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Rhabdomyosarcoma (RMS) is a rare soft-tissue tumor, accounting for 3% of all childhood cancers. RMS can arise virtually anywhere in the body, as it originates from the embryonal mesenchyme. Embryonal RMS (ERMS) and alveolar RMS are the most prevalent types. In this case series, five children with unusual sites of presentation of ERMS have been reported. The first case is a 6-year-old male who presented with episodes of recurrent hemoptysis for 2 months and computed tomography chest showed lung mass. The second case is a 3-year-old male, who presented with right abdominal distention and was diagnosed as a liver ERMS which is a very rare site for RMS. The third case is a 1-year-old male child who presented with isolated right inguinal lymph node swelling. The fourth case presented with recurrent admissions for respiratory distress requiring intubation and was misdiagnosed as recurrent viral infection, but on further, investigation was diagnosed as a laryngeal ERMS. Our fifth case is a 6-year-old male child who presented with infraumbilical mass, diagnosed as a retroperitoneal ERMS. The 5-year survival rate of such tumors is 70% in children with localized disease who receive combined-modality therapy. Therefore, an awareness of the typical signs and symptoms, radiological features, and histomorphological features in a case of pediatric RMS can help a physician to consider this tumors in the differential diagnoses, even at unusual sites.

Objectives: Acute Lymphoblastic Leukemia (ALL) in children presents with varied manifestations. At times, they may mimic symptoms and signs of Systemic onset Juvenile Idiopathic Arthritis (SoJIA). We analyzed children with ALL who were initially diagnosed as SoJIA thus leading to delay in diagnosis and treatment of ALL. Material and Methods: Retrospective study of records of 18 children diagnosed as ALL at our center between the period of January 2016 and December 2020, and who were initially diagnosed as SoJIA. Results: All 18 children presented with fever and joint pains involving large joints such as knee, ankle, wrist, and elbow. Seven (38.8%) cases had associated hepatosplenomegaly and three (16%) had lymphadenopathy at the time of presentation. Ten out of 18 children (55.6%) had normal peripheral complete blood counts. The duration from the time of onset of symptoms to diagnosis of ALL ranged from 15 days to 7 months in these cases. Four children had received steroids as treatment of SoJIA before they were diagnosed with ALL. Conclusion: Possibility of ALL must be ruled out in all cases suspected of having SoJIA, as leukemias may not always present with typical signs like hepatosplenomegaly, lymphadenopathy, or cytopenias. It will prevent delay in diagnosis and treatment of ALL. Administration of steroids to these patients for SoJIA, adversely affects post-ALL treatment outcomes.

Institutions affect environmental quality by enabling economic growth, supporting environmental protection policies, and regulating industries. In this paper, we empirically examine the impact of institutions on carbon emissions. Using the Generalized Methods of Moments and an unbalanced panel of 120 countries from 1984 to 2016, we examine the impact of institutional integrity on per capita carbon emissions and carbon intensity of energy use. We also explore the heterogeneous effect of institutions on carbon emissions across income groups and regions. Lastly, we examine the impact of disaggregated institutional quality factors on carbon emissions. Our results confirm the presence of the Environmental Kuznets Curve in the models with and without institutions. However, the marginal effect of GDP per capita on carbon emissions is lower in the models that account for institutional integrity than the models that do not. Therefore, carbon policies should account for economic growth as well as institutional contexts. The results also show that although the combined institutional integrity is an important determinant of carbon emissions, individual institutional factors in isolation have minor effects.

Papillary endothelial hyperplasia (PEH) is a reactive pseudoneoplastic proliferation of endothelial cells. They are typically well-circumscribed, indolent lesions and curable by complete excision. ...

This study empirically examines the outcomes of two solar energy amendments that were on the ballot in Florida in 2016. One amendment exempts solar energy devices from ad valorem taxation, effectiv...

Agriculture in South Asia is vulnerable to climate change. Therefore, adaptation measures are required to sustain agricultural productivity, to reduce vulnerability, and to enhance the resilience of the agricultural system to climate change. There are many adaptation practices in the production systems that have been proposed and tested for minimizing the effects of climate change. Some socioeconomic and political setup contributes to adaptation, while others may inhibit it. This paper presents a systematic review of the impacts of climate change on crop production and also the major options in the agricultural sector that are available for adaptation to climate change. One of the key conclusions is that agricultural practices that help climate change adaptation in agriculture are available, while the institutional setup to implement and disseminate those technical solutions is yet to be strengthened. Thus, it is important to examine how to bring the required institutional change, generate fund to invest on these changes, and design dynamic policies for long-term climate change adaptation in agriculture rather than a mere focus on agricultural technology. This is one of the areas where South Asian climate policies require reconsidering to avoid possible maladaptation in the long run.

Agriculture in South Asia is highly vulnerable to climate change due to increasing variability in rainfall and rising temperatures leading to the incidence of extreme climatic events such as floods, droughts, heat/cold waves, and storms. Agriculture sector also contributes to the causes of climate change through the emission of greenhouse gasses (GHGs). Hence, adaptation-led mitigation measures are required to sustain agricultural productivity, farm income and reduce GHG emissions wherever possible. This study presents a systematic review of agriculture emission reduction opportunities with a particular focus on agricultural production systems in South Asia. Our review indicates that the adoption of better soil, water, nutrient management practices, and technologies has enormous potential to reduce GHG emissions from agriculture, thereby contributing to the mitigation of climate change. Many existing practices and technologies have the potential to improve both adaptation and mitigation in agriculture which can significantly contribute to complying with nationally determined contributions (NDCs) of South Asian countries. However, barriers to the adoption of GHG mitigating agricultural practices, mainly the financial and institutional barriers, need to be appropriately addressed to achieve the desired level of mitigation.

Increased participation of women in the agricultural technology adoption decision by farm households is one of the key indicators of gender empowerment in the agricultural sector. This study examines whether women’s participation in the household decision to adopt agricultural technology affects the adoption of climate‐smart agriculture (CSA), using data collected from 1,267 farm households from two Indian states of Bihar and Haryana. When we considered the sex of the household head (using a dummy variable for male‐headed vs female‐headed household) as a basis of analyzing the role of gender in the adoption of CSA, we found that women in Haryana had no role in the adoption of CSA. On the contrary, when we considered women’s participation in technology adoption decisions as a basis of gender analysis, we found that women’s participation in technology adoption decisions in Haryana is much higher as compared to Bihar. Consequently, the likelihood to adopt CSA is higher in Haryana than in Bihar. We also found that wealth, training, and access to extension and market positively influenced CSA adoption. Qualitative analysis shows that women farmers prioritize family food security rather than farm income, and therefore, they are more likely to focus on CSA to ensure food security.

Babies with ABO incompatibility are often advised frequent biochemical screening and prolonged hospital stay. Our primary objective of the study was to compare serum bilirubin levels at 48 h and 96 h of age in neonates with and without ABO incompatibility. Our prospective study included neonates with gestation ≥ 34 weeks, with or without ABO incompatibility (92 in each group). A direct Coombs test was performed on cord blood. The mean serum bilirubin and haematocrit levels in both groups at 48 h and 96 h were comparable. The mean reticulocyte count of babies with ABO incompatibility was, however, significantly higher. Late preterm and term neonates with and without ABO incompatibility have similar bilirubin levels and no increased risk of significant hyperbilirubinemia. Prolonged hospitalisation of these neonates appears to be unnecessary.

To assess the efficacy of temporal artery thermometer in febrile and hypothermic neonates in comparison to axillary thermometer. It was a cross sectional observational study. Study participants included 210 neonates admitted in neonatal intensive care unit of a tertiary care teaching hospital, divided into three groups of 70 each, namely normothermic, febrile and hypothermic. Temperatures were measured using temporal artery, axillary and rectal thermometers in each patient. Mean rectal temperature was found to be comparable to mean temporal artery temperature in normothermic babies. Temporal artery thermometer had a better sensitivity to diagnose fever, than hypothermia. Also, temporal artery temperature showed a good correlation with rectal temperature in normothermic and febrile group and not in hypothermic neonates. Temporal artery thermometer can accurately detect temperature in febrile and normothermic fullterm neonates but not in hypothermic neonates. Further studies are required before advocating temporal artery thermometry as a replacement of rectal thermometry among this group of population.

A female neonate presented with progressive abdominal distension. Liver was palpable, 11 cm below costal margin and a spleen of 10 cm. USG abdomen revealed massive hepatomegaly with multiple nodules in liver, kidney size and texture being normal. Contrast enhanced CT scan of the abdomen was suggestive of enlarged multinodular liver with splenomegaly. Liver biopsy revealed replacement of liver architecture by small rounded cells, which were positive for synaptophysin and S100 stains suggestive of neuroblastoma. A repeat abdominal radiological evaluation revealed a small 2 x 1 cm mass in left suprarenal area. Neuroblastoma stage 4S presenting as hepatomegaly is rare.