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Prehospital triage of ST-elevation myocardial infarction (STEMI) for primary percutaneous coronary intervention (PCI) reduces treatment times. Prehospital triage and transport of STEMI patients have traditionally been undertaken in emergency medical service systems with Advanced Care Paramedics (ACPs). However, ACPs are not available in many regions. A pilot study was conducted to determine the feasibility of prehospital STEMI triage in a region with only Primary Care Paramedics. Hemodynamically stable patients with chest pain and suspected STEMI were brought directly to a catheterization laboratory for primary PCI. End points included accuracy of prehospital STEMI identification, complications during transfer, and treatment times. One hundred thirty-four consecutive patients with suspected STEMI were triaged for primary PCI. Only 1 patient developed complications during transport (rapid atrial flutter) that required ACP skills. One hundred thirty-three patients underwent urgent angiography, and 105 patients underwent PCI. Based on physician interpretation of the prehospital electrocardiogram, there was agreement with triage decision for 121 (90%) of the 134 cases. The final diagnosis based on the angiogram and cardiac markers was true STEMI for 106 patients and false positive for 28 patients. The median first medical contact to balloon time was 91 (81-115) minutes. Hemodynamically stable patients with suspected STEMI can be safely and effectively transported directly for primary PCI by paramedics without advanced care training. Prehospital STEMI triage for primary PCI can be extended to regions that have few or no paramedics with advanced care training.

INTRODUCTION:Anxiety or Stress i.e. Chittodvega is mentioned in Manasika Vikaras. The word Chittodvega is made up of two words i.e. Chitta means Mind and Udvega refers to Anxious. Chittodvega refers to state of anxiety, fear and agitation. Stress has become a common problem among the student community. Examinations are the important milestones in the academic life of the students. Based on the examination results further career of the students are decided. But the examination stress in students is affecting the performance which may affect the academic career of the students.In the domain of education, high level of anxiety is often experienced by students during performance related activities such as, exams. Inefficient study, night study before exams, lack of review/revision of study materials, emotional factors, and negative/irrational thinking about exams are some of the causes of exam anxiety. Importantly, in students, high level of anxiety could have an impact on working memory, reasoning abilities, self-esteem, academic performance and achievement. Anxiety in students can affect their physical and psychological characteristics causing panic attacks, which makes them go blank during exams, feel helpless/cold/nervous, have sweaty palms/fast breath/palpation and could even cause stomach upset.In a survey study findings revealed that 35 and 37 percent reported high or very high levels of academic stress and exam anxiety respectively. All students reported high levels of academic stress, but those who had lower grades reported higher levels of stress than those with higher grades. Students who engaged in extracurricular activities were more likely to report exam anxiety than those who did not engage in extra-curricular activities.Tulsi leaves are regarded as an 'adaptogen' or anti-stress agent. Recent studies have shown that the leaves afford significant protection against stress. In this present study Tulsi in the form of tablet will be administered at 2 gm. per day in divided doses. In Rasatarangini, bhavana of the drug will improve the potency and to allow it easy absorption. In this regard Tulsi leaves tablets will be prepared after giving seven bhavana of Tulsi Swarasa. Tulsi (Ocimum sanctum) has not been studied clinically in the management of exam induced anxiety in students previously.Hence this study is taken to observe the effectiveness of Tulsi (Ocimum sanctum) as a medicine in the management of exams induced stress (Chittodvega)AIMS & OBJECTIVES:To study the effectiveness of Tulsi (Ocimum sanctum) in the management of Exam Stress (Chittodvega).METHODOLOGY:124 Volunteers were screened by using Westside test anxiety scale for diagnosing the level of exam stress and 46 volunteers who scored above 2.5 to 4.0 (mild to moderate) were selected for the study.33 Volunteers who fulfilled the inclusion criteria of Exam Stress from OPD and academic section of SDM College of Ayurveda and Hospital, Hassan were selected.The drug Bhavit Tulsi vati (Ocimum sanctum) was given in the dose of 2 vati each of 500mg twice daily after food with Luke warm water 30 days before exam for the duration of 30 days.

Public reporting of procedural outcomes leads to risk averse behavior because physicians do not believe the scores account for patient risk. We investigated the effects of more aggressive percutaneous coronary intervention (PCI) practice on risk-adjusted mortality. 8935 PCI were performed. Risk adjustment was performed with the New York State PCI risk score. The cohort was divided into two eras based on programs implemented to promote more aggressive care. Between eras, overall adjusted mortality ratios rose from 0.66 to 0.90 (observed/predicted, p = 0.02), despite evidence supporting consistent procedural quality. Evidence-based changes in PCI practice were associated with worsening risk-adjusted procedural mortality. These data are consistent with physician beliefs regarding risk-adjusted outcome measures.

Results: Of 5393 eligible subjects who underwent EBCT, 4903 did not receive active treatment and were included in the natural history component of the study; follow-up data were available at a mean of 4.3 years for 4613 patients, of whom 1293 also had risk factor assessment. Only 119 (2.6%) of the 4613 subjects had cardiovascular events over the follow-up period (40 had nonfatal myocardial infarction or coronary death, 7 had a nonhemorrhagic stroke, 59 had coronary revascularization, and 13 underwent peripheral vascular surgery). The relative risk for all CAD events was 9.6 (95% CI 6.7 to 13.9) among subjects with calcium scores greater than 100 compared with subjects whose scores were less than 100. The calcium score predicted cardiovascular events independent of CRP level and standard risk factors, and it had a higher area under the ROC (receiver-operating characteristic) curve than did the Framingham risk index (0.79 v. 0.68, p = 0.0006). The CRP level was not significantly associated with cardiovascular events after adjustment for risk factors. The calcium score appeared to enhance risk stratification based on the Framingham index, particularly for subjects at intermediate risk.

Cardiac surgery-associated acute kidney injury (CSA-AKI) affects up to 42% of cardiac surgery patients. CSA-AKI is multifactorial, with low abdominal perfusion pressure often overlooked. Abdominal perfusion pressure is calculated as mean arterial pressure minus intra-abdominal pressure (IAP). IAH decreases cardiac output and compresses the renal vasculature and renal parenchyma. Recent studies have highlighted the frequent occurrence of IAH in cardiac surgery patients and have linked the role of low perfusion pressure to the occurrence of AKI. This review and expert opinion illustrate current evidence on the pathophysiology, diagnosis, and therapy of IAH and ACS in the context of AKI.

Climate change is one of the major drivers of biodiversity loss. Among vertebrates, amphibians are one of the more sensitive groups to climate change due to their unique ecology, habitat requirements, narrow thermal tolerance and relatively limited dispersal abilities. We projected the influence of climate change on an endemic toad, Malabar Tree Toad ( Pedostibes tuberculosus ; hereafter MTT) from the Western Ghats biodiversity hotspot, India, for two different shared socio-economic pathways (SSP) using multiple modeling approaches for current and future (2061–2080) scenarios. The data used predominantly comes from a citizen science program, ‘Mapping Malabar Tree Toad’ which is a part of the Frog Watch citizen science program, India Biodiversity Portal. We also evaluated the availability of suitable habitats for the MTT in Protected Areas (PAs) under the current and future scenarios. Our results show that annual precipitation was the most important bioclimatic variable influencing the distribution of MTT. We used MaxEnt (MEM) and Ensemble (ESM) modeling algorithms. The predicted distribution of MTT with selected environmental layers using MEM was 4556.95 km 2 while using ESM was 18,563.76 km 2 . Overlaying PA boundaries on predicted distribution showed 37 PAs with 32.7% (1491.37 km 2 ) and 44 PAs with 21.9% (4066.25 km 2 ) coverage for MEM and ESM respectively. Among eight future climate scenarios, scenarios with high emissions showed a decreased distribution range from 33.5 to 68.7% of predicted distribution in PAs, while scenarios with low emissions showed an increased distribution range from 1.9 to 111.3% in PAs. PAs from the Central Western Ghats lose most suitable areas with a shift of suitable habitats towards the Southern Western Ghats. This suggests that MTT distribution may be restricted in the future and existing PAs may not be sufficient to conserve their habitats. Restricted and discontinuous distribution along with climate change can limit the dispersal and persistence of MTT populations, thus enhanced surveys of MTT habitats within and outside the PAs of the Western Ghats are an important step in safeguarding the persistence of MTT populations. Overall, our results demonstrate the use of citizen science data and its potential in modeling and understanding the geographic distribution and the calling phenology of an elusive, arboreal, and endemic amphibian species.

Bestowed with rich botanical wealth, the people of India have probably the oldest, richest and most diverse cultural traditions in the use of medicinal plants super(1). At higher altitudes of the Western Himalayan ranges (extending from ca. 500 m to snow-clad peaks), a variety of important and endemic medicinal plants are found, making it a biodiversity-rich region super(2). Records indicate that these medicinal herbs have been in use for treating diseases since ancient times. The advent of herbal renaissance in recent times has led to heavy extraction of these medicinal plants from the wild. This, aided by loss of habitat by deforestation and excessive grazing pressure in high-altitude pastures in the entire Himalayan region threatens the survival of some important medicinal plants, one of them being Brahma Kamal.