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Background: Cerebral palsy (CP) is one of the leading causes of childhood disability worldwide with the greatest burden found in developing countries. This study is undertaken as there is limited data available regarding CP children in the Andhra Pradesh region. This study was done to evaluate the clinical spectrum, risk factors, and comorbidities associated with CP that will help in better understanding of etiology and for early intervention by District early intervention centers.Methods: This is a hospital-based prospective observational study conducted over 18 months among children from 6 months to 5 years of age visiting a tertiary care hospital.Results: Among 65 enrolled children majority of the children (74%) were between 2 to 5yrs with a male-to-female ratio of 4:1. Consanguinity was observed in 33.8% and the majority were from rural areas (71%). The most frequent presenting complaint was delayed milestones (33.4%). 67.6% of subjects were born at term with the most common risk factor being birth asphyxia (27.6%). The most common type was spastic CP (87%) in whom the Developmental quotient (DQ) was severely affected (56.7%) and 32.3% of children belong to GMFCS level III. Comorbidities like feeding difficulties and GERD (47.6%), visual problems (24.8%), and hearing problems (30%) were commonly associated. At the time of enrollment, only 21.5% of children had normal nutritional status which improved to 30.7% after 12 months of follow-up.Conclusions: Efforts should be made to increase awareness among parents regarding the availability of encouraging utilization of the services to relieve the burden of disorder.
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The most common benign tumour in reproductive age group –uterine leiomyoma can rarely present with bleeding into the peritoneal cavity leading to hemodynamic instability. A 36-year parous woman presented with acute abdomen and hypovolemic shock. Pregnancy test reported to be negative. Emergency laparoscopy was done and detected to have a surface bleeder and emergency laparoscopic myomectomy done.
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Background: Hemophilia is a rare inherited genetic blood disorder that needs a high index of suspicion and appropriate laboratory facilities for diagnosis. Unfortunately, it has not received the same patronage as other bleeding disorders like thalassemia and sickle cell anemia. Its management is expensive and requires lifelong treatment.Methods: This is a hospital-based cross-sectional study done at a hemophilia treatment center in a tertiary hospital in South India to study the clinicoepidemiological profile and complications in hemophilia children admitted during the period of January 2022 to June 2023.Results: 40 children with hemophilia were included in the study, and all of them had Hemophilia A with the majority being of severe type (62.5%). The mean age of diagnosis was 10 months. Hemarthrosis was the presenting complaint in about 50 % of children at admission while the majority had bruises and ecchymosis as clinical presentation at the time of first diagnosis (40%). 5 children tested positive for inhibitors among those tested. Intracranial hemorrhage was the most common occurring complication (17.5%). Knee (60%), elbow (47.5%) and ankle (40%) were the most common target joints.Conclusions: There is a need for awareness of this disease among clinicians and people for appropriate diagnosis. The government should ensure the availability of factor replacement therapy and other treatment modalities even at District hospitals for easy accessibility of patients. Management goals should shift from on-demand therapy to prophylactic therapy for hemophilia children for better living standards and prevent complications like arthropathy in these patients.
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Abdominal pregnancy is a rare obstetric complication with high maternal mortality. Advanced abdominal pregnancy is rare and accounts for 1 in 25,000 pregnancies. 32 years� lady, P2L2, last child birth and interval tubectomy by modified Pomeroy抯 method 12 years ago, reported with Amenorrhoea of two months with vague lower abdominal pain since 2 days. Ultrasonography (USG) abdomen and pelvis showed an extrauterine viable pregnancy of 20+ weeks POG with no hemoperitoneum. she travelled 4 hours by road to her hometown, for second opinion and was referred back to our institution. A laparotomy was done; hemoperitoneum of 1.5 litres was noted. The sac with the live foetus inside with placental implantation seen on entire left fallopian tube except the fimbrial end and a small portion of omentum was noted. Left salpingectomy with excision of the sac with the foetus along with partial omentectomy was performed. Patient received two units of PRBC postoperatively.
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The proper disposal of manufacturing and consumer waste, including sewage sludge, is one of the numerous environmental issues facing today's society. In addition to posing serious health concerns to humans, anthropogenic activities are a major source of environmental pollution and can result in an overabundance of pollutants entering the terrestrial ecosystem. The goal of the current study was to determine how existing tree and plant species near sewage drains were affected by the bioaccumulation of carcinogenic metals (Cd, Ni, Co, and Cr) together with other heavy metals. These heavy metals found in the sewage are hazardous to the health of both people and the environment. To further understand how well these plant species adapted to the metal-contaminated soil, many biological parameters, including stomatal density, leaf length, leaf area index, and stress hormone levels, were investigated. For every species included in the study, soil samples were taken near the sewer drains and the rhizosphere. The plant species' leaves and roots (where feasible) were also harvested. To check for metal buildup in the wood, various tree species had their trunks harvested. All of these samples go through an acid digestion process using an aquaregia combination. Following digestion, the samples are examined using Microwave Plasma Atomic Emission Spectroscopy (MP-AES) for the presence of heavy metals. In this study, we briefly address the findings on the accumulation of heavy metals by certain plant species.
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This study addresses a knowledge gap in understanding the interaction effect of nutrient-plant growth regulators on groundnut which plays a vital role in morpho-physiological processes for achieving enhanced productivity. The main goal was to evaluate how different nutrio-hormonal combinations affect groundnut traits. The experiment was conducted in pot culture at glasshouse, Department of Crop Physiology, TNAU, Coimbatore, utilizing a factorial completely randomized design. Two genotypes, BSR 2 and VRI 8, received five treatments with four replications: T1 - control (foliar water spray), T2 - Nutrio hormonal consortia 1, T3 - Nutrio hormonal consortia 2 (T2 + K2SO4), T4 - Groundnut booster 1 (FeSO4, K2SO4, MgSO4, Borax), and T5 - Groundnut booster 2 (T4 + Salicylic acid + NAA-Naphthalene Acetic Acid). Application of T5 to VRI 8 showed significant results, with higher leaf area (2297.83 cm²) and specific leaf weight (19.87 mg/cm²) where as BSR 2 had smaller leaf area (872.86 cm²) and higher specific leaf weight (51.55 mg/cm²). VRI 8 had fewer pods but higher yield (8.16 g/plant) than BSR 2 (7.07 g/plant). In conclusion, the foliar application of T5 - Groundnut booster 2 with the VRI 8 variety holds promising potential for enhancing groundnut yield.
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Temperature is one of the factors which play a major role in deciding the planting value of a seed lot in the seed testing laboratory. The temperature requirement varies with species. High or low temperature may stimulate or inhibit the germination of seeds under testing. The tropical crops may require higher temperature than temperate crops for germination. Eventhough, a seed lot is having high germination and vigour parameter, it could be revealed with suitable seed testing temperature only. Since bhendi is a tropical vegetable crop, two varieties of bhendi, Arka Anamika and CO4 with each five different lots were tested with four different temperature regimes viz., 15, 20, 25 and 30ºC. The experimental results revealed that bhendi seeds performed well at the temperature regime of 30ºC followed by 25ºC which was on par with each other. It was also accompanied with seed quality characteristics of seedling length, vigour index and dry matter production of seedlings. Irrespective of varieties and lots studied, the high temperature showed its superiority over other temperatures. The study also disclosed that the low temperature of 15ºC was not suitable for bhendi seed germination, because none of the seeds produced normal seedling. At low temperature seeds could produce more abnormal seedlings than rest of the temperature regimes studied. It could be inferred that the seed testing temperature suitable for bhendi seed germination is 30°C or 25°C. Low temperature (15°C) is not suitable, since the normal seedlings were not produced at this temperature.
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Background: Maternal hypothyroid is one of the common thyroid disorder. Hypothyroidism in pregnant women who are not treated can cause premature birth, low birth weight, and respiratory distress in the newborn. Objectives were to find out the prevalence of hypothyroidism in pregnant women during first trimester screening and its association with maternal and foetal outcomes.Methods: The present study was a hospital based study carried out in the department of obstetrics and gynaecology, Chettinad Hospital and Research Institute, Kelambakkam, Chennai, India between January 2021 and January 2023. The study was carried out among the pregnant women in the first trimester visiting the outpatient department of the OBG department during the study period. Based on the thyroid profile obtained, the participants were classified into normal, subclinical hypothyroidism and overt hypothyroidism. They were then followed up to record the maternal and foetal outcome.Results: A total of 2017 patients were included in the study. The prevalence of hypothyroidism was 15.3%. The distribution of type of delivery was found to be different between hypothyroid and normal groups with more number of women underwent Caesarean delivery (18.24%) in the hypothyroid group than those in normal group. The proportion of low birth weight was also statistically higher (45.28%) in the hypothyroid group than in the normal. Similar pattern was observed with birth asphyxia. The APGAR scores recorded were also significantly lower in the hypothyroid group than in the euthyroid group with p value of less than 0.05.Conclusions: The prevalence of hypothyroidism was 15.3%. In our study, women with hypothyroidism showed adverse maternal and foetal outcome such as more caesarean deliveries, low birth weight, and poor APGAR scores and were found to be statistically significant when compared to euthyroid women.
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Background: Maternal hypothyroid is one of the common thyroid disorder. Hypothyroidism in pregnant women who are not treated can cause premature birth, low birth weight, and respiratory distress in the newborn. Objectives were to find out the prevalence of hypothyroidism in pregnant women during first trimester screening and its association with maternal and foetal outcomes.Methods: The present study was a hospital based study carried out in the department of obstetrics and gynaecology, Chettinad Hospital and Research Institute, Kelambakkam, Chennai, India between January 2021 and January 2023. The study was carried out among the pregnant women in the first trimester visiting the outpatient department of the OBG department during the study period. Based on the thyroid profile obtained, the participants were classified into normal, subclinical hypothyroidism and overt hypothyroidism. They were then followed up to record the maternal and foetal outcome.Results: A total of 2017 patients were included in the study. The prevalence of hypothyroidism was 15.3%. The distribution of type of delivery was found to be different between hypothyroid and normal groups with more number of women underwent Caesarean delivery (18.24%) in the hypothyroid group than those in normal group. The proportion of low birth weight was also statistically higher (45.28%) in the hypothyroid group than in the normal. Similar pattern was observed with birth asphyxia. The APGAR scores recorded were also significantly lower in the hypothyroid group than in the euthyroid group with p value of less than 0.05.Conclusions: The prevalence of hypothyroidism was 15.3%. In our study, women with hypothyroidism showed adverse maternal and foetal outcome such as more caesarean deliveries, low birth weight, and poor APGAR scores and were found to be statistically significant when compared to euthyroid women.
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Purpose: To compare the surgical outcomes of trabeculectomy with and without anti?metabolites in patients with juvenile open?angle glaucoma (JOAG). Methods: This retrospective comparative case series included 98 eyes of 66 patients with JOAG who underwent either trabeculectomy without anti?metabolites (group A, n = 53 eyes) or with anti?metabolites (group B, n = 45 eyes) with a minimum of 2 years follow?up. The main outcome measures were intra?ocular pressure (IOP), number of glaucoma medications, visual acuity, additional surgical interventions, surgical complications, and risk factors for failure. Surgical failure was defined as IOP >18 mmHg or failure to reduce IOP by <30% from the baseline value or IOP ?5 mmHg or re?operation for refractory glaucoma or a complication or loss of light perception vision. Results: The mean post?operative IOP reduced significantly from baseline at all post?operative visits until 6 months and thereafter. The cumulative probability of failure at 2 years was 28.7% in group A [95% confidence interval (CI) = 17.6–44.8%] and 29.1% in group B (95% CI = 17.1–46.7%) (P = 0.78). Surgical complications occurred in 18 eyes (34%) in group A and 19 eyes (42%) in group B. Re?operations for glaucoma or complications were performed in two eyes (3.8%) in group A and two eyes (4.4%) in group B. Cox?hazard regression model revealed male gender (HR = 0.29; P = 0.008), baseline high IOP (HR = 0.95; P = 0.002), and an increased number of pre?operative glaucoma medications (HR = 2.08; P = 0.010) as significant factors associated with failure. Conclusion: Our study results on trabeculectomy in JOAG revealed a success of 71% in both groups at 2 years follow?up. There was no significant difference in success or failure rates between the two groups. The risk factors for poor surgical outcome in JOAG were male gender, baseline high IOP, and an increased number of glaucoma medications
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Around 60 to 70 percent of the people from India reside in rural areas and usually opt for herbal medicine for illness from local traditional medicine practitioners before seeking allopathic advice. Kidneys play a central role in excretion of the metabolites of these substances or the substances themselves. Renal injury happens in the form of acute tubular necrosis, interstitial nephritis, rhabdomyolysis, nephrolithiasis, urothelial cancers and rarely renal cortical necrosis and progressive interstitial fibrosis. Physicians and patients may ignore the potential nephrotoxicity caused by certain herbal medicines, assuming them to be harmless. Adverse event reporting is usually done on a voluntary basis, and toxicity has been reported through case reports and series. It is important for clinicians to factor in the use of herbal medicines when treating patients with unexplained acute kidney injury or progressive chronic kidney disease. We hereby present a case series of renal injury mediated by herbal medications with different mechanism of injury to kidney. This article is first of its type reported from central India.
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Around 60 to 70 percent of the people from India reside in rural areas and usually opt for herbal medicine for illness from local traditional medicine practitioners before seeking allopathic advice. Kidneys play a central role in excretion of the metabolites of these substances or the substances themselves. Renal injury happens in the form of acute tubular necrosis, interstitial nephritis, rhabdomyolysis, nephrolithiasis, urothelial cancers and rarely renal cortical necrosis and progressive interstitial fibrosis. Physicians and patients may ignore the potential nephrotoxicity caused by certain herbal medicines, assuming them to be harmless. Adverse event reporting is usually done on a voluntary basis, and toxicity has been reported through case reports and series. It is important for clinicians to factor in the use of herbal medicines when treating patients with unexplained acute kidney injury or progressive chronic kidney disease. We hereby present a case series of renal injury mediated by herbal medications with different mechanism of injury to kidney. This article is first of its type reported from central India.
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Introduction: This present study is about the GC MS analysis of one important Siddha formulation, Nilavembu Kudineer.Methods: Nilavembu Kudineer powder was obtained from standard Siddha medical vendor at Chennai, India and was suitably processed for GC MS analysis.Results: Some important biomolecules such as Z-(13,14-Epoxy)tetradec-11-en-1-ol acetate, piperine, ursodeoxycholic acid, ethyl iso-allocholate, 9,19-cyclolanostan-3-ol, 24,24-epoxymethano, acetate and hexadecanoic acid, 2-(hexadecyloxy)ethyl ester were observed in the GC MS profile which are found to have medicinal roles that are far reaching, which supports this medicine as an effective formulation towards the cure of many inflammatory diseases.Conclusion: This medicine, due to the presence of medicinally important molecules indicates its effectiveness as a potent medicine for which it is usually prescribed.
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In 2020, the global prevalence of glaucoma was estimated to be 76 million and it was projected to increase to 111.8 million by 2040. Accurate intraocular pressure (IOP) measurement is imperative in glaucoma management since it is the only modifiable risk factor. Numerous studies have compared the reliability of IOP measured using transpalpebral tonometers and Goldmann applanation tonometry (GAT). This systematic review and meta-analysis aims to update the existing literature with a reliability and agreement comparison of transpalpebral tonometers against the gold standard GAT for IOP measurement among individuals presenting for ophthalmic examinations. The data collection will be performed using a predefined search strategy through electronic databases. Prospective methods-comparison studies published between January 2000 and September 2022 will be included. Studies will be deemed eligible if they report empirical findings on the agreement between transpalpebral tonometry and Goldmann applanation tonometry. The standard deviation and limits of agreement between each study and their pooled estimate along with weights and percentage of error will be reported using a forest plot. Cochrane’s Q test and the I2 statistic will be used to assess heterogeneity, and the publication bias will be investigated using a funnel plot, Begg’s and Egger’s tests. The review results will provide additional evidence on the reliability of transpalpebral tonometers that, in turn, could possibly assist practitioners to make informed decision about using it as a screening or diagnostic device for clinical practice, outreach camps, or home-based screening. Institutional Ethics Committee registration number: RET202200390. PROSPERO Registration Number: CRD42022321693.
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Purpose: To evaluate safety profile and surgical outcomes of loop myopexy with concurrent intra? ocular lens implantation in cases of myopic strabismus fixus (MSF). Methods: A retrospective chart review of patients who underwent loop myopexy with concurrent small incision cataract surgery with intra?ocular lens implantation between January 2017 and July 2021 for MSF at a tertiary eye care centre was undertaken. A minimum of 6 months of follow?up after surgery was required for inclusion. The main outcome measures were improvement in alignment postoperatively, improvement in extra?ocular motility postoperatively, intraoperative and postoperative complications and post?operative visual acuity. Results: 12 eyes of 7 patients (male (6): female (1)) underwent modified loop myopexy at a mean age of 46.86 years (range 32?65 years). 5 patients underwent bilateral loop myopexy with intra?ocular lens implantation whereas 2 patients underwent unilateral loop with intra?ocular lens implantation. All eyes underwent additional medial rectus (MR) recession with lateral rectus (LR) plication. At the last follow?up, mean esotropia improved to 16 prism dioptres (PD) (Range: 10?20 PD) from 80 PD (Range:60?90PD), P = 0.016; and success (deviation ?20PD) was achieved in 73% (95% CI 48 to 89%). Mean hypotropia at presentation was 10 PD (range 6?14 PD), which improved to 0 PD (range 0?9 PD), P = 0.063. Mean BCVA improved from 1.08 LogMar to 0.3 LogMar units. Conclusion: Loop myopexy combined with intra?ocular lens implantation is a safe and effective procedure in the management of patients who have Myopic Strabismus Fixus with visually significant cataract and improves both visual acuity and ocular alignment significantly.
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Background: The pregnancy time is critical for both the mother抯 and the baby抯 health. The most common unfavourable pregnancy outcome is spontaneous abortion. Spontaneous pregnancy loss is a surprisingly common event, with roughly 15% of all clinically diagnosed pregnancies ending in pregnancy failure. Couples who suffer from frequent miscarriages may find it difficult to cope physically and emotionally. This study was planned to evaluate the association of preterm delivery, low birth weight, IUGR, recurrence of abortion, still birth, IUD, PROM, or any other adverse outcome in patients with history of previous spontaneous abortions. Objectives were to look for association between previous spontaneous abortion and preterm delivery, low birth weight, IUGR, recurrence of abortion, stillbirth, IUD, PROM and other complications in subsequent pregnancies.Methods: This was a prospective observational study done with 150 samples. The information such as demographic data of the antenatal women, clinical history, past obstetrics history, clinical examination, laboratory investigations and outcome of present pregnancy were collected and evaluated.Results: Maternal complications such as UTI (4.6%), Infection and fever (5.3%), PROM (2.7%), PPH (4%), hyperemesis 4%, PPROM 2.7% were observed. In study population, 60% of the foetus were in cephalic position, 19% in breech presentation and 21% in shoulder presentation. 29% of the women had preterm delivery, 34% were delivered by LSCS and 6% had spontaneous abortions. Low birth weight babies delivered in 25% cases. Foetal distress was observed in 15%, FGR in 9%, still birth in 3% and IUD in 1%.Conclusions: Women with previous spontaneous abortion are associated with a higher incidence of preterm delivery, cesarean section rate, neonatal low birth weight, fetal distress and high possibility of infection. Therefore, patients with previous spontaneous miscarriage represent a high-risk population for obstetric complication and close surveillance during the antenatal period is required.
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Adverse cardiac remodeling refers to progressive structural and functional modifications in the heart because of increased wall stress in the myocardium, loss of viable myocardium, and neurohormonal stimulation. The guideline-directed medical therapy for Heart failure (HF) includes Angiotensin receptor-neprilysin inhibitor (ARNI) (sacubitril/valsartan), ?-blockers, sodium-glucose co-transporter 2 (SGLT2) inhibitors, and mineralocorticoid receptor antagonists (MRA). ARNI is under-prescribed in India despite its attractive safety and efficacy profile. Therefore, the consensus discusses objectives and topics related to ARNI in the management of cardiac remodeling, and experts shared their views on the early timely intervention of effective dosage of ARNI to improve the diagnosis and enhance mortality and morbidity benefits in cardiac reverse remodeling (CRR).
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?-catenin (CTNNB1), a scaffold protein plays a vital role in embryonic development, adult tissue homeostasis, neurodegenerative diseases, bone diseases, chronic obstructive pulmonary diseases, wound healing, and pigment disorders. ?-catenin is the crucial component in the Wnt-signaling pathway. ?-catenin levels in the cytosol balances the Wnt-signaling pathway. The activated Wnt-signaling pathway allows the accumulation of ?-catenin in the nucleus and further act as a promoter to initiate transcription of several oncogenes responsible for carcinogenesis. In the present study, we have used systems biology approach to map ?-catenin interactors. Primary protein-protein interaction databases such as PubChem, CTD, and STITCH databases were used to collect all the experimentally valid ?-catenin interactors and their sub-cellular location was traced using UniProtKB database. The interactome was constructed and analyzed by utilizing STRING and Cytoscape tools. MCODE, Cytoscape tool was utilized to construct and analyze the sub-networks. Correlation between modular seed proteins and ?-catenin was studied using UALCAN database. Functional enrichment analysis was done using DAVID database. Cytohubba, a Cytoscape tool was utilized to identify the top gene interactors of ?-catenin. Further, expression and gene ontology of each ?-catenin gene interactors were analyzed using UALCAN and CleuGO tools. The analysis reveals ?-catenin interactors, TP53, EP300, RPS27A, UBC, HDAC1, SRC, AKT1, EGFR, HSP90AA1, and CREBBP as the first top gene interactors. This study uses systems biology driven approach and successful in identifying and understanding the biological roles of the top ?-catenin interactors.
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Iron deficiency (ID) with or without anemia is frequently observed in patients with heart failure (HF). Uncorrected ID is associated with higher hospitalization and mortality in patients with acute HF (AHF) and chronic HF (CHF). Hence, in addition to chronic renal insufficiency, anemia, and diabetes, ID appears as a novel comorbidity and a treatment target of CHF. Intravenous (IV) ferric carboxymaltose (FCM) reduces the hospitalization risk due to HF worsening and improves functional capacity and quality of life (QOL) in HF patients. The current consensus document provides criteria, an expert opinion on the diagnosis of ID in HF, patient profiles for IV FCM, and correct administration and monitoring of such patients.
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Heart failure (HF) is a huge global public health task due to morbidity, mortality, disturbed quality of life, and major economic burden. It is an area of active research and newer treatment strategies are evolving. Recently angiotensin receptor-neprilysin inhibitor (ARNI), a class of drugs (the first agent in this class, Sacubitril–Valsartan), reduces cardiovascular mortality and morbidity in chronic HF patients with reduced left ventricular ejection fraction (LVEF). Positive therapeutic effects have led to a decrease in cardiovascular mortality and HF hospitalizations (HFH), with a favorable safety profile, and have been documented in several clinical studies with an unquestionable survival benefit with ARNI, Sacubitril–Valsartan. This consensus statement of the Indian group of experts in cardiology, nephrology, and diabetes provides a comprehensive review of the power and promise of ARNI in HF management and an evidence-based appraisal of the use of ARNI as an essential treatment strategy for HF patients in clinical practice. Consensus in this review favors an early utility of Sacubitril–Valsartan in patients with HF with reduced EF (HFrEF), regardless of the previous therapy being given. A lower rate of hospitalizations for HF with Sacubitril–Valsartan in HF patients with preserved EF who are phenotypically heterogeneous suggests possible benefits of ARNI in patients having 40–50% of LVEF, frequent subtle systolic dysfunction, and higher hospitalization risk.