The current issue of the journal features Prof Venkataswami, the pioneer of hand surgery in India in the section- ‘Dialogue with a stalwart.’ This issue of the journal carries several interesting articles. The perspective article on Evolution and Medicine, gives a new insight to many of the commonly observed events in clinical practice. It helps us understand the concept of ‘Beneficial dirt.’

To assess the factors that modify the outcome among asphyxiated out born babies who needed ventilation in a tertiary care centre within 24 hours of life. Study design; Observational cross sectional study Setting; Extramural tertiary care neonatal unit, Subjects: Asphyxiated neonates of gestational age>34 weeks requiring ventilation Methods; 114 asphyxiated neonates were included in the study. Data regarding antenatal risk factors, delivery, stabilization and transport details, status of the baby on admission, course in hospital including time of initiation of ventilation and duration of ventilation and final outcome was obtained, Nested case control design was used to analyse and identify risk factors which modify outcome. Results; Adverse antenatal factors, p 0.02 OR 2.49(1.07 -5.85) low birth weight, [p 0.001] OR 5.78(1.62-21.68) and admission within 6 hours was found to be statistically significant as a predictor of poor outcome [p 0.02] 2.50(1.03-6.09) Hypothermia [p 0.04] OR 2.17(1.00 – 4.80)] on admission was also associated with a poor outcome. Conclusion; Lack of Pretransfer stabilization before transport increases the mortality among asphyxiated neonates. Pretransfer stabilization is absolutely essential in neonates before transport to referral centre .

Oral and peri oral structures offer a myriad of possibilities in Forensic identification. The importance of dental identification is on the increase year after year. With the passage of time, the role of Forensic Odontology has increased as often teeth and dental restorations are the only means of identification. However, they cannot always be used; sometimes it is necessary to apply different and less known techniques.

Angiomyolipoma is an uncommon benign tumor. Clinical presentation of angiomyolipoma either sporadic or in association with tuberous sclerosis has been reported in several studies. Synchronous manifestation of angiomyolipoma and renal cell carcinoma in contralateral kidneys raised clinical suspicion of bilateral renal cell carcinoma in our patient. Patient was a 60 year old male and he was thoroughly investigated for evidence of tuberous sclerosis and was found to have none. Ultrasound evaluation of abdomen did not reveal the characteristic echogenicity of fat in the left kidney. Hence bilateral renal tumors were diagnosed as renal cell carcinoma upstaging the tumor and hence modifying the treatment plan.Computerised Tomography (CT) scan examination further confirmed the diagnosis of bilateral renal cell carcinoma. Histopathology examination however confirmed a sporadic angiomyolipoma in the left kidney and renal cell carcinoma in the right.

The peripheral giant cell granuloma (PGCG) is a rare reactive lesion of the gingival tissues. Usual contributing factors include local irritating factors such as plaque, calculus, food impaction, trauma, badly finished fillings and tooth extraction. This case report presents the clinical and histopathological features and management of a PGCG lesion in a 25-year old man.

Many times’ discoveries are accidents. Louis Pasteur was not an exception: he was indeed an average student, skilled at drawing and painting, earned his Bachelor of Arts degree (1840), Bachelor of Science degree (1842) and a doctorate (1847) at the École Normale in Paris, but a careful observer.

Diabetes is a metabolic disorder characterized by hyperglycemia resulting due to defects in insulin secretion, insulin action or both. Type 2 diabetes mellitus is the most common form of diabetes worldwide and its incidence is increasing exponentially due to lifestyle changes and increasing prevalence of obesity. Both genetic and environmental factors contribute to its development. Though insulin resistance and consequent beta cell dysfunction have been described as the two basic defects in the development of type 2 diabetes, recent research has thrown light on several other mechanisms including dysfunctional adipocytes, defective incretin action, mitochondrial injury, endoplasmic reticulum stress and defective gut brain axis. Modern management of type 2 diabetes includes lifestyle modification measures; oral anti-diabetic agents aimed at managing different patho physiological aspects of diabetes and insulin therapy in uncontrolled diabetes. Cardio vascular risk factors should also be aggressively treated.

Among individuals with diabetes, cardiovascular disease (CVD) is the leading cause of morbidity and mortality. Adults with diabetes have a two- to fourfold higher risk of CVD compared with those without diabetes. Diabetes is also accompanied by a significantly increased prevalence of hypertension and dyslipidemia. The intent of this article is to clarify and reinforce the importance of identifying and treating a core set of risk factors ( hypertension, dyslipidemia, obesity and tobacco use). Moreover, since recent evidence suggests that risk assessment and adherence to guidelines remain woefully suboptimal, we call for a renewed effort to prevent and treat these conditions.

Diabetes Mellitus (DM) was first described about 3500 years ago and given its name about 2200 years ago by Demetrios of Apamaia. The word “Diabetes” derives from the Greek “Diabeinein” or “siphon”, a word that captures its association with excess urination. Although DM has been primarily regarded as a disorder of glucose metabolism and homeostasis, it has more recently been viewed as a constellation of metabolic disturbances, including abnormalities of carbohydrate metabolism, adipose storage, lipid metabolism, and protein biochemistry. Commonly characterized as a disease of impaired skeletal muscle glucose uptake, DM adversely affects hepatic, muscle, adipose and vascular function. It is this last effect that represents the greatest mortality and morbidity hazard to this subset of population.

Childhood onset diabetes is encountered more commonly than before. Previously, the main form of diabetes seen in young children was type 1 diabetes characterized by life threatening ketoacidosis without insulin treatment. However, with the alarming rise in childhood obesity worldwide, type 2 diabetes is increasingly seen in children. With advancement in molecular and genetic basis of diseases, other subtypes of diabetes in children which are monogenic in etiology like Maturity Onset Diabetes in Young (MODY) and neonatal diabetes due to sulphonyl receptor mutation responding to oral drugs are also added to the list of different varieties of diabetes seen in children. A brief review of diagnosis and approach to diabetes in young with special focus on various aspects of management of type 1 diabetes is discussed in this article.

Diabetes is one of the commonest medical complications of pregnancy. It could antedate pregnancy or be identified for the first time during pregnancy when it is termed Gestational diabetes mellitus(GDM). GDM is plagued by controversies right from screening, diagnosis and interventions. Identification of GDM is important as it impacts maternal health care during and after pregnancy. Following Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study and International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations, a new screening and diagnostic criteria seems to be gaining consensus around the world. As India is fast catching up with China to become the diabetic capital of the world, thrust is now on universal early testing in our populations at the first prenatal. visit. Diabetes in Pregnancy Study Group India (DIPSI) has also suggested cost effective method of screening in resource-challenged communities. GDM offers an excellent opportunity for primary prevention of Diabetes, as the mothers are at increased risk of future diabetes, predominantly type 2 diabetes, as are their children.

Hyperglycaemia can occur in patients with known or undiagnosed diabetes, or it may occur during acute illness in those with previously normal glucose tolerance (stress Hyperglycaemia). Hyperglycaemia in hospitalized patients is a common problem with serious medical and financial consequences. Hyperglycaemia as well as hypoglycemia has been shown to worsen morbidity and mortality rates in Intensive care unit (ICU) and non-ICU settings. Though tight glucose control has been shown to improve mortality rates in surgical ICU setting, similar results could not be achieved in medical and mixed ICUs. There are no similar large randomized control trials (RCTs) done in general medical and surgical wards. The failure to show good results with intensive therapy is partly attributable to higher frequency of hypoglycemic episodes.

Diabetes is a metabolic disorder that can affect every aspect of life including the oral cavity. Dental problems in diabetic individuals are so rampant that periodontitis is considered as the sixth complication of diabetes. The objective of this review is to highlight the dental problems frequently seen in diabetes and the importance of maintaining the oral health care of diabetic individuals.

How did your sixty years of successful medical career begin? I hail from a small village called Kothaneri near Virudhunagar. My parents were simple rural folk, Gandhian in outlook and very principled. I did my schooling from Ramakrishna Mission Vidyalaya at Perianaikanpalayam Coimbatore, which shaped my character and inculcated in me many values.

Evolutionary medicine is concerned with the rational understanding of diseases, and the application of this understanding to the prevention and treatment of disease, and betterment of public health. Fundamentally, there are three reasons suggested by evolutionary medicine to account for the origins of disease: 1. Natural selection is slow - our bodies are in an environment to which we were not adapted; in addition, we are competing with faster evolving pathogens. 2. Selection is constrained: every trait is a trade-off, and none can be perfect for all aspects; moreover, natural selection must work with existing situation and possibilities, and cannot recover a path that has been forsaken and lost. 3. We misunderstand: organisms are selected for reproductive success, and when the peak reproductive period is past, individual strength and health decline. Further, we mistake the utility of evolved defence responses like fever, pain, and anxiety, which may cause suffering, but are important in the preservation of life. An evolutionary perspective provides a fascinating understanding of previously baffling areas of human health and disease.