Evaluation of Anti-Depressant Potential of Medicinal Ghrita

This article aims to evaluate the possible antidepressant effect of the Ghrita prepared from the combination of these plants and to provide probable scientific explanations for using medicated Ghrita (ghee) in Ayurvedic system of medicine. Herbs for Ghrita like Marsilea quadrifolia, Lawsonia inermis, Mimosa pudica, Piper betle were collected freshly during the month of June. One part Kalka (herb bolus), 4 parts pure cow ghee, and 16 parts Dravadravya were used to make Ghrita (Swarasa). Anti-depressant potential of the Ghrita was evaluated by forced swimming, tail suspension, locomotor activity, rota-rod test (motor co-ordination), elevated plus maze (EPM) model, and hole board test were used to assess the Ghrita's anti-depressant potential. According to the Irwin schedule, Gritha medication reduces alertness but has no effect on other parameters, but imipramine treatment reduces responsiveness, alertness, grooming, and writing reflexes to some extent. Following 14 days of therapy with medicinal Ghrita, the immobility time in the forced swim test and the tail suspension test were reduced by 29% and 42%, respectively. In the rotarod test, it had no significant effect on muscle gripping ability when compared to control animals, whereas imipramine produced a significant result. It was observed that the medicinal Gritha significantly (p<0.05) decreases the locomotor activity in actophotometer test and head dips counts in hole board test as compared to control at the end of 14 days study in a 5 minute observation. Ghrita increased the number of entries in the elevated plus maze by 50% and the time spent in the open arm by 72%. The results of this investigation suggest the possible antidepressant potential of medicinal Ghrita.

Prevalence of Hepatitis B and Hepatitis C Virus Infection in Patients with Advanced Renal Failure: A Tertiary Care Centre Study from North Indian Population

Abstract: Viral hepatitis (Hepatitis B Virus (HBV) & Hepatitis C Virus (HCV)) related liver disease is a leading cause of morbidity and mortality especially in the patients with advanced renal failure who are treated with dialysis, and this is due to high number of blood transfusion sessions and/or cross contamination from the dialysis circuits. Aims & Objectives: This study aimed to determine the prevalence of HBV and HCV infections in patients with advanced renal failure (ARF). Materials & Methods: A cross-sectional study was done in joint collaboration of Department of Nephrology and Department of Gastroenterology, KGMU, Lucknow, from June 2018 to June 2020 among, CRF patients. Clinical data such as age, gender, duration of dialysis; number of transfusions, Serum sample was collected from each patient. Serological markers for HBV and HCV were determined with ELISA by using commercial diagnostic kits. HCV-RNA and HBV-DNA were determined quantitatively by polymerase chain reaction (PCR) assay. Results: A total 934 patients with advanced renal failure attended the nephrology OPD. Out of 934 patients, 65 (6.96%) patients screened positive for HBV/HCV infection. The results of this study also showed that the prevalence of viral hepatitis infection in the haemodialysis (HD) and without HD patients is 8.25% and 6.3% respectively. Conclusion: It has been found that viral infections, particularly HBV and HCV infections are common in advanced renal failure patients who are on HD.

Study of clinical profile of organophosphorus poisoning with special reference to electrocardiographic changes and electrolyte derangement

Background: Organophosphorus Compounds (OPC) are main cause of accidental and suicidal poisoning in agrarian countries like India. Aim was to study the clinical profile of OPC-Poisoning and correlate it with the electrocardiographic (ECG) changes and electrolyte abnormalities.Methods: Hundred consecutive cases admitted to Medicine Department underwent clinical examination, ECG, electrolytes, Acetyl Choline Esterase (AChE) estimation from time to time and Paradeniya Organophosphorus Poisoning (POP) score at the time of admission. All these parameter with duration of hospital stay and outcome were statistically analysed using X2 test, Fisher exact test, and inference was drawn.Results: In hundred OPC-Poisoning patients [Male (n=48), Female (n=52), M: F ratio 0.92:1] with mean age of 37.78�.95 years, commonest poison was cholropyrifos+cypermethrin and was mostly suicidal (96%). Common symptoms were sweating (48%), salivation, blurring of vision, breathlessness and signs were smell of poison (90%), tachypnea, altered sensorium, miosis and fasciculation. POP scoring found 41% of patients in mild, 26% in moderate and 33% in sever grade of poisoning. Hospital stay ranged from 4-18 days. Complications were pulmonary Edema (PE) in 28%, Respiratory Failure (RF) 18%, Aspiration Pneumonia (AP) 15% and Intermediate Syndrome (IS) 4%. 10 died out of 42 patients who had complications and the cause of death was RF in 4, Ventricular Fibrillation (VF) 2 and IS in 2. ECG finding showed sinus tachycardia (31%), prolonged corrected QT (QTc) interval (28%), sinus bradycardia (25%), ST-T changes (17%) and Premature Ventricular Contraction (PVC) in 4% which degenerated to VF in 2%. 24 patients were Hypokalemic from which 16 developed complications.Conclusions: Similar to earlier studies we observed poisoning which was suicidal. QTc prolongation and Hypokalemia are associated with high morbidity and mortality in OPC-Poisoning.

The correlation of cardiovascular risk factors and angiographic findings with serum vitamin D levels in patients undergoing coronary angiography

Background: Studies regarding correlation of various conventional risks factors for Coronary Artery Disease (CAD) are many. Keeping in mind the scarcity of studies regarding Vit-D Deficiency (VDD), a new risk factor in CAD, present study was conducted to correlate Vit-D level with conventional risk factors and Coronary Angiography (CAG).Methods: Hundred adult patients admitted to Medicine and Cardiology undergoing CAG with suspected or established CAD were kept in study. Patients having renal, hepatic, parathyroid disease, osteomalacia and patients taking drugs interfering with Vitamin D (Vit-D) metabolism were excluded. After detailed history and thorough clinical examination, routine investigations and 25-(OH) D level was estimated. Subsequently patients underwent CAG. Statistical analysis by Mann Whitey test and Chi-square Test was done and inference was drawn.Results: 100 patients in different age groups had hypertension (HTN) in 53, diabetics mellitus (DM) 39, dyslipidemia 62, smokers 38 and family history of CAD 19. CAG showed normal coronaries in 4, Single Vessel Disease (SVD) in 30, double vessel diseases (DVD) 43 and triple vessel disease (TVD) 22. Vit-D level <20ng/ml i.e. Vit-D deficiency (VDD) in 68, 20-30ng/ml i.e. Vit-D insufficiency (VDI) in 22 and >30ng/ml (normal) in 10. VDD was profound in 51-60 and 61-70 years age groups. Statistical correlation of VDD was not significant with conventional risk factors, but statistically significant correlation of VDD was observed with dyslipidemia and CAG findings in our study.Conclusions: Like earlier studies we observed significant correlation of Vit-D levels with CAD. Though dyslipidemia was significantly correlated with VDD, correlation of other conventional risk factors like age, sex, HTN, DM, smoking and family history was not found. We conclude from this study presence of significant association of VDD with severe CAD. DVD and TVD by CAG were common with low Vit-D levels.

Sudarshan Kriya yoga improves quality of life in healthy people living with HIV (PLHIV): results from an open label randomized clinical trial.

background & objectives: Improving quality of life (QOL) of healthy people living with HIV (PLHIV) is critical needing home-based, long-term strategy. Sudarshan Kriya yoga (SKY) intervention is acknowledged for its positive impact on health. It is hypothesised that SKY would improve PLHIV’s QOL, justifying an evaluation. Methods: In this open label randomized controlled pilot trial, 61 adult PLHIV with CD4 count more than 400 cells/μl and Karnofsky scale score above 70 were enrolled. Those with cardiac disease, jaundice, tuberculosis, or on antiretroviral therapy/yoga intervention were excluded. All were given standard care, randomized to SKY intervention (31: I-SKY) and only standard of care in control (30: O-SOC) arms. The I-SKY participants were trained for six days to prepare for daily practice of SKY at home for 30 min. A validated 31-item WHOQOL-HIVBREF questionnaire was used to document effect in both arms from baseline to three visits at 4 wk interval. Results: Baseline QOL scores, hypertension and CD4 count were similar in both arms. An overall 6 per cent improvement of QOL scores was observed in I-SKY group as compared to O-SOC group, after controlling for baseline variables like age, gender, education and occupation (p=0.016); 12 per cent for physical (p=0.004), 11 per cent psychological (p=0.023) and 9 per cent level of independence (p=0.001) domains. Improvement in I-SKY observed at post-training and in the SKY adherence group showed increase in these two domains. Conclusions: A significant improvement in QOL scores was observed for the three health related QOL domains in SKY intervention arm. This low cost strategy improved physical and psychological state of PLHIV calling for upscaling with effective monitoring for sustainability of quality of life.

Comparative Evaluation of Simultaneous Bone Marrow Aspiration and Trephine Biopsy - Experience From Routine Hematology Practice.

Background: A bone marrow evaluation encompasses bone marrow aspirate (BMA) and bone marrow biopsy (BMB) along with a review of peripheral smear examination. However, due to variations in practice, bone marrow core biopsy is not performed for all patients. Aim: To compare the diagnostic utility of simultaneous BMA and BMB and to study the concordance rate between the two. Material and methods: All BMA and BMB that were simultaneously done between January 2008 and December 2010 in a multispecialty hospitals were reviewed and analyzed in detail. Results: Four hundred sixty-six aspiration and biopsy slides were reviewed. The commonest indication was anemia (40.3%) followed by pyrexia of unknown origin (36.2%); 15.2% aspirates and 6.4% biopsies were inadequate. The overall concordance rate between aspirates and biopsy was found to be 62.8%. Concordance was highest for acute and chronic leukemias, metastatic deposits, multiple myeloma and tuberculosis and least for lymphoproliferative disorders, myelofibrosis and marrow hypoplasia. Trephine biopsy was useful for patients’ with multiple myeloma, acute leukemias, lymphoproliferative disorders, myelofibrosis, marrow hypoplasia, osteitis fibrosa cystica and metastasis. BMB and BMA could detect tuberculous granulomas in 85.17% and 57.14% cases, respectively. However, parasitic infections (kala-azar, malaria) could be diagnosed exclusively in BMA. Conclusions: BMA and BMB are important, useful complementary diagnostic tools giving a higher diagnostic yield when used in conjunction.

Clinical response of newly diagnosed HIV seropositive & seronegative pulmonary tuberculosis patients with the RNTCP Short Course regimen in Pune, India.

Background & objectives In the Revised National Tuberculosis Control Programme (RNTCP) in India prior to 2005, TB patients were offered standard DOTS regimens without knowledge of HIV status. Consequently such patients did not receive anti-retroviral therapy (ART) and the influence of concomitant HIV infection on the outcome of anti-tuberculosis treatment remained undetermined. This study was conducted to determine the results of treatment of HIV seropositive pulmonary tuberculosis patients with the RNTCP (DOTS) regimens under the programme in comparison with HIV negative patients prior to the availability of free ART in India. Methods Between September 2000 and July 2006, 283 newly diagnosed pulmonary TB patients were enrolled in the study at the TB Outpatient Department at the Talera Hospital in the Pimpri Chinchwad Municipal Corporation area at Pune (Maharashtra): they included 121 HIV seropositive and 162 HIV seronegative patients. They were treated for tuberculosis as per the RNTCP in India. This study was predominantly conducted in the period before the free ART become available in Pune. Results At the end of 6 months of anti-TB treatment, 62 per cent of the HIV seropositive and 92 per cent of the HIV negative smear negative patients completed treatment and were asymptomatic; among smear positive patients, 70 per cent of the HIV-seropositive and 81 per cent of HIV seronegative pulmonary TB patients were cured. Considering the results in the smear positive and smear negative cases together, treatment success rates were substantially lower in HIV positive patients than in HIV negative patients, (66% vs 85%). Further, 29 per cent of HIV seropositive and 1 per cent of the HIV seronegative patients expired during treatment. During the entire period of 30 months, including 6 months of treatment and 24 months of follow up, 61 (51%) of 121 HIV positive patients died; correspondingly there were 6 (4%) deaths among HIV negative patients. Interpretation & conclusions The HIV seropositive TB patients responded poorly to the RNTCP regimens as evidenced by lower success rates with chemotherapy and high mortality rates during treatment and follow up. There is a need to streamline the identification and management of HIV associated TB patients in the programme with provision of ART to achieve high cure rates for TB, reducing mortality rates and ensuring a better quality of life.

Dietary supplies of iodine & thiocyanate in the aetiology of endemic goitre in Imphal East district of Manipur, north east India.

BACKGROUND & OBJECTIVE: The present investigation was undertaken to study the iodine nutritional status of school children of Imphal east district in Manipur where endemic goitre persists during post-salt iodization phase along with the investigation of the factors responsible for the occurrence of goitre endemicity. METHODS: A total of 1,286 children (6-12 yr) were clinically examined for goitre from study areas of Imphal east district. A total of 160 urine samples were collected and analyzed to measure urinary iodine and thiocyanate levels. Iodine content was measured in 140 salt samples and 16 drinking water samples. RESULTS: Overall goitre prevalence was about 30 per cent (grade 1-24.7%; grade 2-5.3%) and median urinary iodine level was 17.25 microg/dl. The mean urinary thiocyanate level was 1.073 +/- 0.39 mg/dl. Iodine/thiocyanate ratio (microg/mg) was in the ranges from 15.65 to 22.34. The mean iodine content in drinking water samples was 2.92 +/- 1.75 microg/l and 97.8 per cent of edible salts had iodine level above 15 ppm at the consumption point. INTERPRETATION & CONCLUSION: Our findings showed that in spite of no biochemical iodine deficiency, iodine deficiency disorders (IDD) is a serious public health problem in Imphal east district of Manipur. The consumption pattern of certain plant foods containing thiocyanate (or its precursors) was relatively high that interfere with thyroid hormone synthesis resulting in the excretion of more iodine. Thus, the existing dietary supplies of thiocyanate in relation to iodine may be a possible aetiological factor for the persistence of endemic goitre in the study region during post salt iodization period.

Dietary supplies of iodine & thiocyanate in the aetiology of endemic goitre in Imphal East district of Manipur, north east India.

Background & objectives: The present investigation was undertaken to study the iodine nutritional status of school children of Imphal east district in Manipur where endemic goitre persists during post-salt iodization phase along with the investigation of the factors responsible for the occurrence of goitre endemicity. Methods: A total of 1,286 children (6-12 yr) were clinically examined for goitre from study areas of Imphal east district. A total of 160 urine samples were collected and analyzed to measure urinary iodine and thiocyanate levels. Iodine content was measured in 140 salt samples and 16 drinking water samples. Results: Overall goitre prevalence was about 30 per cent (grade 1-24.7%; grade 2-5.3%) and median urinary iodine level was 17.25 μg/dl. The mean urinary thiocyanate level was 1.073 + 0.39 mg/dl. Iodine/thiocyanate ratio (μg/mg) was in the ranges from 15.65 to 22.34. The mean iodine content in drinking water samples was 2.92 + 1.75 μg/l and 97.8 per cent of edible salts had iodine level above 15 ppm at the consumption point. Interpretation & conclusion: Our findings showed that in spite of no biochemical iodine deficiency, iodine deficiency disorders (IDD) is a serious public health problem in Imphal east district of Manipur. The consumption pattern of certain plant foods containing thiocyanate (or its precursors) was relatively high that interfere with thyroid hormone synthesis resulting in the excretion of more iodine. Thus, the existing dietary supplies of thiocyanate in relation to iodine may be a possible aetiological factor for the persistence of endemic goitre in the study region during post salt iodization period.

Antiretroviral drug resistance testing.

While antiretroviral drugs, those approved for clinical use and others under evaluation, attempt in lowering viral load and boost the host immune system, antiretroviral drug resistance acts as a major impediment in the management of human immune deficiency virus type-1 (HIV-1) infection. Antiretroviral drug resistance testing has become an important tool in the therapeutic management protocol of HIV-1 infection. The reliability and clinical utilities of genotypic and phenotypic assays have been demonstrated. Understanding of complexities of interpretation of genotyping assay, along with updating of lists of mutation and algorithms and determination of clinically relevant cut-offs for phenotypic assays are of paramount importance. The assay results are to be interpreted and applied by experienced HIV practitioners, after taking into consideration the clinical profile of the patient. This review sums up the methods of assay currently available for measuring resistance to antiretroviral drugs and outlines the clinical utility and limitations of these assays.

Rate of hospitalization and inpatient care costs for HIV-1-infected patients in Pune, India.

BACKGROUND: The transition of human immunodeficiency virus (HIV) infection to acquired immune deficiency syndrome (AIDS) has begun in India, and an increase in AIDS-related hospitalizations and deaths is an anticipated challenge. We estimated the rates of hospitalization and inpatient care costs for HIV-1-infected patients. METHODS: Data were analysed on 381 HIV-1-infected persons enrolled in a HIV-1 discordant couples' cohort between September 2002 and March 2004. Inpatient care costs were extracted from select hospitals where the study patients were hospitalized and the average cost per hospitalization was calculated. RESULTS: A majority of the patients were in an advanced state of HIV-1 disease with the median CD4 counts being 207 cells/cmm (range: 4-1131 cells/cmm). In all, 63 participants who did not receive antiretroviral therapy required hospitalization, 53 due to HIV-1-related illnesses and the remaining 10 due to worsening of pre-existing conditions. The overall HIV-1-related hospitalization rate was 34.2 per 100 person-years (95% CI: 26.94-42.93). The median duration of HIV-1-related hospitalization was 10 days (range 2-48 days) and the median cost was Rs 17,464 (range: Rs 400-63,891). CONCLUSION: It is necessary to strengthen the inpatient care infrastructure and supporting diagnostic set-up, and work out economically optimized treatment algorithms for HIV-1-infected patients. Although this analysis does not cover all costs and may not be generalizable, these baseline data might be a useful reference while planning related studies accompanying the government-sponsored programme to roll out antiretroviral therapy to AIDS patients.

Mycobacterium avium intracellularae complex associated extrapulmonary axillary lymphadenitis in a HIV-seropositive infant--a rare case report.

Opportunistic infections by Mycobacterium avium intracellulare complex in HIV infected patients, though common in adults, are rarely seen in infants. We herewith report an interesting case of an eight month old infant presenting with isolated axillary lymphadenitis, later on diagnosed to be tubercular lymphadenitis by Mycobacterium avium intracellulare and finally proved to be seropositive for HIV infection born to previously undetected HIV seropositive parents.

Tuberculosis and general practitioners.

In spite of advancement of knowledge in diagnosis and management, tuberculosis is still the biggest health problem. There are more than 400 million people infected with tuberculous bacillus and more than 14 million cases are suffering from the disease. Prevention, control and care of tuberculosis are possible. General practitioners play a major role in combating the disease. Quick and right diagnosis and treating the cases effectively should be the motto. Sputum microscopy is the backbone of diagnosis of tuberculosis. With the availability of modern chemotherapy the outcome of a tuberculosis case has undergone dramatic changes. Short-course chemotherapy is the standard choice while tackling cases of tuberculosis. Results of directly observed treatment (DOT) strategy are very good provided execution is proper. HIV/AIDS, another dreaded disease if becomes co-infected along with tuberculosis, mortality and morbidity become very high. The general practitioners are the major strength of healthcare system in any society. They should be good enough to know all about the control programmes well implemented in the country.

Physical status of newborns and neonatal outcome.

OBJECTIVE: To determine the extent to which physical status at birth is associated with neonatal mortality and the causes of mortality vis-a-vis size at birth and gestational age. METHOD: 11,223 consecutive live births completing 26 weeks of gestation and weighing > or = 500 gm were included in the study. Birth weight and chest circumference were recorded as per WHO guidelines. Gestational age was calculated on the basis of L.M.P. and the new Ballard's score. Deaths occurring in the hospital within 28 days were recorded. Percentile values of gestational age specific birth weights were calculated separately for singletons and multiple births. Percentage of SGA was calculated with reference to WHO recommended values. Birth weight-gestational age-specific mortality rates were calculated at 2 wk and 500 gm intervals. RESULT: Low-birth-weight babies constituted 39.8% of the total, much in excess of WHO recommended figure of 15%. 76% deaths occurred among LBW babies and 56.2% among preterms. Mortality showed remarkable decline as the birth weight increased to 2,000 gm. The lowest mortality was among singletons weighing 2,500-3,000 gm and of 38-40 weeks gestation. Prevalence of SGA at 40 and 42 weeks were 73.7% and 83.6% respectively. But, if SGA babies not categorised as LBW were excluded, the values came down to 32% and 36% respectively. 36% of all deaths occurred during the first 24 hrs of birth; asphyxia and related causes contributing to 50% of it. CONCLUSION: Cut-off value of 2,000 gm instead of 2,500 gm for birth weight may be preferable in countries where most LBW babies are SGAs. Simultaneously, deaths in non-LBW babies due to perinatal causes contribute sgnificantly to total neonatal mortality and need due attention through sensitising obstetricians in essential newbom care and timely Intervention.

Comparison of accuracy and safety of computed tomography guided and unguided transthoracic fine needle aspiration biopsy in diagnosis of lung lesions.

OBJECTIVE: To study the accuracy and safety of CT guided and unguided transthoracic fine needle aspiration biopsy in diagnosis of lung lesions. METHOD: The study was carried out in 79 hospitalised patients during the period 1997-1999. In 52 patients having peripheral and large sized lung lesion (> 5 cm in diameter) in chest X-ray unguided FNAB was performed and in the rest 27 patients having relatively central and small sized lesion (< 5 cm). CT guided FNAB was performed. Also in 15 patients having two times failed unguided aspiration, CT guided FNAB was performed. RESULTS: The diagnostic yield of unguided aspiration was 71.1% (37 out of 52). Out of 37 patients 29 (78.3%) had malignant lesion and eight (21.6%) non-malignant lesion. Sensitivity and specificity for detecting malignancy was 90.6% and 100% respectively. Complications were seen in 10 patients (19.3%). Diagnostic yield of CT guided FNAB was 95.2% (40 out of 42), 33 (82.5 %) had malignant lesion, seven (17.5%) had benign lesion. Sensitivity and specificity for detecting malignancy was 97.1% and 100% respectively. Minor complications were seen in three patients (7.1%). CONCLUSION: It was concluded that CT guided

Preliminary observations on lymphocyte subpopulations in HIV seropositive & HIV seronegative tuberculosis patients in Pune, India.

CD4 and CD8 lymphocyte counts were determined in 59 HIV seropositive and 41 HIV seronegative newly diagnosed tuberculosis patients in Pune. There were significant differences in the CD4 counts and CD4/CD8 ratios between HIV seropositive and HIV seronegative tuberculosis patients. Majority of the HIV seropositive patients had a CD4 count less than 500 cells/cu.mm, whereas among the HIV seronegative patients, majority had a CD4 count more than 500 cells/cu.mm. In HIV seropositive patients with extrapulmonary and pulmonary tuberculosis, the CD4 counts were lower than in those who had only pulmonary or extrapulmonary tuberculosis. There was no significant differences in the CD8 counts between HIV seropositive and HIV seronegative tuberculosis patients, except for patients with pulmonary cavity, where the CD8 counts were significantly higher in HIV seropositive tuberculosis patients. In HIV seropositive individuals with pulmonary tuberculosis, the CD8 counts in those with pulmonary cavity were higher than in those without any pulmonary cavity. Absence of cavitation and presence of pulmonary with extrapulmonary tuberculosis occurred when immune activation was at a lower level.

Isolation & preliminary characterization of two HIV-2 strains from Pune, India.

Two HIV-2 strains were isolated from peripheral blood mononuclear cells of two HIV-2 seropositive patients with pulmonary tuberculosis by co-cultivating the cells with phytohaemagglutinin-P stimulated heterologous normal lymphocytes. Biological characterization of the isolates indicated that both isolates were syncytium inducing and induced cytopathic effect in the form of giant cells and syncytia formation in four T lymphoid cell lines. The isolates differed in their replication pattern. The isolates were confirmed as HIV-2 by nested PCR using HIV-1 and HIV-2 specific oligonucleotide primers from the env region and by supplementary tests like indirect immunofluorescence assay, syncytium inhibition assay using reference and HIV-2 reactive patients' sera, western blot and electron microscopy. Neutralization of one isolate (TB1) with two Senegal reference sera also indicated that the isolate may be related to the Senegal strain. To our knowledge, this is the first report of isolation of HIV-2 in India.

Fast track thrombolysis in acute myocardial infarction: a quality improvement project.

Thrombolytic therapy for acute myocardial infarction has been proved to be most effective if given very early in the course of evolving infarction. This study was undertaken to optimise such treatment by overcoming the in-hospital delay in the existing set-up of an industrial hospital. A quality improvement project was undertaken to analyse the existing system of thrombolysing 46 consecutive patients of acute myocardial infarction treated in six months. By following the breakthrough sequence and proceeding in steps, the causes for delay in door to needle time were identified and rectified over two months. Impact of such measures in 32 patients of acute myocardial infarction thrombolysed consecutively in the next five months was studied. Door to needle time in the baseline group (n = 46) was in the range of 15-145 minutes and the average was 48.9 minutes. Only 32.6 percent of the patients in this group were thrombolysed within 30 minutes of arrival in the hospital. After the corrective measures were implemented in a study group of 32 patients, 27 with clear indication on admission were thrombolysed on the fast track i.e. with minimum delay. Five patients with doubtful need were put on the slow track and subsequently thrombolysed. Patients with no indication or a contra-indication for thrombolysis were excluded from this study. In the fast group, door to needle time reduced to an average of 22.56 minutes with a range of 7 to 67 minutes and 75 percent of the thrombolysed patients received the infusion within 30 minutes of arrival in the hospital. Differences in door to needle time between the two groups were statistically significant. Streamlining the hospital systems and procedures can help reduce the door to needle time in thrombolysing patients of acute myocardial infarction. This could be achieved within the existing resources by applying the principles of total quality improvement.