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FDM is a prominent AM process from which 3D models can be generated. Optimisation algorithms are used to get best levels of process parameters. The aim of this article is to analyse statistically the L16 OA and its corresponding responses in order to obtain optimal process parameter level combinations which could make the product efficient. The process parameters considered were extrusion temperature and infill density. The optimal parameter settings obtained were an extrusion temperature of 220°C and an infill density of 80%. Each parameter was considered at four different levels. Since there were two factors at four levels, L16 OA was preferred to design the experimental plan. The process parameters were selected based on the output responses. A total of 16 samples for each response were manufactured and tested, and statistical analysis was carried out. Statistical approaches like ANOVA analysis and S/N ratio analysis were used to get significance of factors and optimal parameter settings, and analysis was performed using MINITAB 16. Validation tests were carried out with optimal parameter settings as input parameters. Statistical analysis showed that extrusion temperature was a more significant factor compared to infill density for both tensile and compressive strengths. [ABSTRACT FROM AUTHOR]

In terms of research, the elliptical antenna arrays (EAA) synthesis is relatively novel. As it does not have to be circular in construction, this novel synthesis can maneuver the primary beam in the right direction, making it easier to realize. The amplitude and angular location of the ellipse, as well as the eccentricity of the ellipse, are all taken into account in the optimization process. The proposed hybrid algorithm is the SSWOA (Salp Swarm Whale Optimization Algorithm), which combines the Salp Swarm Optimization Algorithm (SSA) with the Whale Optimization Algorithm (WOA). The SSA algorithm serves as a guide, while the WOA algorithm serves as a helper in this method. We discover that optimization has a faster convergence time and high convergence accuracy when considering the benefits of SSA and WOA and applying them to the synthesis of antenna array layouts. If Griewank, Rosenbrock, Sphere, and Rastrigin test functions are used, it's worth noting that the hybrid method outperforms both WOA and SSA. [ABSTRACT FROM AUTHOR]

The paper provides the interoperable hybrid Grasshopper–Grey Wolf optimization (GHGWO) of the Square Split-Ring Resonator (SRR) metamaterial unit cell. This paper discusses the complex phase strategies of the electric and magnetic interplay of the charged microstrip line of the split ring resonator (SRR). Optimized unit of metamaterial cells for their bandwidth enhancement is packed into a new square fractal antenna. In the interim period of dual band efficiency, a new design is introduced for a microstrip line-feeding square fractal antenna with a faulty ground composition. In the second stage, a quasi-static SRR model is being used to streamline its structural parameters in an effort to reinforce the bandwidth so that optimized composition resonates at the required intensity area. In the GHGWO hybrid algorithm, SRR unit cell size limitations should be optimized and the convergence actions of the algorithm improved. Certain evolutions termed modified hybrid BF-PSO classical BFO, chaos PSO and IWO are being tested for efficiency of the Hybrid GHGWO algorithm. In the final stage, optimized SRR unit cells are stacked into a square fractal antenna that provides bandwidth output suited to wireless usages with upper and lower band. The prototype square fractal antenna without and with SRR unit cells is efficiently evaluated by trial results. [ABSTRACT FROM AUTHOR]

Anti-glomerular basement (anti-GBM) disease is an uncommon disorder with a bimodal age of presentation. Patients presenting with dialysis-dependent renal failure have poor renal outcomes. There is limited data regarding the clinical presentation and outcomes of anti-GBM disease from India. We conducted this prospective study to analyze the clinical presentation and outcomes of anti-GBM disease at a large tertiary care hospital in North India over 1 1/2 years. Subjects with a biopsy proven anti-GBM disease (light microscopic examination showing crescents and immunofluorescence examination showing linear deposition of IgG) with or without positive anti-GBM antibodies in serum were included in the study and followed-up for at least 12 months. All the patients were treated with steroids, cyclophosphamide, and plasma exchange. A total of 17 patients (nine males) were included. The mean age at presentation was 39.11 ± 16.58 (range 11-72) years. Twelve patients (70%) presented with rapidly progressive glomerulonephritis (RPGN), 4 (23.5%) presented with Goodpasture syndrome, while 1 (5.8%) had nephritic syndrome, 7 (41%) were hypertensive, and 14 (82.3%) required dialysis at the time of presentation. Four patients (23.5%) had associated anti-neutrophil cytoplasmic antibody positivity (anti-myeloperoxidase antibodies in all). Fourteen (87.5%) patients had crescentic glomerulonephritis, while 5 (31.25%) showed necrotizing (n = 4) or granulomatous (n = 1) in the vasculitis. Of 16 patients who received treatment, four (23.25%) achieved complete remission. In this single-center study, the majority of anti-GBM disease patients presented with RPGN and had crescentic glomerulonephritis on biopsy with poor treatment outcome. [ABSTRACT FROM AUTHOR]

Study creates a scenario for enrichment and selection of ligno-hemicellulose degrading genotypes with anaerobic bioreactor as a model using rice straw, vegetable waste and food waste as substrates. Relative discrimination analysis showed that the hydrolytic pathways and associated microbial communities for ligno-hemicellulose degradation were dominatingly colonized with rice straw as substrate. The dominating bacteria were Caldicellulosiruptor , Fervidobacterium , Cytophaga , Ruminococcus , Thermotoga associated with hemicellulose degradation and Burkholderia , Pandorea , Sphingomonas , Spirochaeta , Pseudomonas for lignocellulose hydrolysis. This was further supported by the abundance of anaerobic aromatic compound degrading genes along with genes for xylanase and xylosidase in rice straw enriched community. The metagenome analysis data was validated by evaluation of the biochemical methane potential for these substrates. Food waste being most amenable substrate yielded 1410 mL of biogas/g VS added whereas, biogas yield of 1160 mL/g VS and 1080 mL/g VS was observed in presence of vegetable waste and rice straw respectively. [ABSTRACT FROM AUTHOR]

Demonstrates that insulin receptor substrate 1 (IRS1) and IRS2 localize to an endoplasmic reticulum-enriched fraction in pancreatic beta cells using subcellular fractionation. Localization of IRS1 and sarco-endoplasmic reticulum calcium adenosine triphosphatase (SERCA) in vesicles derived from the endoplasmic reticulum; Importance of the interaction of IRS proteins and SERCA in insulin secretion.

Systemic lupus erythematosus (SLE) is a multisystem disorder with cardiac involvement in about 50% of cases, yet clinically significant lesions are less common. SLE with pancarditis at initial presentation has so far not been reported. We present a rare case of SLE with culture negative endocarditis, reversible left ventricular (LV) dysfunction and mild pericardial effusion. Treatment with steroids showed improvement in cardiac contractile function and mitral valve vegetations disappeared over 3 months. In a case of pancarditis with culture negative endocarditis, SLE as a possibility must be explored. After excluding infective endocarditis, a short trial of high dose corticosteroids effects overall improvement in carditis of SLE. [Copyright &y& Elsevier]

A 60‑year male was admitted with advanced renal failure and bilaterally enlarged kidneys. Kidney biopsy revealed diffuse interstitial infiltration by CD20 + lymphomatous cells suggestive of diffuse large B‑cell, non‑Hodgkin’s lymphoma. Bone marrow examination was negative for malignant cells. Positron emission tomography‑computed tomography showed uniformly diffuse and avid flurodeoxy glucose uptake in both kidneys, multiple hypodense areas of both lobes of liver, and axial and appendicular skeleton. Patient was treated with rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine and prednisolone, became afebrile and serum creatinine normalized. [ABSTRACT FROM AUTHOR]

Micro Electro-Discharge Machining is a precision machining process that uses electrical discharge to produce small-scale components with high accuracy. A metal workpiece is machined in this process by repeatedly generating spark between a tool electrode and the workpiece, removing material in a controlled manner. The significance of µ-EDM lies in its ability to produce highly accurate and complex components with a high surface finish, making it ideal for use in various industries, including aerospace, medical, and electronics. The critical parameters to the success of µ-EDM include the electrical discharge energy, voltage, current, pulse duration, and spark gap between the tool electrode and workpiece, including the shape and size of the tool electrode. This review article discusses the µ-EDM process used to machine biological materials and also examines the µ-EDM, dry µ-EDM procedure, and the features of biomedical materials for biocompatibility, 3D micro shape machining with tool wear composition, and thin film coating for microelectrodes. The impact of introducing nanoparticles to dielectric fluids is further clarified in this article. This study addresses the prospective future research subjects and application areas for the µ-EDM process in order to fulfill the demanding criteria for biomaterials and their usage in the production of bioimplants. [ABSTRACT FROM AUTHOR]

Non-metastatic neurological disease complicating neuroblastoma is well recognized. Gross papilloedema in the absence of intracranial disease as initial manifestation of neuroblastoma is reported in adults. We report for the first time a case of bilateral papilloedema in a child with neuroblastoma in the absence of intracranial disease and hypertension. [ABSTRACT FROM AUTHOR]

Background: India is the world's third largest consumer of tobacco. There are twice as many users of smokeless tobacco products (STPs) as cigarette smokers. The Government of Tamil Nadu has banned the sale of gutkha and pan masala in 2013. Our aim was to identify the varieties of illegal STP available in Chennai, India.Methods: In systematically chosen zones and regions of Chennai city, we randomly identified three kinds of kiosks (n = 18) and asked for "gutkha" and "pan masala," one of each product available. Details of each product were reviewed based on the information printed on the sachets.Results: Totally 65 STPs were collected; 26 distinct products and 23 brands. All products were claimed to be "tobacco" by the shop keepers. Sixty-five percent of the products informed to contain tobacco and 15.4% to contain pan masala. Five sachets did not inform about the content; 30.8% did not have a pictorial warning; a text warning was printed on 80.8%, but only two products had the messages in Tamil; 70% had promotional messages printed, and 57% had their registration numbers printed.Conclusion: The ban on STP is being systematically violated in Chennai. STP are cheap and easily available and due to promotional laudatory messages and lacking information about the content and warning of health damage, the consumers are left with the perception that they buy more or less harmless product. The Indian Government must introduce policies to control production, import, and sale of illicit STP but we also call for a coordinated international solution. [ABSTRACT FROM AUTHOR]

We report a 50‑year‑old female who presented with inflammatory arthritis, upper respiratory tract symptoms, and microscopic hematuria with nephrotic range proteinuria. Antineutrophil cytoplasmic antibodies (ANCA) were detectable and kidney biopsy showed pauci‑immune focal necrotizing crescentic glomerulonephritis. She was treated with pulse intravenous cyclophosphamide (CYC) and prednisolone. Patient developed severe leucopenia after the first dose and subsequently had leucopenia to low dose CYC, mycophenolate mofetil and azathioprine were also tried. However, patient developed leukopenia with all the above agents. Initiation of tacrolimus (TAC) was followed by dramatic response: Proteinuria decreased, serum albumin normalized and C‑ANCA and anti‑PR3 ANCA assays became negative. This is the first successful case of TAC as an induction agent in a patient with GPA (ANCA associated vasculitis with renal involvement). [ABSTRACT FROM AUTHOR]

Background: Automated blood collection platforms use different technological systems to isolate and collect individual blood components. These unique systems could potentially result in differences in platelet in vivo viability, as measured by the corrected count increment (CCI).Study Design and Methods: This retrospective study evaluated CCI data of platelet transfusions among oncology patients who received multiple unmanipulated apheresis platelets between January 1, 2006 and December 31, 2009. Apheresis platelets were collected from our community blood center by standard procedures using two different collection systems and were transfused to patients in a blinded manner.Results: The CCI of the platelet recipient was significantly higher at 0-2 hours post-transfusion among the individuals who received platelets collected on Trima Accel (Terumo BCT) (mean = 6281, standard deviation = 3650) compared to the platelets collected by the Amicus system (Fresenius Kabi) (mean = 5251, standard deviation = 3311, p = 0.004).Conclusions: These hypothesis-generating data suggesting improved recovery and survival of Trima Accel platelets demonstrate the need for the investigation and implementation of the best collection methods to provide better platelet transfusion support. [ABSTRACT FROM AUTHOR]

Background: Blood culture, despite low sensitivity, is the gold standard for enteric fever diagnosis. Understanding predictors of blood culture positivity may help design strategies to optimize enteric fever diagnosis.Methods: A cohort of 6760 children aged 0.5-15 years was followed for 3 years for enteric fever with blood cultures in an automated system, for fevers >3 days. Factors affecting test positivity in fevers and participant-level predictors for culture refusals were analyzed using regression models.Results: Overall, 6097 suspected typhoid/paratyphoid fever (STF) episodes were reported, of which 5703 (93.5%) STFs had sampling for blood cultures, with 394 (6.5%) refusals. Salmonella enterica serovar Typhi/Paratyphi positivity was culture-confirmed in 3.8% (218/5703) of STF episodes. Older children (odds ratio [OR], 1.96 [95% CI, 1.39-2.77]), larger blood volume inoculated (OR, 2.82 [95% CI, 1.71-4.66]), higher temperatures during fever (OR, 3.77 [95% CI, 2.89-4.91]), and fevers diagnosed as suspected typhoid or acute undifferentiated fever (OR, 6.06 [95% CI, 3.11-11.78]) had a higher probability of culture positivity. Antibiotics before culture did not decrease culture positivity. Blood culture refusals were higher for children from wealthier households or with milder illness.Conclusions: Performing blood cultures in older children with fever, especially those fevers with toxic presentation and increasing blood volume for inoculation are strategies to improve enteric fever detection in surveillance settings. [ABSTRACT FROM AUTHOR]

Chemoprevention of hepatocarcinogenesis by green tea (GT) has been examined in young male Fischer rats fed AIN-76A diet with aflatoxin B[sub 1] (AFB[sub 1]) and CCl[sub 4] as the initiator and promoter, respectively. Animals were administered AFB[sub 1] (0.25 mg/kg body wt ip) twice a week for 2 weeks, and 2 weeks later, CCl4 was injected (0.8 ml/kg body wt ip) once per week for 11 weeks. Rats given 0.5% GT in their drinking water before and during initiation (0-4 wk) or during promotion (6-16 wk) or throughout the experimental period were sacrificed 24 hours after the last dose of CCl[sub 4]. Bromodeoxyuridine incorporation as a measure of cell proliferation and glutathione S-transferase placental form- and g-glutamyl transpeptidase-positive hepatic foci were analyzed by histochemical methods. Feeding of GT during initiation or promotion inhibited the number of glutathione S-transferase placental form- and γ-glutamyl transpeptidase-positive hepatic foci by 30-40% and the area and volume by 50%. GT treatment throughout the period inhibited the number of both types of hepatic foci by 60% and the area and volume by 75-80%. Cell proliferation was inhibited 35% by GT given during promotion, whereas inhibition was 65% when GT was given during initiation or throughout the period. These results indicate that GT feeding inhibits initiation and promotion steps of AFB[sub 1] hepatocarcinogenesis and that the inhibition of cell proliferation is responsible for the inhibition of promotion. [ABSTRACT FROM AUTHOR]

Partial albinism with immunodeficiency is a rare and fatal immunologic disorder characterized by pigmentary dilution and variable cellular immunodeficiency. It was initially described in 1978. Primary abnormalities included silvery grayish sheen to the hair, large pigment agglomerations in hair shafts and an abundance of mature melanosomes in melanocytes, with reduced pigmentation of adjacent keratinocytes. We describe a child with Griscelli syndrome who presented with hepatitis, pancytopenia and silvery hair. The diagnosis was confirmed by microscopic skin and hair examination. [ABSTRACT FROM AUTHOR]

Abstract Diarrheal disease due to Group A rotaviruses remain a leading cause of mortality and morbidity in the less developed parts of the world. India has started a phased roll out of rotavirus vaccine in the national immunization program. This analysis summarizes the rotavirus genotype strain distribution pre-vaccine introduction in Vellore, India from December 2005 to June 2016. Rotavirus was responsible for 32% of all diarrheal admission to the hospital. G2P[4] was the predominant strain in the initial years and was gradually replaced by G1P[8]. The emergence of G9P[4] replacing G9P[8], and the detection of G12 strains over several years were documented. There was no clear seasonality of disease. These data form the baseline to monitor genotype distribution post-vaccine introduction in Tamil Nadu. [ABSTRACT FROM AUTHOR]

Leptospirosis is a potentially fatal zoo-anthroponosis caused by pathogenic species of Leptospira belonging to the family of Leptospiraceae, with a worldwide distribution and effect, in terms of its burden and risk to human health. The 'LeptoDB' is a single window dedicated architecture (5 948 311 entries), modeled using heterogeneous data as a core resource for global Leptospira species. LeptoDB facilitates well-structured knowledge of genomics, proteomics and therapeutic aspects with more than 500 assemblies including 17 complete and 496 draft genomes encoding 1.7 million proteins for 23 Leptospira species with more than 250 serovars comprising pathogenic, intermediate and saprophytic strains. Also, it seeks to be a dynamic compendium for therapeutically essential components such as epitope, primers, CRISPR/Cas9 and putative drug targets. Integration of JBrowse provides elaborated locus centric description of sequence or contig. Jmol for structural visualization of protein structures, MUSCLE for interactive multiple sequence alignment annotation and analysis. The data on genomic islands will definitely provide an understanding of virulence and pathogenicity. Phylogenetics analysis integrated suggests the evolutionary division of strains. Easily accessible on a public web server, we anticipate wide use of this metadata on Leptospira for the development of potential therapeutics. Database URL: http://leptonet.org.in [ABSTRACT FROM AUTHOR]

Background: In 2014, 2 studies showed that inactivated poliovirus vaccine (IPV) boosts intestinal immunity in children previously immunized with oral poliovirus vaccine (OPV). As a result, IPV was introduced in mass campaigns to help achieve polio eradication.Methods: We conducted an open-label, randomized, controlled trial to assess the duration of the boost in intestinal immunity following a dose of IPV given to OPV-immunized children. Nine hundred healthy children in Vellore, India, aged 1-4 years were randomized (1:1:1) to receive IPV at 5 months (arm A), at enrollment (arm B), or no vaccine (arm C). The primary outcome was poliovirus shedding in stool 7 days after bivalent OPV challenge at 11 months.Results: For children in arms A, B, and C, 284 (94.7%), 297 (99.0%), and 296 (98.7%), respectively, were eligible for primary per-protocol analysis. Poliovirus shedding 7 days after challenge was less prevalent in arms A and B compared with C (24.6%, 25.6%, and 36.4%, respectively; risk ratio 0.68 [95% confidence interval: 0.53-0.87] for A versus C, and 0.70 [0.55-0.90] for B versus C).Conclusions: Protection against poliovirus remained elevated 6 and 11 months after an IPV boost, although at a lower level than reported at 1 month.Clinical Trials Registration: CTRI/2014/09/004979. [ABSTRACT FROM AUTHOR]

Background Allergic transfusion reaction ( ATR) incidence ranges from 1% to 3% of all transfusions. We evaluated the impact of InterSol platelet additive solution ( PAS) apheresis platelets ( APs) on the incidence of ATRs and the posttransfusion platelet ( PLT) increment. Study Design and Methods This retrospective study evaluated all ATRs among patients at a university hospital that maintained a mixed inventory of PAS APs and non- PAS APs (standard plasma-suspended PLTs). Corrected count increments ( CCIs) were calculated for AP transfusions of individuals who received both a PAS and a non- PAS AP transfusion within a 7-day period. Hypothesis testing was performed with chi-square test for dichotomous variables and t tests for continuous variables. Results The incidence of ATRs among the non- PAS APs was 1.85% (72 ATRs/3884 transfusions) and 1.01% (12 ATRs/1194 transfusions) for PAS APs (risk ratio [ RR], 0.54; 95% confidence interval [ CI] = 0.30-0.99; p = 0.04). However, there was no difference in the incidence of febrile nonhemolytic transfusion reactions between non- PAS APs (incidence, 0.70%; 27/3884) compared to PAS APs (incidence, 0.59%; 7/1194; p = 0.69). Among 223 individuals with paired non- PAS and PAS AP transfusions, the mean CCI at 1 to 4 hours after transfusion was 4932 (95% CI, 4452-5412) for non- PAS APs and was lower for PAS APs ( CCI, 3766; 95% CI, 3375-4158; p ≤ 0.001). However, there was no significant difference in mean CCI at 12 to 24 hours between non- PAS ( CCI, 2135; 95% CI, 1696-2573) and PAS APs ( CCI, 1745; 95% CI, 1272-2217; p = 0.14). Conclusions PAS APs substantially reduce the number of ATRs. CCIs for PAS APs were lower immediately after transfusion, but not significantly different at 12 to 24 hours. [ABSTRACT FROM AUTHOR]

Highlights: [•] 2899 (40%) out of 7285 stool samples were rotavirus positive from 2005 to 2009. [•] G12 infections rose to 39% in Northern India and to 24% in the Western India. [•] 8% of rotavirus detections had multiple G-types and 3% had multiple P-types. [ABSTRACT FROM AUTHOR]

Background: The burden of the pandemic (H1N1) 2009 influenza might be underestimated if detection of the virus is mandated to diagnose infection. Using an alternate approach, we propose that a much higher pandemic burden was experienced in our institution. Methodology/Principal Findings: Consecutive patients (n = 2588) presenting to our hospital with influenza like illness (ILI) or severe acute respiratory infection (SARI) during a 1-year period (May 2009-April 2010) were prospectively recruited and tested for influenza A by real-time RT-PCR. Analysis of weekly trends showed an 11-fold increase in patients presenting with ILI/SARI during the peak pandemic period when compared with the pre-pandemic period and a significant (P<0.001) increase in SARI admissions during the pandemic period (30±15.9 admissions/week) when compared with pre-pandemic (7±2.5) and post-pandemic periods (5±3.8). However, Influenza A was detected in less than one-third of patients with ILI/SARI [699 (27.0%)]; a majority of these (557/699, 79.7%) were Pandemic (H1N1)2009 virus [A/H1N1/09]. An A/H1N1/09 positive test was correlated with shorter symptom duration prior to presentation (p = 0.03). More ILI cases tested positive for A/H1N1/09 when compared with SARI (27.4% vs. 14.6%, P = 0.037). When the entire study population was considered, A/H1N1/09 positivity was associated with lower risk of hospitalization (p<0.0001) and ICU admission (p = 0.013) suggesting mild self-limiting illness in a majority. Conclusion/Significance: Analysis of weekly trends of ILI/SARI suggest a higher burden of the pandemic attributable to A/H1N1/09 than estimates assessed by a positive PCR test alone. The study highlights methodological consideration in the estimation of burden of pandemic influenza in developing countries using hospital-based data that may help assess the impact of future outbreaks of respiratory illnesses. [ABSTRACT FROM AUTHOR]

Objectives To determine health care provider cost and household cost of the treatment of severe pneumonia in infants and young children admitted to secondary and tertiary level health care facilities. Methods The study was done in a private, not-for-profit medical college hospital, in Vellore, India, in mid-2008. Children aged 2–36 months admitted with severe pneumonia with no underlying chronic disease were included in the study. The relatives were interviewed daily on matters relating to patients’ view point of the costs. These were direct medical costs, direct non-medical costs which comprised travel, accommodation and special food during the period of illness, and indirect costs of productivity loss for family members. Patient specific resource consumption and related charges were recorded from charts, nursing records, pharmacy lists and hospital bills, and the providers view point of the costs was estimated. Unit cost estimates for bed days, treatment and investigation inputs were calculated. Results Total cost to health care provider for one episode of hospitalized childhood pneumonia treated at secondary level was US$ 83.89 (INR 3524) and US$ 146.59 (INR 6158) at tertiary level. At both levels the greatest single cost was the hospital stay itself, comprising 74% and 56% of the total cost, respectively. Diagnostic investigations were a large expense and supportive treatment with nebulization and oxygen therapy added to the costs. Mean household expenditure on secondary level was US$ 41.35 (INR 1737) and at tertiary level was US$ 134.62 (INR 5655), the largest single expense being medicines in the former and the hospitalization in the latter. (one US$=INR 42.1 at time of study) Conclusions A considerable cost difference exists between secondary and tertiary level treatment. Admission at lowest possible treatment level for appropriate patients could decrease the costs borne by the provider and the patient. [ABSTRACT FROM AUTHOR]

Familial hemophagocytic lymphohistiocytosis is a very unusual cause for demyelination and the clinician would do well to be aware of the condition, especially when children present with atypical findings on magnetic resonance imaging associated with fever, pancytopenia, and hepatosplenomegaly. This is a rare autosomal recessive, multisystem inflammatory disorder characterized by widespread organ infiltration by macrophages and activated lymphocytes. It is usually diagnosed in the first 2 years of life and is rapidly fatal if untreated. Reported here is the case of a 12-year-old boy, from a poor family, with a 6-year history of visual loss and fever for 5 months, and transient hemiparesis with hepatosplenomegaly and pancytopenia. Cranial magnetic resonance imaging showed multiple areas of hyperintense signal, predominantly involving white matter. The boy also had elevated triglycerides and ferritin, with low fibrinogen level. Bone marrow aspiration revealed hemophagocytosis. He was diagnosed as having familial hemophagocytic lymphohistiocytosis and treated with the HLH 2004 protocol. A sibling also had evidence of hemophagocytosis. Remission was achieved, but his parents could not afford the cost of hematopoietic stem cell transplantation. He relapsed after 8 months and later died. [Copyright &y& Elsevier]

Diarrheal disease due to Group A rotaviruses continues to be an important cause of morbidity in the developing world and India contributes significantly to the disease burden. Surveillance carried out between July 2009 and June 2012 at two medical centers in south India and one center in north India estimated 39% of all diarrheal admissions to be due to rotavirus. The most prevalent genotype isolated was G1P[8](33%) followed by G2P[4](17%). G9P[4] has also emerged as a significant cause of rotavirus diarrhea. No seasonal variation was noticed from the centers in south India, whereas we observed increased rotavirus diarrhea in the center in north India during March and April. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The burden of rotavirus gastroenteritis is greatest in India and other developing countries. With the availability of two licensed vaccines and a number of additional vaccines in various stages of development and trial, analysis of detailed clinical information is essential for the development of a uniform method of severity assessment. Methods: Diarrhoeal stool samples from 1001 children <5 years of age hospitalized with gastroenteritis were screened for rotavirus using a commercial enzyme immunoassay. Positive samples were confirmed by genotyping using hemi nested multiplex RT-PCR. Detailed clinical data was collected for gastroenteritis assessment for 934 children and extraintestinal presentations were analyzed in 470 children. Severity scoring was carried out for all children using the Vesikari score and in a subset by Clark''s scoring system. Results: Rotavirus was detected in 35.4% of samples tested between December 2005 and November 2008. Clark''s and Vesikari scores showed moderate correlation but varied greatly in the categorization of severe disease. Using Clark''s scoring, only 1.6% were categorized as presenting with severe disease in comparison to 66.1% by the Vesikari score. Association of extraintestinal symptoms with rotavirus gastroenteritis was not documented in this study. Conclusion: The assessment of disease severity using two common severity scoring systems highlights the difference in the categorization of “severe” disease. This underscores the need for a robust scoring system which is needed for vaccine trial and in post-licensure surveillance, because vaccine efficacy is estimated for protection against severe rotavirus gastroenteritis. [Copyright &y& Elsevier]