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Several risk stratification tools have been described for quantifying perioperative morbidity, mortality, and adverse events in patients undergoing elective and emergency surgeries. These tools help in decision-making, determining the prognosis and communicating it with patients and family members, and planning admissions to the intensive care units (ICU) if necessary. Emergency surgery poses quite a unique challenge in terms of deranged physiology, age, and comorbid conditions, and often carries a higher incidence of morbidity and mortality. Very few risk stratification tools are available to reliably predict the risk posed by emergency surgical interventions. One of the recently described tools is the Emergency Surgery Score (ESS), which comprises three demographic variables, 10 comorbidities, and nine laboratory variables, the scores of which add up to 29. Several studies have demonstrated that ESS reliably predicts morbidity, mortality, and the need for ICU admission, predicting infectious complications like pneumonia and renal failure. In this review, we analyze the current literature to investigate the efficacy and reliability of ESS as a risk stratification tool for patients undergoing emergency surgeries.

Hydatid infection of the heart is rare and there is always the lethal hazard of cyst perforation. We present an 18-year-old male from Kashmir valley who was admitted to the emergency department of our hospital with fever and chest pain for the last 4 days. Using echocardiography and cardiac tomography (CT), cardiac Echinococcosis was diagnosed. The results of surgical treatment of cardiac Echinococcosis were better than the conservative strategy. Surgical excision was performed. The patient had an uneventful recovery.

The sudden disappearance of peripheral pulse tracing in the post cardiopulmonary bypass period can be an ominous sign of a catastrophic complication in cardiac surgery. It needs to be recognized at the earliest and immediate action should be taken to avoid serious outcome. Here we have described a case of Bentall’s procedure in which the right radial arterial tracing disappeared about 60 minutes post-operatively due to aortic dissection, but was repaired successfully because of early detection. We conclude that following cardiac surgery, one must closely monitor the peripheral pulses. The decrease in amplitude or disappearance of peripheral pulse should be taken seriously. It should be investigated immediately and prompt treatment should be done to save life.

Background: Several recent modifications in technical, operative and perfusion techniques have enabled good operative results and final outcome for patients with aneurysms of the aortic arch. Although surgical procedures for this disease still remain a formidable challenge, availability of improved prosthetic grafts, myocardial protection techniques, brain protection protocols and better blood bank facilities ensure minimal postoperative morbidity and mortality.

Premature coronary artery occlusive disease in familial homozygous hypercholesterolemia might necessitate coronary bypass surgery in children and young adults. Arterial grafts have been shown to be superior to venous grafts in children, with longer patency rates and a better growth potential. Young adults with familial hypercholesterolemia also fare better with internal thoracic grafts, although the benefit of multiple arterial grafts is still unproved in this setting. Surgical angioplasty of the main coronary arteries is another alternative to preserve the precious arterial conduits for future reoperations. Saphenous venous grafts, although inferior, have also been found to have some growth potential and long-term patency, even up to 22 years. The subject of this report is a 12-year-old child with familial homozygous hypercholesterolemia and severe obstructive coronary artery disease who underwent a total arterial revascularization. To the best of our knowledge, this is the first report of total arterial revascularization at this age.

The corporate governance plays a major role in the integrity of businesses and markets and helps in maintaining vitality, growth and stability and leads to increase in economic efficiency. In India SEBI under its listing agreement clause 49 has laid down rules and regulations for effective corporate governance and lot of research has been carried out to evaluate the corporate governance practices of the Indian corporate. At global level Organization for Economic Cooperation and Development (OECD) has also framed principles of corporate governance which are non-binding and intended to assist member and non-member government to evaluate and improve the legal, institutional and regulatory framework of corporate governance. The principles of corporate governance as laid down by OECD can lead to examine the level of disclosure practices to corporate governance at global level of the Indian corporate. Hence, in this study an attempt has been made to examine and evaluate the level of the fulfillment towards the various principles of 30 BSE Sensex companies for the year 2010-11.The analysis reveals that the disclosure practice made by Indian company as per Clause – 49 are to a certain extent capable of meeting the various principles of OECD on Corporate Governance. The Study depicts that the principle on Role of Stakeholders in Corporate Governance has attained greater significance. The principle on Board Responsibilities and Disclosure and Transparency needs to be more emphasised by Indian companies for effective Corporate Governance practice at global level.

The human health and environment is being continuously damaged due to increasing amount of air pollution being emitted into the atmosphere in particular the RSPM. The level of RSPM is found to even exceed the prescribed National Ambient Air Quality Standards in India. The reason for high particulate matter levels are the emissions from auto vehicles, diesel gensets, re-suspension of traffic dust, small scale industries, biomass burning, commercial and domestic use of fuels, etc. Exposures to these factors are responsible for both acute and chronic health diseases specially affecting the respiratory system leading to impaired cardiopulmonary function, reduction of lung function and premature mortality, etc. The study reveals that the males are more exposed to females particularly in the age group of 25-45 and the cost of illness per episode was found to be higher in females as compared to male.

The last decade, has resulted in sever environmental degradation due to increase in harmful pollutants which are emitted in the atmospheric. The pollutants have caused serious health related problems due to exposure to poor air quality such as respiratory symptoms or illness impaired cardiopulmonary function, reduction of lung function, and premature mortality. The intensified process of industrialization and urbanization in India in past decade has resulted in sever environmental degradation causing serious threat to the health of Indian citizens. This study attempts to understand the air pollution level in Agra city and its effects on human health in terms of economic cost. With the application of system dynamic model forecasting of the levels of air pollutants viz., SO2, NO2, PM10, & TSPM for future has been made. The study brings out the fact that the level of SO2 will be decrease and the level of TSPM and PM10, will increase rapidly. This model also shows that the sick population and economic cost will likely be doubled within the gap of just fifteen years.

Clause 41 of the listing agreement as issued by Securities Exchange Board of India (SEBI) directs the India Inc to comply with the provisions laid down by the board in respect of financial reporting. The board has made special requirement in respect of Interim Financial Reporting (IFR) to prepare and publish interim financial results and limited reviews of interim results by the auditor etc. In this paper an attempt has been made to verify the compliance of guidelines issued by SEBI as regard to interim financial result and put it on a scorecard to measure the level of compliance.

Corporate social responsibility is one aspect of sustainability that defines 'corporate voluntary actions designed to improve social or environmental conditions.' This voluntary action leads to the publication of separate special purpose 'sustainability' reports. Now a day’s corporate seek independent assurance of their sustainability reports as a means to further enhance the credibility of their sustainability efforts. One such assurance provider is the Dow Jones Sustainability Index (DJSI). In order to become a member of the DSJI, corporate are assessed on the opportunities and the risks related to economic, environmental, and social dimensions. In this paper an attempt has been made to identify Asia Pacific sustainability leaders as identified by Dow Jones Sustainability Asia Pacific IndexSM through a corporate sustainability assessment. It was found that none of the Indian companies have ever qualified for a position in this index.

Increasing amount of air pollution being emitted into the atmosphere at a global scale is continuously damaging the human health and the environment. The level of air pollutants viz, NO2, PM10 and TSPM levels exceed the prescribed National Ambient Air Quality Standards for the city of TAJ. The reason for high particulate matter levels are vehicles, engine gensets, small scale industries, biomass incineration, boilers, resuspension of traffic dust, commercial and domestic use of fuels, etc. These pollutants are responsible for both acute and chronic effects on human health. The exposure to ambient air pollutants has led to many health diseases, like respiratory symptoms or illness, impaired cardiopulmonary function, reduction of lung function, and premature mortality, etc. Each of these diseases involves the various types of economic costs. In this study an attempt has made to identify the effect of air pollutants on human health and determine the cost of illness due to increase in air pollution in Agra city.

Haemodilution resulting from crystalloid priming of the cardiopulmonary bypass (CPB) circuit is one of the important reasons for blood transfusion in cardiac surgery, especially in patients with low body surface area (BSA). A prospective study was performed to investigate the technique of intraoperative blood donation (IAD) and retrograde autologous priming (RAP) to limit haemodilution and transfusion requirements. Forty patients with low BSA (1.7 m2) undergoing primary valvular cardiac surgery were assigned to either RAP group or a control group (C). The RAP group (n=20) was subjected to IAD by collecting a calculated volume of blood (272+/-44.3 mL) after induction of anaesthesia. Prior to initiation of CPB the prime volume was reduced by discarding some of it and the CPB reservoir was filled retrogradely through the aortic cannula draining 482+/-78.4 mL of blood. In group C (n=20) only IAD was carried out collecting 295.0+/-62.6 mL of blood. Anaesthetic technique was similar in both groups. Strict transfusion thresholds were observed. There were no significant difference between the groups with respect to baseline characteristics, BSA, type of procedure, perfusion technique and haematologic profile. The haematocrit on CPB was significantly higher in the RAP group as compared with group C (24.2+/-1.3% and 22.1+/-2.5% respectively, p=0.009). Transfusion of allogenic blood during and after surgery was significantly lower in the RAP group (143.6+/-117 mL) versus 405.2+/-358.1 mL in group C (p=0.02). Postoperative chest tube drainage was 218+/-67.4 mL in the RAP group and 300+/-191 mL in group C which was not significantly different (p=0.18). The technique of intraoperative autologous donation and retrograde priming is simple, safe and cost effective procedure for blood conservation in patients with small BSA undergoing primary valvular surgery.

A variety of approaches have been described for banding of the pulmonary artery. The indications for this procedure are limited; however in developing countries, many patients still need pulmonary artery banding for a variety of reasons. We describe a new approach, minimally invasive, using only a split in the manubrium sterni to conduct the procedure.Between January 2000 and May 2002, 19 patients who had undergone pulmonary artery banding using a minimally invasive technique were compared with 20 cases of pulmonary artery banding performed by the conventional technique. The mortality was similar in the two groups (p=0.45). The period of intubation and duration of intensive care unit stay were significantly shorter in the minimally invasive group (p=0.015 and 0.002, respectively). The duration of hospital stay was not significantly different between the 2 groups (p=0.139). In the minimally invasive group, three patients underwent subsequent reoperation.Minimally invasive pulmonary artery banding is useful in babies with high-flow cardiac lesions and cardiac cachexia.

Background Bidirectional Glenn procedure can be performed without cardiopulmonary bypass (CPB) with some advantages. But the effect of high central venous pressure can be detrimental on the brain. This short study was undertaken to see the effect of off pump Glenn on Bispectral index (BIS), a sensitive neuro monitor.