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Systemic lupus erythematosus (SLE) is a multisystem immunologic disease. Renal and neurological manifestations are frequently seen in childhood SLE. Out of the neurological features movement disorders are uncommon. A case of SLE is presented here with unusual neurological manifestation i.e. chorea associated with microphonia.

Purpose Antibody mediated rejection (AMR) continues to be a major complication after heart transplantation (OHT) and poses a risk for allograft failure, graft vasculopathy and mortality. Diagnostic criteria for AMR have evolved over the years. Incidence of AMR is estimated to be 11-20% after OHT. We sought to evaluate the histological characteristics of AMR in endomyocardial biopsies (EMB) of deceased pediatric patients with positive HLA-associated antibodies. Methods A retrospective chart review was conducted to identify all pediatric patients ( Results During the study period, 86 OHT recipients had HLA associated antibodies, with 16 eventual deaths, 4 of which followed re-transplantation. A total of 152 biopsies from all 16 patients were reviewed. Eight patients (50%) demonstrated no evidence of pAMR. Eight patients (50%) demonstrated pAMR with peak grade of 3 in two patients; grade 2 in one patient, grade 1(i+) in three, and grade 1(h+) in two patients. Mean duration to onset of pAMR was 16.25 months from OHT, range ( Conclusion In our experience, 50% of the patients with HLA associated antibodies developed pAMR. De-novo DSAs were present in all patients that demonstrated pAMR. Unique histologic predictors of poor outcome are unclear from analysis of existing criteria alone. Additional parameters may need to be included to the existing criteria to improve diagnostic sensitivity of pAMR.

Rationale: Studies have demonstrated that angiotensin-converting enzyme 2 (ACE2) plays a protective role against lung diseases, including pulmonary hypertension (PH). Recently, an antitrypanosomal drug, diminazene aceturate (DIZE), was shown to exert an “off-target” effect of enhancing the enzymatic activity of ACE2 in vitro. Objectives: To evaluate the pharmacological actions of DIZE in experimental models of PH. Methods: PH was induced in male Sprague Dawley rats by monocrotaline, hypoxia, or bleomycin challenge. Subsets of animals were simultaneously treated with DIZE. In a separate set of experiments, DIZE was administered after 3 weeks of PH induction to determine whether the drug could reverse PH. Measurements and Main Results: DIZE treatment significantly prevented the development of PH in all of the animal models studied. The protective effects were associated with an increase in the vasoprotective axis of the lung renin-angiotensin system, decreased inflammatory cytokines, improved pulmonary vasoreactivity, and enhanced cardiac function. These beneficial effects were abolished by C-16, an ACE2 inhibitor. Initiation of DIZE treatment after the induction of PH arrested disease progression. Endothelial dysfunction represents a hallmark of PH pathophysiology, and growing evidence suggests that bone marrow–derived angiogenic progenitor cells contribute to endothelial homeostasis. We observed that angiogenic progenitor cells derived from the bone marrow of monocrotaline-challenged rats were dysfunctional and were repaired by DIZE treatment. Likewise, angiogenic progenitor cells isolated from patients with PH exhibited diminished migratory capacity toward the key chemoattractant stromal-derived factor 1α, which was corrected by in vitro DIZE treatment. Conclusions: Our results identify a therapeutic potential of DIZE in PH therapy.

Background: Despite the advancement in drug and surgical interventions, myocardial damage and associated cardiac dysfunction lead to heart failure that remains common cause of death following myocardial infarction (MI). Spiny mice (Acomys cahirinus, SM) have been shown to possess regenerating capacity following deep tissue injury without scarring ( Nature 2013 ). This led us to investigate if this regenerative property would also be preserved in the heart. Methods and Results: Adult CD1 and SM were subject to left anterior descending coronary artery ligation or sham surgeries. Proliferative cells were identified by nuclear incorporation of 5-bromodeoxyuridine (BrdU, daily, i.p.) and injection was started from 3d post MI continued to 2wks post MI. Cardiac function was assessed using echocardiography and MRI. SM exhibited 3-fold smaller infarct size (SM-MI 18.6±3.4% vs CD1-MI 76.2±3.4%, p+ cells in left ventricle after MI while CD1 mice had 4-fold increase (CD1-sham 11±3.5 vs CD1-MI 44±9.1 and SM-sham 16±9.8 vs SM-MI 101.1±30.9, p Conclusions: SM are protected from ischemia induced cardiac damage and dysfunction. This involves increased proliferating cardiac cells and reduction in infarct size. Thus SM could be an ideal animal model for identification of molecular and genetic circuits involved in preservation/regeneration of cardiac function with translational implication to human MI.

Infectious mononucleosis (IM) caused by Epstein-Barr virus (EBV) is a common benign illness in children all over the world. Most children become exposed to EBV by adolescent age. If a child having X-linked lymphoproliferative (XLP) disease is exposed to EBV, he/she is highly vulnerable to suffer from serious forms of IM such as fulminant hepatic failure, hemophagocytic lymphohistiocytic syndrome (HLHS), meningoencephalitis, and many more, and also to develop various types of malignancies including lymphoreticular types. Therefore, to reduce the IM-related mortality and morbidity, either routine screening for Duncan's disease by genetic analysis for SH2D1A followed by prophylactic EBV vaccine only to SH2D1A-positive children or routine administration of prophylactic EBV vaccine to all the children in early infancy is necessary. An effective, successful therapeutic vaccine, if developed in future, might be beneficial for the patients who develop EBV-related malignancy subsequently.

Hemolytic uremic syndrome (HUS), a common cause of acute renal failure (ARF) in children, consists of triad of microangiopathic haemolytic anemia (MAHA), thrombocytopenia, and ARF. The aim of the present article is to have a recent overview of HUS including its incidence, etiopathogenesis, clinical profile and management. It consists of two types a) Diarrhoea associated i.e. classical also called D+ HUS b) Non-diarrhoea associated i.e. atypical also called D- HUS. D+ HUS is caused mostly by Escherichia coli or occasionally by Shigella dysenteriae. The causes of HUS are infections, genetic defects, systemic diseases and drugs. The atypical form commonly presents with recurrent or chronic persistent attack. Thrombotic microangiopathy (TMA), the pathologic hallmark, includes HUS, atypical HUS (aHUS), thrombotic thrombocytopenic purpura (TTP) which is characterized by endothelial cell damage and microvascular injury. In the vast majority of aHUS susceptibility factors are familial and not acquired. In D+ HUS, following an attack of diarrhoea or dysentery the child abruptly develops pallor, irritability, swelling of body, oligoanuria, hematuria, and hypertension. Central nervous system disturbances like seizure, obtundation and encephalopathy may occur but less common than aHUS or TTP. Diagnosis of HUS is established by presence of MAHA in the peripherl blood smear i.e. schistocytes, burr cells, helmet cells etc. Thrombocytopenia is nearly always seen. ARF is reflected in elevated blood urea and creatinine level. Coagulation studies like prothrombin time (PT), activated partial thromboplastin time (APTT), will be normal unlike disseminated coagulopathy (DIC). D-dimer level will be raised in HUS similar to DIC. Interestingly, direct Coomb’s test will be positive in Streptococcus pneumonia induced D- HUS. With excellent supportive care and often dialysis D+ HUS will show remarkable recovery whereas in addition plasmapheresis or plasma infusion outcome is poor in most of the D-HUS cases. Though incidence of gastroenteritis is very high in our country, only few patients may develop HUS, the reason of which remains unclear. The incidence of HUS as a cause for ARF in India may be reviewed further. Indiscriminate use of antimicrobials is to be avoided as far as possible to prevent HUS related mortality. Facilities for dialysis may be enhanced in most of the health care facilities in our country as a life saving measure to reduce HUS related mortality and morbidity.

Ever since India's independence from Britain in 1947 and the tragic death toll resulting from the partition creating Pakistan, the sub-continent has been marked by religious conflict. Over the last twenty years, this has taken especially bloody turns. This article examines the political roots of the rioting that has ensued. The analysis is anchored in two fundamental distinctions: one between democratic "citizens" and communal "people," and the other between the dynamics of hegemonic "majoritarianism" and the consequences of minority "marginalization." The relationship between the two is explored with special reference to Hindu-Sikh violence in the state of Punjab and the long standing Hindu-Muslim violence generally initiated and sustained by Shiv Sena and other movements of the Hindutva cause, as occurred most recently in the state of Gujarat in 2002. India offers a cautionary tale in which both democracy and religious freedom hang in the balance.

Neuroblastoma is the most common extracranial solid tumor in children. Most common sites of metastases from neuroblastoma are bone marrow, bone and lymph nodes, however cardiac metastasis is rarely seen. Metastatic cardiac tumors are 20 to 40 times more common than primary cardiac tumors. Mechanism of cardiac metastasis can be hematogenous, lymphatogenous, and direct extension/infiltration of tumor cells. Usually right heart metastasis is seen. Left ventricular metastatic tumor has never been reported with neuroblastoma.

To integrate conceptually the relationship between caste and politics, one must appreciate that the pure ritual hierarchy operates only when backed by wealth and power. In fact, there are multiple hierarchies in the caste order because each caste overvalues itself in relation to others. This can be gauged from their origin tales, which, without exception, claim an exalted past regardless of the actual status a caste occupies on the ground. With the breakdown of the closed village economy and the rise of democratic politics, the competitive element embedded in caste has come to the fore. This has resulted in the collapse of the caste system but also in the rise of caste identities.

L'A. analyse l'impact de l'emergence des systemes de stratification sociale ouverts sur l'evolution des Etats-nations. Il rappelle que selon Marx l'avenement du capitalisme marque la disparition des liens sociaux, des solidarites et des systemes de stratification fermes de type traditionnel. Il estime que le capitalisme tend a s'emanciper des frontieres nationales et a rejeter les formes traditionnelles d'identification et de differenciation sociale propres aux systemes de stratification fermes. Il analyse l'influence des ideaux nationalistes au sein des mouvements ouvriers du 19 e siecle. Il montre que l'avenement des Etats-nations est marque par l'arrivee des intellectuels sur le devant de la scene politique. Il examine ce que recouvre, d'une part, les notions de «stratification fermee» et de «stratification ouverte» et, d'autre part, les notions de «pouvoir» et d'«autorite». Il etudie le role joue par les mecanismes de rejet dans la formation de l'identite nationale. Il affirme que les systemes de stratification ouvert induisent une perspective politique qui repose sur la responsabilite

Portable media devices are widely used by today’s youth. When used in hospitals, these devices can produce artefactual arrhythmias on telemetry.

L'A. se demande si la pensee post-moderniste peut se developper au sein des pays en voie de developpement. Il s'interesse a l'œuvre de J. Derrida et a celle de J. Baudrillard. Il souligne que le premier de ces auteurs a plus particulierement porte son attention sur l'epistemologie et que le second s'est efforce d'analyser l'evolution des societes vers une forme postmoderne. Il examine la notion de simulacre au cœur de l'œuvre de Baudrillard ainsi que la lecture du marxisme que propose ce dernier. Il estime que la pensee de Derrida et celle de Baudrillard sont complementaires

This chapter discusses globalisation and the export sector of India, looking at employment and economic growth in the country. It starts with a study of the rise of small-scale industries, which are part of the fastest expanding sector in India. Merchant producerism and cheap labour is discussed, followed by globalisation and social audits. Child labour, contract labour, the absent present worker, and overtime are some of the topics discussed as well. Finally, the chapter ends by determining whether globalisation has made a difference in the economy of India.

Peasants and urbanites are, in certain things, one society, and the peasant knows it. It does not follow that the peasant looks upward to the city man in everything. (Redfield, 1953: 49)

We report the case of a 7 years old previously asymptomatic child who initially presented with respiratory distress because of massive left-sided hemothorax but was subsequently diagnosed to be having strangulated small intestine through a diaphragmatic rent on laparotomy. The case is being discussed in detail and the possible causes of hemothorax in such a scenario discussed.

We report a case of systemic onset juvenile idiopathic arthritis (SOJIA), the manifestations of which started with fever and skin rash followed by arthritis within neonatal age. Such presentation is extremely rare in the newborn. After exclusion of closely mimicking conditions like congenital infections, neonatal onset multisystem inflammatory disease (NOMID), neonatal; lupus erythematosus (NLE) diagnosis of SOJIA may be entertained even in a neonate where arthritis, fever and rash are the presenting features.

In order to allow for efficient use of extremely large moduli, Adi Shamir has proposed a variant of RSA in which one of the two prime factors is much smaller than the other. This note points out that unless special precautions are taken, simple implementations of Shamir's idea are subject to protocol attacks that recover the secret keys.