Hemophagocytic lymphohistiocytosis (HLH) is an aggressive and life-threatening syndrome of excessive immune activation causing multi-organ dysfunction. HLH can be inherited genetically, but can also ...be secondary to infections, malignancy, immunosuppression, and autoimmune conditions. Adult-onset Still’s disease (AOSD) is an autoimmune disorder characterized by fevers, arthritis, and an evanescent rash. It can rarely predispose patients to HLH. Herein, we report a case of a 20-year-old male patient who presented with fever, joint pain, and rash for 1 month. On evaluation, he was diagnosed as a case of AOSD complicated with secondary HLH. A 23-year-old male, with no significant past medical history and family history, presented to our emergency department with complaints of fever with rash for the last 1 month. He had intermittent high-grade fever with chills, which was associated with evanescent rash involving the trunk and proximal upper limbs. There was no history of joint pain, cough, sore throat, burning micturition, or weight loss. On examination, the patient was conscious and oriented with a temperature of 101 °F, pulse rate of 100/min, blood pressure of 120/84 mmHg, and SpO2 of 98% on room air. Physical examination revealed salmon-colored maculopapular rash, cervical lymphadenopathy, and mild splenomegaly. The rest of the physical examination was unremarkable. Lab investigations revealed pancytopenia, transaminitis, elevated CRP with low ESR, highly elevated ferritin, elevated LDH, hypofibrinogenemia, and sterile blood and urine cultures. ANA by ELISA, rheumatoid factor, IGRA, dengue IgM, rapid malaria Ag, typhoid IgM, Leptospira IgM and scrub IgM were reported negative. The patient met the diagnostic criteria for AOSD and HLH, and a diagnosis of HLH secondary to AOSD was made. He was given pulse iv methylprednisolone for 5 days, His general condition improved over the week. Then he was switched to oral prednisolone 60 mg once daily. There were no more episodes of fever, and he was discharged after one week on a tapering dose of steroids. AOSD is a rare autoinflammatory condition which often presents as a diagnostic challenge. A high index of suspicion is important for the diagnosis of HLH, and prompt initiation of treatment is of utmost importance, as it is a rapidly progressive life-threatening condition.
We here report a new assemblage of microvertebrate and arthropod faunas from the Nurpur region of Himachal Pradesh, which erstwhile was known for mega mammalian fauna. The present assemblage consists ...of rodents such as
Karnimata
cf.
K. darwini
and Murinae indet; reptiles such as Crocodylia indet, ‘Colubrinae’ indet. or ‘Natricinae’ indet.; fishes such as Cyprinidae indet. and Perciformes indet.; and crab
Sartoriana
indet. Microvertebrate fauna are well known from the Indian Siwalik deposits but the report here from the Nurpur is the first occurrence. Further, the presence of
Karnimata
cf.
K. darwini
from Nurpur has the potential to extend the Last Appearance Datum (LAD) of
Karnimata darwini
up to 8.2 Ma or younger in the Indian Siwalik. The microfaunal assemblages of this locality indicate freshwater and an open terrestrial environmental condition with tropical to subtropical open grassland separated by woodland forest.
The present experiment was carried out to evaluate the tree crop interaction under agri-horticulture systems in mid-hill region of the Himalayas. For the study two
Allium sativum
L. (Garlic) ...varieties i.e. “UUHF G 12-1” and “Agrifound Parvati” were grown under three fruit trees i.e.
Prunus persica
L. (Peach),
Prunus domestica
L. (Plum) and
Prunus armeniaca
L. (Apricot) and open farming system to examine the growth, yield and economic parameters of two
Allium sativum
(Garlic) varieties. The experiment consists of eight treatments T
1
–UUHF G 12-1 in open field (Control), T
2
–Agrifound Parvati in the open field (Control), T
3
–UUHF G 12-1 + Peach (
Prunus persica
), T
4
–Agrifound Parvati + Peach (
Prunus persica
), T
5
–UUHF G 12-1 + Apricot (
Prunus armeniaca
), T
6
–Agrifound Parvati + Apricot (
Prunus armeniaca
), T
7
–UUHF G 12-1 + Plum (
Prunus domestica
), T
8
–Agrifound Parvati + Plum (
Prunus domestica
) comprising two varieties of garlic; three fruit trees and control (conventional agriculture field). Among the varieties, UUHF G 12-1 was found superior in terms of growth and yield parameters. Among studied farming systems peach based agri-horticulture system performed better as compared to the apricot and plum based agri-horticulture system as well as open farming system. Overall soil properties were observed higher under agri-horticulture systems as compared to sole (garlic) cropping system. The gross return (17,804 $ ha
−1
), net return (13,276 $ ha
−1
) and benefit cost (B:C) ratio (3.93) were found maximum for UUHF G 12-1 grown under the peach
.
The finding of the present study suggested that garlic can be grown more profitably under the agri-horticulture system as an intercrop in comparison to monocropping.
Efficient resource allocation and management can enhance the capacity of an optical backbone network. In this context, spectrum retuning via hitless defragmentation has been presented for elastic ...optical networks to enhance efficient spectrum accommodation while reducing the unused fragmented spaces in the spectrum. However, the quality of service committed in a service level agreement may be affected due to spectrum retuning. In particular, for transmission beyond the conventional C band, the presence of inter-channel stimulated Raman scattering can severely degrade the quality of the signal during defragmentation. To conquer this problem, this paper proposes, for the first time to our knowledge, a signal-quality-aware proactive defragmentation scheme for the C+L band system. The proposed scheme prioritizes the minimization of the fragmentation index and quality of transmission (QoT) maintenance for two different defragmentation algorithms, namely, nonlinear-impairment (NLI)-aware defragmentation (NAD) and NLI-unaware defragmentation (NUD). We leverage machine learning techniques for QoT estimation of ongoing lightpaths during spectrum retuning. The optical signal-to-noise ratio of a lightpath is predicted for each choice of spectrum retuning, which helps to monitor the effect of defragmentation on the quality of ongoing lightpaths (in terms of assigned modulation format). Numerical results show that, compared to a baseline algorithm (NUD), the proposed NAD algorithm provides up to 15% capacity increment for smaller networks such as BT-UK, while for larger networks such as the 24-node USA network, a capacity benefit of 23% is achieved in terms of the number of served demands at 1% blocking.
With over 10,000 mental health- and psychiatry-related smartphone apps available today and expanding, there is a need for reliable and valid evaluation of these digital tools. However, the updating ...and nonstatic nature of smartphone apps, expanding privacy concerns, varying degrees of usability, and evolving interoperability standards, among other factors, present serious challenges for app evaluation. In this article, we provide a narrative review of various schemes toward app evaluations, including commercial app store metrics, government initiatives, patient-centric approaches, point-based scoring, academic platforms, and expert review systems. We demonstrate that these different approaches toward app evaluation each offer unique benefits but often do not agree to each other and produce varied conclusions as to which apps are useful or not. Although there are no simple solutions, we briefly introduce a new initiative that aims to unify the current controversies in app elevation called CHART (Collaborative Health App Rating Teams), which will be further discussed in a second article in this series.
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