Venous thromboembolism after major gynecological cancer surgery: an analysis of cause and effect from the experience of a tertiary referral oncologic centre

Background: Patients undergoing extensive gynecological oncologic surgeries are at greater risk for developing deep vein thrombosis and pulmonary embolism than other oncological procedures. The anatomical confinement of vessels, lymphatics, and other structures in the restrictive pelvic space is contributory. We aimed to establish the etiopathogenesis of venous thromboembolism (VTE) with our practical experience.Methods: We present our experience from a tertiary referral oncologic centre in north India in patients with ovarian cancer undergoing cytoreductive surgery (CRS) with or without HIPEC, with a focus on the incidence and etiopathogenesis of deep venous thromboembolism (DVT), including anatomical barriers, restricted movement during surgical dissection, risk stratification and preventive measures.Results: Of 250 patients who underwent cytoreductive surgery (CRS) for ovarian cancer, 124 additionally underwent hyperthermic intraperitoneal chemotherapy (HIPEC). 20 (8%) patients were diagnosed with DVT within 30 days of surgery, and 3 (1.2%) were detected after 30 days. It is the most common significant postoperative morbidity.Conclusions: DVT is the most common postoperative complication in patients undergoing CRS+HIPEC for carcinoma ovary. Anatomical confinement, closed dependant spaces and more significant surgical trauma to pelvic vessels and lymphatics may be the leading cause. Detailed knowledge of anatomy and careful surgical dissection may prevent the development of DVT.

Breast mass - An uncommon clinical manifestation of ovarian carcinoma: A case report and brief literature review

Metastasis from non-mammary malignant neoplasms to the breast is rare and represents 0.2%-1.3% of all breast malignancies. Fine needle aspiration cytology (FNAC) is the first line of investigation for any breast lump and cyto-morphological appearance of primary breast malignancies is well documented. Occasionally metastasis to the breast may be the initial presentation and can masquerade clinically as primary breast malignancy. The present case describes the clinical and cytological challenges in an unusual case of ovarian carcinoma with initial presentation as breast mass, mimicking as inflammatory carcinoma. In cytology the breast lesion was initially misdiagnosed as primary breast carcinoma and subsequently diagnosed as metastatic ovarian carcinoma based on core needle biopsy findings, aberrant immuno-profile and clinical findings; thus making the complex case worthy of discussion.

Oral metronomic chemotherapy for recurrent & refractory epithelial ovarian cancer: A retrospective analysis

Background & objectives: Advanced epithelial ovarian cancer (EOC) is associated with dismal outcome and progression-free survival (PFS) shortens with each subsequent relapse. For patients with recurrent and platinum refractory disease, therapeutic options are limited. Oral metronomic therapy (OMT) is associated with symptomatic relief and stable response in a significant proportion of patients. We retrospectively evaluated the outcome of patients with EOC treated with OMT at a tertiary care hospital in north India. Methods: Between January 2011 to December 2017, 36 EOC patients received OMT. Patients' median age was 50 yr (range, 38-81 yr) and they had received a median of two lines of prior chemotherapy. OMT regimen included a combination of cyclophosphamide, etoposide (VP-16) and celecoxib with or without pazopanib along with supportive care. Response rates and outcomes were ascertained using the Gynecological Cancer Intergroup Guidelines. The toxicity was graded according to the Common Terminology Criteria for Adverse Events v.4.03. Results: The median CA-125 before initiating OMT was 160 U/ml (range, 42.23-5330 U/ml). The median interval between last chemotherapy and starting OMT regimen was 159 days (range, 1-1211 days). The overall response rate was 50 per cent. The median progression-free survival (PFS) was 8.2 months [95% confidence interval (CI): 5.03-10.33], and the median overall survival was 38 months (95% CI: 25.6-NR). Patients who received two lines of chemotherapy before OMT (P=0.052) and those who received pazopanib-based OMT (P=0.0513) had better PFS. Interpretation & conclusions: For patients with relapse and refractory EOC, OMT could be a reasonable option. A combination of oral etoposide (VP-16) and pazopanib needs further evaluation in a large number of patients in a randomized trial.

Estimation of patient perception on hygiene standards in a tertiary care hospital, West Bengal: A questionnaire-based study

Background: Maintenance of hygiene is very important to lead a healthy, disease-free life. Lack of hygiene increases the chance of communicable and non-communicable diseases. Wastes generated by the hospitals increase the chance of nosocomial infections. Objective: The present study deals with the patient’s perception about hygiene and sanitation rendered by the hospitals. Materials and Methods: The present study was a questionnaire-based cross-sectional survey. The data were collected from the indoor patients admitted in the Department of Surgery, Obstetrics and Gynecology, and General Medicine during December 2016–January 2017 at a Medical College in Kolkata. Results: In the present study, a total of 150 patients were taken as study population, of which majority of them were female. The major age group of the study population was 32–39 years, 33 (22%). In the present study, 93.33% of patients responded that the food was hygienic, 90% of patients opined that all housekeeping staffs used their protective equipment while they were collecting the garbage in this hospital, and 78% of patients agreed that the dustbins were cleaned regularly. Conclusion: In order to improve patients’ compliance and reduce the sufferings, evaluation of to hospital hygiene is of utmost importance. Awareness programs should be implemented in hospitals and health-care centers about the importance and maintenance of hygiene. This would reduce the chances of hospital-borne infections not only for the patients but also for the hospital workers.

A Clinical Study of Acute Subdural Hematoma: A Prospective Study

Background: Acute subdural hematoma (ASDH) is seen in approximately one-third of patients with severe traumatic brain injury and in half to more than two-thirds of those undergoing hematoma evacuation. ASDH is associated with high rates of mortality, ranging from 40% to 90%. The aim of this study is to analyze the clinical spectrum and to evaluate the outcome. Methods: It is a prospective study conducted at the Department of Neurosurgery, Rangaraya Medical College, Kakinada, over a period of 2 years from December 2015 to December 2017. 100 cases are taken for study with head injury, diagnosed to have traumatic ASDH. A detailed clinical history, clinical examination, and computed tomography (CT) scan performed in all cases. Patients segregated as mild, moderate, and severe types of head injuries and studied various factors such as age, sex, mode of injury, Glasgow coma score at admission, pupillary reactivity, surgical/conservative management, and Glasgow outcome score. Results: About 49% of patients are in 3rd–5th decade, percentage of mortality is increasing with age. Male predominance is seen. Rural population is more affected than urban. Road traffic accidents are the most common mode of head injuries. Glasgow coma scale (GCS) between 9 and 12 was found in 46% of patients. Moderate type of TBI is the most common type of neurological presentation at the time of admission. CT images of 53 patients showed <5 mm thickness, 23 patients showed 5–10 mm, in 24 patients, it is >10 mm. Of 100 patients, surgical approach is considered in 50 patients while the remaining 50 patients were managed conservatively. Conclusions: GCS between 9 and 12 was found most common mode of presentation at the time of admission GCS <8 showed highest mortality of 80%, GCS 13–15 showed no mortality. Prognosis is worse in patients with pupillary abnormalities than those without. Early surgery leads to better prognosis.

Epidemiology of Acute Subdural Haematoma – A Prospective Study

Background: Epidemiological knowledge of Acute Subdural Haematoma (ASDH) is needed to prevent and to develop care and rehabilitation of patients. Aims & Objectives: The aims and objectives of this study is to find the solotionsto decrease the incidence of ASDH and offer recommondationsto their prevention. Material & Methods: It is a prospective study conducted in Department of Neurosurgery, Rangaraya Medical College, Kakinada over a period of two years from December 2015 to December 2017. 100 cases are taken for study with head injury, diagnosed to have traumatic Acute Subdural Haematoma (ASDH). Epidemiological pattern of ASDHis studied by performing a systematic review of literature, using information obtained from our centerGovernment General Hospital, Neurosurgery Department, Kakinada. collecting data on demographics, showing characteristics of ASDH including incidence, identification of risk groups on differences in age, gender, geographical variation, severity and mortality. Results: Studies suggest that the incidence of ASDH is between 10 -45 % leading cause of death. Men and people living in social and economical deprived areas, usually young adults and the elderly are high-risk groups for ASDH.: 49% of patients are in 3rd to 5th decade., percentage of mortality is increasing with age. Male predominance is seen. Rural population is more effected than urban. Road Traffic Accidents are the most common mode of head injuries GCS between 9-12 was found in 46% of patients and is most common mode of presentation at the time of admission Conclusions: Most public epidemiological data showed that ASDH is a major cause of mortality and disability. The effort to understand ASDH and the available strategies to treat this lesion, in order to improve clinical outcomes after ASDH, may be based on an increase in research on the epidemiology of ASDH.

Surgical Management of Acute Traumatic Subdural Haematoma: A Single-Center Prospective Study

Background: Acute SDH is seen in approximately one third of patients with severe TBI and in half to more than two thirds of those undergoing hematoma evacuation. Acute SDH is associated with high rates of mortality. Surgical treatment is still Controversial. an analysis of our institutional data is performed in patients with traumatic ASDH to study factors determining clinical outcome. Methods: 50 patients with ASDH underwent surgical treatment are taken for prospective study in our Neurosurgery department, Rangaraya Medical College, Kakinada, between Dec.,2015 to Dec.,2017. Information including patient characteristics, treatment modality, radiologic features, and functional outcome were analyzed. Outcome was assessed according to the Glasgow Outcome Scale (GOS) at 1 month. Furthermore, a multivariate analysis was performed to identify independent predictors of functional outcome. Results: 22% of patients with ASDH after Decompressive Craniectomy achieved favorable outcome. <60 years male patients are commonly effected. Road Traffic Accidents are common mode of injury. Right side Decompressive Craniectomies are commonly done. In this study the overall mortality rate is 60%. Conclusions: A detailed data is provided on patients with ASDH. Despite poor GCS at admission & dilated pupils favorable outcome may be achieved in many patients after Decompressive Craniectomy. Nevertheless, careful individual decision making is necessary for each patient, especially when signs of cerebral herniation have persisted for a long time.

Do Traumatic Acute Subdural Hematoma Patients with a Glasgow Coma Scale Score of 3 and Bilateral Fixed and Dilated Pupils Have any Chance of Survival?

Background: Low Glasgow coma scale score (GCS) and pupillary status predict poor outcomes in traumatic acute subdural hematoma (ASDH) patients. We compared the mortality of GCS 3 patients having bilateral fixed and dilated pupils (BFDPs) with GCS 3 patients having reactive pupils (RPs). We then determined if trauma system or patient factors were responsible for the difference in mortality. Methods: We reviewed all adult, traumatic ASDH patients with GCS 3, admitted to our institution from December 1, 2015 to December 31, 2017. Demographics, injury data, prehospital times, procedures, and outcomes were recorded. Results: During this period, 145 patients were admitted with GCS of 3, and met inclusion criteria. In all, 100 patients were analyzed, after excluding 20 patients who were dead on arrival, and 25 others, who were intoxicated with alcohol or received paralytic agents in the trauma room. All BFDP patients died, whereas 87% of RP patients died. With regard to patient factors, BFDP patients were more likely to be unstable, have extra-axial bleeding, and evidence of midline shift and/or herniation. Trauma system factors, however, may also have had an impact on outcome. Despite having more extra-axial bleeding, BFDP patients were less likely to have a neurosurgical operation than RP patients. Conclusion: Patients with GCS of 3 and BFDPs have a 100% mortality. These patients have suffered devastating brain injuries and tend to be hemodynamically unstable. Clinicians, however, are less likely to aggressively treat BFDP patients than RP patients. Further prospective studies are required to determine which patients with GCS of 3, and BFDPs are likely to benefit from aggressive treatment.

Effect of surfactants and temperature on germination and vegetative growth of Beauveria bassiana

Three non-ionic surfactants: Tween20, Tween80 and Breakthru® were screened for their effects on spore germination and mycelial growth rates and for their influence on three isolates of Beauveria bassiana spore germination at various temperatures. Tween20 and Tween80 were compatible with all the B. bassiana isolates in the germination studies, but inhibited germination at higher surfactant concentrations, irrespective of the conidial concentrations. Breakthru® had an inhibitory effect on germination even at the lowest concentration of 0.1% on all the B. bassiana isolates. The effects of the surfactants on spore germination did not correspond with their effects on colony growth. Conidial viability within the same formulation declined significantly with increases in temperature, irrespective of the surfactant. The optimal temperature for conidial germination of B. bassiana isolates was approximately 25 °C with an upper limit at 30 °C. Isolate 7320 was identified as the least affected by the different surfactants. This isolate was able to germinate rapidly in a broad temperature range of 25–30 °C after 24 h, this characteristic being an essential factor in controlling house fly populations in poultry houses.

Prevalence and Risk Factors of Metabolic Syndrome among Individuals Living with HIV and Receiving Antiretroviral Treatment in Tanzania.

Aim: To estimate the prevalence and risk factors for metabolic syndrome (MetS) among HIV positive patients on antiretroviral therapy (ART) in Tanzania. Study Design: A cross sectional study was conducted among adults aged ≥18years living with HIV-infection and receiving ART. Place and Duration of Study: The study participants were recruited from 12 care and treatment clinics in Dar es Salaam (urban) and Mbeya (rural) regions between October 2011 and February 2012. Methodology: The prevalence of MetS was assessed using International Diabetes Federation’s criteria. Biochemical assays, anthropometric measurements, demographic characteristics and lifestyle behavioural data were collected. Results: Study response rate was 351/377(93.1%) and 177 (50.4%) recruited participants were from urban settings and 238 (67.8%) were females. The prevalence of MetS was 25.6% and was higher among participants from urban than those from rural areas (35.6% vs 15.5%, p<.001). The components of MetS including raised triglyceride (43.5% vs 21.3%, p<.001), low high density lipoprotein (85.9% vs 28.2%, p<.001) and raised blood fasting glucose (10.2% vs 5.2%, p=.04) were more common among participants from urban than those from rural settings. MetS Risk factors including; consumption of fruits/vegetables <5 days/week (77.0% vs 59.3%, p<.001), not participating on vigorous intensity activities (65.5% vs 29.4% p<.001) and consuming mixed cooking oil (animal/vegetable) (15.5% vs 8.5%, p=.03) were higher among participants from rural than those from urban areas. In rural, only consumption of vegetables/fruits <5 days/week (AOR=5.50, 95%CI 1.21-24.95, p=.005) predicted the prevalence of MetS. In urban; sex (female) (AOR=3.01, 95%C 1.31-6.85, p=.002), having primary/no formal education (AOR=0.32, 95%CI 0.12-0.89, p=.04) and ex- or current alcohol drinker (AOR=2.43, 95%CI 1.17-5.06, p=.02) were significant predictors of MetS. Conclusion: Prevalence, components and predictors of MetS prevailed more in urban than in rural settings. Interventions targeting prevention of MetS to reduce diabetes and cardiovascular diseases should consider settings diversification.

Myeloid Sarcoma of Maxillo-Ethmoidal Sinus: An Uncommon Presentation of Acute Myeloid Leukemia.

Introduction: Myeloid sarcoma (MS) is a rare localized extramedullary tumor of myeloid precursor cells. Short clinical history: An 11-year-old male presented with nasal bleed, two days; breathlessness and loss of appetite, one month and bilateral nasal blockade for two months. There was no fever. On clinical examination, bilateral cervical lymphadenopathy and hepatosplenomegaly was found. On opening mouth, a pink mass hanging behind the soft palate was noted. Magnetic resonance imaging of head and neck revealed a nasopharyngeal mass in maxillo-ethmoidal sinus. Gross pathology: Excised mass was greenish pink, measuring 2 × 2 × 2 cm. Microscopic examination: Hemogram revealed total leukocyte count 1.2 lac/mm3, hemoglobin 10.1 g/dl, and platelet count 41,000/mm3. Differential count showed 24% blasts with marked left shift. Bone marrow aspirate revealed 27% blasts. No auer rod seen. Cytochemistry showed myeloperoxidase (MPO) positivity. Trephine biopsy showed myeloid hyperplasia with excess blasts. Histopathological examination of lymph nodes and soft tissues showed leukemic infiltration. Immunohistochemistry showed blasts positive for MPO and negative for CD3. On multicolor flow cytometry blasts were positive for MPO, CD34 and CD45, and negative for CD3 and CD79a. A diagnosis of MS with acute myeloid leukemia (AML) was made. Discussion: It is rare in children (1 month-89 years). Any site of body, most commonly skin, lymph node, bone, etc. are affected. Prediction of first appearance of MS or AML was difficult in this case. MS may progress to AML simultaneously or may remain localized, never progressing to AML. Conclusion: Any extramedullary tumor showing myeloid precursor cells, should be investigated for MS, easily misdiagnosed as solid tumors.

Distal arthrogryposis syndrome.

A 5-month-old male infant presented with weak cry, decreased body movements, tightness of whole body since birth, and one episode of generalized seizure on day 4 of life. He was born at term by elective caesarian section performed for breech presentation. The child had failure to thrive, contractures at elbow and knee joints, hypertonia, microcephaly, small mouth, retrognathia, and camptodactyly. There was global developmental delay. Abdominal examination revealed umbilical and bilateral inguinal hernia. Visual evoked response and brainstem evoked response audiometry were abnormal. Nerve conduction velocity was normal. Magnetic resonance imaging of brain revealed paucity of white matter in bilateral cerebral hemispheres with cerebellar and brain stem atrophy. The differential diagnoses considered in the index patient were distal arthrogryposis (DA) syndrome, cerebroculofacioskeletal syndrome, and Pena Shokier syndrome. The index patient most likely represents a variant of DA: Sheldon Hall syndrome.

CARACTERIZACIÓN DEL TALLO ACEPTOR DEL tARN MEDIANTE DESCRIPTORES LOCALES BASADOS EN CARGAS PARCIALES / tRNA ACCEPTOR STEM CHARACTERIZATION BY MEANS OF LOCAL DESCRIPTORS BASED ON PARTIAL CHARGES / CARACTERIZAÇÃO DO TALO ACEITADOR DO tRNA MEDIANTE DESCRITORES LOCAIS BASEADOS EM CARGAS PARCIAIS

En este trabajo se caracteriza la distribución de carga del tallo aceptor del tARN, considerando todas las posibles combinaciones de pares Watson-Crick. El estudio se realizó con 256 fragmentos moleculares de 10 nucleótidos que modelan los tres primeros pares del tallo aceptor, la base diferenciadora y el extremo CCA. Para caracterizar los nucleótidos se proponen dos descriptores locales basados en la distribución de carga de la base nitrogenada de cada nucleótido, los cuales se calculan a partir de las cargas parciales de Mulliken obtenidas de cálculos HF/6-31G. La caracterización y clasificación de los tallos según estos descriptores mostró cómo la base diferenciadora tiene un comportamiento particular respecto a los demás nucleótidos del tallo y una fuerte influencia sobre el extremo CCA. La clasificación de nueve variaciones del tallo aceptor del tARNAla mostró una buena relación estructura-actividad que pone en evidencia la bondad de los descriptores propuestos para caracterizar de manera local la distribución de carga de estas biomoléculas.

In this work the charge distribution of the tRNA acceptor stem is characterized, considering all the possible Watson- Crick base pair combinations. 256 RNA fragments modeled by 10 nucleotides were used in order to model the first three pairs of the acceptor stem, the discriminator base and the CCA end. We propose two local charge descriptors based on the charge distribution of the nitrogenated base to characterize each nucleotide. These descriptors were computed from atomic partial charges derived from HF/6-31G calculations. From the characterization and classification of the stems according to the proposed descriptors, we found a special behavior for the discriminator base (in contrast to the other positions) and a strong effect of this position on the CCA end. The classification of nine variations of the tRNAAla acceptor stem showed a good structure-activity relationship that makes evident the usefulness of the proposed descriptors to characterize the local charge distributions of these biomolecules.

Nesse estudo é caracterizada a distribuição da carga do talo aceitador considerando- se todas as combinações possíveis dos pares Watson-Crick. O estudo realizouse com 256 fragmentos moleculares dos 10 nucleotídeos que modelam os três primeiros pares do talo aceitador, a base diferenciadora e o extremo CCA. Com o intuito de caracterizar cada nucleotídeo, foram propostos dois descritores locais baseados na distribuição de carga da base nitrogenada de cada nucleotídeo, os quais se calculam a partir das cargas parciais de Mulliken obtidas de cálculos HF/6-31G. A caracterização e classificação dos talos segundo esses descritores demonstrou um particular comportamento da base diferenciadora em relação aos demais nucleotídeos do talo e uma forte influência sobre o extremo CCA. A classificação de nove variações do talo aceitador do tRNA mostrou uma boa relação estrutura-atividade que colocam em evidência a utilidade dos descritores propostos para caracterizar de maneira local a distribuição de carga dessas bio-moléculas.

Hashimoto's encephalopathy in an adolescent boy.

Hashimoto's encephalopathy is an under-recognized cause of acute encephalopathy both in children and adults. We hereby describe a 12.5 yr old boy with this rare disorder that presented with an acute onset of episodic psychosis with hallucinations along with seizures and had elevated antithyroid antibodies. Symptoms improved with thyroxine replacement and anticonvulsants and EEG normalized 3 mth into follow up. Hashimoto's encephalopathy should be considered in patients with unexplained encephalopathy and seizures, as prompt recognition and management can lead to an excellent outcome.

Shaken baby syndrome masquerading as apparent life threatening event.

A variety of diseases and disorders can present as an acute life-threatening event among which shaken baby syndrome has been recently recognized. A high index of suspicion along with an ophthalmologic evaluation and cranial imaging helps to identify this form of child abuse, which needs multidisciplinary management.

Evaluation of the role of melatonin in formalin-induced pain response in mice.

BACKGROUND: Melatonin, the major secretory product of pineal gland has been suggested to play a regulatory role in the circadian rhythm of body activities including the pain sensitivity. Three subtypes of melatonin receptors, i.e. ML1, ML2 and ML3 have been identified. AIM: To investigate the antinociceptive activity of melatonin and to unravel the underlying receptor mechanisms involved in this action. MATERIAL AND METHODS: Effect of melatonin (25-100 mg/kg, ip) and its interaction with putative melatonin receptor antagonists and opioidergic and serotoninergic agents have been studied in formalin test, a model of tonic continuous pain. Formalin (0.1 ml of 1% solution) was injected under the plantar surface of right hind paw of mice and the time an animal spent in licking the injected paw was measured. STATISTICAL ANALYSIS: The data were analysed by one-way ANOVA followed by Tukey's test for multiple comparisons. RESULTS: Injection of formalin produced two phases of intense licking, an early phase (0-5 min) and a late phase (20-25 min). Melatonin dose-dependently decreased the licking response in both the phases, effect being more marked in the late phase. Luzindole, a ML1 receptor antagonist did not block but rather enhanced the antinociceptive activity of melatonin. However, prazosin, a ML2 receptor antagonist in the low dose (0.5 mg/kg) significantly attenuated but in higher dose (1 mg/kg) enhanced the analgesic effect of melatonin. Naloxone, an opioid receptor antagonist did not reverse but morphine, an opioid agonist enhanced the antinociceptive activity of melatonin. Both mianserin and ondansetron the 5HT2 and 5HT3 receptor antagonists, respectively increased the analgesic effect of melatonin. CONCLUSION: The present results suggest the involvement of ML2 receptors in mediating the antinociceptive activity of melatonin in formalin-induced pain response. Further an interplay between melatonin, alpha-1 adrenergic and 5HT2 and 5HT3 serotoninergic receptors may also be participating in this action.

Management of low back pain.

A sizeable section of world's population develop back pain sometime in their lives and the specific causes cannot be identified. Various clinical conditions like trauma, infection (tuberculous, pyogenic, etc), malignancy, rheumatological diseases, neurological disorders and degenerative diseases produce back pain, and also some systemic illnesses cause the same. Radiological studies are very important for the diagnosis of back pain. Plain radiographs, myelography, computed tomography, magnetic resonance imaging and bone scintigraphy are various radiological procedures often selected for diagnosis. Treatment modality comprises non-surgical and surgical methods. Non-surgical treatment consists of rest, pharmacological therapy, physical therapy and injection therapy. Disc surgery, widening of spinal canal, spinal fusion using bone grafts, removal of tumour or sequestrated disc are carried out when surgical intervention is needed.

Antinociceptive activity of a neurosteroid tetrahydrodeoxycorticosterone (5alpha-pregnan-3alpha-21-diol-20-one) and its possible mechanism(s) of action.

The present study investigates the effects of a neurosteroid tetrahydrodeoxycorticosterone (5alpha-pregnan-3alpha-21-diol-20-one) in two experimental models of pain sensitivity in mice. Tetrahydrodeoxycorticosterone (2.5, 5 mg/kg, i.p.) dose dependently decreased the licking response in formalin test and increased the tail flick latency (TFL) in tail flick test. Bicuculline (2 mg/kg, i.p.), a GABA(A) receptor antagonist blocked the antinociceptive effect of tetrahydrodeoxycorticosterone in TFL test but failed to modulate licking response in formalin test. Naloxone (1 mg/kg, i.p.), an opioid antagonist effectively attenuated the analgesic effect of tetrahydrodeoxycorticosterone in both the models. Tetrahydrodeoxycorticosterone pretreatment potentiated the antinociceptive response of morphine, an opioid compound and nimodipine, a calcium channel blocker in formalin as well as TFL test. Thus, tetrahydrodeoxycorticosterone exerts an analgesic effect, which may be mediated by modulating GABA-ergic and/or opioid-ergic mechanisms and voltage-gated calcium channels.

Hyaline membrane disease in a term neonate.

Hyaline membrane disease is primarily a disorder of preterm infants. Its occurrence in term infants is very uncommon and therefore may escape attention. We describe a term infant who developed severe respiratory distress soon after birth. Diagnosis of hyaline membrane disease was revealed at autopsy.

Strangulation injury, a fatal form of child abuse.

Strangulation is a common method of committing murder, though underreported in Indian literature. We managed a girl child, victim of child abuse who later succumbed to its neurological complications. This case report describes the clinical features associated with such injuries and complications which should be anticipated in such cases.