Rosai Dorfman Disease - A Rare Presentation of Cervical Lymphadenopathy - A Case Report

Rosai Dorfman disease is an uncommon histiocytic disorder presenting as bilateral cervical lymphadenopathy in children and young adults. Under the revised classification of histiocytic disorders, it is classified in the` R’ group of histiocytosis. Cutaneous Rosai -Dorfman disease is regarded as a separate entity which falls under the`C’ group of histiocytosis according to this classification system. We herein report a case of cervical lymphadenopathy who initially developed swelling in the right side of the neck and later developed in the left side of the neck. Patient underwent mantoux test which showed induration of 22mm which was significant. No other symptoms like cough with expectoration, loss of appetite was present.chest x ray was normal. Tuberculous Lymphadenitis was suspected. FNAC was done but confirmatory diagnosis was not obtained, so Excision biopsy was done. Finally, microscopic examination revealed marked emperipolesis with sheets of mature lymphocytes and plasma cells which is pathognomic cytoarchitecture of Rosai Dorfman disease. No evidence of granuloma/ RS cells/ atypia seen. Immunohistochemistry showed S -100 – strong positivity

Second round statewide sentinel-based population survey for estimation of the burden of active infection and anti-SARS-CoV-2 IgG antibodies in the general population of Karnataka, India, during January-February 2021

Objective Demonstrate the feasibility of using the existing sentinel surveillance infrastructure to conduct the second round of the serial cross-sectional sentinel-based population survey. Assess active infection, seroprevalence, and their evolution in the general population across Karnataka. Identify local variations for locally appropriate actions. Additionally, assess the clinical sensitivity of the testing kit used on account of variability of antibody levels in the population. Methods The cross-sectional study of 41,228 participants across 290 healthcare facilities in all 30 districts of Karnataka was done among three groups of participants (low, moderate, and high-risk). The geographical spread was sufficient to capture local variations. Consenting participants were subjected to real-time reverse transcription-polymerase chain reaction (RT-PCR) testing, and antibody (IgG) testing. Clinical sensitivity was assessed by conducting a longitudinal study among participants identified as COVID-19 positive in the first survey round. Results Overall weighted adjusted seroprevalence of IgG was 15.6% (95% CI: 14.9–16.3), crude IgG prevalence was 15.0% and crude active infection was 0.5%. Statewide infection fatality rate (IFR) was estimated as 0.11%, and COVID-19 burden estimated between 26.1 to 37.7% (at 90% confidence). Further, Cases-to-infections ratio (CIR) varied 3-35 across units and IFR varied 0.04–0.50% across units. Clinical sensitivity of the IgG ELISA test kit was estimated as ≥38.9%. Conclusion We demonstrated the feasibility and simplicity of sentinel-based population survey in measuring variations in subnational and local data, useful for locally appropriate actions in different locations. The sentinel-based population survey thus helped identify districts that needed better testing, reporting, and clinical management. The state was far from attaining natural immunity during the survey and hence must step up vaccination coverage and enforce public health measures to prevent the spread of COVD-19.The Institutional Ethics Committee (IEC) of the Indian Institute of Public Health - Bengaluru campus reviewed and approved the study (vide. IIPHHB/TRCIEC/174/2020) and the subsequent change of protocol to perform the longitudinal study (vide PHFI/IIPH-BLR/076/2020-21). We informed the participants of the purpose of the surveys, how the samples would be taken and requested them to respond to the screening questions. After obtaining informed consent, we noted basic demographic details, exposure history, symptoms observed in the previous month, and clinical history. Participants' test results were shared with them by the concerned healthcare facility.Scopu

Water Quality Index for measuring drinking water quality in rural Bangladesh: a cross-sectional study

BACKGROUND: Public health is at risk due to chemical contaminants in drinking water which may have immediate health consequences. Drinking water sources are susceptible to pollutants depending on geological conditions and agricultural, industrial, and other man-made activities. Ensuring the safety of drinking water is, therefore, a growing problem. To assess drinking water quality, we measured multiple chemical parameters in drinking water samples from across Bangladesh with the aim of improving public health interventions. METHODS: In this cross-sectional study conducted in 24 randomly selected upazilas, arsenic was measured in drinking water in the field using an arsenic testing kit and a sub-sample was validated in the laboratory. Water samples were collected to test water pH in the laboratory as well as a sub-sample of collected drinking water was tested for water pH using a portable pH meter. For laboratory testing of other chemical parameters, iron, manganese, and salinity, drinking water samples were collected from 12 out of 24 upazilas. RESULTS: Drinking water at sample sites was slightly alkaline (pH 7.4 ± 0.4) but within acceptable limits. Manganese concentrations varied from 0.1 to 5.5 mg/L with a median value of 0.2 mg/L. The median iron concentrations in water exceeded WHO standards (0.3 mg/L) at most of the sample sites and exceeded Bangladesh standards (1.0 mg/L) at a few sample sites. Salinity was relatively higher in coastal districts. After laboratory confirmation, arsenic concentrations were found higher in Shibchar (Madaripur) and Alfadanga (Faridpur) compared to other sample sites exceeding WHO standard (0.01 mg/L). Of the total sampling sites, 33 % had good-quality water for drinking based on the Water Quality Index (WQI). However, the majority of the households (67 %) used poor-quality drinking water. CONCLUSIONS: Higher values of iron, manganese, and arsenic reduced drinking water quality. Awareness raising on chemical contents in drinking water at household level is required to improve public health

An Innovative Approach for Management of Vertical Coronal Fracture in Molar: Case Report

Unlike anterior teeth, acute exogenous trauma is an infrequent cause of posterior coronal vertical tooth fractures. Endodontic and restorative management of such fractures is a great challenge for the clinician. Newer advancements in adhesive techniques can provide successful intracoronal splinting of such teeth to reinforce the remaining tooth structure. This paper describes the diagnosis and management of a case of complicated vertical coronal fracture in mandibular first molar induced by a traffic accident

Using microsatellite data to estimate the persistence of field‑level yield gaps and their drivers in smallholder systems

One way to meet growing food demand is to increase yields in regions that have large yield gaps, including smallholder systems. To do this, it is important to quantify yield gaps, their persistence, and their drivers at large spatio-temporal scales. Here we use microsatellite data to map field-level yields from 2014 to 2018 in Bihar, India and use these data to assess the magnitude, persistence, and drivers of yield gaps at the landscape scale. We find that overall yield gaps are large (33% of mean yields), but only 17% of yields are persistent across time. We find that sowing date, plot area, and weather are the factors that most explain variation in yield gaps across our study region, with earlier sowing associated with significantly higher yield values. Simulations suggest that if all farmers were able to adopt ideal management strategies, including earlier sowing and more irrigation use, yield gaps could be closed by up to 42%. These results highlight the ability of micro-satellite data to understand yield gaps and their drivers, and can be used to help identify ways to increase production in smallholder systems across the globe

Using a systems approach for Drought Risk Financing Solutions in Senegal

The index-based livestock insurance (IBLI), since the time it was launched in 2010 in the arid and semi-arid lands of Kenya and Ethiopia, has evolved into drought risk financing solutions (DRFS). This evolution is characterized by development from a micro product implemented, as potential social protection tools, to a regional level de-risking instrument for pastoralists in the Horn of Africa. There have also been demands for DRFS to rise to several other challenges such as conflict, access to health and market services (feed, fodder) that are being faced in the drylands of Africa. The rapidly changing contexts and the associated challenges mean that the introduction of DRFS requires careful assessment to ensure the necessary pre-conditions are in place for optimal positive impact. Assessment would have to consider incentivizing the private sector from the beginning for investment in these areas, management of natural resources, better access to services (financial and non-financial), gender inclusion and social equity. Such an approach is important for developing resilience not just against challenges related to climate change but the ever-changing dynamics in these complex environments