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Since the industrial revolution, delinquency has been a societal and massive concern, particularly in emerging countries such as India. Delinquent behavior by minors in their teen or pre-teen years is known as juvenile delinquency. In this study, juvenile delinquents and non-delinquents were tested and contrasted in terms of various modes and total frustration. It was assumed that delinquents would score higher than non-delinquents on various modes of total frustration. Furthermore, significant differences between delinquents and non-delinquents' frustration mean scores would be found. In addition, delinquency's major effect on frustration would be revealed to be strong. A total of 400 male subjects (N=400) were included in the study, out of which 200 of them being juvenile delinquents and the remaining 200 being non-delinquents. The frustration test devised by Chauhan and Tiwari (1972), was administered on the sample and the data was then statistically analyzed using suitable statistical tests. The findings supported with the hypothesized predictions, and the complete findings are discussed in great detail in the full paper.

Using a mixed method approach, this study investigates the challenges that the COVID-19 pandemic has posed for entrepreneurs and the strategies that organizations can adopt to make a turnaround towards survival and growth. Empirical analysis is done on the factors which have affected smaller firms during economic slowdowns in the past, and policies and plans adopted by firms to overcome the barriers. Factors such as lockdown, remote working, digital marketing and digitization were accounted through qualitative research. In the empirical analysis section, descriptive statistics and confirmatory factor analysis have been used. In the qualitative section, thematic analysis and hierarchy charts were made with the help of NVivo software. The prime barriers which affected the firms were organizational readiness, infrastructural support by government, technological inadequacy and financial crises. The main strategies emphasized by founders to overcome the barriers of organizational readiness and financial crunch were marketing, strategic networking and product and services, and for technological ineptness was digitization.

Introduction : Topical steroids are most commonly being used today. Mostly these are being misused due to lack of awareness of their adverse effects. Malpractice and easy availability of these agents also responsible for their abuse. Aim : To Evaluate Topical Steroid abuse in various parameters according to CDSCO ADR forms. Objectives : This study was conducted to know the extent of abuse of topical steroid ,along with clinical profile and mode of accessibility in dermatology department of a teaching institute of tertiary health care centre of central India. Material and Method: First 200 patients of adverse drug reaction attending dermatology department were screened according to ICSR form of CDSCO in a period of December 2015 to November 2016 and 181 patients of them who gave history of topical steroid application were further analyzed. Result: Most commonly affected people belong to age of 21 to 30 years (41.98%),Tinea incognito (58%) was the commonest manifestation of steroid abuse, Tinea (58%)was the most common indication of steroid application, self medication (46.40%) was most common mode of steroid accessibility, betamethasone (61.87%) was most commonly applied topical steroid. Conclusion :Self medication and over the counter drug use were most common mode of steroid accessibility both can be controlled by making strict health regulatory policies . Simultaneously health education program must be targeted to young population who are more vulnerable to steroid abuse to make them aware regarding harmful effects of unguided or misguided use of topical steroid.

This study applies positive matrix factorization (PMF) to 140 groundwater samples collected from four different Public Health Centers in North Brahmaputra basin, Assam, India. The aim of this technique is to identify and quantify the pollution sources (natural and anthropogenic) that affect the water quality. Multivariate statistical analysis, especially factor analysis, is successful in interpreting the water quality data, but it has some limitations: It does not consider analytical uncertainty and factor loadings may be negative which do not give a clear representation of the data. Therefore, we applied PMF to groundwater data and compared the results with those obtained from factor analysis. The major findings from the study are as follows: The first and the second factors show that the natural means are the main source of pollution where Cl, SO4, Ca, Mg, TA and TH were the main contributors from erosion and weathering of rocks. The Pb and NO3 from the third and the fourth factor, respectively, are the major sources of contamination from anthropogenic activities such as the use of fertilizers. The fifth factor results in Fe, As, Mn and Cr, suggesting that both natural and anthropogenic processes are the main pollution contributors. PMF exhibits a more realistic representation of data and helps us to better understand the major sources of contamination and the variation in groundwater quality data. Hence, it can be successfully used for the characterization of groundwater chemistry.

A set of planar Hall resistance (PHR) sensors was fabricated on rigid and flexible substrates. High signal-to-noise ratio, low offset voltage, nearly zero hysteresis of signal, and excellent linearity were demonstrated for sensors, based on Ta (5 nm)/NiFe (10 nm)/IrMn (10 nm)/Ta (5 nm) thin films, grown on polydimethylsiloxane (PDMS) and parylene C polymeric substrates. The effect of bending on the performance of the PHR sensors was studied. The effect of bending deformation on the performance characteristics of the fabricated PHR sensors is reversible until the bending angle reaches a critical one. The critical bending angle is shown to depend on the substrate composition. An irreversible deformation of a sensor's film, accompanied by the formation of wrinkles and cracks, occurs when the bending angle exceeds the critical one. This deformation originates from the difference between the values of Young's modulus of the substrate and the film. The bending stability of a PHR sensor, grown on PDMS substrate, was improved by deposition of 1 µm of parylene C as a buffer and as a capping layer. The performance characteristics of the designed bendable PHR sensors are compatible with requirements for applications in wearable electronics and medical diagnostic devices.

Simple Summary The development of new approaches in the field of drug delivery systems is primarily based on increasing the accuracy and precision of the targeted site and improving the stability of the drug by preventing the phagocytosis process inside the body. Among many other methods used to fulfill the above-mentioned requirements, the use of magnetotactic bacteria (MTB) is proven to be a promising solution, as it is self-propelling in nature, and can also be controlled by an external magnetic field. For the present work, we developed an MTB/PEG–biotin complex by exploiting the process of covalent bond formation between bacteria and a biotin–PEG–NHS polymer. In addition to this, attachment efficacy and stability were also determined. In biological applications, cytotoxicity assay of THP-1 cells was performed, showing the MTB/PEG–biotin complex to be less harmful to the cells; meanwhile, to explore the stealth properties of the complex, we performed a cell association assay. With these results, we provide a significant contribution to the field of potential drug delivery system development. Abstract The early removal of drug delivery agents before reaching the affected target remains an area of interest to researchers. Several magnetotactic bacteria (MTB) have been used as self-propelled drug delivery agents, and they can also be controlled by an external magnetic field. By attaching the PEG–biotin polymer, the bacteria are turned into a stealth material that can escape from the phagocytosis process and reach the area of interest with the drug load. In the study, we developed a potential drug carrier by attaching the PEG–biotin to the MTB-through-NHS crosslinker to form a MTB/PEG–biotin complex. The attachment stability, efficacy, and bacterial viability upon attachment of the PEG–biotin polymer were investigated. Biological applications were carried out using a cytotoxicity assay of THP-1 cells, and the results indicate that the MTB/PEG–biotin complex is less harmful to cell viability compared to MTB alone. Along with cytotoxicity, an assay for cell association was also evaluated to assess the complex as a potential stealth material. The development of these complexes focuses on an easy, time-saving, and stable technique of polymer attachment with the bacteria, without damaging the cell’s surface, so as to make it a strong and reliable delivery agent.

Chang et al. link the RECQ-like helicase BLM and its yeast orthologue Sgs1 to preventing DNA damage caused by the accumulation of DNA:RNA hybrid structures called R-loops. This adds to a growing family of helicases implicated in R-loop resolution., Sgs1, the orthologue of human Bloom’s syndrome helicase BLM, is a yeast DNA helicase functioning in DNA replication and repair. We show that SGS1 loss increases R-loop accumulation and sensitizes cells to transcription–replication collisions. Yeast lacking SGS1 accumulate R-loops and γ-H2A at sites of Sgs1 binding, replication pausing regions, and long genes. The mutation signature of sgs1Δ reveals copy number changes flanked by repetitive regions with high R-loop–forming potential. Analysis of BLM in Bloom’s syndrome fibroblasts or by depletion of BLM from human cancer cells confirms a role for Sgs1/BLM in suppressing R-loop–associated genome instability across species. In support of a potential direct effect, BLM is found physically proximal to DNA:RNA hybrids in human cells, and can efficiently unwind R-loops in vitro. Together, our data describe a conserved role for Sgs1/BLM in R-loop suppression and support an increasingly broad view of DNA repair and replication fork stabilizing proteins as modulators of R-loop–mediated genome instability.

Background Chemoprophylaxis vaccination with sporozoites (CVac) with chloroquine induces protection against a homologous Plasmodium falciparum sporozoite (PfSPZ) challenge, but whether blood-stage parasite exposure is required for protection remains unclear. Chloroquine suppresses and clears blood-stage parasitemia, while other antimalarial drugs, such as primaquine, act against liver-stage parasites. Here, we evaluated CVac regimens using primaquine and/or chloroquine as the partner drug to discern whether blood-stage parasite exposure impacts protection against homologous controlled human malaria infection. Methods In a Phase I, randomized, partial double-blind, placebo-controlled study of 36 malaria-naive adults, all CVac subjects received chloroquine prophylaxis and bites from 12–15 P. falciparum–infected mosquitoes (CVac-chloroquine arm) at 3 monthly iterations, and some received postexposure primaquine (CVac-primaquine/chloroquine arm). Drug control subjects received primaquine, chloroquine, and uninfected mosquito bites. After a chloroquine washout, subjects, including treatment-naive infectivity controls, underwent homologous, PfSPZ controlled human malaria infection and were monitored for parasitemia for 21 days. Results No serious adverse events occurred. During CVac, all but 1 subject in the study remained blood-smear negative, while only 1 subject (primaquine/chloroquine arm) remained polymerase chain reaction–negative. Upon challenge, compared to infectivity controls, 3/3 chloroquine arm subjects displayed delayed patent parasitemia (P = .01) but not sterile protection, while 3/11 primaquine/chloroquine subjects remained blood-smear negative. Conclusions CVac-primaquine/chloroquine is safe and induces sterile immunity to P. falciparum in some recipients, but a single 45 mg dose of primaquine postexposure does not completely prevent blood-stage parasitemia. Unlike previous studies, CVac-chloroquine did not produce sterile immunity. Clinical Trials Registration NCT01500980.

Contemporary organizations face constant pressure to enhance levels of service and productivity whilst also improving levels of cost efficiency. The volatility of external environment and rapid pace of technological change increasingly demand innovative means of improving business performance and securing competitive advantage. In this article, the various characters have been analyzedand theoretical perspectives and studies that relate to organization designs which are conducive for innovation. Three major determinants have emerged from this study. These are strategy pertaining to innovations, communication and flexible structure of the organization. Implications of these factors are discussed in the paper and future research recommendations are also proposed. An extensive review of literature has been done to extract some guidelines which can be beneficial for organizations striving to adapt an organizational form which boosts innovation in the organization.

Aims: This study aims to measure the quality of life (QOL), treatment satisfaction, and tolerability of antidiabetic drugs in patients suffering from type 2 diabetes mellitus (DM). Methods: The prospective, observational study was conducted in consenting patients of type 2 DM attending the outpatient department of a tertiary care hospital in Western India. The QOL instrument for Indian diabetes (QOLID) patients questionnaire and the Diabetes Treatment Satisfaction Questionnaire were administered to all patients at baseline, 3 months, and 6 months of treatment. Tukey–Kramer comparison test was used to analyze the difference in QOLID scores in various domains at baseline, 3 months, and 6 months. WHO-UMC scale, Naranjo's probability scale, Hartwig and Siegel, and Schumock and Thornton modified criteria were used to analyze the adverse drug reactions. Results: A male preponderance was observed in 200 patients enrolled in the study. The mean duration of diabetes was 10.96 ± 5.99 years. The patients received metformin alone (40), metformin and glipizide (47), metformin, glipizide and other oral hypoglycemic agents (OHAs) (78), and OHAs and insulin (35). A significant improvement in fasting and postprandial blood sugar was observed at 6 months as compared to the baseline (P < 0.05). A total of 39 (19.5%) patients suffered from adverse effects to metformin and insulin. Physical health and physical endurance improved in patients receiving metformin alone or in combination with glipizide as compared to patients receiving other OHAs and/or insulin. Treatment satisfaction, highest in patients receiving metformin and least in those receiving insulin, was unaltered during the study period. Conclusions: While polypharmacy is evident, using lesser medicines offers better treatment satisfaction and QOL in DM. Periodic assessment of QOL and treatment satisfaction are recommended in DM.

Human populace of Assam, India repeatedly exposed to high concentration of iron in groundwater results in adverse health effects like hemochromatosis, liver cirrhosis and siderosis. In the present study, human hair and nail analysis were carried out to establish a possible relationship between iron toxicity and its deposition among the residents. Nail and hair iron concentrations ranged from 28.2 to 1046μgg(-1) (n=114) and 26.5-838 (n=108)μgg(-1) levels, respectively, among all the study participants. The iron content of the groundwater (421-5340μgL(-1)) (n=64) used for drinking purposes was positively correlated with both nail (r=0.788, p0.0001) and hair (r=0.709, p0.0001) iron concentrations. Age- and sex-matched controls corresponding to each group were selected from population residing in other parts of the country where groundwater does not have excess iron. All the study groups included population drinking iron-contaminated water above the WHO/BIS limit (300µgL(-1)) for 5 years (Group 1), for more than 5-10 years (Group 2) and for more than 10 years (Group 3). Results suggested that the participants consuming groundwater exceeding the WHO limit of iron had significantly more iron accumulation than those using groundwater containing ≤300μgL(-1) iron (p0.01). There was statistically higher concentration of iron in the nail samples than the hair samples in all the study groups (p0.01). There was a positive correlation in iron concentration and the residence time of the participants (p0.01). Iron levels in the male participants were significantly higher than the female participants in the present study (p0.01). The current findings are sufficiently compelling to warrant more extensive study of iron exposure through drinking water and adverse effects to the human in the areas where iron concentration is high.

PurposeThe purpose of the study was to find the incidence of “diabesity” among morning walkers of Jaipur city (20‐60 years).Design/methodology/approachTotally 303 subjects willing to participate in the study were included, out of which 211 were males and 92 were females. Subjects were categorized into two age groups 20‐40 and 40‐60 years. Height (cm), weight (kg), waist circumference (cm), hip circumference (cm) and fasting blood glucose values of morning walkers were measured.FindingsThere was no significant difference in the incidence of “diabesity” among both the genders. The mean body mass index of females (28.47+4.3) was higher than that of males (26.55+3.42). Mean waist‐to‐hip ratio values were 0.86+0.07 for females and 0.92+0.13 for males. Age was better correlated with systolic blood pressure (r=0.276 (M); r=0.359 (F)) than diastolic blood pressure (r=0.037 (M); r=0.165 (F)) for both males and females.Originality/valueThe study aimed at assessing incidence of “diabesity” among the individuals who are regular with morning walk.

PurposeWeight reduction is a complex phenomenon. Dietary intervention is the most popular approach to reduce excess body fat. In this review, it has been tried to analyze the effect of individual nutrients on the weight reduction process. The paper aims to discuss these issues.Design/methodology/approachStudies and review articles discussing role of individual nutrients on weight loss were collected for the purpose.FindingsDiet high in protein and balanced in calories exerts a positive effect on weight reduction. Micronutrients such as calcium, vitamin C, A, D are also required for an effective weight reduction program.Originality/valueThe review tries to analyze the impact of both quantity and quality of various nutrients on weight reduction.

Placental malaria (PM) is characterized by infected erythrocytes (IEs) that selectively bind to chondroitin sulfate A (CSA) and sequester in placental tissue. Variant surface antigen 2-CSA (VAR2CSA), a Plasmodium falciparum erythrocyte membrane protein 1 (PfEMP1) protein family member, is expressed on the surface of placental IEs and mediates adherence to CSA on the surface of syncytiotrophoblasts. This transmembrane protein contains 6 Duffy binding-like (DBL) domains which might contribute to the specific adhesive properties of IEs. Here, we use laboratory isolate 3D7 VAR2CSA DBL domains expressed in Escherichia coli to generate antibodies specific for this protein. Flow cytometry results showed that antibodies generated against DBL4ε, DBL5ε, DBL6ε, and tandem double domains of DBL4-DBL5 and DBL5-DBL6 all bind to placental parasite isolates and to lab strains selected for CSA binding but do not bind to children's parasites. Antisera to DBL4ε and to DBL5ε inhibit maternal IE binding to placental tissue in a manner comparable to that for plasma collected from multigravid women. These antibodies also inhibit binding to CSA of several field isolates derived from pregnant women, while antibodies to double domains do not enhance the functional immune response. These data support DBL4ε and DBL5ε as vaccine candidates for pregnancy malaria and demonstrate that E. coli is a feasible tool for the large-scale manufacture of a vaccine based on these VAR2CSA domains.

Histogram is an integral part of video processing applications. Either of the design methods ASIC or Embedded, histogram computation is an important functional block. This paper proposes the custom Integrated Circuit (IC) as an ASIC and an embedded IP to compute the colored histogram function. Histogram computation has two features: color and spatial. Color feature has been calculated using find_bin and spatial feature is calculated using kernel function. The design is verified using NCSIM Cadence tool, while it is synthesized using RTL compiler. Finally, the embedded IP has interfaced with Kernel based mean shift algorithm in tracking a moving object and implemented on Xilinx Spartan 6 LX150T FPGA.

Purpose – The purpose of this paper is to compare the knowledge, attitudes and practices (KAP) for coronary heart disease (CHD) risk in businessmen and patients suffering from CHD (30‐60 years), in Jaipur city.Design/methodology/approach – The subjects were selected using the purposive sampling method. The subjects were divided into two groups: Group A (n=67) included subjects suffering from frank disease of CHD and were hospitalized for treatment at the time of the study. Group B (n=150) included businessmen with no history of CHD. A detailed standardized pretested and pre‐coded interview schedule was used to elicit information on knowledge, attitude and practices of subjects regarding diet and lifestyle‐related risk factors in CHD patients and businessmen from the normal population.Findings – The major findings of the study suggest that there was a relationship between knowledge and attitudes of subjects for diet and life style‐related risk factors for CHD at p > 0.05. Diet and life style‐related practi...

PurposeThe purpose of this paper is to analyze changes in knowledge, attitudes and practices (KAP) regarding diet and life style related risk factors among male and female coronary artery disease (CAD) patients (30‐60 yrs), in Jaipur city.Design/methodology/approachAll willing patients under medical supervision for CAD were included. A detailed pre‐tested and standardized interview schedule was used to elicit required information. In total, 100 subjects were assessed for KAP. Retrospective data were recorded for the information on KAP prior to the incidence of the disease.FindingsThe major findings revealed that there was a significant change in knowledge, attitudes and practices before and after the incidence of CAD. Knowledge and attitudes were found to have a strong association. Close association was statistically established between knowledge and smoking practice for male subjects and between attitudes and weight loss for female patients. No association could be established for other attributes.Originality/valueThe study explores the effect of CAD on the knowledge, attitude and practices of the patients regarding diet and life style related risk factors. It also observes and compares the data for prior to the frank expression of the disease and after the disease.

Clinical immunolocalization has been attempted by others with an anti-Thomsen-Friedenreich antigen (TF-Ag) mAb that bound both alpha- and beta-linked TF-Ag. In this report, 124 I-labeled mAb JAA-F11 specific for alpha-linked TF-Ag showed higher tumor specificity in in vivo micro-positron emission tomography (micro-PET) of the mouse mammary adenocarcinoma line, 4T1, showing no preferential uptake by the kidney. Labeled product remained localized in the tumor for at least 20 days. Glycan array analysis showed structural specificity of the antibody.

Use of portable pumps is increasing to achieve intensive insulin treatment. Beside unpredictable insulin absorption and insufficient reactivity to changes of insulin flow rate due to the subcutaneous route, this therapy is however limited by the lack of information on blood glucose level provided by self-blood glucose monitoring. Some studies have found that even those patients who intensively manage their disease – measuring their glucose an average of nine times a day – spent less than 30% of the day in normal glucose range. The rest of the time, their glucose was either too high (which can lead to complications including eye, heart, kidney, and nerve disease), or too low (which can cause seizures, comas, and death). But studies have also found that patients with access to real-time glucose levels spent 26% more time in normal glucose range, and have statistically significant improvements in HbA1c levels, an important measure of longer-term glucose control. Still under investigation, implantable glucose sensors should be able to insure vigilance towards the risk of hypo- and hyperglycemia.

Anemia is a frequent problem in both the primary and secondary health care programs. In contrast, most areas of northeast India are vulnerable to iron toxicity. In the present study, we documented the effect of administration of iron rich water on hemolytic anemia in a Wistar rats' animal model. Hemolytic anemia was induced by phenyl hydrazine through intraperitoneal route and diagnosed by the lowering of blood hemoglobin. After inducing the hemolytic anemia, 24 Wistar rats (n = 6 in four groups) were randomly assigned to 1 mg/l, 5 mg/l, and 10 mg/l ferric oxide iron along with 1 mg/ml ascorbic acid administered through drinking water; a control group was treated with iron-free water. The hematological and biochemical parameters, iron levels in liver, spleen, and kidney were estimated after 30 d of treatment. In the group treated with 5 mg/l iron and ascorbic acid, a significant increase of serum iron and ferritin, and a decrease of TIBC (total iron binding capacity) were observed without changes in other biochemical parameters and histopathological findings. However, in the group treated with 10 mg/l iron and ascorbic acid, hematological changes with significantly higher values for white blood cell count, serum glutamic phospho transaminase, serum glutamic oxaloacetic transaminase, alkaline phosphatase, glucose, splenic, and liver iron content, indicate potential toxicity at this supplementation level. Data suggest that the optimum concentration of iron (5 mg/l) and ascorbic acid solution may improve anemic conditions and may be therapeutically beneficial in the treatment of iron deficiency anemia without any negative impact, while 10 mg/l in drinking water seems to be the threshold for the initiation of toxicity.

Keratoconus is a mysterious disease of cornea with diverse genetic complexity. Past 160 years of molecular genetics revolution has witnessed the identification of candidate genes with multiple loci through genome-wide association studies (GWAS). This article provides key insight into the genetics of keratoconus along with diagnosis, treatment and management. Key Concepts: Keratoconus is a noninflammatory corneal progressive ectasia that is bilateral and asymmetric, characterised by steepening and deformation of the cornea, thinning of the apical cornea and corneal scarring. Patients with moderate keratoconus are observed with Fleischer ring around the cone base due to an accumulation of iron deposits. Also Vogt striae, which are fine vertical lines due to compression of Descemet membrane, can be seen. In keratoconus, the cornea's normal defence system is lost and leads to accumulation of free radicals in the tissue, which can cause structural damage. Monozygotic twins have higher concordance of keratoconus than dizygotic twins, which is shown by their phenotypic similarity. This type of evaluation can be made in situations where a clinical sign does not show a genetic pattern. As far as the age groups that get afflicted with the disease are concerned, the keratoconus-affected individuals between 30–40 years of age are higher than the other groups. Approximately 17 genomic loci have been described from 12 studies based on linkage analysis. This propounds at large the genetic disparities in keratoconus. Further, these studies make possible to consider the mutational effects in different genes that are responsible for the disease. Visual System Homeobox 1 (VSX1) is the most widely reported gene for keratoconus. This gene codes for a transcription factor that helps in ocular development and development of cornea. Mutations in the locus of this gene are reported to be pathogenic and are positive in keratoconus patients. Early signs for diagnosing include irregularity of reflex observed by retinoscopy, distortion of the corneal reflection observed by keratometry and conical contour revealed by the fit of a corneal lens. Nowadays, surgical procedures to selectively replace either the anterior or the posterior layer are used. Keratoplasty is employed to remove the damaged cornea. The distorted cornea is replaced entirely or partially by graft. Entire removal of the keratoconic cornea is called penetrating keratoplasty, whereas if a part of the cornea is removed, it is called lamellar keratoplasty. Keywords: keratoconus; cornea; mutations; GWAS; VSX1

Pregnancy malaria is caused by Plasmodium falciparum-infected erythrocytes that adhere to the placental receptor chondroitin sulfate A (CSA) and sequester in the placenta; women become resistant to pregnancy malaria as they acquire antiadhesion antibodies that target surface proteins of placental parasites. VAR2CSA, a member of the P. falciparum EMP1 variant surface antigen family, is the leading candidate for a pregnancy malaria vaccine. Because VAR2CSA is a high-molecular-weight protein, a vaccine based on the full-length protein may not be feasible. An alternative approach has been to develop a vaccine targeting individual Duffy binding-like (DBL) domains. In this study, a consortium of laboratories under the Pregnancy Malaria Initiative compared the functional activity of antiadhesion antibodies elicited by different VAR2CSA domains and variants produced in prokaryotic and eukaryotic expression systems. Antisera were initially tested against laboratory lines of maternal parasites, and the most promising reagents were evaluated in the field against fresh placental parasite samples. Recombinant proteins expressed in Escherichia coli elicited antibody levels similar to those expressed in eukaryotic systems, as did the two allelic forms of the DBL4 and DBL5 domains. The procedures developed for this head-to-head comparison will be useful for future evaluation and down-selection of malaria vaccine immunogens. Fil: Fried, Michal. Seattle Biomedical Research Institute; Estados Unidos. Public Health Service. National Institute Of Health; Estados Unidos Fil: Avril, Marion. Seattle Biomedical Research Institute; Estados Unidos Fil: Chaturvedi, Richa. Seattle Biomedical Research Institute; Estados Unidos Fil: Fernandez, Pablo Mariano. Instituto Pasteur; Francia. Centre National de la Recherche Scientifique; Francia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Inmunología, Genética y Metabolismo; Argentina Fil: Lograsso, Joseph. Seattle Biomedical Research Institute; Estados Unidos Fil: Narum, David. Public Health Service. National Institute Of Health; Estados Unidos Fil: Nielsen, Morten A.. Universidad de Copenhagen; Dinamarca Fil: Oleinikov, Andrew V.. Seattle Biomedical Research Institute; Estados Unidos Fil: Resende, Mafalda. Universidad de Copenhagen; Dinamarca Fil: Salanti, Ali. Universidad de Copenhagen; Dinamarca Fil: Saveria, Tracy. Seattle Biomedical Research Institute; Estados Unidos Fil: Williamson, Kathryn. Seattle Biomedical Research Institute; Estados Unidos Fil: Dicko, Alassane. University of Bamako; Malí Fil: Scherf, Artur. Instituto Pasteur; Francia. Centre National de la Recherche Scientifique; Francia Fil: Smith, Joseph D.. Seattle Biomedical Research Institute; Estados Unidos Fil: Theander, Thor G. . Universidad de Copenhagen; Dinamarca Fil: Duffy, Patrick E.. Seattle Biomedical Research Institute; Estados Unidos. Public Health Service. National Institute Of Health; Estados Unidos

A 9-year-old boy presented with short stature and progressive genu valgum (figure 1). He had frontal bossing, rachitic rosary and widening of wrist. X-Rays of the wrist (figure 2) and knee joint (figure 3) showed cupping, fraying and widening of metaphyses. Laboratory investigations showed serum calcium 9.4 mg/dl, phosphorus 2.2 mg/dl, chloride 105 mmol/l, potassium 3.0 mmol/l, alkaline phosphatase 1004 IU/l, and albumin 4.1 g/dl. 24-Hour urinary calcium excretion was 302 mg. Intact parathyroid hormone (iPTH) level was 50 pg/ml. Blood pH was 7.32 and urine pH 8.0. Intravenous pyelogram was normal. A longitudinal ultrasound scan of the kidneys is shown in figure 4. A test was done to confirm the diagnosis. Figure 1 The patient (reproduced with his father's permission) Figure 2 X-Ray of the wrist Figure 3 X-Ray of the knee joint Figure 4 Longitudinal ultrasound scan of kidney 1 : What does the abdominal ultrasound show? 2 : What is the most likely diagnosis? 3 : Name the test for confirmation of diagnosis. 4 : How should this patient be managed? ### QUESTION 1 The ultrasound scan of the kidneys shows hyperechoic renal pyramids with normal echotexture of …