A study of serum electrolytes in severe acute malnourished children with and without complications

Objective: Children with severe acute malnutrition (SAM) are categorized into “complicated and uncomplicated cases” based on clinical criteria alone. Electrolyte imbalance is one of the prognostic factors in severe malnutrition. We aimed to study serum electrolytes in complicated and uncomplicated SAM children. Methods: This was a cross-sectional observational study conducted at the nutritional rehabilitation center of a tertiary care hospital attached to a medical college from May 2016 to April 2017. Children between the ages of 1 month and 5 years who met the World Health Organization criteria for SAM were included in the study. Serum electrolytes were estimated with an automated analyzer by ion selective electrode method. Results: Among 113 SAM children included, 71 had complications and 42 were without complications. The mean value of serum sodium was 134.58±5.45 meq/L, potassium was 4.29±0.75 meq/L, and chloride was 103.31±7.16 meq/L. Hyponatremia was seen in 43.4% and hypokalemia in 7.1% of children. There was no statistically significant difference in the mean values of serum electrolytes and frequency of hyponatremia and hypokalemia between groups. Conclusion: Dyselectrolytemia occurs in SAM children with and without complications. Serum electrolyte levels may need to be measured in all SAM cases to detect asymptomatic hyponatremia and hypokalemia. This will help in triaging those with asymptomatic hyponatremia and hypokalemia to inpatient care

Safety and efficacy of intravenous pulse cyclophosphamide therapy in children with steroid-dependent nephrotic syndrome

Background: Cyclophosphamide (Cyp) is a well-known alternative agent to spare the use of steroids and avoid the side effects that result from long-term steroid therapy in children with idiopathic nephrotic syndrome (NS). Use of Cyp typically reduces the risk of relapse in comparison with prednisolone by about 50%. Objective: To study the safety and efficacy of intravenous pulse Cyp (IV Cyp) therapy in children with steroid-dependent NS (SDNS). Materials and Methods: This was a retrospective single-center analysis from a large government hospital in South India. The data were retrieved from the records of children attending the pediatric nephrology clinic between 2005 and 2016. Children with SDNS who received the complete schedule of IV Cyp were included in the study. Children who received other alternate drugs were excluded. Results: Fifty patients with SDNS were treated with IV Cyp, seven patients did not complete the treatment and were excluded from the analysis. 24 (56%) of the 43 patients stayed in remission throughout the course of Cyp treatment and prednisolone could be stopped and were considered as Cyp responsive. The remaining 19 (44%) children had relapsed while on Cyp therapy (Cyp resistant) and required treatment with alternate immunosuppressant drugs. 19 of the 24 Cyp responsive patients were in remission 6 months after stopping Cyp treatment (Cyp sensitive) while the remaining five patients relapsed within 6 months of stopping Cyp treatment (Cyp dependent). 9 children (20.9%) were relapse-free till the time of last follow-up with a median follow-up of 2.1 years. Among 24 children, 13 (30.23%) who responded were infrequently relapsing NS and 2 (4.5%) children were frequently relapsing NS

Solitary Mandibular Lesion as the Presenting Sign of Multiple Myeloma: A Rare Case Report

Multiple myeloma (MM) is a rare hematological malignancy caused by monoclonal proliferation of plasma cells in the marrow of various bones. It is more common in men in the sixth and seventh decade of life. Patients usually present with bone pain, fatigue, recurrent infections, renal failure and nervous system dysfunction. Rarely, oral lesions may be the initial sign of multiple myeloma presenting with pain, jaw swelling, tooth mobility, multiple punched out radiolucencies and parasthesia. A case of multiple myeloma occurring in a 71 year old male patient who presented with a solitary lesion in the mandible is presented here. This paper highlights the importance of knowing oral manifestations of multiple myeloma and interdisciplinary approach required for early diagnosis

Florid Cemento-Osseous Dysplasia - A dilemma to intervene or not?!

Florid cemento - osseous dysplasia (FCOD) is a benign, non-neoplastic lesion characterized by multiple sclerosing masses within the jaw bones. We present an uncommon case of FCOD in a 37-year-old Indian woman incidentally discovered on a radiograph. She presented with bilaterally symmetrical lesions of variable radiodensities in the posterior mandible. In this asymptomatic case, the diagnosis of FCOD was made radiologically as biopsy is contraindicated. No treatment was imparted as the lesions were asymptomatic and the patient continues to be reviewed annually. The rationale of the present work is to describe this uncommon entity with only eleven reported cases noted in the literature amongst Indians. The case is unusual in its combination of the disease itself (FCOD) and the race (Indian). The confirmative role of radiography without histopathological evaluation and the need for no intervention is emphasized.   &nbsp

G × E interactions in QTL introgression lines of Spanish-type groundnut (Arachis hypogaea L.)

Multi-environment testing at five locations for rust and late leaf spot (LLS) resistance with 41 introgressed lines (ILs) bred using marker-assisted backcross breeding in the genetic background Spanish- type groundnut varieties identified significant genotype, and genotype 9 environment interactions (GEI) for LLS disease resistance and yield parameters. Significant GEI effects suggest the need to identify location specific breeding lines to achieve gains in pod yield and LLS resistance. The observed variable LLS disease reaction among the ILs in part suggests influence of background genotype on the level of resistance. A breeding scheme with early generation selection using molecular markers followed by phenotyping for LLS, and multi-location testing of fixed breeding lines was optimized to enhance selection intensity and accuracy in groundnut breeding. The ILs, ICGVs 14431, 14436 and 14438 with pooled LLS score at 90 DAS of 3.5–3.7 were superior to respective recurrent parent for pod yield, with early maturing similar to recurrent parents. The pod yield advantage in ILs is attributed by more number of pods, besides resistance to LLS that contributes to better filling

Current tidal power technologies and their suitability for applications in coastal and marine areas

A considerable body of research is currently being performed to quantify available tidal energy resources and to develop efficient devices with which to harness them. This work is naturally focussed on maximising power generation from the most promising sites, and a review of the literature suggests that the potential for smaller scale, local tidal power generation from shallow near-shore sites has not yet been investigated. If such generation is feasible, it could have the potential to provide sustainable electricity for nearby coastal homes and communities as part of a distributed generation strategy, and would benefit from easier installation and maintenance, lower cabling and infrastructure requirements and reduced capital costs when compared with larger scale projects. This article reviews tidal barrages and lagoons, tidal turbines, oscillating hydrofoils and tidal kites to assess their suitability for small-scale electricity generation in shallow waters. This is achieved by discussing the power density, scalability, durability, maintainability, economic potential and environmental impacts of each concept. The performance of each technology in each criterion is scored against axial-flow turbines, allowing for them to be ranked according to their overall suitability. The review suggests that tidal kites and range devices are not suitable for small-scale shallow water applications due to depth and size requirements respectively. Cross-flow turbines appear to be the most suitable technology, as they have high power densities and a maximum size that is not constrained by water depth

Molecular breeding tools improved drought tolerant groundnut variety for resistance to foliar fungal diseases

A largely rainfed crop in India, drought tolerance, particularly mid- and end-season tolerance, is a key trait in groundnut varieties. A combination of both empirical and trait-based approaches was used in breeding programs of ICAR and ICRISAT, resulting in release of few tolerant varieties that have superior pod yield under drought stress and/or have enhanced water-use-efficiency. There is a need to breed varieties with drought tolerance, disease resistance and quality traits that suit different production ecologies as well as meet the needs of the farmers, consumers and industries. ICRISAT has released an early-maturing (90-95 d) and drought- tolerant variety ICGV 91114 for the drought-prone Ananthapur district of Andhra Pradesh, India, where about 0.7 m ha area is under groundnut cultivation and has low (300 mm) and erratic (30-40 rainy days) rainfall. On-farm studies conducted with ICGV 91114 during 2008-10 showed 30% reduction in yield variability over the years. Following screening in hot-spots of both rust and LLS disease during 2014 rainy season, a total of 27 introgression lines derived from ICGV 91114 were selected and advanced for evaluation in multi-location trials at six locations in 2015 under rainfed conditions. Based on the pod yield under rainfed conditions and disease resistance, three superior introgression lines (ICGV 14410, ICGV 13189, ICGV 14421) were proposed for the first-ever NILs trial (near-isogenic lines trial) along with eight others conducted under All India Coordinated Research Project on Groundnut (AICRP-G) at national level

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

“Control-Alt-Delete”: Rebooting Solutions for the E-Waste Problem

A number of efforts have been launched to solve the global electronic waste (e-waste) problem. The efficiency of e-waste recycling is subject to variable national legislation, technical capacity, consumer participation, and even detoxification. E-waste management activities result in procedural irregularities and risk disparities across national boundaries. We review these variables to reveal opportunities for research and policy to reduce the risks from accumulating e-waste and ineffective recycling. Full regulation and consumer participation should be controlled and reinforced to improve local e-waste system. Aiming at standardizing best practice, we alter and identify modular recycling process and infrastructure in eco-industrial parks that will be expectantly effective in countries and regions to handle the similar e-waste stream. Toxicity can be deleted through material substitution and detoxification during the life cycle of electronics. Based on the idea of "Control-Alt-Delete", four patterns of the way forward for global e-waste recycling are proposed to meet a variety of local situations