Can social enterprises aid sustainable development? Evidence from multi-stage investigations.

BACKGROUND: Social enterprises must balance between profitability and sustainability. The impetus on sustainability grew further after the adaption of the SDG agenda by the United Nations (UN). OBJECTIVE: This paper examines the role of social enterprises in helping attain sustainable development goals in India. RESEARCH DESIGN: This multi-stage paper comprises three studies directed at scale development, scale refinement, pre-testing, and construct validity. The scale development stage is conducted through a combination of extensive literature review and focused group discussions. Expert discussions and item-reduction techniques have been used in the second stage aimed at scale refinement and pre-testing. The third stage of testing construct validity is carried out through Partial Least Square-Structural Equation Modelling (PLS-SEM). RESULTS: The findings suggest that all the competencies of social enterprises identified in the study i.e. social mission, collaborative networks, innovation, financial viability and level of scalability significantly impact sustainable development. CONCLUSION: Because the goals of social enterprises and the Sustainable Development Goals (SDGs) are mutually reinforcing and complementary, the study suggests that social enterprises have a lot of potential for achieving the SDGs. The study also suggests future research directions and policy implications that can be replicated in other countries.

Post COVID fatigue: Can we really ignore it?

Long-COVID, also referred to as post-acute COVID-19, chronic COVID-19, post-COVID syndrome, or post-acute sequelae of SARS-CoV-2 infection (PASC), generally refers to symptoms that develop during or after acute COVID-19 illness, continue for ≥12 weeks, and are not explained by an alternative diagnosis. It is not yet known whether "long-COVID" represents a new syndrome unique to COVID-19 or overlaps with recovery from similar illnesses. It's difficult for physicians to predict when symptoms will improve as it varies differently in different people. Patient's recovery depends on various factors including age, associated comorbidities, severity of COVID-19 infection. Some symptoms, like fatigue, might continue even while others improve or go away. This review addresses the pathogenesis, presentation of post covid fatigue, its severity and its management.

Meteorological factors, COVID-19 cases, and deaths in top 10 most affected countries: an econometric investigation.

This paper examines the nexus between the Covid-19 confirmed cases, deaths, meteorological factors, including an air pollutant among the world's top 10 infected countries, from 1 February 2020 through 30 June 2020, using advanced econometric techniques to address heterogeneity across the nations. The findings of the study suggest that there exists a strong cross-sectional dependence between Covid-19 cases, deaths, and all the meteorological factors for the countries under study. The findings also reveal that a long-term relationship exists between all the meteorological factors. There exists a bi-directional causality running between the Covid-19 cases and all the meteorological factors. With Covid-19 death cases as the dependent variable, there exists bi-directional causality running between the Covid-19 death cases and Covid-19 confirmed cases, air pressure, humidity, and temperature. Temperature and air pressure exhibit a statistically significant and negative impact on the Covid-19 confirmed cases. Air pollutant PM2.5 also exhibits a significant but positive impact on the Covid-19 confirmed cases. Temperature indicates a statistically significant and negative impact on the Covid-19 death cases. At the same time, Covid-19 confirmed cases and air pollutant PM2.5 exhibit a statistically significant and positive impact on the Covid-19 death cases across the ten countries under study. Hence, it is possible to postulate that cool and dry weather conditions with lower temperatures may promote indoor activities and human gatherings (assembling), leading to virus transmission. This study contributes both practically and theoretically to the concerned field of pandemic management. Our results assist in taking appropriate measures in implementing intersectoral policies and actions as necessary in a timely and efficient manner. Causal relations of Meteorological factors and Covid-19 (2 models used in the study).

Nexus between environmental, social and economic development in South Asia: evidence from econometric models.

This study investigates the impact of various economic, social and environmental indicators on economic growth in South Asian countries. Using the data throughout 1990-2017, a panel data estimation method is adopted with sophisticated econometric approaches. The obtained results indicate a long-term positive effect of biological capacity, financial development, human development index, income inequality on economic growth while the effect of energy use is the opposite. The findings of the study suggest that governments and associated bodies must promote financial development, human development, and biocapacity to not only attain economic growth in the long-run and but dissuade ecological footprint, and income inequality at the same time while matching the energy consumption with the bio-capacity of each economy.

Effect of a low-dose dexmedetomidine infusion on intraoperative hemodynamics, anesthetic requirements and recovery profile in patients undergoing lumbar spine surgery.

BACKGROUND AND AIMS: Dexmedetomidine has been used as an anesthetic adjuvant; however, hypotension is a concern especially in prone patients. The aim of the study was to evaluate the effect of a low-dose dexmedetomidine infusion on intraoperative hemodynamics, blood loss, anesthetic requirements, and recovery profile in patients undergoing lumbar spine surgery in the prone position. MATERIAL AND METHODS: The study was conducted in a randomized double-blinded manner in 60 patients scheduled for one- or two-level lumbar laminectomy. After administration of general anesthesia, patients were placed in prone position and allocated to either of two groups of 30 patients each. Patients in Group A received dexmedetomidine infusion at the rate of 0.3 µg kg-1 hr-1, whereas, group B patients received a saline infusion. The depth of anesthesia was guided by Bispectral index (BIS) monitoring, maintaining BIS between 40 and 60. RESULTS: The demographic profile and duration of surgery in both groups were similar. Mean heart rate was statistically similar in both the groups. Mean blood pressure was lower in group A, though the difference was significant only for the initial 30 min. The mean end-tidal sevoflurane requirement in group A was significantly less than that in group B (P = 0.003). Patients in group A had better recovery profile with mean emergence, extubation, and recovery times of 8.08 ± 3.48 min, 9.37 ± 3.64 min, and 11.65 ± 4.03 min, respectively, as compared with 11.27 ± 3.05 min, 12.24 ± 2.39 min, and 14.90 ± 2.63 min, respectively, in group B (P < 0.001). Mean intraoperative blood loss in group A of 263.47 ± 58.66 mL was significantly lower than 347.67 ± 72.90 ml in group B (P = 0.0001). CONCLUSION: Group A patients had stable hemodynamic parameters, reduced intraoperative blood loss, less anesthetic requirement, and could be extubated earlier as compared with group B patients.

Primary Pulmonary Rhabdomyosarcoma in a Child.

A 9-year-old female presented with fever, cough, and hemoptysis for a week. The chest skiagram and contrast-enhanced computerized tomography delineated a well-defined solid lesion localized to the superior segment of the right lower lobe with features of a congenital pulmonary airway malformation. The lesion was surgically managed with a segmentectomy and histopathology confirmed a contained pulmonary rhabdomyosarcoma (RMS). No other primary site of origin was evident, and a final diagnosis of "primary" pulmonary RMS was made. She received adjuvant chemotherapy and was disease free after 6 years of surveillance. The unique clinicoradiological features of the case are discussed and the sparse literature is reviewed.

AMPKα2 Regulates Bladder Cancer Growth through SKP2-Mediated Degradation of p27.

AMP-activated protein kinase (AMPK) is the central metabolic regulator of the cell and controls energy consumption based upon nutrient availability. Due to its role in energy regulation, AMPK has been implicated as a barrier for cancer progression and is suppressed in multiple cancers. To examine whether AMPK regulates bladder cancer cell growth, HTB2 and HT1376 bladder cells were treated with an AMPK activator, 5-aminoimidazole-4-carboxamide ribonucleotide (AICAR). AICAR treatment reduced proliferation and induced the expression of p27Kip1 (CDKN1B), which was mediated through an mTOR-dependent mechanism. Interestingly, AMPKα2 knockdown resulted in reduced p27 levels, whereas AMPKα1 suppression did not. To further determine the exact mechanism by which AMPKa2 regulates p27, HTB2 and HT1376 cells were transduced with an shRNA targeting AMPKα2. Stable knockdown of AMPKα2 resulted in increased proliferation and decreased p27 protein. The reduced p27 protein was determined to be dependent upon SKP2. Additionally, loss of AMPKα2 in a xenograft and a chemical carcinogen model of bladder cancer resulted in larger tumors with less p27 protein and high SKP2 levels. Consistent with the regulation observed in the bladder cancer model systems, a comprehensive survey of human primary bladder cancer clinical specimens revealed low levels of AMPKα2 and p27 and high levels of SKP2. IMPLICATIONS: These results highlight the contribution of AMPKα2 as a mechanism for controlling bladder cancer growth by regulating proliferation through mTOR suppression and induction of p27 protein levels, thus indicating how AMPKα2 loss may contribute to tumorigenesis. Mol Cancer Res; 14(12); 1182-94. ©2016 AACR.

Tuberculous celiac axis lymphadenopathy mimicking cystic pancreatic neoplasm - a diagnostic dilemma.

Cystic pancreatic neoplasms are tumors with malignant potential treated surgically. Isolated tuberculosis of celiac lymph nodes is rare, treatment of this entity being non-surgical. Radiological appearances of cystic pancreatic neoplasm and tuberculous peripancreatic lymph nodal mass is similar and difficult to differentiate. Here we present a case of mass lesion in the region of pancreatic head mimicking cystic pancreatic neoplasm which was actually abdominal tuberculous lymphadenopathy proven by biopsy.

Pulmonary hemorrhage in Henoch-Schönlein purpura: case report and systematic review of the english literature.

BACKGROUND: Diffuse alveolar hemorrhage (DAH) is a rare complication of Henoch-Schönlein purpura (HSP) and data on its prevalence, management, and outcomes are scant. OBJECTIVES: To enable evidence-based management of DAH in HSP. METHODS: A case report and a systematic review were conducted of all reported cases of DAH complicating HSP in the English literature. RESULTS: DAH predominantly affects older male children and adults with HSP. The occurrence of DAH in HSP is rare and the reported prevalence ranged from 0.8% to 5%. DAH occurred variably after the diagnosis of HSP, ranging from 2 days to 18 years. Hemoptysis (75%), drop in hemoglobin (74%), and chest infiltrates (94%) were the most common clinical findings. Lung biopsy showed leukocytoclastic vasculitis with alveolar hemorrhage (69.2%) or only alveolar hemorrhage (31.8%) with variable IgA staining by immunofluorescence. DAH was frequently severe and 50% of the patients required mechanical ventilation. Cyclophosphamide and pulse methylprednisolone for DAH was associated with better outcomes, particularly in patients who were already receiving steroids at the time of DAH. Steroids and immunosuppressants were administered for a median duration of 9 and 4.5 months, respectively. Systemic recurrences (27.7%) and recurrences of DAH (8.3%) were frequent. DAH was associated with high mortality (27.6%) and morbidity (persistent urinary abnormalities, 12%; chronic renal failure, 9%; complications of therapy, 27%). CONCLUSIONS: DAH is a life-threatening complication in HSP. Current protocols use pulse methylprednisolone and cyclophosphamide for 6 months.

Atypical extragonadal germ cell tumors.

AIM: To review the experience with the diagnosis and management of extragonadal germ cell tumors (GCT) with a subset analysis of those with atypical features. MATERIALS AND METHODS: A retrospective chart review of patients of extragonadal germ cell tumors between 2000 and 2010 was carried out. RESULTS: Fifteen children aged 7 days to 15 years (median, 1.5 years) were included. Three had an antenatal diagnosis (one sacrococcygeal, one retrobulbar, one retroperitoneal tumor) and were operated in the neonatal period. The locations were distributed between the retrobulbar area (1), anterior neck-thyroid gland (1), mediastinum (4), abdominothoracic extending through the esophageal hiatus (1), retroperitoneal (4) and sacrococcygeal (4). On histological examination, five harbored immature elements while two were malignant; the latter children received postexcision adjuvant chemotherapy. There was no mortality. At a median follow-up of 4.5 years (6 months to 8 years), 14/15 have had an event-free survival. One immature mediastinal teratoma that recurred locally 7.5 years after the initial operation was excised and adjuvant chemotherapy instituted. CONCLUSIONS: Extragonadal GCTs in children are uncommon and occasionally present with atypical clinical, radiological and histological features resulting in diagnostic and therapeutic dilemmas.

Papillary thyroid carcinoma with nodular fasciitis-like stroma: a case report.

Papillary thyroid carcinoma (PTC) is the most frequently occurring malignant neoplasm of the thyroid gland and is known to have several morphologic variants. PTC with nodular fasciitis-like stroma (PTC-NFS) is one of the unusual variants of PTC, with only a few cases being reported in the literature. This neoplasm is characterized by extensive reactive stromal proliferation, which may occupy 60 to 80% of the tumor along with areas of a typical papillary carcinoma. We report a case of PTC-NFS and address the diagnostic difficulties posed by the condition's extensive reactive stromal proliferation. We also emphasize that when one encounters a fibroproliferative lesion of the thyroid, a diligent search should also be made for PTC to avoid diagnostic errors.

Cryptococcal lymphadenitis and immune reconstitution inflammatory syndrome: current considerations.

HIV-related immune reconstitution inflammatory syndrome (IRIS) is increasingly being recognized in regions with a high burden of opportunistic infections. We describe an unusual manifestation of IRIS- 'unmasking' cryptococcal lymphadenitis in a patient shortly after initiation of antiretroviral therapy. Epidemiology, clinical features and management of cryptococcal IRIS with reference to lymphadenitis presentation are briefly reviewed. Early and accurate diagnosis is essential for appropriate management. Standard antifungal therapy along with continuation of antiretroviral therapy is recommended. Cases with severe inflammation may benefit from anti-inflammatory drugs/corticosteroids. Unusual manifestations like lymphadenitis pose diagnostic difficulties in regions with a high prevalence of tubercular lymphadenitis.

Transition metal induced magnetism in smaller fullerenes (Cn for n≤36).

The magnetic properties of 3d transition metals (TM) encapsulated inside smaller fullerenes ranging from C20 to C36 have been investigated using spin polarized density functional theory. The TM impurities stabilize asymmetrically at an off-center position for n≥28. The total magnetic moment (MM) of TM@Cn complexes are largely contributed by TMs and a small amount of MM of 0.12-0.50 µB is induced on the cage carbon atoms. The 3d TM atoms interact with C atoms of C20 and C28 cage ferromagnetically (FM) except for Ni@C28 which shows antiferromagnetic (AFM) interaction. The magnetic interactions change from FM to AFM in C32 cage for Ti, V, Cr and Mn. The MM gets quenched in Ni@Cn for n≥32. The total MM of Mn@Cn does not show any change although the nature of magnetic interactions changes from FM to AFM at n=32. Ti and V are the only TMs which show positive cohesive energy in all fullerenes considered. The smallest fullerene which can encapsulate all 3d TM are Cn for n≥32, consistent with available experimental and theoretical results.

Congenital inclusion tumours in spinal dysraphism.

OBJECTIVE: To review the presentation, diagnosis and management of children with spinal dysraphism and CIT. METHODS: It is a retrospective review of 146 children of spina bifida over 9 years (2000-2008) and details the clinical course and outcome of seven with associated congenital inclusion tumors. RESULTS: 7/146 (4.7%) had spina bifida with CIT, 5 dermoid cysts and 2 mature teratoma. The diagnosis was missed by the primary physician even in the presence of a neurocutaneous marker. Spinal imaging with MRI was conclusive. All were managed with multilevel laminectomy, near total/total excision of the CIT and detethering of cord. Intramedullary involvement and established neurological deficits at presentation were associated with persistent deficits. CONCLUSION: Early detection and comprehensive management of CIT with spinal dysraphism ensures social fecourinary continence, preserves renal function, achieves ambulation and enables patients to lead an acceptable quality of life.

Structural, electronic, and vibrational properties of C(60-n)Nn (n = 1-12).

Ab initio investigation of structural, electronic and vibrational properties of nitrogen-doped fullerenes (C(60-n)Nn, for n = 1-12) has been performed using numerical atomic orbital density functional theory. We have obtained the ground-state structures for C(60-n)Nn for n = 1-12, which show higher stability with a single nitrogen in a pentagon and two nonadjacent nitrogen atoms in a hexagon. Nitrogen doping leads to structural deformation, with the diameter showing variation from (7.14 - 0.24) to (7.14 + 0.10) A. The average diameter of C(60-n)Nn shows a small decrease for n > or = 5, with a minimum value of 7.06 A for n = 12. The change in the average diameter signifies the volume contraction, which is also maximum for C48N12. The binding energy per atom is found to decrease as a function of the number of N atoms. The HOMO-LUMO gap is found to decrease with an increase in substitutional nitrogen atoms; however, no systematic pattern could be observed. The Mulliken charge analysis performed on all optimized geometries shows a charge transfer of -0.3 to -0.45 (or 0.3-0.45 electrons) from nitrogen to carbon atoms, resulting in nitrogen atoms behaving as electrophilic sites. The harmonic vibrational frequency analysis shows the absence of any imaginary mode. The vibrational frequencies are found to decrease with an increase in the number of nitrogen atoms in C(60-n)Nn. The results obtained are consistent with available theoretical and experimental results.

Catastrophic antiphospholipid antibody syndrome.

Antiphospholipid antibody syndrome (APS) is characterized by recurrent thrombosis with the presence of circulating antiphospholipid antibodies. A diagnosis of APS requires the presence of at least one clinical and one laboratory criteria (detection of aCL IgG or IgM antibodies or the presence of lupus anticoagulant on two or more consecutive occasions 6 weeks apart). A severe, rapidly progressive form characterized by clinical involvement of at least three different organ systems with histopathological evidence of small and large vessel occlusion is termed catastrophic antiphospholipid syndrome. Early recognition of APS is crucial since aggressive management can result in a favorable outcome. We present the case of a 12-year-old boy who presented with a devastating illness with multiple thrombotic episodes and rapidly progressive renal failure.

Hemihypertrophy, renal dysplasia and benign nephromegaly.

Hemihypertrophy is associated with malignant visceral abdominal neoplasms in childhood. Benign nephromegaly and nephroblastomas are both known to occur with hemihypertrophy; however, association with renal dysplasia has not previously reported. We describe an infant presenting with recurrent haematuria who had segmental hemihypertrophy, ipsilateral renal dysplasia and contralateral benign nephromegaly. Although debated, renal dysplasia may predispose to and predate malignant change. Rational management and optimal surveillance of renal dysplasia and benign nephromegaly in hemihypertrophy is discussed.

Intra-abdominal, crystal-storing histiocytosis due to clofazimine in a patient with lepromatous leprosy and concurrent carcinoma of the colon.

We report a case with abdominal complications of clofazimine treatment which included blackish discolouration of the lymph nodes, omentum and peritoneum. A 44-year-old female with lepromatous leprosy and a history of adverse reaction to clofazimine 2 years previously, presented with rectosigmoid junction adenocarcinoma. Laparotomy revealed an inoperable tumour with pigmentation of the bowel, serosa and peritoneum. A second operation had o be performed for transverse loop colostomy and a mesenteric lymph node biopsy sent for frozen section showed typical clofazimine crystals. Despite widespread use for many years in the treatment of leprosy, this drug is not known to be carcinogenic and this case provides no evidence for an association or link between its use and the patient's cancer. Apart from its use in leprosy, clofazimine may be used in the treatment of disseminated Mycobacterium avium-intracellulare infection, Buruli ulcer due to M. ulcerans and occasionally in other mycobacterial infections. An awareness of the rare side-effect described above may help in the clinical assessment and management of such cases, including the avoidance of unnecessary laparotomy.