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Background: Medical students are well known to work long hours, have financial difficulties, and face intense competition to succeed which may predispose them to significant psychological stress. Physical Activity may provide relief to stress in this population. Objectives: To evaluate the effect of physical activity on the reduction of stress in medical students in a developing country. Methods: Between April and May 2015, medical students at a private medical college within Karachi, Pakistan participated in a cross-sectional study to evaluate physical activity and stress levels. Questionnaires were distributed to all medical students by convenience sampling. A three-part questionnaire was developed based on the Perceived Stress Score to evaluate for the presence of stress. Patient demographics, Perceived Stress Score, participation, and the total duration of physical activity per week were obtained. Participants were also instructed to answer questions on other activities that they may be performing intending to relieve stress. Results: A total of 235 participants were identified for further analysis. Based upon the Perceived Stress Scale (PSS), 30.3% of the medical students were found to have evidence of the stress with a mean PSS score of 16.95 ± 5.72. Participation in physical activity was found to cause a reduction in stress levels with medical students not reporting exercise is twice as likely to be stressed (OR 0.48, p = 0.015). Besides, the total duration of physical activity per week (>4 vs Conclusion: Both participation and longer duration of physical activity per week are associated with a significant reduction in stress levels within medical students., Butt N, Bader N, Khan MN, Allana A, Ashraf A, Siddiqui D, Baig MH, Mahmood A, Malik A, Khalek IS, Saleem S. The effect of physical activity on stress levels of medical students: a cross-sectional analysis. Pak J Surg Med. 2020;1(2):100-105. doi: 10.37978/pjsm.v1i2.167

The automated internal cardiac defibrillator or shock box is the common name given to the Implantable Cardioverter Defibrillator (ICD). ICD is a state-of-the-art device that treats arrhythmias specifically those of ventricular origin like ventricular tachycardia and fibrillation. It has become the first line of defense in patients who are at high risk for sudden cardiac death (SCD) and has shown consistent survival benefit in cardiac arrest survivors (SCA), in patients with Heart failure and severe systolic dysfunction (left ventricular ejection fraction-LVEF less than or equal to 35%) as well as in patients with hypertrophic cardiomyopathy (HCM).[1][2] ICD is essentially a pacemaker with the ability to recognize abnormally fast cardiac rhythm and provide an immediate treatment which can be in the form of overdrive pacing called anti-tachycardia pacing (ATP) or shock therapy which could be synchronized or asynchronized, depending on the recognized rhythm and the pre-programmed rhythm detection algorithm. It comes in three systems, a single lead or single chamber device, a dual lead or a dual-chamber device, and one that is coupled with cardiac resynchronization therapy (CRT-D) that is essentially a bi-ventricular device with leads in the right atrium (RA), Right ventricle (RV) and coronary sinus (CS) lead. Due to its proximity, CS lead is also called the LV lead. In 2012, the US Food and Drug Administration (FDA) approved the sub-cutaneous device (S-ICD) which used sub-cutaneous leads rather than intra-cardiac leads. Recently, wearable defibrillators (WCD) have also been introduced for short-term usage., (Copyright © 2022, StatPearls Publishing LLC.)

Coronary artery calcification (CAC) is an independent predictor for major cardiovascular events.[1][2][3][4] Additionally, coronary calcium deposition can hinder successful percutaneous coronary intervention (PCI) as a result of inadequate stent expansion, difficulty transiting the catheter through a calcified lesion, coated drug separation from a stent, proclivity for in-stent restenosis and stent thrombosis, and a change to the underlying pharmacokinetics. Consequently, PCI of calcified lesions correlates with worse outcomes.[5]  Shockwave intravascular lithotripsy (IVL) is a novel technique evolved from the established therapy for renal and ureteral calculi that utilizes a percutaneous device to produce acoustic pressure waves resulting in the delivery of energy to break superficial and deep calcium deposits and aid with the subsequent deployment of a vascular stent.[6][7][8] Guidance with an intravascular imaging device either with intravascular ultrasound or optical coherence tomography is crucial in defining the calcium density and choosing the optimal lesion modification strategy, i.e., rotational atherectomy, orbital atherectomy or IVL.[9][10][11][12][13] The feasibility and safety of IVL in the peripheral vasculature was shown in the Disrupt Peripheral Arterial Disease (PAD) studies and the Disrupt Below the Knee (BTK) study.[14][15][16] The Disrupt PAD III study (ClinicalTrials.gov Identifier: NCT02923193) is currently an ongoing prospective multicenter single-arm observational study assessing treatment of moderate and severely calcified femoropopliteal arteries. The disrupt Coronary Artery Disease studies I and II demonstrated the safety and feasibility of IVL in calcified coronary lesions.[17][6] The Disrupt CAD III (ClinicalTrials.gov Identifier: NCT03595176) is an ongoing prospective, multicenter, single-arm study evaluating the safety and effectiveness of IVL in de novo calcified coronary arteries., (Copyright © 2022, StatPearls Publishing LLC.)