The first postmitotic neurons in the developing neocortex establish the preplate layer. These early-born neurons have a significant influence on the circuitry of the developing cortex. However, the exact timing and trajectory of their projections, between cortical hemispheres and intra- and extra-cortical regions, remain unresolved. Here, we describe the creation of a transgenic mouse using a 1.3 kb golli promoter element of the myelin basic protein gene to target expression of a tau-green fluorescent protein (GFP) fusion protein in the cell bodies and processes of pioneer cortical neurons. During embryonic and early neonatal development, the timing and patterning of process extension from these neurons was examined. Analysis of tau-GFP fluorescent fibers revealed that progression of early labeled projections was interrupted unexpectedly by transient pauses at the corticostriatal and telencephalic-diencephalic boundaries before invading the thalamus just prior to birth. After birth the pioneering projections differentially invaded the thalamus, excluding some nuclei, e.g. medial and lateral geniculate, until postnatal days 10-14. Early labeled projections were also found to cross to the contralateral hemisphere as well as to the superior colliculus. These results indicate that early corticothalamic projections appear to pause before invading specific subcortical regions during development, that there is developmental regulation of innervation of individual thalamic nuclei, and that these early-generated neurons also establish early projections to commissural and subcortical targets.

Background Staphylococcus aureus-associated peritonitis and catheter exit-site infections (ESIs) are important causes of hospitalization and catheter loss in patients undergoing chronic peritoneal dialysis. Intranasal and topical use of mupirocin has been found to be an effective strategy in decreasing S. aureus-related infectious complications in persons who are carriers of S. aureus; however, there is no consensus regarding the prophylactic use of mupirocin irrespective of carrier status. We aimed to determine the potential effectiveness of application of mupirocin cream at the catheter exit site in preventing ESI and peritonitis irrespective of carrier status in a tropical country such as India. Methods This prospective historically controlled study was done in a total of 40 patients. From August 2003, all patients, incident and prevalent, were instructed to apply 2% mupirocin cream daily to the exit site instead of the older practice of povidone-iodine and gauze dressing. Patients were not screened to determine whether they were S. aureus carriers. The infection-related data for 1 year, until July 2004, were compared with the historical control, which was infection-related data for the year preceding the year of mupirocin application. Results Mean age of the study population was 62 years, with 61.8% being male and 64.3% being diabetic. Local application of mupirocin led to a significant reduction in the incidence density per patient-month of both ESI and peritonitis compared to controls (0.15 vs 0.37 and 0.37 vs 0.67, p = 0.01 for both). This amounted to a relative reduction of 60.5% and 55% respectively. ESI and peritonitis due to S. aureus were also significantly lower in the study group compared to controls (incidence density per patient-month 0.05 vs 0.13 and zero vs 0.17 respectively, p < 0.01 for both). There occurred no catheter removal due to infection-related complications during the study period compared to two during the control period. None of the patients reported a mupirocin-related adverse effect. Conclusions Daily application of mupirocin at the exit site is a well-tolerated and effective strategy in reducing the incidence of ESI and peritonitis in a tropical country such as India. It can thus significantly reduce morbidity, catheter loss, and transfer to hemodialysis in peritoneal dialysis patients.

Our study has shown that more than 1/3rd of pulmonary infections in renal transplant recipients can be attributed to multiple organisms. Bacterial infections were the commonest cause of post transplant pulmonary infection. Tuberculosis is common cause of pulmonary infection in these patients in our set up. Because of its high diagnostic yield, BAL should be considered in all patients with suspected pulmonary infections in the post transplant period.

SUMMARY The efficacy of silver sulphadiazine in human keratomycosis has not been evaluated so far. Encouraged by the success of an earlier experimental trial, a prospective, controlled, randomised double masked clinical study was designed to evaluate the efficacy of 1% silver sulphadiazine ophthalmic ointment in 20 eyes of mycotic keratitis. Miconazole 1% was used for comparative evaluation in another 20 eyes. Silver sulphadiazine had a higher success rate (80% vs 55%) than miconazole. It had broad antifungal activity and was found to be effective in fusarium keratitis. Absence of side effects, economy, and its efficacy in deeper and extensive lesions were additional advantages. It is concluded from this study that silver sulphadiazine is a safe and effective broad spectrum antifungal agent which can be used for the treatment of human keratomycosis.Fungal keratitis still remains a diagnostic and therapeutic challenge for the ophthalmologist. The management is restricted by the relative unavailability of effective antifungal agents, the extent to which they can penetrate the cornea, and their ocular side effects.'1' Newer and more potent antifungal agents are thus required for the treatment of mycotic corneal ulcers.Silver sulphadiazine, a topical antimicrobial, has been shown to be beneficial in both the prophylaxis and the treatment of infections of the skin following burns.45 It has a powerful antibacterial and antifungal activity.6 In a recent experimental study conducted by us silver sulphadiazine was found to be very effective in the control of fungal infections of the rabbit cornea produced by aspergillus and fusarium.7 Encouraged by the results of this experimental study, a prospective, controlled, randomised, and double masked clinical trial was designed to study the efficacy of silver sulphadiazine in the treatment of mycotic keratitis. Miconazole 1% ophthalmic ointment, a known antifungal agent'36 was used for comparison.Correspondence to Professor Madan Mohan. Subjects and methodsThe study material comprised of 43 smear-positive cases of fungal corneal ulcers. On the patient's initial visit a detailed history including the presence of any predisposing factors such as diabetes, trauma, use of topical steroids, and antimetabolites was elicited. A detailed ophthalmic examination was carried out, and a record of the severity of symptoms and ocular signs, the presence and extent of hypopyon if any, and of digital intraocular pressure was made. The ulcer was graded from grade I to grade V and hypopyon from + to +++ according to Mohan's classification (Table 1).' Corneal scrapings were examined for the presence of fungus by KOH and Gram's stain and also cultured on Sabouraud's agar.After explaining the nature of the study an informed written consent was obtained from all the subjects prior to starting treatment. The patients were assigned alternately to each of two groups. Group I consisted of 22 fungal corneal ulcers treated with 1% miconazole ointment, while group II comprised 21 fungal ulcers treated with...

A female presented with pain in left flank, detected to have bilateral renal calculi with deranged liver functions. On investigation found her to have Wilson's disease with hypercalciuria and incomplete distal renal tubular acidosis. Patient was started on penicillamine following which her hepatitis improved but hypercalciuria persisted after 10 weeks of follow up. The rarity of such presentation and literature review for the same is discussed.