To compare the mean Likert (caregiver impression of change) and CAPUTE scores in children with ITS treated with daily injectable vitamin B12 alone versus injectable vitamin B12 with other multinutrients at 1 wk and 1 mo of therapy.
This was an open-label, active-controlled, assessor-blinded, noninferiority, randomized clinical trial. The participants included children aged 3 mo to 2 y with infantile tremor syndrome. Children were randomized to receive either 1 mg of daily injectable vitamin B12 or 1 mg of daily injectable vitamin B12 with other multinutrients (B12 + MV). Primary outcome measure was the mean Likert score in the two arms at 1 wk. Secondary outcome measures were mean change in CAPUTE scores at 1 wk of therapy; and mean change in CAPUTE and Vineland Social Maturity Scale (VSMS) scores after 1 mo of treatment.
Seventy-two (N = 72) of the 160 screened were enrolled and randomized. The mean (SD) Likert score in the B12 group (n = 38) was 16.1 (3.7) and in the B12 + MV group (n = 34) was 14.9 (3.7); p = 0.237. Mean (SD) change in CAPUTE (CAT/CLAMS) at 1 mo in the groups was not statistically different. The mean (SD) change in social quotient in the B12 monotherapy group, 35.0 (20.7) was significantly higher than the B12 + multinutrient group 23.5 (15.4); p=0.01.
Injectable vitamin B12 monotherapy in ITS resulted in an improvement that was noninferior to combination multinutrient therapy, strongly supporting vitamin B12 deficiency as the cause of infantile tremor syndrome.
The trial was registered at CTRI.org (CTRI/2018/05/013841).

The importance of health policy implementation cannot be overemphasized in contemporary public health. Neglected Tropical Diseases (NTDs) have negatively impacted society, affect quality of life and make the poor societies poorer. Several policies and strategies have been put in place across the world including the neglected tropical diseases programme in Ghana. Though chalked many successes, the programme continues to lag behind in the full attainment of various objectives. Several factors exist that determine how effective a programme is implemented. Identification of these factors on every programme is essential to determine where more programme resources need to be channelled. This study assessed the determinants of successful implementation of the neglected tropical diseases programme in Ghana.
A qualitative approach with the case study design was employed. Purposive and snowball sampling techniques were used to identify key programme officers at the national, regional and district levels of programme implementation. Eighteen (18) Key informant interviews were conducted at all the three levels of the Ghana Health Service NTDs programme. Data were thematically analysed and presented.
Findings from the study revealed that determinants that influenced the successful implementation of the NTDs programme include donor support, education and training, partnerships, reliability of the health structure, integrative nature of the programme and management commitment. These determining factors cut across the inner settings of the implementing agency and the external environment.
Neglected tropical diseases continuously affect Ghanaians, especially the poor. It is important for both policy makers and implementers to identify the factors that ensure the success of the programme in the Ghanaian context. Though the factors are independently sufficient, they synergistically lead to improved programme implementation. Empowering all units involved (local to national level) and maximizing the enabling factors identified to would improve upon implementation and ensure sustainability.

Plant architecture strongly influences ecological performance, yet its role in plant evolution has not been explored in depth. By testing both phylogenetic and environmental signals, it is possible to separate architectural traits into four categories: development constraints (phylogenetic signal only); convergences (environmental dependency only); key confluences to the environmental driver (both); unknown (neither). We analysed the evolutionary history of the genus Euphorbia, a model clade with both high architectural diversity and a wide environmental range. We conducted comparative analyses of 193 Euphorbia species world-wide using 73 architectural traits, a dated phylogeny, and climate data. We identified 14 architectural types in Euphorbia based on trait combinations. We found 22 traits and three types representing convergences under climate groups, 21 traits and four types showing phylogenetic signal but no relation to climate, and 16 traits and five types with both climate and phylogenetic signals. Major drivers of architectural trait evolution likely include water stress in deserts (selected for succulence, continuous branching), frost disturbance in temperate systems (selected for simple, prostrate, short-lived shoots) and light competition (selected for arborescence). Simple architectures allowed resilience to disturbance, and frequent transitions into new forms. Complex architectures with functional specialisation developed under stable climates but have low evolvability.

The study was performed to compare real-time PCR after nucleic acid extraction directly from stool samples as well as from samples stored and transported on Whatman papers or flocked swabs at ambient temperature in the tropics. In addition, the possible suitability for a clear determination of likely aetiological relevance of PCR-based pathogen detections based on cycle threshold (Ct) values was assessed. From 632 Tanzanian children <5 years of age with and without gastrointestinal symptoms, 466 samples were subjected to nucleic acid extraction and real-time PCR for gastrointestinal viral, bacterial and protozoan pathogens. Equal or even higher frequencies of pathogen detections from Whatman papers or flocked swabs were achieved compared with nucleic acid extraction directly from stool samples. Comparison of the Ct values showed no significant difference according to the nucleic acid extraction strategy. Also, the Ct values did not allow a decision whether a detected pathogen was associated with gastrointestinal symptoms.

Early diagnosis of dengue is important to ensure proper management of patients and effective implementation of control measures. The present study was undertaken to determine the outcome of the implementation of dengue NS1-antigen (Ag) rapid diagnostic test (RDT) in the confirmation of dengue at the first patient hospital visit at the University Malaya Medical Centre. A total of 1036 and 1097 sera from the year 2008 and 2015 were used, representing samples from before and after dengue NS1-Ag RDT was implemented as routine diagnostic at the hospital. Results showed that similar dengue confirmation percentage (56%) was made in 2008 and 2015, regardless of the main laboratory diagnostic method used. Confirmation of dengue, however, increased to 68% and 73% when dengue NS1-Ag test or dengue immunoglobulin M-capture enzyme-linked immunosorbent assay was used as the second test for the 2008 and 2015 samples, respectively. Detection of dengue virus (DENV) using multiplex reverse transcription-polymerase chain reaction (RT-PCR) showed that DENV-1 was the highest in circulation in 2008 and that both DENV-1 and DENV-2 were dominant in 2015. In summary, the present study demonstrated that the introduction and use of the dengue NS1-Ag RDT did not change or compromise confirmation of dengue, highlighting the advantage of using the method. With the reducing cost of molecular detection tools, DENV detection using RT-PCR remains a viable option for further confirmation of dengue in hospital settings.

Colonies of leaf-cutting ants of the genus Atta need to collect large quantities of vegetal substrate in their environment to ensure their growth. They do so by building and extending over time a foraging network that consists of several underground tunnels extending above ground by physical trails. This paper presents a longitudinal study of the foraging network of two mature colonies of the grass-cutting ant Atta capiguara (Gonçalves) located in a pasture in central Brazil. Specifically, we investigated whether the extension of the foraging area of the colonies required to reach new resources occurs by building new and longer underground tunnels or by building new and longer physical trails. Each nest was surveyed at intervals of approximately 15 days during 1 year. At each survey we mapped the position of the tunnel entrances and foraging trails at which activity was observed. In addition, we assessed the excavation effort of the colonies since the last survey by the number and distance to the nest of new tunnel entrances, and the physical trail construction effort by the number and length of newly built physical trails. Our study reveals that in A. capiguara the collection of new resources around the nest required to ensure the continuous growth of the colonies is achieved mainly through the excavation of new underground tunnels, opening at greater distance from the nest, not through the building of longer aboveground physical trails.

To prospectively evaluate whether time to debridement has any correlation with union, infection, and quality of life in high-grade lower limb fractures in a tropical setting.
A prospective cohort study was conducted at a tertiary care center in South India. Two hundred fifty-four adult skeletally mature patients with 301 grade 3 fractures involving the femur, tibia, or fibula were recruited. The cohort was empirically divided into two groups (early and late) based on the time to debridement (less than or more than 12 h from injury).
The primary outcome was nonunion. Secondary outcomes were deep infection rates and patients\' quality of life. Short form-36 (SF-36) and short musculoskeletal functional assessment (SMFA) questionnaires were also used. Patients were followed up for 9 months.
The follow-up rate was 93%. The late group had a significantly higher risk of nonunion (odds ratio(OR): 6.5, 95% confidence interval (CI): 2.82-14.95) and infections (OR: 6.05, 95% CI: 2.85-12.82). There was a 4% increase in the infection risk for each hour of delay for the initial 50 h (p < 0.0001). SF-36 and SMFA scores were superior in the early group (p < 0.0001).
The study contradicts findings reported in the literature from the West. Our study was in agreement with our hypothesis and proved that debridement within 12 h resulted in significantly lower rates of nonunion and infections and an overall improved quality of life in high-grade open lower limb fractures in a developing country.
Level II.
German Clinical Trials Register DRKS00015186.

BACKGROUND: Effect of seasonality on acne and acne flare has varied interpretations depending on the geographical area of study. In tropical areas, factors like high temperature and humidity may cause acne flares.
OBJECTIVE: To assess the seasonal variation of acne in patients and to correlate it with the monthly temperature and humidity over a period of 1 year.
METHODS: A cross-sectional study of acne patients was conducted for one year. The patient\'s acne was graded. Patients were specifically questioned about aggravation, improvement, or no change in their acne with respect to the seasons. The mean temperature and humidity of each month in Delhi were compared with grade of acne. This variation in acne was correlated with the temperature and humidity. A P-value < 0.05 was considered as statistically significant.
RESULTS: Out of 171 patients, 82 (47.95%) patients reported seasonal variation in their acne. Among them, 69 patients (40.4%) reported aggravation in summer. Eleven (6.42%) and 2 (1.16%) patients reported aggravation in winter and rainy season, respectively. The aggravation in summer as compared to rainy and winter season was statistically significant. The mean temperature and mean humidity significantly varied with seasonal aggravation of acne.
CONCLUSIONS: Both temperature and humidity have a contributing role in pathogenesis of acne and are causes of acne flare. In our study, aggravation of acne was more in summer and rainy season.

Understanding the baseline geochemistry of stream waters in a prospective mining area is the key to responsible life-of-mine planning and the protection of local rivers. This can be sometimes challenging due to the presence of abandoned mines, small scale mining, and geogenic sources of metals in the same area, particularly under a tropical humid climates with rivers carrying intermittently high solid loads. This study is focused on the Pula Bato, Danlag, Altayan, and Taplan Rivers in such a climatic setting in Philippines. The rivers are located in the vicinity of the Tampakan ore deposit. It was observed that elemental concentrations in water samples from Pula Bato were generally higher when compared to concentrations from Danlag, Taplan, and Altayan samples. In particular, SO42-, TDS, Al, Cu, Fe, Mn, Ni, and Zn present considerably higher concentrations in the water samples from Pula Bato. It was shown that water quality of Pula Bato is influenced by the natural weathering of sulphide minerals which is further enhanced by the small scale mining activities and old underground workings. The mining effects on the water of Pula Bato River were not apparent in the water of the Altayan due to the possible dilution of the uncontaminated water from Danlag River and sorption processes occurring during the course of contaminants transport. The geochemical indicators and water distinctions can be used in future for catchment-scale geochemical balance modelling.