Cognitive conflict detection and resolution develops with age across childhood and likely supports age-related increases in other aspects of cognitive and emotional development. Little is known about the neural correlates of conflict detection and resolution in early childhood. In the current study, we investigated age-related change in neural recruitment during a blocked spatial-incompatibility task (Simon task) in children ages 5–10 years using fMRI. Cortical thickness was measured using structural MRI. Across all children, there was greater activation in right prefrontal and bilateral parietal cortices for incompatible than compatible conditions. In older children, compared with younger children, there was decreased activation and decreased gray matter thickness in the medial pFC. Thickness and activation changes across age were associated within participants, such that thinner cortex was associated with less activation in the rostral ACC. These findings suggest that developmental change in medial pFC activation supports performance on cognitive control tasks in early childhood.

Please cite this paper as: Chatterjee A, Paily VP. Achieving Millennium Development Goals 4 and 5 in India. BJOG 2011;118 (Suppl. 2):47–59. This review relates to achieving the Millennium Development Goals (MDGs), especially MDGs 4 and 5, by India by the year 2015. India contributes the maximum number of maternal deaths (68 000) to the global estimate of 358 000 maternal deaths annually. Infant mortality rate (IMR) is also high at 50 per 1000 (2009). Low budgetary spending on health, poverty, lower literacy, poor nutritional status, rural–urban divide and lack of trained workers in the health sector are cited as reasons for a high maternal mortality ratio and IMR. Increased spending by the Government of India on the health sector has started to show encouraging results. Recent assessments by world bodies like the World Health Organisation have given hope that MDGs 4 and 5 are achievable.

Background:Rheumatoid arthritis is a multi-system autoimmune disorder predominantly involving multiple small and large joints along with certain extra-articular manifestations. The presence of peripheral neuropathy in patients with rheumatoid arthritis contributes significantly to the functional limitation in patients with rheumatoid arthritis.Objectives:To study the prevalence, types, and determinants of peripheral neuropathy in patients with rheumatoid arthritis.Materials and Methods:We studied 74 patients with rheumatoid arthritis of at least 2 year duration for the presence of peripheral neuropathy both clinically and electrophysiologically. The data obtained were entered into a database and continuous variables were analyzed using the Student t test and categorical variables were analyzed using the chi-square test.Results:Peripheral neuropathy was detected in 39.19% (29 out of 74 patients) patients on electrophysiologic testing and 82.76% (24 out of 29 patients) of the patients were asymptomatic. There was significant association between the presence of peripheral neuropathy and disease duration and rheumatoid factor positivity by the latex agglutination method. Sensory neuropathy was the most common form detected.Conclusions:Our study shows that subclinical peripheral neuropathy particularly sensory neuropathy which is not related to disease severity is very common in patients with prolonged disease duration.

Neuropathic pain is still an under-diagnosed and undertreated problem in third world countries. This retrospective study was undertaken to detect the prevalence, etiology and treatment profile of neuropathic pain in cancer. During January-December 2007, 716 new cancer pain patients were examined in Tata Memorial Hospital Pain Clinic. A total of 180 patients with a mean age of 47.14 yrs were found to have neuropathic pain characteristics on the basis of clinical impression, site of pain and the underlying cause i.e. due to tumor itself or cancer therapy. Head and neck cancer (32.2%) was found to be the most common cause of neuropathic pain, followed by breast (20.6%), thoracic (14.4%), genitourinary or gynecology (10.0% each), GI (9.4%), and medical oncology (2.8%). About 56% patients were post surgery, 44.4% post chemotherapy and 51.1% patients were post radiotherapy. The most common site of pain was thoracic (36.7%) due to primary or secondary metastatic disease. Pricking type of pain was the most characteristic feature (47.8%) followed by shooting pain (38.3%). The mean pain score was 5.96 +/- 1.5 (SD) and mean duration (months) of pain was 2.8 +/- 2.5. Neuropathic pain was found commonly associated with somatic pain (59.4%). The most common pharmacological agents prescribed were: tricyclic antidepressants (93.9%), anticonvulsants (66%), Opioids (85%), and nonsteroidal anti-inflammatory drugs (NSAIDs) (97.2%). Only 35% patients followed up more than once at the pain clinic. The most common and challenging patients were of orofacial pain. Nerve blocks techniques have a limited role in neuropathic pain.

Pain is the most feared symptom in cancer. About 52–77% patients suffer pain despite World Health Organization (WHO) recommendations. Out of total, one-third patients suffer moderate to severe pain. This study was undertaken to determine the prevalence, etiopathogenesis and characteristics of severe pain and treatment response among pain clinic referrals in a busy tertiary care cancer center. This study found a high prevalence (31.5%) of severe pain. A total of 251 patients who had complete pain data were analyzed for etiopathological characteristics and treatment response. Head and neck cancer contributed the highest prevalence among all regions. Oncologists prescribed non-steroidal anti-inflammatory drugs (NSAIDs) or paracetamol with or without mild opioids to 14% patients and pain clinic physicians prescribed opioids and overall 63.7% patients had a better response after pain clinic referral, even then, morphine was not prescribed to many deserving patients. Doctors need pain education about opioids to remove any fear of prescribing opioids in presence of severe pain.

Paratracheal air cyst encompasses conditions including tracheoceles, bronchogenic cysts, lymphoepithelial cysts, and tracheal diverticula. The occurrence of tracheal diverticulum is rare and usually does not manifest clinically or may cause symptoms like chronic cough. However, it may have a rare presentation—like in our case—where rupture of tracheal diverticulum post-intubation and assisted ventilation for elective surgery led to pneumothorax, pneumopericardium, pneumomediastinum, pneumoperitoneum, and pneumoretroperitoneum. It may pose diagnostic dilemmas in such cases. An understanding of the underlying mechanism helps in the management, which in majority of cases is conservative.

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Lifetime history of sexual abuse is estimated to range between 15% and 25% in the general female population. Cross-sectional studies have shown that sexual assault survivors frequently report chronic musculoskeletal pain and functional somatic syndromes. Treating chronic pain with opioids went from being largely discouraged to being included in standards of care and titrating doses until patients self-report adequate control has become common practice, with 8% to 30% of patients with chronic noncancer pain receiving opioids. In this clinical review, we will discuss the association between survivors of sexual assault and chronic pain/functional somatic syndromes. We will further review evidence-based treatment strategies for this "pain-prone phenotype."