Retrospective Study of Varicose Vein and its Management in IGIMS, Patna

Introduction: The management of varicose veins haschanged rapidly in recent years. Conservative therapy istypically the first-line treatment for many patients withsymptomatic varicose veins. The present study was conductedfor retrospectively analyzing the profile of varicose vein andits management.Material and methods: A total of 100 patients within the agegroup of 15 to 65 years with varicose vein complications wereincluded. Complete demographic details of all the patientswere obtained from the data record files. Clinical details werealso obtained. A Performa was made and results of routineinvestigations were recorded. Details regarding the treatmentprotocol used (conservative, sclerotherapy, surgical) andfollow-up data was also recorded separately. Patients were notwilling and unfit for surgery and patients with complicationsaccording to data record files, were treated by conservativemanagement.Results: Dilated veins only were found to be present in 18percent of the patients while dilated veins with pain waspresent in 64 percent of the patients. Dilated veins withulcerations and dilated veins with bleeding were present in40 percent and 8 percent of the patients respectively. In 33patients undergoing Sclerotherapy, complete response wasseen in 17 patients, recurrence was seen in 6 patients whilethe remaining 10 patients did not come back on follow-up. In31 patients undergoing surgical therapy, complete resolutionat time of discharge was seen in 28 patients while residualvaricosities were seen in 3 patients.Conclusion: Varicose veins are a frequently encounteredpathology affecting the middle aged group with commonestpresentation being unilateral limb involvement. Hence agood clinical assessment with investigations is necessary forreducing the morbidity associated with it.

Worth of Laparoscopy in Undiagnosed Chronic Abdominal Pain: A Tertiary Care Center Study

Introduction: Chronic abdominal pain which is difficult to diagnose initially not only encumbers the patient but it also affectstheir daily routine, leading to physical and psychological disability, here comes the role of diagnostic laparoscopy which provesto be beneficial aiding in diagnosing most of these cases. Hence, the aim was to evaluate the diagnostic value of laparoscopyin cases with chronic abdominal pain.Materials and Methods: This study was done in the Department of General Surgery at Indira Gandhi Institute of Medicalsciences, Patna, Bihar, from July 2019 to March 2020 in 40 patients. Prior Institutional Ethical Committee approval was alsoobtained for this study.Results: Out of 40 patients included in this study, maximum number of patients were females. Male-to-female ratio was 1:1.4.The maximum number of patients were in the age group of 21–40 years (60%). Maximum patients 45% (n = 18) had complaintof pain in the right lower quadrant of abdomen. The most common finding during diagnostic laparoscopy was found to bepathology in the appendix accounting for 27.5% of cases (11/40).Conclusion: Diagnostic laparoscopy is a safe and effective tool to establish the etiology of chronic abdominal pain and allowsfor appropriate interventions. It can serve as a time saving and cost-effective implement for these patients.

Fibroadenoma/benign phyllodes: a cytologic diagnostic challenge

Background: To study and compare cytomorphological features of histologically proven cases of benign phyllodes and cellular fibroadenoma.Methods: Smears of histologically-proven cases of benign phyllodes and cellular fibroadenoma in one year, were reviewed. The cellular fibroadenoma had epithelial and/or stromal hypercellularity. The stromal and epithelial components as well as the background cells were qualitatively and quantitatively analyzed.Results: Number, cellularity and type of stromal fragments varied significantly in two groups. Higher number, intermediate to large-sized and hypercellular stromal fragments were commonly seen in phyllodes. Hypercellular (3+ cellularity) fragments were seen in 100% cases of phyllodes against 11.1% cases of fibroadenoma. Large-sized stromal fragments were found in 100% of phyllodes while in only 11.1% cases of fibroadenoma. The ratio of number of epithelial to stromal fragments was significantly high (58.5:1) in fibroadenoma against phyllodes (1.3:1). The epithelial architecture, atypia, apocrine metaplasia and presence of cystic macrophages did not very much in the two groups. The cellularity of the dispersed cells in background did not reveal significant difference though the type of cells varied; the proportion of long and short spindle cells was higher in PT group while proportion of oval cells was higher in FA group.Conclusion: The number, cellularity and nature of stromal fragments, ratio of epithelial to stromal fragments, cellularity and type of background cells are helpful in distinguishing benign phyllodes from cellular fibroadenoma. The identification of these features can improve the pickup rate of phyllodes tumor, thereby assisting proper management.

The Use Of Neural Integrity Monitor [NIM Flextm] Tube In Patients Undergoing Posterior Fossa Surgery: Our Institutional Experience

Neurosurgery for cerebellopontine angle tumour involves handling and dissection of cranial nerves at their origin from the brainstem. Lower cranial nerves or their nuclei may be affected by lesions arising from or extending up to the medulla. Preserving their structural and functional integrity is an important goal during surgical resection. Important functions of vagus nerve include swallowing, speech, respiration and heart rate control and its damage is one of the devastating complications of posterior fossa tumour resection. Electromyographic monitoring for recurrent branch of vagus nerve has been done in thyroid surgeries using a specially designed neural integrity monitor (NIM flexTM) electromyogram (EMG) endotracheal tube containing embedded stimulating electrodes placed at the level of vocal cords. We present our experience with the use of this NIM flexTM EMG endotracheal tube for vagus nerve monitoring in neurosurgery for posterior fossa tumours in four patients. Use of this tube in neurosurgery has been less reported in the Indian literature

Pattern of anemia in elderly patients

Background: Anemia is one of the common significant factors responsible for the morbidity and mortality in elderly patients of age 60 years and above. The present was done with the aim to assess the consequences of anemia, and potential etiologies that increase risk of adverse events in geriatric population.Methods: This was a prospective observational study conducted at the department of pathology at Pt. Jawaharlal Nehru Medical College and associated Dr. B. R. A. M. Hospital, Raipur, Chhattisgarh, during the period from December 2011 to December 2012. A total of 150 patients with hemoglobin <12 gm% in female and <13 gm% in male satisfying the WHO criteria of anemia (hemoglobin (Hb) were included in the study. Detailed laboratory investigation of haemoglobin and relevant diagnostic tests were done in all the patients to identify the etiology.Results: The prevalence rate of anemia was 68.67%. Proportion of anemia in males was 56.6% and in females it was 43.4%.Fatigue was the most common symptom found in 87.88 % of patients. Overall mean MCV values in the study population were 80.12±10.71 (fL). Most of the patients were mild anaemic (45.3%). Normocytic-normochromic type of anemia was the most common type constituting 64%.Conclusions: There are no specific clinical guidelines to manage geriatric anemia at present. It is clear that anemia in the elderly should be evaluated, and the underlying cause should be identified at the earliest and treated whenever possible.

Random blood glucose on admission as prognostic factor for assessment of severity of acute myocardial infarction

Background: Assessment of risk factors or prognostic markers is essential to determine the adverse outcome related to acute myocardial infarction (AMI). The aim of the present study was to examine the role of random blood glucose as prognostic marker for assessment of severity of AMI.Methods: This prospective study was conducted on 79 patients with onset symptoms of AMI. All the patients both diabetics and non-diabetics underwent serum blood glucose estimation in the hospital. Primary endpoint of the study was all cause mortality till day 90 follow-up. The secondary end points were composite of death, reinfarction and heart failure till day 90.Mortality rate is higher in the diabetics as compared to nondiabetics.Results: The mean age group was 55.9 years. Males (86%) outnumbered females (14%). The mean BMI was 22.3±2.83. The mean random blood glucose in the study population was 138±92.9 mg/dl (7.7±5.15 mol). Of total 79 patients, 5 were diabetics, of them 2 (40%) died. Among 79 patients, 16 patients were died during 3 months following the qualifying event, 7 had heart failure and 4 had reinfarction.Conclusions: In patients with AMI, hyperglycemia should consider as one of the important prognostic marker to determine the adverse cardiovascular events.

White blood cell count on admission as prognostic marker for assessment of severity of acute myocardial infarction

Background:High white blood cell/leucocyte counts were predicted as important biomarkers for future cardiovascular events in both healthy individuals and are having history myocardial infarction. The aim of the study was to assess the role of leucocytes as predictors of morbidity and mortality during the hospitalization of patients with acute myocardial infarction.Methods:This was a prospective study conducted on 79 patients with evolving STEMI attending the emergency department of Maharaja Yeshwant Rao Hospital, Indore during the period from November 2004 to July 2005. Blood total leucocyte count (TLC) was done in all the patients. All-cause mortality rate during the follow up period was defined as the primary end point of the study. Composite of death, reinfarction and heart failure till follow up day were defined as the secondary outcomes.Results:The mean age of the patients was 55.9±10.4 years. Male dominance was (86%) seen in the study. The mean TLC in the study population was 12345±4922/cumm. A total of 16 (20.2%) patients were died during 3 months of follow up. Statistically significant difference (p<0.001) was seen for characteristics such as age, risk index score,mean blood pressure heart rate and the Kilip class between survivors and non-survivors. The mean difference of TLC and mean CKMB was greater in non-survivors compared to survivors but the difference was not significant (p=0.177). Age, risk index, Kilip class, serum creatinine and baseline TLC, was found to affect the occurrence of the events significantly with a p value of less than 0.05. Conclusions: The findings conclude that the high blood leucocyte count was proved to be an important prognostic factorfor assessing the severity of acute myocardial infarction in study population

Haemovigilance Effect And Its Utility In Quality Management To Prevent Blood Transfusion Reaction

INTRODUCTION: Haemovigilance is defined as a set of surveillance procedures covering whole transfusion chain from the collection of blood and its components to the follow up of its recipients, intended to collect and access information on unexpected or undesirable effects resulting from the therapeutic use of labile blood products, and to prevent their occurrence and recurrence.(1) AIMS AND OBJECTIVES: An effective effort towards the study of haemovigilance programme by evaluating the different adverse reactions occurring due to blood transfusion in patient receiving regular or temporary blood transfusion.The ultimate goal of a haemovigilance system is to improve the safety of blood transfusion. METHODS & MATERIALS: The current study was done at Blood bank AMC MET Medical College & LG Hospital, Ahmedabad. All the adverse reactions related to transfusion of blood components between April-2014 to March-2016 issued were studied.RESULT: In this study, total 17264 blood component (PCV, PRC, FFP, CRYO) were issued. From total 20 BTR, 18 BTR due to PCV, and 02 BTR due to PRC. In which 08 patients have febrile reaction, 07 patients have allergic reaction, 02 patients have non TRALI associated dyspnea and 01 patient has uneasiness-giddiness due to the PCV. 02 patients have allergic reaction which occurred due to PRC.CONCLUSION: Haemovigilance is an essential component of quality management in a blood system and is needed for the continual enhancement of quality and safety of blood products and transfusion process by monitoring and safeguarding the adverse events associated with the use of blood products.

Histopathological Evaluation Of Benign Proliferative Breast Lesions

INTRODUCTION:Benign proliferative breast lesions deserve attention because of high prevalence and impacton women’s life and due to cancerous potential of some histological types.AIMS AND OBJECTIVES:i) To establish the significance of histopathology in the diagnosis of benign proliferative breast lesions.ii) To ascertain the relative frequency of each type of lesion in different age groups and its significance.iii) To compare the study with other different study. MATERIAL AND METHOD:Total 3077 biopsy was received in histopathology department of our institution during August 2015 to July 2016. Among these, 120 cases were of breast lesions. RESULT:Out of 120 breast lesions, 97 were of benign lesions and 23 were of malignant lesion in different age groups. Among these 97 benign proliferative breast lesions, 46 cases (42.22%) has fibroadenoma , 8 cases (8.24%) has epithelial hyperplasia, 27 cases (27.83%) has fibrocystic disease of breast ,5 cases (5.15%) has gynecomastia, 6 cases (6.18%) has phylloid tumour, 2 cases (2.06%) has intraductal papilloma and 3 cases (3.09 %) has adenoma.CONCLUSION:Based on morphological distribution, fibroadenoma constitute maximum number of cases followed by fibrocystic disease of breast. Phylloid tumor is rare but it has clinical relevance. Fibroadenoma is more common in younger age group (16-30 years) whereas fibrocystic disease of breast is more common in older age group (31-45 years).

Ventilator-associated pneumonia among premature infants <34 weeks′ gestational age in neonatal intensive care unit in China: a multicenter study / 中华儿科杂志

Objective@#To investigate the incidence and pathogen distribution of ventilator-associated pneumonia (VAP) among preterm infants admitted to level Ⅲ neonatal intensive care units (NICU) in China.@*Method@#A prospective study was conducted in 25 level Ⅲ NICU, enrolling all preterm infants <34 weeks gestational age admitted to the participating NICU within the first 7 days of life from May 2015 to April 2016. Chi-square test, t test and Mann-Whitney U test were used for statistical analysis.@*Result@#A total of 7 918 patients were enrolled, within whom 4 623(58.4%) were males. The birth weight was (1 639±415) g and the gestational age was (31.4±2.0) weeks; 4 654(58.8%) infants required non-invasive mechanical ventilation and 2 154(27.2%) required intubation. Of all the mechanically ventilated patients, VAP occurred in 95 patients. The overall VAP rate was 7.0 episodes per 1 000 ventilator days, varying from 0 to 34.4 episodes per 1 000 ventilator days in different centers. The incidence of VAP was 9.6 and 6.0 per 1 000 ventilator days in children′s hospitals and maternity-infant hospitals respectively, without significant differences (t=1.002, P=0.327). Gram-negative bacilli (76 strains, 91.6%) were the primary VAP microorganisms, mainly Acinetobacter baumannii (24 strains, 28.9%), Klebsiella pneumonia (23 strains, 27.7%), and Pseudomonas aeruginosa (10 strains, 12.0%).@*Conclusion@#The incidence of VAP in China is similar to that in developed counties, with substantial variability in different NICU settings. More efforts are needed to monitor and evaluate the preventable factors associated with VAP and conduct interventions that could effectively reduce the occurrence of VAP.

Ultrasound guided abdominal field blocks improve postoperative pain relief in cesarean delivery: a prospective randomized controlled study

Background: Abdominal field blocks with local anesthetic solutions have been suggested in postoperative analgesia in patients undergoing abdominal wall incisions. In the present study we assessed the analgesic efficacy of ultrasound guided rectus sheath and transversus abdominis plane blocks over first 24 postoperative hours after cesarean deliveries performed through pfannensteil or midline incisions

Methodology: Sixty women undergoing elective or emergency cesarean delivery were enrolled in this randomized, controlled, double-blind trial, and then randomized either to undergo ultrasound guided rectus sheath and transversus abdominis plane blocks with bupivacaine [n=30] or no block [n=30]. Inj diclofenac and inj. paracetamol 1 G, were given to all patients, and inj tramadol was given on request as a rescue analgesic. All patients received a spinal anesthesia with 0.5% heavy bupivacaine, and at the end of surgery [after the skin sutures] bilateral rectus sheath and transversus abdominis plane blocks were performed using 15 to 20 ml of 0.25% bupivacaine in each block on either side [to maximal dose of 3 mg/kg] and no block in the control patients. Each patient was evaluated postoperatively by a blinded investigator at 2, 4, 6, 12 and 24 h postoperatively

Results: Ultrasound guided abdominal field blocks with 0.25% bupivacaine reduced the total tramadol requirement in the first 24 postoperative hours [157 +/- 50.709 vs 386.67 +/- 29.16 mg] and also the visual analogue pain scores at 2 [2 vs 8], 4 [2 vs 8],6 [2 vs 8],12 [4 vs 7] and 24 [4 vs 7] hours postoperatively. No significant difference was found between groups in the incidence of nausea. Sedation was reduced in the patients who received the blocks. There were no complications attributed to the blocks

Conclusion: Ultrasound guided abdominal field blocks, as a part of a multimodal analgesic regimen, provided greater analgesia up to 24 h postoperatively after elective or emergency cesarean delivery

Evaluating effect of intravenous dexmedetomidine on hyperbaric bupivacaine spinal anesthesia

Background and Aims: Intravenous dexmedetomidine is being increasingly used in perioperative setting including as an adjunct to local anesthetic in various regional techniques with an intent to either improve the block quality, increase the duration of block or to provide sedation and patient comfort during the periblock period. Intravenous dexmedetomidine when used just before or after spinal anesthesia has many desirable effects such as adequate sedation and patient comfort, longer sensory-motor blockade, prolonged postoperative analgesia and reduced post-anesthesia shivering. We aimed to study the effect of intravenous dexmedetomidine on spinal anesthesia with hyperbaric 0.5% bupivacaine

Methodology: One hundred American Society of Anesthesiologists [ASA] physical status I and II patients undergoing orthopaedic surgeries under spinal anesthesia were randomized into two groups of 50 each. After giving spinal anesthesia with 3.5 ml of 0.5% hyperbaric bupivacaine, patients in Group D received a loading dose of 1 microg/kg of dexmedetomidine intravenously by infusion pump over 10 min followed by a maintenance dose of 0.5 microg/kg/h till the end of surgery, whereas patients in Group C received an equivalent quantity of normal saline. The two-dermatome pinprick sensory regression time, duration of the motor block, Ramsay sedation score [RSS], duration of analgesia and side effects of dexmedetomidine were assessed

Results: The time taken for regression of sensory block to S1 dermatome and Bromage 0 motor block was increased significantly by addition of dexmedetomidine. Time to first requirement of analgesic in postoperative period was more in Group D compared to Group C. Sedation was more in patients of Group D compared to Group C [P < 0.001]

Conclusion: Intravenous dexmedetomidine significantly prolongs the duration of sensory and motor block of bupivacaine spinal anesthesia. The incidence of bradycardia is significantly higher when intravenous dexmedetomidine is used as an adjuvant to bupivacaine spinal anesthesia. Dexmedetomidine provides excellent intraoperative sedation and postoperative analgesia

Ultrasound guided rectus sheath block in management of pain in laparoscopic tubal ligation

Background and objectives: Laparoscopic tubal ligation [LTL] is a day care surgery and requires a small supraumbilical incision for the umbilical port. Pain after LTL is more than diagnostic laparoscopy. We aimed to examine the efficacy and benefits of a preemptive ultrasound guided single injection rectus sheath block [RSB] in providing improved early on postoperative pain scores in comparison to general anesthesia alone

Methodology: Sixty patients underwent elective LTL, were randomly allocated by a computer generated list into two groups: the ultrasound guided rectus sheath block group - the Group R, received a bilateral RSB using 20 ml of 0.25% bupivacaine on either side after initiation of anesthesia and earlier than the surgical incision; and general anesthesia group - the Group G, received general anesthesia alone. Intravenous tramadol was also given and its time was recorded. Pain was measured by verbal analogue score [VAS]. Sedation score [from 0 awake to 5 unarousable] was used to record sedation level. Any adverse events were recorded. Statistical Analysis was done with the help of SPSS software version 15. Mann-Whitney U-test, t-test, Pearson ?[2] test and Fisher's exact test was used for analysis of different variables. Statistical significance was set at 5%

Results: The rectus sheath block with bupivacaine compared with control group reduced verbal analogue scores. Tramadol requirements in the first 12 postoperative hours were also lower. The frequency of nausea and sedation was reduced in the Group R. There were no complications accredited to the rectus sheath block

Conclusion: Ultrasound guided rectus sheath block, as a part of multimodal analgesic regimen, provides superior analgesia up to 12 postoperative hours after voluntary laparoscopic tubal ligation

Ultrasound guided superficial cervical plexus and interscalene brachial plexus block for clavicular surgery

Aims and objectives: To study the effect of ultrasound guided superficial cervical plexus and interscalene brachial plexus block for clavicular surgery

Methodology: Thirty American Society of Anesthesiologists [ASA] physical status I and II patients undergoing clavicular surgery, ages 20-60 years were selected. All routine non- invasive monitors were applied and IV line was secured. Ultrasound guided superficial cervical plexus block and interscalene brachial plexus block were given. Injection dexmedetomidine 1 microg/kg infusion over 10 min was started. Block efficacy was evaluated. Any complication or side effects were noted. Sedation was assessed using Ramsay sedation score. Perioperative hemodynamics were charted. Duration of motor block was noted as time of shoulder abduction 3cm from time of block. Duration of analgesia was noted as time for first demand of analgesic from time of block

Results: All the thirty patients allowed clavicular surgeries under combined interscalene brachial plexus and superficial cervical plexus block. No major complications and side effects were noted

Conclusion: USG guided combined superficial cervical plexus and interscalene brachial plexus block are effective for clavicular surgery without any major complication and may be used in place of general anesthesia or blocks by other techniques

Screening of proper leaf size in Centella asiatica for antioxidant potential and separation of phenolics using RP-HPLC.

Centella asiatica is a valuable medicinal plant with abundant amount of pharmaceutically useful compounds; however, it is important to know the proper physiological age for drug formulation. In the present study, smaller to larger thirteen groups of Centella asiatica leaves were evaluated for growth, chlorophyll content and antioxidant activity. The growth was measured in the terms of leaf area, fresh and dry weights and water content. Maximum antioxidant activity was found in third size group of the leaf which was further analyzed for phenolics in RP-HPLC. The probable role of these phenols in antioxidant activities is discussed.

Comparative study of bupivacaine alone and bupivacaine along with buprenorphine in axillary brachial plexus block: a prospective, randomized, single blind study.

Background: Different additives have been used to prolong brachial plexus block. We performed a prospective, randomized single-blind study to compare Bupivacaine alone and Bupivacaine along with Buprenorphine for onset, quality, and duration of block as well as post-operative analgesia and any complication in axillary brachial- plexus block. Methods: Randomized controlled study was carried out among 60 patients of either sex, aged 20-60 years. ASA grade I or II undergoing elective hand, forearm, elbow surgery under axillary brachial plexus block. Patients were randomly divided into two groups. Group-l received 30 ml of 0.35% Bupivacaine alone in axillary block. Group-II received 30 ml of 0.35% Bupivacaine with 3µg/kg Buprenorphine in axillary block. Time taken for onset and completion of motor and sensory block as well as complete duration of block were noted in both groups. Any complication during procedure, during surgery as well as post-operatively were noted and treated. Results: Addition of Buprenorphine (3µg/kg) to Bupivacaine mixture in peripheral nerve block did not affected the onset time for motor as well as sensory block. Mean duration of motor block was 284.33±78.94 mins. in group I and in group II 307.33±60.26 mins. Mean duration of sensory block 305.066±83.64 mins. in group I while 580.166±111.45 mins. in group II. It suggests duration of sensory block was prolonged in group II then group I. Conclusions: Addition of Buprenorphine to local anesthetic drug provides good post-operative analgesia. Buprenorphine significantly prolongs sensory block and lengthens duration of analgesia without prolonging duration of motor block.

Evaluation of biological, physical and chemical properties of mineral trioxide aggregate mixed with 4-META/MMA-TBB.

Aim: To evaluate the change in physical, chemical and biological properties when mineral trioxide aggregate (MTA) is mixed with a resin 4-methacryloxyethyl trimellitate anhydride (4-META)/methyl methacrylate-tri-n-butyl-borane (MMA)-TBB. Materials and Methods: For biological evaluation MTA was inoculated in Wistar rat's subcutaneous tissue and peripheral tissue response was checked after 72 h, 7 days, 15 days and 30 days. Setting time was evaluated using Gillmore needle. The Ca++ release at the end of 24 h was checked using ethylenediaminetetraacetic acid titration method. For all the trials MTA mixed with water was kept as a control and the ratio of MTA with resin was 1:1 by weight. Results: The biological reaction was verified by two observers and their readings were matched using kappa test and there was an excellent relevance. There was no significant difference in the tissue reaction at the end of 30 days where both the groups seemed to show healing. Setting time of MTA with 4-META/MMA-TBB was coming to a mean of 26 min (approx.), which is almost 6 times lesser than that of MTA with water. After applying t test, the difference in Ca++ release was found significant (P = 0.00), with mean of 0.044 and 0.031 mol/L of MTA with water and MTA with 4-META/MMA-TBB respectively. Conclusion: Under the parameters of this study, this new experimental cement has better handling, physical and chemical properties. Even its subcutaneous tissue reaction is comparable to MTA mixed with water.

Reducing the burden of coronary artery disease in India: challenges and opportunities.

Asian Indians--living both in India and abroad--have one of the highest rates of coronary artery disease (CAD) in the world, three times higher than the rates among Caucasians in the United States. The CAD among Indians is usually more aggressive at the time of presentation compared with whites or East Asians. The overall impact is much greater because the CAD in Asian Indians affects the "younger" working population. This kind of disproportionate epidemic among the young Indians is causing tremendous number of work days lost at a time when India is experiencing a dizzying economic boom and needs a healthy populace to sustain this boom. While the mortality and morbidity from CAD has been falling in the western world, it has been climbing to epidemic proportions among the Indian population. Various factors that are thought to contribute to this rising epidemic include urbanization of rural areas, large-scale migration of rural population to urban areas, increase in sedentary lifestyle, abdominal obesity, metabolic syndrome, diabetes, inadequate consumption of fruits and vegetables, increased use of fried, processed and fast foods, tobacco abuse, poor awareness and control of CAD risk factors, unique dyslipidemia (high triglycerides, low HDL-cholesterol levels), and possible genetic predisposition due to lipoprotein (a) [Lp(a)] excess. The effect of established, as well as novel, risk factors is multiplicative, not just additive (total effect>sum of parts). The management would require aggressive individual, societal, and governmental (policy and regulatory) interventions. Indians will require specific lower cut-offs and stricter goals for treatment of various risk factors than is currently recommended for western populations. To this end, the First Indo-US Healthcare Summit was held in New Delhi, India on December 14 and 15, 2007. The participants included representatives from several professional entities including the American Association of Physicians of Indian origin (AAPI), Indian Medical Association (IMA), Medical Council of India (MCI), and Government of India (GOI) with their main objective to address specific issues and provide precise recommendations to implement the prevention of CAD among Indians. The summary of the deliberations by the committee on "CAD among Asian Indians" and the recommendations are presented in this document. OBJECTIVES: Discussion of demographics of CAD in Indians-both in India and abroad, current treatment strategies, primordial, primary, and secondary prevention. Development of specific recommendations for screening, evaluation and management for the prevention of CAD disease epidemic among Asian Indians. Recommendations for improving quality of care through professional, public and private initiatives.

Multiple antibiotic resistance patterns of rhizospheric bacteria isolated from Phragmites australis growing in constructed wetland for distillery effluent treatment.

Susceptibility patterns of 12 different antibiotics were investigated against rhizospheric bacteria isolated from Phragmites australis from three different zones i.e. upper (0-5 cm), middle (5-10 cm), lower (10-15 cm) in constructed wetland system with and without distillery effluent. The major pollutants of distillery effluent were phenols, sulphide, heavy metals, and higher levels of biological oxygen demand (BOD), chemical oxygen demand (COD) etc. The antibiotic resistance properties of bacteria were correlated with the heavy metal tolerance (one of distillery pollutant). Twenty-two species from contaminated and seventeen species from non-contaminated site were tested by agar disc-diffusion method. The results revealed that more than 63% of total isolates were resistance towards one or more antibiotics tested from all the three different zones of contaminated sites. The multiple-drug resistance property was shown by total 8 isolates from effluent contaminated region out of which 3 isolates were from upper zone, 3 isolates from middle zone and 2 isolates were from lower zone. Results indicated that isolates from contaminated rhizosphere were found more resistant to antibiotics than isolates from non-contaminated rhizosphere. Further this study produces evidence suggesting that tolerance to antibiotics was acquired by isolates for the adaptation and detoxification of all the pollutants present in the effluent at contaminated site. This consequently facilitated the phytoremediation of effluent, which emerges the tolerance and increases resistance to antibiotics.