Modern fuels are an important enabler of social and economic development. Still, over 2 billion people rely on traditional biomass for their daily energy needs. To overcome the negative effects of traditional energy on human health and the environment and to enhance the livelihood conditions of the poor, a transition towards cleaner and more efficient forms of energy is needed. Understanding household fuel choice and fuel switching behaviour is of vital importance in search for policies to support such a transition process. This paper adds to the existing energy transition literature in two ways. First, we provide a novel conceptual framework to analyze the decision environment underlying energy and fuel choices. Second, we apply this framework in a meta-analysis of existing choice models investigating energy switching and stacking behaviour in urban and rural areas in developing countries. The meta-analysis shows that socio-economic household characteristics appear to receive most attention so far in identifying groups of fuel users, while relatively little information is available on the impact of the external decision context on household energy choices.

The energy ladder: Theoretical myth or empirical truth? Results from a meta-analysis

In the past, celiac disease was believed to be a chronic enteropathy, almost exclusively affecting people of European origin. The availability of new, simple, very sensitive and specific serological tests (anti-gliadin, anti-endomysium and anti-transglutaminase antibody assays) have shown that celiac disease is common not only in Europe and in people of European ancestry but also in the developing countries where the major staple diet is wheat (Southern Asia, the Middle East, North West and East Africa, South America), both in the general population and in the groups at risk. Gluten intolerance thus appears to be a widespread public health problem and an increased level of awareness and clinical suspicion are needed in the New World where physicians must learn to recognize the variable clinical presentations (classical, atypical and silent forms) of celiac disease. In the developing countries, both serological screening in the general population and serological testing in groups at risk are necessary for an early identification of celiac patients. The gluten-free diet poses a challenging public health problem in the developing countries, especially since commercial gluten-free products are not available.

/pdf/celiac-disease-in-the-developing-countries-a-new-and-2k37ugn6qj.pdf

Celiac disease in the developing countries: A new and challenging public health problem

Some 250 years ago, JB Morgagni with the help of only a knife for anatomical dissection, an acute mind, and an observational skillfulness was able to identify the intraabdominal and mediastinal fat accumulation in android obesity. 1 He clearly described the association between visceral obesity, hypertension, hyperuricemia, atherosclerosis and obstructive sleep apnea syndrome, long before the modern recognition of this syndrome. The concept of insulin resistance is more than 250 years old and was first described in the 20th century by Himsworth, when in Lancet he wrote about subdivision of diabetes into insulin sensitive and insulin resistance in 1936. Yet it needed Prof. Gerald Raeven who delivered the famous Banting Oration in 1988 to introduce the concept of Insulin Resistance. Several terms are used for the same entity namely, Insulin Resistance Syndrome, Reaven’s Syndrome, Metabolic Syndrome, Deadly Quartet, CHAOS, New World Syndrome, Civilization Syndrome, Syndrome ‘X’ etc. The latest term used is ‘Metabolic Syndrome’ as per ATP III and WHO. 2 Metabolic Syndrome is now being increasing recognised as an emerging threat which will invade desktops of public health policy planners in the decades to come. The clusters which make this syndrome and its etiopathogensis will keep getting varied in different ethnic populations, regions and countries. Factors like migration, socioeconomic status, lifestyle, nutrition habits play important role. Therefore research in Metabolic Syndrome provides an interdisciplinary forum to explore the pathophysiology, recognition, and treatment of the cluster of conditions associated with the evolving entity of metabolic syndrome. These include but are not limited to: central obesity, endothelial dysfunction, insulin resistance, dyslipidemia, glucose intolerance, type 2 diabetes, prethrombosis and pro-inflammatory states, hyperinsulinemia, hyperuricemia, hypertension, cardiovascular disease, and polycystic ovarian syndrome (PCOS). The individual conditions are only parts of a more generalized problem that requires more than simply correcting a single lab value. For a majority of those affected, inappropriate or poor or defective nutritional status and lack of physical activity are the root causes in the disease process. Metabolic syndrome is estimated to affect more than one in five adults, and its prevalence is growing in the adult and pediatric populations. Metabolic Syndrome and Related Disorders will be pertinent to the practice of the general physician as well as the endocrinologist, the cardiologist, the diabetologist and other specialists. Metabolic Syndrome always lacked a structure and has different facets seen by different specialists. Diabetologists see it as insulin resistance, cardiologists see it as dyslipidemia and syndrome X, it is polycystic ovarian syndrome for the adolescent physicians and ob-gyn specialists. However both auxological/ anthropometric variables as well as lipid levels need more Asian Indian validation. Each component of cluster has variations based on several factors including migration status, socio-economic class, rural-urban subclass etc. The body fat pattern and lipids are particularly making the Asian Indians coronary prone. Unfortunately the Asian Indian studies outside India outnumber the studies from India. 3 In this issue two groups form North West India report two different but relevant clusters which eventually will be used later to qualify the real Indian criteria for both lipids and may be even Metabolic Syndrome; namely lipid cluster form Chandigarh 4 and low socioeconomic cluster form Jaipur. 5 The group from PGI Chandigarh reports ;Isolated lipid abnormalities in 47 to 51 % in rural-urban non diabetic cohort

Metabolic syndrome--emerging clusters of the Indian phenotype.

There is growing evidence that not only the novel coronavirus disease (COVID-19) but also the COVID-19 vaccines can cause a variety of skin reactions. In this review article, we provide a brief overview on cutaneous findings that have been observed since the emerging mass COVID-19 vaccination campaigns all over the world. Unspecific injection site reactions very early occurring after the vaccination are most frequent. Type I hypersensitivity reactions (e.g., urticaria, angioedema, anaphylaxis) likely due to allergy to ingredients may rarely occur but can be severe. Type IV hypersensitivity reactions may be observed, including delayed large local skin lesions ("COVID arm"), inflammatory reactions in dermal filler or previous radiation sites or even old BCG scars, and more commonly moribilliform and erythema multiforme-like rashes. Autoimmune-mediated skin findings after COVID-19 vaccination include leukocytoclastic vasculitis, lupus erythematosus, and immune thrombocytopenia. Functional angiopathies (chilblain-like lesions, erythromelalgia) may also be observed. Pityriasis rosea-like rashes and reactivation of herpes zoster have also been reported after COVID-19 vaccination. In conclusion, there are numerous cutaneous reaction patterns that may occur following COVID-19 vaccination, whereby many of these skin findings are of immunological/autoimmunological nature. Importantly, molecular mimicry exists between SARS-CoV-2 (e.g., the spike-protein sequences used to design the vaccines) and human components and may thus explain some COVID-19 pathologies as well adverse skin reactions to COVID-19 vaccinations.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jdv.17744

Cutaneous findings following COVID-19 vaccination: Review of world literature and own experience.

COVID-19 vaccines have brought us a ray of hope to effectively fight against deadly pandemic of COVID-19 and hope to save lives. Many vaccines have been granted emergency use authorizations by many countries. Post-authorization, a wide spectrum of neurological complications is continuously being reported following COVID-19 vaccination. Neurological adverse events following vaccination are generally mild and transient, like fever and chills, headache, fatigue, myalgia and arthralgia, or local injection site effects like swelling, redness, or pain. The most devastating neurological post-vaccination complication is cerebral venous sinus thrombosis. Cerebral venous sinus is frequently reported in females of childbearing age, generally following adenovector-based vaccination. Another major neurological complication of concern is Bell's palsy that was reported dominantly following mRNA vaccine administration. Acute transverse myelitis, acute disseminated encephalomyelitis, and acute demyelinating polyneuropathy are other unexpected neurological adverse events that occur as result of phenomenon of molecular mimicry. Reactivation of herpes zoster in many persons, following administration of mRNA vaccines, has been also recorded. Considering the enormity of recent COVID-19-vaccinated population, the number of serious neurological events is miniscule. Large collaborative prospective studies are needed to prove or disprove causal association between vaccine and neurological adverse events occurring vaccination.

/pdf/spectrum-of-neurological-complications-following-covid-19-3zdy1fagqq.pdf

Spectrum of neurological complications following COVID-19 vaccination.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1111/jocd.14268

Herpes zoster after inactivated COVID-19 vaccine: A cutaneous adverse effect of the vaccine.

BACKGROUND Adult celiac disease is infrequent in India. Iron-deficiency anemia as its presenting manifestation is still rarer. METHODS We investigated patients with refractory iron-deficiency anemia attending the hematology clinic of a tertiary-care hospital for celiac disease. The diagnosis of celiac disease was based on histology, serology and response to treatment. RESULTS Of 19 patients with refractory iron-deficiency anemia seen from April 1998 to March 2000, 11 were diagnosed to have celiac disease. Four of these had abnormal D-xylose test and 3 had fat malabsorption. All 11 patients responded to gluten-free diet with improvement in hematological parameters. CONCLUSION Patients with refractory iron-deficiency anemia of unknown cause should be investigated for subclinical celiac disease.

Celiac disease presenting as iron-deficiency anemia in northern India.

Background Lipid abnormalities are common in patients with hypertension The prevalence of isolated lipid abnormalities is not known in normotensive and hypertensive population of north-west India Methods We studied the prevalence of isolated low high density lipoprotein cholesterol (IL-HDLC), isolated high low density lipoprotein cholesterol (IH-LDLC) and isolated high triglycerides (IH-TG) abnormalities among rural and urban normotensive and hypertensives of north-west India Results The prevalence of lipid abnormalities was 476% and 514% in rural normotensives and hypertensives and 438% and 468% in urban normotensives and hypertensives respectively The prevalence of IL-HDLC varied from 38% to 237% among hypertensives and 194% to 304% among normotensives The prevalence of IH-TG abnormalities was 118% to 188% among hypertensives and 70% to 154% among hypertensives The prevalence of isolated high LDLC abnormalities was low (08-92%) There was no significant difference in these abnormalities in relation to age and sex except IH-LDLC in male hypertensives Conclusion Isolated low HDLC and isolated high TG were the commonest isolated lipid abnormalities among rural and urban population of north-west India whereas isolated high LDLC was uncommon

Isolated lipid abnormalities in rural and urban normotensive and hypertensive north-west Indians.

Summary
Introduction

Laboratory diagnosis of hereditary spherocytosis (HS) relies on increased incubated red cell osmotic fragility test for screening. We evaluated the diagnostic role of eosin-5′-maleimide (EMA) binding test by flow cytometry in spherocytic and microcytic hypochromic hematological disorders in North Indians.



Methods

EMA binding test using flow cytometry was performed on 55 HS (40 families), 26 iron deficiency anemia (IDA), 32 β-thalassemia trait (βTT), and 10 autoimmune hemolytic anemia (AIHA) cases and 121 normals. Mean channel fluorescence (MCF) and coefficient of variation (CV) were studied. Different MCF parameters (MCF, MCF ratio, percent decrease MCF) and percent increase in CV were analyzed. Receiver operating characteristics analysis was performed to determine best cutoff values, sensitivity, and specificity for discriminating HS from other red cell disorders.



Results

MCF ratio of HS group was significantly lower than normals (0.67 ± 0.07 vs. 1.01 ± 0.05, P < 0.001) and other cases. All patients with HS showed MCF ratio to be ≤0.79. Four postsplenectomy cases with near-normal hemograms also revealed low MCF ratio, showing the specificity of the test.



Conclusions

EMA assay was efficient to diagnose cases of HS including postsplenectomy cases and shows no overlap with IDA, βTT, and AIHA.

A comparative evaluation of Eosin-5'-maleimide flow cytometry reveals a high diagnostic efficacy for hereditary spherocytosis.

Sir, Acute myeloid leukaemia is a neoplastic proliferation of immature cells of haemopoietic system characterized by infiltration by these cells in blood, bone marrow and other tissues and is diagnosed by finding of blasts more than 30%, either in bone marrow or peripheral blood film (PBF). Myeloblastoma is a rare tumour of early myeloid precursor cells. Dock1 was the first to note the association of it with acute leukaemia, and this tumour is regarded as an ominous harbinger of acute myelocytic leukaemia (AML), or the onset of blast crisis in chronic myelogenous leukaemia. Here, we are reporting a case who presented with subacute paraplegia due to a mass lesion (granulocytic sarcoma) without typical AML symptoms like fever, bleeding, weakness, fatigue.

Purnima Malhotra

Papers

Herpes zoster after inactivated COVID-19 vaccine: A cutaneous adverse effect of the vaccine.

Celiac disease presenting as iron-deficiency anemia in northern India.

Isolated lipid abnormalities in rural and urban normotensive and hypertensive north-west Indians.

A comparative evaluation of Eosin-5'-maleimide flow cytometry reveals a high diagnostic efficacy for hereditary spherocytosis.

Spontaneous tumor lysis syndrome in acute lymphoblastic leukemia.