‘On-table’ extubation in elective paediatric congenital cardiac surgery: A feasibility study in a developing country

Background  

‘On-table extubation’ (OTE) is a simple, cost-effective method promising wider applicability. Most congenital cardiac corrective surgeries involve post operative ventilatory support that lead to ventilator associated complications and cost overuns in elective Congenital Cardiac Surgery (CCS). The objective of the study is to assess the feasibility and safety of OTE in patients undergoing for CCS.     

High-risk corneal allografts: A therapeutic challenge

Corneal transplantation is the most common surgical procedure amongst solid organ transplants with a high survival rate of 86% at 1-year post-grafting. This high success rate has been attributed to the immune privilege of the eye. However, mechanisms originally thought to promote immune privilege, such as the lack of antigen presenting cells and vessels in the cornea, are challenged by recent studies. Nevertheless, the immunological and physiological features of the cornea promoting a relatively weak alloimmune response is likely responsible for the high survival rate in “low-risk” settings. Furthermore, although corneal graft survival in “low-risk” recipients is favourable, the prognosis in “high-risk” recipients for corneal graft is poor. In “high-risk” grafts, the process of indirect allorecognition is accelerated by the enhanced innate and adaptive immune responses due to pre-existing inflammation and neovascularization of the host bed. This leads to the irreversible rejection of the allograft and ultimately graft failure. Many therapeutic measures are being tested in pre-clinical and clinical studies to counter the immunological challenge of “high-risk” recipients. Despite the prevailing dogma, recent data suggest that tissue matching together with use of systemic immunosuppression may increase the likelihood of graft acceptance in “high-risk” recipients. However, immunosuppressive drugs are accompanied with intolerance/side effects and toxicity, and therefore, novel cell-based therapies are in development which target host immune cells and restore immune homeostasis without significant side effect of treatment. In addition, developments in regenerative medicine may be able to solve both important short comings of allotransplantation: (1) graft rejection and ultimate graft failure; and (2) the lack of suitable donor corneas. The advances in technology and research indicate that wider therapeutic choices for patients may be available to address the worldwide problem of corneal blindness in both “low-risk” and “high-risk” hosts.     

Assessment of anterior segment parameters under photopic and scotopic conditions in Indian eyes using anterior segment optical coherence tomography

PURPOSE: To compare the anterior segment parameters in photopic and scotopic conditions using anterior segment optical coherence tomography (AS OCT) in Indian eyes. MATERIALS AND METHODS: One hundred eyes of 100 normal subjects of both sexes, aged 19 to 76 years, underwent anterior segment evaluation by AS OCT (Visante OCT). Central corneal thickness (CCT), central anterior chamber depth (ACD), pupil diameter (PD) and the temporal and nasal peripheral irido-corneal angles were assessed in photopic and scotopic conditions. These anterior segment parameters were stratified for age, sex and refractive error. RESULTS: Mean values of the parameters measured in photopic and scotopic conditions respectively were as follows: ACD (mm) 2.88 +/- 0.32, 2.89 +/- 0.32 (P = 0.10); nasal angle (degrees) 28.80 +/- 5.91, 22.28 +/- 7.50 (P < 0.001); temporal angle (degrees) 29.95 +/- 6.74, 22.82 +/- 8.43 (P < 0.001); pupil diameter (mm) 4.08 +/- 0.91, 4.68 +/- 0.92 (P < 0.001); CCT (microm) 519 +/- 33.88, 519 +/- 33.88. CONCLUSIONS: There was no significant difference in the ACD in photopic and scotopic conditions. While the nasal and temporal angles showed a significant decrease, the pupil diameter showed a significant increase in scotopic conditions. Mean central ACD decreased with age and was shallower in females than in males. It was highest in myopes and lowest in hypermetropes. CCT was not influenced by photopic and scotopic conditions.     

Indistinguishable cellular changes in gastric mucosa between Helicobacter pylori infected asymptomatic tribal and duodenal ulcer patients

AIM： To investigate the changing pattern of different histological parameters occurring in the stomach tissue of Helicobacter pylori （H pylori） infected tribal populations and duodenal ulcer patients among ethnic Bengalis and correlation of the genotypes of H pylori with different histological parameters. METHODS： One hundred and twelve adult individuals were enrolled into this study between 2002 and 2004. Among them, 72 had clinical features of duodenal ulcer （DU） from ethnic Bengali population and 40 were asymptomatic ethnic tribals. Endoscopic gastric biopsy samples were processed for histology, genotyping and rapid urease test. Histologically, haematoxylin and eosin staining was applied to assess the pathomorphological changes and a modified Giemsa staining was used for better detection of Hpylori. For intestinal metaplasia, special stainings, i.e. Alcian blue periodic acid-Schiff and high iron diamine-Alcian blue staining, were performed. PCR was performed on bacterial DNA to characterize the presence or absence of virulence-associated genes, like cagA, and distribution of different alleles of vacA and iceA. RESULTS： Intraglandular neutrophil infiltration, a hallmark of activity of gastritis, was present in 34 （94%） of tribals （TRs） and 42 （84%） of DU individuals infected with H pylori. Lymphoid follicles and aggregates, which are important landmarks in H pylori infection, were positive amongst 15 （41%） of TRs and 20 （40%） of DU subjects. Atrophic changes were observed in 60% and 27.7%, respectively, among DU cases and tribals （P 〉 0.003）. Metaplastic changes were detected in low numbers in both groups. Moderate to severe density distribution of Hpylori in the gastric mucosa was 63% among TRs, whereas it was 62% in DU subjects. There were no significant differences in the distribution of virulence-associated genes like cagA, vacA and iceA of H pylori strains carried by these two populations. CONCLUSION： Our study showed almost similar distribution of inflammatory cells among asymptomatic tribals and DU Bengali patients. Interestingly, the tribal population are free from any clinical symptoms despite evidence of active histologic gastritis and infection with Hpylori strains carrying similar virulence markers as of strains isolated from patients with DU. There was an increased cellular response, especially in terms of neutrophil infiltration, but much lower risk of developing atrophy and metaplastic changes among the tribal population.     

Role of diet in the management of inflammatory bowel disease

Many studies have looked at connections between diet,etiology,signs and symptoms associated with inflammatory bowel disease(IBD).Although these connections are apparent to clinicians,they are difficult to prove qualitatively or quantitatively.Enteral feeding and polymeric diets are equally effective at bringing about remission in Crohn‘s disease(CD).Parenteral feeding is also effective,although none of these methods is as effective as corticosteroid therapy.However,enteral feeding is preferred in the pediat...