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Background: A chronic wound usually results due to halt in the inflammatory phase of wound healing. Bacterial infections and biofilm formation are considered to be the basic cause of it. Chronic wounds significantly impair the quality of life. Antibiotics are now failing due to biofilm formation emergence of drug-resistant bacteria. Objective: This study aims to see the effect of bacteriophage therapy in chronic nonhealing wound infected with the following bacteria: Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa. Subject: Patients with chronic nonhealing wound not responding to conventional local debridement and antibiotic therapy were included in the study. The age of patients ranged between 12 and 60 years. Method: A total of 20 patients selected and tissue biopsies and wound swabs were taken for isolation of the bacteria. After confirmation of organism, a cocktail of customized bacteriophages was topically applied over the wound on alternate days till the wound surface became microbiologically sterile. Mean bacterial count and clinical assessment were done and compared at the time of presentation and after 3 and 5 doses of application. Results: A significant improvement was observed in the wound healing, and there were no signs of infection clinically and microbiologically after 3 to 5 doses of topical bacteriophage therapy. Seven patients achieved complete healing on day21 during follow up while in others healthy margins and healthy granulation tissue were observed. Conclusion: Topical bacteriophage application may be quite effective therapy for the treatment of chronic nonhealing wounds.

Alteration in apolipoprotein levels (A1 and B) in XP patients may predispose to cutaneous and systemic deposition of lipids, including atherosclerosis. Therefore, XP patients irrespective of their lesion size or serum lipid levels should be screened using CIMT for detection of subclinical atherosclerosis.

Objective: Extubation failure after neonatal cardiac surgery has been associated with considerable postoperative morbidity, though data identifying risk factors for its occurrence are sparse. We aimed to determine risk factors for extubation failure in our neonatal cardiac surgical population. Design: Retrospective chart reviewSetting: Urban tertiary care free-standing children's hospital Interventions: Extubation failure was defined as re-intubation within 72 hours after extubation from mechanical ventilation. Multivariate logistic regression analysis was performed to determine independent risk factors for extubation failure. Measurements & Main Conclusions:Neonates with underlying genetic abnormalities, hypoplastic left heart, or postoperative infection were at increased risk for extubation failure. A more conservative approach in these patients, including longer pre-extubation duration of antibiotic therapy for postoperative infections, may be warranted.3

In conclusion, optimized 1.5% w/v chitosan gel was thermoresponsive, mucoadhesive, syringeable, and released drugs in slow and controlled manner with effectiveness against broad range of microbes.

Retrocaval ureter or circumcaval ureter is a rare congenital abnormality arising from dysgenesis of the inferior vena cava (IVC) that results in the right ureter coursing behind and medial to the IVC. The ideal nomenclature for the anomaly is preureteral vena cava, keeping in mind the aberrant embryology. It can result in hydronephrosis and is a rare cause of long-standing cyclical pain abdomen. Ultrasound, intravenous urography, nuclear scintigraphy, computed tomography urography (CTU) and magnetic resonance urography (MRU) have been used in the diagnosis of this abnormality but CTU, with its ability to depict the abnormality in three dimensions gives the most "wholesome" solution to its diagnosis. When symptomatic, the condition is treated surgically, either by laparoscopic or open surgery. The characteristic imaging findings that can help clinch the diagnosis are described as a reminder for this infrequently encountered cause for pain abdomen and hydronephrosis.

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).bilateral infi ltrates on chest radiograph, and 3) pulmonary artery occlusion pressure < 18 mm Hg when measured by pulmonary artery catheterization, or no clinical evidence of left atrial hypertension. Th e term ALI was adopted from the lung injury score to include patients with less severe forms of the same pathological entity. Th erefore, patients with a PaO 2 /FiO 2 of 200 to 300 were included within this group.Since its description, the American and European Consensus Conference defi nition has been widely used for enrollment of ARDS patients in therapeutic clinical trials (11-15). Nevertheless, the aforementioned defi nition also presented several shortcomings. First, the reliability in reading chest radiographs was questionable. Second, the defi nition did not explicitly defi ne the time interval for "acute." Th ird, the level of PEEP utilized during ventilation was not incorporated in the defi nition. Last, the use of pulmonary artery catheters has been decreasing over the last few years, precluding measurements of pulmonary artery occlusion pressures.Based on the aforementioned limitations, and after reviewing current epidemiologic evidence and results of clinical trials, in 2011 the European Society of Intensive Care Medicine proposed the Berlin ARDS defi nition (16), which considered the factors of timing, chest imaging, origin of edema, and oxygenation:• Of note, the term ALI has been eliminated. Th e categories of mild, moderate, and severe correlate with mortalities of 27%, 32%, and 45%, respectively (16). RISK FACTORSMultiple conditions may cause ARDS (Table 1). Sepsis remains the most common cause of ARDS, with 46% of the cases triggered by pulmonary entities (2). Mortality also varies according to the cause. Particularly, mortality in patients with ARDS due to severe trauma (injury severity score > 15) is 24.1%, whereas mortality in patients with severe sepsis with a pulmonary source is 40.6% (2). Notably, certain patientrelated variables have been associated with the risk of developing ARDS and with mortality. Among these risk factors, age (2, 17-19), male gender, African American race (20), and history of alcoholism are associated with a higher incidence and mortality (21-23). Active and passive smoking exposure increases the incidence of ARDS as well (24,25). Patients with a higher body-mass index have an increased incidence of ARDS, but its association with mortality is not clearly defi ned (26-28). Both diabetes mellitus and prehospital antiplatelet therapy seem to have a protective eff ect on development of ARDS (29-31).Interestingly, the Acute Lung Injury Verifi cation of Epidemiology (ALIVE) study (32) reported that ALI occurred in 16.1% of patients who were mechanically ventilated for other reasons. Hence, several groups have investigated a variety of methods to predict ARDS. Particularly, Gajic et al described the Lung Injury Prediction Score (LIPS , Table 2) using a prospective cohort study of 5584 patients (33). A LIPS score higher than 4 was associated with risk of developing ARDS ...