Resuscitation of extremely preterm infants - controversies and current evidence

Despite significant advances in perinatal medicine, the management of extremely preterm infants in the delivery room remains a challenge. There is an increasing evidence for improved outcomes regarding the resuscitation and stabilisation of extremely preterm infants but there is a lack of evidence in the periviable (gestational age 23-25 wk) preterm subgroup. Presence of an experienced team during the delivery of extremely preterm infant to improve outcome is reviewed. Adaptation from foetal to neonatal cardiorespiratory haemodynamics is dependent on establishing an optimal functional residual capacity in the extremely preterm infants, thus enabling adequate gas exchange. There is sufficient evidence for a gentle approach to stabilisation of these fragile infants in the delivery room. Evidence for antenatal steroids especially in the periviable infants, delayed cord clamping, strategies to establish optimal functional residual capacity, importance of temperature control and oxygenation in delivery room in extremely premature infants is reviewed in this article

Correlation between Hand Length and Various Anthropometric Parameters

Background: Estimation of stature is very important chapter in the field of Forensic anthropometry. The present study is a serious effort to establish correlation between Height of an individual and five parameters; Arm span, Hand length, Hand breadth, Foot length, and Foot breadth. Method: Sample of 273 living cases (138 male and 135 female students) between the ages of 17 and 23 years with no obvious deformities or previous history of trauma to hands, feet, spine and limbs, were studied at Government Medical College, Bhavnagar. Sample represents the population of Gujarat. Results: This study shows significant correlation between stature and all five parameters at different degrees. Mathematical formulas were used for estimation of stature from Arm span, Hand length, Hand breadth, Foot length, and Foot breadth. Arm span showed the highest correlation with stature (r=0.908) followed by Hand length, followed by foot length. Hand Breadth showed the lowest degree of correlation (0.467). Conclusion: Present study will be definitely helpful to forensic experts and crime scene investigators in establishing identity of an unknown individual. Copyright©2012 Department of Forensic Medicine and Toxicology. All rights reserved

Acridine Orange Fluroscence Study of Lung - Histopathology in Autopsy Cases of Burns

Background: The major cause of death in the burn patients includes multiple organ failure and septicemia but, sometimes the exact cause of death in many fatally burn patients is difficult to detect. Aim: The aim was to study various histopathological changes in lung in the post-mortem cases of burns, by using routine Haematoxylin and Eosin stain (H&E stain). Periodic and Schiff ’s Stain (PAS) stain to study the role of acridine orange fluorescence study, to explore the forensic utility of this study and to find out the relationship between duration of survival and histopathological changes observed. Material & Methods: Total 32 cases of death due to burns were autopsied at mortuary from october 2010 to september 2012, department of Forensic Medicine and Toxicology in our hospital. These were forwarded to Department of Pathology for histopathological examination. Result: In the present study, maximum number of burns cases in 21-30 years of age group & female predominance. Grossly, 19 cases (59.38%) showed congestion while microscopy showed diffuse alveolar damage (34.38%). The sections stained by acridine orange and observed under fluorescent microscope were negative in 28 cases (87.50%) and lightly positive in 04 cases (12.50%). Conclusion: Routine microscopy does help us in getting specific lesions in lung due to burns. But PAS and Acridine orange fluorescence do not add anything further in our knowledge of pathology due to burns. However, none of these add any new tool to resolve any forensic issues of burns. Therefore, microscopy (including PAS and fluorescent), if done would be redundant

The Wnt/β-catenin pathway regulates growth and maintenance of colonospheres

<p>Abstract</p> <p>Background</p> <p>Recent evidence suggests that epithelial cancers, including colorectal cancer are driven by a small sub-population of self-renewing, multi-potent cells termed cancer stem cells (CSCs) which are thought to be responsible for recurrence of cancer. One of the characteristics of CSCs is their ability to form floating spheroids under anchorage-independent conditions in a serum-free defined media. The current investigation was undertaken to examine the role of Wnt/β-catenin pathway in regulating the growth and maintenance of colonospheres. Human colon cancer cells HCT-116 (p53 wild type; <it>K-ras </it>mutant), HCT-116 (p53 null; <it>K-ras </it>mutant) and HT-29 (p53 mutant) were used.</p> <p>Results</p> <p>Colonospheres formed <it>in vitro </it>exhibited higher expression of colon CSCs markers LGR5, CD44, CD166 and Musashi-1 along with putative CSC marker EpCAM, compared to the corresponding parental cancer cells and also exhibit the ability to form spheroids under extreme limiting dilution, indicating the predominance of CSCs in colonospheres. Colonospheres formed by HCT-116 cells show over 80% of the cells to be CD44 positive, compared to ≤ 1% in the corresponding parental cells. Additionally, colonospheres showed reduced membrane bound β-catenin but had increased levels of total β-catenin, cyclin-D1 and c-myc and down regulation of axin-1 and phosphorylated β-catenin. Increased expression of β-catenin was associated with a marked transcriptional activation of TCF/LEF. The latter was greatly decreased following down regulation of β-catenin by the corresponding siRNA, leading to a marked reduction in CD44 positive cells as well as colonospheres formation. In contrast, upregulation of c-myc, a down-stream effector of TCF/LEF greatly augmented the formation of colonospheres.</p> <p>Conclusion</p> <p>Our data suggest that colonospheres formed by colon cancer cell lines are highly enriched in CSCs and that Wnt/β-catenin pathway plays a critical role in growth and maintenance of colonospheres.</p

The effect of surveillance and appreciative inquiry on puerperal infections : a longitudinal cohort study in India

Peer reviewedPublisher PD

Study protocol for First Dental Steps Intervention: feasibility study of a health visitor led infant oral health improvement programme.

BACKGROUND: Dental caries in childhood is a burden on the daily lives of children and their families, and associated with poor oral health in adulthood. In England, dental caries is the most common reason for young children to be admitted to hospital. It is believed that most tooth extractions (due to decay) for children aged 10 years and under, could be avoided with improved prevention and early management. National public health policy recommendations in England include specific oral health initiatives to tackle tooth decay. One of these initiatives is delivered as part of the Healthy Child Programme and includes providing workforce training in oral health, integrating oral health advice into home visits, and the timely provision of fluoride toothpaste. This protocol seeks to assess the delivery of the First Dental Steps intervention and uncertainties related to the acceptability, recruitment, and retention of participants. METHODS: This study seeks to explore the feasibility and acceptability of the First Dental Steps intervention and research methods. First Dental Steps intervention will be delivered in local authority areas in South West England and includes oral health training for health visitors (or community nursery nurses) working with 0-5-year-olds and their families. Further, for vulnerable families, integrating oral health advice and the provision of an oral health pack (including a free flow cup, an age appropriate toothbrush, and 1450 ppm fluoride toothpaste) during a mandated check by a health visitor. In this study five local authority areas will receive the intervention. Interviews with parents receiving the intervention and health visitors delivering the intervention will be undertaken, along with a range of additional interviews with stakeholders from both intervention and comparison sites (four additional local authority areas). DISCUSSION: This protocol was written after the start of the COVID-19 pandemic, as a result, some of the original methods were adjusted specifically to account for disruptions caused by the pandemic. Results of this study will primarily provide evidence on the acceptability and feasibility of both the First Dental Steps intervention and the research methods from the perspective of both families and stakeholders

Diabetes Health, Residence & Metabolism in Asians: the DHRMA study, research into foods from the Indian subcontinent - a blinded, randomised, placebo controlled trial

<p>Abstract</p> <p>Background</p> <p>Coronary heart disease (CHD) is highly prevalent amongst the South Asian communities in Britain. The reasons for this excess CHD risk are multifactorial, but in part relate to a susceptibility to diabetes mellitus - where the aberrant metabolism of non-esterified fatty acids (NEFA) and glucose are likely to underpin vascular disease in this population. Dietary intervention is an important and first line approach to manage increased CHD risk. However, there is limited information on the impact of the South Asian diet on CHD risk.</p> <p>Methods/Design</p> <p>The Diabetes Health, Residence & Metabolism in Asians (DHRMA) study is a blinded, randomised, placebo controlled trial that analyses the efficacy of reduced glycaemic index (GI) staples of the South Asian diet, in relation to cardio-metabolic risk factors that are commonly perturbed amongst South Asian populations - primarily glucose, fatty acid and lipoprotein metabolism and central adiposity. Using a 10-week dietary intervention study, 50 healthy South Asians will be randomised to receive either a DHRMA (reduced GI) supply of chapatti (bread), stone ground, high protein wheat flour and white basmati rice (high bran, unpolished) or commercially available (leading brand) versions chapatti wheat flour and basmati rice. Volunteers will be asked to complete a 75g oral glucose tolerance test at baseline and at 10-weeks follow-up, where blood metabolites and hormones, blood pressure and anthropometry will also be assessed in a standardised manner.</p> <p>Discussion</p> <p>It is anticipated that the information collected from this study help develop healthy diet options specific (but not exclusive) for South Asian ethnic communities.</p> <p>Trial registration</p> <p>Current Controlled Trials <a href="http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=ISRCTN02839188">ISRCTN02839188</a></p

Metastatic appendiceal adenocarcinoma presenting late as epididymo-orchitis: a case report and review of literature

BACKGROUND: Whereas testicular metastases are in themselves a rare entity, testicular secondaries from an appendiceal carcinoma have not yet been described. The case also illustrates the diagnostic dilemma of a tumour presenting as epididymo-orchitis. CASE PRESENTATION: The authors present a case of an appendiceal carcinoma that, two years after radical therapy, manifested as a secondary in the testis. It was misdiagnosed as an epididymo-orchitis and was only revealed through histology. CONCLUSIONS: Practitioners need to remember that long-standing testicular inflammation may result form secondary tumours. Even "exotic" primary tumours in the medical history of the patient must give rise to an increased suspicion threshold