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In the science of life all the aspects of human being health are clearly mentioned. Due to change in day to day life style, the superiority of human health is falling. Dreadful change in life style has led to disorders like obesity, diabetes. Among these is observed commonly in obesity. Metabolic disorders are discussed in Ayurveda under Sthaulya. Panchakarma the five major procedures of Ayurveda play a role in the management of metabolic disorders. Panchakarma by its Shodhana therapy effect is intended for purification of the body by which the accumulated morbid humours responsible for disease are expelled out to produce an ideal environment for proper functioning of body. However, Sthaulya being Atisthula conditions Panchakarma is not prescribed as a treatment modality. Panchakarma has a major therapy role as promotive, preventive and curative procedure. So there arises a need to practice Panchakarma according to classical in medical situations like Sthaulya so that Panchakarma can be justified as a modality of management in various severe medical conditions in preventive and curative aspects.

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Purpose of review Coronary artery disease (CAD) is commonly observed in patients undergoing transcatheter aortic valve replacement (TAVR). Significant variability exists across institutions for strategies used for CAD diagnosis and its management. The heart team often relies upon traditional practice patterns and the decision for revascularization by percutaneous coronary intervention (PCI) is influenced by patient, angiographic, operator, and system-related factors. Recent findings Contemporary coronary tomography angiography (CTA) shows significant promise for detection of clinically important CAD and preliminary data support CTA use for TAVR patients. The prognostic implications of CAD in a TAVR population remain unclear with studies showing conflicting data for the benefits of PCI. Recent trials show that medical management is an effective initial treatment strategy for stable CAD, a finding likely also applicable for asymptomatic and stable TAVR patients. In addition, PCI performed pre-TAVR, concomitant with TAVR or after TAVR has been shown to produce similar outcomes. Dual antiplatelet therapy (DAPT) is mandated after PCI but associated with increased risk of bleeding in TAVR population with accumulating evidence for single antiplatelet therapy (SAPT) post-TAVR unless DAPT or anticoagulation is indicated for another reason. Summary Although coronary angiography remains the predominant modality for CAD assessment, CTA is increasingly being used in TAVR patients. There is limited evidence to guide CAD management in TAVR patients with significant variability in practice patterns. Medical therapy is recommended for asymptomatic and stable CAD patients with applicability for TAVR population. Despite prior concerns, recent studies suggest successful coronary access post-TAVR and similar outcomes for PCI offered pre-TAVR, concomitant with TAVR and post-TAVR settings. Safety of DAPT should be an important consideration for PCI in TAVR patients. Ongoing studies will determine the preferred testing for CAD diagnosis, benefit of revascularization, timing of PCI, and optimum antithrombotic therapy for TAVR populations.

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