Nonvenomous Snakebite in Pediatric Age Group-Wolf under a Sheep's Coat.

Nonvenomous snakebite, far outnumbering venomous bites, is a neglected occupational hazard in the Indian subcontinent. We encountered four cases of traditionally nonvenomous snakebite in pediatric age group with symptoms of limb swelling proximal to the bite site. All cases were found to have extensive fibrinous exudate and fibrinoid necrosis of the deeper layer of fat, deep to the intact skin and superficial layer of fat, extending far from the wound toward the proximal limb in continuity. This obscured presentation of infection and extensive necrosis of only the deeper layer of fat warrants exploratory incisions proximally for thorough debridement, underlying the normal appearing skin.

Identifying fluoride endemic areas and exposure pathways for assessment of non-carcinogenic human health risk associated with groundwater fluoride for Gujarat state, India.

Analytical data of fluoride concentration in groundwater collected from various geological formations in Gujarat, India, have been studied to assess their spatial distribution characteristics and related potential chronic health risks. Decadal analysis of groundwater was attempted for precise quantification and a realistic ground representation of fluoride concentration in the entire state. This exercise involved collection of 6407 samples over a period of 10 years (2009-2018), from 641 representative locations, distributed evenly throughout the state (6407 = 641 locations × 10 years). The analytical results indicate that 19% of the sample locations have fluoride concentration higher than the permissible limit and 42% of the locations have fluoride concentration much below the desirable limit, thereby exposing children to a higher risk of associated dental morbidities. Monte Carlo simulation integrated with sensitivity and uncertainty analysis was applied for an accurate and realistic assessment of the non-carcinogenic health risk. Model results indicated that groundwater fluoride exposure through consumption is way higher than the exposure due to dermal absorption pathway. It is inferred that 94 locations (15%) have total hazard index greater than the unity value for all population groups, thereby increasing the vulnerability of the local populace to dental and skeletal fluorosis. Total hazard index in 210 locations (36%) and 188 locations (29%) are beyond the permissible limit for the population comprising infants and children. Populaces living in these locations are susceptible to health hazards that stems from high fluoride concentration. Children and infants are at greater risk due to groundwater fluoride toxicity when compared to the adult populace. The order of the geographic stratification of vulnerability is Mainland regions > Saurashtra region > Kachchh region. Ingestion rate and fluoride concentration are the sensitive parameters with high impact and residents of these vulnerable locations should be advised to abstain from direct intake of groundwater and resort to defluoridised groundwater.

A rare case of ureteric involvement in xanthogranulomatous pyelonephritis associated with giant ureteric calculus: An unusual entity.

Xanthogranulomatous pyelonephritis (XGPN) is an uncommon chronic destructive granulomatous inflammation of the kidney with variable clinical and radiological presentation. Due to its similarities to other benign and malignant pathologies, a high index of suspicion is required for preoperative diagnosis, which will ensure appropriate management of this condition. The invasion into the surrounding structures such as pararenal spaces, psoas muscle, small bowel, diaphragm, lung or soft tissues has been reported. However, involvement of ureter is very rarely reported. We report a rare case of left-sided gross hydronephrosis with staghorn calculus with giant uretic calculi, postnephrectomy on the biopsy diagnosis of XGPN was made, which also revealed involvement of ureter also.

Osteopetrosis: presenting as maxillary osteomyelitis.

Osteopetrosis is a rare congenital disease presenting with recurrent fractures, hematopoietic insufficiency and hepatosplenomegaly. Though osteomyelitis is a known complication in osteopetrosis, osteopetrosis presenting as osteomyelitis is rare. Management consists of multidisciplinary approach for complications and bone marrow transplant for the infantile form of disease.

Addition of Questions on Parental Factors to the WHO (Integrated Management of Childhood Illnesses) IMCI-HIV Algorithm Improves the Utility of the Algorithm for Diagnosis of HIV Infection in Children.

The WHO Integrated Management of Childhood Illnesses-HIV (IMCI-HIV) algorithm and its regional adaptation have shown variable performance in clinically identifying HIV-infected children with lack of validation in low prevalence areas. Addition of certain 'parental factors' (proxy indicators of parental HIV) may improve its utility. In this study, children aged 2 months to 5 years were enrolled into Group A (n = 1000, 'suspected symptomatic HIV infected' children as per the IMNCI-HIV algorithm) and group B (n = 50, children newly diagnosed with HIV infection). Parental factors were asked and HIV infection was tested for in Group A. For Group B, retrospective data were collected regarding IMNCI-HIV algorithm signs and parental factors. Utility of individual and various combinations of IMNCI-HIV signs and parental factors to predict HIV status was evaluated. Results showed that incorporating parental factors to IMNCI-HIV algorithm improved its sensitivity and positive predictive value in identifying HIV-infected children while maintaining the same sensitivity.

Thromboembolic complications at the onset of nephrotic syndrome.

Nephrotic syndrome is associated with hypercoagulable states and a subsequent high risk of venous and rarely arterial thromboembolism. Although venous thromboembolism has been a recognised risk, prevalence of pulmonary embolism in patients with nephrotic syndrome is based on data from different case series. Here we report a 5 year old child with nephrotic syndrome who developed life threatening cerebral dural venous sinus thrombosis and pulmonary embolism within a month of disease onset.

Development and Evaluation of Recombinant Nucleocapsid Protein Based Diagnostic ELISA for Detection of Nipah Virus Infection in Pigs.

The recombinant viral protein-based indirect enzyme-linked immunosorbent assay (ELISA) is a cost-effective, safe, specific, and rapid tool to diagnose the viral infection. Nipah virus nucleocapsid (NiV-N) protein was expressed in Escherichia coli and purified by histidine tag-based affinity chromatography. The N protein was selected based on its immuno dominance and conservation among different NiV strains. An indirect immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA) for swine sera was optimized using the recombinant NiV-N protein as an antigen along with negative and positive controls. The background reading was blocked using skim milk powder and chicken serum. A total number of 1709 swine serum samples from various states of India were tested with indirect ELISA and Western blot. The test was considered positive only when its total reactivity reading was higher than 0.2 cut-off value and the ratio of the total reactivity to the background reading was more than 2.0. Since specificity is high for Western blotting it was used as standard test for comparison of results of indirect ELISA. Sensitivity and specificity of indirect ELISA was 100% and 98.7%, respectively, in comparison with Western blotting. Recombinant N protein-based ELISA can be used in screening large number of serum samples for epidemiological investigations in developing countries where high containment laboratories are not available to handle this zoonotic virus.

Multiple enzymatic activities of ParB/Srx superfamily mediate sexual conflict among conjugative plasmids.

Conjugative plasmids are typically locked in intergenomic and sexual conflicts with co-resident rivals, whose translocation they block using fertility inhibition factors (FINs). We describe here the first crystal structure of an enigmatic FIN Osa deployed by the proteobacterial plasmid pSa. Osa contains a catalytically active version of the ParB/Sulfiredoxin fold with both ATPase and DNase activity, the latter being regulated by an ATP-dependent switch. Using the Agrobacterium tumefaciens VirB/D4 type IV secretion system (T4SS), a relative of the conjugative T4SS, we demonstrate that catalytically active Osa blocks T-DNA transfer into plants. With a partially reconstituted T4SS in vitro, we show that Osa degrades T-DNA in the T-DNA-VirD2 complex before its translocation. Further, we present evidence for conservation and interplay between ATPase and DNase activities throughout the ParB/Sulfiredoxin fold, using other members of the family, namely P1 ParB and RK2 KorB, which have general functional implications across diverse biological contexts.