Mean-field bounds for Poisson-Boolean percolation

We establish the mean-field bounds $\gamma \ge 1$, $\delta \ge 2$ and $\triangle \ge 2$ on the critical exponents of the Poisson-Boolean continuum percolation model under a moment condition on the radii; these were previously known only in the special case of fixed radii (in the case of $\gamma$), or not at all (in the case of $\delta$ and $\triangle$). We deduce these as consequences of the mean-field bound $\beta \le 1$, recently established by Duminil-Copin, Raoufi and Tassion under the same moment condition, using a relative entropy method introduced by the authors in previous work.Comment: 21 pages, 4 figures. Version accepted for publication in Electron. J. Probabilit

Upper bounds on the one-arm exponent for dependent percolation models

We prove upper bounds on the one-arm exponent $\eta_1$ for dependent percolation models; while our main interest is level set percolation of smooth Gaussian fields, the arguments apply to other models in the Bernoulli percolation universality class, including Poisson-Voronoi and Poisson-Boolean percolation. More precisely, in dimension $d=2$ we prove $\eta_1 \le 1/3$ for Gaussian fields with rapid correlation decay (e.g.\ the Bargmann-Fock field), and in general dimensions we prove $\eta_1 \le d/3$ for finite-range fields and $\eta_1 \le d-2$ for fields with rapid correlation decay. Although these results are classical for Bernoulli percolation (indeed they are best-known in general), existing proofs do not extend to dependent percolation models, and we develop a new approach based on exploration and relative entropy arguments. We also establish a new Russo-type inequality for smooth Gaussian fields which we use to prove the sharpness of the phase transition for finite-range fields.Comment: 34 pages, 2 figure

Irrational drug use and gastro-duodenal ulcerationsin a 3-month-old infant: A case report

Upper gastrointestinal bleed (UGIB) is an unusual but potentially life-threatening emergency in children. Irrational use of medicines is one of most common cause. We, herein report a case of a three-month-old male child who presented with massive hematemesis and melena, probably due to the use of multiple antibiotics and analgesic use. On upper gastrointestinal endoscopy, multiple diffuse gastric and duodenal ulcers were detected. He was treated with proton pump inhibitors (PPI) and recovered completely within seven days

Clinicolaboratory profile of children with celiac disease in North India

Background: Prevalence of celiac disease (CD) has increased worldwide, but there are only few studies reporting clinicolaboratory profile of children with CD. Aim: To study the current clinicolaboratory profile of celiac disease in North Indian children. Methods: This retrospective study was done in pediatric gastroenterology clinic of a tertiary care center of North India. The primary objective was to study clinical and laboratory profile in children with CD. Secondary objective was to find correlation between duodenal biopsy Marsh stage and IgA tissue with tissue transglutaminase antibody (tTG) titers and also with serum hemoglobin, serum iron levels, and severity of anemia. A total of the 54 children fulfilling the diagnostic criteria of CD were included, and details were reviewed and analyzed. Results: Average age of onset of symptoms was 4.7±2.5 years, 80% had onset of symptoms after 2 years of age. Chronic diarrhea (70.3%), pain abdomen (62.9%), and abdomen distention (53.7%) were the most common manifestations. Wasting (38.4% - <5 years, 41.4% in >5 years), stunting (46.3%), rickets (22%), and anemia (90.7%) were common. Serum hemoglobin levels and serum iron levels were inversely correlated to the serum tTG levels and Marsh biopsy staging; though, not significant. Correlation of hemoglobin levels between Marsh stage 3A and 3C was statistically significant (p=0.036). There was no correlation between serum tTG levels and Marsh biopsy staging with anemia and its severity. Conclusion: Gastrointestinal symptoms still remain the most common presentation in children with celiac disease. Malnourishment, anemia, and rickets require special attention in these children

Refractory kawasaki disease after dpt vaccination: A case report and literature review

The etiology and pathogenesis of Kawasaki disease (KD) remain poorly understood. Among the diverse infectious and environmental factors examined to be triggers for, or be associated with, KD, are immunizations. We are reporting a case of refractory Kawasaki disease after DPT booster in a 5-year-old male child, who responded after two doses of IVIG and a course of IV Methylprednisolone. Prior published case reports and large epidemiological studies, which explore potential associations between immunization and KD, are also comprehensively reviewed

Atypical presentation of caroli’s syndrome: A case report

Caroli’s disease and Caroli’s syndrome are rare congenital disorders. Caroli’s disease is characterized by multiple sequential cystic or saccular dilatations of the large intrahepatic biliary ducts while Caroli’s syndrome has small bile duct involvement and congenital hepatic fibrosis. The incidence of Caroli’s disease is as low as 1/1,000,000 people. The average age of presentation is early adolescence. Magnetic resonance cholangiopancreatography is a most valuable investigation in diagnosis. Here, we report the case of Caroli’s Type II without renal involvement as late as 6 years of age with severe portal hypertension and hypersplenism. The child had no history of jaundice or recurrent abdominal pain in the past

Carotid intimal medial thickness in children with celiac disease

Introduction: Increasing cardiovascular risk in celiac disease (CD) may be attributed to the chronic systemic inflammation and unfavorable biochemical profile leading to accelerated atherosclerosis. Carotid intimal medial thickness (CIMT) has emerged as a direct marker of the early atherosclerosis as compared to traditional biochemical markers. Objectives: The aim of this study was to evaluate the CIMT in children with CD aged 1–16 years. Materials and Methods: A cross-sectional observational study was conducted at the department of Pediatrics and Radio Diagnosis in a tertiary care hospital of New Delhi. Thirty-six children with CD with age- and sex-matched controls were enrolled. CIMT for the anterior and posterior walls on each side was measured, and the mean CIMT was obtained for all the enrolled children. Results: The mean right-sided CIMT was significantly higher in cases (0.053±0.009 cm vs. 0.039±0.007 cm, p=0.000). The mean left-sided CIMT did not significantly differ between the groups (0.051±0.009 cm vs. 0.048±0.055 cm, p=0.702). The mean CIMT (right and left together), although higher in Celiacs, was not significantly different from controls (0.052±0.008 cm and 0.044±0.029 cm, p=0.114). However, a significant positive correlation between the age of the patients, age at the onset of symptoms, and CIMT was noted. Conclusion: Although we could not demonstrate statistically significant results, the mean CIMT and the right-sided measurements were significantly higher in cases than in controls

Early diagnosis of congenital methemoglobinemia type 1 in a 4-year-old child

Bluish discoloration of the skin and mucous membrane is known as cyanosis which is a clinical sign that occurs in many diseases. Thecauses of central cyanosis are cardiac shunts causing mixing of oxygenated and deoxygenated blood, lung diseases with ventilationperfusionmismatch, polycythemia, and methemoglobinemia. Methemoglobin is the oxidized form of hemoglobin, which doesnot bind oxygen and increases the affinity of oxygen for the partially oxidized portion of hemoglobin. Methemoglobinemia maybe congenital or acquired (usually drug induced). Congenital methemoglobinemia is a very rarely reported disease that is causedby a deficiency of nicotinamide adenine dinucleotide phosphate-cytochrome b5 reductase enzyme deficiency or by an abnormalhemoglobin called hemoglobin H. Acquired methemoglobinemia is caused by drugs, namely the sulfonamide group and localanesthetics such as benzocaine and prilocaine. Here, we present the case of a 4-year-old girl who presented with complaints ofbluishness of the fingers and lips without any other associated symptoms and later on diagnosed as congenital methemoglobinemi

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions