The field of catheter and surgical ablation of atrial fibrillation (AF) has seen rapid advances in the past 7 years, necessitating an updated expert consensus document. This joint statement from the European Heart Rhythm Association (EHRA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Latin American Heart Rhythm Society (LAHRS) provides a contemporary framework for patient selection and management for AF ablation.1,2

Severe hypertension sometimes improves with treatment of bradycardia but this phenomenon is under-reported. Here an elderly gentleman with complete heart block and a hypertensive emergency was refractory to medical therapies and blood pressure only improved following pacemaker implantation. We discuss the possible mechanisms relating to heart rate and artificial pacing.

Corona pandemic has infected over 277 million people and has claimed more than 5.4 million lives with recovery of 249 million globally by early 2022. The global case fatality rate ranged from 6-7% in United States, Switzerland, Ireland, 12-14% in Sweden, Spain, Netherlands, United Kingdom, Italy, and 15-16% in France and Belgium among hospitalized and non-hospitalized COVID-19 patients, the prevalence of underlying cardiovascular diseases was 9%. The prevalence of cardiovascular diseases among hospitalized COVID-19 patients and those requiring intensive care unit admission were 23% and 29% respectively. The virus continues to evolve into new formats latest being Delta and Omicron variants. In a multicenter study of 8910 COVID-19 patients from 169 hospitals in Asia, Europe and North America, presence of pre-existing coronary artery disease, chronic heart failure and cardiac arrhythmia was associated with increased mortality of 10.2%, 15.3% and 11.5% respectively, compared with 5-6% mortality in those without the above co-morbidities. The systemic inflammation caused by SARS-CoV-2 could lead to a wide spectrum of cardiovascular complications including acute cardiac injury, acute coronary syndrome, coronary artery dissection, acute myocarditis, cardiomyopathy, chronic heart failure, cardiac arrhythmia, pulmonary embolism, cardiogenic shock, circulatory failure or even cardiac arrest.

The incidence rate and associated mortality of valvular atrial fibrillation (AF) continues to be significantly high. Drug therapy for such a malignant AF type offers minimal relief due to limited success rate and significant side effects.

His-bundle pacing (HBP) appears to be a viable stand-alone or adjunctive physiological pacing therapy in pacemaker dependent patients. It could also serve as an effective adjunct or alternative pacing therapy for heart failure patients who require cardiac resynchronization therapy or pacemaker upgrade. His-bundle pacing has demonstrated improvement of His-Purkinje conduction, left ventricular electrical / mechanical synchronization, and left ventricular ejection fraction (LVEF) compared with right ventricle pacing. Patients who have high pacing dependence and/or LVEF impairment would benefit most from HBP in terms of heart failure hospitalization and LVEF improvement. Mortality benefit has not been consistently demonstrated in latest meta-analysis. The long-term clinical benefit and safety profile of HBP remains to be explored in future studies. Key words: His bundle pacing, physiologic pacing, upgrade pacing

This paper describes the performance evaluation of pasteurising system of a milk processing plant in terms of its operational availability. For the stochastic modelling and analysis Markov chains has been applied. Particle swarm optimisation (PSO) technique is implemented for optimising the results obtained. The optimum combinations of failure and repair rates for various subsystems can be useful in decision making such as maintenance priorities, spare parts and repairmen, etc. Based on this, a decision support system (DSS) has been developed which indicates the most critical components of the system that need the utmost care while setting maintenance priorities.

The demand for new class of specific materials is rising day by day.In this context machining plays an vital role to finish the final product according to required geometry.Lightweight material such as aluminum based metal matrix composites is one of the most suitable material for most of the engineering and structural works.In this research work, an effort is made to optimize the process parameters of 16-TC Botliboi CNC machine to get desired output responses of MRR, surface roughness (SR) and tool flank wear during the processing of previously developed aluminum hybrid composite A359/B4C/Al2O3.Response surface methodology (RSM) has been applied to get the mathematical model of input parameters to get the desired response.The results reveal the optimized value of feed rate, rotational speed and depth of cut to experimentally find the outputs.Further confirmation experiments are performed at optimum level of process parameter.

AIM:Catheter ablation in patients with atrial fibrillation (AF)/atrial flutter carries a risk of thromboembolism and major bleeding. In light of recent prospective trial data on the safety and efficacy of uninterrupted edoxaban in patients undergoing AF/flutter ablation, real-world Data was aimed for validation.METHODS:A total of 228 patients who underwent AF/atrial flutter ablation over 14 months at our centre were retrospectively analyzed. All patients received uninterrupted oral anticoagulation for at least 4 weeks prior to ablation and 3 months post-ablation. Both bleeding and thromboembolic events were assessed at 24 hours comparing patients on warfarin, rivaroxaban and edoxaban.RESULTS:Mean age of patients were 68.5 +/- 8 years in the warfarin group ( N =86), 63.4 +/- 10.6 years; in the edoxaban group ( N =63) and 62.3 +/- 11.6 years in the rivaroxaban group ( N =79). CHADSVASc scores were 2.43 +/- 1.34, 1.68 +/- 1.34 and 1.64 +/- 1.38 respectively. The mean left atrial sizes were 42.7 +/- 6.8 mm, 42.0 +/- 6 mm and 41.1 +/- 6.5 mm respectively. The study endpoint was death, acute thromboembolism or major bleeding. There was 1 pericardial effusion (1.2%) in the warfarin group, 1 pericardial effusion and 1 transient ischaemic attack (2.5%) in the rivaroxaban group and 1 pericardial effusion needing drainage (1.6%) in the edoxaban group. There were no significant differences in the study endpoints between groups.CONCLUSION:This real-world study demonstrated no significant difference in safety and efficacy between uninterrupted edoxaban, warfarin and rivaroxaban in patients undergoing AF/flutter ablation.

The existing electricity billing method used by electricity boards is opaque, making it difficult for the average person to understand his or her consumption. Furthermore, the invoices given by the boards provide no indication of a person's daily consumption. This research work has presented a warning system to address this issue and give a way to restrict MDI. The proposed model is a tap-and-click generation, and users expect to have everything readily available. When the load consumption exceeds the chosen threshold value, this alerting system will sound an alarm. The most essential aspect of the system is the residential users, and this alerting system will be more focused. This real-time monitoring enables us to make the most of IoT and, in the end, pave the way for smart cities.

The study was conducted to investigate the in vitro anti-glycation activity of Phyllanthus amarus plant extract. The above plant has been used for centuries for its useful health benefits in variety of inflammatory diseases. In current study, antioxidant, metal chelating and ferric ion reducing and antiglycation property was studied for the polysaccharides isolated from Phyllanthus amarus plant extract. At 25 μg/mL sugar concentration and Vitamin C, gave 57 % and 65 % inhibition in hydroxyl radical scavenging assay and in Antiglycation assay the extract and vitamin C showed 65% and 87% respectively. It also had metal ion chelating (PAPE 74%, Ascorbic acid 88%) and ferric ion reducing activity showed by PAPE IS about 68% when compared to standard metal ion chelator EDTA 90%. It inhibited fructosamine formation by 52% after 3 days of incubation. The above studies gave an opinion that the inhibition of glycation exhibited by extract was due to its free radical scavenging property but also due to the modification in the amino or carbonyl groups resulted in the inhibition of fructosamine formation. The polysaccharides of the extract may be donating the hydrogen atom to the free radical, and exhibiting the antioxidant activity. So polysaccharide isolated from Phyllanthus amarus plant may use in preventing many free radicals induced diseases and also in delaying or preventing complications of diabetes.

Animal models of obesity have shown that the expression of Thromboxane A2 Receptor (tbxa2r) and thromboxane synthase (Tbxas1) are increased in adipose tissue (AT) and are associated with insulin resistance and inflammation.Objective: To compare Tbxa2r gene expression in the AT of human subjects with different degrees of obesity and to determine the association between AT Tbxa2r with BMI and markers of AT inflammation.Methods: Subcutaneous AT samples were collected from lean (BMI <30), obese (BMI 30-40), and morbidly obese (BMI >40) subjects. Gene expression of Tbxa2r was analyzed in AT and compared among different groups. Correlation analysis to determine the association between AT Tbxa2r and obesity and obesity-related inflammation.Results: The mRNA levels of Tbxa2r were significantly higher in obese compared to normal subjects (P<0.05). A higher Tbxa2r mRNA was noted in morbidly obese compared to normal (P<0.001) and obese (P<0.01) subjects. A positive correlation was observed between AT expression of Tbxa2r BMI (Spearman’s r=0.54, P<0.001). A strong positive correlation was observed between the mRNA levels of AT Tbxa2r, AT Tbxas1 and Ccl2 (encoding MCP-1) mRNAs (Spearman’s r=0.83, P<0.0001).Conclusion: Signaling of TxA2 is higher in AT in obesity and is associated with BMI as well as inflammatory genes. Tbxa2r may be a potential therapeutic target for obesity-linked diseases including type 2 DM and CV disease.View largeDownload slideView largeDownload slide DisclosureD. Alcaraz alvarez: None. S. Viswanathan: None. T. Gopal: None. N. Kumar: None. K. Kelley: None. C. Desouza: Advisory Panel; Self; Bayer AG, Novo Nordisk, Consultant; Self; AstraZeneca.

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Catheter ablation in patients with atrial fibrillation (AF)/atrial flutter carries a risk of thromboembolism and major bleeding. Oral anticoagulation is advised for prevention of thromboembolic complications. Purpose In light of recent prospective trial data on the safety and efficacy of uninterrupted edoxaban in patients undergoing AF/flutter ablation, real-world data was aimed to compared. Methods A total of 228 patients who underwent AF/atrial flutter ablation over 14 months at our centre were retrospectively analyzed. All patients received uninterrupted oral anticoagulation for at least 4 weeks prior to ablation and 3 months post-ablation. Both bleeding and thromboembolic events were assessed at 24 hours comparing patients on warfarin, rivaroxaban and edoxaban. Results Mean age of patients were 68.5 +/- 8 years in the warfarin group (N = 86), 63.4 +/- 10.6 years; in the edoxaban group (N = 63) and 62.3 +/- 11.6 years in the rivaroxaban group (N = 79). CHADSVASc scores were 2.43 +/- 1.34, 1.68 +/- 1.34 and 1.64 +/- 1.38 respectively. The mean left atrial sizes were 42.7 +/- 6.8 mm, 42.0 +/- 6 mm and 41.1 +/- 6.5 mm respectively. The study endpoint was death, acute thromboembolism or major bleeding. There was 1 pericardial effusion (1.2%) in the warfarin group, 1 pericardial effusion and 1 transient ischaemic attack (2.5%) in the rivaroxaban group and 1 pericardial effusion needing drainage (1.6%) in the edoxaban group. There were no significant differences in the study endpoints between groups. Conclusion This real-world study demonstrated no significant difference in safety and efficacy between uninterrupted edoxaban, warfarin and rivaroxaban in patients undergoing AF/flutter ablation.

Abstract Aim Cryoballoon is a widely used tool for ablation for atrial fibrillation (AF). There are several complications after cryoablation. This paper assesses the incidence rate and severity of hemoptysis after cryo ablation for AF. Methods For current systemic review and meta-analysis, literature has been reviewed from 2008 to 2019 focusing on the incidence of hemoptysis after cryoballoon ablation for atrial fibrillation catheter ablation in PubMed, Cochrane library and EMBASE databases. Results This meta-analysis included 3534 patients from 20 studies; of mean age 54.0 ± 10.9 years. All patients had cryoballoon ablation for paroxysmal or persistent AF refractory to treatment and follow up duration for 8.2 ± 5.9 months with mean procedure duration of 153.4± 65.4 minutes. The mean cryoablation duration was 869.4 ± 148 sec with mean temperature of -59.7 ± 5.1 °C and a total of 109 patients (3.08%) had hemoptysis which was mild in the majority of cases (76.1%), mild to moderate in 20.2% and severe in only 3.7%. Hemoptysis onset was at 29.0 ± 56.5 day with median of 7 days, range (2 hours to 210 days). In 11 studies hemoptysis occurred early in 51 patients (95% CI for I2 was 0.0% to 0.0, P =0.95, I2 was 0.0%), but in 9 studies, hemoptysis occurred late in 58 patients (95% CI for I2 was 0.0% to 0.0, P =0.96, I2 was 0.0%). Conclusion Mild hemoptysis is experienced by significant number of cryoballoon AF ablation patients and severe type in 3.5 % attributed to significantly lower temperature in inferior pulmonary veins and is more often associated with bigger cryoballoon. Abstract Figure. Overview of the manuscripts selection

This study deals with the diagenetic history of the Pachmarhi Sandstones of Satpura Gondwana Basin, Central India. The sandstones are classified as quartz-arenite and sub-arkose type. Monocrystalline quartz grains dominate the detrital mineralogy followed by polycrystalline quartz grains, feldspars (more alkali-feldspar than plagioclase), rock fragments, detrital mica and heavy minerals. The diagenetic signatures observed in the Pachmarhi Sandstones include mechanical compaction, cementation (Fe-oxide, quartz overgrowths, calcite, matrix and clay minerals), replacement and dissolution of feldspar and calcite cement. The most commonly observed type of secondary porosity is dissolution of feldspars. The porosity loss is mainly due to cementation by pore occlusion and by early stage of mechanical compaction. In addition, several clay minerals occurred as pore-filling and pore-lining cements. The nature of various types of grain- to grain contacts suggests early cementation and consequent minor compaction. Among the various cements, calcite is the earliest followed by iron oxide while silica cementation occurred probably at a late stage. The carbonate cement formed during burial by dissolution and re-precipitation represents redistributed calcite which was buried with the sandstone. The iron cement was perhaps derived from weathering and leaching of ferromagnesian minerals of overlying Deccan traps. Silica cement was derived from the corrosion of quartz and feldspar grains. Types of grain contacts, minus-cement porosity and porosity reduction indicate a shallow depth of burial conditions for these sandstones.

Uterine inversion is an uncommon and potentially life-threatening event occurring in the third stage of labour. It is associated with significant blood loss, and shock, which may be out of proportion to the haemorrhage. Prompt and aggressive treatment of uterine inversion can result in minimal maternal morbidity and mortality. Here we present the management of a case, followed by a short review of literature.

The study presents the quantitative effect of the recorded failure and repair data on the performance of a liquid milk processing plant in terms of its availability and reduced capacity. Process modeling and behavioral analysis of the system has been carried out by dividing the system into four subsystems placed in series using Petri Nets approach. A licensed software package (named Petri module of GRIF) has been used for model formalism and its simulation. The results of this study are expected to be useful to the proprietors of the milk processing plant as well as for practitioners from other fields such as multiprocessor electronic systems, telecommunication systems and production systems among others who want to analyze, understand and predict the behavior of various types of equipments. Reliability, Availability, and Maintainability modeling tools described here can be of helpful to them in planning selective maintenance strategies for their systems.

Objective Coleus aromaticus CA is a medicinal plant used popularly in India against various diseases. The present study was undertaken to investigate the in vitro antioxidant activity of the proteins isolated from Coleus aromaticus plant leaves.Methods Proteins from the Coleus aromaticus water extract was isolated by ammonium sulphate protein precipitation method. In vitro antioxidant studies were carried out by 22-diphenyl-1- picrylhydrazyl DPPH Nitric oxide and superoxide radical scavenging methods compared with standard antioxidant like Butylated Hydroxy Anisole BHA and Ascorbic acid.Results The percentage inhibition of radical scavenging activity increased with increase in concentrations of crude protein of Coleus aromaticus extract and is comparable with standard antioxidants BHA and ascorbic acid.Conclusion The results of this study showed that the Coleus aromaticus proteins possess significant antioxidant activity when compared to standard antioxidants

Mycetoma is a chronic subcutaneous localized infection characterized by the triad of swelling, discharging sinuses and discharge of grains that may be caused by bacteria (actinomycetoma) or fungi (eumycetoma).Although it most commonly involves the foot, lower leg or hand, involvement of the head or back may also occur.The incidence is low in other parts of the body such as breast because of the lower risk of trauma as the initiating factor.We report an adult woman with single nodules in the breast on FNAC chronic granulomatous decease and later proved to be mycetoma after excisional biopsy.