Acute bilirubin encephalopathy in term neonates: a hospital-based study

Background: Acute Bilirubin Encephalopathy and kernicterus is an important cause of cerebral palsy, developmental delay and hearing impairment in low-middle income countries. Interventions such as universal screening for neonatal jaundice, Rhesus immunoglobulins, intensive phototherapy and exchange transfusion have made kernicterus rare in high income countries, but in our set up such cases continue to be reported.  Methods: Retrospective observational study where case records of term neonates brought to the neonatal ICU with signs and symptoms of acute bilirubin encephalopathy during the years 2016 and 2017 were sought and analysed.Results: A total of ten term babies reported to the neonatal unit with severe hyperbilirubinemia along with signs and symptoms of bilirubin encephalopathy of which 60% were females. 90% had a birth weight of more than 2.5 kg and mean birth weight was 2.7±0.25 kgs. All the babies were out born. A 4 babies were born at home of which 3 pregnancies were completely unsupervised during the antenatal period. 90% of the babies were from the rural areas, 6 of the cases were from the districts Rajouri, Poonch and Reasi where the terrain is hilly, 2 from rural areas of Jammu and 1 from Kathua. Only 1 was from the Jammu city. The age at admission ranged from 3-9 days and serum bilirubin from 24 to 43.3 mg %. A 5 babies had ABO incompatibility, 1 Rh incompatibility, 1 sepsis, while no cause could be found in 3.Conclusions: Neonatal jaundice is often not easily appreciated by mothers and caregivers in the home setting until it becomes severe enough, at which point neurological damage may have already occurred. There is an urgent need to train the primary health care personnel in assessment and early identification of risk factors for severe neonatal hyperbilirubinemia. They can help the families to seek prompt treatment for this preventable cause of cerebral palsy and mental retardation

Vascular patterns on narrow band imaging (NBI) video bronchoscopy of lung cancer patients and its relationship with histology: an analytical cross-sectional study

Introduction: Narrow band imaging (NBI) video bronchoscopy provides better visualisation of submucosal vascular patterns in malignant airway lesions compared to white light bronchoscopy. This analytical cross-sectional study was aimed to look for any relationship between these NBI vascular patterns and the histologic type of lung cancer.Material and methods: After screening 78 patients with suspected lung cancer, 53 subjects underwent video bronchoscopy. Thirty-two patients showing abnormal bronchial mucosa or endobronchial growth with any of the NBI vascular patterns on bronchoscopy were enrolled in the study. These abnormal areas were then biopsied and sent for histologic examination.Results: NBI bronchoscopy revealed a dilated tortuous vascular pattern in 54.8% of the patients, a non-specific pattern in 32%, a dotted pattern in 9.7% and an abrupt ending vessels pattern in 3.2% of the patients. We did not find any statistically significant relationship between a dilated tortuous pattern and squamous-cell carcinoma (p = 0.48), adenocarcinoma (p = 0.667) or small-cell carcinoma (p = 1); between a dotted pattern and squamous-cell carcinoma (p = 1), adenocarcinoma (p = 0.54) or small-cell carcinoma (p = 1), and between an abrupt ending capillary pattern and squamous-cell carcinoma (p = 1), adenocarcinoma (p = 1) or small-cell carcinoma (p =1).Conclusion: No relationship exists between NBI vascular patterns and the histology of lung cancer. Endobronchial lesions showing any vascular pattern on NBI needs to be adequately sampled for proper histologic and molecular studies in lung cancer patients

A prospective study of OAR volume variations between two different treatment planning systems in radiotherapy

Purpose: It has been seen that there is a clinically significant variation in the volume calculated across different planning systems for the same digital imaging and communication (DICOM) contours.The purpose of this study is to investigate the difference in volumes of organs at risk when the structure sets were exported from the Eclipse ((Palo Alto, USA Version 10.0) to XIO CMS (Electa, Crawley, UK Version 4.40.00) treatment planning system (TPS) and identify how the differences occur. Methods: We prospectively analyzed the volumes of organs at risk from computerized tomography (CT) data of 54 patients. Head and neck and brain tumors were taken for this study and contoured on Eclipse treatment planning system (TPS) after importing images from CT. These contoured images were then exported using radiotherapy DICOM transfer facility to XIO CMS planning system and compared the contoured volumes with Eclipse TPS structured volumes. Results: Our analysis showed that the differences in calculated volumes of the contours for the patients between the two planning systems can be large. Mixed results are shown for different organs with the absolute volume difference ranging from -0.25 cc to 319.73 cc. These results clearly shown that the two TPS interprets the contours differently when calculating the volume, and there is a closer match with the theoretical calculated volumes with XIO CMS calculated volumes. Conclusion: Observed discrepancies were consistent between the two planning systems. This impact of contouring variability could play a role on plan quality metrics which is used as criteria for clinical trial protocol compliance

A prospective study of OAR volume variations between two different treatment planning systems in radiotherapy

Purpose: It has been seen that there is a clinically significant variation in the volume calculated across different planning systems for the same digital imaging and communication (DICOM) contours.The purpose of this study is to investigate the difference in volumes of organs at risk when the structure sets were exported from the Eclipse ((Palo Alto, USA Version 10.0) to XIO CMS (Electa, Crawley, UK Version 4.40.00) treatment planning system (TPS) and identify how the differences occur. Methods: We prospectively analyzed the volumes of organs at risk from computerized tomography (CT) data of 54 patients. Head and neck and brain tumors were taken for this study and contoured on Eclipse treatment planning system (TPS) after importing images from CT. These contoured images were then exported using radiotherapy DICOM transfer facility to XIO CMS planning system and compared the contoured volumes with Eclipse TPS structured volumes. Results: Our analysis showed that the differences in calculated volumes of the contours for the patients between the two planning systems can be large. Mixed results are shown for different organs with the absolute volume difference ranging from -0.25 cc to 319.73 cc. These results clearly shown that the two TPS interprets the contours differently when calculating the volume, and there is a closer match with the theoretical calculated volumes with XIO CMS calculated volumes. Conclusion: Observed discrepancies were consistent between the two planning systems. This impact of contouring variability could play a role on plan quality metrics which is used as criteria for clinical trial protocol compliance.</p

High-spin spectroscopy in 207^{207}At: Evidence of a 29/2+^{+} isomeric state

Yrast and near-yrast states above the known 25/2$^{+}$ isomer in $^{207}$At are established for the first time. The level scheme is extended up to 47/2$\hbar$ and 6.5 MeV with the addition of about 60 new $\gamma$-ray transitions. The half-life of the 25/2$^{+}$ isomer is revisited and a value of $T_{1/2}$ = 107.5(9) ns is deduced. Evidence of a hitherto unobserved 29/2$^{+}$ isomer in $^{207}$At is presented. A systematic study of $B(E3)$ values for the transitions de-exciting the 29/2$^{+}$ isomer in the neighboring odd-$A$ At isotopes suggests a half-life in the 2$-$4 $\mu$s range for this state in $^{207}$At. The experimental results are compared with large-scale shell-model calculations performed using the KHM3Y effective interaction in the $Z$ = 50$-$126, $N$ = 82$-$184 model space and an overall good agreement is noted between the theory and the experiment. A qualitative comparison of the excited states and the isomers with analogous states in neighboring nuclei provides further insight into the structure of $^{207}$At.Comment: 15 pages, 13 figure

Bronchiectasis in India:results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India Registry

BACKGROUND: Bronchiectasis is a common but neglected chronic lung disease. Most epidemiological data are limited to cohorts from Europe and the USA, with few data from low-income and middle-income countries. We therefore aimed to describe the characteristics, severity of disease, microbiology, and treatment of patients with bronchiectasis in India. METHODS: The Indian bronchiectasis registry is a multicentre, prospective, observational cohort study. Adult patients ( 6518 years) with CT-confirmed bronchiectasis were enrolled from 31 centres across India. Patients with bronchiectasis due to cystic fibrosis or traction bronchiectasis associated with another respiratory disorder were excluded. Data were collected at baseline (recruitment) with follow-up visits taking place once per year. Comprehensive clinical data were collected through the European Multicentre Bronchiectasis Audit and Research Collaboration registry platform. Underlying aetiology of bronchiectasis, as well as treatment and risk factors for bronchiectasis were analysed in the Indian bronchiectasis registry. Comparisons of demographics were made with published European and US registries, and quality of care was benchmarked against the 2017 European Respiratory Society guidelines. FINDINGS: From June 1, 2015, to Sept 1, 2017, 2195 patients were enrolled. Marked differences were observed between India, Europe, and the USA. Patients in India were younger (median age 56 years [IQR 41-66] vs the European and US registries; p&lt;0\ub70001]) and more likely to be men (1249 [56\ub79%] of 2195). Previous tuberculosis (780 [35\ub75%] of 2195) was the most frequent underlying cause of bronchiectasis and Pseudomonas aeruginosa was the most common organism in sputum culture (301 [13\ub77%]) in India. Risk factors for exacerbations included being of the male sex (adjusted incidence rate ratio 1\ub717, 95% CI 1\ub703-1\ub732; p=0\ub7015), P aeruginosa infection (1\ub729, 1\ub710-1\ub750; p=0\ub7001), a history of pulmonary tuberculosis (1\ub720, 1\ub707-1\ub734; p=0\ub7002), modified Medical Research Council Dyspnoea score (1\ub732, 1\ub725-1\ub739; p&lt;0\ub70001), daily sputum production (1\ub716, 1\ub703-1\ub730; p=0\ub7013), and radiological severity of disease (1\ub703, 1\ub701-1\ub704; p&lt;0\ub70001). Low adherence to guideline-recommended care was observed; only 388 patients were tested for allergic bronchopulmonary aspergillosis and 82 patients had been tested for immunoglobulins. INTERPRETATION: Patients with bronchiectasis in India have more severe disease and have distinct characteristics from those reported in other countries. This study provides a benchmark to improve quality of care for patients with bronchiectasis in India. FUNDING: EU/European Federation of Pharmaceutical Industries and Associations Innovative Medicines Initiative inhaled Antibiotics in Bronchiectasis and Cystic Fibrosis Consortium, European Respiratory Society, and the British Lung Foundation

Optimasi Portofolio Resiko Menggunakan Model Markowitz MVO Dikaitkan dengan Keterbatasan Manusia dalam Memprediksi Masa Depan dalam Perspektif Al-Qur`an

Risk portfolio on modern finance has become increasingly technical, requiring the use of sophisticated mathematical tools in both research and practice. Since companies cannot insure themselves completely against risk, as human incompetence in predicting the future precisely that written in Al-Quran surah Luqman verse 34, they have to manage it to yield an optimal portfolio. The objective here is to minimize the variance among all portfolios, or alternatively, to maximize expected return among all portfolios that has at least a certain expected return. Furthermore, this study focuses on optimizing risk portfolio so called Markowitz MVO (Mean-Variance Optimization). Some theoretical frameworks for analysis are arithmetic mean, geometric mean, variance, covariance, linear programming, and quadratic programming. Moreover, finding a minimum variance portfolio produces a convex quadratic programming, that is minimizing the objective function ðð¥with constraintsð ð 𥠥 ðandð´ð¥ = ð. The outcome of this research is the solution of optimal risk portofolio in some investments that could be finished smoothly using MATLAB R2007b software together with its graphic analysis

Bose-Einstein correlations of charged hadrons in proton-proton collisions at s\sqrt s = 13 TeV

Bose-Einstein correlations of charged hadrons are measured over a broad multiplicity range, from a few particles up to about 250 reconstructed charged hadrons in proton-proton collisions at $\sqrt{s}$ = 13 TeV. The results are based on data collected using the CMS detector at the LHC during runs with a special low-pileup configuration. Three analysis techniques with different degrees of dependence on simulations are used to remove the non-Bose-Einstein background from the correlation functions. All three methods give consistent results. The measured lengths of homogeneity are studied as functions of particle multiplicity as well as average pair transverse momentum and mass. The results are compared with data from both CMS and ATLAS at $\sqrt{s}$ = 7 TeV, as well as with theoretical predictions.[graphic not available: see fulltext]Bose-Einstein correlations of charged hadrons are measured over a broad multiplicity range, from a few particles up to about 250 reconstructed charged hadrons in proton-proton collisions at $\sqrt{s} =$ 13 TeV. The results are based on data collected using the CMS detector at the LHC during runs with a special low-pileup configuration. Three analysis techniques with different degrees of dependence on simulations are used to remove the non-Bose-Einstein background from the correlation functions. All three methods give consistent results. The measured lengths of homogeneity are studied as functions of particle multiplicity as well as average pair transverse momentum and mass. The results are compared with data from both CMS and ATLAS at $\sqrt{s} =$ 7 TeV, as well as with theoretical predictions

Search for supersymmetry in events with one lepton and multiple jets in proton-proton collisions at root s=13 TeV

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