Computational Prediction of Novel Broad-Spectrum Drug Targets Against Vibrio Cholerae by Integrated Genomics and Proteomics Approach

@#Introduction: Vibrio cholerae is a motile, Gram-negative curved rod belonging to the Vibrionaceae family. It is the causative agent of cholera. The acute diarrheal disease cholera causes about 120 000 casualties annually and has a significant effect on the health of young kids between the ages of 1 and 5. The main cause of death is due to resistance to antibiotics. As a result, new drug targets need to be identified immediately. The study’s goal is to identify Vibrio Cholerae’s putative drug target through an integrated approach to genomics and proteomics. Methods: Through this study, 2241 core protein sequence of Vibrio Cholerae were retrieved from the Panx tool. The sequence decreased to 173 druggable sequences by undergoing different phases of the process such as determining the non-homologous sequence against human proteome by using the BlastP tool, identifying the essential genes by using the DEG database, and determining the sequence of virulent proteins by using Virulent prediction tool. Results: 11 potential drug targets were identified through molecular weight, and sub-cellular localization analysis. Conclusion: Through pan-genome analysis, we can able to find potential drug targets. This study also helps to identify the potential drug targets against Vibrio cholerae and to increase the efforts of drug and vaccine developments.

Acute postoperative sepsis mimicking symptomology suspicious for malignant hyperthermia: case report / Sepse aguda pós-operatória simulando sintomatologia suspeita para hipertermia maligna: relato de caso

Abstract Background: Sepsis is a life-threatening organ dysfunction with non-specific clinical features that can mimic other clinical conditions with hyper metabolic state such as malignant hyperthermia. Perioperatively anesthesia providers come across such scenarios, which are extremely challenging with the need for urgent intervention. Objective: To illustrate the need for early intervention and consultation for added assistance to approach and rule out malignant hyperthermia and other possible causes during such a scenario. Case report: A 63-year-old male underwent an uneventful elective flexible cystoscopy and transrectal ultrasound-guided prostate biopsy. Postoperatively he developed symptoms raising suspicion for malignant hyperthermia. Immediately malignant hyperthermia protocol was initiated that included administration of dantrolene and consultation of malignant hyperthermia association hotline along with other diagnostic and interventional management aimed at patient optimization. While early administration of dantrolene helped in hemodynamically stabilizing the patient, the consultation with other providers and malignant hyperthermia association hotline along with repeated examinations and lab works helped in ruling out malignant hyperthermia as the possible diagnosis. The patient later recovered in the intensive care unit where he was treated for the bacteremia that grew in his blood cultures. Conclusions: Sepsis shares clinical symptoms that mimic malignant hyperthermia. While sepsis rapidly progresses to secondary injuries, malignant hyperthermia is life threatening. Providing ideal care requires good clinical judgment and a high level of suspicion where timely and appropriate care such as early administration of dantrolene and consultation of malignant hyperthermia association hotline for added assistance can influence positive outcomes.

Resumo Justificativa: A sepse é uma disfunção orgânica fatal com características clínicas inespecíficas que podem imitar outras condições clínicas com quadro hipermetabólico, como a hipertermia maligna. Os cenários são extremamente desafiadores para a anestesia perioperatória e requerem intervenção urgente. Objetivo: Ilustrar a necessidade de intervenção e consulta precoces para uma assistência adicional na abordagem e exclusão de hipertermia maligna e outras possíveis causas durante tal cenário. Relato de caso: Paciente do sexo masculino, 63 anos, submetido à cistoscopia eletiva com cistoscópio flexível e biópsia transretal da próstata guiada por ultrassom sem intercorrências. No pós-operatório, o paciente desenvolveu sintomas que levantaram a suspeita de hipertermia maligna. O protocolo de hipertermia maligna foi imediatamente iniciado, inclusive a administração de dantrolene e uma consulta pela linha direta da associação de hipertermia maligna, juntamente com outros diagnósticos e manejos intervencionistas com vistas ao aprimoramento do paciente. Enquanto a administração precoce de dantrolene ajudou na estabilização hemodinâmica do paciente, a consulta com outros anestesistas e com a Associação de Hipertermia Maligna, juntamente com repetidos exames físicos e laboratoriais, ajudou a excluir a hipertermia maligna como o possível diagnóstico. O paciente recuperou-se mais tarde na unidade de terapia intensiva, onde recebeu tratamento para a bacteremia detectada em suas hemoculturas. Conclusões: A sepse compartilha sintomas clínicos que mimetizam a hipertermia maligna. Enquanto a sepse progride rapidamente para lesões secundárias, a hipertermia maligna é uma ameaça à vida. Proporcionar o tratamento ideal requer um bom julgamento clínico e um alto nível de suspeita quanto aos cuidados oportunos e apropriados, como a administração precoce de dantrolene e a consulta pela linha direta da Associação de Hipertermia Maligna para assistência adicional, que podem resultar em desfechos positivos.

An Observation of Cooling of Dead Body for Estimation of Time Since Death in IGIMS, Patna, Bihar

Background: Cooling of body after death is also known asAlgor Mortis. Now a days recording of temperature of a deadbodies has its medico-legal importance in connection withdetermination of time since death. It is variable and dependsupon various factor including the atmospheric temperature of aparticular region.Aim & Objective: The main objective of this objective was torecord the fall of temp in dead body as supportive data fordetermination of time since death at Patna (Bihar). Materials &Methods: The present study was conducted on 140 deadbodies brought for post-mortem examination at IGIMS, Patnafrom September 2016 to March 2018 after clearance of ethicalcommittee.Results: Between 3 to 6 hours after death, temperatures wererecorded by 96.6˚F to 95.6˚F in 37.50% of cases and in28.12% cases by 95.6˚F to 94.6˚ F and in 34.37% cases by94.6˚F to 92.6˚F. In the cases examined during 24 hours to 36hours after death rectal temperatures were found to be loweredby 78.6˚F to 74.6˚F in 0.08% cases, and in 91.66% casesbodies were found to be cooled to environmental temperature.Conclusion: The most important responsibility of the doctorsperforming post mortem examination to answer this point asprecisely and accurately as possible. It is manifestly impossibleto say the exact moment of death but a near approximationmay be reached by closely recording of rectal temperatureevery half hourly for three hours

Reproductive cycle of the endemic and threatened fish Puntius shalynius (Cypriniformes: Cyprinidae) in Meghalaya, India / Ciclo reproductivo del pez endémico y amenazado Puntius shalynius (Cypriniformes: Cyprinidae) en Meghalaya, India

Abstract:Puntius shalynius is a highly endemic freshwater minor carp that is economically important and is threatened because of its ornamental value. The present investigation evaluated this barb gonadal maturation, based on morphology and spawning of this species in the Umiam river, Meghalaya, India. The population of this indigenous fish has declined due to its fragmented distribution and exploitation as an ornamental fish. The reproductive cycle of P. shalynius was studied for the first time. A total of 609 fish samples were randomly collected from the river for a period of two years during January 2010 and December 2011. Five maturity phases (rest, primary growth, secondary growth, ripe and spent) were observed on the basis of ovarian and testicular macroscopic evaluation throughout the annual cycle. Peak spawning activity was observed in the month of June/ July and it coincided with the start of the monsoon season. The study showed that the fish spawns once in a year with single spawning peak and that the species is a low fecund fish. It is important to conserve this species for its unique ecological value and urgent management policies should promote its sustainable utilization. Rev. Biol. Trop. 65 (1): 255-265. Epub 2017 March 01.

ResumenPuntius shalynius es un pez de agua dulce altamente endémico que posee importancia económica y esta amenazado por su valor ornamental. En esta investigación se evaluó la maduración de las gónadas de este pez basado en la morfología y desove de esta especie en el río Umiam, Meghalaya, India. La población de esta especie nativa ha decrecido debido a su distribución fragmentada y explotación como pez ornamental. El ciclo reproductivo de P. shalynius se estudió por primera vez. En el río se recolectó al azar una muestra de 609 peces por un período de dos años entre enero 2010 y diciembre 2011. Se observaron cinco estadios de madurez (descanso, crecimiento primario, crecimiento secundario, maduro, agotamiento) basados en la evaluación macroscópica testicular y ovárica durante el ciclo anual. La actividad máxima del desove se observó entre junio y julio lo que coincidió con el comienzo de la época de monzones. El estudio demostró que estos peces desovan una vez al año con un único punto máximo y que la especie es de baja fecundidad. Es importante la conservación de esta especie por su valor ecológico único y se deben promover políticas de manejo urgentes para su uso sostenible.

Polymorphous low-grade adenocarcinoma of the palate: a rare case report

Introduction: Polymorphous low-grade adenocarcinoma [PLGA] has been known as a comparatively less aggressive malignant tumor that predominantly occurs in the minor salivary glands. It has presented as a painless, slow growing tumor in the oral cavity. It has been reported to occur rarely in the palate and the prognosis of this lesion is far better than adenocarcinoma as the regional metastasis would be very minimal. A clear difference between the biologic behaviors of adenocarcinoma and PLGA has been reported in literature

Case Presentation: A 63-year-old female reported at our institute with a swelling in relation to her upper left back region of her jaw for three months, gradual in onset and associated with pain. After clinical and radiological examination, the differential diagnosis were consolidated abscess or minor salivary gland tumor. An incisional biopsy was done and the lesion was diagnosed as PLGA. The lesion was treated by wide excision and reconstruction with immediate obturator. The post-operative follow up showed no evidence of recurrence and the healing was satisfactory

Conclusions: The site of predilection of PLGA is more in favor of palate [49 - 77.8%] followed by either upper lip or buccal mucosa [7.4 - 13.4%]. There are sporadic reports of metastasis sometimes even transformation to a high grade adenocarcinoma, sometimes ending in mortality. Cervical lymph node metastasis is rare with reported incidence of 5 - 15% and is more commonly seen in recurrent tumor than the initial diseases. Extra palatal PLGAs present with significant papillary growth or arising from ventral surface of tongue frequently metastasize to cervical lymph nodes. Distant metastasis is very rare with an incidence of 7.5% and the site involved is the lung which is attributed to the inadequate control of the disease

Intravenous Propofol for Minor Oral and Maxillo Facial Surgery.

Back ground and objectives: this study evaluated the efficacy and feasibility of intravenous propofol along with local anaesthesia for minor oral and maxillofacial surgical procedures. Methods: 25 ASA class 1 or 2 patients undergoing elective minor oral surgery procedures were selected for inclusion in this study. After pre medication with atropine 0.6 mg/kg intramuscularly. Anaesthesia was induced with 2 mg/kg propofol, 1mg midazolam and 50 micro grams of fentanyl and was maintained with a continuous infusion of propofol. 2 % lidocaine with 1:2,00,000 adrenaline was injected and the operative procedure was carried out. The quality of anaesthesia was subjectively evaluated by recording the intra operative vital parameters, the anaesthetist, the surgeon, and the patient (using the Awareness and Recall Questionnaire). Results: Results showed that all vital parameters were within normal limits intra operatively. The anaesthetist, surgeon and the patients were satisfied. No patient complained of any post operative complications secondary to the anaesthetic. Conclusion: Propofol (intravenous) as a supplement to local anaesthesia is a suitable agent to accomplish minor oral surgical procedures. It is safe, effective and comfortable for the surgeon as well as the patient.

Effects of Elevated Blood Lead Levels in Preschool Children in Urban Vellore.

Objectives: To study the burden and associated risk factors for elevated blood lead levels among pre-school children (15-24 months) in urban Vellore, and to study its effects on child cognition and anemia. Design: An investigative study through Mal-ED cohort. Setting: Eight adjacent urban slums in Vellore, Tamil Nadu. Participants: 251 babies recruited through Mal-ED Network. Outcome measures: Blood lead levels using Graphite Furnace Atomic Absorption Spectrophotometry method at 15 and 24 mo; hemoglobin estimation by azidemethemoglobin method; cognitive levels using Bayley Scales of Infant Development III. Results: Around 45% of children at 15 months and 46.4% at 24 months had elevated blood lead levels (>10 μg/dL). Among children who had elevated blood lead levels at 15 months, 69.2% (45/65) continued to have elevated levels at 24 months. After adjusting for potential confounders, children from houses having a piped drinking water supply and houses with mud or clay floors were at significantly higher risk of having elevated blood lead levels at 15 months. Thirty one percent (21/67) of the children with elevated blood lead levels had poor cognitive scores. Children with elevated blood lead levels at 15 months had higher risk (Adjusted OR 1.80; 95% CI 0.80 - 3.99) of having poorer cognitive scores at 24 months. More than half of the children (57%) were anemic at 15 months of age, and elevated blood lead levels were not significantly associated with anemia. Conclusions: Elevated blood lead levels are common among preschool children living in urban slums of Vellore. Poorer conditions of the living environment are associated with elevated lead levels.

A randomized, open-labelled study of the sedative, analgesic and anxiolytic effect of dexmedetomidine and tramadol in postoperative patients.

Background: In the post-operative period, it has always been an important consideration for clinicians, to keep the patient comfortable, calm and pain free. So there is a constant need for an ideal sedative for postoperative patients. Alpha 2 adrenoreceptor agonists such as dexmedetomidine could provide an answer to this problem because they have several relevant physiological properties like sedation, anxiolysis, analgesia and arousability. This prospective, randomized trial was conducted to compare the safety and efficacy of dexmedetomidine and tramadol in the management of postoperative pain. Methods: In the present study 60 patients operated under general anaesthesia with a pain score of 1-3 were randomly allocated into two groups to receive either dexmedetomidine (group D) or tramadol (group T). In both groups, pain score, sedation score, heart rate, blood pressure, SPO2, respiratory rate were monitored for every 5 min for first 30 min, every 10 min for next 1hr, every 15 min for next 1 h, every 30 min for the next 1 h, every 1 h for 3 h and 6th hourly till 24 h. The need for rescue analgesic was also noted. The data were tabulated and analysed using descriptive statistical tool. Mean, standard deviation and comparison between the groups was done by student’s ‘t’ test. A p value less than 0.0001 was considered significant. Results: Mean duration of sedation of dexmedetomidine was 129.6±41.02 and for tramadol was 117.3 ± 47.75 (p=0.14), mean degree of sedation in both group was -1, mean duration of analgesia 139 min in Group D and 280 min in Group T (p<0.0001), rescue analgesia was required at 169th min in Group D and 288th min in Group T (p<0.0001), mean heart rate in Group D was 67.8±5.24 and 69.4±4.79 (p=0.12), mean Mean Arterial Pressure (MAP) in Group D was 78.0±8.97 and in Group T was 89.2±10.63 (p<0.00001), mean respiratory rate in Group D was 15.8±2.33 and in Group T was 15.9±2.09 (p=0.41), mean SPO2 in Group D was 99.5±0.56 and in Group T was 99.4±0.62 (p=0.14). There was no significant difference in degree and duration of sedation, duration of analgesia, vital parameters, and adverse effects in both groups but there was a statistical difference in the duration of analgesia and the need for rescue analgesia in Group D. Conclusion: Though there is no statistical difference in both groups, dexmedetomidine significantly reduced anxiety, agitation and produced calmness in postoperative patients which was not seen with tramadol.

Selective serotonin reuptake inhibitors and the risk of bleeding.

Background: Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed agents for various conditions in general psychiatry. There is a strong consensus that blockade of serotonin reuptake affects primary hemostasis, namely platelet activity, thus resulting in a bleeding tendency. Considering that SSRIs are commonly prescribed, this study was conducted to assess if they were associated with an increased risk of bleeding. Methods: This was a prospective, open-label study of 30 patients attending the Psychiatry out-patient department, Dr. B. R. Ambedkar Medical College, Bangalore who satisfied DSM-IV criteria for a primary diagnosis of depression, treated with SSRIs. Bleeding time, clotting time, prothrombin time, partial thromboplastin time and platelet count were assessed at baseline and at the end of 6 weeks of treatment or occurrence of bleeding symptom. Results: The patients aged between 18-55 years of whom 21 were females, were treated with an SSRI (fluoxetine 12, escitalopram 12 and sertraline 6 patients). Six patients had overt symptoms of bleeding (upper gastrointestinal bleeding (hematemesis) 4; epistaxis 2 and petechiae 2) of whom one patient gave a history of both hematemesis and petechiae and another of hematemesis and epistaxis. The average day after treatment beginning, on which patients reported with bleeding was 30.33 (26-40 days). There was a significant increase in the bleeding time (p=0.028) and clotting time (p=0.042), implying derangement in platelet aggregation. There was no significant change in the other parameters. Conclusion: Treatment with SSRIs increases the risk of bleeding. However, large, randomized controlled trials are required to re-affirm these findings.

Benign breast diseases: experience at a teaching hospital in rural India.

Background: Though benign breast diseases are very common with nearly 1/3 of women suffering some time during their life time, not many studies have focused on this entity, especially in rural areas. Our teaching hospital situated amongst the villages in rural part of India provided the right background for the study. Objective: To determine the frequency of benign breast diseases in a teaching hospital situated in the rural setting and to analyze the role of triple assessment in assessing benign breast diseases. Study design: Prospective, descriptive study. Setting: MVJ Medical College and Research Hospital, Hoskote, Bangalore Rural district, Karnataka, India. Method of study: Data including age, complaints, clinical examination, radiological investigations and histopathological diagnosis was collected from patients presenting to the department of surgery with breast complaints. Patients with carcinoma of the breast were excluded from the study. Results: A total of 110 patients were studied between November 2009 to March 2011. Mean age of patients was 28.6 years. Fibroadenoma was the most common diagnosis in 56.4% followed by fibroadenosis in 20.9%. There was one case each of lipoma, tuberculosis and duct ectasia and two cases of atypical ductal hyperplasia. The sensitivity of clinical diagnosis in our study was 91.1% and FNAC was 100% accurate in all patients with fibroadenoma but had a sensitivity of only 78% in the diagnosis of fibroadenosis. Only 3.3% of cases of fibroadenoma were treated conservatively.

Morphological changes in the gills of Heteropneustes fossilis (Bloch) exposed to coal mining effluent water.

Ultrastructural changes in the gills of cat fish Heteropneustes fossilis exposed to coal mining effluent water collected from Rymbai river in Jaintia hills, Meghalaya, India was investigated under scanning electron microscopy (SEM). The pH of effluent water in the river was significantly low (2.5 – 3.0) due to coal mining activity in the adjacent areas. The dissolved oxygen (DO) was 7.7 mg l-1 and conductivity 0.93 mS. Morphological changes like dissociation of the epithelium (E) of branchial arches and gill filaments, hypertrophy and disorientation in the array of lamellae were observed in the treated fish, leading to fish death. The primary and secondary gill lamellae (PL and SL) exhibited fusion, distortion and loss of alignment. Some of the gill rackers showed necrosis at certain places. The morphological features of the gills as revealed through SEM were highly deteriorated when compared to control.

Effectiveness of physical activity promotion in blood pressure and blood sugar reduction: a community-based intervention study in rural south India

Physical activity of moderate intensity for 30 minutes a day, on most days substantially reduces the risk of many chronic diseases. To assess the effect of regular physical activity on blood pressure and blood sugar levels in a rural Indian community. This community-based study was carried out in Periakattupalayam and Rangareddipalayam in south India, with 485 subjects, aged 20 to 49 years. The study was done in five phases: Awareness campaign, baseline assessment of participants, intervention phase [10 weeks], interim, and final assessment. Physical activity of moderate intensity [brisk walking for 30 minutes on four days / week] was promoted by forming 30 small walking groups, in a home-based setting, with professional supervision. Village leaders and Self-Help Group members were the resource people for the promotion of physical activity. Analysis was done by using paired 't' test; the 'Intention-to-Treat' approach was utilized for the interpretation of the findings of the study. Of the 485 subjects, 265 [54.6%] complied with walking on more than four days / week, while 156 [32.2%] walked on one to four days / week, and 64 [13.2%] dropped out during the intervention period. This study has shown that a 10-week intervention to promote physical activity was effective in significantly decreasing the population's BP by 1.56 / 0.74 mm Hg, fasting blood sugar levels by 2.82 mg%, body weight by 0.17 kg, and BMI by 0.06 kg / m[2]. This study has proved the functional feasibility of enabling people to undertake physical activity in a rural Indian community, and the effectiveness of using physical activity, to significantly reduce the population's mean BP and blood sugar levels

Population dynamics of earthworms in relation to soil physico-chemical parameters in agroforestry systems of Mizoram, India.

Earthworm population dynamics was studied in two agroforestry systems in the tropical hilly terrain of Mizoram, north-east India, over a period of 24 months, from July 2002 to June 2004. Two sites of agroforestry situated at Sakawrtuichhun (SKT) and Pachhunga University College (PUC) campus, Aizawl, having pineapple as the main crop, were selected for detail studies on population dynamics. Five of the total twelve species of earthworm reported from the state were recorded in the study sites. The density of earthworm ranged from 6 to 243 ind.m-2 and biomass from 3.2 - 677.64 g.m-2 in SKT. Comparatively the density and biomass in PUC, which is at relatively higher altitude were lower with a range of 0 to 176 ind.m-2 and biomass from 0 - 391.36 g.m-2 respectively. Population dynamics of earthworm was significantly correlated with rainfall and physical characters of the soil. Earthworm biomass was significantly affected by rainfall and moisture content of the soil. The influence of chemical factors was relatively less.

N-terminal PDZ-like domain of chromatin organizer SATB1 contributes towards its function as transcription regulator.

The special AT-rich DNA-binding protein 1 (SATB1) is a matrix attachment region (MAR)-binding protein that acts as a global repressor via recruitment of CtBP1:HDAC1-containing co-repressors to its binding targets. The N-terminal PSD95/Dlg-A/ZO-1 (PDZ)-like domain of SATB1 mediates interactions with several chromatin proteins. In the present study, we set out to address whether the PDZ-domain-mediated interactions of SATB1 are critical for its in vivo function as a global repressor. We reasoned that since the N-terminal PDZ-like domain (amino acid residues 1–204) lacks DNA binding activity, it would fail to recruit the interacting partners of SATB1 to its genomic binding sites and hence would not repress the SATB1-regulated genes. Indeed, in vivo MAR-linked luciferase reporter assay revealed that overexpression of the PDZ-like domain resulted in de-repression, indicating that the PDZ-like domain exerts a dominant negative effect on genes regulated by SATB1. Next, we developed a stable dominant negative model in human embryonic kidney (HEK) 293T cells that conditionally expressed the N-terminal 1–204 region harbouring the PDZ-like domain of SATB1. To monitor the effect of sequestration of the interaction partners on the global gene regulation by SATB1, transcripts from the induced and uninduced clones were subjected to gene expression profiling. Clustering of expression data revealed that 600 out of 19000 genes analysed were significantly upregulated upon overexpression of the PDZ-like domain. Induced genes were found to be involved in important signalling cascades and cellular functions. These studies clearly demonstrated the role of PDZ domain of SATB1 in global gene regulation presumably through its interaction with other cellular proteins.

Evaluation of phytoconstituents and anti-nephrotoxic and antioxidant activities of monochoria vaginalis

Monochoria vaginalis is an herbaceous medicinal plant used to treat, liver problems India. Acetaminophen is a commonly used analgesic and antipyretic agent which, at high doses, causes liver and kidney necrosis in man and animals. The aim of the present study is to evaluate phytoconstituents and investigate the nephroprotective and antioxidant activities of the ethanol extract of Monochoria vaginalis on acetaminophen induced toxicity in rats. Phytoconstituents like n-hexadecanoic acid, 3-methyl- acetate-1-butanol, 1,1,3-triethoxy- propane, Z,Z,Z-1,4,6,9 - nonadecatetraene, undecanoic acid, 3-trifluoroacetoxy penta decane and 4-ethyl-5-octyl-2,2-bis [trifluoromethyl] - cis-l,3-dioxalone were identified from ethanol extract of Monochoria vaginalis by using a gas chromatograph-mass spectrograph [GC MS]. Biochemical studies show that there is an increase in the levels of serum urea and creatinine along with an increase in the body weight and reduction in the levels of uric acid in acetaminophen induced groups. These values are retrieved significantly by treatment with Monochoria vaginalis extracts at two different doses. The antioxidant studies reveal that the levels of renal SOD, CAT, GSH and GPx in the APAP treated animals are increased significantly along with a reduced MDA content in ethanol extract of Monochoria vaginalis treated groups. Apart from these, histopathological changes also reveal the protective nature of the Monochoria vaginalis extract against acetaminophen induced necrotic damage of renal tissues. In conclusion, these data suggest that the ethanol extract of Monochoria vaginalis can prevent renal damage from APAP induced nephrotoxicity in rats and it is likely to be mediated through active phytoconstituents and its antioxidant activities

Malignant epignathus teratoma

A baby boy who had a left facial mass detected on antenatal ultrasound was delivered by Caesarian section after foetal distress was detected. Imaging investigations by plain radiographs and MRI showed a large mass with calcifications, soft tissue, fat and fluid components. A total surgical excision was perfomed and histology examination showed teratoma with no malignant features. Two weeks postoperatively, there was rapid recurrence of the tumour with intracranial involvement and obstructive hydrocephalus shown on MRI. The tumour was inoperable at surgery and the baby subsequently died at 5 weeks of life. This case describes the clinical course and imaging features of a neonatal epignathus teratoma with malignant and aggressive features.

Osteosarcoma of the rib

This case describes the radiological-surgical correlation of a rare case of osteosarcoma of the rib in a 15-year-old boy. Successful repair of his chest wall defect using a wire mesh following extensive surgical resection of the tumour is highlighted,such a procedure being the first instituted at our centre.

Identifying the need for pre-hospital and emergency care in the developing world: a case study in Chennai, India.

OBJECTIVES: Increasing industrialization in the developing world has contributed to an epidemiological transition in disease pattern from infectious disease as a primary cause of morbidity and mortality, to more chronic illness such as heart disease and trauma. This study was done in order to assess the effectiveness of pre-hospital and emergency care as the health care needs of the population changes and to make recommendations to meet the growing need for organized emergency services in that community. METHODS: Sundaram Medical Foundation Hospital in the town of Annanagar, Chennai, India was our study site. Statistics describing the health status, demographic, and socio-ecoomic profiles of the community were obtained from a published community survey. Information regarding availability of resources in the hospitals for management of trauma and cardio-vascular emergencies was obtained from unpublished survey results of the local hospitals. Retrospective data was obtained from trauma and ambulance registries regarding trauma related admissions, death and pre-hospital assistance. RESULTS: Data analysis revealed increasing mortality from trauma and cardiovascular etiologies. Hospital statistics showed that 1/3 of the annual hospitalizations were from trauma and acute coronary syndromes. Half the trauma victims had no formal prehospital intervention. Standard of care in the emergency departments varied considerably with less than half of them carrying defibrillators and only a third of them carrying defirbillators and only a third of them carrying intubation equipment. CONCLUSION: As developing countries begin to urbanize and grow, so do their health care needs. The current system does not meet the needs of increased mortality from trauma and cardiovascular disease. We have suggested necessary changes for establishment of emergency medical services to meet the evolving health care needs.