IntroductionThe pro‐ and anti‐inflammatory cytokines play crucial role in the development and functions of placenta. Any changes in these cytokines may be associated with many pregnancy‐related disorders like preeclampsia. Therefore, the present study is aimed to study the expression of pro‐inflammatory (TNF‐α, IL‐6) and anti‐inflammatory (IL‐4, IL‐10) cytokines in placenta and serum of preeclamptic pregnant women.Material and MethodsFor this study, a total of 194 cases of preeclamptic and control cases were enrolled in two Groups as per the gestational age that is, Group I (28‐36 weeks) and II (37 weeks onwards). The number of samples was 55 in Group I and 139 in Group II. The immunohistochemistry (IHC) and enzyme‐linked immunosorbent assay (ELISA) were conducted on placenta and serum of both preeclamptic and normal samples, respectively. IHC results were revalidated by reverse transcriptase PCR (RT‐PCR).ResultsBoth Groups (I, II) of preeclampsia showed amended levels of pro‐ and anti‐inflammatory cytokines in placental tissues and serum samples. The levels of TNF‐α and IL‐6 were significantly increased in preeclamptic cases (P = 0.0001, P = 0.0001) while the IL‐4 and IL‐10 were downregulated (P = 0.0001, P = 0.0001) in comparison to control. In addition, a negative correlation was also observed between the two in preeclampsia (P = 0.0001).ConclusionThe balanced ratio of pro‐ and anti‐inflammatory cytokines is essential to regulate the maternal inflammation system throughout pregnancy. Therefore, the gradual cytokine profiling of the pregnant women may be useful for the management of preeclampsia.

Background: Prescribing criteria have been suggested for proprotein convertase subtili-

An unusual variation creates interest among anatomists, but is a cause of concern among clinicians when it mimics a pathology. The sternalis muscle is one such variant of the anterior chest wall located subcutaneously over the pectoralis major, ranging from a few short fibers to a well-formed muscle. We observed a bilateral case, which was accompanied by an atypical presentation on the left side where a huge, bulky sternalis muscle was associated with the absence of the sternal fibers of the pectoralis major. The fibers arose as a lateral strip from the upper two-thirds of the body of the sternum and costal cartilages 2 through 6 with the intervening fascia and aponeurosis of the external oblique. The right sternalis was strap-like and was placed vertically over the sternal fibers of the pectoralis major, arising from the underlying fascia and aponeurosis of the external oblique. The sternalis muscles, on each side, converged into an aponeurosis over the manubrium that was continuous with the sternal heads of the right and left sternocleidomastoid muscle, respectively. This rare anomaly has puzzled radiologists and surgeons in confirming diagnosis, missing it all together or mistaking it for a tumor on mammography or CT scan. These findings prompted us to review its topography, development, and application in relation to the anterior chest wall.

Introduction: Skin disorders are common in children but have not been regarded as a public health problem even though they put a large burden on health care systems worldwide. About one-third of children in India are affected by skin disorders at any given time. Climatic factors, poor hygiene, poor access to water, household overcrowding and close contact lead to this high prevalence. However there is a relative paucity of data in comparison to this high prevalence. Study objective was to determine the prevalence and pattern of skin disorders amongst school going children aged 6 to 17 years in rural and urban Jaipur and their nutritional, socioeconomic and standard of sanitation correlates. Material and Methods: Descriptive cross-sectional study carried out in 410 children aged 6-17 years from ten randomly selected schools, five rural and five urban, in Jaipur from 1 st January 2017 to 30 th June 2018. Detailed history including grading of socioeconomic status and standard of sanitation as well as physical examination were done with due regard to privacy. Clinical diagnosis was made. Results: The prevalence of skin disorders was found to be 48.3%, more in girls (59.6%) and more in rural areas (58.1%). Seborrhoea capitis (15.4%) was the most common followed by Acne vulgaris (13.2%), Pityriasis alba (4.4%), Tinea (all types) (3.9%), Pediculosis capitis (3.2%), and Furunculosis, Scabies and Pityriasis versicolor (<2% each). Prevalence had a significant correlation with level of sanitation whereas not with literacy of parents, socioeconomic status (Kuppuswamy score) and type of school. Only one fourth of symptomatic children took treatment. Conclusion: High prevalence of skin disorders exists in school-going children of Western India, especially noninfectious dermatosis. Rural residence and level of sanitation are significant attributes.

Background and Aims: The coronavirus disease -19 has changed various aspects of education and training in all fields, and e-learning has now become the preferred mode of training and teaching. The aim of this study was to assess the impact of online training and to overcome the limitations of e-learning. Methods: A total of 176 medical officers (MOs) and 720 community health officers (CHOs) were trained in four batches by using seven training modules with online videos and lecture series. Each batch received two days of training. A pre-test and post-test were conducted which consisted of 25 multiple-choice questions of 4 marks each. There was no negative marking. Candidates obtaining >80 marks were declared as having passed. The results of the pre-test and post-tests were compared. Results: There was remarkable improvement in the knowledge regarding critical care management after virtual training, as evidenced by the test results. None of the MOs scored more than 80% in the pre-test; however, 153 MOs scored more than 80% in the post-test. The average score improved from 47.82 (pre-test) to 89.05 (post-test). The difference was statically significant ( P < 0.0001). Similarly, 123 CHOs scored more than 80% in the pre-test, while 378 CHOs scored more than 80% in the post-test. Improvement in average marks was also seen: 90.5 in the post-test as compared to 62.76 in the pre-test. The difference was statically significant ( P < 0.0001). Conclusion: Online training is beneficial for many candidates from various locations within a short period. The interactive sessions after training are also helpful, and well-designed pre- and post-tests are adequate for assessment.