Approaches in Managing Resistant Hypertension: A Review.

In India, around 234 million adults (one in three) suffer from hypertension (HTN). An average of 10% of these cases are likely to be resistant hypertension (RH). This load of 23 million patients is expected to expand further with revisions in diagnostic criteria. The treatment and control rates of hypertension in India average around 30% and 15%, respectively. Pharmacological management involves a stepwise approach starting with optimizing the A-C-D (angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), and thiazide-like diuretics) triple-drug combination, followed by substitution with a thiazide-like diuretic and use of spironolactone as a next step (fourth drug). The subsequent steps are suggestions based on expert input and must be individualized. These include using a ß-blocker as the fifth drug and an α1-blocker or a peripheral vasodilator as a final option when target blood pressure (BP) values are not achieved. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are likely to be helpful in managing RH due to their renal and cardiovascular protection as well as mortality benefits. SGLT2i lowers BP independent of the dosage and concomitant anti-hypertensive medications. Patient education and tools to monitor BP and treatment compliance will improve outcomes with these medications. In addition to therapeutic intervention, a preventive approach for RH mandates a need to identify patients at risk and use appropriate preventive and optimal therapy to prevent uncontrolled hypertension in patients with cardiovascular disorders.

Nanophotosensitizing through Space Charge Transfer Assemblies of Pentacenequinone Derivative for 'Metal-free' Photoamidation Reactions.

The present study demonstrates the influence of small portion (20 %) of organic co-solvent (DMSO/THF/ACN/MeOH) in mixed aqueous media (80 % water) in controlling the size, quantum yield and life time of the through space charge transfer assemblies (TSCT) of pentacenequinone derivative (TPy-PCQ-TPy). Among various solvent systems [H2 O : DMSO (8 : 2), H2 O : THF (8 : 2), H2 O : ACN (8 : 2) and H2 O : MeOH (8 : 2)] examined, highly emissive (Φf =12 %) and nano-sized assemblies having long life time (3.11 ns) were formed in H2 O : DMSO (8 : 2) solvent system. The solvent dependent differences in the size and excited state properties of TPy-PCQ-TPy assemblies are reflected in their photosensitizing behaviour in different solvent systems. Backed by excellent photosensitizing properties, TPy-PCQ-TPy assemblies smoothly catalyse the photoamidation reactions between unactivated/activated aldehydes and secondary amine under mild reaction conditions (visible light irradiation, aerial atmosphere, room temperature) in H2 O : DMSO (8 : 2) solvent mixture. The as prepared assemblies of TPy-PCQ-TPy also exhibit high potential to catalyse the oxidation of benzyl alcohols to aromatic aldehydes, thus, generating a possibility to use aromatic alcohols as the starting material in photoamidation reactions. The real time application of TSCT assemblies has also been demonstrated in gram scale transformation of aromatic aldehydes to aromatic amides and photooxidation of benzyl alcohol to aromatic aldehyde.

Functional magnetic nanoparticles for protein delivery applications: understanding protein-nanoparticle interactions.

Iron oxide nanoparticles (IONPs) surface functionalised with thermo-responsive polymers can encapsulate therapeutic proteins and release them upon heating with an alternating magnetic field above the lower critical solution temperature (LCST). In order to make this delivery system clinically-relevant, we prepared IONPs coated with poly-N-isopropylmethacrylamide (PNIPMAM), a polymer with LCST above human body temperature. The optimal polymer chain length and nanoparticle size to achieve LCST of ca. 45 °C were 19 kDa PNIPMAM and 16 nm IONPs. The PNIPMAM-coated IONPs could encapsulate a range of proteins which were released upon heating above LCST in the presence of a competitor protein or serum. A small amount of encapsulated protein leakage was observed below LCST. The efficiency of protein encapsulation and release was correlated with molecular weight and glycosylation state of the proteins. Magnetic heating resulted in a faster protein release as compared to conventional heating without significant temperature increase of the bulk solution.

Potential applications of green-synthesized iron oxide NPs for environmental remediation.

Water pollution is a significant issue worldwide due to an increase in anthropogenic activities. Heavy metals and dyes are among the most problematic contaminants that threaten the environment and negatively impact human health. Iron oxide nanoparticles (IONPs) synthesized using green methods have shown potential in these areas due to their significant adsorption capacity and photocatalytic potential. The size and morphology of biogenic IONPs can be tailored depending upon the concentration of the reducing medium and metal salt precursor. Green-synthesized IONPs have been found to be effective, economical, and environmentally friendly with their large surface area, making them suitable for removing toxic matter from contaminated water. Furthermore, they exhibit antibacterial potential against harmful microorganisms. The study emphasizes the importance of using such environmentally friendly tools to remove heavy metal ions and organic compounds from contaminated water. The underlying mechanism for the adsorption of heavy metal ions, photocatalytic degradation of organic compounds, and antimicrobial action has been explored in detail. The future prospective for the beneficial utilization of biogenic IONPs has also been signified to provide a detailed overview.

Biogenic synthesis of iron oxide nanoparticles using leaf extract of Spilanthes acmella: antioxidation potential and adsorptive removal of heavy metal ions.

The sequestration of contaminants from wastewater, such as heavy metals, has become a major global issue. Multiple technologies have been developed to address this issue. Nanotechnology is attracting significant interest as a new technology, and numerous nanomaterials have been produced for sequestrating heavy metals from polluted water due to their superior properties arising from the nanoscale effect. This study reports biosynthesis of iron oxide nanoparticles (IO-NPs) and their applications for adsorptive sequestration of various metal ions from aqueous solutions. Biosynthesis of IO-NPs has been carried out by using leaf extract of Spilanthes acmella, a medicinal plant. FTIR analysis of the leaf extract and biosynthesized IO-NPs marked the role of various functional groups in biosynthesis of IO-NPs. FESEM analysis revealed the average size range of IO-NPs as 50 to 80 nm, while polydisperse nature was confirmed by DLS analysis. EDX analysis revealed the presence of Fe, O, and C atoms in the elemental composition of the NPs. The antioxidant potential of the biosynthesized IO-NPs (IC50 = 136.84 µg/mL) was confirmed by DPPH assay. IO-NPs were also used for the adsorptive removal of As3+, Co2+, Cd2+, and Cu2+ ions from aqueous solutions with process optimization at an optimized pH (7.0) using dosage of IO-NPs as 0.6 g/L (As3+ and Co2+) and 0.8 g/L (Cd2+ and Cu2+). Adsorption isotherm analysis revealed the maximum adsorption efficiency for As3+ (21.83 mg/g) followed by Co2+ (20.43 mg/g), Cu2+ (15.29 mg/g), and Cd2+ (13.54 mg/g) using Langmuir isotherm model. The biosynthesized IO-NPs were equally efficient in the simultaneous sequestration of these heavy metal ions signifying their potential as effective nanoadsorbents.

Heat stress tolerance indices for identification of the heat tolerant wheat genotypes.

Heat stress is one of the major challenges in wheat cultivation because it coincides with the flowering period and limits the crop productivity. This study was conducted for evaluation of 50 wheat genotypes to identify the heat stress tolerant genotypes for improvement of stress tolerance. All genotypes were cultivated for two consecutive years (2018-2020) under normal and late sown conditions. The results of the study revealed that the combined analysis of variance indicated significant variations among genotypes for all the studied stress indices. The reduction in mean grain yield of all genotypes under stress condition as compared to non-stress condition, indicating that the heat stress significantly affect the grain yield. The correlation analysis showed that the negative correlation of tolerance index and stress susceptibility percentage index with the grain yield of genotypes under heat stress condition (Ys) and a highly positive correlation of stress tolerance index, mean productivity, geometric mean, harmonic mean and mean relative performance with grain yield (Yp and Ys) under both conditions, helped accurately to identify the desirable genotypes. From the results obtained from principal component, biplot and cluster analysis, it was reported that HD 2967, WH 1249, HI 1617, WH 1202, WH 1021 and WH 1142 are suitable and good yielding genotypes under both conditions. Thus, above genotypes can be used for cultivation at high temperature or as genetic resources for introducing genetic variations in wheat genotypes to improve stress tolerance.

Determinants of quantification of tourism waste in the hilly terrain of Himalayas: A spatial approach.

The rapid economic development in environmentally sensitive zone of Himalayas resulted in the increased generation of tourism waste. However, the accounting methodology for accumulation of tourism waste in the hilly terrain was found to be missing. Accordingly, the socio-economic factors influencing the tourism waste generation were identified, and their correlation analysis was performed. The tourism waste generated within and outside an urban local body was quantified over a period of 12 years (2008-2019) using a novel methodology, considering the socioeconomic factors, such as economic significance, geographical terrain, location of tourist destinations and tourism-related activities. The spatial dependency of tourism waste accumulation in the Himalayan state of Himachal Pradesh, India was analyzed using the geographically weighted regression. Furthermore, the air pollutants' emission (PM2.5, PM10, CO, SO2 and NOx) from the open burning of neglected tourism waste were also quantified and compared with the existing literature.

Analysis of seasonal and spatial distribution of particulate matters and gaseous pollutants around an open cast coal mining area of Odisha, India.

Open cast mining - a predominant method of coal production in India (94.46% of total coal production) - has been found to be a major factor which is responsible for the emission of dust particles and gaseous pollutants, leading to the deterioration of air quality in the coal mining area. Considering the health concerns and environmental impacts of these pollutants, the inhabited villages of Ib valley coalfield area of Orisha, India, were selected for this study. In this regard, various researchers have performed the analysis of air quality data and modeling for the dispersion of pollutants. However, a long-term study on spatial and seasonal variations of air pollutants and their relationship with meteorological parameters were missing in the literature. Accordingly, the spatial and seasonal variations of air pollutants in the area were assessed for a period of six years (2014 - 2020), and concentrations of PM2.5, PM10, and SPM were found to be above the annual national ambient air quality standards (NAAQS) for all the three seasons. The overall mean concentrations of NOx, PM10, PM2.5, SPM, and SO2 during this period were found to be 17.2 ± 9.28, 152.5 ± 99.7, 53.27 ± 37.70, 268.5 ± 158.2, and 12.58 ± 7.47 µg/m3, respectively. The analysis of meteorological parameters showed a strong and significant negative correlation of relative humidity with PM2.5 (r = - 0.30, p-value = 5.659 × 10-10), PM10 (r = - 0.36, p-value = 1.97 × 10-13), and SPM (r = - 0.45, p-value = 2.2 × 10-16). Furthermore, the spatial distribution of pollutants was performed using the geographic information system (GIS) and inverse distance weighting (IDW) method, wherein the seasonal distribution of pollutants was shown through the bivariate polar plots. Therefore, the analyses and recommendations provided in this study can help the policymakers in developing a long-term air quality improvement strategy around a coal mining area, including the spatial and seasonal variations of air pollutants and their relationship with meteorological parameters.

A toxic shrub turned therapeutic: The dichotomy of Nerium oleander bioactivities.

Nerium oleander L. is a medicinal plant, used for the treatment of cancers and hyperglycemia across the world, especially in Indian sub-continent, Turkey, Morocco, and China. Although clinical studies supporting its pharmacological effects remain critically underexplored, accidental and intentional consumption of any part of the plant causes fatal toxicity in animals and humans. While the polyphenolic fraction of oleander leaves has been attributed to its pre-clinical pharmacological activities, the presence of diverse cardiac glycosides (especially oleandrin) causes apoptosis to cancer cells in vitro and results in clinical signs of oleander poisoning. Thus, the dual pharmacological and toxicological role of oleander is a perplexing dichotomy in phytotherapy. The current investigative review, therefore, intended to analyze the intrinsic and extrinsic factors that likely contribute to this conundrum. Especially by focusing on gut microbial diversity, abundance, and metabolic functions, oleander-associated pharmacological and toxicological studies have been critically analyzed to define the dual effects of oleander. Electronic databases were extensively screened for relevant research articles (including pre-clinical and clinical) related to oleander bioactivities and toxicity. Taxonomic preference was given to the plant N. oleander L. and synonymous plants as per 'The World Flora Online' database (WCSP record #135196). Discussion on yellow oleander (Cascabela thevetia (L.) Lippold) has intentionally been avoided since it is a different plant. The review indicates that the gut microbiota likely plays a key role in differentially modulating the pharmacological and toxicological effects of oleander. Other factors identified influencing the oleander bioactivities include dose and mode of treatment, cardiac glycoside pharmacokinetics, host-endogenous glycosides, plant material processing and phytochemical extraction methods, plant genotypic variations, environmental effects on the phytochemical quality and quantity, gene expression variations, host dietary patterns and co-morbidity, etc. The arguments proposed are also relevant to other medicinal plants containing toxic cardiac glycosides.

Comparison of smear layer removing efficacy of Cold Atmospheric Pressure (CAP) Plasma Jet with different chelating agents. An ex-vivo study.

The present study aimed to assess the effectiveness of different final irrigation regimens (Cold Atmospheric Pressure Plasma Jet, MTAD, and EDTA) in removing the smear layer from intra-radicular dentin using a Scanning Electron Microscope (SEM). Eighty-four mandibular premolars were prepared with ProTaper Universal hand files and were equally divided into four groups i.e. Normal saline (control), EDTA, MTAD and CAP Plasma Jet. Prepared samples in the control, EDTA and MTAD groups were irrigated with 5 milliliters of the irrigant, and it was retained for 2 min. In the CAP Plasma Jet group, the plasma plume was directed towards the canal lumen for 2 min. The smear layer removal of all the groups was evaluated at the coronal, middle and apical thirds. Statistical analysis was performed using Kruskal-Wallis test followed by Dunn's test. Evaluation by SEM showed that the smear layer removal ability of MTAD and EDTA were significantly better than CAP Plasma Jet (p < 0.05). While CAP Plasma Jet showed results comparable to EDTA in the coronal third. In the middle and apical third of the canal, its effect was comparable to the control group (p > 0.05). MTAD and EDTA aided in better smear layer removal than the CAP Plasma Jet in the coronal, middle, and apical third of the test samples. CAP Plasma jet performed better in the coronal third.

Transcriptome Profiling in Leaves of Wheat Genotype under Heat Stress.

Hexaploid wheat is the main cereal food crop for most people but it is highly influenced by climatic variations. The influence of these climatic variations was studies in wheat genotype WH -1184 in field conditions under two different environments (normal and late sown) and it was found that the genotype is less yielding under late sown conditions. To study the effects of heat stress at transcript level, it was grown under two different conditions (WH-1184 control and heat treated) in pots and transcriptome analysis based on Illumina Novoseq 6000 was carried out for the identification of the differentially expressed genes (DEGs) and metabolic processes or gene regulations influenced by heat stress which lead to a reduction in both quality and quantity of wheat production. These DEGs were utilized to set up a subsequent unigene assembly and GO analysis was performed using unigenes to analyze functions of DEGs which were classified into three main domains, i.e., biological process, cellular component, and molecular function. KEGG (Kyoto Encyclopedia of Genes and Genomes) ontology was used to visualize the physiological processes or to identify KEGG pathways that provide plants their ability to shield in adverse conditions of heat stress. From KEGG ontology, it was reported that genes which encoded protein detoxification and ABC1 domain-containing protein were upregulated while genes thatencoded glutathione transferase (GST), peroxidase, and chitinase enzymes were downregulated. Downregulation of these enzymes during heat stress causes oxidative damages in plants while upregulated proteins play a main role in detoxification to protect plants from heat stress. It was hypothesized that the yield of WH-1184 decreased 44% under heat stress due to the downregulation of genes that encoded GST, peroxidase, and chitinase enzymes which can protect plants from oxidative damage. Hence, upregulation of these genes might be helpful for the adaptation of this genotype under heat stress condition.

Understanding Acquired Brain Injury: A Review.

Any type of brain injury that transpires post-birth is referred to as Acquired Brain Injury (ABI). In general, ABI does not result from congenital disorders, degenerative diseases, or by brain trauma at birth. Although the human brain is protected from the external world by layers of tissues and bone, floating in nutrient-rich cerebrospinal fluid (CSF); it remains susceptible to harm and impairment. Brain damage resulting from ABI leads to changes in the normal neuronal tissue activity and/or structure in one or multiple areas of the brain, which can often affect normal brain functions. Impairment sustained from an ABI can last anywhere from days to a lifetime depending on the severity of the injury; however, many patients face trouble integrating themselves back into the community due to possible psychological and physiological outcomes. In this review, we discuss ABI pathologies, their types, and cellular mechanisms and summarize the therapeutic approaches for a better understanding of the subject and to create awareness among the public.

Demonstration of the DC-Kerr effect in silicon-rich nitride.

We demonstrate the DC-Kerr effect in plasma enhanced chemical vapor deposition (PECVD) silicon-rich nitride (SRN) and use it to demonstrate a third order nonlinear susceptibility, χ(3), as high as (6±0.58)×10-19m2/V2. We employ spectral shift versus applied voltage measurements in a racetrack resonator as a tool to characterize the nonlinear susceptibilities of these films. In doing so, we demonstrate a χ(3) larger than that of silicon and argue that PECVD SRN can provide a versatile platform for employing optical phase shifters while maintaining a low thermal budget using a deposition technique readily available in CMOS process flows.

Impact of the updated diastolic function guidelines in the real world.

BACKGROUND: Echocardiographic assessment of diastolic function is complex but can aid in the diagnosis of heart failure, particularly in patients with preserved ejection fraction. In 2016, the American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) published an updated algorithm for the evaluation of diastolic function. The objective of our study was to assess its impact on diastolic function assessment in a real-world cohort of echo studies. METHODS: We retrospectively identified 71,727 consecutive transthoracic echo studies performed at a tertiary care center between February 2010 and March 2016 in which diastolic function was reported based on the 2009 ASE Guidelines. We then programmed a software algorithm to assess diastolic function in these echo studies according to the 2016 ASE/EACVI Guidelines. RESULTS: When diastolic function assessment based on the 2009 guidelines was compared to that using the 2016 guidelines, there were significant differences in proportion of studies classified as normal (23% vs. 32%) or indeterminate (43% vs. 36%) function, and mild (23% vs. 23%), moderate (10% vs. 8%), or severe (1% vs. 2%) diastolic dysfunction, with poor agreement between the two methods (Kappa 0.323, 95% CI 0.318-0.328). Furthermore, within the subgroup of studies with preserved ejection fraction and no evidence of myocardial disease, there was significant reclassification from mild diastolic dysfunction to normal diastolic function. CONCLUSION: The updated guidelines result in significant differences in diastolic function interpretation in the real world. Our findings have important implications for the identification of patients with or at risk for heart failure.

A review on biogenic synthesis, applications and toxicity aspects of zinc oxide nanoparticles.

Nanoparticles (NPs) have become an important field of research over the past several decades with applications in various sectors, such as biomedical, cosmetic, food and many others, because of their unique characteristics. The green synthesis of nanoparticles has been preferred because of the naturally occurring reductants present in biological systems that decreases exposure to toxic chemicals compared with physico-chemical methods and is eco-friendly. Zinc oxide (ZnO) NPs exhibit broad and potential applications in different fields with their specific characteristics such as surface area, size, shape, low toxicity, optical properties, high binding energy and large band gap. This paper focuses on the bio-synthesis of ZnO NPs by utilizing extracts of different plant parts (stem, flower, fruit, peel, and leaves) through efficient, economical, simple, pure, and eco-friendly green routes. In this process, zinc salts have been used as precursor and phytochemicals in the plant extract reduce the metal salt to lower oxidation state as well as stabilize the ZnO NPs. The morphological and physico-chemical properties of obtained NPs analyzed by various characterization techniques have been discoursed. Further, antimicrobial activity and potential photocatalytic application in terms of the degradation of dyes have also been reviewed in addition to the toxicity aspects of these NPs on human beings and animals.

Thermo-optic properties of silicon-rich silicon nitride for on-chip applications.

We demonstrate the thermo-optic properties of silicon-rich silicon nitride (SRN) films deposited using plasma-enhanced chemical vapor deposition (PECVD). Shifts in the spectral response of Mach-Zehnder interferometers (MZIs) as a function of temperature were used to characterize the thermo-optic coefficients of silicon nitride films with varying silicon contents. A clear relation is demonstrated between the silicon content and the exhibited thermo-optic coefficient in silicon nitride films, with the highest achievable coefficient being as high as (1.65±0.08) ×10-4 K-1. Furthermore, we realize an SRN multi-mode interferometer (MMI) based thermo-optic switch with over 20 dB extinction ratio and total power consumption for two-port switching of 50 mW.

Outcomes of extracorporeal membrane oxygenation support in the cardiac catheterization laboratory.

OBJECTIVES: The aims of this single-center retrospective study were to characterize and determine predictors of 30-day survival in a cohort of patients requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO) supported cardiopulmonary resuscitation (E-CPR) in the cardiac catheterization laboratory (CCL) for cardiac arrest (CA) or refractory cardiogenic shock (CS). BACKGROUND: While safety in the CCL has improved, periprocedural mortality from CA remains high. The application of VA-ECMO is an emerging form of resuscitation with a paucity of data evaluating its use in the CCL for CA or CS. METHODS: All consecutive patients aged 18 years or older presenting to a single CCL from October 2010 to May 2018 who required E-CPR for CA or refractory CS were included. The primary outcome of our study was overall survival 30 days from VA-ECMO initiation. Secondary outcomes included 1-year survival, hospital length of stay, and ECMO related complications. RESULTS: Sixty-two patients with a mean age of 60 ± 9 years, 63% male, were included. VA-ECMO was initiated for CA in 39 patients (63%) and for CS in 23 patients (37%). The median ECMO duration was 48 hr. Overall 30-day survival was 47% (CA group 44% vs. CS group 52%; p = .414). One-year survival was 44%. Initial serum creatinine (OR 1.18 per 10 µmol/L increase; p = .016; AUC = 0.65) was the only multivariate predictor of 30-day mortality. CONCLUSIONS: The use of VA-ECMO in the CCL is feasible, demonstrating 47% 30-day survival, largely persistent to 1 year, in a cohort that otherwise has extremely high mortality.

In-Hospital Cardiac Arrest in the Cardiac Catheterization Laboratory: Effective Transition from an ICU- to CCU-Led Resuscitation Team.

OBJECTIVES: (1) To examine the incidence and outcomes of in-hospital cardiac arrests (IHCAs) in a large unselected patient population who underwent coronary angiography at a single tertiary academic center and (2) to evaluate a transitional change in which the cardiologist is positioned as the cardiopulmonary resuscitation (CPR) leader in the cardiac catheterization laboratory (CCL) at our local tertiary care institution. BACKGROUND: IHCA is a major public health concern with increased patient morbidity and mortality. A proportion of all IHCAs occurs in the CCL. Although in-hospital resuscitation teams are often led by an Intensive Care Unit- (ICU-) trained physician and house staff, little is known on the role of a cardiologist in this setting. METHODS: Between 2012 and 2016, a single-center retrospective cohort study was performed examining 63 adult patients (70 ± 10 years, 60% males) who suffered from a cardiac arrest in the CCL. The ICU-led IHCAs included 19 patients, and the Coronary Care Unit- (CCU-) led IHCAs included 44 patients. RESULTS: Acute coronary syndrome accounted for more than 50% of cardiac arrests in the CCL. Pulseless electrical activity was the most common rhythm requiring chest compression, and cardiogenic shock most frequently initiated a code blue response. No significant differences were observed between the ICU-led and CCU-led cardiac arrests in terms of hospital length of stay and 1-year survival rate. CONCLUSION: In the evolving field of Critical Care Cardiology, the transition from an ICU-led to a CCU-lead code blue team in the CCL setting may lead to similar short-term and long-term outcomes.