Apex Heart Institute

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Hypertension is a leading cause of cardiovascular morbidity and mortality globally, with particularly low control rates in India. Beyond controlling blood pressure (BP), effective management must address associated comorbidities such as cardiovascular disease (CVD), chronic kidney disease (CKD), and type 2 diabetes mellitus (T2DM). A multidisciplinary panel of experts, including cardiologists, nephrologists, and physicians, developed this consensus through six advisory board meetings. A comprehensive literature review of randomized controlled trials and systematic reviews published between 2019 and 2025 was conducted via PubMed and Google Scholar. Key topics included pharmacological and non-pharmacological management of hypertension, combination therapy, and comorbidity-focused treatment strategies. Early screening for hypertension-mediated organ damage and the use of combination therapy, specifically telmisartan and cilnidipine for their complementary benefits, were emphasized. Evidence showed improved BP control, reduced proteinuria, and organ protection in individuals with CVD, CKD, and T2DM. Non-pharmacological interventions such as dietary modification, physical activity, smoking cessation, stress management, and adherence to therapy through fixed-dose combinations were also endorsed. This expert consensus supports a comprehensive, patient-centered approach to hypertension management in India. Available evidence suggests that cilnidipine and telmisartan may offer potential benefits beyond BP reduction, largely based on pharmacologic properties and surrogate outcomes. Future large-scale, randomized, comparative outcome trials are needed to better define the relative clinical benefits of this combination.

Workplace automation powered by artificial intelligence, robotic process automation (RPA), and advanced machine learning has shifted from back-office trial balloons to a central operational strategy. AI systems that remove routine work from manufacturing, IT services and gig platforms by no: it technological displacement clauses. This development is in line with a broader trend towards proactive measures against such practices, involving bias audits in AI hiring tools. This historical development illustrates a tension between technological determinism and worker protections. The primary legal reforms address automation risks through mandatory reskilling, compensation amendments and algorithmic accountability as India's labor codes fall short of global standards such as the ban on opaque high-risk systems in EU AI Act. The lagging regulation creates a paradox in most jurisdictions automation races ahead unconstrained by law, while employees are assured that “humans remain in the loop,” fostering an ambient that fuels imposter syndrome.

Coronary artery disease (CAD) remains a leading cause of global morbidity and mortality despite advances in medical and interventional therapies. Mesenchymal stem cell (MSC) therapy has emerged as a promising regenerative approach for patients with refractory or non-revascularizable CAD. MSCs exhibit unique immunomodulatory, pro-angiogenic, and anti-fibrotic properties, primarily through paracrine mechanisms involving the secretion of cytokines, growth factors, and exosomal microRNAs. Clinical and preclinical studies have demonstrated improvements in myocardial perfusion, left ventricular ejection fraction (LVEF), and functional capacity following MSC-based interventions, particularly in patients with low baseline LVEF and heightened inflammation. Various MSC sources-including bone marrow, adipose tissue, and umbilical cord-offer distinct advantages, while delivery strategies such as intracoronary, intramyocardial, intravenous, and subcutaneous administration impact cell retention and efficacy. Advances in genetic modification, hypoxic preconditioning, and exosome-based therapies aim to enhance MSC survival and therapeutic potency. However, challenges persist regarding cell engraftment, cryopreservation effects, and inter-patient variability. Moving toward precision cell therapy, future approaches may involve stratifying patients by inflammatory status, ischemic burden, and comorbidities to optimize treatment outcomes. MSCs may not yet replace conventional therapies but are increasingly positioned to complement them within a personalized, regenerative framework for CAD management.

Background: Nepal’s National AI Policy 2081 is positioned as a cornerstone for AI-driven national growth, with a focus on agriculture, healthcare, and education. However, challenges such as limited infrastructure, a shortage of skilled professionals, and low AI awareness persist. This study critically evaluates the policy through a SWOT analysis. Methods: A qualitative research approach was employed, utilizing thematic content analysis to review Nepal’s AI policy alongside global AI frameworks. Secondary data from policy documents, academic literature, and reports were analyzed to identify the policy's strengths, weaknesses, opportunities, and threats, and to propose strategies for improving its efficacy. Results: The SWOT analysis revealed key strengths, including a clear vision for AI-driven digital transformation, a sector-focused AI approach, promotion of AI research and ethical governance, and investment in AI entrepreneurship. Weaknesses identified include a lack of an implementation roadmap, limited AI infrastructure, outdated data governance laws, and insufficient strategies for mitigating job displacement. Opportunities highlighted include AI as a driver for economic growth, public service efficiency, and agricultural innovation. However, threats such as inadequate AI infrastructure, cybersecurity risks, and AI bias were also noted. Conclusion: Nepal’s AI Policy 2081 marks significant progress in recognizing AI’s potential. However, its success will depend on addressing its infrastructural, regulatory, and socio-economic gaps. A more defined implementation roadmap, investment in infrastructure, and strategies for addressing potential job displacement are crucial for sustainable development. Novelty: It provides context-specific strategies to integrate AI equitably within the socio-economic landscape of developing nations.

Approximately, 40% of gastroesophageal reflux disease (GERD) patients experience insufficient symptom relief from proton-pump inhibitors (PPI), resulting in PPI-refractory GERD (rGERD). To review the existing literature and develop an Indian expert group consensus statement on the place of vonoprazan in the management of rGERD. A panel of 35 leading Indian gastroenterologists extensively reviewed the literature to develop consensus statements for the management of rGERD in Indian patients, with a focus on the newly available potassium-competitive acid blocker (P-CAB), vonoprazan. This process involved two structured meetings in which experts deliberated on literature reviews and draft statements, which were further rigorously discussed and modified. Consensus was achieved through a voting process employing a five-point Likert scale, with results meticulously documented. The final statements unanimously approved by all participants and subsequently developed into a comprehensive manuscript. Based on the evidence, 14 statements were developed and confirmed by expert panelists for the assessment and management of rGERD. Among these 14 statements, 5 obtained Level A evidence, 4 received Level B, 4 were classified as Level C, and 1 as Level D. The consensus highlights the importance of symptom assessment, lifestyle modifications, and medication adherence, followed by a diagnostic procedure with upper gastrointestinal (GI) endoscopy. If needed, manometry or 24-hour pH impedance may be considered. Vonoprazan, a novel and reversible potassium-competitive acid blocker (P-CAB), has emerged as a potential alternative to proton pump inhibitors (PPIs), offering rapid, potent, and sustained acid suppression. Based on current evidence, a daily dose of 20 mg vonoprazan for 4-8 weeks is recommended as an initial treatment strategy for rGERD. The consensus endorses the use of vonoprazan to improve patient outcomes and quality of life, highlighting its important place in therapy for controlling rGERD in Indian patients.

Abstract Background: Oral semaglutide has shown efficacy in clinical trials worldwide; however, real-world evidence in Indian settings is scarce. The current study examined the effectiveness of oral semaglutide in patients with type 2 diabetes within the context of routine clinical practice in Indian settings. Methodology: This retrospective, multicenter, observational study assessed the effectiveness of oral semaglutide in adult patients with type 2 diabetes who had inadequate glycemic control (HbA1c ≥6.5). The included patients need to have ≥1 HbA1c report within 12 weeks of the study initiation. The primary end point was change in HbA1c% from baseline to end of study (EOS; 30 weeks), with secondary end points including changes in body weight, waist circumference, and body mass index (BMI). These end points were evaluated for patients who were on oral semaglutide at EOS. Results: Of 414 screened patients, 340 were included in the study, with 176 patients on oral semaglutide at EOS. A mean reduction of 0.96 ± 1.02% (P < 0.001) in HbA1c from baseline to EOS was observed, with greater reductions in patients with 5–10 years of diabetes. At EOS, 92.6% of patients achieved a target of ≥1% HbA1c reduction from baseline. In addition, significant reductions in body weight (6.04 ± 5.40 kg, P < 0.001), waist circumference (3.47 ± 5.42 cm, P < 0.001), and BMI (1.94 ± 1.42 kg/m2, P < 0.001) were observed at EOS. Conclusion: Oral semaglutide shows promise as a therapeutic option for glycemic control and weight management in diabetic patients in Indian settings. However, further randomized clinical trials in Indian patients are warranted to validate these findings and optimize further treatment strategies.

Torsemide, a loop diuretic, is increasingly recognized for its role in managing essential hypertension. Its mechanism of action involves inhibiting the reabsorption of sodium and chloride ions in the ascending loop of Henle in the kidneys. By doing so, torsemide promotes diuresis, which refers to increased urine production, and subsequently lowers blood pressure. Studies have shown that torsemide is comparably effective to other antihypertensive agents in lowering blood pressure, with the added benefit of potentially improving renal function. However, while torsemide shows promise in hypertensive management, further research is necessary to fully understand its long-term effects and to establish optimal dosing strategies. Future research should focus on clarifying its role in long-term blood pressure control and refining its use in clinical practice to maximize efficacy and minimize adverse effects.