Congenital Diaphragmatic hernia – a review

Congenital Diaphragmatic hernia (CDH) is a condition characterized by a defect in the diaphragm leading to protrusion of abdominal contents into the thoracic cavity interfering with normal development of the lungs. The defect may range from a small aperture in the posterior muscle rim to complete absence of diaphragm. The pathophysiology of CDH is a combination of lung hypoplasia and immaturity associated with persistent pulmonary hypertension of newborn (PPHN) and cardiac dysfunction. Prenatal assessment of lung to head ratio (LHR) and position of the liver by ultrasound are used to diagnose and predict outcomes. Delivery of infants with CDH is recommended close to term gestation. Immediate management at birth includes bowel decompression, avoidance of mask ventilation and endotracheal tube placement if required. The main focus of management includes gentle ventilation, hemodynamic monitoring and treatment of pulmonary hypertension followed by surgery. Although inhaled nitric oxide is not approved by FDA for the treatment of PPHN induced by CDH, it is commonly used. Extracorporeal membrane oxygenation (ECMO) is typically considered after failure of conventional medical management for infants ≥ 34 weeks’ gestation or with weight >2 kg with CDH and no associated major lethal anomalies. Multiple factors such as prematurity, associated abnormalities, severity of PPHN, type of repair and need for ECMO can affect the survival of an infant with CDH. With advances in the management of CDH, the overall survival has improved and has been reported to be 70-90% in non-ECMO infants and up to 50% in infants who undergo ECMO

Texture of inner shelf sediments off Penner river, east coast of India

195-198Grain size studies of surface sediments off Penner river shelf have been carried out. Though there is wide range in the sediment types, the shelf is predominantly occupied by sands. The inner shelf(< 20 m isobath) is composed of silty sands and clays, which are transported towards north by prevailing waves and currents from the fluvial source. Grain size parameters and C-M pattern suggest that the offshore coarse sediments are deposited from beach and shallow marine origin predominantly by rolling. Further the coarse sands are considered to be relict and represent a beach deposit; which may be the result of Flandrian (Holocene) transgression. The well preserved sands indicate that the existing hydrodynamic conditions on the inner outer shelf are strong enough neither to rework the sediments nor transport river contributed fine sediments. to the outer parts

Clay mineral studies in the modern Penner delta, east coast of India

69-74Clay mineral studies have been carried out in the modern sediments of the river channel, estuary, lagoon, tidal creek and shelf of the Penner river. Smectite is the most abundant mineral followed by illite, kaolinite and chlorite. Smectite is more in river channel and in the shelf sediments and lower in estuary, tidal creeks and lagoon. High content of smectite corresponds to high content of clay in the sediments. Illite distribution is just reverse to smectite distribution. The type of clay minerals were determined by the source rocks but their distribution depends on various factors such as selective transport, differential flocculation and response to sediment depositional environment

Perforated appendicitis in children: Is there a best treatment?

Purpose: This study was performed to provide outcome data for the development of evidenced-based management techniques for children with appendicitis in the authors\u27 hospital. Methods: This is a retrospective analysis of 1,196 consecutive children with appendicitis over a 5-year period (1996 to 2001) at a metropolitan hospital. Results: The median age was 9 years (7 months to 18 years). The perforation rate was 38.9%, and the nonappendicitis rate was 5.6%. Predictors of perforation included age less than 8 years, Hispanic ethnicity, generalized abdominal tenderness, rebound tenderness, and increased number of bands. In perforated cases, the median length of stay was 5 days, and the complication rate was 13.5%. There was no difference in complication rates related to type or timing of antibiotics or related to the individual surgeon. There was no difference in infection rates related to type of wound management. Conclusions: Children with perforated appendicitis are treated effectively by a less expensive broad-spectrum antibiotic regimen, expeditious operation by open or laparoscopic technique, primary wound closure, and postoperative intravenous antibiotics until they are afebrile for 24 hours and have a white blood cell count of less than 12,000/mm3. This approach is to be used in our prospective, randomized analysis of children treated on or off a clinical pathway. © 2003 Elsevier Inc. All rights reserved

Plasma adenosine deaminase activity among HIV1 Clade C seropositives: relation to CD4 T cell population and antiretroviral therapy

Background Plasma adenosine deaminase and its isoenzymes(s) activities have been used as diagnostic marker for intracellular parasitism, including HIV infection, and malignancy of immune cells. HIV infection being primarily targeted against CD4 cells, it would be of interest to relate the activity of total plasma ADA and isoenzymes fractions to immune status and antiretroviral therapy. Methods In the present study, plasma total ADA activity (ADA<SUB>T</SUB>) including ADA<SUB>1</SUB> and ADA<SUB>2</SUB> isoenzyme(s) were assayed among HIV seropositive Clade C (n = 90) comprising both asymptomatic (n = 71) and symptomatic (n = 19) and compared with that of HIV seronegatives (n = 35). Results A significant increase in the activity of ADA<SUB>T</SUB> (16.30 ± 0.80 v/s 6.18 ± 0.30) as well as ADA<SUB>1</SUB> (6.50 ± 0.42 v/s 2.34 ± 0.16) and ADA<SUB>2</SUB> (9.79 ± 0.53 v/s 3.85 ± 0.23) isoenzyme(s) among the asymptomatic as well as the symptomatic subjects as compared to respective controls was noted. Increase in plasma ADA<SUB>T</SUB> activity, including ADA<SUB>1</SUB> and ADA<SUB>2</SUB> isoenzyme(s), were found to have negative correlation with CD4 counts (r, - 0.273; p &lt; 0.05). The increased plasma ADAT activity among the asymptomatic HIV seropositive with CD4 counts &gt; 500 (13.2 ± 1.65; p &lt; 0.01) as well as those who were on antiretroviral therapy (19.31 ± 1.36; p &lt; 0.001) was evident. Conclusions These findings suggest that plasma ADA can be a sensitive marker of an ongoing biological insult to host tissues either because of infection and/or side effects of medication. Measurement of plasma ADA activity, along with serological evidence for HIV infection may provide an alternate laboratory tool to monitor intracellular parasitism including secondary infection vis a vis the after effects of therapeutic outcome