Loop Diuretics Unique Mechanism of Action.

Loop diuretics, including torsemide, furosemide, bumetanide, and piretanide, act by inhibiting the sodium-potassium-chloride (Na/K/2Cl) cotransporter in the thick ascending limb of the loop of Henle within the nephron. This mechanism is pivotal in managing fluid retention associated with conditions such as heart failure, cirrhosis, chronic kidney disease, and hypertension. A comprehensive understanding of how these diuretics uniquely target this transporter provides crucial insights into effectively addressing fluid overload across diverse clinical conditions.

Consensus Statement from India on the Renal Benefits of ARNi, SGLT-2i, and Bisoprolol in Chronic Kidney Disease.

Chronic kidney disease (CKD) is a major contributor to morbidity and mortality in India. CKD often coexists with heart failure (HF), diabetes, and hypertension. All these comorbidities are risk factors for renal impairment.

The Potential Role of Torsemide in Optimizing Loop Diuretic Therapy for Heart Failure Patients.

Heart failure is associated with an increased frequency of hospitalization, reduced life span, and greater risk to public health, thus posing a challenge. In India, torsemide is one of the commonly used loop diuretics for decongestion in heart failure. However, this use of torsemide, including its dosing, and up/down titration, is based on practical experience.

Role of Indocyanine Green Angiography in Free Flap Surgery: A Comparative Outcome Analysis of a Single-Center Large Series of 877 Consecutive Free Flaps.

 This study aims to assess and validate the role and cost-effectiveness of indocyanine green angiography (ICGA) in free flap surgery outcomes. A new intraoperative protocol of whole-body surface warming (WBSW) for all free flap surgeries during the strategic "microbreaks" is also described.  A retrospective analysis of 877 consecutive free flaps, performed over 12 years, is presented.

First Case Report of Breast Implant Associated-Anaplastic Large Cell Lymphoma from India: Are We Ready?

Breast implant associated-anaplastic large cell lymphoma (BIA-ALCL) has become a hot topic in recent plastic surgery and oncology forum. Its cases have been on the rise since its first emergence more than two decades ago. This condition is less known and management guidelines are still evolving.

Effect of light source and UVA quotient on monoclonal antibody stability during ambient light exposure studies.

Therapeutic proteins such as monoclonal antibodies (mAbs) are exposed to ambient light conditions during manufacturing and handling processes, and the exposure time limits are generally determined by conducting relevant room temperature and room light (RT/RL) stability studies. In the case study presented here, a mAb drug product showed an unexpectedly higher level of protein aggregation during a formal RT/RL study conducted at a contract facility as compared to what had previously been seen during development studies. An investigation led to the finding that the RT/RL stability chamber was set up differently as compared to the one used for the internal studies.

Container Closure Integrity of Vial Primary Packaging Systems under Frozen Storage Conditions: A Case Study.

As the complexities of the pharmaceuticals needed to prevail over serious diseases continue to grow, the need for technologies to enable their efficient storage and delivery are as essential as ever. Lately, drugs such as vaccines, proteins, and stem cells are increasingly requiring frozen storage to maintain their efficacies before use. Notably, the advent of cellular therapy products has invariably elevated the need for cryopreservation and frozen storage of cellular starting materials, intermediates, and/or final product.

Smart Grid Stability Prediction Model Using Neural Networks to Handle Missing Inputs.

A smart grid is a modern electricity system enabling a bidirectional flow of communication that works on the notion of demand response. The stability prediction of the smart grid becomes necessary to make it more reliable and improve the efficiency and consistency of the electrical supply. Due to sensor or system failures, missing input data can often occur.

New 'ZISIS' (Zigzag Incision-Suction-Irrigation System) Technique for Endoscopic-Assisted Forehead Tumour Excision.

Background: Endoscopic-assisted excision of forehead tumours like osteomas and lipomas is well established, but the conventional techniques suffer from many limitations like inadequate access, fogging of the endoscope and unclear vision due to collection of blood and debris.

Method: Three simple modifications of the conventional endoscopic forehead technique for benign tumour excisions are described by the acronym 'ZISIS'. Zigzag scalp incision increases the surface area of the opening permitting easy insertion of multiple instruments along with the endoscope.

Suprazygomatic Aponeurotic McLaughlin Myoplasty for Facial Reanimation.

Background: Suprazygomatic aponeurotic McLaughlin (SAM) myoplasty technique for facial reanimation is based on the classical McLauglin's lengthening temporalis myoplasty with a series of new modifications. A comprehensive review of previously described other orthodromic temporalis myoplasty techniques is also included to give a succinct comparison.

Methods: Twelve adult patients of facial palsy underwent SAM myoplasty for a period of 4 years.

Prevalence of familial hypercholesterolemia in premature coronary artery disease patients admitted to a tertiary care hospital in North India.

Aims: The prevalence of premature coronary artery disease (CAD) in India is two to three times more than other ethnic groups. Untreated heterozygous familial hypercholesterolemia (FH) is one of the important causes for premature CAD. As the age advances, these patients without treatment have 100 times increased risk of cardiovascular (CV) mortality resulting from myocardial infarction (MI).

Balancing Container Closure Integrity and Aesthetics for a Robust Aseptic or Sterile Vial Packaging System.

Container closure integrity (CCI) is one of the requirements for a sterile packaging system. For vial-based systems, the capping process is a critical step in creating and ensuring an adequate seal with acceptable CCI. Container closure integrity tests (CCITs) such as the dye ingress and the helium leak rate are two methods among many that, in the appropriate scenario, help to challenge this required attribute.

18F-Fluorodeoxyglucose Positron Emission Tomography-computed Tomography in Evaluation of Large Vessel Vasculitis.

18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) is a rapidly evolving hybrid imaging technique in evaluation of infection and inflammation. Usually, functional changes often precede anatomical changes. 18F-FDG PET-CT, a noninvasive diagnostic test and it is useful for the early detection of inflammation.

Profiling cardiac arrhythmia and heart failure patients in India: The Pan-arrhythmia and Heart Failure Observational Study.

Background: The PANARrhythMia and Heart Failure Registry (PANARM HF) characterized demographic, clinical and interventional therapy indication profiles of cardiac arrhythmia (CA) and heart failure (HF) patients in India.

Methods: Consulting Physicians (CP) who medically manage CA and HF patients enrolled patients with one or more of the following: syncope, pre-syncope, dyspnea, palpitation, fatigue and LV dysfunction. The CPs were trained by interventional cardiologists (IC) to identify CA/HF patients indicated for implantable device/radiofrequency ablation (RFA).

Congenital Hypothyroidism: An Unusual Combination of Biochemical Abnormalities.

A forty-five-day-old female infant presented with prolonged jaundice with clinical features suggestive of congenital hypothyroidism (CHT). On investigations, the infant was noted to have indirect hyperbilirubinemia (13.8 mg/dl) with increased levels of AST (298 IU/dl) and ALT (174 IU/dl) in the serum.

Rapidly Resorbable Skin Sutures: Story Retold!

Unlabelled: Rapidly resorbable skin sutures have an elaborate use not only in facial surgeries but also in breast, abdomen, and hand wound closure. Its removal may not require trimming, as gentle rubbing with a moisturizing agent makes them fall off easily in 10-14 days postoperatively. This practice has a good acceptance, especially among children, and gives a favorable aesthetic outcome.

Correlation of Phosphorus Cross-Linking to Hydration Rates in Sodium Starch Glycolate Tablet Disintegrants Using MRI.

Understanding the behavior of tablet disintegrants is valuable in the development of pharmaceutical solid dosage formulations. In this study, high-resolution magnetic resonance imaging has been used to understand the hydration behavior of a series of commercial sodium starch glycolate (SSG) samples, providing robust estimates of tablet disintegration rate that could be correlated with physicochemical properties of the SSGs, such as the extent of phosphorus (P) cross-linking as obtained from infra-red spectroscopy. Furthermore, elemental analysis together with powder X-ray diffraction has been used to quantify the presence of carboxymethyl groups and salt impurities, which also contribute to the disintegration behavior.