16 month old child was brought to the hospital with loose motions, vomiting and a history of failure to gain weight. Examination revealed hepatomegaly. Investigations revealed a space occupying lesion in the right lobe of the liver. She was diagnosed as a case of hepatoblastoma and was given 7 cycles of chemotherapy following which she was taken up for Right hepatectomy. Hepatic malignancies being rare in this age group and the surgery planned being extensive, the anaesthetic management was challenging. The child was taken up as a high risk case and successfully managed with the use of balanced anaesthesia in conjunction with epidural analgesia and invasive pressure monitoring.

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Introduction: Oxygen toxicity is a major limiting factor in underwater combat operations and Clearance diving operations. It is imperative to screen in the induction phase of military diving, those individuals who have lower threshold of oxygen toxicity to avoid it during combat diving operations. In addition, susceptibility to oxygen toxicity is a n entity not only for combat diver but for all divers as in the event of Decompression Sickness (DCS), they shall be exposed to oxygen partial pressures up to 2.8 ATA for prolonged durations as part of standard treatment protocols. A susceptible individual might suffer from oxygen toxicity during a therapeutic recompression. Oxygen Tolerance Test: Oxygen Tolerance Test is a standardised procedure to evaluate the oxygen susceptibility of prospective divers. A physiologically sound protocol based on internationally accepted norms has been developed. Standards of Fitness and Unfitness have also been clearly delineated. Conclusion: By following a standardised protocol for Oxygen Tolerance Test, an objective assessment and recordkeeping is possible. This shall entail a more effective screening during the initial diving medical examination.

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Behaviour is wired into and a product of our brain's circuitry. In this paper we discuss the neuroanatomical templates of education, training and decision making. This awareness is important and could influence the way we train young minds, to take over the mantle of tomorrow's leadership. The bulk of our brain's volume is in two cerebral hemispheres, constituted by the frontal, parietal and occipital lobes. These hemispheres (the neocortex) act as centres of information processing and storage. Life sustenance and locomotion are controlled by the brainstem and cerebellum. The 60 billion neurons we are born with and their connections or synapses constitute the brain's ‘hardware'. While the software for life sustenance is loaded at birth, the information storage zones are blank pages. The dominant mode of information input is initially visual. Speech acquisition facilitates verbal dominance. Verbal information is initially stored in the hippocampus. Hippocampi are ‘sea horse’ shaped structures located in the medial temporal lobes which act as the ‘desktop’ for easy storage and retrieval of information. Hippocampal relations with the lateral ventricle (regenerative potential), the Meyers loop of the visual pathway and the amygdala (rage centre) provide twists in the tale. Information from the hippocampal desktop is projected in waves of bulk information transfer called ‘thalamocortical’ spindles to the neocortex. Fresh inputs modify this information by creating new synapses in a process called neosynaptogenesis. Retrieval and reinforcement of information circuits is by task performance and job training. A silent quorum of neurons (Around 70%) is the repository of our personalities and character and the seat of our souls. Decision making involves the information template. Mature decisions invokes these personal qualities (which too a r e partially acquired and hence modifiable) modulating ethical and humane decisions. Decisions made in anger may bypass the information template altogether in a n ‘amygdala hijack'. The capability of the human brain to process the varying levels of information, knowledge and wisdom anagrams bestows upon it a potential for ‘Fuzzy Logic’ and the ability to create ‘Blue Ocean’ strategies.

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Introduction: Febrile seizures are the most common seizures in children less than five years of age and occur in 2-5%. They are mostly benign with an excellent prognosis. Despite its benign nature, the febrile convulsion is one of the most common reasons for admission .The present study was aimed to study the demographic, clinical & laboratory profile in children admitted with febrile seizures for the first time and compare with other similar studies. Study Design: A descriptive prospective study conducted in a tertiary care centre. A l l children admitted with Febrile Seizure for the first time; aged 06 mo - 60mo were enrolled. Diagnostic criteria as per ??? Clinical Practice Guidelines, 2008 were used. Patient's demographic and clinical data were obtained. Laboratory investigation for each patient was guided by clinical examination. The cause for the fever was evaluated and managed with antibiotics wherever indicated .The data was analysed by using Microsoft Excel. Results: There were 75 children which constituted 5.7% of total Paediatric admissions. Mean age of presentation was 27.78mo (± 15.16 mo) with peak in less than 2 years of age. At presentation, Simple febrile seizure was observed in majority (85.3%). Mean duration of seizure was 1.25 (± 1.23 ) min. Majority of children (n=54, 72%) developed seizure within 24 hours of onset of fever and around 17.3% had positive family history. The upper respiratory tract infection was the most common cause of fever (92%) and around 84.1 % did not require antibiotics. Around 44% of children had microcytic hypochromic anaemia. Recurrence was observed in 4% of patients. The average length of stay (ALS) was 3.4 (+1-2.4) days. Conclusions: Parents should be appropriately counselled regarding prophylaxis and benign nature of illness. The yield of investigation remains low and does not justify extensive workup or prolonged hospitalization. As most of the cases are of viral etiology, antibiotics should be used with discretion.

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Sepsis is the most common cause of neonatal mortality in developing countries accounting for approximately 30-50% of neonatal deaths. Early diagnosis and treatment of neonatal sepsis is crucial for a favourable outcome. Early onset sepsis can presents within hours after birth and is usually acquired from the maternal genital tract. The clinical signs may be subtle and close monitoring of high risk patients is warranted in this scenario. Late onset sepsis usually presents after seventy two hours of birth and the source of infection in this situation is usually nosocomial or community acquired. Blood culture and sepsis screen are two most important diagnostic as well as corroborative investigations in this situation which also help in deciding the appropriate treatment. Presence of polymorphs in gastric aspirate at birth points towards chorioamnionitis and could be used as a n additional parameter of sepsis screen for diagnosing early onset sepsis. Other useful investigations include lumbar puncture, urine culture and chest radiography. An array of newer diagnostic tests is now available for early diagnosis of neonatal sepsis. These tests are highly sensitive and also have a high negative predictive value. The treatment includes supportive care along with administration of appropriate antibiotics. Adjuvant treatment includes IVIG, GCSF, exchange transfusion and pentoxifylline administration. This paper aims to present an algorithmic approach to neonatal sepsis to expedite the diagnosis along with providing appropriate and adequate treatment.

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Spinal myoclonus occurring after spinal anaesthesia is very rare and characterised by sudden involuntary jerks of the back and limbs. A 34 year old male without any comorbidities underwent a subarachnoid block with bupivacaine heavy for laminectomy of L4-L5. Within minutes he developed pain and severe myoclonic jerks of lower back radiating to lower and upper limbs which lasted for 48 hours. Another 65 year old obese lady, known diabetic and hypertensive who presented for a percutaneous nephrolithotomy underwent an epidural catheter placement at L2-L3 and a subarachnoid block with bupivacaine heavy at L3-L4. Within minutes she developed severe myoclonic jerks of the lower limbs and back radiating to upper limbs which again lasted for 48 hours. Both cases ofprolonged acute propriospinal myoclonus following subarachnoid block occurred within a period of six months at a tertiary care centre and were managed with sedation, muscle relaxation, mechanical ventilation and anti epileptics.

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Aim: A n observational cross-sectional study conducted to analyze the impact of diabetes mellitus on anterior chamber depth. Materials and methods: 100 Consecutive diabetic patients aged 40 years and above who attended the Department of Ophthalmology of Command Hospital (Air force) fulfilling the eligibility criteria were included after obtaining informed consent. Anterior chamber depth (ACD) was measured using I O L Master (partial coherence laser interferometry). Patients were grouped into different categories based on duration of diabetes and the glycemic control. Results: 100 right eyes of as many patients were studied. The mean ACD of patients with diabetes more than 5 years was 2.59+0.42 mm compared to 2.74+0.33 mm of patients with less than 5 years duration was statistically significant (p=0.056). In patients with controlled diabetes the mean ACD was 2.96+0.21 mm as against 2.50+0.32 mm of patients with poorly controlled diabetes which was statistically significant (p<0.0001). Conclusion: This study showed that diabetic patients with more than 5 years duration and poor glycaemic control had shallower anterior chamber, than that of those who had diabetes less than 5 years duration and good glycaemic control. ACD can be used as a screening tool for detecting angle closure disease in diabetic patients.

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Introduction: Diving is a n operational commitment of navy. Diving operations are conducted with I without the presence of a MM spl. Study of MM done along with phases of attachments at different diving operational units as practical orientation. Classes of Divers: (a) Ship Diver (SD). Trained to dive up to 35 MSW (b) Clearance Diver (CD): They are trained to dive up to 55 MSW. (c) CD (DD): They are Deep divers, also trained in saturation diving using Helium Oxygen mixture, (d) Chariot Diver: They are combat divers of the Navy. (e)Air crew diver: Specially trained SD & CD. (f) Combat Diver: from Army. Diving Establishments: Diving School - shore estt, kochi. INS Nireekshak - floating platform. INS Satavahana - submarine training estt - shore estt, vizag. INS Abhimanyu - chariot diving with pure Oxygen breather for clandestine operations. CCDH! - one per command, CDU at A & N. INS Matanga, INS Gaj - floating platforms. Recompression Chamber Complex, INHS Asvini Decompression Sickness: Due to metabolically inert gases and due to fast ascent rate. It is never with pure oxygen diving. Never occur while at bottom. As per grading, Type I - not serious type, generally known as bends and Type II - serious type Treatment: Treatment for DCS is followed as per guidelines promulgated in INBR 2806. Mainstay of treatment remains with Oxygen Table 61 & 62 of INBR 2806 which is same as RNBR 2806 as table 5&60fUS navy D i v i n g Manual. Incidences: Incidences of DCS are found at Diving School and Nireekshak. At ETS other diving related injuries like Mask injury, hypoxia, CAGE are documented. At CCDTk no DCS documented in last five years. Conclusion: DCS in Navy is rather very less due to stringent training, fitness of divers and proper follow of procedures.

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Decompression illness is caused by intravascular or extravascular bubbles that are formed as a result of reduction in environmental pressure (decompression). The term covers both arterial gas embolism, in which alveolar gas or venous gas emboli (via cardiac shunts or via pulmonary vessels) are introduced into the arterial circulation, and decompression sickness, which is caused by in-situ bubble formation from dissolved inert gas. Both syndromes can occur in divers, compressed air workers, aviators, and astronauts, but arterial gas embolism also arises from iatrogenic causes unrelated to decompression. Risk of decompression illness is affected by immersion, exercise, and heat or cold. Manifestations range from itching and minor pain to neurological symptoms, cardiac collapse, and death. First-aid treatment is 1 0 0 % oxygen and definitive treatment is recompression to increased pressure, breathing 1 0 0 % oxygen. Adjunctive treatment, including fluid administration and prophylaxis against venous thromboembolism in paralysed patients, is also recommended Treatment is, in most cases, effective although residual deficits can remain in serious cases, even after several recompressions.

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Presentation with intra-abdominal lymphadenopathy comes with a wide range of differentials, usually metastasis from regional organs, tuberculosis and lymphomas. But sometimes they surprise us with a histopathological diagnosis of Castleman's disease (CD). CD, also known as angiofollicular lymph node hyperplasia or giant lymph node hyperplasia is a distinct form of lymphoproliferative disorder of uncertain origin that typically affects mediastinal or axillary lymph nodes. The present report describes a 30-year-old serving male who presented with pain abdomen and on and off episodes ofmelena, found to have peripancreatic lymphadenopathy on CECT abdomen. Ultrasound guided FN AC was done in private hospital revealed reactive lymphadenopathy. Excision biopsy was done in our institute and a diagnosis of Castleman's disease was made.

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Introduction: Diving training involves prolonged exercise at high intensity on daily basis, continued for months. During the daily prolonged training (also known as circuit training), the under-trainee divers carry out running, swimming and other strengthening exercises for a 2-21/2 hrs at a stretch. The divers are not provided with any form of supplementation during the exercise routine. There are occasional incidences of exhaustion and unexplained syncope in these under-trainees especially just before finishing the exercise schedule, which could possibly be due to hypoglycemia. In order to investigate this unexplained syncope, a pilot study was carried out on a batch of under-trainee divers to evaluate their capillary blood sugar levels before and after the training schedule. Material and methods: 36 under-trainee divers (all males) were included in the study. Their blood glucose levels were checked using glucometer (Accuchek active) before and after the circuit training. The findings were recorded on excel worksheet and analysed. Their mean blood glucose levels were calculated pre and post training and a paired 't' test was done to analyse the significance of the change in blood glucose levels. Results: The mean BMI of the under-trainee divers was 22.41±1.25 Kg/m2. The mean blood glucose levels pre-training was 113.92±22.48 mg/dl. 3 0 % under-trainees were found to have pre-exercise blood sugar < lOOmg/dl. Six divers(16.66%) were found to have blood sugar value >140mg/dl. The mean blood glucose after exercise was significantly lower at 91.50±10.80 mg/dl. 75 % divers were found to have post exercise blood glucose< lOOmg/dl. All of the divers with high pre-training glucose levels had post exercise blood glucose < lOOmg/dl. The mean fall in blood sugar values of these was significantly greater as compared to those having pre-training blood sugar < 140mg/dl (65.66±10.01 mg/dl vsl3.76±20.08 mg/dl). Conclusion & Recommendations: It is recommended that HbAlC measurements of all undertrainee divers be carried out prior to induction for training and if found > 6.5%, it should be further investigated using blood sugar fasting (F) and Post Prandial (PP). Also the undertrainee divers should be provided with carbohydrate, salt and fluid supplementation during the circuit training to prevent exhaustion.

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Background: Community acquired Pneumonia (CAP) can be defined clinically as the presence of signs and symptoms of pneumonia in a previously healthy child caused by an infection acquired outside a hospital. CAP is a substantial cause of childhood morbidity and mortality throughout the world. We studied the clinical features, laboratory findings, radiological features of CAP and its complications in children admitted to a tertiary care hospital. Material And Methods: This is a retrospective observational study of 50 children aged 2 months to 14 years admitted under Paediatric care at a tertiary care hospital in Mumbai between Jan 2014 to April 2015. Pneumonia was diagnosed based on evidence of consolidation on chest radiograph and lor presence of clinical findings suggestive of pneumonia. Results: The mean age of children was 4.5 years with range from 4 months to 13 years. Male to Female ratio was 0.98:1. 16 children had pre-existing risk factors. 65% children had history of fever? 5 days with tachypnea noted in 3 2 % children and 2 0 % had SP02 <95%. Tachypnea was noted in 32 % of children. As per WHO clinical classification, the distribution of pneumonia as very severe pneumonia, severe pneumonia; pneumonia; and no pneumonia was 4%,2%, 32% , 62% respectively. However 42% of children as no pneumonia as per WHO criteria had evidence of pneumonia on chest radiograph and remainder 20% had clinical findings on auscultation. 80% of study subjects had evidence ofpneumonia on chest radiograph. Average length of hospital stay was 7.2 days. A l l children were started on intravenous antibiotics. Complications developed in 5 patients. 4% of patients died in our study which co-relates with the outcome in developed nation. Conclusion: Community acquired pneumonia has been on the decline in developed countries due to newer vaccines, anti-microbial therapy, advances in diagnostic modalities and excellent access to healthcare; childhood pneumonia still remains a major cause of morbidity and mortality in developing countries.

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Introduction: Late preterm neonates have been defined as those born between 34 completed weeks to 3 6 weeks and 6 days of gestation. Late preterm neonates though bear close resemblance to full-term neonates in appearance and birth weights; are a special group because they are still physiologically immature and vulnerable. Despite the increase in their numbers, there is limited data concerning problems of late preterm neonates in India. The objective of this study is to compare morbidities of late preterm neonates with term neonates. Study design: Retrospective study conducted at a Level 3 NICU of a tertiary care hospital in Mumbai between Oct 2011 to Sep 2 0 1 3 . Late preterm neonates formed the cases and equal number of matched term neonates formed the controls. Maternal risk factors and neonatal morbidities were compared among the two groups. Results: Late preterm neonates formed a major share of preterm births. Significantly more number of late preterm neonates had the maternal risk factors (as defined) and also required more NICU admissions. Late preterm neonates had lower birth weights compared to term neonates. There was a statistically significant difference in the incidence of respiratory distress consequently requiring more ventilator support in late preterm neonates. Average length of NICU stay was more for late preterm neonates. Conclusion: Late preterm neonates have more neonatal morbidities compared to term neonates.

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A 56 year old female underwent open cholecystectomy followed by exploratory laparotomy the following day. She was not known to have any airway disease. She developed intra and postoperative hypoxemia during and after the second surgery, the first surgery being uneventful. Intra operative findings included decreased air entry over the entire left lung field but post operative there was no air entry on right side. Postoperative Chest X ray and fiber optic Bronchoscopy was performed. Chest radiography revealed right lung collapse, while Bronchoscopy revealed a thick mucus plug causing complete occlusion of the right main bronchus and near total occlusion of the left main bronchus. A Bronchoscopic lavage corrected the problem.

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Oguchi disease, first described in 1907, is a rare autosomal recessive disorder characterized by congenital stationary night blindness with a unique morphological and functional abnormality of the retina. The cause, though largely unknown, is associated with ARRESTIN and RHODOPSIN KINASE gene defects. This is a case report of a 20 yr old male patient of Oguchi disease who presented with classical symptoms and morphological features in the form of Mizuo phenomenon.

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Biosimilars are highly similar versions of already authorized innovator biological therapies. They demonstrate no clinically meaningful difference with their innovator products in terms of efficacy, safety and quality characteristics and biological activity. Biosimilars have demonstrated growing acceptance and use, especially in the developing countries due to severe cost constraints. Global market for Indian non-innovator products is approximately worth USD 1.5 Billion/annum with an annual growth rate of 27%. Estimated exports of Indian biopharmaceutical products have been increasing at a rate of 47%. In India, there is a good acceptance of non-innovator healthcare products amongst healthcare professionals and patients. Several home grown biopharmaceutical industries are now actively developing and marketing non innovator products in India.

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