Green Building: A Step towards Environmental and Economic Construction

The purpose of this article is to provide planners with an introduction to the concept of green buildings and building assessment systems and to identify and explore the major themes in the literature as they relate to planning. Green building is one of the measures that has been put forward to alleviate the remarkable impacts of the building stock on the environment, society and economy. GRIHA (Green Rating for Integrated Habitat Assesment) is a rating instrument that helps individuals evaluate their building's efficiency against certain benchmarks that are acceptable nationwide, it evaluates a building's environmental efficiency over its entire life cycle holistically. This paper reports a critical review of the GRIHA rating system and incentives provided by GRIHA in India, techniques, and methods for construction of the green building, financial aspects of the green building. The efficiency of different environment-friendly models is broadly discussed in this study. The purpose of this paper is to explore the benefits of green building in order to proceed towards sustainable construction in the future.

An effective integrated learning programme in the first year of the medical course.

BACKGROUND: An integrated approach to teaching medical subjects is an effective educational strategy. Yet, this has not become popular in medical colleges in India. We describe an integrated learning programme to teach the gastrointestinal system in the first year of the medical course. METHODS: The integrated learning programme was conducted for 3 years (2003-2005). It incorporated elements of problem-based learning, early clinical exposure, lectures and small group laboratory work. Student assessment was formative (for problem-based learning sessions) and summative (using problem-based learning and knowledge tests). Evaluation of the programme was based on feedback from the students and faculty members. RESULTS: Ninety-six per cent of the students obtained more than 60% marks in the problem-based learning test. The mean (SD) score in the knowledge test was 62 (0.89)%. The majority of students received satisfactory and more than satisfactory grades for their performance in the problem-based learning sessions. The feedback from faculty members and students was positive, which highlighted benefits such as integrated learning of the basic sciences, their application to clinical cases and active student learning. The challenges encountered included the higher input required from faculty members. Most of the faculty members and students recommended that the integrated programme should be continued and extended to other parts of the curriculum. CONCLUSION: An integrated learning programme is feasible within a conventional medical curriculum of an Indian medical college.

Inoperable non-small cell lung cancer: palliative radiotherapy with two weekly fractions.

Thirty seven cases (30 males; 7 females) of advanced non-small cell lung cancer were treated with short course of palliative radiotherapy. All the patients were inoperable. Their main symptoms were related to primary intrathoracic disease and poor performance status. Radiotherapy was delivered to a total dose of 17 Gy in two fractions one week apart. Ninety percent of the patients had cough, 50% complained of haemoptysis, 45% chest pain and 30% breathlessness. Palliation of main symptoms was achieved in majority of the patients, more than 90% in haemoptysis, 60% in cough, 70% in chest pain and 50% in breathlessness. Mean duration of palliation was four months and performance status improved in 60% of the patients. Short course radiotherapy of 17 Gy in two weekly fractions is recommended in patients with advanced non-small cell lung cancer (NSCLC) having poor performance status.

Clinical dysautonomia in diabetes mellitus--a study with seven autonomic reflex function tests.

Thirty-eight patients of NIDDM, 12 of IDDM and 10 healthy age matched controls were subjected to seven standardised autonomic reflex function tests. A scoring criteria was utilised for diagnosing and grading the severity of dysautonomia. Eight patients of IDDM and 24 of NIDDM had dysautonomia. One-third of the patients in each group had grade IV autonomic dysfunction. Severity of autonomic dysfunction was directly related to the duration of disease in NIDDM whereas in IDDM this relation was not seen. Peripheral neuropathy was almost always associated with dysautonomia in NIDDM. On the contrary, in IDDM dysautonomia was independent of peripheral neuropathy. Charcot's arthopathy, dysphagia, constipation and nocturnal diarrhea were always associated with evidence of dysautonomia. Other symptoms viz. gustatory sweating, postural dizziness and impotence did not necessarily indicate dysautonomia.

Plasmacytoma of scalp.

An interesting case of plasmacytoma of the scalp is described. Extramedullary plasmocytoma of scalp is rarely reported. This patient was treated with external radiotherapy dose of which was 40 Gy/20 fraction. Disease responded very well to radiotherapy.

Post orchiectomy management in stage II testicular seminoma.

Twenty eight patients with stage II A and twenty patients with stage II B testicular seminoma were treated at this institute between January 1982 and December 1988. The three year crude survival observed in this retrospective analysis was 82% and 75% respectively. Post orchiectomy infradiaphragmatic radiotherapy was the mainstay of the treatment. In stage II A 4 patients were administered adjuvant chemotherapy as well. Prophylactic Mediastinal Irradiation (PMI) was not employed as a routine in this subgroup. Eight patients (28%) relapsed (Mediastinal Nodes--4, Pulmonary--3, Scrotal--1). In stage II B twelve patients were treated with primary abdominal radiotherapy and of them 4 were delivered PMI as well. Induction chemotherapy was administered in remaining 8 patients. Seven patients (35%) relapsed (Pulmonary-4, Mediastinal Nodes-3). Mediastinal recurrence was noted only in those who were treated with abdominal radiotherapy alone. Though salvage chemotherapy proved successful in 5 of the seven patients (70%) with nodal relapse, none of the patients with extranodal relapse responded to subsequent chemotherapy. For stage II A we recommend abdominal radiotherapy alone and for stage II B Induction chemotherapy is advised keeping radiotherapy reserved for residual mass. We do not advocate PMI as a routine in stage II testicular seminoma as no survival benefit is observed.

Adenoid cystic carcinoma of the cervix.

Adenoid cystic carcinoma constitute around 0.4 to 1.7% of all carcinomas of cervix. It generally presents in elderly age group, however few cases in younger age have also been reported. Majority of cases present in early stage. Though concluding statement regarding the results cannot be made from the cases accumulated from the various reported series, nonetheless this review shows that radiotherapy too is effective in early stage and even in stage I results with radiotherapy appear better than surgery. In advanced stage outcome is invariably poor. In early stage main pattern of failure is distant metastasis. Both local and distant failure are observed in stage III and IV. Though lung is the commonest site of metastases (51%), abdominal cavity and brain are also found to be involved in some cases. Limited experience shows effectiveness of high doses of cisplatin and multiagent chemotherapy. Cases of early stage disease having risk for metastases and local failure should be identified and managed with multimodality treatment using surgery for bulky disease with post-operative radiotherapy and chemotherapy. In advanced stages combination of chemotherapy and radiotherapy is required. Exenterative surgery for central failure has been used effectively. Overall no evidence of disease rate is found to be about 48%, with mean follow-up of 39 months.

Leiomyosarcoma of the ovary.

A diagnosis of leiomyosarcoma of ovary was made in a 60 year old female presenting with generalised weakness and abdominal lump. On clinical examination, a hard, big mass with some cystic areas was found occupying the pelvic cavity. Chest X-ray revealed presence of metastases. Deranged renal function and structure due to extrinsic pressure were evident on pyelography and USG. USG also suggested the ovarian origin of the mass. Fine needle aspiration biopsy was suggestive of leiomyosarcoma. Laparotomy was carried out for excision of tumor along with bilateral salpingo-oophorectomy and hysterectomy. Post-operatively renal functions normalized. A course of radiotherapy was given. At 6 months' follow-up, abdomino-pelvic sonography was normal but lung metastases were found to be enlarged. The patient was asked to follow up for chemotherapy but did not come. She died 18 months after treatment, as revealed through correspondence.

Carcinoma of the oesophagus: correlation of radiological appearance with response to radiotherapy.

In order to predict possibility of local control in carcinoma of the oesophagus by radiotherapy, the relationship between the x-ray findings before and after radiotherapy were analyzed in 55 irradiated cases. In the superficial or proliferative type on x-ray before treatment, local control was observed in 87% cases with dose of 40 Gy, whereas in the ulcerative or infiltrative type it was observed in 20% cases. Radiation response is remarkably good in proliferative and superficial lesions seen in oesophagogram.

Effect of some natural pesticides on entomogenous muscardine fungi.

Five commercial preparations of natural pesticides were tested for in vitro compatibility with muscardine fungi, Beauveria brongniartii and Metarhizium anisopliae. Neemark (azadirachtin) was found compatible with both the fungi. Phytoallexin, the natural fungicide, significantly inhibited the growth of both the fungi, while other natural pesticides showed moderate to severe inhibition.

Cardiovascular response to dynamic treadmill exercise in patients with essential hypertension before and after therapy with atenolol or captopril.

Thirty eight patients with essential hypertension and 20 healthy volunteers were subjected to treadmill exercise test. The hypertensives were then controlled with atenolol or captopril by randomly forming two groups of 19 patients each, and treadmill evaluation was repeated. The resting rate-pressure product (RPP) and myocardial oxygen consumption (MVO2), as well as peak RPP and MVO2 and recovery time, were increased and exercise duration decreased significantly in uncontrolled hypertensives (p less than 0.001). Control of hypertension resulted in significant improvement of exercise performance in both the groups. Atenolol, when compared to captopril, resulted in better exercise conditioning with considerable lowering of resting and peak RPP and MVO2 (p less than 0.001), though the difference in exercise duration, maximum work load and recovery time were not significant (p greater than 0.05). Thus, where myocardial oxygen consumption is an important consideration while treating hypertension, atenolol offers a better choice.