Efficacy of Ayurved based therapy on global longitudinal strain in ischemic heart disease: a retrospective analysis

Background: The current study aimed to investigate the efficacy of the Ischemia Reversal program (IRP) as an Ayurveda based therapy to standard anti-ischemic therapy in patients with ischemic heart disease (IHD). Methods: A retrospective, single centre, observational study was conducted from January 2022 to May 2023. A total of 39 patients diagnosed with ischemic heart disease and global longitudinal strain (GLS) <15, regardless of underlying co-morbidities such as diabetes mellitus, hypertension, obesity, hyperlipidemia, low ejection fraction, history of myocardial infarction were included in this study. The primary endpoint was improvement in GLS from baseline to the 90-day follow-up in various different categories. Secondary endpoints were improvement in EF, abdominal girth, weight and reduction in dependency on allopathic medication from baseline to the 90-day follow-up. Results: The mean age of the study population was 59.23±9.01 years. Weight (day 1: 67.29±13.16 kg and day 90: 61.39±11.11 kg; p=0.00), body mass index (day 1: 25.75±4.03 and day 90: 23.79±3.50; p=0.00), abdominal girth (day 1: 95.31±10.75 cm and day 90: 85.67±17.02 cm p=0.00), EF (day 1: 40.74±10.30% and day 90: 53.91±11.87%; p=0.00), and GLS (day 1: -10.99±2.72 and day 90: -13.17±3.75; p=0.00) improved at the 90 day follow-up. Conclusions: The study showed notable improvements in weight, body mass index, abdominal girth, EF, and GLS after 90 days. These results suggest that IRP is beneficial treatment for IHD, but more extensive research is needed to confirm its effectiveness

Unzipping flood vulnerability and functionality loss:tale of struggle for existence of riparian buildings

Floods pose significant risk to riparian buildings as evidenced during many historical events. Although structural resilience to tsunami flooding is well studied in the literature, high-velocity and debris-laden floods in steep terrains are not considered adequately so far. Historical floods in steep terrains necessitate the need for flood vulnerability analysis of buildings. To this end, we report vulnerability of riparian-reinforced concrete buildings using forensic damage interpretations and empirical/analytical vulnerability analyses. Furthermore, we propose the concept and implications of functionality loss due to flooding in residential reinforced concrete (RC) buildings using empirical data. Fragility functions using inundation depth and momentum flux are presented for RC buildings considering a recent flooding event in Nepal. The results show that flow velocity and sediment load, rather than hydrostatic load, govern the damages in riparian RC buildings. However, at larger inundation depth, hydrostatic force alone may collapse some of the RC buildings

Ethical Duty of a Lawyer to Defend His Client in a Criminal Case: Issues and Challenges in India

The fate of a criminal case to a large extent depends upon choosing the right lawyer. But the choice of a right lawyer requires some amount of experience and expertise, which a layman intending to hire a lawyer may not be equipped with. Even if the client has made a smart choice in identifying a right lawyer for him, the lawyer so identified might not be willing to accept a brief for the reasons best known to the lawyer. At times a peculiar situation may arise before the lawyer where the lawyer seeks to withdraw from representing the accused. There are various pitfalls to the client’s right from the stage of making a choice of a competent lawyer to defend the accused up to the end of the legal battle. The article deals with the professional ethics involved when a counsel accepts a brief or seeks to withdraw from representing an accused and terminate the advocate–client relationship. </jats:p

Aldosterone Antagonists in Heart Failure

Aldosterone antagonists represented by nonselective spironolactone and mineralocorticoid-selective eplerenone are approved for treatment of symptomatic heart failure with reduced systolic function. Their cardioprotective, antifibrotic, and antiarrhythmic effects have been proven in animal experiments, and their effects on morbidity and mortality have been demonstrated in randomized clinical trials. Yet, they remain the most underutilized of all classes of medications for heart failure, primarily because of fear of hyperkalemia. Thorough patient screening and selection is the key for minimizing risks and optimizing benefits from these drugs. Ongoing trials will demonstrate whether the indication for aldosterone antagonists can be expanded to less severe heart failure or patients with preserved systolic function. </jats:p

Photocatalysed eosin Y mediated synthesis of biologically potent 4 (3H)-quinazolinone

An environmentally benign green and metal-free visible light mediated approach for the synthesis of biologically potent 4(3H)-quinazolinone through multicomponent reaction of readily available starting materials potassium salt of anthranilic acid, aryl carboxylic acid, aliphatic/aromatic amine catalyzed by Eosin-Y has been developed with wide range of applications in pharmaceutical. Integrated process reduces the mechanical loss of the intermediate during the process of isolation

Gender differences in the value of ST-segment depression during adenosine stress testing

Previous studies have suggested that ST-segment depression with adenosine myocardial perfusion imaging (MPI) may be a marker of significant coronary artery disease (CAD). It is unclear if the significance of ST depression differs between men and women. We investigated the diagnostic accuracy of ST-segment depression with adenosine radionuclide MPI as a marker of significant CAD in men and women. Consecutive patients who had angina or suspected CAD and underwent an adenosine stress test and subsequent angiography were retrospectively analyzed. The inclusion criteria were met by 959 patients. Mean age was 64 ± 11 years, and 43% were women. ST depression occurred in 7.6% of the cohort and more often in women (64% women vs 36% men, p <0.001). Among men and women, patients with ST-segment depression had a significantly higher peak rate–pressure product, more chest pain, and a higher ejection fraction in response to the adenosine infusion compared with those without ST-segment depression. ST-segment depression occurred more often in the presence of stenotic lesions (≥50% and ≥70%), and left main or 3-vessel disease, regardless of gender. Transient ischemic dilation occurred more often in men with ST-segment depression. The logistic regression analysis demonstrated that the only significant predictors of left main or 3-vessel CAD were gender, an abnormal result on MPI, transient ischemic dilation, and ST-segment depression. In conclusion, ST-segment depression during adenosine MPI is an important marker of angiographically significant CAD in men and women. The presence of ST-segment depression is associated with left main disease and 3-vessel CAD