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There have been no published recommendations for management of Low Risk Chest Pain in Emergency Departments across India. This is despite the fact that chest pain continues to be one of the most common presenting complaints in Emergency Departments. Risk stratification of patients utilizing an Accelerated Diagnostic Protocol has been shown to decrease hospitalizations by approximately 40% with a low 30 day risk of Major Adverse Cardiac Events. The Experts Group of Academic Leaders from the Indian College of Cardiology and Academic College of Emergency Experts in India partnered with Academic Experts in Emergency Medicine and Cardiology from leading Institutions in the UK and USA collaborated to study the scientific evidence and make recommendations to guide emergency physicians working in Emergency Departments across India.

The precise location and functional organization of the spinal neuronal locomotor-related networks in adult mammals remain unclear. Our recent neurophysiological findings provided empirical evidence that the rostral lumbar spinal cord segments play a critical role in the initiation and generation of the rhythmic activation patterns necessary for hindlimb locomotion in adult spinal rats. Since added epidural stimulation at the S1 segments significantly enhanced the motor output generated by L2 stimulation, these data also suggested that the sacral spinal cord provides a strong facilitory influence in rhythm initiation and generation. However, whether L2 will initiate hindlimb locomotion in the absence of S1 segments, and whether S1 segments can facilitate locomotion in the absence of L2 segments remain unknown. Herein, adult rats received complete spinal cord transections at T8 and then at either L2 or S1. Rats with spinal cord transections at T8 and S1 remained capable of generating coordinated hindlimb locomotion when receiving epidural stimulation at L2 and when ensembles of locomotor related loadbearing input were present. In contrast, minimal locomotion was observed when S1 stimulation was delivered after spinal cord transections at T8 and L2. Results were similar when the nonspecific serotonergic agonists were administered. These results demonstrate in adult rats that rostral lumbar segments are essential for the regulation of hindlimb locomotor rhythmicity. In addition, the more caudal spinal networks alone cannot control locomotion in the absence of the rostral segments around L2 even when loadbearing rhythmic proprioceptive afferent input is imposed.NEW & NOTEWORTHY The exact location of the spinal neuronal locomotor-related networks in adult mammals remains unknown. The present data demonstrate that when the rostral lumbar spinal segments (~L2) are completely eliminated in thoracic spinal adult rats, hindlimb stepping is not possible with neurochemical modulation of the lumbosacral cord. In contrast, eliminating the sacral cord retains stepping ability. These observations highlight the importance of rostral lumbar segments in generating effective mammalian locomotion.

Fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) scan is fast becoming a very useful tool in diagnosing and staging of several malignancies that affect the human body. We report three cases of ocular choroidal malignant melanoma, wherein FDG PET-CT scan did not show as good uptake as seen in other cancers.

The impact of intracoronary autologous bone marrow mononuclear cells (BMMC) in patients with DCM (dilated cardiomyopathy) with severe left ventricular (LV) dysfunction was assessed. The study included five DCM patients (age group 20 - 65 years) with ejection fraction (EF) of 30%. Mononuclear cells (Mean MNC count: 9.16 x 107 and Mean CD34 positive cell count: 3.68 x 105) were infused through intracoronary injection into the patients. Left ventricular ejection fraction (LVEF) was increased from 25 - 30% to 40 - 45% (approximately 500,000 CD34 + cells) in two of the patients. Conclusively, bone marrow mononuclear cell therapy has a potential to be considered a standard therapeutic entity for thetreatment of dilated cardiomyopathy with severe LV dysfunction.

The guidelines ignore the common catastrophic first presentation of coronary disease, the powerful predictive value of serum cholesterol in young persons, the effectiveness of cholesterol-lowering interventions, the low cost of effective dietary modification, and the effectiveness of lipid lowering in women and in the elderly.

B-6, Shantiniketan Row Houses, Near Sneh Sankul Wadi, Anand Mahal road, Adajan, Surat – 395009 e mail id : pratikshah20@gmail.com Vogt Koyanagi Harada syndrome is an idiopathic multisystem autoimmune disease having autoimmune reaction to melanocyte/their tyrosinase related peptide, results in inflammation of melanocyte-containing tissues (uvea, ear, skin, meninges).1 The disease is more common in females of 3rd-4th decade from pigmented race with HLA associations (HLADR4, DR53 & DQ4).1 At early stage, flu like manifestation may precede the ocular manifestations like diffuse choroiditis, serous retinal detachment/ focal areas of subretinal fluid (Figure 1-3). Diffuse choroidal thickening on B – Scan ultrasonography with fluorescein angiographic finding-focal areas of delayed choroidal perfusion/ multifocal pinpoint leakage/areas of placoid hyperfluorescence / pooling of subretinal fluid /optic nerve staining can aid in diagnosis. At late stage, evidence of previous early manifestations along with ocular depigmentation / nummular chorioretinal scars/retinal pigment epithelium clumping & migration / anterior uveitis are known. Disease may be associated with extra ocular manifestation (Figure 4) like neurologic & auditory signs i.e. Meningismus – Malaise / fever / headache / nausea / abdominal pain / stiffness of the neck & back / tinnitus, Cerebrospinal fluid pleocytosis and Integumentary signs like Alopecia / Poliosis / Vitiligo. It is known to have good visual outcome with early diagnosis & prompt treatment.1,2 The case of a 31 year male, who presented to casualty department with a complaints of sudden loss of vision in both eye over two days. On examination, the key finding was bilateral visual acuity of perception of light with projection of rays from all four quadrant along with vitritis – choroiditis & hyperemic optic disc with multiple discrete shallow exudative retinal detachment (Figure 1-3) with small folds that radiate from the macula. Differential diagnosis was reviewed in detail and Figure 1: fundus photograph of RE, having Exudative RD involving macula.note the other small discrete pocket of subretinal fluid temporal to the Macula

Atherosclerotic cardiovascular disease results in >19 million deaths annually, and coronary heart disease accounts for the majority of this toll. Despite major advances in treatment of coronary heart disease patients, a large number of victims of the disease who are apparently healthy die suddenly without prior symptoms. Available screening and diagnostic methods are insufficient to identify the victims before the event occurs. The recognition of the role of the vulnerable plaque has opened new avenues of opportunity in the field of cardiovascular medicine. This consensus document concludes the following. (1) Rupture-prone plaques are not the only vulnerable plaques. All types of atherosclerotic plaques with high likelihood of thrombotic complications and rapid progression should be considered as vulnerable plaques. We propose a classification for clinical as well as pathological evaluation of vulnerable plaques. (2) Vulnerable plaques are not the only culprit factors for the development of acute coronary syndromes, myocardial infarction, and sudden cardiac death. Vulnerable blood (prone to thrombosis) and vulnerable myocardium (prone to fatal arrhythmia) play an important role in the outcome. Therefore, the term “vulnerable patient” may be more appropriate and is proposed now for the identification of subjects with high likelihood of developing cardiac events in the near future. (3) A quantitative method for cumulative risk assessment of vulnerable patients needs to be developed that may include variables based on plaque, blood, and myocardial vulnerability. In Part I of this consensus document, we cover the new definition of vulnerable plaque and its relationship with vulnerable patients. Part II of this consensus document focuses on vulnerable blood and vulnerable myocardium and provide an outline of overall risk assessment of vulnerable patients. Parts I and II are meant to provide a general consensus and overviews the new field of vulnerable patient. Recently developed assays (eg, C-reactive protein), imaging techniques (eg, CT and MRI), noninvasive electrophysiological tests (for vulnerable myocardium), and emerging catheters (to localize and characterize vulnerable plaque) in combination with future genomic and proteomic techniques will guide us in the search for vulnerable patients. It will also lead to the development and deployment of new therapies and ultimately to reduce the incidence of acute coronary syndromes and sudden cardiac death. We encourage healthcare policy makers to promote translational research for screening and treatment of vulnerable patients.