Prophylactic Amnioinfusion During Labour Complicated by Meconium

EDITORIAL COMMENT: This study of amnioinfusion during labour complicated by the known passage of meconium shows that the technique seems clinically worthwhile, even in a centre without facilities for electronic fetal heart monitoring or scalp blood pH and blood gas analysis. The series is small and more data from larger studies is required to test the conclusions reported by the authors.
Summary: A prospective study to see the safety and efficacy of transcervical amnioinfusion in labour complicated by meconium-stained amniotic fluid (MSAF) was carried out in a teaching hospital with limited resources. Fifty patients in labour with meconium-stained amniotic fluid and fulfilling the inclusion criteria (vertex presentation, gestational age of 36 weeks or more, no medical or obstetrical complications and normal fetal heart rate at time of inclusion) were taken for the study; 25 patients received amnioinfusion. The control group received only supportive therapy. Labour outcome was compared in the 2 groups. The incidence of Caesarean section was seen to be decreased but neonatal parameters showed no significant difference in the amnioinfusion group.     

Cellular and molecular mechanisms in the development of a cleft lip and/or cleft palate; insights from zebrafish (Danio rerio)

Human cleft lip and/or palate (CLP) are immediately recognizable congenital abnormalities of the face. Lip and palate develop from facial primordia through the coordinated activities of ectodermal epithelium and neural crest cells (NCCs) derived from ectomesenchyme tissue. Subtle changes in the regulatory mechanisms of NCC or ectodermal epithelial cells can result in CLP. Genetic and environmental contributions or a combination of both play a significant role in the progression of CLP. Model organisms provide us with a wealth of information in understanding the pathophysiology and genetic etiology of this complex disease. Small teleost, zebrafish (Danio rerio) is one of the popular model in craniofacial developmental biology. The short generation time and large number of optically transparent, easily manipulated embryos increase the value of zebrafish to identify novel candidate genes and gene regulatory networks underlying craniofacial development. In addition, it is widely used to identify the mechanisms of environmental teratogens and in therapeutic drug screening. Here, we discuss the value of zebrafish as a model to understand epithelial and NCC induced ectomesenchymal cell activities during early palate morphogenesis and robustness of the zebrafish in modern research on identifying the genetic and environmental etiological factors of CLP.     

Comparison of the flow characteristics of irrigants with standard and Max‐i‐Probe needles

The objectives of this study were to determine the direction and pattern of flow of irrigating solutions inside simulated root canals with different irrigation needles; and to determine whether different needle designs increase the likelihood of irrigating solution passing through the apical foramen. Two types of needles were compared: a standard needle with a bevel and an open end, and a needle with a side opening and closed rounded tip. Observations of irrigant flow within the canals indicated that the side‐venting needle can be dangerous if the needle gauge is small and it reaches the full length of the canal, since this allowed irrigants to flow into the periapical area. With the standard needle, the fluid did not go beyond the tip of the needle when minimal irrigating pressure was employed. As the size of canal increased, the fluid did not extrude beyond the tip of both needles. However, if the needles bound in the canals, then the fluid was forced away from the needle tip, and the pressure applied to the syringe was directly proportional to the distance the fluid flowed away from the needle tip. Both side‐venting and standard needles can be used for irrigation safely and effectively if a dynamic irrigation technique (moving the needle up and down inside the canals while irrigating) is employed.     

A Correlation of the Platelet Count with D-Dimer Levels as an Indicator for Component Therapy in Children with Dengue Hemorrhagic Fever

Dengue Fever (DF) may evolve into two life threatening forms—Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS). DHF is associated with increased vascular permeability and plasma leakage causing thrombocytopenia and loss of clotting factors into the third space and may result in bleeding initially due to thrombocytopenia and later due to disseminated intravascular coagulation (DIC), often as a terminal event. Prompt recognition and treatment of minor bleeds in DF children with incipient DIC with component therapy may be associated with improved survival while failure to do so is usually catastrophic. A sensitive marker for early DIC is the presence of D-dimer (DD) in the blood. To determine the correlation between the severity of thrombocytopenia and early DIC in children with DHF. The impact of additional factors like age and shock will also be evaluated. Case control prospective study of 60 DHF sero -positive children (1–15 years) with thrombocytopenia. After clinical evaluation they were divided into two equal groups based on the degree of thrombocytopenia (more than/less than 30,000/mm³). PT/APTT and DD levels were estimated in all children of both groups and statistical correlation was done. There was no significant difference in the DD levels between the two groups. However, children in either group, presenting with clinical features of shock and thrombocytopenia had significantly higher DD levels. Empirical component therapy in children with DHF based purely on their low platelet counts may not be justified. However, in DHF children with thrombocytopenia and features of shock, aggressive component therapy may prevent subsequent bleeding and may be justified.     

Asymptomatic Carotid Stenosis: Immediate Revascularization or Watchful Waiting?

Based on several randomized clinical trials, carotid revascularization has been shown to reduce future stroke risk among individuals with severe asymptomatic carotid stenosis. However, a well-recognized problem with such prophylactic intervention is the risk of periprocedural stroke, death, or myocardial infarction. If actual stroke risk with asymptomatic carotid stenosis can be reduced significantly by aggressive medical management, carotid revascularization may yield marginal benefit or even cause harm especially in those with limited life expectancy. Based on recent observational data, it is becoming apparent that the stroke risk in this population has been declining with better medical management alone. This has prompted a few to avoid carotid revascularization for asymptomatic carotid stenosis altogether. Others feel such conclusions cannot be made with observational data alone. In the midst of this controversy, it is important that clinicians perform carotid revascularization on a case by case basis while ensuring optimal medical management in all patients. An algorithmic approach to decision making based on available evidence will enable clinicians to personalize patient management with efficiency.     

The TNF-derived TIP peptide activates the epithelial sodium channel and ameliorates experimental nephrotoxic serum nephritis

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