The Chennai Declaration: a roadmap to tackle the challenge of antimicrobial resistance.

"A Roadmap to Tackle the Challenge of Antimicrobial Resistance - A Joint meeting of Medical Societies in India" was organized as a pre-conference symposium of the 2 nd annual conference of the Clinical Infectious Disease Society (CIDSCON 2012) at Chennai on 24 th August. This was the first ever meeting of medical societies in India on issue of tackling resistance, with a plan to formulate a road map to tackle the global challenge of antimicrobial resistance from the Indian perspective. We had representatives from most medical societies in India, eminent policy makers from both central and state governments, representatives of World Health Organization, National Accreditation Board of Hospitals, Medical Council of India, Drug Controller General of India, and Indian Council of Medical Research along with well-known dignitaries in the Indian medical field. The meeting was attended by a large gathering of health care professionals. The meeting consisted of plenary and interactive discussion sessions designed to seek experience and views from a large range of health care professionals and included six international experts who shared action plans in their respective regions. The intention was to gain a broad consensus and range of opinions to guide formation of the road map. The ethos of the meeting was very much not to look back but rather to look forward and make joint efforts to tackle the menace of antibiotic resistance. The Chennai Declaration will be submitted to all stake holders.

Body fat percent by bioelectrical impedance analysis and risk of coronary artery disease among urban men with low rates of obesity: the Indian paradox.

OBJECTIVE: To determine the association between body fat percent and prevalence of coronary artery disease (CAD) and coronary risk factors in subjects with low rates of obesity. SUBJECTS AND METHODS: We randomly selected 850 men, aged 25 to 64 years. The survey methods were questionnaire and bioelectrical impedance analysis for body composition. Subjects were divided into high-fat (n = 357), over-fat (n = 230), normal-fat (n = 200) and under-fat (n = 63) based on criteria of body-fat percent analysis. RESULTS: The prevalence of CAD and the coronary-risk factors hypercholesterolemia, hypertension, diabetes, mellitus and sedentary lifestyle were significantly associated with high and moderate body fat percent despite low body-mass index (23.6+/-4.1 kg/m2). Mean total cholesterol, triglycerides and blood pressure were significantly associated with high and moderate body fat percent. The prevalence of smoking was weakly but inversely associated with high body-fat percent. Mean HDL cholesterol was positively associated with high body-fat percent. Body mass index was positively associated with high body-fat percent. CONCLUSIONS: High and moderate body-fat-percent subjects were associated with high prevalence of CAD and the coronary-risk factors hypertension, diabetes mellitus, higher body-mass index and sedentary lifestyle.

Trans-telephonic electrocardiographic monitoring--experience in India.

A centre for trans-telephonic electrocardiographic monitoring (TTEM) was established at the Escorts Heart Institute in May 1996. We have reviewed our experience in the first 398 patients. There were 321 males (81%) and 77 females (19%); their age range was 1 month to 95 years. Sixty-five per cent of patients were from New Delhi, while the remainder were from other cities in India and abroad. As well as follow-up of patients after discharge, the system was used for the evaluation of chest pain, palpitation, chronic angina, arrhythmias, and pacemaker implants. Out of 664 symptomatic transmissions, 510 (77%) were for cardiac symptoms like chest pain (309), palpitation (90), uneasiness (61), dizziness (28) and breathlessness (22); the other 154 (23) were for non-cardiac symptoms like stitch pain and backache (51), typical chest pain (39), weakness and fever (45), and sweating (19). The majority of patients with chest pain (84%), palpitation (78%) and dizziness (75%) transmitted their electrocardiograms within one hour of the onset of the symptoms. Out of 664 symptomatic transmissions, 531 required either reassurance or drug-dose adjustment by telephone and 97 were called to the outpatient department on an elective basis. Immediate hospitalization was advised for 36 patients, for acute management of their symptoms. TTEM was useful in avoiding 628 unnecessary visits to the hospital, while 36 patients were immediately hospitalized for acute care.

Evaluation of cardiac symptoms by trans-telephonic electro-cardiographic monitoring (TTEM): preliminary experience.

Between May 1996 and May 1997, a total of 398 patients (321 males, 77 females) were registered at our institute for trans-telephonic electro-cardiographic monitoring (TTEM). Their age ranged from one month to 95 years. Almost two-third (67%) of patients were from Delhi and one-third (33%) from other places in India and neighbouring countries. Clinical profile of these patients was post-bypass surgery, post-myocardial infarction, chest pain for evaluation, post-percutaneous transluminal coronary angioplasty, chronic stable angina, evaluation of palpitations, arrhythmias, and pace-maker follow-up. Out of 664 symptomatic transmissions, 568 (86%) were received for cardiac symptoms and 96 (14%) for non-cardiac symptoms. Seventy-nine percent patients had chest pain or palpitations at the time of transmission, whereas 21 percent had other symptoms like chest discomfort, breathlessness or dizziness. The electro-cardiograms were transmitted within one hour of the onset of chest pain in 84 percent, palpitations in 78 percent and dizziness in 75 percent. Of patients with symptomatic transmissions, 628 (95%) required either reassurance or drug-dose adjustment and outpatient department review. Only 36 (5%) patients were hospitalised as an emergency, and out of these only 19 (3%) needed acute management. In conclusion, trans-telephonic electro-cardiographic monitoring is a very convenient and an 'all-time-available' monitoring facility for establishing patient-physician contact in the shortest time. It is useful in rendering instant advice for hospitalisation in emergency situations while avoiding unnecessary visits to the hospital.

Trans-telephonic electro-cardiographic monitoring (TTEM)--first Indian experience.

Trans-Telephonic Electro-Cardiographic Monitoring (TTEM) centre, is an easy to use tool, now freely available in India. Between May 1996 and May 1997, 398 patients were registered at Escorts Heart Alert Centre (EHAC) for TTEM; 321 (81%) males and 77(19%) females. Age range was from 1 month to 95 years 65% patients were from New Delhi; 35% from other cities in India and abroad. Patients' clinical profile were post-CABG, post-PTCA, post-MI, patients after discharge; evaluation of chest pain, palpitation, chronic angina, arrhythmias, and pace-maker follow up. Out of 664 symptomatic transmissions, 510 (77%) were for cardiac symptoms like chest pain 309 (61%); palpitation 90 (18%); uneasiness 61(12%); dizziness 28(5%) breathlessness 22(4%). 154(23%) were for non-cardiac symptoms like stitch pain and backache (51); Atypical chest pain (39); weakness and fever (45) and sweating (19). 84%, 78% and 75% patients of chest pain, palpitation and dizziness respectively transmitted their ECGs within one hour of the onset of the symptoms. Out of 664 symptomatic transmissions, 531 required either re-assurance or drug-dose adjustment on telephone. 97 were called to OPD on elective basis. 36 patients were advised immediate hospitalization, for acute management. TTEM was useful in avoiding 628 unnecessary visits to the hospital whereas 36 patients, were immediately hospitalized, for receiving acute life-saving interventions.

Alteration of hepatic drug metabolism in female patients with congestive cardiac failure.

Antipyrine was used to assess the status of drug metabolism in ten female patients with congestive cardiac failure. Ten age-matched female subjects were used as controls. Patients showed a 40% increase in antipyrine plasma half-life (APH). Elimination constant (Ke) was decreased by 19% in patients as compared to controls. The area under the curve (AUC) was increased by 32% in the patient group. The routine liver function tests did not show any significant alteration in the patients. Increase in APH and AUC and decrease in Ke suggest impaired hepatic drug metabolism in patients with congestive cardiac failure.