An analytical study on clinical patterns of herpes zoster in this era

Background: Herpes zoster is a major health burden in all age groups. It is caused by reactivation of varicella zoster virus from dormant form. The immunity that plays a role in this reactivation is cell mediated immunity. Prodromal features like Fever, pain and itch are common before the onset of zoster rash. The most common complication associated with this disease is post-herpetic neuralgia. Complications associated with herpes zoster depend on the age, immune status, and the time of initializing treatment. Treatment with antiviral drugs within 72 hours of onset of rash onset has been shown to reduce severity and complications associated with zoster and the post-herpetic neuralgia.Methods: We analysed 120 cases of herpes zoster patients who attended Dermatology OPD, in Chengalpattu Medical College Hospital from January 2018 to December 2018. The study design was descriptive study. A detailed history taking, thorough clinical examination and appropriate relevant investigations were done.Results: The mean age group of the 120 patients (male-56, female-64) was 35 years. Segmental distribution: Thoracic-60%, cervical-6%, lumbosacral-2%, herpes zoster ophthalmicus-22%, herpes zoster oticus-10%. 34% were diabetic, 2% HIV, 4% following surgery/trauma, 10% on steroid therapy. 13% had history of native treatment. Prodromal symptoms in 34%, post herpetic neuralgia-60%, sepsis in 52%.Conclusions: Herpes zoster occurs in dermatomes in which the rash of varicella achieves highest intensity. Herpes zoster can affect any age group with a higher incidence in elderly patients and in those with immuno-compromised status, treatment with antivirals within 72 hours of onset of rash has shown a reduction in severity and complications.

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A study on clinical characteristics of herpes zoster in a tertiary care center

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20170081 ◽

2017 ◽

Vol 3 (1) ◽

pp. 79

Author(s):

Rachana R. ◽

Shivaswamy K. N. ◽

Anuradha H. V.

Keyword(s):

Herpes Zoster ◽

Clinical Characteristics ◽

Care Center ◽

Tertiary Care ◽

Age Groups ◽

Age Group ◽

Female Ratio ◽

Varicella Zoster ◽

Medical College ◽

Male To Female

Background: Herpes zoster (HZ), also known as shingles, derived from the Latin word Cingulum, for “girdle”. This is because a common presentation of HZ involves a unilateral rash that can wrap around the waist or torso like a girdle. HZ results due to reactivation of an earlier latent infection with the varicella zoster virus (VZV) in dorsal root ganglia. It occurs at all age groups, common over 60 years of age. It is estimated that in non-immune populations, approximately 15 cases per 1000 people occur per year. The objective of the study was to study the clinical characteristics in patients with uncomplicated herpes zoster.Methods: A total of 72 patients attending dermatology OPD at Ramaiah medical college between June 2013 to September 2014 were recruited after obtaining informed consent. A detailed history regarding onset of rash, pain, progression, duration and distribution of the lesions were recorded. Demographic information including age, sex, and any other co morbidities noted. Tzanck smear and serology for HIV was done where-ever necessary.Results: Of the 72 patients, females outnumbered males [M=35(48.61%), F=37 (51.39%)] with male to female ratio of 0.9 to 1. The mean age of presentation was 58±18 years. Majority of the patients (54%) were in the age group of 51 to 70 years followed by 31-50 years (25%). Least number of cases (9%) was in the age group of 21 to 30 years. Of the 72 subjects, thoracic involvement was noted in 30.6%, followed by lumbar (22%), and trigeminal (16%). Cervical (4%) and sacral (2%) involvement was the least. Conclusions: Herpes zoster commonly occurs in old age and the presenting symptom being pain and burning sensation. Thoracic dermatome is the commonest site. Immunocompromised states like diabetes, malignancy and HIV can increase the risk of developing herpes zoster.

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HISTOMORPHOLOGICAL SPECTRUM OF LESIONS OF HYSTERECTOMY SPECIMENS IN GCS MEDICAL COLLEGE, HOSPITALAND RESEARCH CENTER, AHMEDABAD : A STUDY OF 100 CASES

10.36106/ijsr/2320116 ◽

2020 ◽

pp. 80-82

Author(s):

Shweta Shah ◽

S.K. Suri ◽

Ami Shah

Keyword(s):

Retrospective Study ◽

Age Groups ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Medical College Hospital ◽

Research Centre ◽

Age Group ◽

Gynaecological Surgery ◽

College Hospital ◽

Medical College

Background: Most frequently performed gynaecological surgery is hysterectomy. The prevalence of hysterectomy varies within different regions. There are mainly two types of hysterectomies according to which part of uterus is removed. The main types of hysterectomy are total and subtotal or partial hysterectomy. The hysterectomy can be performed by three routes abdominal, laproscopic and vaginal hysterectomy. The main objective of our study is to know most common pathology and different age groups of the patients underwent hysterectomy. Materials and Methods: In this retrospective study was carried during period 6 months, at GCS medical college, hospital and research centre, Ahmedabad. Total 100 hysterectomy specimens were analyzed for histopathological lesions. We had taken the clinical and histopathological findings of these cases from the records of department of pathology, GCS medical college , hospital and research centre. Results: In our study of 100 cases, most common age group underwent hysterectomy was 40-49 years and least common age group was 20-29 years. Type of hysterectomy performed most commonly in this study was total abdominal hysterectomy with bilateral salpingoophorectomy. Most of lesions were seen in the myometrium 42 cases (42%), Endometrium 32 cases (32%), Cervix 16 cases (16%) and Ovary 10 cases (10%). Hysterectomy remains the widely used treatment modality.

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Effectiveness of Live Zoster Vaccine in Preventing Herpes Zoster Ophthalmicus (HZO)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.1035 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S413-S413 ◽

Cited By ~ 1

Author(s):

Laurie Aukes ◽

Joan Bartlett ◽

Bruce Fireman ◽

John Hansen ◽

Edwin Lewis ◽

...

Keyword(s):

Herpes Zoster ◽

Cox Regression ◽

Age Groups ◽

Weighted Average ◽

Care Seeking ◽

Zoster Vaccine ◽

Herpes Zoster Ophthalmicus ◽

Varicella Zoster ◽

Grant Recipient ◽

Restricted Stock

Abstract Background Herpes zoster ophthalmicus (HZO), caused by reactivation of varicella-zoster virus in or around the eye, can be severe and often results in care-seeking that may be less discretionary than for uncomplicated herpes zoster (HZ). We compared the vaccine effectiveness (VE) of live zoster vaccine against HZO with the VE against HZ overall. Methods Kaiser Permanente Northern California (KPNC) members enter the ongoing cohort study when age-eligible for zoster vaccine starting in 2007. Incident HZ was defined as a new diagnosis of HZ with an antiviral prescription or a positive varicella viral test. Among those, an HZO case was defined as having an HZO diagnosis during an ophthalmology visit within 30 days of the initial HZ diagnosis. VE by age at vaccination and time since vaccination was estimated using Cox regression adjusted for age, race, sex and time-varying measures of healthcare use, comorbidities and immunocompromise status. Average VE over the first 5 years following vaccination was calculated as a weighted average of annual VE estimates. Results During 2007–2014, ~1.3 million individuals ≥50 years of age entered the study population and 29% were vaccinated. Among 48,889 incident HZ cases, 2,858 (6%) had HZO, 87% of whom were unvaccinated. For all ages combined, VE against HZO was 72% (95% CI, 64%-79%) in year 1, similar to 68% (95% CI, 65%-70%) against HZ. VE fell in years 2, 3, 4, and 5 to 47%, 45%, 42% and 27% for HZO and to 47%, 39%, 41% and 37% for HZ. For age groups 60 – 69 and 70 – 79, where we have the most data, initial VE and waning were similar for HZO and HZ. Numbers of HZO cases for 50–59 year olds were too small to evaluate at this time. Average VE against HZO over the first 5 years following vaccination was 52% (95% CI, 42%–60%) for ages 60–69, 51% (95% CI, 39%–61%) for ages 70-79, and 39% (95% CI, 14%-57%) for ages 80+; similarly, 5-year average VE against HZ was 49%, 46%, and 44% for these 3 age groups. Conclusion VE against HZO was similar to VE against HZ regardless of age at vaccination or time since vaccination. Effectiveness of live zoster vaccine in preventing HZO was highest in year one with subsequent waning. Disclosures E. Earley, Merck & Co.: Research Contractor, Salary; M. Marks, Merck and Co. Inc.: Employee, Restricted Stock and Salary; P. Saddier, Merck & Co., Inc.: Employee, Salary; N. P. Klein, GSK: Investigator, Grant recipient; sanofi pasteur: Investigator, Grant recipient; Merck & Co.: Investigator, Grant recipient; MedImmune: Investigator, Grant recipient; Protein Science: Investigator, Grant recipient Pfizer: Investigator, Grant recipient

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Sero-prevalence of Transfusion Transmissible Infections among Voluntary Blood Donors of Khulna Medical College Hospital

Bangladesh Medical Journal ◽

10.3329/bmj.v46i2.40212 ◽

2019 ◽

Vol 46 (2) ◽

pp. 16-21 ◽

Cited By ~ 1

Author(s):

SM Tushar Alom ◽

Kanak Jyoti Mondal ◽

Shirin Tarafder ◽

Farah Anjum Sonia ◽

Poritosh Kumar Chowdhury ◽

...

Keyword(s):

Blood Donors ◽

Age Groups ◽

Medical College Hospital ◽

Age Group ◽

College Hospital ◽

Blood Samples ◽

Medical College ◽

Disease Markers ◽

Males And Females ◽

Frequent Infection

Transfusion transmitted infections (TTI) are a great concern of safety for patients. Blood transfusion is a lifesaving procedure but always caries a potential risk of infections.The present study was designed to evaluate the prevalence of infectious disease markers and frequency in males and females of various age groups among healthy blood donors. A retrospective review of donor record over a period of 2 years between 2015 to2016 was done at the department of transfusion medicine Khulna medical college Hospital, Khulna, Bangladesh.Among the total 37,266 donors,358(0.96%) donors were infected and therefore not suitable for blood donations.HBV was found to be the most frequent infection with a total frequency of 0.72% followed by TP (0.20%), HCV (0.03%) and HIV (0.01%). None of the blood samples showed positivity for malarial parasite.Majority of the seropositive donors, (47.96%) were in the age group of 26 to 35 years followed by 29.47% in 18 to 25 years’ age group. Bangladesh Med J. 2017 May; 46 (2): 16-21

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Ear Foreign Body: A Study of 148 Cases

Medicine Today ◽

10.3329/medtoday.v29i2.34617 ◽

2017 ◽

Vol 29 (2) ◽

pp. 5-8

Author(s):

Jahangir Alam Mazumder ◽

Rafiqul Islam Sarker ◽

AHM Delwar ◽

Kamrunnahar

Keyword(s):

Foreign Body ◽

Successful Outcome ◽

Complication Rates ◽

Age Group ◽

College Hospital ◽

Female Ratio ◽

Medical College ◽

History Of ◽

The Right ◽

Time Of Presentation

Ear foreign body is a common ENT emergency and a challenge also to otolaryngologist worldwide. Prompt and appropriate management of it can reduce the morbidity. An observational retrospective study of 148 cases of foreign body in the ear done in Comilla Medical College Hospital and two upazilla health complexes (Nangalkot and Chowddagram) of Bangladesh within the period of January 2014 to December 2014 to evaluate the nature, mode of presentation, technique of removal and outcome of it. Data were collected from hospital records including age, sex of patient and mode and time of presentation, nature of foreign body, management outcome and complication, and the result showed that children o funder 15 year age group were mostly affected (60%), among them highest incidence were in 5-10 year age group (25%) with male to female ratio 1:1.28. The most common foreign body was the seeds of various vegetables (25.67%) followed by plastic beads (18.24%) and cotton bud (15.54%), the right ear affected more (54%). Almost half of them (47.97%) presented with history of insertion of a foreign body and most of them (91.98%) were removed in OPD or emergency department under direct vision and remaining required general anesthesia. Despite a high proportion of cases managed in the office setting, complication rates were within acceptable level. It is inversely proportional to the skill of the personnel, number of attempts &availability of equipment. Key to successful outcome are prompt help by well-trained doctor and otolaryngological equipment set up.Medicine Today 2017 Vol.29(2): 5-8

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Study on Morphological and Clinical Characteristics of Herpes Zoster In A Tertiary Medical College Hospital

Medicine Today ◽

10.3329/medtoday.v22i2.12439 ◽

2012 ◽

Vol 22 (2) ◽

pp. 80-82

Author(s):

Md. Rokon Uddin ◽

Md. Motahar Hossain Bhuyain ◽

Farzana Akhter

Keyword(s):

Socioeconomic Status ◽

Herpes Zoster ◽

Large Scale ◽

Ganglion Cells ◽

Sensory Nerve ◽

College Hospital ◽

Female Ratio ◽

Varicella Zoster ◽

Medical College ◽

Medicine Today

Herpes zoster is caused by reactivation of VZV (varicella zoster virus) following primary infection or vaccination. VZV remains latent in sensory dorsal root ganglion cells. The virus begins to replicate in some later time, traveling down the sensory nerve into the skin. Forty one cases (3 children and 38 adults) of Herpes Zoster were assessed over a period of three and half years. Structured questionnaire, check-list and face-to-face interview were used as tools of data collection. The prevalence of herpes zoster amongst Skin & Eye OPD cases were found 0.60 percent. Maximum cases (23; 63.41%) were above 45 years of age. The male female ratio was 1.4:1.0. By socioeconomic status maximum patient from middle class (13; 31.70%), followed by poor (12; 26.26%) and very poor (11; 26.82%). Prodromal syndrome in maximum cases was paresthesia (13; 31.70%) and pain (11; 26.82%). Cases were mostly presented with pain (35; 85.36%). Twenty-three cases had classic herpes zoster followed by necrotic or ulcerated herpes zoster (16 cases) and hemorrhagic herpes zoster (2 case). Trigeminal dermatome was the most common involvement in 18 cases (43.9%) followed by thoracic dermatome 16 cases (39.02%). Unidermatomal involvement was seen in 97.56% cases (40) followed by multidermatomal 1 case (2.43%). Nine cases were screened for HIV-1 by ELISA, but none was detected as seropositive. . The analysis and findings put this recommendation that large scale study needed to examine the correlation ship between VZV infection and socioeconomic status of patients. Medicine Today 2010 Volume 22 Number 02 Page 80-82 DOI: http://dx.doi.org/10.3329/medtoday.v22i2.12439

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SEX AND AGE WISE DISTRIBUTION, PRESENTATION AND SUCCESSFUL REMOVAL AND MORTALITY OF FOREIGN BODY ASPIRATION USING RIGID BRONCHOSCOPE IN CHILDREN OF DISTRICT D.I.KHAN, PAKISTAN

Gomal Journal of Medical Sciences ◽

10.46903/gjms/18.01.1949 ◽

2020 ◽

Vol 18 (01) ◽

pp. 3-11

Author(s):

Ali Khan ◽

Mohammad Ismail Khan ◽

Muhammad Afaq Ali ◽

Altaf Hussain ◽

Muhammad Ibrahim ◽

...

Keyword(s):

Foreign Body ◽

Age Groups ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Age Group ◽

Mortality And Morbidity ◽

X Ray ◽

Medical College ◽

History Of ◽

Successful Removal

Background: Foreign body aspiration commonly occurs in young children and is associated with high degree of mortality and morbidity. The objectives of this study were to determine epidemiologic, clinical and endoscopic perspectives of foreign body aspiration in children of District D.I.Khan, Pakistan. Materials & Methods: This descriptive study was conducted in Department of ENT, Gomal Medical College/ DHQ Teaching Hospital, D.I.Khan, Pakistan from November 2017-April 2019. 105 children with suspected foreign body (FB) aspiration were included. All patients underwent rigid bronchoscopy under GA. After check X-ray and one day observation, they were discharged. Variables were sex, age in years and age groups, successful removal, mortality, history of FB aspiration, cough, wheezing, choking, stridor, reduced air entry and location of FB. Age in years was numeric, age groups ordinal and all other variables were on nominal scale. Age in years was described by mean & SD and others by count and percentage. Results: The sample with suspected foreign body aspiration (n=105) included 61 (58.1%) boys and 44 (41.9%) girls, with 20 (19.05%) in age group 0-2.0 years, 58 (55.24%) 2.0-5.0 years and 27 (25.71%) 5.0-14 years. Chest X-Ray was done in 98/105 (93.33%) cases. Frequency of successful FB removal by rigid bronchoscopy was 86/105 (81.90%). Mortality was none. Out of 86 confirmed cases, 51 (59.30%) were boys and 35 (40.70%) girls, with 19 (22.10%) in age group 0-2.0 years, 55 (63.95%) 2.0-5.0 years and 12 (13.95%) 5.0-14 years. Mean age was 3.57±1.78. History of FB aspiration was in 75/86 (87.21%), cough 65 (75.58%), stridor 14 (16.28%), wheezing 54 (62.79%) and choking 28 (32.56%) cases. Reduced air entry was 44 (51.16%) on right side, 17 (19.77%) on left side and 25 (29.05%) bilateral. Location of FB was larynx 6 (9.98%), trachea 20 (23.26%), right bronchus 44 (51.16%) and left bronchus 16 (18.60%). Conclusions: Foreign body aspiration in children in not an uncommon event. The parents should try to prevent such event, and if there, should present the child to emergency department of a hospital. ENT surgeons are supposed to evaluate and plan an earlier intervention as rigid bronchoscopy for these children.

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An Overview of Herpes zoster: Aetiology, Pathogenesis and Treatment

Asian Journal of Research in Pharmaceutical Science ◽

10.52711/2231-5659.2021-11-2-8 ◽

2021 ◽

Vol 11 (2) ◽

pp. 140-144

Author(s):

Shreya Parkar ◽

Prajakta Kegade ◽

Akshay Gade ◽

Rutuja Sawant

Keyword(s):

Herpes Zoster ◽

Secondary Glaucoma ◽

Cell Mediated Immunity ◽

Herpes Viruses ◽

Post Herpetic Neuralgia ◽

Varicella Zoster ◽

Vesicular Rash ◽

Upper Respiratory ◽

Antiviral Medications

Varicella zoster virus is one of the eight herpes viruses that are pathogenic only for humans. It is alpha-herpes zoster of the genus varicellovirus, which causes varicella (chickenpox) and zoster (shingles). Herpes zoster is described as a multivesicular eruptive rash that follows a single or multiple adjacent dermatomal distribution. VZV infection begins with replication in epithelial cells of upper respiratory mucosa, which is followed by widely distributed vesicular rash. Cell-mediated immunity plays a role in this reactivation. Patients with conditions that decrease cell-mediated immunity are 20 to 100 times more prone to develop herpes zoster. It is often accompanied by acute pain and itchiness. Complications may be dermatological (e.g. secondary bacterial infection), neurological (e.g. long-term pain, segmental paresis, stroke), ophthalmological (e.g. keratitis, iridocyclitis, secondary glaucoma) or visceral (e.g. pneumonia, hepatitis). Most common Complications of the infection are post herpetic neuralgia and ophthalmic zoster. Treatment includes antiviral medications such as acyclovir, famciclovir, and valacyclovir given within 72 hours of symptom has been shown to reduce severity and complications associated with herpes zoster and post-herpetic neuralgia, both these diseases are vaccine preventable. Before the invention of the recombinant VZV vaccine, live VZV vaccine was the recommended immunization, approved for adults 50 years and older.

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PROFIL HERPES ZOSTER DI POLIKLINIK KULIT DAN KELAMIN RSUP PROF. DR. R. D. KANDOU MANADO 2011-2013

JURNAL BIOMEDIK (JBM) ◽

10.35790/jbm.7.3.2015.9486 ◽

2015 ◽

Vol 7 (3) ◽

Author(s):

Dwi H. Danardono ◽

Nurdjannah J. Niode

Keyword(s):

Herpes Zoster ◽

General Hospital ◽

Medical Records ◽

Antiviral Agent ◽

Age Group ◽

Post Herpetic Neuralgia ◽

Thoracic Region ◽

Varicella Zoster ◽

Dermatology Clinic ◽

Acute Viral Infection

Abstract: Herpes zoster is a reactivation of varicella zoster virus (VZV) that affects the skin and mucosa. The incidence of herpes zoster increases with age. There are three main goals of treatment: overcoming the acute viral infection, relief from acute pain, and prevention of post-herpetic neuralgia. This study aimed to determine the profile of herpes zoster in the Dermatology Clinic of Prof. Dr. R. D. Kandou General Hospital for three years based on the number of new cases, gender, ages, dermatome locations, and treatment. This was a retrospective study using the medical records of the Dermatology Clinic of Prof. Dr. R. D. Kandou General Hospital during period January 2011- Desember 2013. The results showed that there were 96 (0.84%) herpes zoster patients of 11,367 new patients, consisted of 51 (53.11%) males and 45 (46.87%) females. The most frequent age group was 45-64 years with a number of 59 cases (61.46%). The most frequent dermatome location was on the left thoracic region with a number of 18 cases (18.75%). The most widely prescribed treatment was a combination of antiviral agent, analgesic drugs, roborantia, and topical medicine (powder/antibiotic cream), with a number of 43 cases (44.79%).Keywords: herpes zoster, morbidityAbstrak: Herpes zoster merupakan reaktivasi virus varicella zoster (VZV) yang menyerang kulit dan mukosa. Insiden herpes zoster meningkat seiring dengan bertambahnya usia. Terdapat tiga tujuan utama pengobatan yaitu: mengatasi infeksi virus akut, mengatasi nyeri akut, dan mencegah timbulnya neuralgia pasca-herpetik. Penelitian ini bertujuan untuk mengetahui profil herpes zoster di Poliklinik Kulit dan Kelamin RSUP Prof. Dr. R. D. Kandou Manado yang meliputi jumlah kasus baru, jenis kelamin, usia, lokasi dermatom, dan terapi. Metode penelitian ialah retrospektif dengan menggunakan catatan medis pasien baru herpes zoster yang berobat di Poliklinik Kulit dan Kelamin RSUP Prof. Dr. R. D. Kandou Manado selama periode Januari 2011 hingga Desember 2013. Hasil penelitian memperlihatkan terdapat 96 (0,84%) kasus herpes zoster dari 11.367 pasien baru yang terdiri dari 51 (53,11%) laki-laki dan 45 (46,87%) perempuan. Kelompok usia terbanyak ialah 45-64 tahun sejumlah 59 kasus (61,46%). Lokasi dermatom tersering pada regio torakalis sinistra sejumlah 18 kasus (18,75%). Terapi yang paling sering diberikan ialah kombinasi antivirus, analgetik, roboransia, dan pengobatan topikal (bedak/cream antibiotika) sejumlah 43 kasus (44,79%).Kata kunci: herpes zoster, morbiditas

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Lung Cancer - Prevalence and Patterns

Mapana Journal of Sciences ◽

10.12723/mjs.1.4 ◽

2002 ◽

Vol 1 (1) ◽

pp. 40-47

Author(s):

Karuna Ramesh Kumar ◽

K. Payal

Keyword(s):

Lung Cancer ◽

Market Integration ◽

Age Groups ◽

Correlation Coefficients ◽

Age Group ◽

College Hospital ◽

Cross Sectional ◽

Female Ratio ◽

Medical College ◽

The Common

Background and setting Recent reports have indicated the increasing incidence of lung cancer in women and younger age groups. A cross- sectional, retrospective study was undertaken to study the age and sex distribution and histological patterns of lung cancer in the patient population presenting to St.John's Medical college Hospital, Bangalore. Methods The age, sex and the clinical features of patients and gross findings of the specimens were retrieved from the archives of the department.Hematoxylin and Eosin stained paraffin sections were used for assessment of histological patterns. Results and Conclusions 80 patients(13.5%) were histologically diagnosed as having lung cancer in the study done over a period of 6 years(1995-2000).Peak incidence was seen in 5th and 6th decade. 15 patients were <40 years of age with a male-female ratio 1.5:1 while the trend changed to 4.9:1 in >40 years age group. among the classifiable patterns, the common years age group. Among the classifiable patterns, the common histological pattern was squamous cell carcinoma, while 26.5% of lung cancer cases were poorly differentiated and could not be further categorized indicating the need for advanced techniques. In 18.5% of patients who were less than 40 years of age with lack of male preponderance, the genesis was probably multifactorial. Market integration Correlation is a measure of market integration. Correlation Coefficients of Prices, which include trend, seasonal and cylindrical effects are not adequate to precisely measure the degree of market integration. Integration of "pure errors" (pure errors means error series free from autocorrelation effects) of several time series enables us to determine the significance or otherwise integration of markets.

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