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29th November 2016
AHA/ACC Clinical practice guideline on management of peripheral artery disease
 
The American Heart Association and American College of Cardiology (AHA/ACC) have released updated clinical practice guideline on management of patients with lower extremity peripheral artery disease (PAD), published in Journal of the American College of Cardiology and copublished in the journal Circulation.
  • Clinical assessment of PAD, as with any other condition, begins with history and physical examination. 
  • In patients with history or physical examination findings suggestive of PAD, the resting ankle-brachial index (ABI), with or without segmental pressures and waveforms, is recommended to establish the diagnosis.
  • Resting ABI results should be reported as abnormal (ABI ≤0.90), borderline (ABI 0.91-0.99), normal (1.00-1.40) or noncompressible (ABI >1.40). 
  • Toe brachial index should be measured to diagnose patients with suspected PAD when the ABI is >1.40.
  • Invasive and noninvasive angiography (i.e., CTA, MRA) is not recommended for the anatomic assessment of patients with asymptomatic disease. Invasive angiography is useful for patients with critical limb ischemia in whom revascularization is considered.
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Antibiotic awareness
 
Spurious use of antibiotics has lead to the precious drugs being prescribed profusely. This has raised concern among the medical fraternity as we head towards a post-antibiotic era.
 
New Delhi, Nov 28, 2016:  Use of antibiotics needs to be carefully monitored to curb unnecessary prescription. Antibiotics work by targeting specific mechanisms within the microorganisms essential for growth and survival, however, bacteria have certain defense systems that gradually evade these effects, and become resistant. Spurious use of antibiotics can speed up this defense system much faster than we can counteract them. Hence, it is necessary that awareness be raised about global antibiotic resistance and encourage best practices of usage amongst doctors and patients.
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