If Fate Had A Date!

When you get a premium extra leg room on a long flight, you are instantly reminded of LG’s slogan “Life is good”. Well! I paid a premium to experience that prime feeling. However, when I was about to treasure that short term pleasure, life reminded me that pleasure in any measure will float away like a feather as Casio says “Expect the unexpected”. A baby in the backseat as if rigidly following Harley Davidson’s “American by birth, but Rebel by choice”, felt envious of my pleasure in leisure and began to express it with a deafening cry. The helpless mom trying to be considerate to others, and to herself picked her up, and meandered in to my cherished, premium leg space as if it was Disneyland’s “Happiest place on earth (or was it on flight!).

I had no choice but to retract my reveling limbs from my space of luxury. The cry now transformed into a mocking smirk on that intolerant infant. Mother pleased with her baby’s new found happiness, decided to linger longer than an hour. This procreator, and cry creator combination became an instant inspiration for similar pairs on the flight. One after another began to savor the Shangri-La with my begrudging benevolence. It seemed my premium space had Sony Playstation tag: “live in your world, play in ours”. I was made to sit and feel like McDonald’s “I’m lovin it!”. I could neither evade the charming smile of the child, nor reconcile with the aching recoiled legs of mine. I finally had to settle with Burger King’s way “Have it your Way!”

It was time to enjoy the joy of the ocean. As we landed in the island of seafood, vegetarian like me had sea, but not food! The resort’s chef had personally handpicked several fallen leaves and decoratively arranged them on a tiny plate, sprinkled with drops of dressing. When asked if there was any other variety of vegetarian food, he promised that he would have grass the next day, perhaps coinciding with lawn mowing tonight, I thought. Having had not so yummies in our tummies, we decided to venture out to see the creatures of the coral world. After forfeiting my biweekly paycheck for the entrance fees, we zoomed in to the coral park. We were then asked to buy some honey to feed the lorikeets. We gladly obliged, and eagerly awaited to satiate the culinary needs of this lorikeet. None came. Environmentalist excitedly informed that if they are not hungry, they wouldn’t feed. We waited. Having had only leaves for lunch, the honey was very tempting. Neither birds would have it, nor we could have it. I wished we were standing at the back of the crowd, so that we could cherish the nectar, which was looking like a loaf of meat for a hungry lion. Social constraints lead to extreme self-restraint.

We then proceeded to the turtle feeding. We didn’t realize that they ate carrots, broccoli etc. it seemed they had a better vegetarian menu than ourselves in the resort. I offered with the pretext to feed the not so hungry turtles. However, the staff showed no interest thus depriving me of the option to satisfy my growling stomach. Interestingly, I saw a couple with some enticing vegetarian snack trying to feed the beastly looking Iguanas. Out of sheer curiosity combined with bare necessity, I approached the couple and enquired where did they get it? The naïve couple couldn’t remember the place or the name, much to my chagrin. But, offered the delicious dissert to me. My face gleamed, my appetite beamed until my esteemed couple screamed “please, feel free to feed the iguanas”. I glanced at them as gloom began to bloom, and muttered “of course, thank you”.

As we boarded our long flight back, we couldn’t carry food from the airport, as it was too small to have any vegetarian options. We were happy to see the cheese platter on the flight menu. We asked for platter, and water, and attendant thought it will make us fatter and gave us the latter to shatter the prospect of eating any veggie matter. I asked for peanuts, she explained to me the cost cuts. My initial hope was great, but as fate had its date, I was left without a plate, and continued my hunger state.

Oh! Mother..

Oh! Mother, our appreciation, how can we Show
You are our hearts doctor, for you Know
When our spirits are Low.
You hug, and laugh to make our spirits Glow
And happiness, you love to Bestow
In our best, and ill times, you are with us like a Shadow
Who is that not yet experienced your mollifying affection Flow
In our hearts the love seeds, you Sow
Peace & prosperity, you love to see in us Grow
You are like colors of Rainbow
We love to look up to and Bow
Oh! Mother, our appreciation, how can we Show.
Pradeep Alur.
May 8, 2016.

Antenatal Betamethasone in Late Preterm Deliveries

http://www.nejm.org/doi/full/10.1056/NEJMoa1516783?query=featured_home

multicenter, randomized trial involving women with a singleton pregnancy at 34 weeks 0 days to 36 weeks 5 days of gestation who were at high risk for delivery during the late preterm period (up to 36 weeks 6 days). The participants were assigned to receive two injections of betamethasone or matching placebo 24 hours apart. The primary outcome was a neonatal composite of treatment in the first 72 hours (the use of continuous positive airway pressure or high-flow nasal cannula for at least 2 hours, supplemental oxygen with a fraction of inspired oxygen of at least 0.30 for at least 4 hours, extracorporeal membrane oxygenation, or mechanical ventilation) or stillbirth or neonatal death within 72 hours after delivery.

Results

The primary outcome occurred in 165 of 1427 infants (11.6%) in the betamethasone group and 202 of 1400 (14.4%) in the placebo group (relative risk in the betamethasone group, 0.80; 95% confidence interval [CI], 0.66 to 0.97; P=0.02). Severe respiratory complications, transient tachypnea of the newborn, surfactant use, and bronchopulmonary dysplasia also occurred significantly less frequently in the betamethasone group. There were no significant between-group differences in the incidence of chorioamnionitis or neonatal sepsis. Neonatal hypoglycemia was more common in the betamethasone group than in the placebo group (24.0% vs. 15.0%; relative risk, 1.60; 95% CI, 1.37 to 1.87; P<0.001).

Conclusions

Administration of betamethasone to women at risk for late preterm delivery significantly reduced the rate of neonatal respiratory complications.

Hypoglycemia management podcast

The NLRP3 inflammasome is critically involved in the development of bronchopulmonary dysplasia

Nature Communications 6, Article number: 8977 doi:10.1038/ncomms9977
http://www.nature.com/ncomms/2015/151127/ncomms9977/full/ncomms9977.html
www.sciencedaily.com/releases/2016/01/160115140128.htm

The pathogenesis of bronchopulmonary dysplasia (BPD), a devastating lung disease in preterm infants, includes inflammation, the mechanisms of which are not fully characterized. Here we report that the activation of the NLRP3 inflammasome is associated with the development of BPD. Hyperoxia-exposed neonatal mice have increased caspase-1 activation, IL1β and inflammation, and decreased alveolarization. Nlrp3−/− mice have no caspase-1 activity, no IL1β, no inflammatory response and undergo normal alveolarization. Treatment of hyperoxia-exposed mice with either IL1 receptor antagonist to block IL1β or glyburide to block the Nlrp3 inflammasome results in decreased inflammation and increased alveolarization. Ventilated preterm baboons show activation of the NLRP3 inflammasome with increased IL1β:IL1ra ratio. The IL1β:IL1ra ratio in tracheal aspirates from preterm infants with respiratory failure is predictive of the development of BPD. We conclude that early activation of the NLRP3 inflammasome is a key mechanism in the development of BPD, and represents a novel therapeutic target for BPD.