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A 13-year-old adolescent boy presents to the emergency department with a chief complaint of sore throat and fever for 2 days. He reports that his younger sister has been ill for the past week with “the same thing.” The patient has pain with swallowing, but no change in voice, drooling, or neck stiffness. He denies any recent history of cough, rash, nausea, vomiting, or diarrhea. He denies any recent travel and has completed the full series of childhood immunizations. He has no other medical problems, takes no medications, and has no allergies. On examination, the patient has a temperature of 38.5°C (101.3°F), a heart rate of 104 beats per minute, blood pressure 118/64 mm Hg, a respiratory rate of 18 breaths per minute, and an oxygen saturation of 99% on room air. His posterior oropharynx reveals erythema with tonsillar exudates without uvular deviation, or significant tonsillar swelling. Neck examination is supple without tenderness of the anterior lymph nodes. Chest and cardiovascular

Zero Budget Natural Farming in India Introduction Zero Budget Natural Farming (ZBNF), which is a set of farming methods, and also a grassroots peasant movement, has spread to various states in India. It has attained wide success in southern India, especially the southern Indian state of Karnataka where it first evolved. A rough estimation for just Karnataka puts the figure there at around 100,000 farmer families1 , while at the national level, ZBNF leaders claim that numbers could run into millions. This has been achieved without any formal movement organization, paid staff or even a bank account. ZBNF inspires a spirit of volunteerism among its peasant farmer members, who are the main protagonists of the movement. The neoliberalization of the Indian economy led to a deep agrarian crisis that is making small scale farming an unviable vocation. Privatized seeds, inputs, and markets are inaccessible and expensive for peasants. Indian farmers increasingly find themselves in a vicious cycl

Electrolyte  and  acid-base  disorders  may  result  from  many different  diseases.  Timely  correction  of  fluid,  electrolyte, and  acid-base  disturbances  is  often  of  more  immediate benefit  to  patients  than  a  specific  diagnosis,  although both  are  important. SERUM  POTASSIUM CONCENTRATION Commonly  Indicated  •  Common  indications  to  measure  serum  potassium  concentration  include  prolonged anorexia,  vomiting,  diarrhea,  muscle  weakness,  bradycardia,  supraventricular  arrhythmias,  oliguria,  anuria,  and polyuria.  Serum  potassium  concentrations  should  be measured  if  hypoadrenocorticism,  acute  or  chronic  renal failure,  diabetic  ketoacidosis,  prolonged  vomiting,  urethral  obstruction,  uroabdomen,  or  postobstructive  diuresis  are  suspected,  or  if  prolonged  use  of  diuretics  (e.g., furosemide,  thiazides,  spironolactone)  or  angiotensinconverting  enzyme  inhibitors  (e.g.,  enalapril)  has occurred. Analysis  •  Serum  potassium