Current Place of SGLT2i in the Management of Heart Failure: An Expert Opinion from India.

Heart failure (HF) is a global health concern that is prevalent in India as well. HF is reported at a younger age in Indian patients with comorbidity of type 2 diabetes (T2DM) in approximately 50% of patients. Sodium-glucose cotransporter-2 inhibitors (SGLT2i), originally approved for T2DM, are new guideline-recommended and approved treatment strategies for HF. Extensive evidence highlights that SGLT2i exhibits profound cardiovascular (CV) benefits beyond glycemic control. SGLT2i, in conjunction with other guideline-directed medical therapies (GMDT), has additive effects in improving heart function and reducing adverse HF outcomes. The benefits of SGLT2i are across a spectrum of patients, with and without diabetes, suggesting their potential place in broader HF populations irrespective of ejection fraction (EF). This consensus builds on the updated evidence of the efficacy and safety of SGLT2i in HF and recommends its place in therapy with a focus on Indian patients with HF.

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.

Role of Bisoprolol in Heart Failure Management: A Consensus Statement from India.

In India, heart failure (HF) is an important health concern affecting younger age groups than the western population. A limited number of Indian patients receive guideline-directed medical therapy (GDMT). Selective ß-1 blockers (BB) are one of the GDMTs in HF and play an important role by decreasing the sympathetic overdrive. The BB reduces heart rate (HR) reverse the adverse cardiac (both ventricular and atrial), vascular, and renovascular remodeling seen in HF. Bisoprolol, a ß-1 blocker, has several advantages and can be used across a wide spectrum of HF presentations and in patients with HF and comorbid conditions such as coronary artery disease (CAD), atrial fibrillation (AF), post-myocardial infarction (MI), uncontrolled diabetes, uncontrolled hypertension, and renal impairment. Despite its advantages, bisoprolol is not optimally utilized for managing HF in India. This consensus builds on updated evidence on the efficacy and safety of bisoprolol in HF and recommends its place in therapy with a focus on Indian patients with HF.

Effects of drying methods on oxidative stability of roselle seed oil (Hibiscus Sabdariffa): an optimization approach.

The objective of this study was to optimize the extraction of oil from pre-dried roselle seeds using response surface methodology (RSM). We also determined the oxidative stability of oil extracted from oven and freeze-dried roselle seed in terms of iodine value (IV), free fatty acid (FFA) value, peroxide value (PV), P-anisidine and total oxidation values (TOTOX value). The RSM was designated based on the central composite design with the usage of three optimum parameters ranged from 8 to 16 g of sample weight, 250-350 mL of solvent volume, and 6-8 h of extraction time. The highest oil yielded from roselle seed using the optimization process was 22.11% with the parameters at sample weight of 14.4 g, solvent volume of 329.70 mL, and extraction time of 7.6 h. Besides, the oil extracted from the oven dried roselle seed had the values of 89.04, 2.11, 4.13, 3.76 and 12.03 for IV, FFA, PV, P-anisidine, and TOTOX values, respectively. While for the oil extracted from freeze-dried roselle seed showed IV of 90.31, FFA of 1.64, PV of 2.47, P-anisidine value of 3.48, and TOTOX value of 8.42. PV and TOTOX values showed significant differences whereas; IV, FFA, and P-anisidine values showed no significant differences between the oven and freeze-dried roselle seed oils.

Meta-analysis of postoperative pain using non-sutured or sutured single-layer open mesh repair for inguinal hernia.

Background: Chronic postoperative pain occurs in up to 21·7 per cent of patients undergoing open inguinal hernia repair. Several mesh fixation techniques using glue or self-gripping meshes have been developed to reduce postoperative pain. The aim of this meta-analysis was to evaluate RCTs comparing adhesional/self-gripping and sutured single-layer open mesh fixations in the repair of inguinal herniation, with postoperative pain as endpoint. Methods: PubMed, Embase and Cochrane CENTRAL databases were searched systematically for RCTs according to the PRISMA guidelines; the study was registered at PROSPERO (CRD42017056373). Different fixation methods were analysed. The primary outcome, chronic pain, was defined as a postoperative visual analogue scale (VAS) score of at least 3 at 12 months. Secondary outcomes were mean VAS score at 1 week and at 1 month after surgery. Results: Twenty-three studies including 5190 patients were included in the meta-analysis. Adhesional (self-adhering or glued) or self-gripping fixation methods were associated with a significantly lower VAS score at 1 week (mean difference -0·49, 95 per cent c.i. -0·81 to -0·17; P = 0·003) and at 1 month (mean difference -0·31, -0·58 to -0·04; P = 0·02) after surgery than suture fixation, but the incidence of chronic pain after 12 months was similar in the two groups (odds ratio 0·70, 95 per cent c.i. 0·30 to 1·66). Differences in recurrences and complications between groups did not reach statistical significance. Conclusion: There was no difference in the incidence of chronic pain 12 months after different mesh repair fixation techniques despite significant reductions in short-term postoperative pain favouring a non-sutured technique. There were no differences in recurrence rates or in rates of other complications at 1 year.

Variation of δ2H, δ18O & δ13C in crude palm oil from different regions in Malaysia: Potential of stable isotope signatures as a key traceability parameter.

A total of 33 crude palm oil samples were randomly collected from different regions in Malaysia. Stable carbon isotopic composition (δ13C) was determined using Flash 2000 elemental analyzer while hydrogen and oxygen isotopic compositions (δ2H and δ18O) were analyzed by Thermo Finnigan TC/EA, wherein both instruments were coupled to an isotope ratio mass spectrometer. The bulk δ2H, δ18O and δ13C of the samples were analyzed by Hierarchical Cluster Analysis (HCA), Principal Component Analysis (PCA) and Orthogonal Partial Least Square-Discriminant Analysis (OPLS-DA). Unsupervised HCA and PCA methods have demonstrated that crude palm oil samples were grouped into clusters according to respective state. A predictive model was constructed by supervised OPLS-DA with good predictive power of 52.60%. Robustness of the predictive model was validated with overall accuracy of 71.43%. Blind test samples were correctly assigned to their respective cluster except for samples from southern region. δ18O was proposed as the promising discriminatory marker for discerning crude palm oil samples obtained from different regions. Stable isotopes profile was proven to be useful for origin traceability of crude palm oil samples at a narrower geographical area, i.e. based on regions in Malaysia. Predictive power and accuracy of the predictive model was expected to improve with the increase in sample size. Conclusively, the results in this study has fulfilled the main objective of this work where the simple approach of combining stable isotope analysis with chemometrics can be used to discriminate crude palm oil samples obtained from different regions in Malaysia. Overall, this study shows the feasibility of this approach to be used as a traceability assessment of crude palm oils.

A comparative study of metal contamination in soil using the borehole method.

The present study deals with possible contamination of the soil by metal ions which have been affecting the environment. The concentrations of metal ions in 14 borehole samples were studied using the ICP-OES standard method. The degree of contamination was determined on the basis of single element pollution index (SEPI), combined pollution index (CPI), soil enrichment factor (SEF), and geo-accumulation index (Igeo). Geo-accumulation indices and contamination factors indicated moderate to strong contaminations for eight boreholes (BL-1, BL-2, BL-6, BL-8, BL-9, BL-10, BL-12, and BL-13) while the rest were extremely contaminated. Among all the boreholes, BL-3 and BL-11 demonstrated the highest level of Cd(II) and Pb(II) which were found the most polluted sites. The level of metal contamination was also compared with other countries. The development, variation, and limitations regarding the regulations of soil and groundwater contamination can be provided as a helpful guidance for the risk assessment of metal ions in developing countries.

Mango (Mangifera indica L.) by-products and their valuable components: a review.

The large amount of waste produced by the food industries causes serious environmental problems and also results in economic losses if not utilized effectively. Different research reports have revealed that food industry by-products can be good sources of potentially valuable bioactive compounds. As such, the mango juice industry uses only the edible portions of the mangoes, and a considerable amount of peels and seeds are discarded as industrial waste. These mango by-products come from the tropical or subtropical fruit processing industries. Mango by-products, especially seeds and peels, are considered to be cheap sources of valuable food and nutraceutical ingredients. The main uses of natural food ingredients derived from mango by-products are presented and discussed, and the mainstream sectors of application for these by-products, such as in the food, pharmaceutical, nutraceutical and cosmetic industries, are highlighted.

Hard cocoa butter replacers from mango seed fat and palm stearin.

The blending effects of mango seed fat (MSF), extracted using supercritical fluid, and palm stearin (PS) to formulate hard cocoa butter replacers (CBRs), were investigated. The triglycerides (TG), thermal properties and solid fat content (SFC) of the formulated blends were determined using different chromatographic and thermal techniques. All the blends had three main TGs; namely, 1,3-dipalmitoyl-2-oleoylglycerol (POP) (8.6-17.7%), 1-palmitoyl-2-oleoyl-3-stearoyl-glycerol (POS) (12.6-19.6%), and 1,3-distearoyl-2-oleoyl-glycerol (SOS) (37.2-31.4%), with SOS being the major component. The melting peak temperatures gradually increased and shifted towards higher temperatures with PS. The crystallization onset temperatures increased, while the offset decreased with PS. The SFC did not drop to 0% at 37.5°C, which was shifted to 0% at and above 40°C for some blends. The studies revealed that CBRs could be prepared by blending MSF and PS, and they could be utilised by chocolate manufacturers in tropical countries.

Safety of Prasugrel in Indian patients - multicentric registry of 1000 cases.

BACKGROUND: Clopidogrel has been the only available antiplatelet drug used along with aspirin in patients of ACS. In recent years 2 new antiplatelet drugs (Prasugrel and Ticagrelor) have become available. Prasugrel in the dose of 10 mg OD has been found to be more efficacious but with increased risk of major bleeding. For this reason it has not gained widespread usage in ACS patients undergoing PCI. There are no systematic data on the use of Prasugrel in Indian population. METHOD: This is a prospective, multicentric, hospital registry of 1000 patients with ACS undergoing PCI who were administered Prasugrel. The primary safety endpoint of this study was major and minor bleeding while the efficacy endpoint is the composite of CV death, nonfatal MI, nonfatal stroke up to 30 days after PCI. Patients with high bleeding risk were excluded. RESULTS: Most patients (91%) received loading dose of Prasugrel along with the maintenance dose getting according to the defined protocol. Patients were followed up to 30 days post procedure. Primary efficacy end point was reached in 3 patients only with two of them dying due to possible stent thrombosis and the third requiring revascularization of the target vessel for stent thrombosis. One major and 19 minor bleeding complications were recorded, with access site bleeding in 0.7% & non-access site bleeding in 1.2% of the subjects. CONCLUSION: Prasugrel was found to be effective & not associated with a high incidence of bleeding in the high risk ACS patients when those at a high bleeding risk were excluded.

Chemical, enzymatic and cellular antioxidant activity studies of Agaricus blazei Murrill.

Mushrooms possess nutritional and medicinal properties that have long been used for human health preservation and that have been considered by researchers as possible sources of free radical scavengers. In this work, the antioxidant properties of water extracts from Agaricus blazei Murill, produced by maceration and decoction, are demonstrated in vitro. Resistance to oxidation is demonstrated through three mechanisms: i) inhibition of enzymatic oxidative process, with 100% inhibition of HRP (horseradish peroxidase) and MPO (myeloperoxidase); ii) inhibition of cellular oxidative stress, with 80% inhibition of the oxidative burst of polymorphonuclear neutrophils (PMNs); and iii) direct action over reactive species, with 62% and 87% suppression of HOCl and superoxide anion radical (O2• -), respectively. From the data, it was concluded that the aqueous extract of A. blazei has significant antioxidant activity, indicating its possible application for nutraceutical and medicinal purposes.

Mechanism of trivalent gold reduction and reactivity of transient divalent and monovalent gold ions studied by gamma and pulse radiolysis.

The detailed kinetics of the multistep mechanism of the Au(III) ion reduction into gold clusters have been investigated by radiation chemistry methods in 2-propanol. In particular, a discussion on the steady state radiolysis dose-dependence of the yields concludes to a comproportionation reaction of nascent gold atoms Au(0) with excess Au(III) ions into Au(II) and Au(I). This reaction should be achieved through Au(III) consumption before the coalescence of atoms Au(0) into gold clusters may occur. Then gold clusters catalyze the reduction of Au(I) by 2-propanol. It was also found that a long-lived Au(II) dimer, (Au(II))(2), was transiently formed according to the quantitative analysis of time-resolved absorbance signals obtained by pulse radiolysis. Then the disproportionation of Au(II) is intramolecular in the dimer instead of intermolecular, as usually reported. The yields, reaction rate constants, time-resolved spectra, and molar extinction coefficients are reported for the successive one-electron reduction steps, involving especially the transient species, such as Au(II), (Au(II))(2), and Au(I). The processes are discussed in comparison with other solvents and other metal ions.

Clinical solid waste management practices and its impact on human health and environment--A review.

The management of clinical solid waste (CSW) continues to be a major challenge, particularly, in most healthcare facilities of the developing world. Poor conduct and inappropriate disposal methods exercised during handling and disposal of CSW is increasing significant health hazards and environmental pollution due to the infectious nature of the waste. This article summarises a literature review into existing CSW management practices in the healthcare centers. The information gathered in this paper has been derived from the desk study of open literature survey. Numerous researches have been conducted on the management of CSW. Although, significant steps have been taken on matters related to safe handling and disposal of the clinical waste, but improper management practice is evident from the point of initial collection to the final disposal. In most cases, the main reasons of the mismanagement of CSW are the lack of appropriate legislation, lack of specialized clinical staffs, lack of awareness and effective control. Furthermore, most of the healthcare centers of the developing world have faced financial difficulties and therefore looking for cost effective disposal methods of clinical waste. This paper emphasizes to continue the recycle-reuse program of CSW materials after sterilization by using supercritical fluid carbon dioxide (SF-CO2) sterilization technology at the point of initial collection. Emphasis is on the priority to inactivate the infectious micro-organisms in CSW. In that case, waste would not pose any threat to healthcare workers. The recycling-reuse program would be carried out successfully with the non-specialized clinical staffs. Therefore, the adoption of SF-CO2 sterilization technology in management of clinical solid waste can reduce exposure to infectious waste, decrease labor, lower costs, and yield better compliance with regulatory. Thus healthcare facilities can both save money and provide a safe environment for patients, healthcare staffs and clinical staffs.

Aneurysm of sinus of Valsalva dissecting into interventricular septum with left ventricular communication.

Septal dissection with left ventricular communication is a rare complication of aneurysm of sinus of Valsalva. This report describes a case of aneurysm of sinus of Valsalva with septal dissection, almost in its entirety with left ventricular communication--which is a very rare occurrence.

[Vasectomy. A prospective, randomized trial of vasectomy with bilateral incision versus the Li vasectomy]. / Vasektomi. Et prospektivt, randomiseret studie af vasektomi med dobbeltsidig incision vs. vasektomi a.m. Li.

INTRODUCTION: Studies have shown that the Li vasectomy can match the effectiveness of and reduce the duration of operation and rate of complications compared to standard vasectomy with bilateral incision. MATERIALS AND METHODS: A prospective, randomised trial was conducted to compare the Li vasectomy with the standard vasectomy with bilateral incision. Data regarding effectiveness, time of operation, the patient's pain and discomfort, and peroperative and postoperative complications were recorded. Overall, 99 patients were entered in the trial, 51 with vasectomy with bilateral incision, 48 with the Li vasectomy. RESULTS: No significant difference was found between the two methods with regard to effectiveness, time of operation, the patient's pain and discomfort, and peroperative and postoperative complications. Overall, vasectomy was inadequate in 5%, haematoma was found in 13%, infection in 9%, and scrotal pain or painful ejaculation in 9%. DISCUSSION: The Li vasectomy can be learned and practiced under routine conditions by residents in training with the same effectiveness and the same rate of complications as standard vasectomy with bilateral incision. The total morbidity was at the same level as in previous Danish studies, but higher than in the international studies with the Li vasectomy.

Increasing the fertilizer value of palm oil mill sludge: bioaugmentation in nitrification.

Malaysia is essentially an agricultural country and her major polluting effluents have been from agro-based industries of which palm oil and rubber industries together contribute about 80% of the industrial pollution. Palm oil sludge, commonly referred to, as palm oil mill effluent (POME) is brown slurry composed of 4-5% solids, mainly organic, 0.5-1% residual oil, and about 95% water. The effluent also contains high concentrations of organic nitrogen. The technique for the treatment of POME is basically biological, consisting of pond systems, where the organic nitrogen is converted to ammonia, which is subsequently transformed to nitrate, in a process called nitrification. A 15-month monitoring program of a pond system (combined anaerobic, facultative, and aerobic ponds in series) confirmed studies by other authors and POME operators that nitrification in a pond system demands relatively long hydraulic retention time (HRT), which is not easily achieved, due to high production capacity of most factories. Bioaugmentation of POME with mixed culture of nitrifiers (ammonia and nitrite oxidizers) has been identified as an effective tool not only for enhancing nitrification of POME but also for improving quality of POME as source of liquid nitrogen fertilizer for use in the agricultural sector, especially in oil palm plantations. Nitrate is readily absorbable by most plants, although some plants are able to absorb nitrogen in the form of ammoniun. In this study, up to 60% reduction in HRT (or up to 20% reduction in potential land requirement) was achieved when bioaugmentation of POME was carried out with the aim of achieving full nitrification.