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Abstract: To cope with environmental issues, scientists strive to develop innovative materials and methods. Bismuth vanadate (BiVO4) has attracted attention because of its significant characteristics like low toxicity, corrosion resistance, photo-stability, narrow band-gap, and ability to provide better efficiency invisible light. However, fast recombination of charge carriers limits its photocatalytic activity. Many researchers have improved BiVO4 properties by metal doping and coupling with other semiconductors to improve charge separation and photocatalytic activity. This review addressed the recent improvement in BiVO4 structural modification by doping and composite formation using metal and non-metals and compared the efficiency with pure one. In addition, BiVO4 synthesis and application are also extensively discussed, such as dye degradation, water splitting, and water purification. This review can be beneficial for researchers and those interested in exploring and evolving BiVO4-based material as an efficient photocatalyst.

To compare outcomes in Sapien 3 Ultra (S3U) transcatheter aortic valve replacement (TAVR) with extreme annular undersizing (EAU) versus nominal annular sizing (NAS).The Edwards S3U valve has reduced paravalvular leak (PVL) in TAVR but outcomes remain unknown in extremely undersized anatomy. Implanting a smaller S3U valve may facilitate future redo-TAVR but risk compromising hemodynamics.From December 2019 to July 2021, 366 patients with native aortic stenosis underwent S3U TAVR. Patients with EAU (annular areas430 mmThere were 79 (21.6%) EAU patients, with more bicuspid (p = 0.0014) and ≥moderate annular/left ventricular outflow tract calcification (p 0.001). The EAU group had less annular oversizing than NAS group (23 mm: -8.2 ± 2.6% vs. 4.0 ± 7.0%, p 0.001; 26 mm: -8.9 ± 2.2% vs. 6.7 ± 6.9%, p 0.001), more balloon overfilling (71.3% vs. 11.6%, p 0.001), and postdilatation (15.0% vs. 5.8%, p = 0.016). No differences were found in in-hospital or 30-day mortality and stroke (p 0.05). Mild PVL (13.4% EAU vs. 11.5% NAS, p = 0.56) and mean gradients (23 mm: 13.0 ± 4.5 vs. 14.1 ± 5.4 mmHg, p = 0.40; 26 mm: 11.4 ± 4.1 vs. 11.5 ± 3.9 mmHg, p = 1.0) were similar at 30 days. Had the EAU group undergone NAS with the larger Sapien 3/S3U, by computed tomography analysis simulating 80:20 or 90:10 target implant depth, 33.3%-60.9% (vs. 4.3%-23.2%) would not be feasible for redo-TAVR due to high risk of coronary obstruction.In this first report of EAU with S3U TAVR, similar excellent short-term outcomes can be achieved compared to NAS, and may preserve future redo-TAVR option.

Use of both rotational atherectomy (RA) and intravascular lithotripsy (IVL)-the "RotaTripsy" technique-offers a potentially synergistic calcium-modification strategy that can treat both luminal and abluminal calcification. An upfront RotaTripsy strategy using an undersized burr in large-caliber coronaries also offers the advantage of facilitating IVL catheter passage while being able to undertake the procedure with a 6-Fr system.Consecutive patients with heavily calcified lesions on angiographic or intravascular imaging and large target-vessel caliber (≥3 mm) who underwent an upfront RA followed by IVL between July 2021 and January 2022 were included in this study. Study aims were to evaluate periprocedural efficacy and safety.Of the 21 patients included, RotaTripsy was used for treatment of de novo lesions in 12 patients (57%) and for in-stent-restenosis in 9 patients (43%). Seven cases of in-stent restenosis (ISR) involved 2 layers of stents. Mean reference vessel diameter was 3.67 ± 0.46 mm and baseline diameter stenosis was 77.4 ± 11.3%. Average RA burr-to-artery ratio was 0.43 ± 0.05 and IVL balloon-to-artery ratio was 0.93 ± 0.06, with IVL balloon crossing the lesion in all cases following RA. Procedural success was attained in 20 of 21 cases; 1 periprocedural complication (a death related to coronary perforation following stent postdilation) was recorded.An upfront RotaTripsy strategy is associated with a high degree of procedural success in de novo lesions and ISR cases by facilitating the use of a smaller burr-to-artery ratio and smaller-bore vascular access. Larger studies are required to further evaluate the potential benefits of an upfront RotaTripsy strategy from a safety and cost-benefit perspective.

Peripheral artery disease (PAD) remains a major cause of morbidity and future cardiovascular events despite advancement in the surgical interventions and optimal medical therapy. The aim of our study is to evaluate the efficacy and safety of anticoagulation (AC) therapy for reducing cardiovascular and limb events in patients with PAD. PUBMED, Medline, and Cochrane Library were searched through 2020 for randomized clinical trials comparing major adverse cardiovascular events (MACE) and risk of major bleeding (MB), between AC and standard of care (SOC) therapy, among patients with PAD. Meta-analysis was performed using weighted pooled absolute risk difference (RD) with 95% confidence interval (CI) and fixed effects model for overall and sub-groups of full dose (FD) and low dose (LD) AC therapies. Amongst 17,684 patients from 7 different studies, the addition of AC to SOC therapy was associated with MACE reduction (RD -0.022, 95% CI -0.033 to -0.012, p0.001) and increased MB (RD 0.02, 95% CI 0.014 to 0.025, p0.001). For FD, MACE reduction was (RD -0.021, 95% CI -0.042 to 0.001, p = 0.061) and MB (RD 0.036, 95% CI 0.025 to 0.047, p0.001). For LD, MACE reduction was (RD -0.023, 95% CI -0.035 to -0.011, p0.001) and MB (RD 0.011, 95% CI 0.005 to 0.017, p0.001). In conclusion, addition of AC to the current SOC therapy can mitigate future MACE events in patients with PAD albeit at risk of increased bleeding. LD AC is associated with an efficacy/safety net benefit compared to FD AC therapy.

Despite current valve guidelines recommending both transcatheter and surgical aortic valve replacement (TAVR and SAVR, respectively) in patients with symptomatic severe aortic stenosis (AS), TAVR has recently become the preferred treatment over SAVR, driven by its minimal invasiveness, faster recovery and earlier improvement in quality of life. However, several limitations and unresolved issues remain with TAVR, including stroke, conduction system disorder, durability, bicuspid anatomy, coronary reaccess and lifetime management with aortic valve reintervention. Our review aims to highlight the above issues and discuss them in depth, to demonstrate the complementary role of TAVR and SAVR in the treatment of AS.

Ellis Type III cavity spilling coronary perforation is a rare complication. We report to our knowledge, the first case of rotational atherectomy induced Type III cavity spilling coronary perforation of right posterior descending artery draining into middle cardiac vein, successfully managed by covered stent deployment. (Level of Difficulty: Advanced.), Graphical abstract, Ellis Type III cavity spilling coronary perforation is a rare complication. We report to our knowledge, the first case of rotational atherectomy…

Introduction Numerous case series have reported on the baseline characteristics and in-hospital mortality of patients with COVID-19, however, these studies included patients localized in a specific geographic region. The purpose of our study was to identify differences in the clinical characteristics and the in-hospital mortality of patients with a laboratory-confirmed diagnosis of COVID-19 internationally. Methods A comprehensive search of all published literature on adult patients with laboratory-confirmed diagnosis of COVID-19 that reported on the clinical characteristics and in-hospital mortality was performed. Groups were compared using a Chi-square test with Yates correction of continuity. A two-tailed p value of less than 0.05 was considered as statistically significant. Results After screening 516 studies across the globe, 43 studies from 12 countries were included in our final analysis. Patients with COVID-19 in America and Europe were older compared to their Asian counterparts. Europe had the highest percentage of male patients. American and European patients had a higher incidence of co-morbid conditions (p

Acute pulmonary thromboembolism is associated with high mortality, similar to that of myocardial infarction and stroke. We studied the clinical presentation and management of pulmonary thromboembolism in the Indian population. An analysis of 140 patients who presented with acute pulmonary thromboembolism at a large volume center in India from June 2015 through December 2018 was performed. The mean age of our study population was 50 years with 59% being male. Comorbidities including deep vein thrombosis, diabetes mellitus, hypertension, and chronic obstructive pulmonary disease were present in 52.9%, 40%, 35.7% and 7.14% of patients, respectively. Out of 140 patients, 40 (28.6%) patients had massive pulmonary thromboembolism, 36 (25.7%) sub-massive pulmonary thromboembolism, and 64 (45.7%) had low-risk pulmonary thromboembolism. Overall, in-hospital mortality was 25.7%. Multivariate regression analysis found chronic kidney disease and pulmonary thromboembolism severity to be the only independent risk factors. Thrombolysis was performed in 62.5% of patients with a massive pulmonary thromboembolism and 63.9% of patients with a sub-massive pulmonary thromboembolism. In the massive pulmonary thromboembolism group, patients receiving thrombolytic therapy had lower mortality compared with patients who did not receive therapy ( p =0.022), whereas this difference was not observed in patients in the sub-massive pulmonary thromboembolism group. We conclude that patients with acute pulmonary thromboembolism in India presented more than a decade earlier than our western counterparts, and it was associated with poor clinical outcomes. Thrombolysis was associated with significantly reduced in-hospital mortality in patients with massive pulmonary thromboembolism.

Dual antiplatelet therapy (DAPT) is the cornerstone of pharmacological therapy preventing atherothrombotic complications. Advances in drug-eluting stent technology, antiplatelet pharmacotherapy, and novel parenteral and oral anticoagulants (OAC) have led to constant evolution in periprocedural antithrombotic strategy. The following chapter outlines our cardiac catheterization laboratory’s current approach to antiplatelet and anticoagulation therapy in various clinical settings based on current guidelines and expert opinion.

Acute coronary syndrome is a spectrum ranging from ST-elevation myocardial infarction to troponin-negative unstable angina. Plaque rupture or erosion leads to thrombus formation resulting in ischemic myocardial damage. Current guidelines recommend primary angioplasty for patients with STEMI and early invasive strategy (

Covid-19 disease can involve any organ system leading to myriad manifestations and complications. Cardiovascular manifestations are being increasingly recognised with the improved understanding of the disease. Acute coronary syndrome, myocarditis, arrhythmias, cardiomyopathy; heart failure and thromboembolic disease have all been described. The elderly and those with prior cardiac diseases are at an increased risk of mortality. Overlapping symptomatology, ability of drugs to cause QTc interval (start of Q wave to the end of T wave) prolongation on electrocardiogram and arrhythmias, potential drug interactions, the need to recognise patients requiring urgent definitive management and provide necessary bedside interventions without increasing the risk of nosocomial spread have made the management challenging. In the background of a pandemic, non-Covid-19 cardiac patients are affected by delayed treatment and nosocomial exposure. Triaging using telemedicine and artificial intelligence along with utilization of bedside rapid diagnostic tests to detect Covid-19 could prove helpful in this aspect.

In patients undergoing cardiac resynchronization therapy with defibrillator (CRT-D) implantation for left ventricular systolic dysfunction (LVSD) accompanied by permanent atrial fibrillation (AF), generally, the unused atrial port is plugged at device implantation. We describe an alternative use for the atrial-port in this case report. A 43 year old gentleman with LVSD due to left ventricular non-compaction (LVNC) and AF of unknown duration underwent a CRT-D implantation after optimization of cardiac failure treatment. The atrial-port which would otherwise have been plugged was connected to a high right ventricular septal (RVS) pacing-lead and the shock-lead was positioned at the right ventricular apex (RVA). This approach permitted modified cardiac resynchronization in a high RVS to left ventricular (LV) and RVA pacing sequence using the high RVS and LV pacing combined with a shock vector including the RV apex. A standard CRT-D device with a minimum programmable A–V delay of 30 ms (technically RVS to LV delay in the ‘DDD’ pacing mode) was used. The device was programmed to a ‘DDD’ pacing mode (sequential multi-site ventricular pacing with some programmability). The mode switch operation was programmed ‘OFF’ since atrial sensing is unavailable. Device-delivered shocks did not cardiovert the patient back to sinus rhythm suggesting that the AF was permanent (no prior cardioversion attempts were made on the presumption that the chances of maintaining sinus rhythm, given the underlying cardiac condition, were low). Subsequently, the patient required radio-frequency ablation of the atrio-ventricular node for conducted AF. Symptomatic, echocardiographic and radiological improvement preceded atrio-ventricular node ablation. Conclusion Amongst AF patients with permanent AF undergoing CRT-D implantation, those patients who are likely to have the CRT-D device atrial-ports plugged could benefit from having both the options of (i) a RVA shock vector as well as (ii) a high RVS-pacing feasible, by utilizing the atrial-port of a conventional CRTD device for a RVS pacing lead, should a RVA shock-lead position be preferred. New device programming algorithms will be necessary to make patient-customized programming in this lead configuration flexible, more useful clinically and easy.

AimsIn India, larger proportions of patients with ACS present with STEMI. We sought to study the recent trends of reperfusion in patients of acute STEMI.Methods and Results1905 patients presenting with acute STEMI enrolled. 1636 (86%) received some form of reperfusion therapy. Streptokinase, 1235 (65%) patients, was the most common mode of reperfusion therapy used followed by primary PCI (205, 10.7%) and tenecteplase (196, 10%). 269 (14%) did not receive any form of reperfusion therapy, the most common reason being late presentation in 230 (85.7%). Patients presenting with STEMI increased from 297 to 446 comparing first and last half-year of study period. The PCI and tenecteplase numbers increased from 19 to 68 and 27 to 97 respectively.ConclusionThere was 20% increase in STEMI every year. Younger patients are least likely to receive primary PCI or tenecteplase. 1 in 8 patients of STEMI did not receive any form of reperfusion therapy.

Pacemaker infection with Mycobacterium chelonae has not been reported previously. We report the first case of pacemaker lead endocarditis due to M. chelonae, which was successfully treated with multidrug regimen. M. chelonae is regarded as an environmental bacterium and its pathogenicity has been recognised recently. The present case illustrates its ability as a primary invader should not be underestimated, especially in an immunocompetent patient with indwelling devices. Epidemiology and management of this rare cause of culture-negative endocarditis is discussed.

Doctor and the Healing Touch Doctors have been since ages, put on the pedestal of being GOD, but in recent fast pacing world, where materialism and corruption has crept into every aspect of life, where everything is weighed in terms of money, where doctor patient relationship has turned into customer driven marketing, where I see corporate hospitals selling health packages and salesmanship at its best for satisfying their customers (patients), I wonder, ‘Is the golden era still alive?’ I wonder ‘Are we are deviating away from the original field of medicine?’ As a young doctor who has just entered the world of clinical medicine, the spectacularity of this so called noble profession has triggered many questions and it has posed many enigmas in my mind. This article aims to discover the unsaid aspects and so called healing touch of medical profession and the clinical experiences in this rigorous, competitive, hard, sensitive, perplexing, enigmatic world of medicine and it presents the perspective and analysis through the eyes of a young medico, for the question: ‘Is medicine going the right way or is it deviating???’ ‘Has the golden era gone?’ “He has a gentle touch to wipe all tears Loving hand to support all in fear Someone with ability and knowledge to give advice Someone next to God, who can save a precious life!” This noble pedestal of being next to God has been given to a doctor who is healing the world around him or is it just an illusion or mere imagination? Has the world come to a point where in this materialistic post Y2K generation, materialism has eroded the true value of medicine, role of doctors often being confined to prescribing pills and filling his /her pockets? Is Medicine being chosen as Profit Producing Career? Is Profession of Medicine at the verge of dying? Objective evidences for the same need no clinical experience. A very look at newspapers selling health is the evidence of health marketing. A newspaper article advertising hysterectomy at the cheapest possible price is tempting enough for anyone to think even without indication i.e. ‘Should we get it done as it could the best deal that is ever available?’ It may sound bizarre, but I had few young patients asking me whether it was a viable option!!!! But there is no denying of the fact that even in this era of materialism and industrialization, even in this corrupt world, many noble doctors are standing up to serve the world. Yes, we have numerous examples of those moving against time and making a difference to others life with their empathy, wisdom and knowledge. I hope, wish and desire that young doctors of tomorrow may inherit this empathy, efficiency and humility that many luminary doctors of today have. Having known and read about fake medicines, doctors selling themselves to pharmaceutical companies and many stories of disgraceful acts, I still believe that heart of medicine is still beating, with endless number of medicos rendering their lives to serve humanity. Is it right to disgrace the whole profession for the misdeeds of sparingly few doctors? With growing medico legal controversies, many false cases being filed by patients against doctors, with unreasonable expectations, with growing number of patients who are considering medical practice as a market for buying service on demand, patients demand unreasonable investigations and demand to prescribe their Google searched information without realizing their clinical conditions. I sometimes wonder as to why the doctor has to be blamed when the patient demands to buy health as a commodity. After years of hard work in the medical school, sleepless nights, relentless work, perspiration and struggle, is it unjust and cruel for a doctor to demand a decent life?

International audience; Analysis of intrinsic symmetries of non-rigid and articulated shapes is an important problem in pattern recognition with numerous applications ranging from medicine to computational aesthetics. Considering articulated planar shapes as closed curves, we show how to represent their extrinsic and intrinsic symmetries as self-similarities of local descriptor sequences, which in turn have simple interpretation in the frequency domain. The problem of symmetry detection and analysis thus boils down to analysis of descriptor sequence patterns. For that purpose, we show two efficient computational methods: one based on Fourier analysis, and another on dynamic programming. Metaphorically, the later can be compared to finding palindromes in text sequences.

A 24-year-old man presented with a history of persistent neck pulsations with two episodes of transient ischaemic attack. His cardiovascular examination was unremarkable except for a bilateral carotid bruit. An arch angiogram in left anterior oblique 45° view revealed a dilated aortic root (annulus size 50.6 mm), an aneurysmal brachiocephalic trunk, …

Stroke in young poses a major health problem. Thrombophilic factors have been implicated in 4-8% of the young strokes worldwide. Protein S deficiency is a rare cause of recurrent ischemic stroke in young population. Only a few sporadic cases have been described in the literature. We are reporting a case of protein S deficiency-related recurrent ischemic stroke in a 16-year-old girl. Early diagnosis and targeted approach can help such patients to prevent recurrent thrombotic episodes.

Aims Coronary artery disease is the leading cause of mortality and morbidity in our country, of which ST elevation myocardial infarction (STEMI) accounts for the major part of health spending. We sought to study the effect of induction of government health insurance scheme on the trends of reperfusion in patients of acute STEMI. Methods and results 1133 patients presenting with acute STEMI enrolled. 1079 (95.1%) received some form of reperfusion therapy. Primary PCI was used in 60.6% of patients as the primary reperfusion modality, a six fold increase as compared to previous years. Government health insurance accounted for the one third of all. 34.5% patients underwent pharmacological reperfusion, most commonly with streptokinase. 4.9% patients of STEMI did not receive any form of reperfusion therapy in contrast to 14% during previous years. Conclusion Introduction of government health insurance along with increased awareness has resulted in dramatic changes in the management of STEMI patients.