Morgagni hernia with Down syndrome: a rare association -- case report and review of literature

Morgagni hernia is a rare diaphragmatic hernia accounting for only 2% of the congenital diaphragmatic defects. A case of Morgagni hernia was diagnosed radiologically in a 12-months-old male with Down syndrome, with recurrent respiratory distress and chest deformity. The 2-dimensional echocardiography was normal. The diagnosis of Morgagni hernia was confirmed by barium studies. The patient underwent a corrective surgery at 18 months of age following which his symptoms subsided. Literature review revealed only 18 cases of Morgagni hernia with Down syndrome reported till date, with age of presentation varying from neonatal age group to 12 years of age. The mode of presentations varied from asymptomatic detection to severe respiratory distress. The possible mechanism of association and its clinical implication has been discussed. The case emphasises a need for diaphragmatic hernia to be looked for as a possible cause of respiratory distress in Down syndrome.     

Ovarian dysgenesis with balanced autosomal translocation

Autosomal translocations are rare in the patients with ovarian dysgenesis. An 18-year-old female who presented with primary amenorrhoea had hypergonadotropic hypogonadism and streak ovaries with hypoplastic uterus. Karyotype analysis revealed a balanced autosomal translocation involving chromosomes 1 and 11. The probable role of autosomal translocations in ovarian dysgenesis has been discussed.     

Lipid profile in the progeny of parents with ischemic heart disease

Lipid profile of 50 offsprings of parents with ischemic heart disease and 15 control children aged 5–16 years was studied. The children in both the groups were categorized into 3 sub groups, 5–10, 11–15 & >15 years. The Serum total cholesterol levels (mean ±S.D.) (in mg/dl) in the test group were 169.8±15.13, 173.34±33.56, 177.4±27.89 respectively for the 3 age subgroups. The Serum LDL cholesterol levels (mean ±S.D) (in mg/dl) in the test group were 102.2±15.25, 95.13±30.38, 101.09±26.96 respectively. The serum total cholesterol levels (mean ±S.D) (in mg/dl) in the control group were 123±1.33, 118±7.51 and 127.4±5.77 respectively for the 3 age subgroups. The serum LDL cholesterol levels (mean +S.D) (in mg/dl) in the control group were 56.64±8.75, 43.36±6.10 and 45.16±6.78 respectively. The serum total cholesterol and LDL cholesterol levels in the test group were significantly higher as compared to controls (p>0.05). Among test subjects, 54% had elevated total cholesterol (>170 mg/dl) and 38% had elevated LDL cholesterol (>110 mg/dl). These cases had a significant correlation with elevated parental total cholesterol and LDL cholesterol levels (p>0.05). Thus, a selective screening of the offsprings of parents with premature ischemic heart disease and hypercholesterolemia is advocated.     

Neonatal parotitis

Neonatal parotitis is a rare condition. Infection of the parotid glad is more common than that of the submandibular glad. Dehydration is the most important predisposing factor for this. Most common organism responsible for this condition is Staphylococcus aureus. Untreated condition can lead to various complications.     

Why i.p. therapy cannot yet be considered as a standard of care for the first-line treatment of ovarian cancer: a systematic review.

A National Cancer Institute (NCI) clinical announcement recommended i.p. therapy for women with optimally debulked ovarian cancer. Its basis was a summary of eight randomised controlled trials and two systematic reviews, which appear to indicate benefit of i.p. therapy. However, the systematic reviews that inform the recommendations have been inappropriately presented and interpreted. The systematic reviews inappropriately pooled results from 'confounded' trials in which different drugs and different doses of drugs were given in the control and i.p. treatment arms. Therefore, it is not possible to assess which component of treatment is responsible for improving outcome. In addition, none of the trials use a control arm of the internationally accepted standard of care. Using just the unconfounded trials, indirect comparisons show that the magnitude of benefit observed when i.p. regimens are compared with older i.v. regimens [hazard ratio (HR) for overall survival (OS) 0.75; 95% confidence interval (CI) 0.60-0.92, P = 0.006] is smaller than the magnitude of benefit achieved with modern day standard of i.v. treatment compared with the same i.v. regimen used as control in the unconfounded i.p. trials (HR for OS 0.68; 95% CI 0.58-0.80, P < 0.001). A further difficulty is that the reviews cannot recommend an i.p. regimen for standard use. Drug-related toxicity and catheter complications that occur with i.p. therapy are considerable. The NCI recommendations have major implications for the treatment of women with ovarian cancer and for the next generation of clinical trials. We do not believe that the body of evidence currently available supports the recommendation that i.p. therapy should form part of routine care. The choice of treatment of women with newly diagnosed, optimally debulked, ovarian cancer, where therapy has the best chance of influencing OS, is too important to be left with this uncertainty. A clinical trial that investigates a practical and acceptable regimen which gives some or all chemotherapy by the i.p. route and compares this with standard i.v. chemotherapy should be a priority for those who wish to promote its use.     

Experience with Kangaroo mother care in a neonatal intensive care unit (NICU) in Chandigarh, India

Objective  To study the feasibility and acceptability of Kangaroo mother care (KMC) on the low birth weight infants (LBWI) in the neonatal intensive care unit (NICU) by the mothers, family members and health care workers (HCW) and to observe its effect on the vital parameters of the babies. Method  A observation in the NICU. Results  A total of 135 babies (74 boys and 61 girls) who completed minimum of 4 hrs of KMC/day, were included. The mean birth weight and gestation were 1460gm and 30 week respectively. 47% babies started KMC within first week of age. Mean duration of KMC was 7 days (3–48) days. The O₂ saturation improved by 2–3%, temperature (°C) rose from 36.75 ± 0.19 to 37.23 ± 0.25, respiration stabilized (p<0.05 for all) and heart rate dropped by 3–5 beats. No episodes of hypothermia or apnea were observed during KMC. KMC was accepted by 96 % mothers, 82% fathers and 84% other family members. 94% HCW considered it to be safe and conservative method of care of LBWI. Benefits of KMC on the babies’ behavior and on maternal confidence and lactation were reported by 57%, 94% and 80% respectively. A decline in use of heating devices in the NICU was reported by 85% and 79% said it did not increase their work load. Conclusion  KMC was found to be safe, effective and feasible method of care of LBWI even in the NICU settings. Positive attitudes were observed in mothers, families and HCW.     

Evaluation of khat (Catha edulis Forssk) for antifertility activity in rats

The effect of the methanolic extract of khat (Catha edulis Forssk) was studied on female fertility in rats. The parameters included the effect on oestrus cycle, implantation, foetal loss, abortion, inhibition of uterotrophic activity and teratogenicity. The extract, in the doses of 250 and 500 mg/kg, produced dose dependent and significant anti-implantation activity. However, it failed to produce complete infertility in this dose range. Treatment of animals during day 8 to day 12 of pregnancy produced significant abortifacient activity. There was significant decrease in the weight and length of foetuses delivered by rats treated with the extract but there were no gross abnormalities in the organs of the offsprings. It also produced significant anti-oestrogenic activity as assessed by the mean weight of the uteri of rats treated with oestradiol and its combination with the khat extract.