After the first outbreak identified in Mexico in March 2009, influenza A sustained by a modified H1N1 virus (“swine flu”) rapidly spread to all continents. Swine-origin influenza (H1N1) virus is considered a worldwide pandemic and is associated with a large number of patients admitted to intensive care. In a proportion of these patients, acute respiratory distress syndrome (ARDS) can develop. This paper describes a case of life-threatening ARDS associated with H1N1 virus confirmed by a throat swab tested with real-time reverse transcription-polymerase chain reaction. The clinical course was extremely eventful in spite of aggressive management with mechanical ventilation and parental antibiotics. In spite of marked clinical and functional recovery on 30^th day admission in ICU, radiological findings suggestive of ARDS persisted.

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The evolving role of regenerative medicine in functional restoration mandates that all clinicians be aware of its potential and limitation. In this article we attempt an overview of the available knowledge with a look at the technical aspects of cryopreservation techniques.

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As Indian Navy is sentient of its responsibilities as the primary guarantor of security of Indian National interests wherever they may lie and as such has progressively advanced its blue water capability and also enhanced brown water operations to ensure coastal security. In this evolution habitability has emerged as an important gearwheel in operational readiness of naval platforms. Policy makers have progressively fine-tuned operational needs with habitability needs as each new class of ship is inducted and old ones refitted. The need of the hour is to sustain the bench marks set by successive standardizing agencies in Navy Orders and Books of Reference covering these issues. Given the long service life of Naval Platforms and the unique man-machine interface issues likely to manifest on them, focus is on real-time evaluation and a persistent, pro-active approach to Habitability. This article is an effort towards sensitization of personnel on various aspects and issues concerning habitability.

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The nature of the profession makes heavy psychological demands on submariners, who operate for prolonged durations in an environment which is cognitivcly demanding, socially isolated, potentially hazardous, with habitability constraints and cireadian rhythm challenges. Various navies around the world have adopted different approaches towards psychological screening of submariners. This article reviews available literature, assesses the need for psychological screening of Indian submariners and discusses the way forward.

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Tuberculosis (TB) is associated with myriad clinical presentations posing diagnostic challenges to the treating physician. We report a case of Hepatic Tuberculosis presenting as a space occupying lesion (SOL) in the Liver, presenting consequent to successful completion of treatment for tubercular pleural effusion.

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The Role and Realistic utility of cord blood banking is an issue of contemporary debate. Abrief overview is presented.

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Upper Gastrointestinal hemorrhage can result on devastating outcomes. A review of current trends in the management of UGI bleed is presented.

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Hyperbaric medicine, also known as Hyperbaric Oxygen Therapy (HBOT), is the medical use of oxygen at a level higher than atmospheric pressure. The equipment required consists of a pressure chamber and a means of delivering 100% oxygen. Several therapeutic principles are made use of in HBOT, the main one being the increased overall pressure when used in the treatment of decompression sickness and air embolism, as it provides a physical means of reducing the volume of inert gas bubbles within the body. There are various approved and under-trial indications for HBOT. The main facility required for hyperbaric medicine is the Hyperbaric chamber, which is essentially designed to withstand pressurization so as to enable oxygen delivery at pressures greater than atmospheric pressure. The complications associated with HBOT are related to pressure changes causing barotrauma and those related to oxygen toxicity. The only absolute contraindication to hyperbaric oxygen therapy is untreated tension pneumothorax.

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A case of decompression sickness manifesting as shoulder pain, with good response to recompression therapy is presented herewith.

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Flying in a Maritime Environment offers special challenges. A brief overview of Aeromedicai aspect of Marine Aviation is presented.

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Here we present a case report of a young sailor with moderate level of claustrophobia, where his symptoms caused him severe distress and interfered with his work and daily functioning onboard a ship.

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A scoop stretcher is used to evacuate trauma cases, where minimum movement of a patient is advisable. There stretcher are available onboard ships and established of the Indian Navy. The correct use of this stretcher with photographic representation is depicted in the article.

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The management of spinal cord injuries involves multiple specialities, dose monitoring and supervised rehabilitation. An overview of spinal cord injury management based on experience of the INHS Asvini spinal care unit is presented.

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Preventing genetic transmission of disease is of paramount importance. A brief overview of Pre implantation genetic diagnosis is presented.

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Colloid cysts of 3rd Ventricle have the potential risk of precipitating Hydrocephalic crises. We present a case of a young German sailor who collapsed onboard his warship while in international waters. Abrief glimpse offered of the paradigm of onboard resuscitation, a staged helicopter evacuation to our centre for emergency life saving surgery followed by evacuation to Germany where further elective surgery was undertaken. This is the first reported case of a Hydrocephalic crisis at sea with a good out come.

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New knowledge related to Oncology continues to emerge at a rapid pace. The need to cull evidence based information from the enormous mass of data circulating through print and electronic media is crucial for clinicians who are hard pressed for time, attending to patients and committed to providing state of the art treatment from resources at their command. This review is not exhaustive but is an attempt to collate data for the busy clinician based on felt needs over three decades of experience as a surgeon with an abiding interest in Oncology.

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With the increasing use of ionising radiation in diagnostics and therapeutics it is imperative that all clinicians have an understanding of the effects of radiation on tissue.

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With increasing capability of genomic manipulation new therapeutic paradigms are evolving. A quick glimpse into the prospect and promise of gene therapy is desirable.

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Post traumatic seizures induce structural and neurochemical changes in the Neural Stem cell (NSC) niches. The NSC niche shows a classic biphasic response to seizures. In the early weeks after a post traumatic seizure, there is an increase in neurogenesis. However, the integration of these new neurons into existing circuitry is defective leading on to epileptogenic circuits. As seizures continue, there is a decrease in neural proliferation, with consequences on cognition and mood. In this article, we explore the aetiopathogenesis of hippocampal epileptic circuitry and discuss conceptual and evolving therapeutic options.

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Emerging antibiotic resistance has created a major public health dilemma, compounded by a dearth of new antibiotic options. The development of antimicrobial resistance especially among gram-negative pathogens has been progressive and relentless. Pathogens of particular concern include extended-spectrum β-lactamase- producing Enterobacteriaceae, Carbapenem-resistant Enterobacteriaceae, multidrug-resistant Pseudomonas aeruginosa and multidrug-resistant Acinetobacter spp. which are emerging as significant pathogens in various parts of the world. In some cases, these pathogens have expressed resistance to all clinically available compounds. Of the few new drugs available, many have already become targets for bacterial mechanisms of resistance. Furthermore, the Carbapenems, currently the most successful class of antibiotics are showing signs of vulnerability. While the search for new antibiotic options continues, there is urgent need to employ strategies that will slow the development of resistance to the current available armamentarium. A one year retrospective study from Jan 2011 to Dec 2011 was carried out at INHS Asvini to recognise the burden of multidrug-resistant gram-negative organisms in causing health care-associated infections. Antimicrobial susceptibility patterns for all available antibiotics classes were studied. Overall, 14.3% of all gram negative isolates were multidrug-resistant gram negative bacilli (MDR-GNB). Of all the antimicrobial agents, the least effective was Ampicillin (88% resistance), while the most effective antibiotic against MDR-GNB were Imipenem (6% resistance), Meropenem (14% resistance) & Piperacillin-Tazobactam (20% resistance). However, a high degree of resistance among isolates was found against Cephalosporins (35% - 40%).

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Somatisation Disorder presents as myriad bodily symptoms, for which repeated clinical examination and detailed investigation reveals no organic basis. Patients seek various doctors and are unconvinced by explanations of lack of major physical illness. It can be conceptualised as a condition where psychological distress is communicated through physical symptoms. Loss of trained manpower can be averted through greater awareness among doctors about this condition.

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The importance of the role of Vitamin D in bone metabolism is well known but its effect on other systems is emerging with greater understanding of this vitamin-cum hormone. The growing evidence of widespread deficiency particularly in high-risk population is alarming. The high prevalence of deficiency in pregnant and lactating mothers and their newborn babies is disturbing. The levels of Vitamin D considered adequate as well as the recommended doses for the pregnant and lactating mother and infant are still areas of controversy. The long-term harmful effects of Vitamin D deficiency on the fetus and newborn need to be addressed urgently. The article highlights these issues and discusses remedial measures.

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The concept of casualty care supporting naval operations is of “Life & limb saving” care on the ship, with rapid tactical helo aero-medical evacuation to progressively more specialised medical/surgical levels of care. A hospital ship is a desirable support platform for a ‘Blue Wate’ Navy.

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