This is the opening issue of Chettinad Health City Medical Journal for the year 2019. There is a good assortment of articles from various specialties which is the hallmark of our Journal. The perspective article on Food as the Accelerator and the Brake of Human Progress has very valuable tips for a good eating habit. A series of a rare and interesting dermatosis, the Sneddon -Wilkinson Disease, with only about 200 cases have been reported so far. This is very educative, there is also an original article on the animal study in the use of two different culture media, namely, sequential culture media and single culture media for in-vitro embryo culture, which is a high quality research work. There are interesting case reports on the anesthetic management of two rare situations - SLE patient with multiorgan involvement with ischiorectal abscess and a redo valve replacement in a patient with endocarditis and thrombocytopenia - both of which have been managed very efficiently and successfully.

Subcorneal pustular dermatosis is a rare, chronic, relapsing neutrophilic dermatosis characterized by typical clinical pattern of eruption with multiple sterile, flaccid pustules , vesiculopustules or bullae commonly arising in females with a predisposition to the flexural sites. Its characteristic histopathology reveals subcorneal neutrophilic infiltrate. Here we report a case series of three patients of different age groups -15 year old male, 23 year old female and a 45 year old female who came with the complaints of sudden onset of discrete, flaccid pustules over the body. Most of them showed hypopyon formation. Patients were otherwise healthy and asymptomatic.

Embryo quality plays a significant role in determining the success in ART (Assisted Reproductive Technology). In-vitro embryo culture in varying culture media per se has its own impact on the embryo quality. Due to the varying compositions in Sequential and Single embryo culture media, this study was carried out to compare the outcomes of pre-implantation embryo culture using these media.

Systemic Lupus Erythematosus (SLE) is a multisystem disorder. The cause of SLE is unknown. It is believed to be a combination of genetic and environmental factors contributing to the formation of the antibodies that lead to lupus. SLE has a wide spectrum of presentation, ranging from mild to severe life-threatening disease. It is characterized by its waxing and waning course. So patient can present at any stage and severity of disease for either elective or emergency intervention. A thorough pre-anesthetic evaluation is mandatory for safe anesthesia and anesthetic plan must be individualized based on the degree of the involvement of the various systems, current medications, and review of detailed laboratory investigations. Here in, we report a case of SLE with high damage index, dialysis dependent end stage renal disease (ESRD) and right heart failure secondary to pulmonary hypertension.

Prosthetic valve endocarditis (PVE) is a serious complication of cardiac valve replacement surgery as it is associated with high rates of morbidity and mortality. Early diagnosis and appropriate treatment determines the clinical outcome of the patient with blood culture-negative endocarditis. Risk of post- operative bleeding, need for transfusion, its associated morbidity and mortality impose a challenge for cardiac surgery in patients with thrombocytopenia. We report a case of 60 year old male with persistent fever and bradycardia for 5 days with negative blood cultures and thrombocytopenia, with history of aortic valve replacement (AVR) done 7 months back, diagnosed as prosthetic valve endocarditis and was taken up for early redo AVR despite thrombocytopenia, following which patient had good recovery. Hence we emphasis that high index of suspicion of infective endocarditis and timely intervention is needed in patients with prosthetic valves presenting with fever for early diagnosis and good outcome.

Cancer is characterized by the uncontrolled proliferation of abnormal cells which have the capacity to spread to normal tissues and healthy organs. Various therapeutic methods such as surgery, radiation, hormone treatment, chemotherapy, bone marrow transplantation, etc are available for the treatment of cancer, however, advanced cancer remains difficult to be treated requiring novel strategies.

Cardiovascular disease (CVD) is the biggest killer and now accounts for over a third of all deaths worldwide. Developing countries like India are simultaneously dealing with poverty related malnutrition and the obesity epidemic related CVD. Chronic diseases like CVD, cancer, obesity, diabetes, arthritis and dementia are increasing 5% annually and cost over $3 trillion healthcare dollars in the US alone. While there are several reasons for these ‘new’ challenges plaguing modern society, the first place to look for a real solution may very well be our diet.