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Sodium glucose cotransporter 2 inhibitors in the management of heart failure:Veni,Vidi,and Vici

World Journal of Cardiology 2024年第10期16卷 550-563页

作者： Monika Bhandari Akshyaya Pradhan Pravesh Vishwakarma Abhishek Singh rishi sethi Department of Cardiology King Georg’s Medical UniversityLucknow 226003Uttar PradeshIndia

Heart failure(HF)is a chronic disease associated with high morbidity and mortality ***-angiotensin-aldosterone system blockers(including angiotensin receptor/neprilysin inhibitors),beta-blockers,and mineralocorticoid receptor blockers remain the mainstay of pharmacotherapy for HF with reduced ejection fraction(HFrEF).However,despite the use of guideline-directed medical therapy,the mortality from HFrEF remains *** with preserved ejection fraction(HFpEF)comprises approximately half of the total incident HF cases;however,unlike HFrEF,there are no proven therapies for this *** glucose cotransporter-2 inhibitors(SGLT-2is)represent a new class of pharmacological agents approved for diabetes mellitus(DM)that inhibit SGLT-2 receptors in the kidney.A serendipitous finding from seminal trials of SGLT-2is in DM was the significant improvement in renal and cardiovascular(CV)*** importantly,the improvement in HF hospitalization(HHF)in the CV outcomes trials of SGLT-2is was *** mechanisms have been proposed for the pleiotropic effects of SGLT-2is beyond their glycemic ***,as patients with HF were not included in any of these trials,it can be considered as a primary ***,two landmark studies of SGLT-2is in patients with HFrEF,namely,an empagliflozin outcome trial in patients with chronic HF and a reduced ejection fraction(EMPEROR-Reduced)and dapagliflozin and prevention of adverse outcomes in HF(DAPA-HF),demonstrated significant improvement in HHF and CV mortality regardless of the presence of *** impressive results pitchforked these drugs as class I indications in patients with HFrEF across major ***,empagliflozin outcome trial in patients with chronic HF with preserved ejection fraction(EMPEROR-Preserved)and dapagliflozin evaluation to improve the lives of patients with preserved ejection fraction HF(DELIVER)trials successively confirmed that SGLT-2is also benefit patients w

关键词： Heart failure with preserved ejection fraction Gliflozins Diuresis Natriuresis N terminal-pro brain natriuretic peptide Heart failure hospitalization

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Coronavirus and cardiovascular manifestations-getting to the heart of the matter

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World Journal of Cardiology 2021年第10期13卷 556-565页

作者： Monika Bhandari Akshyaya Pradhan Pravesh Vishwakarma rishi sethi Department of Cardiology King George's Medical UniversityLucknow 226003Uttar PradeshIndia

Coronavirus disease has unarguably been the largest pandemic of recent *** 150 million cases have occurred worldwide,and more than 3 million have succumbed to the *** manifestations can have varied presentations from an asymptomatic troponin rise to fulminant *** pathogenesis of myocardial damage could be direct or indirect,including inflammation,coronary spasm,plaque rupture,and cytokine *** is also an important feature of cardiovascular affliction with both arterial and venous systems being ***,anticoagulation has also been a matter of *** myocarditis is the most severe form and can lead to circulatory shock with a high *** of cardiac patients with coronavirus disease 2019(COVID-19)infection is not considerably different from non-COVID-19 cardiovascular disease,but interaction between cardiovascular drugs and anti-COVID-19 therapy requires careful *** recently,vaccines have emerged as a ray of hope for the *** simultaneously,there have been reports of thromboembolism following *** this review,we discuss the various aspects of coronavirus disease affecting of heart and its management.

关键词： Myocarditis Cytokine storm Angiotensin-converting enzymes-2 Acute coronary syndrome Hypercoagulable state Vaccine

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Intravascular lithotripsy for coronary calcium:A case report and review of the literature

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World Journal of Cardiology 2022年第9期14卷 496-507页

作者： Akshyaya Pradhan Pravesh Vishwakarma Monika Bhandari rishi sethi Department of Cardiology King George Medical UniversityLucknow 226006Uttar PradeshIndia

BACKGROUND Coronary calcium poses a challenge for the interventional cardiologist often leading to stent under-expansion and subsequent ischemic *** balloon post-dilatation though helpful is usually *** plaque ablation techniques are in vogue,but they are technically demanding and are not without *** intravascular lithotripsy(S-IVL)has emerged as a user-friendly and effective mechanism for calcium management with a high safety margin.A series of trials(DISRUPT CAD I-IV)have demonstrated both short-term and long-term safety and efficacy of the *** experience with the technique grows more and more,therapy areas like stent restenosis are being covered by the *** SUMMARY We report a series of 2 cases successfully managed with S-IVL therapy at our *** first case is of a 57-year-old smoker who presented with acute coronary *** left anterior descending coronary artery revealed calcified 90%stenosis on angiogram and a combination of superficial-deep calcium on intracoronary *** calcium was treated with 20 pulses of S-IVL to create discontinuity and a sirolimus eluting drug-eluting stent was successfully *** second case is that of an elderly lady who presented with stable angina and demonstrated diffuse calcified lesions in the left anterior descending artery on *** also demonstrated a mixture of superficial and deep seated calcium zones on imaging.S-IVL therapy was applied to generate fractures in calcium,and two overlapping drug-eluting stents were implanted successfully without any *** S-IVL is an emerging,efficient,user-friendly and safe therapy for managing intracoronary calcium in routine interventional practice.

关键词： Coronary artery calcification Acute coronary syndromes DISRUPT-CAD Shock wave Premature ventricular contraction Case report

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Study of coronary sinus anatomy during levophase of coronary angiography

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World Journal of Cardiology 2022年第6期14卷 372-381页

作者： Akshyaya Pradhan Vrishank Bajaj Pravesh Vishwakarma Monika Bhandari Akhil Sharma Gaurav Chaudhary Sharad Chandra rishi sethi Varun Shankar Narain Sudhanshu Dwivedi Department of Cardiology King George Medical UniversityLucknow 226003Uttar PradeshIndia

BACKGROUND Coronary sinus(CS)imaging has recently gained importance due to increasing need for mapping and ablation of electrophysiological arrhythmias and left ventricular(LV)pacing during cardiac resynchronization therapy(CRT).Retrograde venogram is the current standard for imaging CS and its *** To evaluate CS anatomy during levophase of routine coronary angiography to aid LV lead implantation during *** In this prospective observational study,164 patients undergoing routine coronary angiography for various indications(Chronic stable angina-44.5%,acute coronary syndrome-39.5%,Dilated cardiomyopathy-11%,atypical chest pain-5%)were *** phase(levophase)of left coronary injection was recorded in left anterior oblique-cranial and right anterior oblique-cranial *** of coronary veins,width and shape of CS ostium,angulations of proximal CS with body of CS were ***,size,take-off angle and tortuosity of posterolateral vein(PLV),anterior interventricular veins(AIV)and middle cardiac vein(MCV)were also *** During levophase,visibility grade(Muhlenbruch grade)for coronary veins was 3 in 74%and 2 in 26%of *** of CS did not correlate with body mass *** diameter of CS ostium was15 mm in 48%,42%and 10%of patients *** CS was tubular in 136(83%)patients and funnel-shaped in 28(17%)*** take-off angulation between ostium and body of CS was seen in 16(10%)*** or more PLV were present in 8 patients while PLV was absent in 52(32%)*** of take-off of PLV with body of CS was favourable(0°-45°)in 65(40%)*** angle was 45°-90°in 36 patients and difficult take-off angle(>90°)was seen in 8 *** of PLV reached distal third of myocardium in 84 cases and middle third in 11 *** was no tortuosity in 79 cases,a single bend in 29 cases and more than 2 bends in 4 *** nine(24%)patients had other veins supplying poste

关键词： Posterolateral vein Ostium Angiography Sharp take off Favourable angulation

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Feasibility and efficacy of delayed pharmacoinvasive therapy for STelevation myocardial infarction

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World Journal of Cardiology 2023年第1期15卷 23-32页

作者： rishi sethi Lalit Mohan Pravesh Vishwakarma Abhishek Singh Swati Sharma Monika Bhandari Ayush Shukla Akhil Sharma Gaurav Chaudhary Akshyaya Pradhan Sharad Chandra Varun Shankar Narain Sudhanshu Kumar Dwivedi Department of Cardiology King George's Medical UniversityLucknow 226003Uttar PradeshIndia

BACKGROUND ST-elevation myocardial infarction(STEMI)refers to a clinical syndrome that features symptoms of myocardial ischemia with consequent ST-elevation on electrocardiography and an associated rise in cardiac *** restoration of brisk flow in the coronary vasculature is critical in reducing mortality and *** patients with STEMI who could not receive primary percutaneous coronary intervention(PCI)on time,pharmacoinvasive strategy(thrombolysis followed by timely PCI within 3-24 h of its initiation)is an effective *** To analyze the role of delayed pharmacoinvasive strategy in the window period of 24-72 h after *** This was a physician-initiated,single-center prospective registry between January 2017 and July 2017 which enrolled 337 acute STEMI patients with partially occluded coronary *** received routine pharmacoinvasive therapy(PCI within 3-24 h of thrombolysis)in one group and delayed pharmacoinvasive therapy(PCI within 24-72 h of thrombolysis)in another *** primary endpoint was major adverse cardiac and cerebrovascular events(MACCE)within 30 d of the *** secondary endpoints included major bleeding as defined by Bleeding Academic Research Consortium classification,angina,and dyspnea within 30 *** The mean age in the two groups was comparable(55.1±10.1 years vs 54.2±10.5 years,P=0.426).Diabetes was present among 20.2%and 22.1%of patients in the routine and delayed groups,*** rate was 54.6%and 55.8%in the routine and delayed groups,*** was initiated within 6 h of onset of symptoms in both groups(P=0.125).The mean time from thrombolysis to PCI in the routine and delayed groups was 16.9±5.3 h and 44.1±14.7 h,*** significant difference was found for the occurrence of measured clinical outcomes in the two groups within 30 d(8.7%vs 12.9%,P=0.152).Univariate analysis of demographic characteristics and risk factors for patients who reporte

关键词： Coronary artery disease ST-elevation myocardial infarction Primary percutaneous coronary intervention Pharmacoinvasive strategy Thrombolysis Atherosclerosis

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Pain management in chronic pancreatitis

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World Journal of Clinical Cases 2024年第12期12卷 2016-2022页

作者： Deb Sanjay Nag Bhanu Pratap Swain rishi Anand Tapas Kumar Barman Vatsala Department of Anaesthesiology Tata Main HospitalJamshedpur 831001India

Pain in chronic pancreatitis(CP)is difficult to *** patients suffer from inadequate pain relief,completely incapacitating them in their daily ***,despite their well-known adverse effects,opioids have been the pillar of treatment regimens in painful *** management is now gradually evolving with a better understanding of the underlying pathophysiology of CP-related *** should follow a holistic approach to the management of CPassociated pain,which must involve lifestyle changes that are coupled with analgesic medications and other pain-relieving ***,there is no easy cure for vanquishing CP-associated *** patient must be evaluated on a case-by-case basis by a multidisciplinary team to decide which treatment option is best suited for that individual.

关键词： Pancreatitis Abdominal pain Palliative care Analgesics Life style Psychology

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Home-based Detection and Prediction of Diabetic Foot Ulcers at Early Stage Using Sensor Technology and Supervised Learning

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Journal of Harbin Institute of Technology(New Series) 2024年第1期31卷 26-37页

作者： Kamasamudram Bhavya Sai rishi Raghu Sai Surya Varshith Nukala Jayashree Jayaraman Vijayashree Jayaraman School of Computer Science and Engineering Vellore Institute of TechnologyVellore 632014India

For years,foot ulcers linked with diabetes mellitus and neuropathy have significantly impacted diabetic patients’ health-related quality of life(HRQoL). Diabetes foot ulcers impact15% of all diabetic patients at some point in their lives. The facilities and resources used for DFU detection and treatment are only available at hospitals and clinics,which results in the unavailability of feasible and timely detection at an early stage. This necessitates the development of an at-home DFU detection system that enables timely predictions and seamless communication with users,thereby preventing amputations due to neglect and severity. This paper proposes a feasible system consisting of three major modules:an IoT device that works to sense foot nodes to send vibrations onto a foot sole,a machine learning model based on supervised learning which predicts the level of severity of the DFU using four different classification techniques including XGBoost,K-SVM,Random Forest,and Decision tree,and a mobile application that acts as an interface between the sensors and the patient. Based on the severity levels,necessary steps for prevention,treatment,and medications are recommended via the application.

关键词： diabetic foot ulcer podiatry diabetes mellitus healthcare footcare internet of things machine learning human⁃computer interaction

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Recognition and Anticipation of Diabetic Foot Ulcer in Type Ⅱ Diabetic Patients using Multi-layered Fuzzy Model

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Journal of Harbin Institute of Technology(New Series) 2024年第4期31卷 13-23页

作者： Sai Surya Varshith Nukala Jayashree Jayaraman Vijayashree Jayaraman rishi Raghu School of Computer Science and Engineering Vellore Institute of TechnologyVellore 632014Tamil NaduIndia

Diabetes mellitus is associated with foot ulcers,which frequently pave the way to lower-extremity ***,trauma,deformity,high plantar pressures,and peripheral vascular disease are the most common underlying *** 15%of diabetic patients are affected by diabetic foot ulcer in their lifetime.64 million people are affected by diabetics in India and 40000 amputations are done every *** ulcers are evaluated and classified in a systematic and thorough manner to assist in determining the best course of *** paper proposes a novel model which predicts the threat of diabetic foot ulcer using independent agents for various input values and a combination of fuzzy expert *** proposed model uses a classification system to distinguish between each fuzzy framework and its *** on the severity levels necessary prevention,treatment,and medication are *** the results of all the fuzzy frameworks derived from its constituent parameters,a risk-specific medication is *** work also has higher accuracy when compared to other related models.

关键词： diabetic ulcer typeⅡdiabetic fuzzy model

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Current evidence on artificial intelligence in regional anesthesia

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World Journal of Clinical Cases 2024年第33期12卷 6613-6619页

作者： Bhanu Pratap Swain Deb Sanjay Nag rishi Anand Himanshu Kumar Pradip Kumar Ganguly Niharika Singh Department of Anaesthesiology Tata Main HospitalJamshedpur 831001India Department of Anesthesiology Manipal Tata Medical CollegeJamshedpur 831017India

The recent advancement in regional anesthesia(RA)has been largely attributed to ultrasound ***,the safety and efficiency of ultrasound-guided nerve blocks depend upon the skill and experience of the *** with adequate training,experience,and knowledge,human-related limitations such as fatigue,failure to recognize the correct anatomical structure,and unintentional needle or probe movement can hinder the overall effectiveness of *** amalgamation of artificial intelligence(AI)to RA practice has promised to override these human *** learning,an integral part of AI can improve its performance through continuous learning and experience,like the human *** enables computers to recognize images and patterns specifically useful in anatomic structure identification during the performance of *** can provide real-time guidance to clinicians by highlighting important anatomical structures on ultrasound images,and it can also assist in needle tracking and accurate deposition of local *** future of RA with AI integration appears promising,yet obstacles such as device malfunction,data privacy,regulatory barriers,and cost concerns can deter its clinical *** current mini review deliberates the current application,future direction,and barrier to the application of AI in RA practice.

关键词： Artificial intelligence Regional anesthesia Machine learning Ultrasonography Nerve block

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Robertson-Walker cosmological models with perfect fluid in general relativity

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Research in Astronomy and Astrophysics 2011年第7期11卷 767-775页

作者： rishi Kumar Tiwari Department of Mathematics Govt.Model Science College Rewa(M.P.) 486001India

Einstein＇s field equations with variable gravitational and cosmological constants are considered in the presence of perfect fluid for a Robertson-Walker universe by assuming the cosmological term to be proportional to R-m（R is a scale factor and m is a constant）.A variety of solutions is *** physical significance of the cosmological models has also been discussed.

关键词： cosmological parameters—cosmology:variable cosmological term

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