Browsing by Author "D.S. Rana"

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Consensus Statement from India on the Renal Benefits of ARNi, SGLT-2i, and Bisoprolol in Chronic Kidney Disease
(Journal of Association of Physicians of India, 2024) H.K. Chopra; Dinesh Khullar; Tiny Nair; G.S. Wander; C.K. Ponde; Saumitra Ray; Navin C. Nanda; Ravi R. Kasliwal; D.S. Rana; Ashok Kirpalani; J.P.S. Sawhney; Praveen Chandra; Yatin Mehta; Viveka Kumar; S. Tewari; A.K. Pancholia; Vijay Kher; Sandeep Bansal; Sanjay Mittal; Praful Kerkar; P.K. Sahoo; Ramesh Hotchandani; Sunil Prakash; Nagendra Chauhan; Vishal Rastogi; A. Jabir; S. Shanmugasundaram; Mangesh Tiwaskar; Ajay Sinha; Vittul Gupta; S.S. Mishra; S.N. Routray; A.K. Omar; Onkar C. Swami; Aparna Jaswal; Shamsad Alam; Rajeev Passey; Rajeeve Rajput; Justin Paul; Aditya Kapoor; D. Prabhakar; Subhash Chandra; Poonam Malhotra; Vivudh Pratap Singh; Manish Bansal; Priyank Shah; Sanjay Jain; Mohan Bhargava; I.B. Vijayalakshmi; Kiron Varghaese; Dharmender Jain; Anupam Goel; Namrata Gaur; Rohit Tandon; Asha Moorthy; Sheeba George; V.K. Katyal; R.R. Mantri; Rahul Mehrotra; Dilip Bhalla; Vinod Mittal; Sarita Rao; Manish Jagia; Harmeet Singh; Surabhi Awasthi; Ameet Sattur; Rekha Mishra; Anand Pandey; Rajeev Chawla; Shalini Jaggi; Blessy Sehgal; Alok Sehgal; Naresh Goel; Ripen Gupta; Samir Kubba; Abhinav Chhabra; Saurabh Bagga; N.R. Shastry
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. HF and CKD are pathophysiologically intertwined, and the deterioration of one can worsen the prognosis of the other. There is a need for safe renal pharmacological therapies that target both CKD and HF and are also useful in hypertension and diabetes. Neurohormonal activation achieved through the activation of the sympathetic nervous system (SNS), the renin–angiotensin–aldosterone system (RAAS), and the natriuretic peptide system (NPS) is fundamental in the pathogenesis and progression of CKD and HF. Angiotensin receptor neprilysin inhibitor (ARNi), sodium-glucose cotransporter 2 inhibitors (SGLT-2i), and selective β1-blocker (B1B) bisoprolol suppress this neurohormonal activation. They also have many other cardiorenal benefits across a wide range of CKD patients with or without concomitant HF, diabetes, or hypertension. This consensus statement from India explores the place of ARNi, SGLT-2i, and bisoprolol in the management of CKD patients with or without HF and other comorbidities. ©The Author(s). 2024.
Crop and water productivity, energy auditing, carbon footprints and soil health indicators of Bt-cotton transplanting led system intensification
(Academic Press, 2021) Sudhir K. Rajpoot; D.S. Rana; Anil K. Choudhary
Direct-seeded-cotton (DSC) leads to low crop and water productivity and energy-output with higher carbon-footprints besides impairing system-intensification under conventional cotton-wheat cropping system (CWCS). Hence, we evaluated two methods of Bt-cotton establishment [transplanted cotton (TPC) & DSC)] at three planting geometries/densities in four Bt-cotton based cropping-systems [DSC-wheat (DSC-W), TPC-wheat-mungbean (TPC-W-M), DSC-onion (DSC-O), TPC-onion-fodder cowpea + fodder maize (TPC-O-FC + FM)] in semi-arid region of south Asia. Poly-glass nursery-raised TPC exhibited significantly higher germination (96.5%), seedling-survival (96.1%) and 14.1% higher plant-stand owing to lower seedling-mortality (3.2%). TPC used ∼60% less irrigation-water but exhibited significantly higher seed-cotton, seed and lint yield, net-returns, radiation-use-efficiency and water-productivity by 11.4, 9.9, 14.3, 17.3, 10.7 and 260.6%, respectively over DSC. Planting geometry/density of 60 × 45 cm (37,037 plants ha−1) exhibited significantly higher crop and water productivity and economic-returns. Bt-cotton transplanting led system-intensification enhanced the system-productivity (26.1%), profitability (30.5%), water-productivity (19.3%) and land-use-efficiency (8.5%) over the DSC-based systems with significantly higher values under TPC-O-FC + FM. Energy-use pattern reveled that farm inputs viz. Fertilizers (54–60%), water (15–25%) and diesel (6–10%) consumed bulk of the input-energy in different cropping systems with greatest values under TPC-O-FC + FM. TPC-W-M exhibited highest system energy-output (604.6 × 103 MJ ha−1) and energy-returns (566.2 × 103 MJ ha−1). TPC-O-FC + FM exhibited significantly higher carbon-consumption (668.9 kg CE ha−1) and carbon-output (21431.3 kg CE ha−1) while maintaining significantly higher carbon-efficiency (32.0) and carbon sustainability index (31.0). TPC-O-FC + FM had least carbon-footprints (0.07 kg CE kg−1 SCEY) while conventional-CWCS exhibited 2-folds higher carbon-footprints. Legume-imbedded TPC-based cropping systems markedly increased the soil physical (bulk-density, water-stable-aggregates), chemical (SOC, available-NPK) and biological properties (soil-microbial-biomass-carbon, dehydrogenase and ergosterol activity) over the conventional CWCS and DCS-O systems. Overall, Bt-cotton transplanting led system-intensification upholds great importance in enhancing the system crop and water-productivity, profitability, energy-productivity, resource-use-efficiency and soil-health with minimal carbon-footprints in semi-arid agro-ecosystems of south Asia. © 2021 Elsevier Ltd
Current Place of SGLT2i in the Management of Heart Failure: An Expert Opinion from India
(Journal of Association of Physicians of India, 2024) H.K. Chopra; Tiny Nair; G.S. Wander; C.K. Ponde; Saumitra Ray; Dinesh Khullar; Navin C. Nanda; Jagat Narula; Ravi R. Kasliwal; D.S. Rana; Ashok Kirpalani; J.P.S. Sawhney; Praveen Chandra; Yatin Mehta; Viveka Kumar; S. Tewari; A.K. Pancholia; Vijay Kher; Sandeep Bansal; Sanjay Mittal; Praful Kerkar; P.K. Sahoo; Ramesh Hotchandani; Sunil Prakash; Nagendra Chauhan; Vishal Rastogi; A. Jabir; S. Shanmugasundaram; Mangesh Tiwaskar; Ajay Sinha; Vittul Gupta; S.S. Mishra; S.N. Routray; A.K. Omar; Onkar C. Swami; Aparna Jaswal; Shamsad Alam; Rajeev Passey; Rajeeve Rajput; Justin Paul; Aditya Kapoor; D. Prabhakar; Subhash Chandra; Poonam Malhotra; Vivudh Pratap Singh; Manish Bansal; Priyank Shah; Sanjay Jain; Mohan Bhargava; I.B. Vijayalakshmi; Kiron Varghaese; Dharmender Jain; Anupam Goel; Kiran Mehmood; Namrata Gaur; Rohit Tandon; Asha Moorthy; Sheeba George; V.K. Katyal; R.R. Mantri; Rahul Mehrotra; Dilip Bhalla; Vinod Mittal; Sarita Rao; Manish Jagia; Harmeet Singh; Surabhi Awasthi; Ameet Sattur; Rekha Mishra; Anand Pandey; Rajeev Chawla; Shalini Jaggi; Blessy Sehgal; Alok Sehgal; Naresh Goel; Ripen Gupta; Samir Kubba; Abhinav Chhabra; Saurabh Bagga; N.R. Shastry
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 Author(s). 2024.
Effect of la doping on microstructure and critical current density of MgB2
(2005) Chandra Shekhar; Rajiv Giri; R.S. Tiwari; D.S. Rana; S.K. Malik; O.N. Srivastava
In the present study, La-doped MgB2 superconductors with different doping levels (Mg1-xLaxB2; x ≤ 0.00, 0.01, 0.03 and 0.05) have been synthesized by the solid-state reaction route at ambient pressure. Effects of La doping have been investigated in relation to microstructural characteristics and superconducting properties, particularly intragrain critical current density (Jc). The microstructural characteristics of the as-synthesized Mg(La)B2 compounds were studied employing the transmission electron microscopic (TEM) technique. The TEM investigations reveal inclusion of LaB6 nanoparticles within the MgB2 grains, which provide effective flux pinning centres. The evaluation of intragrain Jc through magnetic measurements on the fine powdered version of the as-synthesized samples reveal that Jc values of the samples change significantly with the doping level. The optimum result on Jc is obtained for Mg 0.97La0.03B2 at 5 K; Jc reaches ∼1.4 × 107 A cm-2 in self-field, ∼2.1 × 106 A cm-2 at 1 T, ∼2.5 × 10 5 A cm-2 at 2.5 T and ∼1.8 × 104 A cm-2 at 4.5 T. The highest value of intragrain Jc in the Mg0.97La0.03B2 superconductor has been attributed to the inclusion of LaB6 nanoparticles, which are capable of providing effective flux pinning centres. © 2005 IOP Publishing Ltd.
Post-emergence herbicides for effective weed management, enhanced wheat productivity, profitability and quality in north-western Himalayas: A ‘participatory-mode’ technology development and dissemination
(MDPI AG, 2021) Anil K. Choudhary; D.S. Yadav; Pankaj Sood; Shakuntla Rahi; Kalpana Arya; S.K. Thakur; Ramesh Lal; Subhash Kumar; Jagdev Sharma; Anchal Dass; Subhash Babu; R.S. Bana; D.S. Rana; Adarsh Kumar; Sudhir K. Rajpoot; Gaurendra Gupta; Anil Kumar; M.N. Harish; A.U. Noorzai; G.A. Rajanna; Mohammad Halim Khan; V.K. Dua; Raj Singh
‘Participatory-mode’ adaptive research was conducted in wheat in north-western Himalayas (NWH) during 2008–2014 to develop an improved chemical weed management (ICWM) technology. First of all, two years ‘on-farm experimentation’ was performed in a randomized block design at 10 locations in NWH using seven treatments (Clodinafop @ 60 g a.i./ha (Clod); Clod followed by 2,4-D (Na-salt) @ 1.0 kg a.i./ha (Clod-fb-D); Isoproturon 75 WP @ 1.0 kg a.i./ha (Iso); Iso + D; Sulfosulfuron 75% WG @ 25 g a.i./ha + Metsulfuron 5% WG @ 2 g a.i./ha (Sulf + Met); weed-free-check; and un-weeded-check). In this study, the post-emergence application of Sulf + Met reported the lowest weed-index and NPK depletion by weeds with higher weed control efficiency (86.4%), weed control index (81.1%) and herbicide efficiency index (2.62) over other herbicides. Sulf + Met exhibited significantly higher wheat productivity (3.57 t/ha), protein yield, net-returns and water-productivity, which was followed by Iso + D and Clod-fb-D, all of which remained statistically at par with each other. An impact assessment of intensive technology-transfer programme (2008–2014) revealed a higher technology adoption rate (71–98%) of ICWM leading to higher wheat productivity (~22%) and net income gains (2.8–26.4%) in NWH. Overall, Sulf + Met proved highly effective against mixed weed flora in wheat to boost wheat productivity, profitability, quality and water productivity in addition to a higher technology adoption rate and NIGs to transform rural livelihoods in NWH. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.
Role of Bisoprolol in Heart Failure Management: A Consensus Statement from India
(Journal of Association of Physicians of India, 2023) H.K. Chopra; Tiny Nair; G.S. Wander; C.K. Ponde; Saumitra Ray; Dinesh Khullar; Navin C. Nanda; Ravi R. Kasliwal; D.S. Rana; Ashok Kirpalani; J.P.S. Sawhney; Praveen Chandra; Yatin Mehta; Viveka Kumar; S. Tewari; A.K. Pancholia; Vijay Kher; Sandeep Bansal; Sanjay Mittal; Praful Kerkar; P.K. Sahoo; Ramesh Hotchandani; Sunil Prakash; Nagendra Chauhan; Vishal Rastogi; A. Jabir; S. Shanmugasundaram; Mangesh Tiwaskar; Ajay Sinha; Vittul Gupta; S.S. Mishra; S.N. Routray; A.K. Omar; Onkar C. Swami; Aparna Jaswal; Shamsad Alam; Rajeev Passey; Rajeeve Rajput; Justin Paul; Aditya Kapoor; D. Prabhakar; Subhash Chandra; Poonam Malhotra; Vivudh Pratap Singh; Manish Bansal; Priyank Shah; Sanjay Jain; Mohan Bhargava; I.B. Vijayalakshmi; Kiron Varghaese; Dharmender Jain; Anupam Goel; Namrata Gaur; Rohit Tandon; Asha Moorthy; Sheeba George; V.K. Katyal; R.R. Mantri; Rahul Mehrotra; Dilip Bhalla; Vinod Mittal; Sarita Rao; Manish Jagia; Harmeet Singh; Surabhi Awasthi; Ameet Sattur; Rekha Mishra; Anand Pandey; Rajeev Chawla; Shalini Jaggi; Blessy Sehgal; Alok Sehgal; Naresh Goel; Ripen Gupta; Samir Kubba; Abhinav Chhabra; Saurabh Bagga; N.R. Shastry
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 β-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 β-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. © The Author(s).
The Power and Promise of Angiotensin Receptor Neprilysin Inhibitor (ARNI) in Heart Failure Management: National Consensus Statement
(Journal of Association of Physicians of India, 2023) H.K. Chopra; G.S. Wander; C.K. Ponde; Navin C. Nanda; Dinesh Khullar; K. Venugopal; Saumitra Ray; Tiny Nair; D.S. Rana; Vijay Kher; J.P.S. Sawhney; R.R. Kasliwa; A. Jabir; Rabin Chakraborty; Praveen Chandra; Sandeep Bansal; Viveka Kumar; A.K. Pancholia; Aditya Kapoor; Sunil Prakash; Anil Saxena; Vishal Rastogi; Vinod Sharma; Y.K. Arora; Arup Dasbiswas; Mohan Bhargava; Aparna Jaswal; K. Bhargava; Mona Bhatia; A.K. Omar; N.N. Khanna; Rajiv Passey; Dilip Bhalla; I.B. Vijayalakshmi; A.K. Bhalla; Asha Moorthy; H.S. Isser; S.S. Mishra; S.N. Routray; Vivek Tandon; Ajay Sinha; Manish Bansal; Praveen Jain; Ramesh Hotchandani; Dharmendra Jain; V.K. Katyal; Sanjiv Gulati; Rohit Tandon; Shalini Jaggi; Blessy Sehgal; Vitull Gupta; Rahul Mehrotra; N.C. Krishnamani; S.N. Pathak; M.S. Yadav; Rajeev Chawla; Jyotirmoy Pal; Nandini Chatterjee; Shambo S. Samajdar; N.R. Shastry
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. © 2023 Journal of Association of Physicians of India. All rights reserved.
The Promise of Cilnidipine in Hypertension with Comorbidities: National Consensus Statement
(Journal of Association of Physicians of India, 2024) Hirday Kumar Chopra; Gurpreet S. Wander; Chandrashekhar K. Ponde; Navin C. Nanda; Dinesh Khullar; K. Venugopal; Saumitra Ray; Tiny Nair; D.S. Rana; Vijay Kher; J.P.S. Sawhney; R.R. Kasliwal; Jabir Abdullakutty; Rabin Chakraborty; Praveen Chandra; Sandeep Bansal; Viveka Kumar; Arvind K. Pancholia; Aditya Kapoor; Sunil Prakash; Anil Saxena; Vishal Rastogi; Vinod Sharma; Y.K. Arora; Arup Dasbiswas; Mohan Bhargava; Aparna Jaswal; Kartikeya Bhargava; Mona Bhatia; Ashok K. Omar; Narendra Nath Khanna; Rajiv Passey; Dilip Bhalla; I.B. Vijayalakshmi; Anil Kumar Bhalla; Asha Moorthy; Harmohander S. Isser; S.S. Mishra; Satyanarayan Routray; Vivek Tandon; Ajay Sinha; Manish Bansal; Praveen Jain; Ramesh Hotchandani; Dharmendra Jain; V.K. Katyal; Sanjiv Gulati; Rohit Tandon; Shalini Jaggi; Blessy Sehgal; Vitull Gupta; Rahul Mehrotra; N.C. Krishnamani; S.N. Pathak; M.S. Yadav; Rajeev Chawla; N.R. Shastry; Nandini Chatterjee; Shambo Samrat Samajdar; Jyotirmoy Pal; Mangesh Tiwaskar
The rapidly increasing burden of hypertension is responsible for premature deaths from cardiovascular disease (CVD), renal disease, and stroke, with a tremendous public health and financial burden. Hypertension detection, treatment, and control vary worldwide; it is still low, particularly in low- and middle-income countries (LMICs). High blood pressure (BP) and CVD risk have a strong, linear, and independent association. They contribute to alarming numbers of all-cause and CVD deaths. A major culprit for increased hypertension is sympathetic activity, and further complications of hypertension are heart failure, ischemic heart disease (IHD), stroke, and renal failure. Now, antihypertensive interventions have emerged as a global public health priority to reduce BP-related morbidity and mortality. Calcium channel blockers (CCB) are highly effective vasodilators. and the most common drugs used for managing hypertension and CVD. Cilnidipine, with both L- and N-type calcium channel blocking activity, is a promising 4th generation CCB. It causes vasodilation via L-type calcium channel blockade and inhibits the sympathetic nervous system (SNS) via N-type calcium channel blockade. Cilnidipine, which acts as a dual L/N-type CCB, is linked to a reduced occurrence of pedal edema compared to amlodipine, which solely blocks L-type calcium channels. The antihypertensive properties of cilnidipine are very substantial, with low BP variability and long-acting properties. It is beneficial for hypertensive patients to deal with morning hypertension and for patients with abnormal nocturnal BP due to exaggerated sympathetic nerve activation. Besides its BP-lowering effect, it also exhibits organ protection via sympathetic nerve inhibition and renin–angiotensin–aldosterone system inhibition; it controls heart rate and proteinuria. Reno-protective, neuroprotective, and cardioprotective effects of cilnidipine have been well-documented and demonstrated. © 2024 Journal of Association of Physicians of India. All rights reserved.