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The purpose of this study is to understand the behaviour of Zillennials.The study has used constructs like personal innovativeness, technologicalinnovativeness, gadget lovers, and technological opinion leadership for gain-ing insight into the overall behaviour of Zillennials. The study involvequantitative research where descriptive research design is used. This studymakes use of both primary and secondary data. Survey research method hasbeen used in this study where primary data is collected through a question-naire. The questionnaire consists of 16 items where each of these items isevaluated on a five-point Likert scale ranging from 1 (Strongly Disagree)to 5 (Strongly Agree). The data is collected from a sample of 300 studentsfrom various colleges of Pithoragarh belonging to the category of Zillennials.Purposive sampling technique is used to collect the data. The study usesdescriptive measures of central tendency, cronbach alpha, and confirmatoryfactor analysis technique. The data is analysed in RStudio with the helpof readxl, psych, lavaan, and summarytools packages. The results of thisstudy reveal that Zillennials in Uttarakhand have personal innovativeness andtechnological opinion leadership.

Radioactive trivalent chromium (51Cr3+) is a known radiopharmaceutical used to tag plasma proteins, platelets and also for estimation of blood volume. Nevertheless, there exist insufficient reports with limited sample sizes concerning its clearance from blood and its biodistribution after intravenous administration. This study focused to understand clearance rate of 51Cr3+ from blood and analyze its biodistribution. For biodistribution, six adult New Zealand white albino rabbits were injected with 51Cr3+ through their marginal vein. Percentage clearance of 51Cr3+ from blood was calculated by recording radioactive counts obtained at 1, 58, 61, 120, 180 and 240 minutes post-administration in thirty-three adult New Zealand white albino rabbits. For evaluating 51Cr3+ biodistribution, organs were surgically removed from the rabbits and weighed. Radioactivity of the organs and urine were counted in a nucleonix gamma-ray spectrometer with a NaI scintillation detector. Data were expressed as cps/g. Average clearance of 51Cr3+ was 34% from the first to the 58 minute. Subsequent measurements for hourly clearance at 120, 180 and 240 minutes showed percentage reduction of radioactivity of 33, 14 and 8, respectively. Minimal specific activities were found in the muscle and brain. Spleen, lungs, liver and kidneys exhibited moderate radioactivity. Urine tracer-concentrations were found to be ten times more than that of plasma. From this study, it has been observed that clearance of 51Cr3+ from blood was faster initially which slowed down progressively and there displayed moderate uptake of 51Cr3+ by certain organs. Understanding pharmacokinetics of 51Cr3+ is relevant for its potential use as a diagnostic tool.

Purpose The purpose of this paper is to find out the different types of business networks formed by firms with the stakeholders present in a cluster, i.e. how firms in a cluster interact with the cluster stakeholders? Design/methodology/approach To answer the research question, this study uses an exploratory research design, which is carried out in two stages, Stage 1 involves use of primary data, which was collected through semi-structured personal face-to-face interview mode and Stage 2 involves survey research method where data was collected through a survey questionnaire. Data for interviews and questionnaires were collected from managers and owners of firms operating in the cluster at their offices. Findings The study has identified four types of business networks between a firm and its buyers, only one type of business network with the suppliers and educational institutes, finally two types of business networks with government agencies and local associations. However, with respect to network with other stakeholders such as research institutes and competitors, the study shows that the interaction between a firm and these stakeholders is not strong i.e. the linkages between them remain largely unfilled. Research limitations/implications The study has been limited to only one cluster thus it might not be appropriate to generalise the findings. Further research in this area needs to be done by taking other clusters to generalise the findings. Originality/value The study has tried to answer the research gap of lack of literature on types of business networks formed by firms with the stakeholders present in an industrial cluster, and thus, contributed to the existing literature of business networks. The identified business networks provide a much deeper understanding of how firms connect with its buyers, its suppliers, government agencies and educational institutes operating in an auto-component cluster.

Introduction/Background No gut syndrome or near total enterectomy (NTE) is defined as the removal of the entire jejunum and ileum, a rarely performed procedure indicated in very specific situations and associated with parenteral nutrition (PN) dependency, multiple complications and poor quality of life in general. To date, only few cases have been reported in literature, all in the adult setting. Aim The aim of this report is to raise awareness of this condition in paediatric patients and the difficulties encountered in their management. Subjects and Methods Two male patients (2 and 5 year old) are presented. One secondary to an ischaemic event of unknown cause and the second post a failed small bowel transplant, both suffering complications specific to this condition. Results Case 1: First-born to non-consanguineous parents at 37 weeks of gestation with 22 q11 deletion. Born with large VSD, had several respiratory infections initially. At 2.5 months while in PICU with a respiratory deterioration, developed intestinal infarction from duodenum to sigmoid colon and was left with D1-D2 (D2 showed patches of ischemia). A duodenal tube was left in the duodenal stump and was started on PN. A month later, a contrast study showed 2 fistulas between the duodenum and the rectum that resolved spontaneously. Currently he continues to be total PN dependent having only some water orally (thicker consistency can block the tube), has a balloon G/J tube pushed into the stomach due to a narrowed duodenal stump to try and minimise vomiting, and has issues with leakage around the tube. His liver function tests (LFTs) have been abnormal intermittently and his liver US shows hepatomegaly and gallstones. Case 2: Third child to non-consanguineous parents born at 35 weeks of gestation with complex gastroschisis, jejunal atresia and hypoplastic colon - remaining anatomy 15 cm from GJ junction. Initial treatment involved placement/removal of a silo followed by bowel expansion, formation of a jejunostomy and a mucous fistula closed a year later when he had a jejunocolonic anastomosis. He had several interventions but was unable to tolerate minimal enteral amounts with a high stoma output despite treatment with octreotide. He underwent an isolated bowel transplant at 4 years of age followed by severe rejection not responsive to ATG/Campath and complicated with PTLD. He had a graft enterectomy with remaining anatomy 5 cm of duodenum and leakage from the duodenal stump. Currently he has a mucus fistula, an abdominal drain and a gastrostomy. Type 1 Chiari malformation was incidentally found and he developed seizures. He has intestinal failure associated liver disease and renal stones. He continues to have frequent admissions due to his health needs and frequent complications. Summary and Conclusion Advances in PN have made possible the long-term survival of patients with no gut syndrome in specialized centres but complications, patient and family quality of life, use of health resources, medical and surgical challenges and overall outcomes are important aspects to be considered and more paediatric data is necessary.

Shiva Parvati temple is an uncommon shrine built on a four-step brick platform. It stands out particularly due to its three golden pinnacles. It was Bahadur Shah Idea to construct a hybrid temple that incorporated Newar and Rajput style on top of the pavilion built by King Laxmi Narasimha Malla who ruled in the seventeenth century. The temple has been renovated in 1998AD. The golden pinnacle of this temple is quite artistic and one of the best in the Durbar Square. It consists of three tapering spires alternating with four floral stalks on a small platform. It is unique because it departs from the traditional Newar appearance and adopts the Rajput/Mughal style. Shiva-Parvati Temple which is adorned with images of Shiva and his consort Parvati. With its “Shiva-Parvati Temple” historical importance as Monument underlying the UNESCO World Heritage Sites and One which is affected by the Gorkha Earthquake (2015). The main objective of the study is to carry out seismic condition assessment of the temple based on detail damage assessment. A set of Architectural and Structural Drawings has been prepared along with the NonDestructive Tests and Finite Element Modeling by using the Structural Analysis and Design software SAP. The temple is built with the traditional newer construction technology with load bearing walls in surkhi mortar cladding on outer face by Dachi Appa and floor and roof with timber members. This paper focuses on the visual damage assessment and detail study of the cracks in different locations of the temple. The flexible diaphragm, lack of bands and insufficient chukuls (Spikes) leads to the damage on the Temple.

Due to the client demand on architectural drawings and land structure of Nepal, it is very difficult to make the structure with regular plan shapes, and thus, horizontal or vertical irregularity may be developed. These irregularities of the structure are more responsible for the collapse of building under the dynamic loads action during strong ground motions of earthquake and cause a significant torsional reaction in the structure. The main objectives of this paper are to study the torsional behaviour of reinforced concrete building with plan asymmetry which is located in zone V subjected to earthquake load and its parameters reflect the torsion effect and recommending the practical solution in order to reduce torsional effect. To carry out the study, both symmetric and asymmetric (L-SHAPE, + shape and T shape) plan buildings of eleven storey were modelled and ETABS software is used for analysis. The result proves that asymmetrical plan buildings are more vulnerable than symmetrical plan buildings. To reduce the torsional irregularity effect of asymmetrical plan structure curtailed shear wall system is recommended as practical solution with considering the stiffness. It was concluded that curtailed shear wall system improves the seismic performance of the structure reducing the cost criteria. After additional of shear wall, the torsional irregularity ratio of asymmetrical plan structure comes with in permissible limit as per IS 1893. Torsion creates damage or complete structures collapse, to control torsion, irregular structures should be carefully analysed.

OBJECTIVES There is limited literature on the spectrum of pediatric autoimmune liver disease (AILD, encompassing both autoimmune hepatitis/AIH and autoimmune sclerosing cholangitis [ASC]) in Asian populations and its diagnostic scores similarly require further validation. This work thus aimed to study the clinical characteristics, and to validate available diagnostic criteria in the local pediatric AILD cohort. METHODS A review of all pediatric AILD cases, presenting over a 6-year (2011-2017) period was done, along with comparison of the available diagnostic scores: original (1999), simplified (2008) score, and new proposed (2017) score. RESULTS A total of 85 subjects (AIH = 70 and ASC = 15) were diagnosed as having AILD. Majority of the cases in both groups presented with advanced hepatic disease (portal hypertension and/or hepatic decompensation). Overall 38 (44.7%) subjects had extrahepatic autoimmune disorders. Good outcome (survival with native liver with medically controllable disease), was seen in 80% AIH subjects, while poor outcome (death/need for liver transplantation or LT) was seen in 13% subjects, with similar results in the ASC cohort. All the 3 available scores had area under receiver operating characteristic (AUROC) curves exceeding 0.9 suggestive of excellent discrimination of AILD (to non-AILD patients), with no statistical difference between them (P >0.05). CONCLUSIONS In Indian subcontinent, pediatric AILD subjects usually present with advanced hepatic disease, but may have a good outcome if timely therapy can be instituted. Associated autoimmune disorders should be carefully screened. There is no difference in the predictive value of the available diagnostic scores for pediatric AILD.

To find association of pediatric NAFLD with metabolic risk factors, and Patatin-like phospholipase domain-containing protein 3 (PNPLA3) gene polymorphism. Cross-sectional study Pediatric Hepatology unit of a tertiary care hospital Overweight/obese children (

We studied the etiological spectrum, clinicolaboratory and histological profile, and outcome of infants and children under 18 years of age presenting between December 2010 and May 2016 with histological evidence of paucity of intralobular bile ducts (PILBD, bile ducts to portal tract ratio 0.6) Post-transplant PILBD was excluded. Of 632 pediatric liver biopsies screened, 70 had PILBD-44 were infants. PILBD was classified histologically into destructive (n = 50) and non-destructive PILBD (n = 20). Presentations were jaundice (98%), organomegaly (94%), pale stools (50%), and pruritus (43%). Infants had more cholestasis but less fibrosis on histology. Overall, 29 required liver transplantation (LT) for portal hypertension (n = 26), decompensation (n = 25), growth failure (n = 20), intractable pruritus (n = 5), and recurrent cholangitis (n = 2). Destructive PILBD has an odds for poor outcome (decompensation or need for LT within 1 year) of 1.53 (95% CI = 1.15-2.04). On binary logistic regression analysis, poor outcome was related to advanced fibrosis on liver biopsy [Exp (B) = 5.46, 95% CI = 1.56-19.04].PILBD was present in 11% of pediatric liver biopsies and has a varied etiological spectrum. Destructive PILBD has poor outcome. Need for LT is guided by the presence of advanced fibrosis. What is Known: • Natural history of syndromic ductal paucity (Alagille syndrome) is complex. • Duct loss is commonly seen with late presentation of biliary atresia. What is New: • The study classifies the etiological spectrum of ductal paucity histologically into destructive and non-destructive. • Destructive duct loss carries poor prognosis regardless of the etiology of liver disease with subsequent need for liver transplantation.

The concept of irreversibility of cirrhosis has been challenged in the recent past with literature in this regard, albeit still scarce, now being accumulated across all age groups, etiologies, and geographical regions. This small series of nine pediatric cases elegantly recapitulates the concept of regression of hepatic fibrosis/cirrhosis and paves way for further detailed studies to enable development of therapeutic anti-fibrotic modalities in future.

There are no evidence-based recommendations on the ideal dose and regimen for supplementation of vitamin D in children with chronic liver disease (CLD). This study aimed to compare the safety and efficacy of weekly and stoss regimens for treatment of vitamin D deficiency in these children. Children between the ages of 1 to 18 years with CLD and hypovitaminosis D defined by 25-OH vitamin D (25(OH)D)30µg/l were included. They were randomized to receive either stoss regimen (600,000 IU on day 1) or weekly (60,000 IU weekly) regimen of vitamin D. The 25(OH)D levels at 3 and 6 months were compared in the two groups. A total of 210 suspected cases of CLD were assessed for eligibility. Of a total of 67 children satisfying the inclusion criteria, 33 and 34 were randomized to receive stoss and weekly regimen, respectively. Final analysis included 28 children in each group. Clinical rickets was seen in 25.4% of children with hypovitaminosis D. The rise in levels of 25(OH)D at 3 months was higher with weekly regimen (34.3 ± 30.7 µg/l) as compared to stoss regimen (17.2 ± 11.5 µg/l) (p = 0.009). Rise at 6 months as compared to baseline was significantly higher with weekly regimen (30.7 ± 24µg/l) as compared to stoss regimen (11 ± 8.4 µg/l) (p0.001). Normal levels of 25(OH)D at 6 months were achieved in 24/28 (85.7%) of those receiving weekly regimen and 9/28 (32.1%) of those receiving stoss regimen (p0.001). With stoss therapy, 25(OH)D increased at 3 months as compared to baseline but thereafter dropped significantly at 6 months (p = 0.008).Weekly regimen of vitamin D supplementation is more effective than stoss regimen for treatment of hypovitaminosis D in children with CLD. Once normal levels are achieved, child should be shifted to 60,000 IU per month as maintenance dose. What is Known: • Vitamin D deficiency is more common and severe in children with chronic liver diseases. • Currently used doses fail to achieve normal vitamin D levels in these children. What is New? • Weekly regimen of 60,000 IU of vitamin D3 is the most effective regimen for treating vitamin D deficiency in children with CLD. • Children with CLD should further receive maintenance dose of 60,000 IU every month.

Background & aims There are no studies on acute kidney injury in paediatric acute-on-chronic liver failure. This study was planned with aim to describe the clinical presentation and outcome of acute kidney injury among paediatric acute-on-chronic liver failure patients. Methods Data of all children 1-18 years of age presenting with acute chronic liver failure (Asia pacific association for the study of the liver definition) was reviewed. Acute kidney injury was defined as per Kidney Diseases-Improving Global Outcomes guidelines. Poor outcome was defined as death or need for liver transplant within 3 months of development of acute kidney injury. Results A total of 84 children with acute-on-chronic liver failure were presented to us in the study period. Acute kidney injury developed in 22.6% of patients with acute-on-chronic liver failure. The median duration from acute-on-chronic liver failure to development of acute kidney injury was 4 weeks (Range: 2-10 weeks). The causes of acute kidney injury were hepatorenal syndrome (31.6%), sepsis (31.6%), nephrotoxic drugs (21%), dehydration (10.5%) and bile pigment related acute tubular necrosis in one patient. On univariate analysis, higher baseline bilirubin, higher international normalized ratio, higher paediatric end stage liver disease, presence of systemic inflammatory response syndrome and presence of spontaneous bacterial peritonitis had significant association with presence of acute kidney injury. On logistic regression analysis, presence of systemic inflammatory response syndrome (adjusted OR: 8.659, 95% CI: 2.18-34.37, P = .002) and higher baseline bilirubin (adjusted OR: 1.07, 95% CI: 1.008-1.135, P = .025) were independently associated with presence of acute kidney injury. Of the patients with acute kidney injury, 5(26.3%) survived with native liver, 10(52.6%) died and 4 (21.1%) underwent liver transplantation. Conclusion Acute kidney injury developed in 22.6% of children with acute-on-chronic liver failure. Bilirubin more than 17.7 mg/dL and presence of systemic inflammatory response syndrome were high risk factors for acute kidney injury. Development of acute kidney injury in a child with acute-on-chronic liver failure suggests poor outcome and need for early intervention.

Objectives Fatty acid oxidation defects (FAODs) may underlie or modify the course of acute liver failure (ALF). Overall significance of carnitine/acylcarnitine and amino acid profile in ALF is similarly undetermined. Thus, this study was undertaken to study the abnormalities in carnitine/acylcarnitine and amino acid profile in ALF. Methods A prospective study was performed including all patients with ALF, and detailed evaluation including metabolic testing was done. Results A total of 55 patients (33 pediatric and 22 adult patients) were included in the study. Three patients (a 1-year 6-month-old child, a 13-year-old adolescent, and a 21-year-old adult, ie, 5.5% of all) were identified for the study with underlying metabolic etiology, that is, carnitine palmitoyl transferase-1 deficiency, based on the abnormal carnitine/acylcarnitine profile. Almost three-fourths of patients (78%) had evidence of serum hyperaminoacidemia. Thirty-one patients (56%) had evidence of abnormal carnitine/acylcarnitine profile with predominant abnormality being low free carnitine (C0). Higher levels of serum tyrosine (P = 0.002) and lower levels of serum C0 (P = 0.032) in children and higher levels of serum phenyalanine (P = 0.047) in adults predicted poor outcome (death/liver transplant) on univariate analysis. Conclusions FAODs are not uncommon in ALF with a suggested prevalence of approximately 5.5%. FAODs can cause ALF or modify the natural course of ALF caused by other etiologies. Serum hyperaminoacidemia and low serum free carnitine may predict poor outcome in patients with acute liver failure.

This paper focuses on two main aspects of the clusters, namely, which factors gives rise to development of clusters and what benefits are acquired by firms from participating in clusters of India. The methodology used for this article is a literature review of published materials. A broad search strategy was used using key terms like industrial clusters, evolution of clusters, and advantages of clusters from electronic databases. Among the factors that give rise to clusters in India, the more important ones are historical background, easy availability of raw materials, existence of one or few large enterprises, pooled labour market of skilled workers, regional government policy, and presence of entrepreneurial spirit. The important benefits reported by enterprises through their presence in clusters are formation of new business, n etwork formation with supporting institutions, women empowerment, m arket development, product development, e asy availability of finance, increased trust and collaboration among members, increase in sales, skills up gradation of workers and employment opportunities . We expect that the findings from this study will assist firms and policy makers in making more informed decisions regarding the adoption of a cluster approach and start new initiatives for promoting inter-firm relations within MSME clusters. The major contribution of this paper is that it attempts to justify the positive impact of cluster approach and describe the status of clusters in India .

Background and Aims The outcome of Pediatric acute liver failure largely depends on age and etiology. The aim of this work was to study the etiological spectrum and outcome of the pediatric acute liver failure cases. Methods This prospective observational study included all children (< 18 years age) fulfilling pediatric acute liver failure study group definition. Etiological evaluation was done and predictive factors for poor outcome (death or liver transplantation) were analyzed. Results There were 109 children in total. The commonest etiology was viral infections (50, 45.8%) followed by metabolic liver diseases (14, 13.2%) and drug induced liver injury (12, 11%). Viral, indeterminate and drug induced liver injury group were older in age, had higher international normalised ratio and alanine transaminases in comparison to metabolic liver diseases and other etiologies (p 7 days (Adjusted OR 9.16, 95% CI 1.55-53) and higher Pediatric/Model for End Stage Liver Disease scores at 72 hours (Adjusted OR 1.2, 95% CI 1.08-1.32) were associated with poor outcome. Conclusion Viral infections, indeterminate and drug induced liver injury related pediatric acute liver failure usually present in older children with higher international normalised ratio and alanine transaminases. Jaundice to encephalopathy interval > 7 days and Pediatric/Model for End Stage Liver Disease >24 at 72 hours are associated with poor outcome. This article is protected by copyright. All rights reserved.

Though often used in cardiac intensive monitoring set up, simultaneous evaluation of several variables like CVP, PCWP, SVV and hTEE for fluid volume resuscitation (especially when capillary permeability is major problem than cardiac performance) is a major challenge in many ICU setups. Therefore, repetitive determination of blood volume by trivalent chromium [51Cr (III)] as a direct single variable method may be a near ideal method during fluid volume resuscitation in cases where capillary permeability is a major problem (e.g. Burns). Hence, in the present article the repeatability and reliability of 51Cr (III) method in New Zealand white rabbits was explored. Mean blood volume values of initial measurement were 195.66 ± 47.30 ml or 89.81 ± 17.88 ml/kg body weight. Repeated mean blood volume values, measured after 1 h, was 181.98 ± 53.16 ml or 83.68 ± 22.09 ml/kg body weight. The average difference between the initial and repeated measurements was 10.93 ml (95% CI −3.33, 25.19 ml), which is not statistically significant (P = 0.128). The method using 51Cr (III) for repeat blood volume measurements after sixty minutes in rabbits is a reliable method. • Rapid • Repeatable • Reliable Method name: Technique for repeat blood volume measurement, Keywords: Blood volume, Trivalent chromium, New Zealand white rabbits, Repeat blood volume, Capillary leakage, Volume shift, Sepsis

Objectives The aim of the study was to assess the prevalence, profile, outcome, and predictive factors of pediatric acute-on-chronic liver failure (ACLF). Methods All children 3 months to 18 years satisfying the Asia Pacific Association for the Study of Liver Diseases definition of ACLF were included. Data were both extracted from records (January 2011 to December 2014) and prospectively collected (January to October 2015). Successful outcome was defined as survival with native liver at 90 days, whereas poor outcome included those who died or received liver transplantation. Results Of the 499 children with chronic liver disease (CLD), 56 (11.2%) presented as ACLF, with a mean age of 9.35 (±4.39) years. Wilson disease and autoimmune hepatitis were the commonest underlying CLDs accounting for 24 (42.8%) and 18 (32.1%) cases, respectively. The most frequent events precipitating ACLF were a flare up of the underlying disease in 27 (48.2%) and acute viral hepatitis in 17 (30%). Poor outcome occurred in 22 (39.3%) children: 17 (30.4%) died and 5 (8.9%) received liver transplantation. Poor outcome was associated with grades 3 to 4 hepatic encephalopathy, bilirubin ≥17.5, international normalized ratio ≥3.5, and presence of 2 or more organ failures. On multivariate analysis, a Chronic Liver Failure-Sequential Organ Failure Assessment score ≥10 best predicted mortality (odds ratio 20.45, 95% confidence interval 3.9-106.7). Conclusions ACLF is present in 11.2% of childhood CLD, with a 90-day native liver survival of 61%. A Chronic Liver Failure-Sequential Organ Failure Assessment score of ≥10 best predicts mortality at day 90.

Objective To study the clinical and laboratory profile of children with progressive familial intrahepatic cholestasis (PFIC) and evaluate their outcome. Methods The study is a retrospective review of all cases diagnosed with PFIC between January 2011 and July 2015. All children underwent histopathological examination and immunostaining. Management was done as per institute's protocol. Results There were a total of 24 PFIC cases (PFIC 1—2, PFIC 2—19, PFIC 3—3). Eleven presented as neonatal cholestasis, whereas 13 others presented after 6 months of life. Median age of presentation in PFIC 2 was 5.5 months with a time lag of 13 months in diagnosis. PFIC 1 and 2 presented in infancy, whereas PFIC 3 presented late. Familial clustering was seen in 12 of 24 cases. Pruritus resolved with medical management in two-thirds of cases, 3 cases required biliary diversion (BD) with dramatic improvement. One child improved after liver transplantation. Conclusions PFIC accounts for 8% of neonatal cholestasis and 34% of cholestasis in older children with PFIC 2 being the commonest subtype. Medical therapy is successful in majority. Partial internal BD should be offered to non-cirrhotic low gamma glutamyl transferase PFIC with intractable pruritus. Progression to cirrhosis may be prevented or delayed by early diagnosis and timely intervention.

Our aim was to evaluate the efficacy and safety of sequential therapy using pegylated interferon (Peg-IFN) and nucleos(t)ide analogue (NA) for treatment of children in immunoactive (IA) and immunotolerant (IT) phases of chronic hepatitis B. It was a prospective observational study where those willing for sequential therapy were allocated to group 1 (sequential therapy) and others to group 2 (standard therapy). Sequential therapy included 8 weeks of NA followed by 44 weeks of combination of NA and Peg-IFN. In group 2, IA children received NA monotherapy, and IT children received no therapy. HBe seroconversion, HBs seroconversion, and loss of HBV DNA were the major outcome measures. A total of 61 children (36 IA and 25 IT) were included in the analysis. Among the IA children, 17 received sequential therapy and 19 received standard therapy; whereas, among the IT children, 12 received sequential therapy and 13 did not receive any therapy. In IA phase, sequential therapy led to higher HBe seroconversion (64.7% vs. 21.05%, p = 0.017) and higher virological clearance (94.12% vs. 52.63%, p = 0.008). In IT children, there was no benefit of treatment with sequential therapy over observation alone. Baseline ALT > 100 IU/L predicted response to therapy with 100% sensitivity, 89.5% specificity, and LR+ of 9.52. Sequential therapy leads to higher HBe seroconversion and virological response in children in IA phase. Children with baseline ALT > 100 IU/mL are more likely to respond to sequential therapy. There appears to be no role of sequential therapy in children in IT phase.

Wilson disease and cholestatic liver diseases may present as a diagnostic dilemma if standard guidelines incorporating markers of copper overload are followed. We hereby present a series of four cases of sclerosing cholangitis masquerading as Wilson disease. True Wilson disease cases had significantly lower ceruloplasmin (6 vs. 16 mg/dL) and higher 24-hour urinary copper (322.3 vs. 74.5 μg/day) as compared to mimickers. Initial low serum ceruloplasmin levels normalized in mimickers on follow up, and this may used as a diagnostic indicator. Standard Wilson disease diagnostic criteria thus need further modification especially in developing countries to help avoid mismanagement.

To study the etiological spectrum of acute liver failure in infants and young children and to identify clinical and biochemical markers for metabolic liver disease (MLD). This study was conducted at Department of Pediatric Hepatology, in a tertiary care specialized centre for liver diseases. All children less than 3 y of age, with liver dysfunction and INR ≥2 were included in the study. They were managed as per the departmental protocol. Included children were divided based on the etiology into 2 groups: MLD and non MLD group. Comparison analysis (MLD vs. non MLD) of the clinical and biochemical parameters was done. There were 30 children under 3 y of age with acute liver failure (ALF) with median age of 12.5 mo. Fifteen children were less than 12 mo. MLD (33 %) and hemophagocytic lymphohistiocytosis (HLH) (17 %) together accounted for half of the cases of ALF in children below 3 y of age. The other common etiologies were drug induced liver injury and acute viral hepatitis A. Etiology remained indeterminate in 3 cases (10 %). Comparative analysis of the clinical and biochemical parameters between MLD and non MLD group showed significant difference between the two groups in the median values of age (p = 0.014), bilirubin (p = 0.017), jaundice to encephalopathy (JE) interval (p = 0.039) and blood sugar (p = 0.001). Suggestive family history (OR 3.73, 95 %CI 1.67–8.30), developmental delay (OR 4.4 95 %CI 2.03–9.51), presence of diarrhea/vomiting (OR 3.28, 95 %CI 1.32–8.13) in the history and presence of urinary non glucose reducing substance (NGRS) (OR 15.5, 95 %CI 2.26–106.87) were also significantly associated with MLD group. Only 40 % children survived with native liver. MLD and HLH account for majority of ALF in infants. About 10 % of cases remain indeterminate. Viral hepatitis is more common in young children. Apart from clinical indicators, young age, high bilirubin, synthetic dysfunction, low sugar and NGRS in urine indicate MLD as a cause. Survival with native liver is low.

This study was undertaken to evaluate the effect of external metal filters on the image quality of computed tomography (CT) and single photon emission computed tomography (SPECT)/CT images. Images of Jaszack phantom filled with water and containing iodine contrast filled syringes were acquired using CT (120 kV, 2.5 mA) component of SPECT/CT system, ensuring fixation of filter on X-ray collimator. Different thickness of filters of Al and Cu (1 mm, 2 mm, 3 mm, and 4 mm) and filter combinations Cu 1 mm, Cu 2 mm, Cu 3 mm each in combination with Al (1 mm, 2 mm, 3 mm, and 4 mm), respectively, were used. All image sets were visually analyzed for streak artifacts and contrast to noise ratio (CNR) was derived. Similar acquisition was done using Philips CT quality control (QC) phantom and CNR were calculated for its lexan, perspex, and teflon inserts. Attenuation corrected SPECT/CT images of Jaszack phantom filled with 444-555 MBq (12-15 mCi) of (99m)Tc were obtained by applying attenuation correction map generated by hardened X-ray beam for different filter combination, on SPECT data. Uniformity, root mean square (rms) and contrast were calculated in all image sets. Less streak artifacts at iodine water interface were observed in images acquired using external filters as compared to those without a filter. CNR for syringes, spheres, and inserts of Philips CT QC phantom was almost similar to Al 2 mm, Al 3 mm, and without the use of filters. CNR decreased with increasing copper thickness and other filter combinations. Uniformity and rms were lower, and value of contrast was higher for SPECT/CT images when CT was acquired with Al 2 mm and 3 mm filter than for images acquired without a filter. The study suggests that for Infinia Hawkeye 4, SPECT/CT system, Al 2 mm, and 3 mm are the optimum filters for improving image quality of SPECT/CT images of Jaszack or Philips CT QC phantom keeping other parameters of CT constant.

Limited literature is available in pediatric population regarding drug-induced liver injury (DILI) making it a diagnostic challenge. This study was thus planned to determine the clinical spectrum and the outcome of DILI in children. All patients with DILI under 18 y of age were retrospectively reviewed and details regarding clinical presentation, Roussel Uclaf Causality Assessment Method (RUCAM) scale, drugs implicated, biochemical abnormalities and outcome were noted. DILI constituted 3.7% of all children with liver disease. Cases were divided into the hepatocellular (18, 50%), cholestatic (10, 27.8%), and mixed pattern (8, 22.2%). Complementary and alternative medicines (CAM) and antitubercular (ATT) drugs accounted for three-fourth cases of total DILI (39% and 33% cases respectively). Overall, 4 (11%) patients died and 5 (14%) patients progressed to chronic DILI. Presence of ascites, non-hepatocellular injury pattern and high serum total IgG levels were significantly associated with unfavourable outcome (death or chronicity).

OBJECTIVES Noncirrhotic portal fibrosis (NCPF) has been classically described as a disease of young to middle age with limited literature regarding its occurrence, onset, or clinical presentation in children. We hereby present a series of 19 patients diagnosed and managed as NCPF in pediatric age group. METHODS A retrospective review of all the patients presenting to the pediatric hepatology department (age

Pathophysiology of liver disorders involves an interaction between environmental genetic and host factors. This includes childhood liver diseases like familial cholestatic syndromes as well as liver diseases manifesting in adulthood like alcoholic liver disease, non-alcoholic liver diseases, viral hepatitis, etc. Genetic predisposition can be due to single-gene mutations (as in alpha-1 antitrypsin deficiency), susceptible single-nucleotide polymorphisms in intrahepatic cholestasis of pregnancy, or modifier genes in drug-induced liver disease and histocompatibility leucocyte antigen (HLA) association in complex diseases as autoimmune hepatitis (AH). Understanding the genetic contribution to liver diseases is important for clinicians as the same disorder may have wide phenotypic variability while this is vital for research workers due to therapeutic implications.

This paper aims to answer two research questions: first, what are the different types of business networks formed by firms with the stakeholders present in a cluster and second, to explain the relationship between business networks and the performance of firms. To answer the first research question, this study uses an exploratory research design which involves survey research method where data was collected through survey questionnaire. Data for questionnaire was collected from managers and owners of firms operating in the cluster at their offices. To answer the second question, this study uses a descriptive research design which makes use of survey research method to examine the relationship among business networks and firm performance by collecting data through survey questionnaire. With respect to exploration of different types of business networks, the study has identified two types of business networks with local associations and government agencies, only one type of business network with the educational institutes and suppliers, and lastly four different types of business networks between a firm and its buyers. However, with respect to network with other stakeholders like financial institutes (banks), research institutes, and competitors, the study shows that the interaction between a firm and these stakeholders is weak. With respect to impact of business networks on firm performance, the study suggested that majority of the formed business networks are significantly and positively related to firm performance. The business networks identified in the study provide a much deeper understanding of how firms connect with its suppliers, its buyers, government agencies, and educational institutes operating in an auto-component cluster.

The purpose of this paper is to find out the different types of business networks formed by firms with the stakeholders present in a cluster, i.e. how firms in a cluster interact with the cluster stakeholders? This study uses an exploratory research design which is carried out in two stages, first stage involves use of primary data which was collected through semi-structured personal face-to-face interview mode and second stage involves survey research method where data was collected through survey questionnaire. The study has identified four types of business networks between a firm and its buyers, only one type of business network with the suppliers and educational institutes respectively, and lastly two types of business networks with government agencies. However with respect to business networks with other stakeholders like research institutes and competitors, the study shows that the interaction between a firm and these stakeholders remains largely unfilled.

Primary pancreatic lymphoma in children has been described infrequently in literature, and its acute presentation as cholestatic hepatitis is similarly rare. We report a case of a 7-year-old child with primary pancreatic lymphoma presenting as acute infective hepatitis, leading to delay in correct diagnosis and management.

We report on the performance of supercapacitor devices fabricated using 1-pyrenecarboxylic acid (PCA)-functionalized graphene electrodes. The specific capacitances obtained (using 6 M KOH aqueous solution as an electrolyte) was found to be an order of magnitude higher than nonfunctionalized graphene electrodes (∼30 and ∼200 F/g for pure graphene and PCA-functionalized graphene electrodes, respectively). The analysis of electrochemical impedance spectroscopy using equivalent circuit modeling as well as electrolyte wettability measurements shows a substantial increase in the electrical double layer capacitance due to the PCA functionalization. These findings indicate that PCA functionalization of graphene can significantly enhance the capacitive storage ability of graphene-based electrodes and can act as superb electrode materials in electrical energy applications.

We report kinetics measurements for the adsorption of methane, ethane, propane, butane, and pentane on close-ended single-walled carbon nanotube bundles. The measurements were conducted by monitoring the adsorption equilibration times. For methane and ethane, equilibration times were found to decrease as the fractional coverage on the surface of the nanotube bundles increased, approaching monolayer completion. However, for propane, butane, and pentane, the opposite trend was observed: for these longer alkanes, there was an increase in the equilibration time with increasing fractional coverage. We propose a plausible explanation for our experimental findings, and we suggest that different mechanisms for attaining equilibrium may be in place for short and long alkane chains.

The results of adsorption isotherm measurements for ethylene on purified HiPco SWNTs conducted at 11 different temperatures (between 110 K and 220 K) are reported, together with a comparison with the results we have obtained for ethane on the same substrate. Two groups of distinct binding sites were observed for ethylene on bundles of carbon nanotubes; this is in agreement with previously reported observations for ethane on this same sorbent. In addition, a consistent value of the specific surface area of the substrate was obtained from the ethylene and ethane data measured at approximately the same temperature. We have also determined the coverage dependence of the isosteric heat of adsorption for ethylene on the HiPco nanotube bundles. The reported experimental isosteric heat results are compared with simulation results for ethane and ethylene.

We present the results of adsorption isotherm measurements for propane films on single-walled carbon nanotubes, for coverages limited to the first layer. Isotherms were measured at six different te...

We have explored the adsorption kinetics of argon and methane on chemically opened and on as-produced carbon nanotubes. We monitored the evolution of the adsorbate pressure after each gas dose was added to the cell during the performance of adsorption isotherms. We found significant differences between the equilibration times measured on these two groups of nanotubes. We propose an explanation for our experimental observations that makes use of recent computer simulations conducted for similar adsorbed systems.

Non hepatic origin of refractory ascites is not a rarity. Hemolytic anemias are known to cause inspissated bile and biliary obstruction. Distal biliary obstruction can lead to biliary perforation. The authors report a case of hereditary spherocytosis leading to inspissated bile causing bile duct perforation and biliary ascites. A high index of suspicion for biliary ascites should be kept in a child with refractory ascites in the setting of progressive ascites with decreasing bilirubin. Ascitic fluid bilirubin analysis will clinch the diagnosis. Surgical repair is the optimal management.

Over the last few years a number of groups have been exploring the possibilities and limitations associated with using adsorption on newly developed materials for the storage of hydrogen. Here we report the results of hydrogen adsorption investigations on a newly synthesized form of carbon nanofiber-doped carbon liquid crystals. This material shows a marked increase in specific surface area upon activation with water vapor, leading to activated samples that are capable of adsorbing hydrogen upto 3.5% by weight at 77.3 K, at moderate pressures. The possibility of higher adsorption (∼6.5 wt. %) in these materials is also discussed.

This paper focuses on two main aspects of the clusters, namely, which factors gives rise to development of clusters and what benefits are acquired by firms from participating in clusters of India. The methodology used for this article is a literature review of published materials. A broad search strategy was used using key terms like industrial clusters, evolution of clusters, and advantages of clusters from electronic databases. Among the factors that give rise to clusters in India, the more important ones are historical background, easy availability of raw materials, existence of one or few large enterprises, pooled labour market of skilled workers, regional government policy, and presence of entrepreneurial spirit. The important benefits reported by enterprises through their presence in clusters are formation of new business, network formation with supporting institutions, women empowerment, market development, product development, easy availability of finance, increased trust and collaboration among members, increase in sales, skills up gradation of workers and employment opportunities. We expect that the findings from this study will assist firms and policy makers in making more informed decisions regarding the adoption of a cluster approach and start new initiatives for promoting inter-firm relations within MSME clusters. The major contribution of this paper is that it attempts to justify the positive impact of cluster approach and describe the status of clusters in India.

An eleven-year-old clinically dysmorphic and developmentally retarded male child presenting with complaints of 5 episodes of recurrent cholestatic jaundice since 3 years of age was evaluated. Imaging revealed features consistent with congenital extrahepatic portocaval shunt (Abernethy type 1b), multiple regenerative liver nodules and intrahepatic biliary radical dilatation. The presence of ductal paucity and trisomy 8 were confirmed on liver biopsy and karyotyping. The explanation for unusual and previously unreported features in the present case has been proposed.