Lack of Dependence of Indian Summer Monsoon Rainfall Extremes on Temperature: An Observational Evidence.

The intensification of precipitation extremes in a warming world has been reported on a global scale and is traditionally explained with the Clausius-Clapeyron (C-C) relation. The relationship is observed to be valid in mid-latitudes; however, the debate persists in tropical monsoon regions, with the extremes of the Indian Summer Monsoon Rainfall (ISMR) being a prime example. Here, we present a comprehensive study on the dependence of ISMR extremes on both the 2 m surface air temperature over India and on the sea surface temperature over the tropical Indian Ocean. Remarkably, the ISMR extremes exhibit no significant association with temperature at either spatial scale: neither aggregated over the entire India/Tropical Indian Ocean area nor at the grid levels. We find that the theoretical C-C relation overestimates the positive changes in precipitation extremes, which is also reflected in the Coupled Model Intercomparison Project 5 (CMIP5) simulations. We emphasize that the changing patterns of extremes over the Indian subcontinent need a scientific re-evaluation, which is possible due to availability of the unique long-term in-situ data. This can aid bias correction of model projections of extremes whose value for climate adaptation can hardly be overemphasized, especially for the developing tropical countries.

Indian Summer Monsoon Rainfall: Implications of Contrasting Trends in the Spatial Variability of Means and Extremes.

India's agricultural output, economy, and societal well-being are strappingly dependent on the stability of summer monsoon rainfall, its variability and extremes. Spatial aggregate of intensity and frequency of extreme rainfall events over Central India are significantly increasing, while at local scale they are spatially non-uniform with increasing spatial variability. The reasons behind such increase in spatial variability of extremes are poorly understood and the trends in mean monsoon rainfall have been greatly overlooked. Here, by using multi-decadal gridded daily rainfall data over entire India, we show that the trend in spatial variability of mean monsoon rainfall is decreasing as exactly opposite to that of extremes. The spatial variability of extremes is attributed to the spatial variability of the convective rainfall component. Contrarily, the decrease in spatial variability of the mean rainfall over India poses a pertinent research question on the applicability of large scale inter-basin water transfer by river inter-linking to address the spatial variability of available water in India. We found a significant decrease in the monsoon rainfall over major water surplus river basins in India. Hydrological simulations using a Variable Infiltration Capacity (VIC) model also revealed that the water yield in surplus river basins is decreasing but it is increasing in deficit basins. These findings contradict the traditional notion of dry areas becoming drier and wet areas becoming wetter in response to climate change in India. This result also calls for a re-evaluation of planning for river inter-linking to supply water from surplus to deficit river basins.

Eribulin mesylate in Indian patients: A single center experience.

BACKGROUND: Eribulin mesylate is the latest addition in the armamentarium of management of metastatic breast cancer (MBC) with a unique mechanism of action. Although the multicentric EMBRACE trial suggests significant overall survival benefit from this novel drug, its effectiveness in Indian population is yet to be evaluated. MATERIALS AND METHODS: Presented here is a single center experience of eight patients who were administered eribulin for MBC. Patients had received a median of 3 prior chemotherapies before eribulin administration. The median dose of eribulin therapy was 5 cycles (range: 2-6 cycles). RESULTS: The objective response rate was 75% (CR in one and PR in five out of eight patients). Response was seen across all subtypes of patients. Eribulin was well tolerated. No serious adverse events were reported. CONCLUSION: Eribulin conferred good response rates with satisfactory tolerability profile in Indian patients. Its use in earlier lines and in combination with other drugs may achieve deeper and longer responses.

Botulinum toxin for gastrointestinal disorders: therapy and mechanisms.

Botulinum toxin has gained widespread acceptance as a treatment option for various spastic gastrointestinal disorders such as achalasia, gastroparesis, sphincter of Oddi dysfunction, chronic anal fissures, and pelvic floor dyssnergia, despite the lack of strong evidence supporting its use in many of these diseases. This review summarizes the trials investigating the use of BoNT since it was first utilized as a treatment in achalasia. BoNT has proven to be safe, but long-term efficacy in many disorders has not been observed, primarily due to is relatively short duration of action. BoNT may be most useful in confirming a diagnosis which can lead to a more definitive treatment modality. Furthermore, its safety profile allows it to be a useful alternative in patients who are at high risk for invasive procedures.