Saving and early discharge of a neonate with severe meconium aspiration syndrome

Surfactant is the treatment of choice in severe respiratory distress syndrome. Intubation, administration of surfactant, extubation (INSURE) is never reported to have been used for meconium aspiration syndrome (MAS) although it is used as the standard method of delivery of surfactant for respiratory distress syndrome. This is a case report of the use of INSURE technique for severe MAS. The baby was born at term gestational age to a primigravida mother by C-section for fetal distress. The baby was vigorous with chest retractions. Hence, the baby was supported with delivery room Continuous positive airway pressure and shifted to Neonatal Intensive Care Unit (NICU). In NICU, the baby was stabilized and given surfactant using the INSURE technique. Subsequently, a chest X-ray showed clearing of lung infiltrates and drastically reduced oxygen requirement of the baby and the baby was discharged early to home.

Transmission modes of severe acute respiratory syndrome coronavirus 2 and implications for infection control: a review

The complete picture regarding transmission modes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unknown. This review summarises the available evidence on its transmission modes, our preliminary research findings and implications for infection control policy, and outlines future research directions. Environmental contamination has been reported in hospital settings occupied by infected patients, and is higher in the first week of illness. Transmission via environmental surfaces or fomites is likely, but decontamination protocols are effective in minimising this risk. The extent of airborne transmission is also unclear. While several studies have detected SARS-CoV-2 ribonucleic acid in air samples, none has isolated viable virus in culture. Transmission likely lies on a spectrum between droplet and airborne transmission, depending on the patient, disease and environmental factors. Singapore's current personal protective equipment and isolation protocols are sufficient to manage this risk.

Evaluation of oral stereognosis in completely edentulous patients with palatal tori / Evaluación de la estereognosia oral en pacientes completamente edéntulos con toros palatinos

Background: The corollary is not investigated in the completely edentulous patients with palatal tori. Objective: The aim of this study was to assess the oral stereognostic ability in completely edentulous patients with palatal tori. Material and Methods: Thirty-four completely edentulous patients aged 50 to 89 years were allocated to Group 1 (without palatal tori, n=18) and Group 2 (with palatal tori, n=16). The oral stereognostic test was conducted using 6 intraoral test pieces (circle/square/rectangle/triangle/plus/toroid) that were fabricated to standard dimensions using the light cure acrylic resin. Each test piece was placed in the patient's mouth and was asked to manipulate the test piece between the tongue and the palate. The patients identified the shapes by matching them on a shape chart. Each correct identification was assigned a score of 1. The response time taken to identify each shape was recorded. Statistical computation was done using a chi - square test and Mann-Whitney U test. Results: Significant difference was observed in the overall scoring percentages between the 2 groups (p<0.05). Group 2 had lower oral stereognostic scores compared to group 1 (p<0.05). There was no statistically significant difference in the mean response time for identifying the shapes among the groups, however group 2 patients had longer response time. Conclusion: Oral stereognostic ability of the completely edentulous patients with torus palatinus was lower when compared to completely edentulous patients without tori.

Antecedentes: el corolario no se investiga en los pacientes completamente desdentados con toros palatinos. Objetivo:El objetivo de este estudio fue evaluar la capacidad estereognóstica oral en pacientes completamente edéntulos con toros palatinos. Material y Métodos: Treinta y cuatro pacientes completamente edéntulos de 50 a 89 años fueron asignados al Grupo 1 (sin toros palatinos, n = 18) y al Grupo 2 (con toros palatinos, n = 16). La prueba estereognóstica oral se realizó utilizando 6 piezas de prueba intraorales (círculo / cuadrado / rectángulo / triángulo / cruz / aro) que se fabricaron a dimensiones estándar utilizando la resina acrílica fotopolimerizable. Cada pieza de prueba se colocó en la boca del paciente y se le pidió que manipulara la pieza de prueba entre la lengua y el paladar. Los pacientes identificaron las formas haciéndolas coincidir en un gráfico de formas. A cada identificación correcta se le asignó una puntuación de 1. Se registró el tiempo de respuesta necesario para identificar cada forma. El cálculo estadístico se realizó mediante la prueba de chi-cuadrado y la prueba U de Mann-Whitney. Resultados: Se observó una diferencia significativa en los porcentajes de puntuación generales entre los 2 grupos (p<0,05). El grupo 2 tuvo puntuaciones estereognósticas orales más bajas en comparación con el grupo 1 (p<0,05). No hubo diferencia estadísticamente significativa en el tiempo medio de respuesta para identificar las formas entre los grupos, sin embargo, los pacientes del grupo 2 tuvieron un tiempo de respuesta más largo.Conclusión: La capacidad estereognóstica oral de los pacientes completamente edéntulos con torus palatino fue menor en comparación con los pacientes completamente edéntulos sin torus.

Quality of life among elderly living in old age homes and in family of Kancheepuram district, Tamil Nadu, India

Background: Quality of life in elderly is more relevant towards an ageing society. In India, the awareness is very little about the special needs of the elderly and their care takers (physical and mental health, psychological and social support). Furthermore, among elderly there is a variation between those living in old age homes (OAHs) and those living in general population. Hence the present study was undertaken to assess and compare the quality of life of elderly living in OAHs and community.Methods: A cross-sectional descriptive study was conducted among elderly in old age homes and family set up of Kanchipuram district, Tamil Nadu. QOL of elderly was assessed using WHO QOL - brief questionnaire after taking informed consent from the participants. Data was analyzed using SPSS 23.Results: A total of 106 elders from each group old age home and family setup were the study participants. Quality of life was good 72.5% in family and in OAHs it was only 56.2%. The main reason for residing in OAHs was no family, lack of care takers. All the four domains were found to be highly statistically significant.Conclusions: From this study we are able to find out that quality of life in family setup is better than OAHs, psychologically many people were depressed as they live separately from their family and relatives, friends and the community they lived.

Indian Academy of Pediatrics Guidelines on the Fast and Junk Foods, Sugar Sweetened Beverages, Fruit Juices, and Energy Drinks

Justification: In view of easy availability and increasing trend of consumption of fast foods and sugar sweetened beverages (fruit juicesand drinks, carbonated drinks, energy drinks) in Indian children, and their association with increasing obesity and related non-communicable diseases, there is a need to develop guidelines related to consumption of foods and drinks that have the potential toincrease this problem in children and adolescents. Objectives: To review the evidence and formulate consensus statements related toterminology, magnitude of problem and possible ill effects of junk foods, fast foods, sugar-sweetened beverages and carbonated drinks;and to formulate recommendations for limiting consumption of these foods and beverages in Indian children and adolescents. Process:A National Consultative group constituted by the Nutrition Chapter of the Indian Academy of Pediatrics (IAP), consisting of variousstakeholders in private and public sector, reviewed the literature and existing guidelines and policy regulations. Detailed review ofliterature was circulated to the members, and the Group met on 11th March 2019 at New Delhi for a day-long deliberation on framing theguidelines. The consensus statements and recommendations formulated by the Group were circulated to the participants and aconsensus document was finalized. Conclusions: The Group suggests a new acronym ‘JUNCS’ foods, to cover a wide variety ofconcepts related to unhealthy foods (Junk foods, Ultra-processed foods, Nutritionally inappropriate foods, Caffeinated/colored/carbonated foods/beverages, and Sugar-sweetened beverages). The Group concludes that consumption of these foods and beveragesis associated with higher free sugar and energy intake; and is associated with higher body mass index (and possibly with adversecardiometabolic consequences) in children and adolescents. Intake of caffeinated drinks may be associated with cardiac and sleepdisturbances. The Group recommends avoiding consumption of the JUNCS by all children and adolescents as far as possible and limittheir consumption to not more than one serving per week. The Group recommends intake of regional and seasonal whole fruits over fruitjuices in children and adolescents, and advises no fruit juices/drinks to infants and young children (age <2 y), whereas for children aged 2-5 y and >5-18 y, their intake should be limited to 125 mL/day and 250 mL/day, respectively. The Group recommends that caffeinatedenergy drinks should not be consumed by children and adolescents. The Group supports recommendations of ban on sale of JUNCSfoods in school canteens and in near vicinity, and suggests efforts to ensure availability and affordability of healthy snacks and foods. TheGroup supports traffic light coding of food available in school canteens and recommends legal ban of screen/print/digital advertisementsof all the JUNCS foods for channels/magazines/websites/social media catering to children and adolescents. The Group further suggestscommunication, marketing and policy/taxation strategies to promote consumption of healthy foods, and limit availability and consumptionof the JUNCS foods

Cross-country transport and isolation and identification of Streptococcus pneumoniae by use of alternate sources of blood supplemented media among laboratories in India

Background: The isolation of S. pneumoniae (Sp) depends on specimen integrity / transport, media and expertise. The non-availability of sheep blood agar poses a challenge in identification of colonial morphology and identification in India. Methods: Laboratories processed swabs containing either pure Sp or Sp in mixed cultures with a second (confounding) bacterium shipped across the country in cold conditions. Duplicate set of swabs was shipped back to the central laboratory to assess the impact of shipping on culture viability. The identical swab was cultured on sheep, human blood and one additional agar plate used in the laboratory. Results: 46/60(77%) of cultures containing only Sp were correctly identified. In specimens where Sp was present in mixed culture, the proportion of isolates in which Sp was correctly identified varied, with most variability attributed to the particular confounding organism rather than the media. There was no discernible impact of temperature-controlled (4-6°C) transport on the isolation of Sp from culture swabs. Conclusions: The study clearly elucidates the ability of laboratories for isolation of S. pneumoniae on human blood agar in resource limited settings. The results highlight the difficulties inherent in correctly identifying pathogens in mixed cultures in needs improvement using standardized tests across the study centers. The study also reaffirms the ability to transport biological specimens over long geographical distances without loss.

Efficacy and safety of denosumab compared to bisphosphonates in improving bone strength in postmenopausal osteoporosis: a systematic review

INTRODUCTION@#Osteoporosis is the main cause of fractures among women after menopause. This study aimed to evaluate the efficacy and safety of denosumab compared to bisphosphonates in treating postmenopausal osteoporosis.@*METHODS@#Databases including PubMed and the Cochrane Central Register of Controlled Trials were systematically searched for randomised controlled trials (RCTs) that directly compared denosumab and bisphosphonates. RCTs that studied both denosumab and bisphosphonates in postmenopausal women with osteoporosis and had a Jadad score ≥ 3 were included.@*RESULTS@#Nine studies were eligible for inclusion. They were further categorised into six cohort groups. All studies had denosumab with oral bisphosphonates as the active comparator. Four out of six cohort studies showed significant improvements in bone strength (p < 0.001) at the distal radius, tibia, total hip, femoral neck, lumbar spine and trochanter at 12 months for patients on denosumab compared to the bisphosphonate group. Serum C-telopeptide of cross-linked collagen, a bone turnover marker, was consistently lower in the denosumab group in all studies. There were no significant differences in hypocalcaemia, atypical fractures, fragility fractures, osteonecrosis of the jaw, all infections (including fever or influenza-like symptoms), gastrointestinal side effects or dermatological conditions in all studies, except for one that did not document side effects.@*CONCLUSION@#Denosumab can be used both as a first-line agent and an alternative to bisphosphonate in the treatment of postmenopausal osteoporosis. There is currently insufficient data to show that denosumab is not inferior to bisphosphonates in fracture prevention.

A review on application of biomarkers in heart failure

Heart failure (HF) remains the leading cause of death in the elderly population. Since last decade there is an advance in the field of biomarkers in managing these patients. Hence identifying novel and potential biomarkers that help in accessing the risk, predicting the disease and monitoring the prognosis is very crucial in reducing the overall morbidity and mortality. These biomarkers are elevated mainly in response to myocardial stress, dynamic changes in extracellular matrix, myocyte necrosis, oxidative stress, and inflammation. The biomarker that has good clinical correlations may be useful in diagnosis, prognosis, and therapeutic management of HF. Understanding the role of each biomarker and their clinical implication is very crucial. In this review, we summarize the attainments and challenges of using different types of biomarkers in HF.

A Metric Scrutiny Of The Orbital Margins

Background: The anatomical boundaries of the orbit are defined and the contribution of various bones in makingup the orbital margins is determined .Associated with this, orbital dimensions like length, breadth and theorbital index are determined along with the associated dimorphic and bilateral variations. The findings of theseterritorial specimens are analyzed and compared with similar findings from other vernacular territories. Thebilateral craniofacial structures are studied and they are dimensionally classified and characterized.Comprehensive documentation thus promulgated functions to prove vital in the conquest of dexterity in the fieldof surgery and forensic anthropometry alike. The evaluated parameters also serve as an empirical guide indiscerning tenuous sites that are susceptible to impaction and in defining the safe limits of orbital explorationResults: The study has returned an average value of 81.47 as the orbital index of the scrutinized dry skullspecimens thus placing them under the category of microseme. The average values of orbital length and breadthwere found to be 31.26mm and 38.37mm respectively. The superior margin formed exclusively by the frontalbone measured 32.7mm on average with the supraorbital notch/foramen being displaced 5.92mm from themedial limit of the superior margin. For 25.88mm, which was the average length of medial margin, maxilla stoodthe dominant contributor (13.81mm) with the frontal bone chipping in to contribute to the rest. The inferiormargin paints a contrary picture of maxilla being the secondary contributor (16.13mm) whilst here it is thezygoma which makes a greater contribution (17.29mm).Conclusion: This study hereby establishes Microseme to be the predominant orbital index of the scrutinized skullspecimens in addition to quantifying the contributions of various bones towards making up the margins.Comparative analysis with confluent such studies from other provinces of the Indian subcontinent has confirmedthe latitude variation associated with orbital index. The results thus established will be unerringly essential inthe field of surgery and forensic anthropometry

A technique utilising cobalt-chromium framework as a key in master cast preparation for removable prosthesis in microstomia patients: A case report

Prosthodontic rehabilitation and management of microstomia patient presents challenges at all stages during prosthesis fabrication; from making primary impressions to the prostheses insertion. These patients have reduced mouth opening, and hence it can be extremely challenging to make impressions and to fabricate dentures using the conventional methods. The present case report describes prosthodontic management of a partially dentate patient with microstomia that developed secondary to surgical resection and radiation therapy of head and neck cancer. A simplified novel approach has been advocated using the patient’s existing metal removable partial denture as a key in master cast preparation.

A study of impact of smoking on glycemic index status among patients who are attending Government Dharmapuri Medical College Hospital, Dharmapuri

Introduction: Tobacco use has long been known to be a major risk factor for cardiovascular disease. Recent studies have identified a positive association between smoking and incidence of diabetes. The evidence that smoking is an independent risk factor for the development of diabetes is still considered preliminary. Some studies have shown a dose response association between smoking and incidence of diabetes. Aim of The Study: To assess whether smokers are more likely than non-smokers to develop clinically relevant glucose intolerance or diabetes and to assess whether total pack years’ correlates with the severity of glucose intolerance/ diabetes. Materials and Methods: We have evaluated Hundred smokers and FIFTY nonsmokers Baseline characteristics of the study were as follows; age, sex, occupation, Education status, family history of diabetes, comorbid illness of smoking. Our Baseline examination included Ht, Wt, BMI, BP, HC, WC, Waist Hip ratio (anthropometric measurements), Lab investigation – Blood sugar (F and PP) and Lipid profile. Participants were defined as current smokers and former smokers. Former smoker were those who, at baseline, reported previously using cigarettes but denied current smoking. Results: Nearly 5% of the case population were obese. Among the control population, obesity accounted for 2% of them. There was a significant statistical difference between cases and controls with respect to BMI (‘p’ = 0.0116). With regard to Blood Pressure, there was no significant statistical difference between cases and controls (‘p’ = 0.4989). Glucose Intolerance among case population G. Indumathi. A study of impact of smoking on glycemic index status among patients who are attending Government Dharmapuri Medical College Hospital, Dharmapuri. IAIM, 2017; 4(9): 25-31. Page 26 were found to be 29% and among the control population, found to be 22%. Thus there was no significant statistical difference between cases and controls (‘p’ = 0.4727). 53 cases of the study group (53%) had high Triglyceride. 46% of the control group had high TG. Thus, there was no significant statistical association between study and control group (p =0.52) 13 cases of the study group (13%) had low HDL. 14% of the control group also had low HDL. Thus there was no significant statistical association between study and control group (p = 0.93). 10% of the case population had metabolic syndrome and 6% of the control population had the same. There was no significant statistical association. 10% of the case population had metabolic syndrome and 6% of the control population had the same. There was no significant statistical association. Conclusion: Smoking stimulate symathetic system, which inturnleads to anelevated catecholamine levels and there by insulin resistence.Smoking influences visceral adipose tissue and there by insulin resistance.Smokers(especially heavy smokers) are prone for unhealthy food habits and low physical activity which in turn leads to visceral fat accumulation and insulin resistance.

Cardiac changes in hepatic cirrhosis in Government Dharmapuri Medical College Hospital, Dharmapuri

Introduction: Cirrhosis liver, is characterized by diffuse destruction and regeneration of hepatic parenchymal cells leading to deposition of connective tissue with resulting disorganization of the lobular and vascular architecture. Despite the remarkable regenerative capacity of the liver, once hepatic parenchymal reserve is exceeded, clinically overt or decompensated cirrhosis ensues. Portal hypertension develops due to resistance to blood flow through the liver resulting increase in portal venous pressure leading to diversion of blood flow through low resistance portosystemic collaterals thereby bypassing the liver. The current study was designed to precisely evaluate the cardiovascular system in a group of patients with hepatic cirrhosis based on clinical examination. Aim of the study: To clinically evaluate patients with hepatic cirrhosis with respect to changes in heart rate, blood pressure, mean arterial pressure, ECG jugular venous pressure and precordial examination. Materials and Methods: 50 patients of cirrhosis liver were selected for the study. These patients were admitted in the general medical wards. All patients were subjected to routine investigations. All patients were subjected to ultrasound scan abdomen to confirm the diagnosis of cirrhosis. Patients with ascites underwent abdominal paracentesis and fluid was analyzed for protein content and cells. All patients were then subjected to electrocardiography, chest X-ray and M-mode 2-Dimensional echocardiography. Results: Out of the 50 patients studied 35 (70%) were males and 15 (30%) were females. The age of the patients ranged from 19 years to 75 years. 5 Patients (10%) were alcoholics, 14 patients (28%) had past history of jaundice or, 8 patients (16%) presented with haemetemesis. Among this 4 patients were P. Elango, G. Indumathi. Cardiac changes in hepatic cirrhosis in Government Dharmapuri Medical College Hospital, Dharmapuri. IAIM, 2017; 4(9): 19-24. Page 20 HbsAG+ (8%) and 2 patients were diabetics 4%. All patients had sonographic evidence of cirrhosis.with portal hypertension. Out of 50 patients, 3 patients had elevated blood pressure. Previous studies show that the systolic blood pressure more than 160 mmHG and diastolic blood pressure more than 95 mmHg are the range for hypertension in cirrhotic patients. The electro cardiac gram showed an average heart rate of 82/ m. The low QRS voltage in chest leads and limb leads were found in 10 patients. T wave inversion was found in chest leads (V1 to V3 / V6) in 4 (8%) patients, in II, III avf in 7 patients (14%). The chest roentgenogram showed Hepatic Hydrothorax in 5 patients (10%). Cardio megaly was evident in chest X – ray in 11 patients (22%). Conclusion: The result of this study clearly showed that a large number of patients with hepatic cirrhosis are asymptomatic (40%) about cardiovascular system, have evidence of cardiac involvement in electrocardiography and echo cardiograph. cardiac decompensation in cirrhosis is rare despite the high output state and its presence as indicated by left ventricular systolic dysfunction.

A study of serum amylase levels in acute organophosphorous poisoning at Government Dharmapuri Medical College Hospital, Dharmapuri

Introduction: In India, OP compounds cause more self-poisoning deaths in southern and central India. In Northern India, aluminum phosphide causes most deaths with a fatality ratio. Poisoning due to occupational exposure, accounted for about one fifth of the incidents, with a fatality ratio of less than 1%. More than 90% of the non-occupational incidents were suicidal, with a fatality rate more than 10% and the majority of the subjects are young males. Accidental exposures accounted for 8- 10% of the incidents and homicidal use (less than 1%) were other forms of poisoning. The reported overall mortality following OP insecticide poisoning varies from 4-30% in different countries and institutions. Aim: To estimate serum Amylase levels in acute organophosphorus compound poisoning and the find out the clinical outcomes. Materials and methods: The study was conducted in Government Dharmapuri Medical College Hospital, Dharmapuri. Study duration was from January 2017 to June 2017. Of a total of 145 patients with organophosphorus compound poisoning admitted to the hospital during the study period, 40 were included in the study. 10 healthy (age matched) individuals were kept as a control. Biochemical evaluation which includes Serum Amylase Blood glucose, urea, creatinine, and Liver function tests were analyzed and matched among the two groups. Results: The biochemical results have not shown much variation from the normal levels in our study. P. Elango, G. Indumathi. A study of serum amylase levels in acute organophosphorous poisoning at Government Dharmapuri Medical College Hospital, Dharmapuri. IAIM, 2017; 4(9): 6-11. Page 7 In the study, the Amylase levels were significantly elevated at the time of admission (185.2 U/L) and have shown a gradual remission with proper treatment. The mean Amylase level in severely poisoned patients was 297.7 U/L which was significantly (P < 0.01) higher than the healthy control group. On comparing the Amylase levels in first 24 hours against control, the variations were considered to be significant (P < 0.01). Conclusion: From the observation we made, it could be suggested that OP pesticide poisoning is a serious condition that needs rapid diagnosis and treatment. The mean Amylase level in first 24 hours of OP poisoning was 154 U/L which is significantly higher than the control groups.

Study on analysis of socio-demographic aspects, clinical profile, ECG changes, electrolyte status and outcome with acute yellow oleander seed poison patients in GDMCH, Dharmapuri

Background: Patients with diabetes mellitus (DM) are at an increased risk of dying from cardiovascular diseases, the reason for which is not completely understood. Aim: To study the clinico-demographic profile of type 2 diabetes patients with cardiac autonomic neuropathy (CAN). Materials and methods: This was a cross sectional study involving 100 patients attending the diabetic clinic of a tertiary care hospital. Demographic data was collected and autonomic function testing was done with Ewing and Clark’s tests. Results: The prevalence of CAN was 58 %. CAN had statistically significant association with increasing duration of diabetes (p < 0.00001), increasing values of HbA1c (p < 0.00001), and with combined use of insulin and oral medications (p < 0.05). Conclusion: There is a high prevalence of CAN in the diabetic population providing a large pool of patients awaiting effective interventions.

Isolation & molecular characterization of human parainfluenza virus in Chennai, India.

Background & objectives: Human parainfluenza virus (HPIV) accounts for a significant proportion of lower respiratory tract infections in children as well as adults. This study was done to detect the presence of different subtypes of HPIV from patients having influenza like illness (ILI). Methods: Throat and nasal swabs from 232 patients with ILI who were negative for influenza viruses were tested by multiplex reverse transcription polymerase chain reaction(mRT-PCR) for the detection of human parainfluenza virus. All samples were inoculated in rhesus monkey kidney (LLC-MK2) cell line. Results: Of the 232 samples, 26(11.2%) were positive by mRT-PCR and nine (34.6%) showed cytopathic effect with syncytium formation for HPIV and all were HPIV-3 serotype, other serotypes like 1,2,4 were negative. The HPIV-3 strains (HN gene) were sequenced and analysed. Two novel mutations were identified at amino acid residues 295 and 297. Interpretation & conclusions: The mRT-PCR assay offers a rapid, sensitive and accurate diagnostic method for detection of HPIV which enables early detection and control. In our study there was a predominance of HPIV among 1-5 yr age group and the school going age group was less affected. Further studies need to be done to characterize HPIV isolated from different parts of the country.

Morphometric and Clinical Analysis of Moderator Band in Humans.

Background: The moderator band has the right bundle of His within the right ventricle. It also is known to prevent the over dilatation of RV. It is important because of its involvement in RV infarcts, in differentiating RV from LV in congenital anomalies, in VPDs & VTs and in VSDs. The present literature is very much lacking in its morphometry. Materials and Methods: Moderator band was looked for in 50 hearts and only in this study did we find it in all the hearts. The length, the thickness, the distance from the tricuspid valve along with the presence of any trabeculations in the septal end or in the papillary muscle end were looked for and recorded. Results: The average length was 14.71±4.99mm, the average thickness was 4.97±1.64 mm, the average distance from the tricuspid orifice was 19.85±5.92 mm. The attachment to the anterior papillary muscle was found to be branched in 8 hearts that is having an incidence of 14% . The septal end were branched and separated as two in only two specimens. Only one specimen had branched attachments on both the apical and septal ends. Conclusion: The distance from tricuspid valve and knowledge of branching are important in corrective surgeries of the VSDs. An awareness of length and thickness helps the clinician to differentiate moderator band from the other structures, which may result in misdiagnosis during echocardiography. Its presence may in fact be of significance in preventing over distension of the heart in RV myocardial ischaemia.

Diphtheria-like illness in a fully immunised child caused by Corynebacterium pseudodiphtheriticum.

Corynebacterium pseudodiphtheriticum is a common commensal flora of the upper respiratory tract in humans. Though the pathogenicity of C. pseudodiphtheriticum is not rare, its role as an opportunistic pathogen is mainly limited to the lower respiratory tract, particularly in patients with underlying systemic conditions or immune‑compromisation. We hereby present the first case of C. pseudodiphtheriticum causing diphtheria‑like illness affecting the upper respiratory tract of a 6‑year‑old fully immunised otherwise healthy child. In countries with very low incidence of diphtheria, C. pseudodiphtheriticum should be included in differential diagnosis for a child presenting with diphtheria‑like illness. Simple, rapid screening tests should be used to differentiate it from C. diphtheriae and hence, to prevent unnecessary concern in community.

Clinical Profile and Outcome of Clinical BCG Disease in Infants.

Objective: To describe the clinical profile, immunological status and outcome of BCG disease in infants. Methods: All infants with a diagnosis of BCG disease in a period of 17 months were followed up. Results: Among 25 infants with BCG disease; 19 had local/ regional involvement and 6 had suspected or confirmed distant/disseminated disease, Mean (range) age of presentation was 3.6 (1.5-9) months. Two of 6 infants with disseminated disease required second-line anti-tubercular treatment. One infant with confirmed disseminated disease had INFγ R1 receptor deficiency. There was no mortality. Conclusion: Most infants with BCG- related disease have local or regional disease.

Oral epithelial cells transplanted on to corneal surface tend to adapt to the ocular phenotype.

To understand the response of oral epithelial cells, transplanted on corneal surface to the ocular cues in vivo. The corneal bu􀄴 on obtained after penetrating keratoplasty (PK) of an eye of a patient with total limbal stem cell defi ciency (LSCD), previously treated with cultured oral mucosal epithelial transplantation (COMET) was examined by immunohistochemistry for the expression of keratins, p63, p75, PAX6, Ki-67, CD31, and CD34. COMET followed by optical-PK has improved visual acuity to 20/40 and rendered a stable ocular surface. The excised corneal tissue showed the presence of stratifi ed epithelium with vasculatures. The epithelial cells of the corneal bu􀄴 on expressed K3, K19, Ki- 67, p63, p75 and the cornea-specifi c PAX6 and K12. This study confi rms that the oral cells, transplanted to corneal surface, survive and stably reconstruct the ocular surface. They maintain their stemness at the ectopic site and acquire some of the corneal epithelial-like characters.

Transforming ocular surface stem cell research into successful clinical practice.

It has only been a quarter of a century since the discovery of adult stem cells at the human corneo-scleral limbus. These limbal stem cells are responsible for generating a constant and unending supply of corneal epithelial cells throughout life, thus maintaining a stable and uniformly refractive corneal surface. Establishing this hitherto unknown association between ocular surface disease and limbal dysfunction helped usher in therapeutic approaches that successfully addressed blinding conditions such as ocular burns, which were previously considered incurable. Subsequent advances in ocular surface biology through basic science research have translated into innovations that have made the surgical technique of limbal stem cell transplantation simpler and more predictable. This review recapitulates the basic biology of the limbus and the rationale and principles of limbal stem cell transplantation in ocular surface disease. An evidence-based algorithm is presented, which is tailored to clinical considerations such as laterality of affl iction, severity of limbal damage and concurrent need for other procedures. Additionally, novel fi ndings in the form of factors infl uencing the survival and function of limbal stem cells aft er transplantation and the possibility of substituting limbal cells with epithelial stem cells of other lineages is also discussed. Finally this review focuses on the future directions in which both basic science and clinical research in this fi eld is headed.