Dr RR Baliga's "Got Knowledge Doc" Podkast

Summary on Kaṇāda Kaṇāda, also known as Ulūka or Kashyapa, was an ancient Indian natural philosopher and the founder of the Vaisheshika school of Indian philosophy. He is often regarded as the earliest proponent of atomism in the world, proposing that the universe is composed of indivisible, eternal atoms (paramanu), which combine in various ways to form different substances. His ideas were recorded in the seminal text Vaiśeṣika Sūtra, which outlined a realistic and pluralistic ontology. Estimated to have lived between the 6th century BCE and 2nd century BCE, Kaṇāda's philosophy explains the creation and functioning of the universe through six fundamental categories (padarthas): dravya (substance), guna (quality), karma (motion), samanya (generality), visesha (particularity), and samavaya (inherence). These categories encompass everything that can be experienced and known. Kaṇāda's atomistic theory influenced later Hindu, Jain, and Buddhist philosophies and may have inspired thinkers in fields like medicine and physics, including scholars like Charaka. Though primarily focused on physical phenomena, Kaṇāda also integrated metaphysical ideas, such as the concept of Atman (soul) and the pursuit of moksha (liberation) through knowledge. Key Contributions: 1. Atomism: Proposed that all matter is made of indestructible atoms. 2. Nine Substances: Identified nine dravyas (substances) including earth, water, fire, air, ether (akasha), time, direction, mind, and soul. 3. Non-Theistic Approach: Suggested that natural laws, rather than a deity, govern the universe. 4. Empirical Observations: Explained natural phenomena such as fire rising upwards, magnetism, and rainfall using logical reasoning. 5. Ethical Framework: Defined dharma as that which leads to material progress and spiritual liberation. Kaṇāda's logical and analytical approach laid the groundwork for scientific inquiry in India and significantly influenced the Nyaya school of philosophy, which emphasized logic and epistemology. His ideas on atoms and matter predated similar concepts proposed by Greek philosophers like Democritus.

The study investigates the K210del mutation in genetic cardiomyopathy, which impairs myocardial contractility due to calcium discoordination in the troponin complex. Using a structure-based drug repurposing approach, researchers identified risedronate, an FDA-approved bisphosphonate, as a structural corrector that restores the calcium-binding domain's normal configuration. Experiments with patient-derived iPSC cardiomyocytes and a mouse model demonstrated that risedronate normalized calcium sensitivity, improved contraction velocity, and restored left ventricular function. The findings highlight the potential of repurposing existing drugs to treat genetic cardiomyopathies.

Recent randomized trials, including EARLY TAVR, AVATAR, RECOVERY, and EVOLVED, suggest benefits of early aortic valve replacement (AVR) in asymptomatic severe aortic stenosis (AS). Early AVR reduces stroke, heart failure hospitalizations, and cardiovascular events, with a trend toward improved survival. The data support shifting from clinical surveillance to early intervention?

The EVOLVED trial investigated whether early aortic valve intervention could improve outcomes in asymptomatic patients with severe aortic stenosis and myocardial fibrosis. The randomized, multicenter study of 224 patients found no significant difference in all-cause mortality or unplanned aortic stenosis-related hospitalizations between early intervention and guideline-directed conservative management. However, early intervention was associated with lower rates of NYHA class II-IV symptoms and fewer unplanned hospitalizations. The trial highlights the potential symptomatic benefits of early intervention but underscores the need for further research to assess long-term outcomes.

Summary: Cold-Related Deaths in the US (1999–2022) 1. Overview and Trends • Cold-related deaths more than doubled over the study period. • 40,079 deaths recorded; age-adjusted mortality rate (AAMR) rose from 0.44 (1999) to 0.92 (2022) per 100,000 population (109% increase). • A significant upward trend began in 2017, with an annual percentage change (APC) of 12.1%. 2. Demographic Insights • Age: Mortality was highest among individuals aged ≥75 years (4.23/100,000 in 2022). • Largest Increase: Adults aged 45–74 years experienced the steepest rise (APC: 4.8%). • Gender: Males consistently exhibited higher mortality than females, although both increased significantly. • Race/Ethnicity: • Highest Rates: American Indian/Alaska Native populations (6.26/100,000). • Fastest Growth: Hispanic populations (APC: 4.1%). 3. Regional Patterns • Midwest: Highest mortality (1.41/100,000) and steepest increase (APC: 4.3%). • Northeast: Recorded the smallest increase. 4. Public Health Implications • Rising Deaths Despite Global Warming: Likely driven by extreme winter events, homelessness, and social isolation. • At-Risk Populations: Older adults and marginalized communities face the greatest risk. • Recommendations: • Expand access to warming centers. • Enhance community awareness of cold-related risks. • Support research into climate change impacts on health. Conclusion: The sharp increase in cold-related mortality rates highlights the growing importance of climate-adaptive health strategies and targeted interventions for vulnerable populations.

The AZALEA–TIMI 71 trial compared abelacimab, a monoclonal antibody targeting factor XI, with rivaroxaban in atrial fibrillation patients at moderate-to-high stroke risk. 🚨 New study: Abelacimab vs. Rivaroxaban in AFib 📊 ✅ 62-69% lower bleeding risk than rivaroxaban ✅ 5x lower GI bleeding ⚠️ Slightly higher ischemic stroke rates A promising safer anticoagulant? 🔬 More data needed! #CardioTwitter #CardioEd #MedEd Abelacimab significantly reduced bleeding compared to rivaroxaban (HR: 0.38 for 150 mg, 0.31 for 90 mg, p Gastrointestinal bleeding was five times lower with abelacimab. However, ischemic stroke rates were slightly higher. The study highlights abelacimab's potential as a safer anticoagulant, with further phase 3 trials (LILAC–TIMI 76) needed to assess stroke prevention efficacy.

The Tri.Fr Randomized Clinical Trial evaluated the efficacy of Transcatheter Edge-to-Edge Repair (T-TEER) + Optimized Medical Therapy (OMT) versus OMT alone in 300 patients with severe, symptomatic tricuspid regurgitation (TR) across 24 centers in France and Belgium. At 1-year follow-up, 74.1% of patients in the T-TEER group improved, compared to 40.6% in the OMT-alone group (P . T-TEER significantly reduced TR severity, improved NYHA class, patient global assessment (PGA), and Kansas City Cardiomyopathy Questionnaire (KCCQ) scores, and had a high procedural success rate (97.3%) with a low 30-day major adverse event rate (0.7%). The findings support T-TEER as an effective intervention for symptomatic severe TR, warranting long-term follow-up to assess mortality and hospitalization impact.

Three studies examined the health impacts of aircraft noise exposure. The Heathrow Study (2023) found that nighttime aircraft noise increased cardiovascular events, particularly between 22:00–23:00 and 04:30–06:00, likely due to sleep disturbance and stress-related mechanisms. 🚨 New studies link aircraft noise to serious health risks! 🛩️🔊 📌 Nighttime noise boosts heart disease risk 🫀 📌 Increases cognitive decline & dementia risk 🧠 📌 Alters heart structure, raising cardiac event risk 💔 Time for stronger noise regulations! #Health #NoisePollution The Swedish Longitudinal Cohort (2024) linked long-term exposure to aircraft and railway noise to faster cognitive decline and a higher risk of cognitive impairment, while road traffic noise showed no significant effect. The UK Biobank Study (2025) revealed that higher nighttime aircraft noise exposure was associated with adverse cardiac remodeling, leading to an increased risk of major adverse cardiac events, with obesity and hypertension acting as mediators.

🚨 Air traffic controllers face severe fatigue due to the 2-2-1 shift system, causing sleep loss, cognitive impairment & safety risks. 🛑 FAA & NATCA now plan to replace it with a safer schedule to enhance aviation safety. ✈️ #Fatigue #AviationSafety #ATC The 2-2-1 shift system in air traffic control (ATC) compresses five shifts into four days, leading to severe fatigue due to counterclockwise rotation and insufficient rest periods. The FAA's 2024 study found that this schedule causes sleep deprivation, cognitive impairment, and increased safety risks, with 77% of controllers unintentionally falling asleep on duty and 36% falling asleep while driving home. The FAA and NATCA have now agreed to replace this system with a new schedule that prioritizes fatigue management and aviation safety through improved rest periods and scheduling practices.

The POPular PAUSE TAVI trial investigated whether continuing or interrupting oral anticoagulation during transcatheter aortic valve implantation (TAVI) affected clinical outcomes. The randomized, open-label, noninferiority study included 858 patients and assessed a composite primary outcome of cardiovascular death, stroke, myocardial infarction, major vascular complications, or major bleeding at 30 days. The trial found that continuation was not noninferior to interruption, with higher bleeding risk but no significant difference in thromboembolic events, supporting interruption of anticoagulation in high-bleeding-risk TAVI patients.

The six orthodox Indian schools of philosophy—Nyaya, Vaisheshika, Samkhya, Yoga, Mimamsa, and Vedanta—offer valuable insights into the mind-body connection, ethics, logic, and holistic well-being. Understanding these systems can benefit healthcare providers and patients in promoting mental, emotional, and physical health.

The TCW Trial compared TAVI + FFR-guided PCI versus SAVR + CABG in patients with severe aortic stenosis and complex coronary artery disease. This multicenter, randomized controlled trial included 172 patients aged ≥70 years. At 1 year, the primary composite endpoint (death, MI, stroke, revascularization, valve reintervention, or major bleeding) was significantly lower in the TAVI + PCI group (4%) compared to SAVR + CABG (23%), meeting both noninferiority and superiority criteria. The study suggests TAVI + PCI as a safer, less invasive alternative with reduced mortality and bleeding risks in selected patients.

🚑 New studies on #OHCA: No significant survival benefit of intraosseous (IO) over IV access. IV remains the preferred route, with IO as backup. #EmergencyMedicine #CPR #CardiacArrest These 2 randomized clinical trials compared intraosseous (IO) vs. IV vascular access in out-of-hospital cardiac arrest (OHCA). The first study (Denmark) found no significant difference in return of spontaneous circulation (ROSC), 30-day survival, or neurological outcomes between IO and IV access. The second study (UK) showed slightly higher ROSC in the IV-first group but no survival advantage. Both studies suggest IV access should remain the first choice, with IO as a backup when IV is not feasible.

🚨 New study: Evolocumab shows strong CV benefits in older adults (≥75 yrs) with ASCVD! 📉 Lower LDL-C, reduced events (HR: 0.79, NNT: 19), & no major safety concerns. Time to rethink lipid guidelines for seniors? 🔬💙 #Cardiology #LipidLowering #Evolocumab

Lipoprotein(a) [Lp(a)] is a genetically determined risk factor for atherosclerotic cardiovascular disease (ASCVD) and aortic stenosis. Traditional lipid-lowering therapies have minimal impact on Lp(a), necessitating novel treatments. Zerlasiran, a small-interfering RNA (siRNA), significantly reduces Lp(a) (~85%) by inhibiting hepatic apolipoprotein(a) synthesis via subcutaneous injection. Muvalaplin, an oral small-molecule inhibitor, prevents Lp(a) particle formation, reducing levels by up to 85.8%. Both drugs were well-tolerated in Phase 2 trials, with further studies needed to evaluate cardiovascular event reduction.

1. NEJM Article (2024): A 30-year study of 27,939 U.S. women found that high-sensitivity CRP, LDL cholesterol, and lipoprotein(a) independently predicted cardiovascular risk. Higher levels of these biomarkers increased the risk of major cardiovascular events, emphasizing the need for early screening and prevention in women. 2. BrJSportsMed Article (2024): A study of 13,018 women found that even 1–3 minutes/day of vigorous intermittent lifestyle physical activity (VILPA) significantly reduced cardiovascular risk. Women engaging in 3.4 minutes/day had a 45% lower MACE risk and 67% lower heart failure risk, highlighting VILPA as a simple yet effective prevention strategy.

1. "Bioaccumulation of Microplastics in Decedent Human Brains" (Nature Medicine, 2024) This study confirms the presence of microplastics and nanoplastics (MNPs) in human brain tissue, particularly the frontal cortex. Researchers used pyrolysis gas chromatography-mass spectrometry (Py-GC/MS) and electron microscopy to analyze postmortem samples, finding polyethylene (PE) as the dominant plastic type. Brain tissue exhibited significantly higher plastic concentrations than the liver or kidney, with even greater MNP accumulation in individuals diagnosed with dementia. The findings raise concerns about potential neuroinflammation and long-term neurological effects, though causality remains unproven. 2. "Microplastics and Nanoplastics in Atheromas and Cardiovascular Events" (New England Journal of Medicine, 2024) This study investigates the presence of microplastics in atherosclerotic plaques and their potential role in cardiovascular disease. Analyzing carotid artery plaques from patients undergoing endarterectomy, researchers found polyethylene (PE) and polyvinyl chloride (PVC) in 58.4% of plaques. Patients with MNP-containing plaques had a 4.53 times higher risk of heart attack, stroke, or death over a three-year follow-up. The study also linked MNP presence to elevated inflammatory markers (IL-18, IL-1β, TNF-α, IL-6), suggesting that microplastics might exacerbate cardiovascular disease progression.

Kapila: Founder of Samkhya Philosophy Kapila (7th–6th century BCE) is regarded as the founder of the Samkhya school, one of the six orthodox systems of Hindu philosophy. Known for his rational and dualistic approach, he emphasized the distinction between Purusha (consciousness) and Prakriti (matter). His teachings are captured in the Samkhya Sutras and the Bhagavata Purana, where he elaborated on metaphysics, self-realization, and liberation from suffering. Kapila's influence extends to Hinduism, Buddhism, and Jainism, making him a pivotal figure in ancient Indian philosophy.

Coronary CT angiography-guided management of patients with stable chest pain: 10-year outcomes from the SCOT- HEART randomised controlled trial in Scotland Michelle C Williams, Ryan Wereski, Christopher Tuck, Philip D Adamson, Anoop S V Shah, Edwin J R van Beek, Giles Roditi, Colin Berry,Nicholas Boon, Marcus Flather, Steff Lewis, John Norrie, Adam D Timmis, Nicholas L Mills, Marc R Dweck, David E Newby, on behalf of theSCOT-HEART Investigators* Summary Background The Scottish Computed Tomography of the Heart (SCOT-HEART) trial demonstrated that management guided by coronary CT angiography (CCTA) improved the diagnosis, management, and outcome of patients with stable chest pain. We aimed to assess whether CCTA-guided care results in sustained long-term improvements in management and outcomes. Methods SCOT-HEART was an open-label, multicentre, parallel group trial for which patients were recruited from 12 outpatient cardiology chest pain clinics across Scotland. Eligible patients were aged 18–75 years with symptoms of suspected stable angina due to coronary heart disease. Patients were randomly assigned (1:1) to standard of care plus CCTA or standard of care alone. In this prespecified 10-year analysis, prescribing data, coronary procedural interventions, and clinical outcomes were obtained through record linkage from national registries. The primary outcome was coronary heart disease death or non-fatal myocardial infarction on an intention-to-treat basis. This trial is registered at ClinicalTrials.gov (NCT01149590) and is complete. Findings Between Nov 18, 2010, and Sept 24, 2014, 4146 patients were recruited (mean age 57 years [SD 10], 2325 [56·1%] male, 1821 [43·9%] female), with 2073 randomly assigned to standard care and CCTA and 2073 to standard care alone. After a median of 10·0 years (IQR 9·3–11·0), coronary heart disease death or non-fatal myocardial infarction was less frequent in the CCTA group compared with the standard care group (137 [6·6%] vs 171 [8·2%]; hazard ratio [HR] 0·79 [95% CI 0·63–0·99], p=0·044). Rates of all-cause, cardiovascular, and coronary heart disease death, and non-fatal stroke, were similar between the groups (p>0·05 for all), but non-fatal myocardial infarctions (90 [4·3%] vs 124 [6·0%]; HR 0·72 [0·55–0·94], p=0·017) and major adverse cardiovascular events (172 [8·3%] vs 214 [10·3%]; HR 0·80 [0·65–0·97], p=0·026) were less frequent in the CCTA group. Rates of coronary revascularisation procedures were similar (315 [15·2%] vs 318 [15·3%]; HR 1·00 [0·86–1·17], p=0·99) but preventive therapy prescribing remained more frequent in the CCTA group (831 [55·9%] of 1486 vs 728 [49·0%] of 1485 patients with available data; odds ratio 1·17 [95% CI 1·01–1·36], p=0·034). Interpretation After 10 years, CCTA-guided management of patients with stable chest pain was associated with a sustained reduction in coronary heart disease death or non-fatal myocardial infarction. Identification of coronary atherosclerosis by CCTA improves long-term cardiovascular disease prevention in patients with stable chest pain.

Anaximander of Miletus (c. 610 – c. 546 BCE), a pre-Socratic philosopher and student of Thales, was a pioneer of cosmology, astronomy, and natural philosophy. He introduced the concept of the apeiron (infinite) as the origin of all things, developed early theories on evolution, and created one of the first world maps. His revolutionary ideas laid the groundwork for scientific thinking and inspired generations of philosophers and scientists.

"The Protein Puzzle: Debunking Myths About Protein Deficiency in India" This episode explores and debunks the myth of protein deficiency in India, highlighting that most Indians meet their protein needs through balanced diets. It explains the Protein-to-Energy Ratio (PER) and how traditional food pairings like cereals and legumes enhance protein quality. Key insights include varying protein needs across age groups, the risks of overconsumption, and practical tips for improving dietary protein through affordable, accessible options. The episode emphasizes that protein is a vital part of a holistic diet, naturally achieved through thoughtful planning and traditional practices.

Gargi Vachaknavi, an esteemed philosopher and Vedic scholar of ancient India, is celebrated as one of the earliest female intellectuals in recorded history. Known for her profound knowledge of Brahma Vidya, she engaged in rigorous philosophical debates, including a renowned discourse with sage Yajnavalkya on the nature of existence and the ultimate reality. Revered as a Brahmavadini, Gargi contributed significantly to the intellectual and spiritual traditions of Vedic India, inspiring generations with her wisdom and critical thinking.

"Discover the legacy of Thales of Miletus, the first Greek philosopher and one of the Seven Sages. Known for proposing 'all is water,' pioneering geometry, and predicting a solar eclipse, he laid the foundation for science and rational inquiry. #Philosophy #Thales"

Explore timeless wisdom with Dr. RR Baliga's Philosophical Discourses! Dive into the teachings of Yajnavalkya: Vedic Sage and Philosopher and more, blending ancient philosophy with modern insights.

COVID-19 in Patients with Heart Disease and Cancer Dr RR Baliga's 'Got Knowledge Doc' Podcasts for Physicians Coronaviruses and the Cardiovascular System Coronavirus Fulminant Myocarditis Case Review COVID-19 in Patients with Cardiovascular Disease and Cancer Sarju Ganatra, Sarah P. Hammond, Anju Nohria JACC: CardioOncology:Accessed online March 20, 2020 Not Medical Advice or Opinion

Not Medical Advice or Opinion

MINOCA=Myocardial Infarction with Non-Obstructive Coronary Arteries

Nature NEWS AND VIEWS 14 May 2024 The phenomenon of genomic imprinting was discovered 40 years ago Some genes carry an 'imprint' on either the maternal or the paternal copy, which determines whether or not that copy is expressed. This 1984 discovery changed how scientists think about gene regulation and inheritance. By Anne C. Ferguson-Smith & Marisa S. Bartolomei https://www.nature.com/articles/d41586-024-01338-4

Dr RR Baliga's 'GOT KNOWLEDGE DOC' Podcasts for Physicians: Cardio-Oncology Rehabilitation in Cancer Patients and Survivors derived from Cardio-Oncology Rehabilitation in Cancer Patients and Survivors: AHA Scientific Statement Circulation. 2019;139:e997–e1012 Not Medical Advice or Opinion

This episode explores the therapeutic potential of singing for cardiovascular health, highlighting its benefits on respiratory function, emotional well-being, and heart rate variability. It discusses the physiological responses to singing, comparable to moderate exercise, and emphasizes the need for further research to validate these findings. Join us as we delve into how singing could become a holistic approach to heart health. Baliga RR. Sing for a long and healthy life? Eur Heart J. 2024 Apr 12:ehad819. doi: 10.1093/eurheartj/ehad819. Epub ahead of print. PMID: 38607286. https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehad819/7644698?login=false

EKG Sunday | Is this benign? |Dr RR Baliga's "MUST KNOW EKG" Podkast for Physicians

Fluoropyrimidine Cardiotoxicity |Not Medical Advice or Opinion|

Connecting the Dots Between Cardio-Oncology & Door-to-GDMT Time for Heart Failure

Trastuzumab Deruxtecan in Previously Treated HER2-Low Advanced Breast Cancer | NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2203690#.YsoGdaAS_fY.twitter DESTINY-Changing Results for Advanced Breast Cancer | NEJM https://www.nejm.org/doi/full/10.1056/NEJMe2206661#.YsoGjty1ahE.twitter Early Detection and Monitoring of Vulnerable Myocardium in Patients Receiving Chemotherapy: Is It Time to Change Tracks? https://www.heartfailure.theclinics.com/article/S1551-7136(11)00037-7/fulltext#.YsoHTLcs3-M.twitter Using a Magnet to Strike Gold https://www.heartfailure.theclinics.com/article/S1551-7136(09)00026-9/fulltext#.YsoG3Cq5rAs.twitter

Dr Baliga's 'Got Knowledge Doc' PODKASTS for Physicians: on 'Hypertension in the Cardio-Oncology Clinic' Not Medical Advice or Opinion

Artificial Intelligence & Machine Learning Primer for PHYSICIANS Dr RR Baliga's GOT KNOWLEDGE DOC PodKasts associated with Baliga's Textbook of Medicine with 1480 MCQs available at www.MasterMedFacts.com

Cardiovascular Events with CHOP/RCHOP in Non-Hogkin's - Dr RR Baliga's 'Got Knowledge Doc' PODCASTS for Physicians Published in Lancet Hematology Online March 2nd, 2020 https://doi.org/10.1016/S2352-3026(20)30031-4 Not Medical Advice or Opinion