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We describe a patient who developed severe retroperitoneal and intraperitoneal bleeding complicating femoral arterial catheterization for Percutaneous coronary intervention. Balloon tamponade of the actively bleeding femoral artery was effective in sealing off the leakage. This management strategy for this problem emphasizing an anatomical based interventional approach if the patient does not stabilize with volume resuscitation.

WHO and UNICEF state that the use of human milk from other sources should be the first alternative when it is not possible for the mother to breastfeed. Human milk banks should be made available in appropriate situations. The IYCF Chapter is actively concerned about the compelling use of formula feeds in the infants because of the non availability of human breast milk banks. A National Consultative Meet for framing guidelines was summoned by the IYCF Chapter and the Ministry of Health and Family Welfare, Government of India on 30th June, 2013, with representations from various stakeholders. The guidelines were drafted after an extensive literature review and discussions. Though these guidelines are based on the experiences and guidelines from other countries, changes have been made to suit the Indian setup, culture and needs, without compromising scientific evidence. To ensure quality of donated breast milk as a safe end product. Human Milk Banking Association should be constituted, and human milk banks should be established across the country. National coordination mechanism should be developed with a secretariat and technical support to follow-up on action in States. Budgetary provisions should be made available for the activities.

The National Neonatal Perinatal Database (NNPD) network is a collaborative group of leading neonatal units in India involved in the prospective collection of morbidity and mortality data on uniform protocols. The present article reports the morbidity and mortality profile of outborn neonates in the year 2000. Ten centers provided data on outborn neonates. The data were analysed at the nodal center using Epi-Info statistical software version 6 and Excel 97. A total of 3831 neonates were admitted at the participating institutions. A majority of them (87.2 per cent) were delivered in nursing homes and small hospitals. Most of the admissions (68.7 per cent) were male. Nearly half of them (48.7 per cent) were low birthweight and one-third (32.1 per cent) were preterm. Overall mortality was 16.4 per cent, while 7.5 per cent left hospitals against medical advice. Nearly half of all neonatal deaths occurred within the first 48 h following admission. Common primary causes of deaths (n = 630) included: infections (36.0 per cent), prematurity related conditions (26.5 per cent), perinatal hypoxia (10.0 per cent), and malformations (7.8 per cent). Systemic infections (28.4 per cent), hyperbilirubinemia (27.9 per cent), seizures (11.7 per cent), hypoglycemia (11.5 per cent), hypoxic ischemic encephalopathy (8.3 per cent), anemia (8.9 per cent), and hypocalcemia (8.6 per cent) were common morbidities observed. Of systemic infections, 39.2 per cent were culture positive and 51.4 per cent were early onset (72 h). Sick babies were managed with antibiotics (75 per cent), oxygen administration (45.3 per cent), phototherapy (34.9 per cent), and assisted ventilation (16.3 per cent). In conclusion, the present study describes the morbidity and mortality profile of a large multicentric cohort of outborn neonates from a developing country.

Objective—To correlate substance P content of synovial fluid with prostaglandin E2content, radiographic evidence of joint abnormality, and anatomic location of the joint for normal and osteoarthritic joints of horses.Sample Population—Synovial fluid from 46 normal joints in 21 horses and 16 osteoarthritic joints in 10 horses.Procedure—Normal and osteoarthritic joints were identified by clinical and radiographic examination, by response to nerve blocks, during scintigraphy or surgery, or by clinicopathologic evaluation. Substance P and prostaglandin E2contents of synovial fluid were determined by radioimmunoassay. Radiographs of joints were assigned a numeric score reflecting severity of lesions. Joints were assigned a numeric score reflecting anatomic location.Results—Median concentrations of substance P and prostaglandin E2 were significantly increased in osteoarthritic joints, compared with normal joints. A significant correlation was found between concentrations of substance P and prostaglandin E2in synovial fluid, but a correlation was not detected between substance P concentration in synovial fluid and anatomic location of the joint or between radiographic scores of osteoarthritic joints and concentrations of substance P or prostaglandin E2.Conclusions and Clinical Relevance—A correlation existed between concentrations of substance P and prostaglandin E2in synovial fluid obtained from normal and osteoarthritic joints. However, content of substance P in synovial fluid cannot be predicted by the radiographic appearance of the joint or its anatomic location. Substance P and prostaglandin E2may share an important and related role in the etiopathogenesis of osteoarthritis, lending credence to the importance of neurogenic inflammation in horses. (Am J Vet Res2000;61: 714–718)

In experimental diabetes, diastolic dysfunction of the left ventricle has been associated with collagen-linked glycation. To determine whether less severe hyperglycemia may have similar effects, we gave alloxan to mongrel dogs (group 2) to induce impaired glucose tolerance (IGT) for comparison with normal subjects (group 1). After 6 months, hemodynamic studies were performed in the anesthetized animals. Basal heart rate, aortic pressure, and ejection fraction were comparable in the two groups, but calculated chamber stiffness was increased in group 2, associated with a reduced end diastolic volume and increased pressure. During infusion of dextran, the volume and pressure responses were similarly abnormal in group 2. In the myocardium, the collagen concentration rose with an increased interstitial distribution histologically. To assess glycation, collagen was extracted, digested with collagenase, and measured for fluorescence. Advanced glycation end products were increased in group 2 to 10.6 +/- 1.6 vs. 6.9 +/- 0.7 fluorescent units (FU)/mg collagen in group 1 (P < 0.01). To assess whether this could be pharmacologically prevented, we administered enalapril to inhibit ACE during the 6 months of glucose intolerance to group 3. This resulted in normal glycation and significant reduction in chamber stiffness increment. We gave group 4 animals aminoguanidine daily for 6 months, which prevented abnormal collagen glycation and chamber stiffness. Thus, in animals with IGT, collagen-linked glycosylation appeared to be a major factor affecting diastolic function and was shown to be amenable to pharmacological intervention.

Background and Aims We surveyed late preterm and term mother-newborn dyads (n=380) in a tertiary care hospital to determine the epidemiology of breastfeeding problems during initial 72 hours. Methods The subjects were enrolled within 12 hours of delivery and assessed 12 hourly for perception of and documented breastfeeding problems using validated open ended questionnaire and checklist respectively. Results A total of 220 (57.9%) mothers delivered vaginally, and 228 (60%) had no previous experience of breastfeeding. Nearly all mother-infant dyads had one or more breastfeeding related problems. The major self reported problems included insufficiency of milk (341, 89.7%), difficulty in latching (145, 38.2%) and breast related problems (112, 29.5%). The major documented problems included poor attachment (378, 99.5%), poor positioning (378, 99.5%), breast engorgement (76, 20%) and poor sucking (65, 17.5%). A significant proportion of mother-infant dyads continued to have breastfeeding problems at 72 hours after delivery. The common problems were poor positioning (121, 31.8%), poor attachment (121, 31.8%) and breast engorgement (71, 18.7%). Caesarean delivery was found to be a significant predictor of self reported breastfeeding problems. Conclusion There is a huge burden of breastfeeding problems in mothers delivering at gestation of 34 weeks or more. There is a need to examine the impact of breastfeeding problems and the interventions directed to them on breast feeding outcomes.

Background and aims: We surveyed late preterm and term mother-newborn dyads (n=380) in a tertiary care hospital to determine the epidemiology of breastfeeding problems during initial 72 hours.

Conventional plate ML-ELISA technique for diagnosis of recent cases of amoebiasis was converted into a simple polyvinyl chloride strip multilayer-enzyme linked immunosorbent assay (PVC strip ML-ELISA). This report details the development and preliminary characterization of the PVC strip ML-ELISA method for Entamoeba histolytica antigen detection in human fecal samples. In addition, we evaluated the relative efficacies of the PVC strip ML-ELISA and the conventional plate ML-ELISA methods by screening different categories of amoebiasis patients and other intestinal parasites. A significant correlation was found (P less than 0.01) between the two assay methods with reference to sensitivity and specificity of detecting E. histolytica antigens. However, with reference to operational case and economy, the PVC strip ML-ELISA may be performed even by paramedical technical personnel under field conditions.

Summary Five patients with acute viral hepatitis developed severe intrasvascular haemolysis and unusually high levels of serum bilirubin (427 to 1368 mumol/l). All 5 had high fever, marked anaemia, reticulocytosis and neutrophilic leucocytosis. Three of them developed acute renal failure, which was of non-oliguric type in 2. The clinical course was protracted, but complete recovery occurred in 4 patients between 4 to 10 weeks. One patient with hepatic coma and oliguric renal failure died. Deficiency of the enzyme G-6-PD was confirmed in 4 cases. Massive haemolysis in the patients was probably induced by the administration of chloroquine and other drugs. Intravascular haemolysis should be suspected in patients with acute viral hepatitis, if they show unexplained anaemia and very high serum bilirubin levels, and measures to prevent renal failure should be instituted in such cases.

In this paper, a novel approach is proposed to predict the pressure-settlement and pressure-tilt characteristics of eccentrically-obliquely loaded footings using the hyperbolic stress-strain curves of soils as nonlinear constitutive laws. The analysis is developed for strip footing. Stresses in the soil mass were obtained using the theory of elasticity. It is capable of incorporating the effect of shape, base roughness, and flexibility of footings. The results are obtained for the rigid strip footing resting on clay for load inclinations of 0°, 10°, and 20°, and eccentricity width ratios of 0, 0.1, and 0.2. The values of ultimate pressure obtained using the double-tangent method were found to decrease with the increase in eccentricity and inclination of load, and its comparison with the work of previous investigators showed good agreement.

It has been the primary objective of the considered studies to determine and describe, through calculation, measurement, and visualization of the flowfields, the basic character of isolated and interacting impinging jets. The secondary objective has been to provide computed and experimental flow properties which can be used in the development and verification of empirically based prediction methodologies for complete aircraft configurations. The studies have resulted in the solution of the Reynolds-averaged Navier-Stokes and Jones-Launder turbulence model equations for two- and three-dimensional configurations and in the acquisition of an extensive data base and flow-visualization photographs for these configurations.

Summary A 9 year old Libyan boy presented with a history of delayed walking and abnormal gait. The presence of marked muscle under-development with hypotonia led to the initial diagnosis of primary muscle disease; later, he was found to have hyperelastic, fragile skin and hypermobile joints-the cardinal features of Ehlers Danlos syndrome. In this instance the disease seems to have been inherited in an autosomal recessive manner.