Clinicopathological Profile of Pyoderma Gangrenosum: A 10-Year Retrospective Study from a Tertiary Care Center in South India.

Background: Pyoderma gangrenosum (PG) is a reactive neutrophilic inflammatory dermatosis with a varied clinicopathologic presentation. It commonly manifests as rapidly progressive painful ulcers, mimicking varied conditions including infections, vasculitis, and malignancies, and is a diagnosis of exclusion. There are scarce data on PG from the Indian subcontinent. Aim and Objectives: The aim of the study was to study the clinicopathologic profile of patients with PG and their underlying systemic associations. Materials and Methods: A retrospective observational study was done between 2011 and 2021, and patients diagnosed as PG based on the diagnostic tool proposed by Maverakis et al. were recruited and their demographic, clinical, and histological findings were obtained. Results: Among 54 patients with suspected PG, 17 patients (eight males and nine females) fulfilled the diagnostic criteria, and the mean age of disease onset was 32.1 years (range: 3-60 years). Ulcerative variant was the most common type (9/17, 52.9%), and 29.4% had systemic associations including autoinflammatory syndromes. The onset at atypical sites such as face and hand were noted in one patient each. Histopathology revealed a polymorphous dermal infiltrate with neutrophilic predominance in the majority (94.1%). Systemic steroids (dose ranging from 0.5-1 mg/kg prednisolone equivalent) were used in 11/17 (64.7%) patients. The commonly used alternative drugs included clofazimine (47%), minocycline (29%), thalidomide (23.5%), adalimumab and mycophenolate mofetil in 17.6% each, dapsone and ciclosporine in 11.7% each. Remission was achieved between two weeks and three months in 10 (58.8%) patients after treatment initiation and two mortalities (11.7%) were recorded. Conclusion: PG can affect any age group and may be localized to rarer, atypical sites. The possibility of underlying autoinflammatory conditions should be considered in addition to the evaluation of other disorders like inflammatory bowel disease, hematological disorders, and rheumatological disorders.

UVB emitting phosphors based on singly and co-doped Ce3+, Gd3+ in Li4ZrF8 phosphors.

Preparation of Li4ZrF8:Ce3+ and Li4ZrF8:Ce3+,Gd3+ phosphors is described. Data on luminescence characteristics are presented. Hydrothermal route was employed for the synthesis. Li4ZrF8 crystallizes in orthorhombic system with Pnma space group. Li atoms are distributed over two sites, both having same coordination of six. Zr is also similarly distributed over two 8 coordinated sites. Li4ZrF8:Ce3+ emits a broad band UVB light, while the emission of Li4ZrF8:Ce3+,Gd3+ is in form of a narrow line around 311 nm attributed to 6P7/2 â†’ 8S7/2. Both phosphors exhibited a broad excitation spectrum with a peak at 253 nm. The excitation and emission properties are thus adequate enough to obtain UVB light sources using a conventional high pressure mercury vapour lamp or an ultraviolet LED.

Mapping Advantages and Challenges in Analytical Development for Fixed Dose Combination Products, a Review.

Formulations containing more than one active ingredient are increasingly gaining popularity due to advantages with regard to patient convenience as well as reduced cost of production, packaging, and transportation. Such fixed-dose combinations (FDCs) demand for enhanced analytical methodologies and tools to efficiently achieve quality control of these complex products as compared to the conventional products containing only one active constituent. Highly efficient analytical methods can measure multiple constituents at once, improving their quality control. This review article discusses the challenges in the development of such methods due to the similarities or differences in the chemical identity of the participating drug molecules in an FDC. The latest developments in multiple analyte determination using various analytical techniques (HPLC, LC-MS, NMR, IR, powder XRD and DSC) are discussed, with a focus on special considerations in each case. The article discusses challenges with sample preparation of complex FDC products, and the use of Chemometrics and Quality by Design to develop efficient analytical methods. Lastly, an equation-based approach is proposed and demonstrated to arrive at a parameter referred to as "percentage efficiency gain" that would be useful in directly accessing the relevance and commercial benefits of a simultaneous method vis-a-vis separate methods for individual components.

Farm size limits agriculture's poverty reduction potential in Eastern India even with irrigation-led intensification.

CONTEXT: Millions of people living in the Eastern Gangetic Plains (EGP) of India engage in agriculture to support their livelihoods yet are income poor, and food and climate insecure. To address these challenges, policymakers and development programs invest in irrigation-led agricultural intensification. However, the evidence for agricultural intensification to lift farmers' incomes above the poverty line remains largely anecdotal. OBJECTIVE: The main objective of this study is to use a large household survey (n = 15,572; rice: 8244, wheat: 7328; 2017/18) to assess the link between agricultural intensification and personal daily incomes from farming (FPDI) in the rice-wheat systems of the EGP - the dominant cropping system of the region. METHODS: We use the Intensification Benefit Index (IBI), a measure that relates farm size and household size to FPDI, to assess how daily incomes from rice-wheat production change with irrigation-led intensification across the EGP. RESULTS AND CONCLUSIONS: Relative to the international poverty line of 1.90 Purchasing Power Parity (PPP)$ day-1 and accounting for variations in HH size in the analysis, we found that small farm sizes limit the potential for agricultural intensification from irrigation to transform the poverty status of households in the bottom three quartiles of the IBI. The estimated median FPDI of households with intensified systems in the bottom three quartiles is only 0.51 PPP$ day-1 (a 0.15 PPP$ gain). The median FPDI increases to 2.10 PPP$ day-1 for households in the upper quartile of the IBI distribution (a 0.30 PPP$ gain). Irrigation-led agricultural intensification of rice-wheat systems in the EGP may provide substantial benefits for resilience to climatic change and food security but achieving meaningful poverty reduction will require complementary investments. SIGNIFICANCE: Transforming the poverty status of most smallholder farmers in the EGP requires diversified portfolios of rural on- and off-farm income-generating opportunities. While bolstering food- and climate security, agronomic intervention programs should consider smallholders' limited monetary incentives to invest in intensification. Irrigation-led agricultural intensification programs and policies should explicitly account for the heterogeneity in household resources, irrigation levels, and degree of dependence on agricultural income.

Pathway to achieve a sustainable food and land-use transition in India.

India has committed to reducing the emissions intensity of GDP by 33-35% from the 2005 level by 2030 in alignment with objectives of the Paris Agreement. This will require a significant reduction in greenhouse gas (GHG) emissions from the food and land-use sector. In this paper, we construct three potential pathways for India to achieve its emissions target by 2050 involving moderate ambitions of mitigation action (BAU), moderate ambitions combined with achieving healthy diets (BAU + NIN), and high levels of mitigation action inclusive of healthy diets (SUSTAINABLE). Using an integrated accounting tool, the FABLE Calculator, that harmonizes various socioeconomic and biophysical data, we project these pathways under the conditions of cross-country balanced trade flows. Results from the projections show that the demand for cereals will increase by 2050, leading to increased GHG emissions under BAU. Under the SUSTAINABLE pathways, GHG emissions will decrease over the same period due to reduced demand for cereals, whereas significant crop productivity and harvest intensity gains would lead to increased crop production. The exercise reveals the indispensability of healthy diets, improved crop, and livestock productivity, and net-zero deforestation in achieving India's mid-century emission targets from the agriculture sector. Supplementary Information: The online version contains supplementary material available at 10.1007/s11625-022-01193-0.

Synthesis, characterization, and luminescence studies of rare-earth-activated NaMgF3.

NaMgF3 -based phosphors have been described frequently in the literature. Their synthesis faces difficulties typical of fluoride materials. A simple precipitation synthesis for NaMgF3 -based phosphors is described in this paper. This consisted of mixing aq. NaF and MgCl2 /MgSO4 solutions. Various activators could be incorporated by adding the required salts during this process. Characteristic emission of the activators was observed in the prepared phosphors. As-prepared samples exhibited predominantly trivalent lanthanide emission. After thermal treatment in a reductive atmosphere, europium-doped samples showed the intense emission of Eu2+ . By virtue of the intense nature of the emission, lifetime measurements could be made for this sample. Notably, intense thermoluminescence and optically stimulated luminescence were observed in NaMgF3 :Eu. A simple, fast method for the synthesis of NaMgF3 was therefore developed.

Massive lateral neck mass: aberrant ectopic thyroid malignancy.

Lateral aberrant ectopic thyroid is very rare, comprising only 1%-3% of all the ectopic thyroid tissue. Clinically, these lesions are mistaken for lymph node swelling or metastatic tumour. Primary carcinoma in lateral aberrant ectopic thyroid with normal active native thyroid is very uncommon. We report a case of papillary carcinoma in lateral aberrant ectopic thyroid tissue, with a completely normal native thyroid gland in a 53-year-old man, who presented with a massive swelling in the lateral aspect of the neck clinically and radiologically diagnosed as a malignant soft tissue tumour with differential diagnosis of malignant lymphoma. Fine needle aspiration cytology revealed metastatic papillary carcinoma. In toto excision of the soft tissue mass along with subtotal thyroidectomy was performed. Histology of the mass revealed papillary carcinoma of lateral aberrant ectopic thyroid, while the thyroid gland did not show evidence of malignancy. The postsurgical period was uneventful, and the patient underwent radioiodine ablation.

Demand for Crop Insurance in Developing Countries: New Evidence from India.

Determining farmers' real demand for crop insurance is difficult, especially in developing countries, where there is a lack of formal financial sector integration and a high reliance on informal risk mitigation options. We provide some new estimates of farmers' willingness-to-pay for insurance in the context of a large-scale subsidised programme in India. We conducted a discrete choice experiment with agricultural households across four states in India, enabling us to estimate preferences for specific insurance policy attributes such as coverage period, method of loss assessment, timing of indemnity payments and the cost of insurance. Our results suggest that farmers do value crop insurance under certain conditions and some are willing to pay a premium for such coverage in excess of the subsidised rates they are currently required to pay under this programme. In particular, farmers value the assurances that they will receive timely payouts when they incur losses, and may not have a strong preference for the method with which losses are assessed. On the other hand, farmers are quite sensitive to coverage periods. Our baseline assessment shows that when optimised to farmer requirements, there can be a sizeable demand for crop insurance by developing country farmers.

Predictors and outcomes of healthcare-associated infections in COVID-19 patients.

INTRODUCTION: Healthcare-associated infections (HAI) after viral illnesses are important sources of morbidity and mortality. This has not been extensively studied in hospitalized COVID-19 patients. METHODS: This study included all COVID-19-positive adult patients (≥18 years) hospitalized between 01 March and 05 August 2020 at the current institution. The Centers for Disease Control and Prevention definition of HAI in the acute care setting was used. The outcomes that were studied were rates and types of infections and in-hospital mortality. Several multivariable logistic regression models were constructed to examine characteristics associated with development of HAI. RESULTS: Fifty-nine (3.7%) of 1565 patients developed 140 separate HAIs from 73 different organisms: 23 were Gram-positive, 39 were Gram-negative and 11 were fungal. Patients who developed HAI did not have higher odds of death (OR 0.85, 95% CI 0.40-1.81, p = 0.69). HAIs were associated with the use of tocilizumab (OR 5.04, 95% CI 2.4-10.6, p < 0.001), steroids (OR 3.8, 95% CI 1.4-10, p = 0.007), hydroxychloroquine (OR 3.0, 95% CI 1.0-8.8, p = 0.05), and acute kidney injury requiring hemodialysis (OR 3.7, 95% CI 1.1-12.8, p = 0.04). CONCLUSIONS: HAI were common in hospitalized Covid-19 patients. Tocilizumab and steroids were associated with increased risk of HAIs.

A Quality Improvement Initiative to Increase the Opportunity of Play Activities and Reduce the Screen Time Among Children Admitted in Hospital Setting of a Tertiary Care Centre, North India.

OBJECTIVE: To increase the time spent by children on play activities and reduce screen time on daily basis from baseline to 25% over the period of 10 wks in hospital setting of a tertiary care centre, North India. METHODS: The quality improvement design was chosen and the study was conducted in the pediatric surgery and medicine wards of a tertiary care centre in North India. The participants of the study were children admitted in the medical and surgical wards, their caregivers and health care personnel (both nurses and physicians) working in the respective wards. The study was conducted in three phases: planning, development and implementation phase. In planning phase, the baseline assessment of outcome and process measures was performed and the root cause analysis was done which revealed that there was problem with the procedure and policy. This is why day-to-day play implementation procedure protocol development and implementation was chosen as a change based on Eisenhower's matrix. In development phase, day-to-day play implementation procedure protocol was developed and was implemented in the units by using PDSA (Plan, Do, Study and Act) model. Three PDSA cycles were conducted. The outcome measures were 'the time spent by the child on play activities on daily basis' (calculated by the time spent by child in play/total time the child was awake in a day) and 'the reduction in screen time' (calculated by the average time spend by the child on android based phone in a day). The process measures were day-to-day play implementation score, time spent by child on play activities and screen time on daily basis during hospitalization. The data was collected by the team members and the investigator. RESULTS: At the end of all PDSAs, the day-to-day play implementation score and time spent on play activities increased by 50% and 20% respectively and the screen time reduced to 73%. Though the outcome measures were nearly achieved, the continuous efforts are still required to ensure sustainability and future incorporation of play in day-to-day routine of hospital care. CONCLUSION: This QI initiative helped in increasing the play opportunities and reducing the screen time in wards. Hence, both the process and outcome measure were nearly achieved, whereas sustainability remained an issue.

Designing better input support programs: Lessons from zinc subsidies in Andhra Pradesh, India.

India has one of the largest agricultural input support programs in the world, delivered in the form of subsidies to farmers, raising concerns about its sustainability. This paper evaluates the performance of one such support, the micronutrient subsidy program in the state of Andhra Pradesh (AP) and presents a case for providing this support in the form of direct cash transfers. Under the program, key soil micronutrients- zinc, boron, and gypsum were distributed free of cost to farmers living in micronutrient-deficient areas, with identification and targeting managed entirely by the state. We survey 1621 farmers, 61 agriculture extension officers, and 78 agriculture input dealers to assess the efficacy of the program and to identify bottlenecks preventing effective targeting, with a focus on zinc. We find that use of non-subsidized zinc is high in AP, and awareness of benefits of zinc and physical access to input dealer shops are significant predictors of zinc use. We argue that the free provision of micronutrients may have created demand among farmers, but there is little justification to continue subsidizing such a program at such high rates or resorting to public distribution. We find that micronutrient procurement and distribution has become a burden on extension staff and crowds out the private sector. Our analysis shows that the subsidy can benefit more farmers if it is channeled through the network of private fertilizer dealers. We use administrative data on budgetary outlays and digital soil maps to suggest fiscal redistribution in the form of direct cash transfers that may ensure more effective targeting at a lower cost to the state.

Impact of rainfall variability on the ecophysiology of Hyptis suaveolens: a study in the constructed tropical grassland.

Hyptis suaveolens is considered one of the most potent invaders in the eastern part of Uttar Pradesh, India. Climate change especially precipitation variability along with invasion has enormous consequences. To understand how an invasive plant (H. suaveolens) performs and interacts with precipitation variability, particularly in tropical monsoon climate, is vital. To assess the above, three rainout shelters with simulated rainfall of 1600 mm (60% more rainfall than ambient), 1100 mm (average rainfall) and 800 mm (20% less rainfall than ambient) along with one unsheltered plot (open C) were established. Three invaded grassland (IG) and three uninvaded grasslands (NIG) patches of 1 × 1 m2 size were established randomly in each sheltered and unsheltered plot. Among the studied physiological properties and growth measurements, photosynthetic rate, height, diameter and biomass varied significantly with precipitation, in general, the maximum value of these in plots receiving maximum precipitation. Also, the aboveground biomass of H. suaveolens was found to be more sensitive towards precipitation treatment than belowground biomass. H. suaveolens biomass was linearly related to soil moisture (R2 = 0.73), and a linear combination of SM and soil pH increased the R2 value by 19%. The results indicate that H. suaveolens mediates certain soil properties especially related to N-mineralisation, to maintain a constant supply of nutrient, for faster growth under the favourable condition of enhanced precipitation. These findings suggest that the population of H. suaveolens has not evolved drought tolerance, so it is likely that H. suaveolens will not spread in the part of the world which is drier either naturally or due to climate change.

Nature's Benefaction as a Life Saver for an Avulsed Tooth: An In vitro Study.

INTRODUCTION: Dentoalveolar trauma is a very common and avulsion is the most frequent injury. Treatment of choice following avulsion is immediate reimplantation. However, in cases where this might not be possible the prognosis of reimplanted teeth can be improved by the selection of an appropriate storage media. Prevention of ankylosis and replacement resorption depends more on the potential of storage media to maintain cell viability rather than the extraalveolar time period. AIM: To compare and evaluate the efficacy of different storage media in maintaining the viability of Periodontal Ligament (PDL) cells in an avulsed tooth. MATERIALS AND METHODS: A total of 58 freshly extracted human premolar teeth were divided into four experimental groups and two control groups. The positive and negative controls corresponded to 0 minute and an eight hours dry time, respectively. The experimental teeth were stored dry for 30 minutes and then immersed in one of the four media: Hank's Balanced Salt Solution (HBSS), coconut water, aloe vera and saline for 45 minutes. The teeth were then treated with Collagenase Type II and Dispase for 30 minutes. The number of viable PDL cells were counted with a haemocytometer and analysed. The statistical analysis was done using SPSS version 15.0. The Analysis of Variance (ANOVA) and Post-hoc tests (Tukey-HSD) were performed to reveal the statistical significance. The values were represented in number (%) and mean±SD. RESULTS: Statistical analysis demonstrated that among the experimental groups maximum percentage of viable cells were seen in HBSS (87.33%) followed by coconut water (79.87%), aloe vera (70.59%) and saline (50.56%). CONCLUSION: Within the parameters of this study, it can be concluded that the HBSS is the most effective storage media in maintaining the viability of PDL cells. However, in Indian scenario where availability of HBSS is questionable, coconut water can be considered as the best natural storage media for an avulsed tooth followed by aloe vera.

Thecamoebians (Testate Amoebae) Straddling the Permian-Triassic Boundary in the Guryul Ravine Section, India: Evolutionary and Palaeoecological Implications.

Exceptionally well-preserved organic remains of thecamoebians (testate amoebae) were preserved in marine sediments that straddle the greatest extinction event in the Phanerozoic: the Permian-Triassic Boundary. Outcrops from the Late Permian Zewan Formation and the Early Triassic Khunamuh Formation are represented by a complete sedimentary sequence at the Guryul Ravine Section in Kashmir, India, which is an archetypal Permian-Triassic boundary sequence. Previous biostratigraphic analysis provides chronological control for the section, and a perspective of faunal turnover in the brachiopods, ammonoids, bivalves, conodonts, gastropods and foraminifera. Thecamoebians were concentrated from bulk sediments using palynological procedures, which isolated the organic constituents of preserved thecamoebian tests. The recovered individuals demonstrate exceptional similarity to the modern thecamoebian families Centropyxidae, Arcellidae, Hyalospheniidae and Trigonopyxidae, however, the vast majority belong to the Centropyxidae. This study further confirms the morphologic stability of the thecamoebian lineages through the Phanerozoic, and most importantly, their apparent little response to an infamous biological crisis in Earth's history.

Modification of luminescence spectra of CaF2:Eu2+.

CaF2:Eu(2+) is a well known phosphor having efficient excitation in the near ultraviolet (NUV) range. Phosphors with NUV excitation are required in newly emerging applications such as photoluminescence liquid crystal displays (PLLCD), solid-state lighting (SSL), and down-conversion for solar cells. However, emission of CaF2:Eu(2+) is around 424 nm. Eye sensitivity drops considerably at these wavelengths. It is thus not useful for display applications for which emission in one of the primary colours (blue - 450 nm, green - 540 nm or red - 610 nm) is required. Efforts were made to modify the Photoluminescence (PL) spectra of CaF2:Eu(2+) to meet these requirements using co-dopants. A Ca0.49 Sr0.50 Eu0.01 F2 phosphor showing better colour coordinates and having an emission maximum around 440 nm was discovered during these studies.

Ecophysiological characteristics of five weeds and a wheat crop in the Indo-Gangetic Plains, India.

The objective of this research was to compare selected ecophysiological parameters for a wheat crop found in the Indo-Gangetic Plains of India and its five dominant weeds. The dominant and regionally ubiquitous weeds in the wheat field that was selected for the study were Anagallis arvensis, Chenopodium album, Melilotus albus, Phalaris minor and Rumex dentatus. Taller weeds, such as C. album and P. minor, constituted one group along with the crop, with a low photosynthetic rate, specific leaf area, leaf nitrogen mass basis, chlorophyll content, photosynthetic nitrogen-use efficiency and leaf area ratio, in comparison to shorter weeds, such as A. arvensis, M. albus and R. dentatus, which formed another group with a high photosynthetic rate, specific leaf area, leaf nitrogen mass basis, chlorophyll content, photosynthetic nitrogen-use efficiency and leaf area ratio. Interspecific variations in the photosynthetic rate were driven mainly by variability in the specific leaf area and leaf nitrogen content. The taller weeds and the crop had a low specific leaf area later in the season, whereas the smaller weeds had a relatively high specific leaf area, which might be an adaptation to the shaded environment below the canopy. The result indicates that any weed management in the wheat fields of the Indo-Gangetic Plains will need two different approaches because of the different strategies followed by the two weed groups that were identified in the present study.

Eco-physiological performance of two invasive weed congeners (Ageratum conyzoides L. and Ageratum houstonianum Mill.) in the Indo-Gangetic plains of India.

Morphological (easily measureable) and physiological (hard to measure) traits of two closely related invasive alien congeners-Ageratum conyzoides L. and Ageratum houstonianum Mill. were studied with a perspective that which species will be potentially be more successful as an invader in the Indo-Gangetic plains of India. Leaf construction cost (LCC) is considered as a quantifiable measure of energy demand for biomass production and is related to energy use efficiency as it include component of both morphological and physiological traits. We hypothesised that a low LCC would give the invaders growth advantage by utilizing energy efficiently. Low LCC of A. houstonianum on mass basis (0.54 g glucose g( -1)) and area basis (20.48 g m( -2)) gives insight into the success of this invasive weed over A. conyzoides. The present study gives evidence that how the morphological traits are linked to physiological traits that could directly affect invasive attributes of the invader, which in turn would be crucial to prioritize species for ecosystem management.