Structural insights into loss of function of a pore forming toxin and its role in pneumococcal adaptation to an intracellular lifestyle.

The opportunistic pathogen Streptococcus pneumoniae has dual lifestyles: one of an asymptomatic colonizer in the human nasopharynx and the other of a deadly pathogen invading sterile host compartments. The latter triggers an overwhelming inflammatory response, partly driven via pore forming activity of the cholesterol dependent cytolysin (CDC), pneumolysin. Although pneumolysin-induced inflammation drives person-to-person transmission from nasopharynx, the primary reservoir for pneumococcus, it also contributes to high mortality rates, creating a bottleneck that hampers widespread bacterial dissemination, thus acting as a double-edged sword.

Lung protective strategy and prone ventilation resulting in successful outcome in a patient with ARDS due to H1N1.

Acute respiratory distress syndrome (ARDS) is an acute respiratory condition caused by various pulmonary and extrapulmonary conditions including H1N1 virus infection. ARDS has a high mortality worldwide and in India various studies suggest that mortality in children is as high as 73-75%. Different lung protective ventilation strategies have recently been adopted to reduce mortality.

Vomiting and food refusal causing failure to thrive in a 2 year old: an unusual and late manifestation of congenital duodenal web.

Congenital duodenal anomalies like atresia, stenosis and web or diaphragm commonly present in the neonatal age with signs of intestinal obstruction. Duodenal webs can sometimes present in early infancy and very rarely beyond infancy. The authors present a case of congenital duodenal web with a very small central aperture in a 2-year-old child with presenting features of persistent vomiting and resultant failure to thrive without any overt signs of intestinal obstruction.

Social factors in clinical complexity: reflections from a paediatric unit.

Medical text books have taught us evaluation and diagnosis of disease based on patients' symptoms, signs and relevant investigations and treatment is then implemented according to the clinical condition and current best available evidence. There are objective scoring scales to assess the severity of the condition, progress and eventual outcome. These scales rarely if ever consider the impact of social factors on the course of treatment and eventual clinical outcome.