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To assess the prevalence of Iron Deficiency and impact of Parenteral Iron therapy in patients with Symptomatic Heart failure, the role of exercise capacity and serial Echocardiography in assessing treatment response.Study was performed in a Government Hospital for 24 months, December 2017 to December 2019.120 participants were recruited. Patients with symptomatic heart failure and Serum Ferritinlt;100 mg/dl were recruited and those with diagnosed Ischemic Cardiomyopathy or unwilling to give consent were excluded. They underwent a functional assessment and 2D Echo at baseline, after 30 and 90 days of IV Carboxymaltose. The data was analysed represented in appropriate figures. A P valuelt;0.05 was considered significant.Of 120 patients recruited, 28 were male and 92 were female. The mean age of presentation was 44 +/- 5.4 years. The Mean baseline Haemoglobin was 11.7 +/- 0.38 gm/dl.The baseline Ferritin levels were 16.69 +/-2.9 ug/L. HFpEF was predominant with 65% cases. The NYHA status and 6min HWT tests showed a statistically significant improvement and Echocardiography findings showed a statistically insignificant improvement after Parenteral Iron.Iron Deficiency is a major risk factor in Heart Failure including HFpEF and prevails in the younger population.Parenteral Iron Carboxymaltose followed by oral iron supplementation is effective in Heart Failure patients, especially in HFpEF. Functional capacity and NYHA status appear to be the time tested markers for Iron repletion.

Introduction Intracoronary imaging by means of optimal coherence tomography (OCT) provides valuable incremental information that can be used clinically to optimize stent implantation and minimize stent-related problems. Over the past decades, OCT has progressively evolved with respect to technical performance and procedural aspects. Principle OCT is a fiberoptic wire with a rotating lens emitting near infrared (1,300 nm) light and records the light reflected from the tissue. The currently used Fourier domain-OCT allows superior image quality and faster image acquisition. OCT in Acute Coronary Syndrome (ACS) It helps in accurate detection of actual event leading to ACS among plaque rupture, plaque erosion, and calcified nodule. OCT has an advantage over intravascular ultrasound for identification of vulnerable plaque and also detection of thin cap fibroatheroma < 65 µm. Clinical Utility OCT helps in diagnosis of an angiographically ambiguous lesion such as dissection, thrombus, and calcified nodule. It also helps in planning different aspects of percutaneous coronary intervention such as lesion preparation, determining stent size and length and also helps in optimization of results of stent deployment.Certain nonatherosclerotic events such as coronary arteritis can be diagnosed with OCT.Continued advancement in technology, faster image acquisition, and more sophisticated coregistered image analysis will facilitate greater adoption through ease of use and interpretation.

Policymakers need insight from humanities and social sciences to tackle the pandemic. Policymakers need insight from humanities and social sciences to tackle the pandemic.

Without human insights, data and the hard sciences will not meet the challenges of the next decade, says Hetan Shah. Without human insights, data and the hard sciences will not meet the challenges of the next decade, says Hetan Shah.

Background: Quantification of mitral regurgitation (MR) has always required an “integrated approach” as there is no single gold-standard method. We investigated a new Doppler-derived parameter “left ventricular early inflow-outflow index (LVEIO)” for the quantification of MR and its likelihood to predict severe MR in correlation with already established parameters in an Indian population including a large subset of patients with rheumatic etiology. Methods: A prospective study was performed at a major tertiary care center in western India over a 5-month period. Five hundred patients diagnosed with isolated MR including 260 (52%) patients with rheumatic etiology were included in the study after applying exclusion criteria. We analyzed MR using color flow jet, effective regurgitant orifice area (EROA), and vena contracta (VC) width. LVEIO is a simplification of the regurgitant volume (RV) method, which was calculated as “E velocity divided by LV outflow velocity integrated over the systolic ejection period left ventricular outflow tract velocity time integral” and compared with the established parameters. Results: LVEIO was 4.65 ± 1.45, 6.56 ± 1.52, and 9.91 ± 3.70 among patients diagnosed with mild, moderate, and severe MR, respectively (p

There is enormous opportunity for positive social impact from the rise of algorithms and machine learning. But this requires a licence to operate from the public, based on trustworthiness. There are a range of concerns relating to how algorithms might be held to account in areas affecting the public sphere. This paper outlines a number of approaches including greater transparency, monitoring of outcomes and improved governance. It makes a case that public sector bodies that hold datasets should be more confident in negotiating terms with the private sector. It also argues that all regulators (not just data regulators) need to wake up to the challenges posed by changing technology. Other improvements include diversity of the workforce, ethics training, codes of conduct for data scientists, and new deliberative bodies. Even if these narrower issues are solved, the paper poses some wider concerns including data monopolies, the challenge to democracy, public participation and maintaining the public interest. This article is part of a discussion meeting issue ‘The growing ubiquity of algorithms in society: implications, impacts and innovations’.

Severe pulmonary valve stenosis in association with a large atrial septal defect is uncommon. Simultaneous percutaneous closure of the atrial septal defect and pulmonary valvuloplasty appears to be an attractive modality when compared to patients with these two lesions being subjected to surgery or being treated percutaneously at different sittings. We encountered a case of 40 years female, with significant pulmonary valvular stenosis associated with large 27 mm ostium secundum atrial septal defect. Both lesions were successfully treated percutaneously in the same sitting. Pulmonary valvuloplasty was done initially and the atrial septal defect closed later to minimize catheter manipulation after device implantation.

Tetralogy of Fallot is diagnosed in about 3.5% of patients who have congenital heart defects. In tetralogy of Fallot, ventricular septal defect is usually large because of malalignment of outlet septum. But the restrictive ventricular septal defect has been reported rarely & its association with dextrocardia and situs inversus is uncommon. We report all these findings in a 10-year-old boy and review the medical literature relevant to these combined conditions.

Background: Sudden cardiac death is a catastrophic event which leads to loss of young and middle-aged population with dire consequences. Sometimes, a careful history, physical examination and most importantly electrocardiogram (ECG) can help in suspecting the common causes in young population like underlying channelopathies and cardiomyopathies which can further be diagnosed using echocardiography, cardiac MRI and in some cases genetic tests. Case summary: A 33-year-old male presented with sycope and ventricular tachycardia leading to death. This patient was diagnosed to have Arrythmogenic right ventricular dysplasia (ARVD) on post mortem pathological examination with features of fatty infiltration and thinning of right ventricular myocardium. Furthermore, on histologically fatty infiltration with inflammatory infiltrates were visualized. Discussion: Clinical awareness amongst physicians about cardiomyopathies especially ARVD with its subtle yet suggestive ECG changes is the need of the hour. ARVD is a rare disease and can be diagnosed with certainty by analyzing ECG and adding imaging to it. When diagnosed cases are treated appropriately, at least a few cases of sudden cardiac death can be averted.

Background We are aware of increasing prevalence of coronary artery disease in young patients and its potential implications on morbidity and mortality. Aim This study was done with the aim of evaluation of clinical and angiographic characteristics in young Indian patients ( Method The methodology used was single centre cross-sectional study with retrospective analysis. 400 young patients ( Result Males were predominant, anterior wall myocardial infarction was most common presentation. Recanalised infarct related artery, ST resolution >50% at 90 min, low TIMI frame count (less than 28), were seen in patients receiving early thrombolysis. Smoking was the most common and only risk factor in 34% patients. 43% patients had single vessel disease and only 5.5% patients had triple vessel disease. Evidence of heart failure was seen in 14.5% of patients at presentation. Family history of premature CAD was seen in 6% patients. Younger age, early presentation, thrombolysis within 12 h were associated with favourable outcome. Conclusion The study concluded that significant number of young patients had recanalised vessel after thrombolysis. Significant number of patients can be managed with pharmacotherapy. Prevention of smoking, tobacco addiction, screening for hypertension, diabetes and dyslipidemia is vital and should begin from early period of life.

Endocarditis complicating hypertrophic cardiomyopathy (HCM) is rarely reported. The estimated cumulative 10 year probability of developing endocarditis in obstructive HCM is

Although economic output has nearly doubled in the last 30 years, life satisfaction levels in the UK and other developed countries have remained resolutely flat, with evidence that depression and anxiety are increasing, notably among young people. While governments in the developed world focus on economic development as the key route to well‐being, a growing body of research suggests that, once basic needs have been met, this approach is flawed. This well‐being manifesto for a flourishing society, produced by the think tank new economics foundation (nef), proposes eight alternative priorities for government action to promote well‐being. While the focus is on UK policy and the examples are largely drawn from the UK, the key themes of the manifesto will apply to many developed country contexts.

Technology giants should take lessons from the Human Genome Project and be data stewards, not data owners, says Hetan Shah. Technology giants should take lessons from the Human Genome Project and be data stewards, not data owners, says Hetan Shah.

Hetan Shah reviews three timely books on the same urgent topic

Mishandling of patient information shows how governments and companies must become more worthy of trust, says Hetan Shah.

cardioembolic strokes are responsible for more than 20% of all ischemic strokes. The examination of atrial sources of cardioembolic strokes has focused almost exclusively on the left atrial appendage (LAA) and the pathophysiology of thrombus formation at this site is well understood. However

In order to generate the gains that can come from analysing and linking big datasets, data holders need to consider the ethical frameworks, principles and applications that help to maintain public trust. In the USA, the National Science Foundation helped to set up a Council for Big Data, Ethics and Society, of which there is no equivalent in the UK. In November 2015, the Royal Statistical Society convened a workshop of 28 participants from government, academia and the private sector, and discussed the practical priorities that might be assisted by a new Council of Data Ethics in the UK. This article draws together the views from that meeting. Priorities for policy-makers and others include seeking a public mandate and informing the terms of the social contract for use of data; building professional competence and due diligence on data protection; appointment of champions who are competent to address public concerns; and transparency, across all dimensions. For government data, further priorities include improvements to data access, and development of data infrastructure. In conclusion, we support the establishment of a national Data Ethics Council, alongside wider and deeper engagement of the public to address data ethics dilemmas. This article is part of the themed issue ‘The ethical impact of data science’.

Patient initials or identifier number Mr Kishore Kanojiya ### Relevant clinical history and physical exam 52 years Male, Non Hypertensive, Type II Dm since 10 years. Diagnosed as Severe Sclerodegenerative AS 6 months back, S/p AVR bioprosthetic valve PARIMOUNT - 19 mm 10/9/11 C/o