Unusual case of failure to thrive: Type III Bartter syndrome.

Bartter syndrome Type III is a rare autosomal recessive disorder resulting from an inherited defect in the thick ascending limb of the loop of henle of the nephrons in kidney. The typical clinical manifestations in childhood are failure to thrive and recurrent episodes of vomiting. Typical laboratory findings which help in the diagnosis are hypokalemic metabolic alkalosis, hypomagnesemia and hypercalciuria. We report a case of Type III Bartter syndrome not responding to repeated conventional treatment of failure to thrive

Village Baseline Study: Site Analysis Report for Haryana - Karnal, India

This is the report of the village baseline study of Pakhana in the CCAFS benchmark site of Karnal, India conducted from March 15-17, 2013 to complement an earlier household baseline survey done in the same village. Pakhana is located in the fertile flat land of the Indo-Gangetic plains and has good access to roads, markets, electricity and communication. The community has not experienced a food crisis and 90% of the population enjoys year-round food security. Pakhana benefited from the Green Revolution and has adopted improved varieties and the use of chemical fertilizers and pesticides. However, Pakhana now faces challenges resulting from population growth, deforestation, reduced and variable rainfall, declining soil fertility and organic matter, monocropping, over application of chemical inputs, and depletion of the water table. As a result, access to water resources is more difficult, profits have decreased and production is constrained. Without adjustments, Pakhana’s food security, livelihoods and natural resources will be further strained and threatened

Provision of acute and elective general surgical care at a tertiary facility in the era of subspecialisation

Background. The need for an acute care and general surgical unit (ACGSU) to provide care for patients previously managed on an ad hoc basis by subspecialist units was recognised by the provincial government of the Western Cape Province, South Africa, the management of Groote Schuur Hospital (GSH) and the Department of Surgery.Objective. To describe the resulting ACGSU and its functioning.Methods. Data available from administrative records, patient files and operating room forms were collected in spreadsheet form for the period July 2013 - November 2016 inclusive.Results. The ACGSU comprised a medical care team of four consultants and four to five trainees. A total of 7 571 patients were seen during the study period, the majority (66.1%) referred from the GSH Emergency Centre. Skin and soft-tissue infections formed the major disease complex. A total of 3 144 operative records were available. The most common procedures were wound debridement and inguinal hernia repairs. Trainees acted as primary surgeon in most cases. Complications (Clavien-Dindo grades I - V) were noted in 25.0% of patients.Conclusions. The ACGSU provides patient management that would otherwise complicate care in the subspecialist surgical units. It serves as a training ground for registrars and stands as a model for other institutions. Further research into the effect on patient care is planned.

The functional, social and economic impact of acute encephalitis syndrome in Nepal--a longitudinal follow-up study.

notes: PMCID: PMC3772013Open Access JournalOver 133,000 children present to hospitals with Acute Encephalitis Syndrome (AES) annually in Asia. Japanese encephalitis (JE) accounts for approximately one-quarter of cases; in most cases no pathogen is identified and management is supportive. Although JE is known to result in neurological impairment, few studies have examined the wider impact of JE and AES on patients and their families.Wellcome TrustUniversity of Liverpool Clinical Fellowshi

Associations between eight earth observation-derived climate variables and enteropathogen infection: An independent participant data meta-analysis of surveillance studies with broad spectrum nucleic acid diagnostics

Diarrheal disease, still a major cause of childhood illness, is caused by numerous, diverse infectious microorganisms, which are differentially sensitive to environmental conditions. Enteropathogen‐specific impacts of climate remain underexplored. Results from 15 studies that diagnosed enteropathogens in 64,788 stool samples from 20,760 children in 19 countries were combined. Infection status for 10 common enteropathogens—adenovirus, astrovirus, norovirus, rotavirus, sapovirus, Campylobacter, ETEC, Shigella, Cryptosporidium and Giardia—was matched by date with hydrometeorological variables from a global Earth observation dataset—precipitation and runoff volume, humidity, soil moisture, solar radiation, air pressure, temperature, and wind speed. Models were fitted for each pathogen, accounting for lags, nonlinearity, confounders, and threshold effects. Different variables showed complex, non‐linear associations with infection risk varying in magnitude and direction depending on pathogen species. Rotavirus infection decreased markedly following increasing 7‐day average temperatures—a relative risk of 0.76 (95% confidence interval: 0.69–0.85) above 28°C—while ETEC risk increased by almost half, 1.43 (1.36–1.50), in the 20–35°C range. Risk for all pathogens was highest following soil moistures in the upper range. Humidity was associated with increases in bacterial infections and decreases in most viral infections. Several virus species\u27 risk increased following lower‐than‐average rainfall, while rotavirus and ETEC increased with heavier runoff. Temperature, soil moisture, and humidity are particularly influential parameters across all enteropathogens, likely impacting pathogen survival outside the host. Precipitation and runoff have divergent associations with different enteric viruses. These effects may engender shifts in the relative burden of diarrhea‐causing agents as the global climate changes

Geotechnical Field Reconnaissance: Gorkha (Nepal) Earthquake of April 25, 2015 and Related Shaking Sequence

The April 25, 2015 Gorkha (Nepal) Earthquake and its related aftershocks had a devastating impact on Nepal. The earthquake sequence resulted in nearly 9,000 deaths, tens of thousands of injuries, and has left hundreds of thousands of inhabitants homeless. With economic losses estimated at several billion US dollars, the financial impact to Nepal is severe and the rebuilding phase will likely span many years. The Geotechnical Extreme Events Reconnaissance (GEER) Association assembled a reconnaissance team under the leadership of D. Scott Kieffer, Binod Tiwari and Youssef M.A. Hashash to evaluate geotechnical impacts of the April 25, 2015 Gorkha Earthquake and its related aftershocks. The focus of the reconnaissance was on time-sensitive (perishable) data, and the GEER team included a large group of experts in the areas of Geology, Engineering Geology, Seismology, Tectonics, Geotechnical Engineering, Geotechnical Earthquake Engineering, and Civil and Environmental Engineering. The GEER team worked in close collaboration with local and international organizations to document earthquake damage and identify targets for detailed follow up investigations. The overall distribution of damage relative to the April 25, 2015 epicenter indicates significant ground motion directivity, with pronounced damage to the east and comparatively little damage to the west. In the Kathmandu Basin, characteristics of recorded strong ground motion data suggest that a combination of directivity and deep basin effects resulted in significant amplification at a period of approximately five seconds. Along the margins of Kathmandu Basin structural damage and ground failures are more pronounced than in the basin interior, indicating possible basin edge motion amplification. Although modern buildings constructed within the basin generally performed well, local occurrences of heavy damage and collapse of reinforced concrete structures were observed. Ground failures in the basin included cyclic failure of silty clay, lateral spreading and liquefaction. Significant landsliding was triggered over a broad area, with concentrated activity east of the April 25, 2015 epicenter and between Kathmandu and the Nepal-China border. The distribution of concentrated landsliding partially reflects directivity in the ground motion. Several landslides have dammed rivers and many of these features have already been breached. Hydropower is a primary source of electric power in Nepal, and several facilities were damaged due to earthquake-induced landsliding. Powerhouses and penstocks experienced significant damage, and an intake structure currently under construction experienced significant dynamic settlement during the earthquake. Damage to roadways, bridges and retaining structures was also primarily related to landsliding. The greater concentration of infrastructure damage along steep hillsides, ridges and mountain peaks offers a proxy for the occurrence of topographic amplification. The lack of available strong motion records has severely limited the GEER team’s ability to understand how strong motions were distributed and how they correlate to distributions of landsliding, ground failure and infrastructure damage. It is imperative that the engineering and scientific community continues to install strong motion stations so that such data is available for future earthquake events. Such information will benefit the people of Nepal through improved approaches to earthquake resilient design

Menstrual hygiene management among women and adolescent girls in the aftermath of the earthquake in Nepal.

BACKGROUND: Menstrual hygiene management (MHM) is an essential aspect of hygiene for women and adolescent girls between menarche and menopause. Despite being an important issue concerning women and girls in the menstruating age group MHM is often overlooked in post-disaster responses. Further, there is limited evidence of menstrual hygiene management in humanitarian settings. This study aims to describe the experiences and perceptions of women and adolescent girls on menstrual hygiene management in post-earthquake Nepal. METHODS: A mixed methods study was carried out among the earthquake affected women and adolescent girls in three villages of Sindhupalchowk district of Nepal. Data was collected using a semi-structured questionnaire that captured experiences and perceptions of respondents on menstrual hygiene management in the aftermath of the Nepal earthquake. Quantitative data were triangulated with in-depth interview regarding respondent's personal experiences of menstrual hygiene management. RESULTS: Menstrual hygiene was rated as the sixth highest overall need and perceived as an immediate need by 18.8% of the respondents. There were 42.8% women & girls who menstruated within first week of the earthquake. Reusable sanitary cloth were used by about 66.7% of the respondents before the earthquake and remained a popular method (76.1%) post-earthquake. None of the respondents reported receiving menstrual adsorbents as relief materials in the first month following the earthquake. Disposable pads (77.8%) were preferred by respondents as they were perceived to be clean and convenient to use. Most respondents (73.5%) felt that reusable sanitary pads were a sustainable choice. Women who were in the age group of 15-34 years (OR = 3.14; CI = (1.07-9.20), did not go to school (OR = 9.68; CI = 2.16-43.33), married (OR = 2.99; CI = 1.22-7.31) and previously used reusable sanitary cloth (OR = 5.82; CI = 2.33-14.55) were more likely to use the reusable sanitary cloth. CONCLUSIONS: In the immediate aftermath of the earthquake, women and girls completely depended on the use of locally available resources as adsorbents during menstruation. Immediate relief activities by humanitarian agencies, lacked MHM activities. Understanding the previous practice and using local resources, the reusable sanitary cloth is a way to address the menstrual hygiene needs in the post-disaster situations in Nepal

Production of IFN-β during Listeria monocytogenes Infection Is Restricted to Monocyte/Macrophage Lineage

The family of type I interferons (IFN), which consists of several IFN-α and one IFN-β, are produced not only after stimulation by viruses, but also after infection with non-viral pathogens. In the course of bacterial infections, these cytokines could be beneficial or detrimental. IFN-β is the primary member of type I IFN that initiates a cascade of IFN-α production. Here we addressed the question which cells are responsible for IFN-β expression after infection with the intracellular pathogen Listeria monocytogenes by using a genetic approach. By means of newly established reporter mice, maximum of IFN-β expression was observed at 24 hours post infection in spleen and, surprisingly, 48 hours post infection in colonized cervical and inguinal lymph nodes. Colonization of lymph nodes was independent of the type I IFN signaling, as well as bacterial dose and strain. Using cell specific reporter function and conditional deletions we could define cells expressing LysM as the major IFN-β producers, with cells formerly defined as Tip-DCs being the highest. Neutrophilic granulocytes, dendritic cells and plasmacytoid dendritic cells did not significantly contribute to type I IFN production