Experts’ Consensus on Use of Long-Acting Nitroglycerine in the Management of Angina and Chronic Coronary Syndrome in India

Aim: To address the existing gaps in knowledge about long-acting nitroglycerine (LA-NTG) and provide recommendations to address these issues. Methodology: Approved LA-NTG questionnaire that included 17 questions related to the role of LA-NTG in the management of angina and chronic coronary syndrome (CCS) was shared with 150 expert cardiologists from different regions from India. Results of these survey questionnaires were further discussed in 12 regional level meetings. The opinions and suggestions from all the meetings were compiled and analyzed. Further, recommendations were made with the help of attending national cardiology experts and a consensus statement was derived. Results: This is the first consensus on LA-NTG, summarizing the clinical evidence from India and suggesting recommendations based on these data. The experts recommended early use of LA-NTG as a first-line antianginal therapy in combination with beta-blocker since it improves exercise tolerance in patients with CCS. A strong consensus was observed for using LA-NTG in patients with co-morbid hypertension, diabetes, chronic kidney disease and post-percutaneous coronary intervention angina. As a part of cardiac rehabilitation, LA-NTG allows patients with angina to exercise to a greater functional capacity. Conclusions: A national consensus was observed for several aspects of LA-NTG in the management of angina and CCS. The clinical experience of the experts confirmed an extremely satisfied patient perception about the efficacy of LA-NTG.

Fish communities and trophic metrics as measures of ecological degradation: a case study in the tributaries of the river Ganga basin, India / Métricas tróficas y de comunidades de peces como medidas de la degradación ecológica: un estudio de caso en los afluentes de la cuenca del río Ganga, India

In India, freshwater aquatic resources are suffering from increasing human population, urbanization and shortage of all kind of natural resources like water. To mitigate this, all the major rivers have been planned for a river-interlinking through an interlinking canal system under a huge scheme; yet, the baseline information on ecological conditions of those tropical rivers and their fish communities is lacking at present. In view of that, the present study was undertaken to assess the ecological condition by comparing the trophic metrics of the fish community, conservation status and water chemistry of the two tropical rivers of the Ganga basin, from October 2007 to November 2009. The analysis of trophic niches of the available fish species indicated dominancy of carnivorous (19 species) in river Ken and omnivorous (23 species) in Betwa. The trophic level score of carnivorous species was recorded similar (33.33%) in both rivers, whereas omnivorous species were mostly found in Betwa (36.51%) than Ken (28.07%). Relatively undisturbed sites of Betwa (B1, B2 and B3) and Ken (K2, K3 and K5) were characterized by diverse fish fauna and high richness of threatened species. The higher mean trophic level scores were recorded at B4 of Betwa and K4 of Ken. The Bray-Curtis index for trophic level identified the carnivorous species (>0.32) as an indicator species for pollution. Anthropogenic exposure, reflected in water quality as well as in fish community structure, was found higher especially in the lower stretches of both rivers. Our results suggest the importance of trophic metrics on fish community, for ecological conditions evaluation, which enables predictions on the effect of future morphodynamic changes (in the post-interlinking phases), and provide a framework and reference condition to support restoration efforts of relatively altered fish habitats in tropical rivers of India.

En la India, los recursos acuáticos de agua dulce están sufriendo debido a la creciente población humana, la urbanización y la escasez de todo tipo de recursos naturales como el agua. Para mitigar esto, se ha planificado bajo un amplio esquema que todos los grandes ríos estén interconectados a través de un sistema de canales, sin embargo, la información básica sobre las condiciones ecológicas de los ríos tropicales y sus comunidades de peces es escasa en la actualidad. En vista de ello, el presente estudio se realizó para evaluar el estado ecológico, mediante la comparación de los parámetros tróficos de la comunidad de peces, estado de conservación y el agua de los dos ríos tropicales de la cuenca del Ganges, de octubre 2007 a noviembre 2009. El análisis de los nichos tróficos de las especies de peces disponibles indican dominancia de carnívoros (19 especies) en el río Ken y omnívoros (23 especies) en Betwa. El nivel trófico de las especies carnívoras fue similar en ambos ríos (33.33%), mientras que las especies omnívoras fueron mayores en Betwa (36.51%) que en Ken (28.07%). Sitios relativamente inalterados de Betwa (B1, B2 y B3) y Ken (K2, K3 y K5) se caracterizaron por la alta diversidad y riqueza de especies de peces amenazadas. Los puntajes medios más altos del nivel trófico se registraron en B4 de Betwa y K4 de Ken. El índice de Bray-Curtis para el nivel trófico identificó las especies carnívoras (>0.32) como indicadoras de contaminación. Exposición antropogénica, reflejada en la calidad del agua, así como en la estructura de la comunidad de peces, fue más alta, especialmente en los tramos inferiores de ambos ríos. Nuestros resultados sugieren la importancia de métricas tróficas en la comunidad de peces, para la evaluación de las condiciones ecológicas, lo que permite hacer predicciones sobre el efecto de futuros cambios morfodinámicos (en las fases de post-interconexión), y proporcionar un marco y condición de referencia para apoyar los esfuerzos de restauración de hábitat de peces relativamente alterados en los ríos tropicales de la India.

Horseshoe kidney--a case report.

The congenital anomalies of kidney are important as they may cause renal failure in middle age group. Horseshoe kidney is the most common fusion anomaly. It has been said to occur in every 400 births and is seen in approximately 1 out of 300 pyelographies. A horseshoe kidney was observed in a thirty-two year old male in the archives of the Department of Anatomy, PGIMER, Chandigarh. The kidney was placed at lower level as compared to its normal position. The lower poles were fused to form the isthmus opposite to the L4 vertebra. There was no extra renal anomaly. Relation of structures in hilum was normal on right side while on left side pelvis was anterior to vein and artery. The right and left renal arteries arose as usual as lateral branches of the aorta just below the level of superior mesenteric artery. Two accessory renal arteries originated from the ventral aspect of aorta just above the isthmus. Right kidney was drained by three renal veins directly into the inferior vena cava while the left kidney was drained by a renal vein which had three tributaries outside the hilum. The right kidney appeared normal under the light microscope while in the left kidney, glomeruli were decreased and glomerular space appeared more. Some of the glomeruli appeared atrophied and filled with eosinophilic material. The horseshoe kidney has been estimated to be occurring in 0.25% of the general population and is more common in men.

An extradural and subdural hematoma in a neonate.

Traumatic brain injury following birth is common in newborn but significant intracranial haematoma following birth injury is not that usual. Even busy pediatric trauma center have about only 1 to 3 % of admission that require neurosurgical care. Extradural haematoma (EDH) associated with intracerebral and subdural haematoma (SDH) is even more rare in newborn. If this is not detected and treated in time, the outcome may be fatal. A case of EDH with subdural and intracerebral haematoma in a 3 days old neonate is presented. Etiology and problems in diagnosis and management are discussed.

Spinal intramedullary arachnoid cyst.

Spinal arachnoid cysts are a relatively uncommon lesion. They may be either intra or extradural; intradural cysts being less common. Symptomatic spinal arachnoid cysts in the pediatric age group are rare. To the best of our knowledge only 2 cases of intramedullary arachnoid cysts have been reported to date. We report an unusual case of intramedullary cyst diagnosed in a 10-year-old female who presented with progressive quadriparesis. MRI scans revealed an intramedullary cystic lesion from C4 to T2. She underwent a C3 to T2 laminectomy with partial excision of the cyst. Histopathological findings confirmed the diagnosis of an arachnoid cyst. Postoperatively the patient showed dramatic recovery with marked improvement in neurological status. Arachnoid cysts should be considered in the differential diagnosis of progressive quadri / paraparesis in the pediatric age group as surgical decompression leads to marked improvement in the symptoms.

Endoscopic management of anal protrusion of ventriculo-peritoneal shunt.

A 2-year-old male child, who was operated on 18 months earlier for tuberculous meningitis with hydrocephalus by placement of a ventriculo-peritoneal shunt, presented with the lower end of the shunt tube coming out through the anus. Colonoscopy showed the shunt tube coming out through the colon 22 cm from the anal opening. The cranial end, along with a malfunctioning valve, were disconnected surgically, and the shunt was removed endoscopically using a pediatric flexible colonoscope.