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Introduction: Nitric oxide (NO) is an important biological mediator of inflammation which is exhaled after being produced in the lungs. Fractional exhaled NO (FENO) is a new tool which measures the amount of NO exhaled. Aims and Objective: The objective of our study was to find the correlation between the FENO levels between atopic dermatitis and asthma patients in comparison to healthy controls and hence identify steroid responsiveness. Methodology: Our study was a cross-sectional observational study performed in a tertiary care hospital involving 150 children (>5–

Background: Changes in skin, hair, and nails may be initial manifestations of an underlying thyroid hormone deficiency. Symptomatic treatment of cutaneous manifestations without treatment of underlying hypothyroidism contributes to long-term morbidity in patients. Aims and Objectives: The aim of the study was to study the cutaneous manifestations and demographic profile of patients with hypothyroidism. Materials and Methods: We conducted a hospital-based cross-sectional study of 200 patients presenting with cutaneous changes in primary hypothyroidism for a period of 18 months. A detailed history, clinical examination, and relevant investigations were performed. Results: Out of 200 patients, cutaneous manifestations were more prevalent in the age group between 30 and 49 years. The ratio of male to female was 1.0:6.4. A family history of hypothyroidism was present in 34.5% of patients. The most common cutaneous features were alteration in skin texture (53.0%), dry skin (48.5%), generalized pruritus (42.5%), urticaria (17%), followed by pigmentation of the skin (34.5%), out of which vitiligo was 9.0%, melasma was 5.5%, and others were 20.0%. Other changes include xerosis (32.5%), eczematous disorder (13%), acquired palmoplantar keratoderma (11.5%), and brittle nails (3.5%). 39.5% had hair changes, out of which diffuse hair loss was 17.5%, coarse hair wa s 12%, alopecia areata was 4.5%, and lateral loss of eyebrows was 4.5%. Changes in the oral cavity and mucous membrane were present in 3.0% of the patients, which included lip vitiligo (1.5%), oral lichen planus (1%), and oral candidiasis (0.5%). Menstrual abnormalities were present in 50.84% of females. The percentage of hypothyroid patients who complained of easy fatigability, facial puffiness, cold intolerance, weight gain, constipation, neck swelling, hoarseness of voice, increased sleeping pattern, and non-pitting edema of feet were 38.5%, 36.5%, 26.0%, 23.5%, 17.0%, 9%, 8%, 7.5%, and 6.5%, respectively. Conclusion: Based on our study, it can be concluded that the presence of certain skin conditions, such as alteration in skin texture, dry skin, generalized pruritus, urticaria, skin pigmentation, and diffuse hair loss, may indicate the possibility of hypothyroidism. These cutaneous manifestations may occur earlier than the diagnosis of hypothyroidism through biochemical testing. Therefore, it is important to consider the possibility of hypothyroidism when examining patients with these skin conditions.

Living with a chronic condition like psoriasis can significantly affect the individual involved. Psoriasis patients have difficulties with their physical, psychological, occupational, and social functioning. These impairments can result in psychiatric morbidity depression and anxiety disorders. This systematic review (SR) assessed the impact of psychological factors in life of psoriasis patients. The literature search comprised Medline through PubMed, Web of Science, the Cochrane Library, Wiley Online Library, and additional sources such as Google Scholar, spanning the period from 2014 to 2023. Thorough examination of the most important electronic databases was conducted. Various study designs, including observational studies, trials, and commentaries, were incorporated to ensure a comprehensive examination of the research topic. The risk of bias was evaluated using established methodology. This SR comprised 13 studies, with the Cochrane Risk of Bias Tool employed to assess biases in randomized trials across five domains. The majority of the studies demonstrated a low risk (57.69%), indicating their reliability while those categorized as unclear (37.17%) exhibited some ambiguity without compromising the validity of results. Studies categorized as high risk (5.12%) suggested significant bias and potential errors. The findings indicate an association between psoriasis and various psychological factors, including depression, anxiety, suicidal ideation, impaired emotional functioning, negative body image, and self-perception. The significant impact of depression and anxiety on individuals with psoriasis underscores the need for greater awareness of its psychological aspects. Incorporating psychological interventions into care and management strategies is crucial for addressing this chronic condition and enhancing overall well-being, thus improving quality of life.

The structural parameters of the lattice water (∠H-O-H=141.79° and dO-H=0.896 Å) in the orthorhombic Fdd2 polymorph of PPh3O.hemihydrate as revealed by the Baures’s report more than three decades ago, considerably deviate from the standard bond parameters of a water molecule at equilibrium geometry. In particular, the anomalous value of ∠H-O-H in lattice water has unfortunately turned the H-bond network in the Fdd2 lattice completely unrealistic from chemical viewpoint. We have successfully synthesized the Fdd2 polymorph of TPPO.hemihydrate through oxygen atom transfer from [ReO]3+ moiety to the metal-bound oxophilic PPh3 group in presence of α-benzilmonoxime ligand. Successful X-ray structure reassessment of the Fdd2 polymorph has resolved the dire issue related to lattice water and the H-bond network engendered from our orthorhombic Fdd2 structure has now become chemically valid as well as meaningful. We have rationally attempted a comparative analysis of the salient structural features and existential non-covalent interactions for all the three polymorphs of PPh3O.hemihydrate crystallised in the Fdd2, C2/c and Cc space groups. The orthorhombic crystal polymorph has exhibited particularly the O–H…O and C–H…π intermolecular non-covalent interactions that result in the generation of characteristic seven-member rings in the lattice. An interplay of the O–H…O, C–H…O and C–H…π interactions has been noticed in the monoclinic C2/c and Cc space groups. Such interactions have triggered the formation of several exquisite ring patterns, viz., R32(7), R22(12), R43(16) and R42(22) in the monoclinic C2/c space group, unlike the monoclinic Cc space group where no such definitive rings have been isolated due to intergrowth of crystals during twinning. The quantum-chemical topological descriptors arising from QTAIM analysis have acquainted us with various aspects of chemical bonding including mild to moderate H-clashes. We have also performed the SAPT analysis that has revealed the average strength of the intermolecular non-covalent interactions: C–H…OPPh3O (∼ -6.7 kcal/mol) > C–H…π (∼ -3.0 kcal/mol) > C–H…Owater (∼ -1.0 kcal/mol).

Summary: Background: The phenotypical profile of cardiovascular malformations in patients with congenital rubella syndrome (CRS) is varied. We aimed to describe the profile of cardiac defects among CRS patients detected in the sentinel CRS surveillance in India during 2016–22. Methods: Sentinel sites enrolled infants with suspected CRS based on presence of cardiac defects, hearing impairment, eye signs, or maternal history of febrile rash illness. Suspected CRS cases underwent detailed systemic examination, including echocardiography and serological investigation for rubella. Cardiac defects were categorized as ‘Simple’ or ‘Complex’ as per the National Heart, Lung, and Blood Institute classification. We compared the distribution of cardiac defects among laboratory confirmed CRS cases and seronegative discarded cases. Findings: Of the 4578 suspected CRS cases enrolled by 14 sites, 558 (12.2%) were laboratory confirmed. 419 (75.1%) laboratory confirmed cases had structural heart defects (simple defects: n = 273, 65.2%, complex defects: n = 144, 34.4%), with ventricular septal defect (42.7%), atrial septal defect (39.4%), patent ductus arteriosus (36.5%), and tetralogy of Fallot as the commonest defects (4.5%). Laboratory confirmed CRS cases had higher odds of left to right shunt lesions (OR = 1.58, 95% CI: 1.15–2.17). This was mainly on account of a significant association of PDA with CRS (OR = 1.77, 95% CI: 1.42–2.21). Mortality was higher among CRS patients with complex heart defects (HR = 2.04, 95% CI: 1.26–3.30). Interpretation: Three-fourths of the laboratory confirmed CRS cases had structural heart defects. CRS patients with complex cardiac defects had higher mortality. Detecting CRS infection early and providing timely intervention for cardiovascular defects is critical for the management of CRS patients. Funding: Ministry of Health and Family Welfare, Govt of India, through Gavi, the Vaccine Alliance.

Abstract This commentary discusses new advances in the predictability of east African rains and highlights the potential for improved early warning systems (EWS), humanitarian relief efforts, and agricultural decision‐making. Following an unprecedented sequence of five droughts, 23 million east Africans faced starvation in 2022, requiring >$2 billion in aid. Here, we update climate attribution studies showing that these droughts resulted from an interaction of climate change and La Niña. Then we describe, for the first time, how attribution‐based insights can be combined with the latest dynamical models to predict droughts at 8‐month lead‐times. We then discuss behavioral and social barriers to forecast use, and review literature examining how EWS might (or might not) enhance agro‐pastoral advisories and humanitarian interventions. Finally, in reference to the new World Meteorological Organization “Early Warning for All” Executive Action Plan, we conclude with a set of recommendations supporting actionable and authoritative climate services. Trust, urgency, and accuracy can help overcome barriers created by limited funding, uncertain tradeoffs, and inertia. Understanding how climate change is producing predictable climate extremes now, investing in African‐led EWS, and building better links between EWS and agricultural development efforts can support long‐term adaptation, reducing chronic needs for billions of dollars in reactive assistance. In Africa and beyond, climate change brings increasingly extreme sea surface temperature (SST) gradients. Using climate models, we can often see these extremes coming. Prediction, therefore, offers opportunities for proactive risk management and improved advisory services, if we can create effective societal linkages via cross‐silo collaborations.

Background: In India, facility-based surveillance for congenital rubella syndrome (CRS) was initiated in 2016 to estimate the burden and monitor the progress made in rubella control. We analyzed the surveillance data for 2016–2021 from 14 sentinel sites to describe the epidemiology of CRS. Method: We analyzed the surveillance data to describe the distribution of suspected and laboratory confirmed CRS patients by time, place and person characteristics. We compared clinical signs of laboratory confirmed CRS and discarded case-patients to find independent predictors of CRS using logistic regression analysis and developed a risk prediction model. Results: During 2016–21, surveillance sites enrolled 3940 suspected CRS case-patients (Age 3.5 months, SD: 3.5). About one-fifth (n = 813, 20.6%) were enrolled during newborn examination. Of the suspected CRS patients, 493 (12.5%) had laboratory evidence of rubella infection. The proportion of laboratory confirmed CRS cases declined from 26% in 2017 to 8.7% in 2021. Laboratory confirmed patients had higher odds of having hearing impairment (Odds ratio [OR] = 9.5, 95% confidence interval [CI]: 5.6–16.2), cataract (OR = 7.8, 95% CI: 5.4–11.2), pigmentary retinopathy (OR = 6.7, 95 CI: 3.3–13.6), structural heart defect with hearing impairment (OR = 3.8, 95% CI: 1.2–12.2) and glaucoma (OR = 3.1, 95% CI: 1.2–8.1). Nomogram, along with a web version, was developed. Conclusions: Rubella continues to be a significant public health issue in India. The declining trend of test positivity among suspected CRS case-patients needs to be monitored through continued surveillance in these sentinel sites.

Background: Traumatic brain injury (TBI), a leading cause of morbidity and mortality worldwide, is an alteration in brain function, caused by an external force. With rapid surge in urbanization, motorization and economic liberalization in India, risk of TBI is increased, raising a cause for concern about its neurological as well as psychiatric sequelae. Aims and Objectives: This study was planned to understand the magnitude of the problem which could give us insights to manage/ rehabilitate it in a more comprehensive manner. Materials and Methods: The current study included 50 patients aged 18-60 years at DY Patil Medical College, Pune. GCS scores were noted for severity of TBI. Patients were assessed through MMSE, BCRS, HAM-A & BDI. Results: On GCS, 20% cases had severe head injury; 22% moderate and 58% had mild. On MMSE initially, at six months and one year; 26.19%, 21.88% & 11.1% cases had cognitive impairment respectively. On BCRS, 38.10%, 34.4% & 37.10% cases had cognitive deterioration initially, at six month & at one year respectively. On HAM-A, mild & moderate to severe anxiety was found in 64.3% & 35.7% cases respectively. On BDI, initially 7.14% cases had depression, 25% at six months and 37.05% after one year. No statistically significant change was seen in BCRS score during follow up. Comparison of the mean scores at first interview and at six months demonstrated statistically significant (P-value p

Diet quality is a critical determinant of human health and increasingly serves as a key indicator for food system sustainability. However, data on diets are limited, scattered, often project-dependent, and current data collection systems do not support high-frequency or consistent data flows. We piloted in Rwanda a data collection system, powered by the principles of citizen science, to acquire high frequency data on diets. The system was deployed through an unstructured supplementary service data platform, where respondents were invited to answer questions regarding their dietary intake. By combining micro-incentives with a normative nudge, 9,726 responses have been crowdsourced over 8 weeks of data collection. The cost per respondent was < $1 (system set-up, maintenance, and a small payment to respondents), with interactions taking 70% of respondents consume tubers and starchy vegetables, leafy vegetables, fruits, legumes, and wholegrains. Women consumed better quality diets than male respondents, revealing a sex-based disparity in diet quality. Similarly, younger respondents (age ≤ 24 years) consumed the lowest quality diets, which may pose significant risks to their health and mental well-being. Middle-income Rwandans were identified to have consumed the highest quality diets. Long-term tracking of diet quality metrics could help flag populations and locations with high probabilities of nutrition insecurity, in turn guiding relevant interventions to mitigate associated health and social risks.

On taking the intermediate value theorem (IVT) and its converse as a point of departure, this paper connects the intermediate value property (IVP) to the continuity postulate typically assumed in mathematical economics, and to the solvability axiom typically assumed in mathematical psychology. This connection takes the form of four portmanteau theorems, two for functions and the other two for binary relations, that give a synthetic and novel overview of the subject. In supplementation, the paper also surveys the antecedent literature both on the IVT itself, as well as its applications in economic and decision theory. The work underscores how a humble theorem, when viewed in a broad historical frame, bears the weight of many far-reaching consequences; and testifies to a point of view that the apparently complicated can sometimes be under-girded by a most basic and simple execution.

Agricultural index insurance contracts increasingly use remote sensing data to estimate losses and determine indemnity payouts. Index insurance contracts inevitably make errors, failing to detect losses that occur and issuing payments when no losses occur. The quality of these contracts and the indices on which they are based, need to be evaluated to assess their fitness as insurance, and to provide a guide to choosing the index that best protects the insured. In the remote sensing literature, indices are often evaluated with generic model evaluation statistics such as R2 or Root Mean Square Error that do not directly consider the effect of errors on the quality of the insurance contract. Economic analysis suggests using measures that capture the impact of insurance on the expected economic well-being of the insured. To bridge the gap between the remote sensing and economic perspectives, we adopt a standard economic measure of expected well-being and transform it into a Relative Insurance Benefit (RIB) metric. RIB expresses the welfare benefits derived from an index insurance contract relative to a hypothetical contract that perfectly measures losses. RIB takes on its maximal value of one when the index contract offers the same economic benefits as the perfect contract. When it achieves none of the benefits of insurance it takes on a value of zero, and becomes negative if the contract leaves the insured worse off than having no insurance. Part of our contribution is to decompose this economic well-being measure into an asymmetric loss function. We also argue that the expected well-being measure we use has advantages over other economic measures for the normative purpose of insurance quality ascertainment. Finally, we illustrate the use of the RIB measure with a case study of potential livestock insurance contracts in Northern Kenya. We compared 24 indices that were made with 4 different statistical models and 3 remote sensing data sources. RIB for these indices ranged from 0.09 to 0.5, and R2 ranged from 0.2 to 0.51. While RIB and R2 were correlated, the model with the highest RIB did not have the highest R2. Our findings suggest that, when designing and evaluating an index insurance program, it is useful to separately consider the quality of a remote sensing-based index with a metric like the RIB instead of a generic goodness-of-fit metric.

Biodiversity in ecosystems plays an important role in supporting human welfare, including regulating the transmission of infectious diseases. Many of these services are not fully-appreciated due to complex environmental dynamics and lack of baseline data. Multicontinental amphibian decline due to the fungal pathogen Batrachochytrium dendrobatidis (Bd) provides a stark example. Even though amphibians are known to affect natural food webs—including mosquitoes that transmit human diseases—the human health impacts connected to their massive decline have received little attention. Here we leverage a unique ensemble of ecological surveys, satellite data, and newly digitized public health records to show an empirical link between a wave of Bd-driven collapse of amphibians in Costa Rica and Panama and increased human malaria incidence. Subsequent to the estimated date of Bd-driven amphibian decline in each ‘county’ (canton or distrito), we find that malaria cases are significantly elevated for several years. For the six year peak of the estimated effect, the annual expected county-level increase in malaria ranges from 0.76 to 1.1 additional cases per 1000 population. This is a substantial increase given that cases country-wide per 1000 population peaked during the timeframe of our study at approximately 1.5 for Costa Rica and 1.1 for Panama. This previously unidentified impact of biodiversity loss illustrates the often hidden human welfare costs of conservation failures. These findings also show the importance of mitigating international trade-driven spread of similar emergent pathogens like Batrachochytrium salamandrivorans .

The reduced emissions in deforestation and degradation (REDD+) initiative uses payments for ecosystem services as incentives for developing countries to manage and protect their forests. REDD+ initiatives also prioritize social (and environmental) co-benefits aimed at improving the livelihoods of communities that are dependent on forests. Despite the incorporation of co-benefits into REDD+ goals, carbon sequestration remains the primary metric for which countries can receive payments from REDD+, but after more than 10 years of REDD+, many site-specific programs have failed to complete the carbon verification process. Here, we examine whether the REDD+ social co-benefits alone are sufficient to have slowed deforestation in the absence of carbon payments on Pemba, Tanzania. Using satellite imagery (Landsat archive), we quantified forest cover change for the period before (2001–2010) and after (2010–2018) the launch in 2010–2011 of Pemba island’s REDD+ readiness project. We then compared rates of forest cover change between shehia (administrative units) that were part of REDD+ readiness intervention and those that were not, adjusting for confounding variables and the non-random selection of REDD+ shehia with a statistical matching procedure. Despite considerable variation in forest outcomes among shehia , the associated co-benefits with the Pemba REDD+ project had no discernible effect on forest cover change. Likewise, we did not detect an effect of socioecological covariates on forest cover change across all shehia , though island-wide human population growth since 2012 may have played a role. These findings are unsurprising given the failure to secure carbon payments on Pemba and indicate that co-benefits alone are insufficient to reduce deforestation. We conclude that better oversight of all-involved parties is needed to ensure that REDD+ interventions satisfactorily conclude the process of securing a mechanism for carbon payments, if slowing deforestation is to be achieved.

Chronic mucocutaneous candidiasis (CMC) is a clinical entity where extensive fungal infection of skin, hair, nail, and mucosa with Candida sp. is seen. It has got association with several immunological and endocrinal dysfunctions. We report a case of a 14-year-old boy who presented with peculiar facies, gross failure to thrive, fungal granulomatous lesions with scaring alopecia, oropharyngeal candidiasis, ectodermal dystrophy, grade 3 clubbing of all four limbs, interstitial keratitis with leukoma due to recurrent corneal ulcerations, and persistent deciduous teeth. A diagnosis of CMC was made and evaluation of immunological pathways revealed a high titer of immunoglobulin E. CMC with overlapping features of autoimmune polyendocrinopathy candidiasis ectodermal dystrophy syndrome and hyper IgE syndrome is extremely rare in literature. Timely diagnosis of an underlying etiology and proper treatment of a case of CMC may provide a better quality of life of the patient.

The value of ophthalmological examination is often overlooked when we deal with disorders of hepatobiliary system. There is a wide spectrum of genetic, metabolic and other acquired disorders in infants and children that have ocular changes along with hepatic involvement. If the disease course is insidious then these findings may be noted in adolescence or early adulthood in several such conditions. Some ocular findings are very suggestive of the underlying etiology giving the clinician an opportunity for early diagnosis and intervention. Where the condition is untreatable, decision regarding palliative measures, prognostic counselling and genetic counselling for future pregnancies can be offered earliest to the caregivers. The article attempts to discuss the ophthalmological findings of several such disorders manifesting in infancy and childhood. Pediatricians, ophthalmologists and even physicians dealing with adult medicine should be aware of these findings.

Study on heat affected zone (HAZ) width is very essential for getting required weld quality. Minimization of HAZ width is urgent for high quality of weld. In present paper, an attempt has been made to find out relationship between process control factors and HAZ width. Optimum setting of processes parameters for getting minimum HAZ width with the help of Lagrangien multiplier method has also been attempted. Interaction effect of processes parameters on HAZ width have also been presented in graphical form. Good approximation of estimated HAZ width(s) has been revealed by comparing estimated and measured data.

Multiple café au lait macules are one of the cornerstones in diagnosing neurofibromatosis Type 1 (NF 1). NF 1 is often a multisystem neurocutaneous disorder, plexiform NF being one of the most important variants of this phacomatosis. Here, a rare case of a 2.5-year-old male child without positive family history has been described who presented with multiple large café au lait spots, alopecia, dysmorphic facies, proptosis, protrusion and deviation of tongue, biphasic stridor, bilateral neck swelling, and abnormal gait due to foreshortened left leg. Magnetic resonance imaging revealed abnormal soft-tissue infiltration of cavernous sinus through sphenoid bone, retro-orbital, retropharyngeal, parapharyngeal spaces, floor of mouth, and encasement of unilateral neck vessels and compression over trachea. Indirect laryngoscopy revealed unilateral vocal cord palsy most likely due to recurrent laryngeal nerve involvement. Biopsy confirmed the diagnosis of NF. Pediatricians and dermatologists should be aware of syndromic causes and their varied presentations while encountering a child with multiple large café au lait spots.

Ecthyma gangrenosum (EG) is a severe invasive cutaneous infection caused classically by Pseudomonas aeruginosa typically affecting immunocompromised patients especially those with neutropenia. We report the case of a 2-year-old boy with autoimmune lymphoproliferative syndrome presenting with solitary EG on the forehead. Blood culture, as well as culture from the lesion both, showed growth of P. aeruginosa. Pseudomonal sepsis responded well to piperacillin-tazobactam and amikacin therapy. Prompt diagnosis of the lesion is crucial as failure to start timely appropriate therapy may lead to fatal outcome.

Obtaining detailed data on the spatio-temporal variation in crop phenology is critical to increasing our understanding of agro-ecosystem function, such as their response to weather variation and climate change. It is challenging to collect such data over large areas through field observations. The use of satellite remote sensing data has made phenology data collection easier, although the quality and the utility of such data to understand agro-ecosystem function have not been widely studied. Here, we evaluated satellite data-based estimates of rice phenological stages in California, USA by comparing them with survey data and with predictions by a temperature-driven phenology model. We then used the satellite data-based estimates to quantify the crop phenological response to changes in weather. We used time-series of MODIS satellite data and PhenoRice, a rule-based rice phenology detection algorithm, to determine annual planting, heading and harvest dates of paddy rice in California between 2002 and 2017. At the state level, our satellite-based estimates of rice phenology were very similar to the official survey data, particularly for planting and harvest dates (RMSE = 3.8–4.0 days). Satellite based observations were also similar to predictions by the DD10 temperature-driven phenology model. We analyzed how the timing of these phenological stages varied with concurrent temperature and precipitation over this 16-year time period. We found that planting was earlier in warm springs (−1.4 days °C−1 for mean temperature between mid-April and mid-May) and later in wet years (5.3 days 100 mm-1 for total precipitation from March to April). Higher mean temperature during the pre-heading period of the growing season advanced heading by 2.9 days °C−1 and shortened duration from planting to heading by 1.9 days °C−1. The entire growing season was reduced by 3.2 days °C−1 because of the increased temperature during the rice season. Our findings confirm that satellite data can be an effective way to estimate variations in rice phenology and can provide critical information that can be used to improve understanding of agricultural responses to weather variation.

Declines in agricultural biodiversity associated with modern farming practices may negatively affect the sustainability of agro-ecosystems, but formal knowledge of historical variation in spatio-temporal variation of agro-biodiversity is limited. We used time series of national (1947-2014) and district-level (1956-2008) crop distribution data for India to show that despite strong agricultural intensification after 1960, the average crop species diversity at the district level was stable, but increased at the country-level. While there was a decline in diversity in the major rice and wheat producing regions of northwestern India, associated with intensification of the production of these crops, diversity in western and southern India increased due to expansion of oilseeds and horticultural crops that replaced millet and sorghum. These opposite, but related, trends in crop-level diversity at the sub-national level partially canceled each other out at national level, but there nevertheless was a noticeable increase in overall crop diversity in India during this time period. Our results illustrate how patterns of change in crop diversity need to be considered at different levels of aggregation, and how a decrease in diversity associated with intensification and specialization in one area, may be associated with increased diversity elsewhere, and that support for intensive agriculture with relatively low crop diversity in some regions may be associated with an increase in crop diversity in other regions and at a higher level of aggregation.

Bullous mastocytosis (BM) is a rare variant of diffuse cutaneous mastocytosis where there is disorderly infiltration of the skin by mast cells. We report a 4-month-old male infant with this rare disease who presented with wrinkled tough skin and generalized multiple bullous lesions. Diagnosis was done by serum tryptase level and histopathological examination. The patient responded well to oral corticosteroid and antihistaminic therapy. Although a congenital disorder, timely diagnosis and treatment can be potentially rewarding in patients with BM.

Introduction: Antibiotic resistance is an increasing global problem which hampers appropriate treatment of Urinary Tract Infection (UTI) in paediatric population, rendering the developing kidneys vulnerable for scarring and long-term complications. The present study stressed upon the most severely affected patients who required hospitalisation for treatment of UTI. Authors conducted this study observing the higher degree of drug resistance in patients admitted to general paediatric ward lately, suffering from UTI. Aim: To observe different clinical presentations of paediatric patients hospitalised with UTI. Authors also intended to identify locally prevalent community acquired bacterial uropathogens of clinical importance and note the sensitivity and resistance patterns of the isolated organisms against different antibiotics. Materials and Methods: This prospective observational pilot study was conducted at the Institute of Child Health, Kolkata, a tertiary care paediatric referral hospital. A total of 950 urine samples (single sample per patient) were collected from hospitalised children (from neonatal age group, upto 12 years) with suspected UTI/sepsis, between October 2014 to April 2016. Of 132 culture positive samples, 35 were excluded as per exclusion criteria, and 97 isolates had antimicrobial sensitivity performed on them. Clinical presentation was documented. Statistical analysis was done using the Chi-Square test. Results: The most common clinical presentations were fever, pain abdomen and anorexia. The most common isolates were Escherichia coli 59/97 (60.82%), followed by Enterococcus spp. 19/97 (19.59%) and Klebsiella pneumoniae 9/97 (9.28%). The majority of E. coli (n=59) isolates showed resistance against all Cephalosporins: 49-52 (83.1-88.1%), meropenem: 39 (66.1%), cotrimoxazole: 42 (71.1%), amoxycillin-clavulanic acid: 55 (93.2%) and quinolones: 50-51 (84.8-86.4%). Most Enterococcus spp. (n=19) isolates were resistant to amikacin: 17 (89.5%). Overall, a large proportion, 79/97 (81.4%) of uropathogens isolated showed Multidrug-Resistance (MDR). Conclusion: The alarming rates of resistance of uropathogens to commonly used antibiotics calls for review of empiric treatment guidelines and emphasises the need for preventing antibiotic misuse in day-to-day practice.

Recurrent bacterial meningitis is very rare phenomenon in paediatric age group. Finding the aetiology of recurrent meningitis often poses diagnostic challenge to clinicians. Among the several aetiologies, structural deficiencies at the base of skull, congenital or acquired, are readily correctable ones and hence it’s imperative to find out the location of the gap in order to surgically repair it. We report the diagnostic dilemma faced while managing a 15-year-old boy with recurrent pneumococcal meningitis. Aetiology could only be found after exclusion of immunodeficiency and performing a series of imaging studies. CT cisternogram clinched the diagnosis and patient was cured successfully. A single imaging modality, be it CT/MRI scan, although proven to be better than others according to literature, might not be sufficient while finding the cause of recurrent bacterial meningitis in an immunocompetent host.

Mapping the extent and location of field boundaries is critical to food security analysis but remains problematic in the Global South where such information is needed the most. The difficulty is due primarily to fragmentation in the landscape, small farm sizes, and irregular farm boundaries. Very high-resolution satellite imagery affords an opportunity to delineate such fields, but the challenge remains of determining such boundaries in a systematic and accurate way. In this paper, we compare a new crowd-driven manual digitization tool (Crop Land Extent) with two semi-automated methods (contour detection and multi-resolution segmentation) to determine farm boundaries from WorldView imagery in highly fragmented agricultural landscapes of Ethiopia. More than 7000 one square-kilometer image tiles were used for the analysis. The three methods were assessed using quantitative completeness and spatial correctness. Contour detection tended to under-segment when compared to manual digitization, resulting in better performance for larger (approaching 1 ha) sized fields. Multi-resolution segmentation on the other hand, tended to over-segment, resulting in better performance for small fields. Neither semi-automated method in their current realizations however are suitable for field boundary mapping in highly fragmented landscapes. Crowd-driven manual digitization is promising, but requires more oversight, quality control, and training than the current workflow could allow.

In many countries, in situ agricultural data is not available and cost-prohibitive to obtain. While remote sensing provides a unique opportunity to map agricultural areas and management characteristics, major efforts are needed to expand our understanding of cropping patterns and the potential for remotely monitoring crop production because this could support predictions of food shortages and improve resource allocation. In this study, we demonstrate a new method to map paddy rice using Google Earth Engine (GEE) and the Landsat archive in Bangladesh during the dry (boro) season. Using GEE and Landsat, dry-season rice areas were mapped at 30 m resolution for approximately 90,000 km2 annually between 2014 and 2018. The method first reconstructs spectral vegetation indices (VIs) for individual pixels using a harmonic time series (HTS) model to minimize the effect of any sensor inconsistencies and atmospheric noise, and then combines the time series indices with a rule-based algorithm to identify characteristics of rice phenology to classify rice pixels. To our knowledge, this is the first time an annual pixel-based time series model has been applied to Landsat at the national level in a multiyear analysis of rice. Findings suggest that the harmonic-time-series-based vegetation indices (HTS-VIs) model has the potential to map rice production across fragmented landscapes and heterogeneous production practices with comparable results to other estimates, but without local management or in situ information as inputs. The HTS-VIs model identified 4.285, 4.425, 4.645, 4.117, and 4.407 million rice-producing hectares for 2014, 2015, 2016, 2017, and 2018, respectively, which correlates well with national and district estimates from official sources at an average R-squared of 0.8. Moreover, accuracy assessment with independent validation locations resulted in an overall accuracy of 91% and a kappa coefficient of 0.83 for the boro/non-boro stable rice map from 2014 to 2018. We conclude with a discussion of potential improvements and future research pathways for this approach to spatiotemporal mapping of rice in heterogeneous landscapes.

Aim. This paper aimed to examine the chemoprotective actions of aqueous black tea extract (BTE) against nonalcoholic steatohepatitis- (NASH-) induced skeletal changes in rats. Material. Wistar rats (body wt. 155–175 g) of both sexes, aged 4–5 months, were randomly assigned to 3 groups; Group A (control), Group B (60% high-fat diet; HFD), and Group C (HFD + 2.5% BTE). Methods. Several urinary (calcium, phosphate, creatinine, and calcium-to-creatinine ratio) serum (alkaline phosphatase and serum tartrate-resistant acid phosphatase), and molecular markers of bone turnover (receptor activator of NF-κB ligand (RANKL), osteoprotegerin (OPG), and estrogen) were tested. Also, several bone parameters (bone density, bone tensile strength, bone mineral content, and bone histology) and calcium homeostasis were checked. Results. Results indicated that HFD-induced alterations in urinary, serum, and bone parameters as well as calcium homeostasis, all could be significantly ameliorated by BTE supplementation. Conclusion. Results suggest a potential role of BTE as a protective agent against NASH-induced changes in bone metabolism in rats.