Cost accounting The philosophy of the activity-based chargeback system is that SSG will be responsible for managing the unit cost of the individual voice services and the customer will be responsible for managing the consumption of services. The consumption of services will now be monitored through detailed reports generated by the chargeback system. In contrast to the simplified chargeback system, users will now be charged for the services actually consumed.

51 What is the exact link between C-reactive protein (CRP) and coronary artery disease?

52 In angina pectoris, why does the chest pain get radiated to the left side, i.e. left arm and back?

53 Please explain why thrombolytic therapy is not indicated in cases of unstable angina and non-ST-segment elevation myocardial infarctions (nSTE-MI) despite the fact that both nSTE-MI and ST-elevated MI (STEMI) are caused by a thrombus for which thrombolytic therapy is highly indicated? Could it be true that, in the case of unstable angina and nSTE-MI has a higher incidence of intracranial haemorrhage than in the case of ST-segment elevation MI?

54 Doesn't the term 'acute coronary syndrome' include unstable angina, nonST-segment elevation myocardial infarctions and ST-elevated MI (STEMI)?

55 Kindly mention the indications for clopidogrel in acute coronary syndrome (ACS). Should it be used along with aspirin or alone if the latter is contraindicated? Are there any studies that combine both with either low-molecular-weight heparin (LMWH) or unfractionated heparin? How long should clopidogrel be continued?

56 What role do IV fluids play in the management of acute inferior wall myocardial infarction?

57 Is there any benefit in combining aspirin with clopidogrel in post-MI angina and ischaemic stroke? A MATCH trial showed this combination not to be of benefit - would you therefore recommend we stop using this combination in our hospital unit?

58 In a patient with the typical chest pain of myocardial infarction (MI) and no other criteria for thrombolysis would highly elevated cardiac enzymes indicate thrombolysis?

59 I cannot figure out the role of an acetylcholinesterase inhibitor in postmyocardial infarction from Conn's Current Therapy and Swanson's Family Practice. Can you help?

60 Can thrombolytic therapy for myocardial infarction (MI) be started in patients who have cardiac pain and raised cardiac markers? Can streptokinase be given irrespective of electrocardiogram (ECG) changes (according to some books, ST elevation has to be present)?