treatment of underlying acquired cause may correct HU. Here, we are presenting a rare case of allopurinol hypersensitivity syndrome in an AHU patient. Our aim is to raise awareness among physicians so that they avoid using unnecessarily allopurinol in AHU patients and also titrate the dose of allopurinol in patients of renal failure. Risk-benefit ratio must be considered in these patients before starting allopurinol

A case of nevirapine-induced exfoliative dermatitis in an immunocompromised patient: a case report

Nevirapine is a non-nucleoside reverse transcriptase inhibitor used as one of the first-line drugs for the highly active antiretroviral therapy (HAART) in human immunodeficiency virus positive patients. The side effects range from skin rashes to fulminant hepatotoxicity. The most of the side effects are manifested in the first 6-10 weeks indicating a need for close monitoring and follow-up of the patient in first few weeks. We hereby are presenting a case of a 41-year-old female who developed exfoliative dermatitis after 4 weeks of therapy

Impact of co-morbidities in COVID -19 infected patients

Background- During the COVID- 19 pandemic in the first wave, infected patients age was range from 4 weeks to 90 years and those who have more age and with comorbidities are more susceptible to develop serious illness and have high mortality rates. Objective-To study the association between survivor vs non survivor on the basis of demographic profile and high risk factors. Material & methods: This study was done in the Government Medical College, Kannauj on the COVID-19 patients who were admitted in the isolation wards, from 1st September 2020 to December 31st 2020. Statistical Analysis- Analysis was done using SPSS- 23 trial version software. Results: case fatality rate was 2.7% in this study. Most common symptoms was cough (61.0%) and among these admitted patients the most common comorbidities was hypertension (26.7%), followed by diabetes (20.7%), and COPD (14.0%) respectively. Platelets (< 0.02), post prandial blood sugar (PPBS) (< 0.01) have significant role in survivability of COVID- 19 patients. Conclusion: This study concludes that those patients who were older in age and with comorbidity especially (hypertension, COPD, high PPBS, High platelets) have poorer prognosis as compare to those without

Comparison of intravenous Magnesium Sulphate with intrathecal Magnesium Sulphate for post- operative analgesia in orthopaedic patients undergoing extracapsular hip fracture surgery

Background: Magnesium sulphate (MgSO4) N methyl D aspartate receptor antagonist has the potential to be an ideal adjuvant for postoperative analgesia via intrathecal or intravenous route. The aim of the study was, we compared the efficacy of two routes of MgSO4 (Intravenous vs intrathecal) as an adjuvant to bupivacaine in subarachnoid block (SAB).Methods: Ninety, American Society of Anesthesiologists physical status 1 or 2 patients, aged 20-60 years, scheduled for hip surgeries under SAB were recruited in department of Anaesthesia and Dept. of Orthopaedics. Patients in group 1 (n=29) received intrathecal 0.5% (H) bupivacaine 15 mg with 0.1 ml of normal saline and 250 ml 0.9% normal saline intravenous 30 minutes before giving SAB. Group 2 (n=30) patients received intrathecal 0.5% bupivacaine 15mg with 0.1 ml of normal saline and 50mg/kg of magnesium sulphate in 250 ml normal saline intravenous 30minutes before giving SAB. In Group 3 (n=30) patients received intrathecal 0.5% (H) bupivacaine 15 mg with 50mg (0.1ml) magnesium sulphate and 250 ml 0.9% normal saline intravenous 30 minutes before giving SAB. They were evaluated for block characteristics, visual analogue scale at various time intervals up to 24 hours and total rescue analgesic and duration of postoperative analgesia were noted.Results: Intravenous magnesium sulphate had maximum pain free interval, lower pain scores, longer sensory and motor blockade and less requirement of rescue analgesia as compared to the patients in intrathecal group or control group (P<0.05).Conclusions: Intravenous magnesium sulphate was more effective as compared to intrathecal route with regards to the pain scores and in providing postoperative analgesia

Assessment of burn-out among staff nurses working in a tertiary care health centre in North India

Background: This descriptive, cross sectional study identified the occurrence of burnout and some associated factors among nurses working in various departments at Indira Gandhi Medical College, Shimla, Himachal Pradesh, India which is a tertiary care health centre in the state.Methods: A total of 257 nurses screened in the hospital out of which 81 completed the study. Eighty-one nurses answered a self-administered questionnaire (sociodemographic aspects, working conditions, and Maslach Burnout Inventory). Mean scores were compared using ANOVA test. Student T-test was applied to compare mean scores between the groups.Results: All the participants were females (100%), with up to five years’ experience. High levels of emotional stress (45.7%) and depersonalization (24.7%) were identified, as well as low professional fulfilment (6.2%), and 8.6% presented burnout. The following factors were associated: high levels of emotional stress and always perform tasks very quickly (p=0.04) and receiving a salary incompatible to the effort employed (p=0.03); high levels of depersonalization and with up to five years’ experience (p=0.02) and often perform tasks very quickly (p=0.008). For 19.0%, at least two of the three dimensions pointed to high propensity to the syndrome.Conclusions: Searching for personal solutions for work problems must draw our attention, since it discourages health and work performance. Professionals may feel more fulfilled and satisfied by adjusting their work expectations. However, on a long-term basis, persisting in stressful work conditions enhances emotional exhaustion, depersonalization and feelings of low fulfilment at work

Effect of epidural volume extension with colloid on dose requirement for intrathecal spinal block: a double blind prospective study

Background: Epidural volume extension (EVE) is a modification of combined- spinal epidural anaesthesia (CSEA) in which fluid is injected in epidural space after the intrathecal block. Fluid in epidural space compress subarachnoid space and causes cephalic spread of intrathecal drug to increase block height. Purpose of study is to determine efficacy of EVE on dose requirement of intrathecal bupivacaine when colloid was used for EVE.Methods: Sixty patients of ASA physical status I or II, scheduled for elective caesarean sections were recruited and randomized into two groups (30 each group). Group 1: CSEA in which spinal block is followed by 10 ml Colloid (HES 6%) in epidural space; Group 2: CSEA but no fluid in epidural space. Onset of sensory block and hemodynamic variables were measured at 5 min. intervals up to 40 minutes then at 10 min. intervals till end of surgery. Ineffective block was top- up by epidural 0.5% bupivacaine in incremental doses.Results: Median effective dose of intrathecal bupivacaine was significantly lower, 4.0 mg (95% CI 4.40-5.60) in group 1 versus 7.0 mg (95% CI 6.93-7.61) in group 2. Only 11 patients required ephedrine in group 1 versus 20 in group 2. Requirement of ephedrine was significantly lower 2.20 (±2.94) mg in group 1 versus 4.0 (±2.88) mg groups 2. Changes in haemodynamic variables from baseline were significantly lower in group 1 than those in group 2.Conclusions: EVE with colloid was effective in lowering dose requirement of spinal bupivacaine while patients hemodynamically were more stable.

Constraining X-ray variability of the blazar 3C 273 using XMM-Newton observations over two decades

Blazars exhibit relentless variability across diverse spatial and temporal frequencies. The study of long- and short-term variability properties observed in the X-ray band provides insights into the inner workings of the central engine. In this work, we present timing and spectral analyses of the blazar 3C 273 using the X-ray observations from the $\textit{XMM-Newton}$ telescope covering the period from 2000 to 2020. The methods of timing analyses include estimation of fractional variability, long- and short-term flux distribution, rms-flux relation, and power spectral density analysis. The spectral analysis include estimating a model independent flux hardness ratio and fitting the observations with multiplicative and additive spectral models such as \textit{power-law}, \textit{log-parabola}, \textit{broken power-law}, and \textit{black body}. The \textit{black body} represents the thermal emission from the accretion disk, while the other models represent the possible energy distributions of the particles emitting synchrotron radiation in the jet. During the past two decades, the source flux changed by of a factor of three, with a considerable fractional variability of 27\%. However, the intraday variation was found to be moderate. Flux distributions of the individual observations were consistent with a normal or log-normal distribution, while the overall flux distribution including entire observations appear to be rather multi-modal and of a complex shape. The spectral analyses indicate that \textit{log-parabola} added with a \textit{black body} gives the best fit for most of the observations. The results indicate a complex scenario in which the variability can be attributed to the intricate interaction between the disk/corona system and the jet.Comment: 18 pages, 8 figures, ApJ accepte