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Background Hypertension is associated with endothelial cell dysfunction. E-selectin, an endothelial cell adhesion molecule, is specific for endothelial cell activation. Polymorphism in E-selectin gene has recently been identified among which Leu554Phe E-selectin gene polymorphism is least investigated in essential hypertension. This study reports the association of E-selectin gene Leu554Phe polymorphism and the expression of E-selectin gene in patients with essential hypertension. Materials and methods We analysed the Leu554Phe polymorphism and expression of E-selectin gene in 250 patients with essential hypertension and 250 normal healthy controls. Genotyping of Leu554Phe polymorphism was performed by polymerase chain reaction-restriction fragment length polymorphism ( PCR- RFLP), and the expression of E-selectin gene at mRNA and protein levels were carried out by real-time PCR and Western blot, respectively. Results A significant association of E-selectin genotypes ( CT + TT) with essential hypertension ( P < .0001, Odds ratio = 2.2 [1.58-3.24] at 95% CI) was observed. The expression of mRNA for E-selectin gene in patients with essential hypertension was ~12-fold higher as compared to control. We observed an elevated level of E-selectin protein expression (up to 1.9 times) in patients as compared to controls. Conclusions A significant association of E-selectin (Leu554Phe) gene and increased expression of E-selectin gene at mRNA and protein levels in patients might be related to the genetic predisposition to develop essential hypertension. [ABSTRACT FROM AUTHOR]

Hematite nanoparticles (α‐Fe2O3) were successfully synthesised using facile and eco‐friendly hydrothermal method. Synthesised hematite nanoparticles were characterized using X‐ray diffraction, Fourier transform infrared spectroscopy, surface area analysis and transmission electron microscopy. Nano/micro particles of Hematite (1, 3&5 %, w/w) were incorporated in aerosol forming composite (AFC). For the first time, catalytic effect of nano and micro size hematite on performance of AFC has been creatively investigated with respect to combustion and fire extinguishment parameters. Incorporation of nano hematite (5 %, w/w) in AFC reduced the combustion temperature (by 11 %) and tremendously boosted the burn rate & combustion efficiency by 30&7.5 % respectively. This in turn produced the aerosols in less time and put out the fire quickly (<5 s). Hematite nano counterpart was discovered to be more promising than its micro equivalent. This exploratory study is valuable in the field of development of futuristic ultra‐fast fire extinguishants. [ABSTRACT FROM AUTHOR]

Introduction: Universal coverage of vaccines alone cannot be relied upon to protect at-risk populations in lower- and middle-income countries against the impact of the coronavirus disease 2019 (COVID-19) pandemic and newer variants. Live vaccines, including Bacillus Calmette–Guérin (BCG), are being studied for their effectiveness in reducing the incidence and severity of COVID-19 infection. Methods: In this multi-centre quadruple-blind, parallel assignment randomised control trial, 495 high-risk group adults (aged 18–60 years) were randomised into BCG and placebo arms and followed up for 9 months from the date of vaccination. The primary outcome was the difference in the incidence of COVID-19 infection at the end of 9 months. Secondary outcomes included the difference in the incidence of severe COVID-19 infections, hospitalisation rates, intensive care unit stay, oxygen requirement and mortality at the end of 9 months. The primary analysis was done on an intention-to-treat basis, while safety analysis was done per protocol. Results: There was no significant difference in the incidence rates of cartridge-based nucleic acid amplification test (CB-NAAT) positive COVID-19 infection [odds ratio (OR) 1.08, 95% confidence interval (CI) 0.54–2.14] in the two groups, but the BCG arm showed a statistically significant decrease in clinically diagnosed (symptomatic) probable COVID-19 infections (OR 0.38, 95% CI 0.20–0.72). Compared with the BCG arm, significantly more patients developed severe COVID-19 pneumonia (CB-NAAT positive) and required hospitalisation and oxygen in the placebo arm (six versus none; p = 0.03). One patient belonging to the placebo arm required intensive care unit (ICU) stay and died. BCG had a protective efficacy of 62% (95% CI 28–80%) for likely symptomatic COVID-19 infection. Conclusions: BCG is protective in reducing the incidence of acute respiratory illness (probable symptomatic COVID-19 infection) and severity of the disease, including hospitalisation, in patients belonging to the high-risk group of COVID-19 infection, and the antibody response persists for quite a long time. A multi-centre study with a larger sample size will help to confirm the findings in this study. Clinical Trials Registry: Clinical Trials Registry India (CTRI/2020/07/026668). Plain Language Summary: The Bacillus Calmette–Guérin (BCG) vaccine has been studied previously in several settings, including reducing childhood mortalities due to viral infections and induction of trained immunity and reducing upper respiratory tract infections and pneumonia in older adults. This multi-centre trial has tried to evaluate the efficacy of BCG revaccination in reducing the incidence and severity of COVID-19 infections in adults between 18 and 60 years of age belonging to the high-risk group owing to the presence of comorbidities including diabetes, chronic kidney disease, chronic liver disease and chronic lung diseases. A single dose of BCG vaccine produced significantly high titres of BCG antibodies lasting for six months. While there was no significant reduction in the incidence of COVID-19 infection, there was an 8.4% reduction in the incidence of symptomatic COVID-19 disease at the end of 9 months of follow-up. In addition, there were significantly fewer severe COVID-19 infections requiring hospital stay and oxygen support. However, the overall numbers of severe COVID-19 infections were low. Thus, the study shows that BCG can protect against symptomatic and severe COVID-19 disease. However, it might not reduce the incidence of new infections. The study results are significant for low- and middle-income countries without adequate coverage of primary doses of COVID-19 vaccination, let alone the booster doses. Future studies should evaluate the BCG vaccine's efficacy as a booster compared with routine COVID-19 vaccine boosters. [ABSTRACT FROM AUTHOR]

Implementation of Montreal Protocols-1987 enforced phase wise ban on production and application of ozone depleting chemicals (Halons). Since then, condensed aerosol-based fire extinguishing technology as an alternative to Halons has been a subject for numerous investigations for its research and applications worldwide. It has come up as the most efficient halon alternative technology in comparison to other alternatives such as water mist, dry powders, inert gases, hydro fluorocarbons, and carbon dioxide. Even it is three times more efficient than that of Halon 1301 on weight to volume basis. Over other Halon alternatives, it has many advantages, e.g., zero ozone depletion potential -atmospheric lifetime -global warming potential, modular structure, low space requirements, easy & cost-effective installation & maintenance, no requirement of piping & pressurized cylinders, no oxygen depression etc. Condensed aerosol based fire extinguishing systems (CAFES) have found versatile fire safety applications worldwide in many areas such as power generation, transportation, storage rooms, public buildings, heavy industries, battery storage systems, defence etc. This review mainly focuses on applications of CAFES for extinguishment of: class A fires in libraries, archives, storage rooms etc.; class B fires in machinery spaces, gas turbine enclosures, combat vehicles, chemical storage rooms; electrical fires occurring in control rooms, UPS rooms, electrical/power substations & panels. Various reports and case studies demonstrating its testing and implementation methodologies have also been covered. The future prospects of aerosol technology and potential research/applications areas are also discussed. [ABSTRACT FROM AUTHOR]

Background: The impact of bariatric surgery on atherosclerosis is a relatively less studied subject. Obesity has been identified as an independent risk factor for cardiovascular disease (CVD). Carotid intima-media thickness (CIMT), a surrogate marker for atherosclerosis and risk of CVD, has been found to be associated with obesity. Recent literature has shown that there is significant reduction in CIMT following bariatric surgery. The aim of this study was to evaluate the impact of bariatric surgery on CIMT and risk of CVD in an Indian population.Methods: This is a prospective study conducted in a tertiary referral centre in India. Patients undergoing bariatric surgery from December 2017 to September 2019 were included. CIMT measurements and American College of Cardiology/American Heart Association (ACC/AHA)-pooled cohort CVD risk scores were done before and at 6 months and 12 months after surgery.Results: Fifty-four patients were enrolled, of which 70% were females. Mean age was 40.8 ± 10.7 years. Mean pre-operative weight and mean BMI were 115.2 ± 21.9 kg and 45.9 ± 6.5 kg/m2, respectively. Patients who completed 12-month follow-up were considered for analysis of outcomes. There was significant reduction in BMI to 33.1 ± 5.7 kg/m2 at 12 months after surgery (p < 0.0001). Mean CIMT reduced significantly from 0.58 ± 0.08 mm at baseline to 0.52 ± 0.10 mm at 12 months. Lipid profile, fasting blood sugar and HbA1C also improved, which resulted in reduction of lifetime and 10-year CVD risk from 42.3 to 26% and 4 to 1.5%, respectively, at 12 months after surgery.Conclusions: Bariatric surgery results in significant reduction in CIMT and CVD risk in patients with morbid obesity. [ABSTRACT FROM AUTHOR]

Background & objectives: Slow breathing increases parasympathetic activity and baroreflex sensitivity (BRS) in healthy individuals, also similarly observed in yoga practitioners. Pranayama which is an important component of yoga when practiced at a slow pace was at a respiratory frequency of around 0.1 Hz (6 breaths/min). Therefore, it was hypothesized that yoga practitioners might have adapted to slow breathing. This study was aimed to decipher the role of yoga on cardiovascular variability during slow breathing (0.1 Hz) in yoga practitioners. Methods: A cross-sectional study was undertaken in naïve-to-yoga individuals (n=40) and yoga practitioners (n=40) with an average age of 31.08 ± 7.31 and 29.93 ± 7.57 yr, respectively. The analysis of heart rate variability, blood pressure variability (BPV) and BRS during spontaneous and slow breathing was compared between the two groups. Results: During slow breathing, the heart rate (P<0.01) was lower, respiratory rate interval (P<0.05) and pNN50 per cent (P=0.01) were higher, mean systolic BP (SBP) (P<0.05) and SDSD (Standard deviation of successive beat to beat systolic blood pressure differences) (P<0.01) of SBP variability were lower with sequence BRS (P<0.001) and α low frequency (P<0.01) and α high frequency (P<0.001) of spectral BRS were higher in yoga practitioners. Interpretation & conclusions: The present study indicated higher parasympathetic activity and BRS with lower SBP variability at rest and during slow breathing in yoga practitioners compared to naive group. Findings indicate that the short-term practice of slow breathing complements the augmented parasympathetic activity and BRS in the yoga group. [ABSTRACT FROM AUTHOR]

Fluorosurfactants are active components of firefighting foams used to extinguish hydrocarbon fires. Nonetheless, the outdoor application of perfluorochemicals based on perfluorooctanoic acid and perfluorooctane sulfonate has created concerns of environmental pollution and health issues. Long-chain perfluorosurfactants have high stability, high transportability, high solubility, long half-life of human serum elimination, high bioconcentration factor in fish and substantial aquatic toxicity. As a consequence, these chemicals have been phased out and replaced by short-chain fluorosurfactants. Here we review fluorosurfactants, their role in firefighting foam, environmental concern of long-chain perfluorosurfactants, and international legislative regulations. Furthermore, we compare short-chain and long-chain fluorosurfactants in terms of physicochemical properties, fire extinguishing capabilities and environmental fate. [ABSTRACT FROM AUTHOR]

Aerosol forming compositions (AFCs) have come up as one of the most efficient fire extinguishing Halon alternative since the implementation of Montreal protocol-1987 on ozone layer depleting substances. These aerosol based systems have gained much attention in recent years because of higher fire extinguishing efficiencies, modular nature, non pressurized container, less maintenance requirement, extended shelf-life and negligible ODP, GWP and ALT values. Aerosols are traditionally produced using pyrotechnique compositions having mostly metal salts of group IA or IIA. Potassium nitrate has been used predominantly as oxidizing agent (40–75%, w/w), whereas for electric and electronics systems, strontium nitrate (15–70%, w/w) has been recommended. Versatile reducing agent, binders, gas forming agents, burn rate modifiers and many such functional additives have been used recently for preparations of AFCs. AFCs indicated variable burn rate values, 2–7 mm/s. AFCs were found highly efficient with minimum fire extinguishing concentrations mostly ranging between 30 g/m3 and 200 g/m3. Moreover, the development of highly efficient, non-corrosive, non-toxic and environmentally benign AFC is still an elusive goal. This review mainly focuses on advances of aerosol forming chemical compositions, its future prospects and potential research areas. [ABSTRACT FROM AUTHOR]

Correction to: Efficacy of Bacillus Calmette-Guérin (BCG) Vaccination in Reducing the Incidence and Severity of COVID-19 in High-Risk Population (BRIC): a Phase III, Multi-centre, Quadruple-Blind Randomised Control Trial The original article can be found online at https://doi.org/10.1007/s40121-022-00703-y. The supplementary material file has been corrected and the original article has been updated. [Extracted from the article]

Stroke and systemic embolism occur frequently in patients with rheumatic mitral stenosis (MS) in sinus rhythm (SR), but the risk and predictors of embolic events in this population are not well studied. The aim of this study was to determine if transient, subclinical atrial fibrillation (AF) increases the risk of systemic embolism in patients with MS in SR. A single-center, prospective observational study of patients with rheumatic MS in SR was performed. The rate of the composite primary outcome of stroke, transient ischemic attack, or non-central nervous system embolism was determined, as well as the predictive value of Holter-detected episodes of transient (<30 seconds), subclinical AF for this outcome. Hazard ratios were derived for subclinical AF, after adjustment for clinical and echocardiographic predictors of systemic embolism, using Cox regression. The sensitivity, specificity, and area under the receiver-operating characteristic curve of subclinical AF were determined for the primary outcome. Among 179 patients (mean follow-up 10.2 months), the rate of the primary outcome was 5.3/100 patient-years (95% confidence interval [CI] 2.6 to 10.5). In univariate analysis, subclinical AF (hazard ratio 4.54, 95% CI 1.08 to 19.0, p = 0.038) and dense spontaneous echocardiographic contrast (hazard ratio 4.32, 95% CI 1.03 to 18.09, p = 0.045) were predictors of the primary outcome. In multivariate analysis, subclinical AF remained the only significant predictor (hazard ratio 5.02, 95% CI 1.15 to 22.0, p = 0.032). Subclinical AF had an area under the receiver-operating characteristic curve of 0.68 and high negative predictive value (97.7%) for the primary outcome. In conclusion, Holter-detected, transient (<30 seconds), subclinical AF is a predictor of stroke and systemic embolism in patients with rheumatic MS in SR. Considering the high risk for embolism, randomized trials of oral anticoagulation are needed in this population. [ABSTRACT FROM AUTHOR]

Modification of Polylactic acid (PLA), a biopolymer, is a strategy still to be fully explored for the next generation of bioresorbable vascular stent (BVS) biomaterials. With this focus, inclusions upto 5% of Polycaprolactone (PCL) and Magnesium in PLA were tested in the rat subcutaneous model and their cellular and tissue interactions characterized, specifically with respect to inflammatory response, angiogenesis and capsularization. The cytokines IL6, TNF Alpha and IL-1Beta were estimated in the peri-implant tissue, all of which showed a non-significant difference between the non-implanted animals and those containing PLA by 8 weeks, speaking to the benign nature of PLA as an implant biomaterial. Both modified materials, had increased macrophage counts and cytokine levels, except IL6 at 8 weeks. Vascularization only at 8 weeks in PLA PCL containing tissue was significantly higher than pure PLA, which may be more carefully controlled along with the material hydrophobicity for possible efforts towards therapeutic angiogenesis. Capsule thickness, measured by staining with both Hematoxylin & Eosin and Masson's Trichome did not show any differences between materials, including PLA. [ABSTRACT FROM AUTHOR]

Background: Hypertension presents as a modifiable risk factor for cardiovascular diseases, with approximately two-thirds of the global hypertensive population concentrated in low- and middle-income nations. Sarpagandha Mishran is an Ayurveda intervention utilized for the management of hypertension. The objective of the study is to assess the clinical efficacy and safety of Sarpgandha Mishran in the Management of Stage-I Hypertension., Methods: This clinical trial employs a prospective design characterized by a double-dummy, double-blind, placebo-controlled methodology being conducted at Cardiology Outpatient Department of the AIIMS, New Delhi. A total of 150 participants (75 per group), diagnosed with Stage-I essential hypertension will be randomized and allocated in a 1:1 allocation ratio, to either Ayurveda group or Conventional Care group. Participants in Group I will receive Ayurvedic intervention, Sarpagandha Mishran 500 mg capsules orally twice daily, in addition to a matching placebo of Amlodipine 5 mg capsules orally once daily. Group II will receive a matching placebo of Sarpagandha Mishran 500 mg capsules along with Amlodipine 5 mg capsules orally once daily. All participants will also be administered Hydrochlorothiazide 12.5 mg tablets orally once daily for a duration of 12 weeks. The primary endpoint of this study involves evaluating changes in SBP and DBP from baseline to week 12. Secondary outcome includes assessing changes in IL-6, Serum Pro-BNP, oxidative stress markers, lipid profile, and the SF-36 Health Survey Score. Safety assessments will be done through recording of AE/ADR and assessments of liver function tests and renal function tests parameters., Discussion: The present study is poised to furnish comprehensive insights into the clinical efficacy and safety profile of Sarpagandha Mishran in the management of Grade 1 hypertension. By adopting a rigorous scientific methodology, this investigation aims to contribute robust evidence that may significantly impact the formulation of future guidelines for integrative treatment protocols in hypertension management., Trial Registration: The trial is prospectively registered with the Clinical Trial Registry of India [CTRI/2021/12/038589], dated 13.12.2021., Competing Interests: Declarations. Ethics approval and consent to participate: The study protocol has been approved by the institutional Ethics committees of All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India on 13th August 2019 (vide IEC-311/03.05.2019, RP-39/2019, RP-06/2019) respectively. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. After informing the participants about the research study as per Patient Information Sheet, written consent (in triplicate) will be taken from the participants before screening them. Funding: Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Government of India, New Delhi., (© 2025. The Author(s).)

Competing Interests: Declaration of competing interest No conflict of interest.

Aim: This study illustrates parameters, procedures, and calculations for the statistical determination of sample size for different clinical study designs., Materials and Methods: In any research process, the sample size is an important consideration for the implementation of the planned study. From time to time, literature on sample size has been documented in the medical literature. However, the situations covered under them lack comprehensiveness in terms of different study designs, demonstration of calculations, and overreliance on statistical software., Results: The present study provides various facets of sample size determination, such as prerequisite parameters, mathematical formulation, and calculations for clinical study designs [descriptive studies, randomized controlled trials (RCT), correlational studies, comparison of multiple outcomes, survival analysis, sensitivity, and specificity], which will be quite useful., Conclusion: This communication will be a good education and learning source for medical professionals to pick and choose a specific scenario and estimate the sample size., (© Journal of the Association of Physicians of India 2024.)

Context: Hypocalcemia predisposes patients with chronic hypoparathyroidism (cHypoPT) to an increased risk of QTc prolongation and life-threatening arrhythmias. Information on clinical and biochemical correlates of QTc in cHypoPT is limited., Design and Setting: Observational cohort study at tertiary-care-center., Subjects and Methods: Eighty-eight non-surgical cHypoPT (mean age 44.1 ± 15.4 years, 45 males) were assessed for QTc interval and its possible correlates including arrhythmic symptoms (palpitation/giddiness/syncope), serum total-calcium, phosphate, 25(OH)D and iPTH., Results: The mean QTc in HypoPT cohort was 428 ± 34 ms with 13.6% having prolonged QTc. There was a significant inverse correlation between QTc interval and serum total-calcium measured on the same day (r = -0.43, p < 0.001). The mean serum total-calcium was significantly lower in patients with prolonged QTc (7.05 ± 1.94 vs. 8.49 ± 1.01 mg/dL, p = 0.02). 21.6% of cHypoPT patients had arrhythmic symptoms. They had significantly higher mean QTc (p = 0.02) and also tended to have lower mean serum total-calcium during follow-up (p = 0.06). In multivariable regression, female gender, higher current-age, higher BMI, and low serum total-calcium showed significant association with prolonged QTc. For every mg/dL decrease in serum total-calcium, QTc increased by 13 ms. Receiver-operating-characteristic analysis revealed serum total-calcium at cut-off of 8.3 mg/dL discriminated prolonged QTc with area-under-curve being 0.72 [95% CI: 0.51,0.93]., Conclusion: One-fifth of cHypoPT had arrhythmic symptoms and a significant proportion had prolonged QTc. This highlights the need for close monitoring of cHypoPT patients for arrhythmic symptoms and QTc prolongation. The serum total-calcium should be maintained to at least 8.3 mg/dL to minimize the risk of potentially life-threatening arrhythmia in cHypoPT., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Coronary arteritis leading to aneurysm is one of the unusual presentations of IgG4-related disease. Acute myocardial infarction as a complication of IgG4-related giant coronary artery aneurysm is even rarer., Case Summary: We describe the case of a 56-year-old gentleman who presented to our institute with Canadian Cardiovascular Society (CCS) class III angina. His symptoms were persistent even with high-dose antianginal medications. He had an acute coronary syndrome two weeks back for which he was treated conservatively in a peripheral health centre. His 12-lead electrocardiogram at the time of the event was suggestive of high lateral ST-segment elevation myocardial infarction (South African flag sign). His transthoracic echocardiography showed mild left ventricular dysfunction and a large echogenic mass lateral to the left ventricle. Coronary angiography followed by cardiac computed tomography revealed a giant pseudoaneurysm of the proximal and mid-left anterior descending coronary artery. FDG-PET scan showed significant metabolic activity in the aneurysm wall and mediastinal lymph nodes suggesting active inflammation. IgG4-related coronary arteritis was suspected, and the patient underwent aneurysmectomy and coronary artery bypass (CABG) surgery. The histopathology of the resected segment showed diffuse IgG4-secreting plasma cells confirming the diagnosis., Discussion: Atherosclerosis is the most common cause of coronary aneurysms in adults. However, cardiologists should be aware of atypical causes like IgG4-related disease that can even present with acute coronary syndrome. Although multimodality imaging is beneficial during early evaluation, histopathological analysis is the cornerstone for the diagnosis of IgG4-related disease. The management involves both immunosuppressive medication and endovascular or surgical repair., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: Antibiotics resistance is an paramount threat affecting the whole world but nowhere situation is as gloomy as in India. No study till date regarding epidemiology of hospital acquired infections in coronary care units(CCU) and cardiology wards from India. From Indian perspective it is the first observational study to analyse microbiological profile and antibiotic resistance in CCU. The purpose of this observational study is to explore the epidemiology and importance of infections in CCU patients., Methodology: After ethics committee approval, the records of all patients who were admitted in coronary care units, adult and pediatric cardiology wards surgery between January 2020 and December 2021 were reviewed retrospectively. The type of organism,source of infection ,age wise distribution and seasonal variability among patients who developed hospital acquired infection (HAI) were determined., Results: 271 patients developed microbiologically documented HAI during from January 2020 to December 2021. Maximum number of organisms(78/271 28.78%) are isolated from urinary samples ,followed by blood stream(60/271 22.14%) and Endotracheal tube (54/271 19.92%). Acinetobacter baumanii (53/271, 19.5%) being the most common isolate among all the samples taken . Acinetobacter was the most frequent pathogens isolated in patients with LRTI and blood stream infection while E. coli was from urinary tract infection . In the adult population, infection with E. coli(24.6%) is the most common followed by Klebsiella pneumoniae (12.8%) and Acinetobacter baumanii (10.1%). In the pediatric population Acinetobacter baumanii (38.6%%) is the most common followed by Klebsiella pneumoniae (20.5%) and Methicillin Resistant Staphylococcus aureus, MRSA (6.8%). Commonly used antibiotics eg ciprofloxacin,ceftazidime and amikacin were found to be resistant against the top three isolates., Conclusion: Urinary tract was the most common site of infection and Gram-negative bacilli, the most common pathogens in adult as well as pediatric population. Antibiotic resistance was maximum with commonly isolated microorganisms., (Copyright © 2024 Copyright: © 2024 Annals of Cardiac Anaesthesia.)

Retrograde flow in endothelial cell cultures has been shown to induce a pro-atherogenic phenotype. Despite its potential role as a pathophysiological link between cardiovascular risk factors and atherosclerotic disease, resting retrograde flows between patients with cardiovascular disease and healthy subjects have not been compared. Further, the vascular characteristics governing retrograde flow in human arteries have not been systematically investigated. Association of central and peripheral vascular characteristics with retrograde flow profile was investigated in 32 healthy subjects and 47 patients with ischemic heart disease. Endothelial dysfunction was assessed by brachial ultrasound-based calculation of flow-mediated dilation (FMD) and sub-clinical atherosclerosis was estimated from carotid-intima media thickness (CIMT). Retrograde blood flow velocity (RBFV) and shear rate were comparable between the two groups (RBFV 1.82(0.97-3.32) vs 1.78(1.24-2.65) cm/s p  =  0.79). Augmentation index was a significant determinant of retrograde flow in both patients and healthy subjects. Carotid artery incremental elastic modulus was an independent determinant of retrograde flow patterns in healthy subjects while ejection fraction, cf/cr PWV ratio and forearm vascular conductance emerged as independent determinants in patients. Retrograde flow patterns were also associated with FMD (RBFV r  =  -0.43, p  =  0.004) and CIMT (r  =  0.30, p  =  0.041) in patients. The results of the study suggest a difference in the determinants of retrograde flow in patients and healthy subjects, with central arterial stiffness being a major contributor in healthy subjects while interaction between central, peripheral, and cardio-arterial factors influence retrograde flow in patients with ischemic heart disease., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

Objective: Patients with chronic hypoparathyroidism (cHypoPT) are prone to intracranial-calcification, cataract and nephrocalcinosis. In this study, we systematically investigated the possibility of increased coronary artery calcification (CAC) and coronary artery disease (CAD) in them., Design: Cross-sectional., Patients and Measurements: Ninety-four nonsurgical cHypoPT (M:F = 50:44; age = 45 ± 15 years) with 18.6 ± 9.3 years of illness were assessed. Those with dyspnoea, angina, syncope, abnormal electrocardiogram, echocardiography or significant CAC underwent coronary angiography or myocardial-perfusion-stress imaging. Their lipid parameters and high-sensitivity C-reactive protein (hsCRP) were compared with age-matched healthy controls (Group A, n = 101). The prevalence of CAC in cHypoPT was compared with that of subjects referred from cardiology-clinics (Group B, n = 148, age = 52 ± 11 years)., Results: One of 94 cHypoPT had known CAD. On screening, 17 cHypoPT required evaluation for CAD. Two of 17 had severe coronary stenosis, and 12 showed subclinical CAD. CAC and aortic-valve calcification occurred in 21.5% and 11.8%. Clinical and subclinical CAD, CAC and aortic-valve calcification in cHypoPT ≥50 years of age was 8.1%, 27.0%, 52.8% and 27.8%, respectively. Frequency of age-adjusted CAC was comparable between cHypoPT and control Group B (30.2% vs. 30.7%, p = .93). Elevated hsCRP was higher in cHypoPT than in controls A (52% vs. 32%, p < .01). Factors associated with CAD in cHypoPT were CAC and hypertension. However, CAD and CAC showed no association with long-term calcemic or phosphatemic control and intracranial-calcification in cHypoPT., Conclusions: Clinical and subclinical CAD was observed in 3.2% and 12.8% of cHypoPT patients. The increased prevalence of CAD, CAC and aortic-valve calcification in cHypoPT above 50 years of age suggested their careful cardiac evaluation during follow-up., (© 2022 John Wiley & Sons Ltd.)

Background: Atherosclerosis, a progressive manifestation of coronary artery disease, has been observed to be regulated by microRNAs (miRNAs) targeting various protein-coding genes involved in several pathophysiological events of coronary artery disease., Objective: In our previous report, we identified differential expression profiles of candidate miRNAs, miR-133b and miR-21, in patients with coronary artery disease as compared with controls, suggesting their possible implication in the pathophysiology of coronary artery disease. To better understand the functional role of these miRNAs, we sought to predict and validate their target genes while assessing the expression pattern of these genes in patients with coronary artery disease, as well as in macrophages., Methods: Potential target genes of miR-133b and miR-21 were predicted bioinformatically followed by validation through the identification of their expression at  the protein level in patients with coronary artery disease (n-30), as well as in macrophages treated with respective miRNA inhibitors (antagomiRs), through immunoblotting., Results: SGPP1, a gene associated with the sphingolipid pathway, was predicted to be a potential target gene of miR-133b while ATG5 and LRP6 were target genes of miR-21 while being associated with autophagy and Wnt signalling pathways, respectively. SGPP1 was observed to be upregulated significantly (p = 0.019) by 2.07-fold, whereas ATG5 and LRP6 were found to be downregulated (p = 0.026 and 0.007, respectively) by 3.28-fold and 8.46-fold, respectively, in patients with coronary artery disease as compared with controls. Expression patterns of all the genes were also found to be modulated when cells were treated with respective miRNA inhibitors., Conclusions: Results from the present study suggest that SGPP1, ATG5 and LRP6, target genes of miR-133b and miR-21, may serve as potential therapeutic hotspots in the management of coronary artery disease, which undoubtedly merit further experimental confirmation., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Objective: To study the factors associated with waist-to-height ratio (WHtR) among school children aged 5-15 y and its association with hypertension., Methods: In this cross-sectional study, data on background characteristics, socioeconomic status (SES), anthropometric parameters, and blood pressure were obtained from school children from three states of India. WHtR ≥ 0.5 was defined as obesity and hypertensives were defined based on Fourth Report criteria. Descriptive statistics were applied and multiple linear regression was done to identify factors associated with WHtR. A receiver operating characteristics (ROC) analysis was used to evaluate the predictive ability of WHtR to predict hypertension RESULTS: The mean WHtR among the 12,068 students was 0.40 (± 0.05) and it showed a U-shaped distribution with age with trough at 10 y of age for both genders. Mean WHtR was higher among residents of Manipur, among boys and hypertensives. WHtR was positively associated with weight > 30 kg, male gender, schools with high SES, Manipur and Goa region, and negatively associated with age > 10 y. The area under the ROC curve of WHtR for diagnosis of hypertension was low 0.544 (95% CI 0.532, 0.556)., Conclusion: There is a nonlinear relation between age, gender, and WHtR, which varies by geographical region and HT. This would need to be kept in mind while using it to identify obesity in children, though its discriminant value for hypertension is low., (© 2021. Dr. K C Chaudhuri Foundation.)

Objectives: This study aims to determine the impact of yoga as an adjunct to standard therapy versus standard therapy alone on the symptomatic burden in patients with recurrent vasovagal syncope (VVS)., Background: There is a significant reduction in the quality of life (QoL) of patients with recurrent VVS. Existing management therapies have been largely ineffective. Recent trials have demonstrated the efficacy of yoga in diseases with autonomic imbalance, suggesting its possible utility in VVS., Methods: Patients with recurrent VVS were randomized to receive either a specialized yoga training program in addition to current guideline-based therapy (intervention arm, group 1) or current guideline-based therapy alone (control arm, group 2). The primary outcome was a composite of the number of episodes of syncope and presyncope at 12 months. Secondary outcomes included QoL assessment by World Health Organization Quality of Life Brief Field questionnaire (WHOQoL-BREF) scores and Syncope Functional Status Questionnaire scores at 12 months, head up tilt test, and heart rate variability at 6 weeks., Results: A total of 55 patients underwent randomization. The mean number of syncopal or presyncopal events at 12 months was 0.7 ± 0.7 in the intervention arm compared to 2.52 ± 1.93 in the control arm (P < 0.01). In the intervention arm, 13 (43.3%) patients remained free of events versus 4 (16.0%) patients in the control arm (P = 0.02). QoL at 12 months showed significant improvement of all Syncope Functional Status Questionnaire scores and 2 domains of WHOQoL-BREF scores (P < 0.05)., Conclusions: Yoga as adjunctive therapy is superior to standard therapy alone in reducing the symptomatic burden and improving QoL in patients with recurrent VVS., Competing Interests: Funding Support and Author Disclosures The trial was supported under the extramural research (EMR) scheme by the Ministry of AYUSH, Government of India [(Z.28015/63/2018-HPC (EMR)]. The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

The ongoing Pandemic of COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has severely stressed the worldwide healthcare system and has created dangerous shortages of personal protective equipment (PPE) including N95 filtering facepiece respirators (FFRs). Even though suppliers struggled to meet global demand for N95 masks at an unprecedented level, a shortage of FFR appears as a significant factor in the transmission of the disease to frontline workers. CDC, USA has mentioned that FFR decontamination and reuse may be necessary during times of shortage to ensure guaranteed availability. Hence present stressed condition faced by the healthcare sector seeks for an affordable decontamination strategy that can be replicated easily broadening the utility of FFR decontamination across a range of healthcare settings. After reviewing available literature on the various disinfection techniques that may be used for the decontamination of FFRs, a first of its kind, portable Hybrid Decontamination System/procedure has been conceptualized and designed. This system combines the disinfecting properties of both vaporous hydrogen peroxide (VHP) and ultra-violet C irradiation (UV C) to ensure maximum decontamination of N95 respirators. The instrument will be equipped with a hydrogen peroxide chamber and UV light source. Sterilization of the FFRs will be done through treatment with VHP followed by UV light treatment. The proposed system will allow the user to completely sterilize the FFRs in a time-efficient manner., (© 2021 The Author(s).)

Backgound: Acute rheumatic fever (ARF) with carditis and chronic rheumatic heart disease (RHD) may be difficult to differentiate and may lead to missed diagnosis of carditis. We aimed to determine differences between these groups and to develop a new scoring system for this purpose., Methods: Children (N = 514; mean age 11.6 ± 2.8, range 5-18 years; 65% males) enrolled in a RHD registry at a tertiary care centre were studied. Clinical, laboratory and echocardiographic features of acute rheumatic carditis group (N = 126) were compared with chronic RHD group (N = 388). We performed multiple regression analysis and then developed a new scoring system using independent predictors. Accuracy of this scoring system was assessed using receiver operating characteristic (ROC) curve analysis., Results: Patients with ARF and carditis were younger, more commonly had history of fever, arthritis/arthralgias and had worse NYHA class. On echocardiography, severity of mitral regurgitation, presence of mitral leaflet nodules, mitral valve prolapse and pericardial effusion were more common in ARF group. On multiple regression analysis, following features were found to be independently predictive of ARF with carditis: age -negative association, NYHA class, severity of mitral regurgitation, mitral leaflet nodules, erythrocyte sedimentation rate and antistreptolysin titer. Based on these 6 variables, a new scoring system (0-13) was developed. A score of 5 or more was found to be best threshold for diagnosis of carditis (ROC AUC 0.87, sensitivity 76%, specificity 79%)., Conclusion: A new scoring system based on independent statistical associations appears promising for differentiating ARF with carditis from chronic RHD., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Angina is a type of chest pain, experienced by patients with ischemic heart diseases. Cardiac autonomic modulation as assessed by heart rate variability and baroreflex sensitivity is found reduced in ischemic heart disease patients. Marked reduction in heart rate variability and baroreflex sensitivity in ischemic heart disease patients is found associated with sudden cardiac death. We report a case of a 35-year-old man who presented with angina for the last few months. Thorough investigations showed no evidence of any cardiac or other systemic diseases. However, his cardiovascular autonomic modulation (as assessed by heart rate variability) and spontaneous baroreflex sensitivity were markedly reduced. The patient had sudden death within 6 months of follow-up. Reportedly, no other specific abnormalities were found before death. This case report suggests that patients presenting with typical chest pain as angina may have severe dysautonomia and risk of sudden death even in the absence of cardiovascular or any other known end-organ diseases.

The interrelationship between endothelial function and arterial stiffness may be different for central and peripheral arteries due to their structural and functional differences. The study aims to assess the interrelationship between central and peripheral vascular function and haemodynamics in metabolic syndrome. Thirty-seven patients [63.0 (57.5-66.0) years, 68.4% males] of metabolic syndrome (National Cholesterol Education Program - Adult Treatment Panel-III criteria) were studied. Carotid-femoral, carotid-radial pulse wave velocity and augmentation index (AI x @75) were assessed using applanation tonometry. Endothelial function was evaluated by brachial flow-mediated dilation using B-mode ultrasonography. Central and peripheral pressures were measured by radial tonometry and sphygmomanometer, respectively. Carotid-radial pulse wave velocity correlated significantly with peripheral diastolic blood pressure ( r = 0.33, p = 0.04) and inversely with flow-mediated dilation ( r = -0.61, p = 0.0001). AI x @75 correlated significantly with carotid-femoral pulse wave velocity ( r = 0.35, p = 0.03) and with aortic pulse pressure ( r = 0.43, p = 0.01). In principal component analysis, an inverse relationship was observed between flow-mediated dilation and carotid-radial pulse wave velocity but not with carotid-femoral pulse wave velocity. Regional arterial stiffness assessed by pulse wave velocity in central-elastic and peripheral-muscular arteries differentially relates to endothelial dysfunction. The central arteries might be predominantly influenced by endothelial dysfunction-induced structural changes, while the peripheral arteries are majorly affected by functional alterations.

Dysregulated expression of lysosomal cysteine cathepsins is associated with adverse cardiac remodeling, a characteristic of several cardiovascular diseases. However, the information regarding the role of cysteine cathepsin L (CTSL) and cathepsin B (CTSB) in dilated cardiomyopathy (DCM) is limited. The present study was aimed to investigate the expression of CTSL and CTSB in animal model of doxorubicin (doxo)-induced cardiomyopathy as well as in peripheral blood samples of DCM patients. Cardiac tissue sections from doxo-treated and control rats were used to study the expression of CTSL and CTSB by enzyme assay and immunohistochemistry (IHC). Peripheral blood mononuclear cells (PBMCs) isolated from DCM patients (n = 29) along with age-matched healthy controls (n = 28) were used to assay enzymatic activity of these cathepsins. Activities of these proteases were further correlated with echocardiographic parameters of DCM patients. A significant increase in CTSL activity and protein expression was observed with no changes in CTSB levels in doxo-treated rats as compared to controls. We also observed a drastic increase in the functional activity of cathepsin L+cathepsin B (CTSL+B), CTSL, and CTSB in DCM patients compared to controls (p ≤ 0.001). Increased levels of these proteases exhibited a statistically significant correlation with reduced left ventricular ejection fraction (LVEF) in DCM patients (ρ = -0.58, p = 0.01). For the first time, this study demonstrates a correlation between increased expression of CTSL and CTSB in PBMCs with severity of left ventricular dysfunction in DCM patients. Thus, these proteases may serve as blood-based biomarker of DCM and prove useful in its management.

Background: The relationship between perfusion pattern and stress-induced changes in left ventricular mechanical dyssynchrony (LVMD) on stress-rest thallium-201-gated SPECT myocardial perfusion imaging (Tl-201 SPECT MPI) is not clear. The aim of the study is to assess the relation of perfusion pattern with stress-induced changes in LVMD on Tl-201 MPI., Methods: Data of 194 patients who underwent exercise-rest Tl-201 MPI between January to December 2012 at our institute was retrospectively evaluated. Institute Ethical committee approval was obtained. Fifty patients who underwent Tl-201 MPI for suspected CAD and had normal LV perfusion and function on MPI were taken as normal group. Patients with perfusion abnormalities (n = 144) were divided into three groups: ischemia (n = 66), infarct (n = 32), and mixed group (n = 46; ischemia and infarct both). Summed stress score, summed rest score, summed difference score (SDS), and LV ejection fraction (EF) were evaluated. Two LVMD parameters, phase standard deviation (PSD) and phase histogram bandwidth (PHB), were assessed in post-stress and rest MPI images. ΔPSD (post-stress PSD - rest PSD) and ΔPHB (post-stress PHB - rest PHB) were calculated to measure stress-induced changes in LVMD., Results: In all the groups, mean post-stress LVMD parameters were lower as compared to LVMD parameters at rest. Post-stress PSD was significantly lower than rest PSD in all groups. Similar trend was noted with PHB values also, but it was statistically significant in the normal and ischemia group only. Post-stress worsening of at least one of the LVMD parameters was noted in 28 patients and all these patients had perfusion abnormalities. But on subgroup analysis, no difference was found in proportion of patients showing post-stress worsening of LVMD between ischemia (13.6%), infarct (25%), and mixed (23.6%) groups. No significant correlation was found between ΔPSD/ΔPHB and ΔLVEF/SDS in any group., Conclusion: LV mechanical dyssynchrony parameters are smaller in post-exercise stress as compared to rest on Tl-201 MPI, regardless of perfusion pattern. Stress-induced worsening of LV dyssynchrony was observed only in patients with perfusion abnormalities, but this is not related to the type of perfusion abnormality.

Normal rats pre-treated with P. kurroa (200 mg/kg) alone did not showed significant change, however, isoproterenol (ISP) administration resulted in hemodynamic and left ventricular dysfunction, oxidative stress, and lipid peroxidation. Such cardiac dysfunction was significantly prevented by P. kurroa root extract pre-treatment. Pre-treatment significantly attenuated the ISP-induced oxidative stress by restoring myocardial superoxide dismutase, catalase, and glutathione peroxidase enzymes except reduced glutathione content. P. kurroa pre-treatment markedly attenuated the ISP-induced rise in lipid peroxidation, thereby prevented leakage of myocyte creatine kinase-MB and lactate dehydrogenase enzymes. The results suggest that P. kurroa root extract possesses significant cardioprotective effect, which may be attributed to its antioxidant, anti-peroxidative, and myocardial preservative properties.

Background: Cardiovascular diseases have become the leading cause of mortality and morbidity in most countries of the world. The aim of the present study was to estimate the prevalence of cardiovascular risk factors among administrative employees working at a tertiary hospital (All India Institute of Medical Sciences, New Delhi) and their families., Methods and Results: A cross-sectional survey was conducted among a total of 453 individuals aged 30 years and above (N1 = 453 for the questionnaire, anthropometric and clinical parameters; N2 = 429 for biochemical investigations). Evaluation for cardiovascular risk factors, anthropometric measurements, blood pressure, fasting blood glucose and serum lipids were performed using standard definitions. The mean age of the study group was 43.3 +/- 9.5 years. There was a high prevalence of major cardiovascular risk factors--current smoking in 58 (12.8%), tobacco consumption in 26 (5.7%), family history of coronary artery disease 79 (17.4%), diabetes mellitus in 25 (5.8%), hypertension in 94 (20.7%), hyperlipidemia--hypercholesterolemia in 110 (25.7%) & hypertriglyceridemia in 148 (34.5%), physical inactivity in 180 (39.7%), body mass index e" 23 kg/m2 in 350 (77.3%), central obesity i.e. waist circumference > 90 cm for males and > 80 cm for females -in 201 (80.1%) of males and 163 (80.7%) of females, inadequate fruit and vegetable consumption in 387 (85.4%), heavy drinking in 12 (2.6%), and stress in 58 (12.7%)., Conclusion: The study demonstrated an overall high prevalence of cardiovascular risk factors even amongst employees at a tertiary hospital and their families. This indicates an urgent need to initiate a comprehensive health promotion and cardiovascular disease prevention programme at workplace and community level.

Background: Brain natriureticpeptide (BNP) levels are elevated in patients with rheumatic mitral stenosis (MS) and decrease after a successful percutaneous transvenous mitral commissurotomy (PTMC)., Methods: In 37 consecutive patients of symptomatic MS (mean age 30 +/- 8.6 years) NTpro BNP levels were determined pre and 24-hours post PTMC. We seek to determine whether NT-pro-BNP levels be used as a marker of success of PTMC., Results: PTMC was successful orpartial successful in 33 (89 %) cases. The mean NT-pro- BNP levels decreasedfrom 771 +/- 456 pg/ml to 700 +/- 595 pg/ml (p < 0.05) following PTMC. The mean NT-pro-BNP levels decreased by 20.6% in patients with a successful PTMC and decreased by 10.8% in patients with a partially successful PTMC, while the levels increased by 33.4% in patients with an unsuccessful procedure. Patients with associated aortic regurgitation failed to show a decline in NT-pro-BNP levels despite a successful procedure., Conclusion: NT-pro-BNP levels fall significantly after a successful PTMC, and a significant decrease in levels is a good marker of success of PTMC. It may not decrease in patients with associated aortic regurgitation despite a successfiul PTMC.

Background and Aim of the Study: The role of screening coronary angiography in Asian Indian patients with rheumatic heart disease (RHD) due to undergo valve replacement surgery is unclear. Hence, the study aim was to determine the prevalence of coronary artery disease (CAD), and to monitor its correlation with demographic variables and valvular lesion type, in this patient group., Methods: A retrospective analysis of 2,188 consecutive patients (1,319 men, 869 women; mean age 48 +/- 7 years) with rheumatic valvular heart disease was conducted. The patients underwent preoperative coronary angiography in a tertiary care hospital between 1991 and 2004., Results: The overall prevalence of CAD was 11% (12% in men, 8% in women). The prevalence of CAD in the age groups of 40-44, 45-49, 50-54, 55-59 and > 60 years was 4%, 5%, 9%, 15% and 20% in men, and 2%, 2%, 3%, 7% and 10% in women, respectively. Both, age and male gender were independently associated with the occurrence of CAD (p < 0.01). The unadjusted odds ratio of having CAD was highest in patients with aortic stenosis (2.08; p < 0.01), and lowest in those with aortic regurgitation (AR) (0.58; p = 0.018). Those patients with AR also showed an independent inverse association with the occurrence of CAD (p = 0.006)., Conclusion: The overall prevalence of CAD among Asian Indian patients with RHD was lower than that in patients from western countries. The cut-off age to perform coronary angiographic screening should be maintained at 40 years for men, and 55 years for women. The prevalence of CAD may be lower in those patients with AR.

In present study, hydroalcoholic extract of C. mukul significantly improved the cardiac function and prevented myocardial ischemic impairment manifested in the form of increased heart rate, decreased arterial pressure, increased left ventricular end diastolic pressure, and altered myocardial contractility indices. C. mukul treatment additionally also produced a significant increase in lactate dehydrogenase levels and prevented decline of protein content in heart. C. mukul preserved the structural integrity of myocardium. Reduced leakage of myocyte enzyme lactate dehydrogenase and maintenance of structural integrity of myocardium along with favorable modulation of cardiac function and improved cardiac performance indicate the salvage of myocardium with C. mukul treatment. Guggulsterones which are considered to be responsible for most of the therapeutic properties of C. mukul may underlie the observed cardioprotective effect of C. mukul against cardiac dysfunction in isoproterenol-induced ischemic rats.

Objective: Provide preliminary data on prevalence and functional significance (association with atherosclerotic risk factors and stress test positivity) of fluoroscopically detected CAC (Coronary Artery Calcification) in asymptomatic elderly Indian-Asian., Design: Prospective observational study., Setting: Outpatient services at 1000-bed tertiary care hospital in Northern India., Patients: 100 sedentary elderly (>60 years) Asian-Indian subjects (70 males, 30 females, age 65.9 +/- 5.1 years) with no history of CAD (asymptomatic)., Methods: CAC assessment was done using high intensity cine fluoroscopy and semi quantitative CAC scoring (scores 0-3) in all subjects (n = 100). Risk factor profile (diabetes, hypertension, smoking, serum lipids, body-mass index, waist-hip ratio) documented for all subjects. In 50 (the latter half of 100) consecutive subjects (29 males and 21 females, age 64.2 +/- 4.9 years), exercise stress test (treadmill test, TMT) was also done using standard Bruce protocol., Results: 92% (84.8-96.1, 95% CI) had fluoroscopic calcification and there was no significant association of higher CAC scores and risk factors, except for a positive trend with serum total cholesterol (p = 0.086). 20% (11-33.2, 95% CI) tested positive on exercise stress test and a positive trend (OR = 7.2, 95% CI = 0.8-63, p value = 0.067) with higher CAC scores was seen., Conclusion: High prevalence of fluoroscopic CAC and stress test positivity was observed in asymptomatic elderly Asian-Indians. The newly observed positive trend with increasing total cholesterol levels and stress test positivity highlights the importance of fluoroscopic CAC in asymptomatic elderly and should be corroborated with larger studies.