Angiotensin Receptor-Neprilysin Inhibitor Therapy and Cardiac Remodeling in Heart Failure: Consensus Statement from India

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).

Role of Iron Therapy in Heart Failure: A Consensus Statement from India

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.

The Power and Promise of Angiotensin Receptor Neprilysin Inhibitor (ARNI) in Heart Failure Management: National Consensus Statement

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.

Analysing The Correlation Of Lipid Profile Pattern In Chronic Rheumatic Heart Disease (RHD) Patients

Background:The global burden of ARF and RHD is significant, and is predominantly found in populations living in low-resource settings. This study was conducted with a view for analysing the lipid profile variation in patients with chronic Rheumatic Heart Disease (RHD) and correlating the same. The early management of RHD has to be started to prevent further cardiac complications. To date no hypothesis is established on the relation between the Lipid Profile and RHD. This study would be beneficial to Indian cardiologists in defining the optimal treatment by the choice of antibiotic therapy and Lipid lowering agents like Statins.Material And Methods:It was a cross-sectional study carried out on the patients visiting Cardiology Out Patient Department (OPD) at a tertiary care hospital in Ahmedabad and who were diagnosed with Rheumatic Heart Disease (RHD).The blood lipids levels of thepatients were evaluated with current classification schemes and treatment levels for hyperlipidemia based on the National Cholesterol Education Panel’s (NCEP) Adult Treatment Program-3 (ATP-III) guidelines.Result:Total 89 patients were included in the study. 76 patients were associated with dyslipidaemia and 13 patients had normal lipid values. As far as total cholesterol levels were concerned, 23 out of 76 patients (30.26%) had above target levels for total cholesterol. Also 46 patients out of 76(60.52%) had raised triglycerides levels and 47 patients (61.84%) had raised LDL levels. As far as HDL levels were concerned, 38 out of 76 patients (50.00%) had below desirable levels. The frequency of deranged LDL is higher as compared to HDL, triglycerides and total cholesterol levels. If these values are to be co-related to the disease, then LDL as a lipid parameter stands most significant.Conclusion:Morbidity and mortality in RHD is very high in Indian patients and one of the determinants of the cardiovascular morbidity is the increased lipid levels. The frequency of deranged LDL is higher as compared to HDL and total cholesterol levels in these patients. This study was planned to evaluate an entirely novel hypothesis that RHD is an independent risk factor for Atherosclerosis and CAD. The exact reason behind the occurrence is unknown but it can be environmental or genetic. RHD and Dyslipidaemia might engulf younger patients. The study is also aimed at evaluating all lipid parameters with RHD.

Evaluation Of Therapeutic Modalities And Outcome In Patients Of Infectious Keratitis: A Prospective Observational Study At A Tertiary Care Eye Hospital

Background:Among corneal diseases, microbial keratitis is a major blinding disease.Objectives: To study the disease pattern and aetiology, to evaluate drug use pattern and the therapeutic outcome in Infectious Keratitis patients.Material And Methods:Prospective observational follow up study was carried out for 16 weeks. IEC permission and Written Informed Consent fr om the patients were taken before hand. Patients above 18 years of age and of either gender presenting to Outpatient department of Ophthalmology and diagnosed with Infectious Keratitis were included in the study. Patient's demographic details, diagnosis and the complete prescription were recorded in a case record form.Result:A total of 150 patients wereenrolled. Infectious Keratitis was prevalent in age group of 61–70 years (39.33%). Bacterial keratitis (52%) was the most common type followed by fungal (42%) and Viral keratitis (5%). A total of 17(11.33%) patients needed surgical intervention. At the last follow up 61(40.66%) patients had improved vision. There was a significant statistical difference found between age groups of <65 years and >65years for keratitis outcome. Improvement in vision (p=0.0264) & slit lamp findings (p=0.0148) were seen in younger age group.Conclusion:Bacterial keratitis was the most common cause of Infectious keratitis. Trauma was the commonest factor found majority of cases. Younger age group had better visual outcome.

Interactive effects of Zn, Pb and Cd in barley.

The effects of different concentrations of Zn, Pb and Cd singly as well as in the combination of zinc-lead, zinc-cadmium and lead-cadmium on the shoot root length and dry mass as well as chlorophyll contents of barley plants during early seedling growth were studied. The effects of different concentrations of Zn x Pb and Pb x Cd in combinations showed a synergistic relationship, while at higher concentrations the relationship was antagonistic. Lower as well as higher Zn x Cd concentrations showed antagonistic effects.

Assessment of hypertension control in chronic kidney disease patients by ambulatory blood pressure monitoring.

BACKGROUND: Inadequate control of blood pressure (BP) increases cardiovascular mortality and morbidity in chronic kidney disease (CKD) and renal transplant patients. 24 hour ambulatory BP was recorded to evaluate the adequacy of BP control in these patients. METHODS: 60 CKD patients (25 conservative therapy, 16 maintenance hemodialysis, 19 renal transplant patients) were studied prospectively. After achieving clinic BP control, 24 hour ambulatory BP was recorded at 1 and 6 months. The patients were followed up for one year. RESULTS: Mean daytime and nighttime systolic blood pressure (SBP) both at 1 month and at 6 month was higher in non-survivors than in survivors. The survivors had better control of their daytime (p=0.018) as well as nighttime SBP levels (p=0.018) at 6 months compared to those at 1 month. Survivors achieved nocturnal dipping of SBP at 1 and 6 months (p=0.047, p=0.025, respectively). Non-survivors failed to achieve lower daytime (p=0.375) or nighttime SBP (p=0.254) at 6 months as compared to SBP at 1 month in spite of optimizing antihypertensive therapy. Daytime (p=0.022) and nighttime (p=0.029) diastolic BP (DBP) in the non-survivors was higher than in survivors. Nocturnal dip in DBP was not seen in either survivors at 1 (p=0.177) and 6 months (p=0.434) or non-survivors at 1 (p=0.408) and at 6 months (p=0.081). Renal transplant patients did not exhibit nocturnal dipping of BP. CONCLUSION: We conclude that, unlike survivors, there was worsening of 24 hour BP control in non-survivors. ABPM has a role in better management of total BP burden in CKD patients.

Some explorative information regarding 'Jwaratimirabhăskara' and its author Kăyastha Camunda.

Out of the treasure of Ayurvĕdic literature, a few texts have come in to lime light while some are in dark and available in incomplete form. But many names of the texts with unknown or known authors have been quoted by different subsequent authors in their texts or in the explications by their commentators, for which complete texts are not available at present. Among the texts on specific diseases, one notable work is 'Jwaratimirabhăskara' written by Kăyastha Camunda. Nowhere a detailed account of author's identity, time and place has been mentioned, while short references are available in some historical books. However, manuscripts of this text are available in many repositories of our country. In this article, an attempt has been made to establish the identity of the author, period of the text and also to highlight the salient features of this text.

Influence of aluminium on growth and water relations of cowpea.

The effect of aluminium on shoot-root fresh weight and water relations [water potential (psiw), osmotic potential (psis), turgor potential (psip), and relative water content (RWC)] was studied in cowpea. The 3 microg g(-1) Al showed slight enhancement in psiw and psip in test plants. Concentrations beyond 3 microg g(-1) Al significantly decreased psiw (less negative) and psip. Relative water content (RWC) vis a vis the fresh weight was also affected adversely at higher Al concentrations.

Growth and cadmium uptake in barley under cadmium stress.

Effect of various additions of cadmium (5 to 3125 microg g(-1) air dried soil) was studied on growth and Cd uptake in barley grown in pots containing two soil types- a loamy sand and a sandy loam, during different stages of growth. While lower doses (5 to 25 microg g(-1)) led to an increase, the higher doses resulted in a substantial decrease in barley growth. The plant Cd content increased with an increase in soil applied Cd. A decrease in translocation ratio prevailed at higher soil applied Cd, indicating the existence of an exclusion mechanism.

Optimising dialytic therapy.

It is better to understand functions of kidneys, consequences of renal failure, aims of ideal replacement therapy and limitations of dialytic therapy as replacement therapy before discussing optimising dialytic therapy. Types of replacement therapy are as follows--haemodialysis, peritoneal dialysis and kidney transplantation. All patients of end stage renal disease require replacement therapy.