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Abnormal uterine bleeding and severe anemia cause the life-threatening condition

Published on: 22nd November, 2022

The World Health Organisation (WHO) defines anemia as a global public health problem. It is a medical condition in which the number of red blood cells or the hemoglobin concentration within them is below the physiological range. We present a case of a 40-year-old woman with Abnormal Uterine Bleeding (AUB) accompanied by malaise, weakness, and tachycardia. The patient reported heavy menstrual bleeding for the past 14 days. Speculum examination revealed that the bleeding was from the uterus. There were no pathological findings during a gynecological and transvaginal ultrasound examination. A complete blood count performed at the time of her arrival showed a low hemoglobin level of 24 g/L, a low hematocrit level of 7,4%, a mean corpuscular volume of 98,7 fL and a number of red blood cells 0,75 x 1012/L. Due to the severity of the anemia, she was given 6 units of red blood cell transfusion, 2 fresh frozen plasmas and tranexamic acid accompanied with calcium carbonate. The curettage was performed. The pathohistological finding was endometrium in proliferation. Afterward, the hemoglobin level increased to 90 g/L. Their past medical history revealed that she abused alcohol. On an abdominal CT scan, Alcohol-Related Liver Disease (ARLD) was confirmed. We should keep in mind that coagulopathy could be the underlying cause of abnormal uterine bleeding and that anemia must be analyzed for successful treatment. A multidisciplinary approach to anemia caused by AUB is required in cases of severe anemia.
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Comparative analysis of mobile forensic proprietary tools: an application in forensic investigation

Published on: 22nd November, 2022

The utilization of the Internet and wireless communication reaches its pinnacle from one side of the planet to the other. Marking the rise of criminal activity in recent years sees enormous growth in security breaches and data theft-related cases in mobile phones. To mitigate them, the implementation of security patches, safety fixes, and updates in mobile devices is of high priority for the organization. The need to foster techniques and procedures in the field to be able to extract and precisely dissect digital crime cases, providing valuable tactical data about the investigation. Mobile forensics is a developing branch assisting the investigator in criminal trials and investigations. Acquisition, Collection, and Analysis of mobile phones settle the purpose of recovering cumulative and corroborative evidence. Upgradation and innovation of mobile devices with time imposed a challenge to mobile forensic technology to extract information from such devices. The study aims at extracting comparative and statistical approaches in the analysis of Physical data acquisition utilizing significant versatile mobile criminological proprietary tools. The proposed study also introduces newly developed utility tools along with their characteristic features which help in successful data extraction from mobile devices.
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A retrospective observational study of mycotic keratitis in Saveetha Hospitals, Chennai

Published on: 22nd November, 2022

Aim and objective:1.    To study the manifestations of fungal corneal ulcer in different age groups and sex 2.    To study the distribution of fungal corneal ulcer in relation to occupation3.    To know the effect of Natamycin and Fluconazole as anti-fungal agents.Materials and methods: This is a retrospective analysis of microbiology records of patients presenting with suspected microbial keratitis seen between January 2021 and June 2021. Patients with positive fungal cultures were analyzed in detail for the type of fungus isolated.Results: 90 patients with suspected microbial keratitis were reviewed. A microbiological diagnosis of mycotic keratitis was established 9 (10%) patients over a period of 6 months, based on positive fungal cultures. Filamentous fungi were isolated more often than yeasts. Aspergillus species followed by Fusarium species were the commonest filamentous fungi isolated. Conclusion: Over a period of 6 months, the cumulative incidence of mycotic keratitis was 10%. The pathogenic organisms most frequently responsible for mycotic keratitis were Aspergillus species. When beginning an empirical therapy for mycotic keratitis, etiological factors were helpful. Eight of the 90 patients with corneal ulcers who were admitted to the patient department for treatment had positive fungal cultures in Sabouraud’s media. The age range of 50 to 60 years had a high prevalence of illness. There were 90 total cases of corneal ulcers. Out of those there were 8 (8.8%) incidences of fungal ulcers. More men than women were impacted. Workers in agriculture are more impacted than others. The main cause of a fungus-induced corneal ulcer was trauma.Natamycin was the better option for the treatment of fungal keratitis. Filamentous fungi (Aspergillus species, fusarium, and curvularia) responded effectively to Natamycin 5% eyedrop.
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Climate change - a review of the mass balance of biogenic and fossil carbon

Published on: 22nd November, 2022

Trying to understand the causes of climate change can be confusing. On the one hand, methane (CH4) emissions from cattle, and methane emissions from food wastes in landfills, are said to contribute to greenhouse gases (GHGs) that drive climate change.  People are working on feed additives for dairy cows to reduce their methane emissions. But, at the same time, cattle manure and food wastes can be fed into anaerobic digesters to convert these organic wastes to biogas; the resulting “renewable methane” or “renewable natural gas” (RNG), can be used in place of fossil natural gas and avoid extra GHG emissions and stop global warming. Can we have it both ways?  Burning gasoline in our cars and trucks generates carbon dioxide (CO2), which is said to contribute to climate change. But more than 8 billion people on planet Earth, breathe in oxygen and exhale carbon dioxide every minute of the day. And so do all the other animals who live on this planet, breathe in oxygen and exhale carbon dioxide. Is our breathing also contributing to climate change, just as the emissions from our automobile tailpipes?It is time to step back from all the hype, evaluate the various sources of CO2 and CH4 being generated and review the “mass balance” of these gases in our atmosphere. Some of these are part of the natural biogenic carbon cycle and some are simply adding to the overall mass balance. What is driving climate change - excess GHGs from the biogenic carbon cycle, excess emissions from other sources, or both? Let’s take a fresh look at the available data.  (Of course, water vapor also plays a part in the climate change story, as a “positive feedback” effect. As non-condensable GHGs rise in concentration and slightly warm the planet, slightly warming oceans add a bit more water vapor to the story and push the warming up a bit more).  During the past few decades, a great deal of pertinent data has been carefully observed and recorded, by world-class scientists and engineers. This data is available in the public domain and is now easily available on the internet. These data sources come from reputable organizations, such as NASA (National Atmospheric and Space Administration), NOAA (National Oceanic and Atmospheric Administration), USGS (United States Geological Survey) and international organizations such as the “Global Carbon Project” and “Our-World-in-Data”.  How much of the growing concentration of CO2 (and CH4) in our atmosphere can be attributed to out-of-control emissions of biogenic carbon? How much of the CO2 rise can be attributed to fossil fuel emissions: 10%, 50%, 90%, or more?  The available data appear to show that the emissions from burning fossil fuels, more than account for all of the rise of carbon dioxide in our atmosphere during the past 60 years, or longer.  In comparison, the biogenic carbon cycle data seem to be very consistent, year after year, decade after decade and have little or no impact on climate change. But, let’s have a closer look at the available data, and let the data speak for itself.
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Determination of the in vivo activity of leaves extract of Zanthoxylum Chiloperone var. Angustifolium (Tembetary hú) orally and intralesionally administered to BALB/c mice experimentally infected with Leishmania

Published on: 23rd November, 2022

Natural products are becoming increasingly important as an unlimited source for obtaining chemical substances with possible pharmacological potential. Current existing drugs for the treatment of cutaneous leishmaniosis produce major side effects; therefore the search for new drugs is justified. The stem bark of Zanthoxylum chiloperone var. Angustifolium Engl. (Rutaceae) is traditionally used in Paraguay for its antiparasitic properties. The leaf extract was evaluated for the first time to determine its leishmanicidal activity in BALB/c mice infected with amastigote forms of Leishmania amazonensis (PH8). The mice were treated orally with the extract at three concentrations (100, 50 and 10 mg/mL), intralesional (50 mg/mL), and subcutaneously using glucantime as a control (100 mg/mL). The percentage of decrease in parasite load was measured and with intralesional 50 mg/kg a reduction of 72% occurred, with the reference drug (Glucantime) a reduction of 62% was obtained with the same oral dose a reduction of 50%, while with an oral dose of 10 mg/mL the percentage of reduction was 55%. When the oral dose was increased to 100 mg/mL, the reduction percentage of the parasitic load was only 16%. These results indicated that the leaf extract of Z. chiloperone var. angustifolium Engl. at low oral concentrations (50 and 10 mg/mL) had very good activity against L. amazonensis, and it was even more efficacious intralesionally at 50 mg/mL but at the oral dose of 100 mg/kg has very reduced antiparasitic activity. This study showed the efficacy of the extract leaves of Z. chiloperone in reducing the parasite load in an in vivo test, so its use as a potential leishmanicidal could be suggested to develop and evaluate new drugs for the oral treatment of leishmaniosis disease with fewer side effects and lower cost.
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SARS-CoV-2 antibody response to third dose vaccination in a healthy cohort

Published on: 23rd November, 2022

Determining the extent of immunity induced by booster doses of COVID-19 vaccinations is crucial for informing recommendations for booster dose regimens as well as constant adjustments of immunization strategies amongst different groups of people within the population. The study involved 31 healthy volunteers (majority were healthcare professionals) who completed either vaccination course with Pfizer or Moderna mRNA vaccines and received a third dose of the vaccine. Here we report results on the evaluation of an antibody response to four different SARS-CoV-2 antigens: RBD, S1, S2 and nucleocapsid prior to third dose and two and four weeks after a booster vaccination. We detected a peak of high titers of antibodies after the third dose with a gradual decline after four weeks. No significant differences were seen between the two vaccines in terms of antibody response. There were no gender discrepancies between the two vaccines. Our results suggest that: third doses are necessary due to the emergence of different SARS-CoV-2 variants and postvaccination antibody testing continues be essential in determining possible standardization of SARS-CoV-2 vaccines regimens.
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Atypic subacute sclerosing panensefalitis in a six-year-old male

Published on: 23rd November, 2022

Subacute sclerosing panencephalitis is a rare, slow, and insidious neurodegenerative disease caused by measles. This disease mostly has a classic course. However, sometimes it can be presented with atypical manifestations. In this paper, we aim to present a six years old male patient that was hospitalized due to seizures and ataxia. Cerebral magnetic resonance imaging was normal on the first day of admission, but within a few days, the patient started to be apathetic. On the seventh day, magnetic resonance imaging showed hyperintense lesions in the thalamic, brainstem, and periventricular areas. Periodic epileptiform discharges were detected in the repeated electroencephalogram. Investigations from the cerebrospinal fluid showed markedly elevated measles virus IgG at 230U/ml consistent with the diagnosis of SSPE which should always be ruled out when a patient comes in with uncontrollable seizures, ataxia and apathy.
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Survival and predictors of mortality among HIV-infected adults receiving ART in Hawassa comprehensive specialized hospital, Sidama regional state, Ethiopia

Published on: 25th November, 2022

Background: Having claimed lives, HIV/AIDS is still a significant global public health concern. Antiretroviral therapy (ART) is now widely available, and this rapid expansion of access is dramatically improving HIV epidemic survival rates worldwide.Objectives: The aim of this study was to identify the mortality risk factors and survival status of ART patients attending Hawassa Comprehensive Specialized Hospital in 2020.Methods: In a five-year retrospective cohort research, all patients seen between January 2015 and December 2019 were analyzed. The data were analyzed with SPSS 25.0. The Kaplan-Meier Log-rank model was employed to gauge the survival time of ART patients based on explanatory variables. Both bivariate and multivariate Cox proportional hazards regression models were employed to identify the independent causes of mortality.Results: Patients on ART had a 74% overall survival probability. With a median survival of 34 months, there are 0.135 deaths for every 100 person-years. Hemoglobin level (HR = 2.38; 95% CI = 3.3-6.3), WHO clinical stage III and IV (HR = 3; 95% CI = 2.2-9.5, p = 0.04), Age >=60 (HR = 1.6; 95% CI = 1.3-2, p = 0.04) and Functional status bed ridden (HR = 3.1; 95% CI = 1.2-9.4,p = 0.04) were all independent predictors of death among RVI patients.Conclusion: In comparison to trials conducted in wealthy countries, the survival rate of ART patients in this study was low. Patients who are anemic; WHO advanced clinical stage; old age, and functional status bedridden should be closely followed and monitored.
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Effect of crossfit-trainings on the heart rate of adolescent judokas

Published on: 23rd November, 2022

Background: One of the types of the complex control system is medico-biological, which includes a set of methods and measures aimed at assessing the health, and functional state of the athlete’s body, taking into account the reaction of his systems to various loads. CrossFit is a constantly varied and high-intensity functional training program in which with increasing the training load, the pulse rate increases.The context and purpose of the study: The research was aimed to find out the frequency of heart rate of adolescent judokas in the presence of CrossFit-trainings in the process of physical fitness, for which a pedagogical scientific experiment was held at the youth sports and cultural training center after V. Zakaryan (Hrazdan city). From the groups of 10-12-year-olds practicing judo at the sports school, one experimental and control group was formed, each with 10 athletes. During CrossFit-trainings “Tabata”, “AMRAP”, “21-15-9” and “WOD” methods were mainly used. Athletes’ pulse rate was measured manually at the wrist before training, during training, and immediately after training in order to control the athletes’ feelings toward the training load.Results: In the September-June period, with the implementation of the CrossFit-training program, the heart rate of athletes before training was on average 102,2 bpm, during training 158,3 bpm and immediately after training – 157,8 bpm.Conclusion: The indicators obtained as a result of the research correspond to the norms suggested in literature sources.
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Chronic thromboembolic pulmonary hypertension resulting in decompensated right heart failure

Published on: 24th November, 2022

Chronic thromboembolic pulmonary hypertension is a notoriously underdiagnosed cause of severe pulmonary hypertension. It is a form of precapillary pulmonary hypertension (PH) that results from intraluminal thrombus organization and fibrous formation which ultimately results in the complete obliteration of pulmonary arteries, resulting in increased pulmonary vascular resistance which leads to the development of pulmonary hypertension and as a result right heart failure. The mechanism involves the narrowing of the pulmonary artery which increases blood pressure within the lungs and impairs blood flow which increases the workload of the right side of the heart ultimately causing right heart failure. Pulmonary hypertension can also cause arrhythmias, blood clots, and bleeding in the lungs. Even though CTEPH is a deadly condition, among all forms of pulmonary hypertension, CTEPH is the only curable form. Echocardiography is the initial assessment tool for suspected PH. A right heart catheterization may be performed to confirm the presence of pulmonary hypertension. Confirmation of CTEPH requires a V/Q scan. Although ventilation/perfusion scintigraphy has a major role in the evaluation of patients with suspected CTEPH, nowadays CTA chest is being used widely as it produces much better-quality images compared to V/Q scan. Without treatment, the prognosis is very poor. Out of three treatment modalities such as; pulmonary endarterectomy (PEA) surgery, balloon pulmonary angioplasty (BPA), and medical therapy, surgery is the gold standard. The physician must be familiar with the disease entity, early diagnosis, and appropriate treatment to improve survival. Here we present a literature review on this topic.
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Pulmonary congenital cystic adenomatoid malformation: a rare congenital abnormality in adults and review of literature

Published on: 25th November, 2022

Congenital cystic adenomatoid malformation of the lung (CCAM) is characterized by an adenomatoid proliferation of bronchiole-like structures and cysts formation. The condition is most commonly found in newborns and children and may be associated with other malformations; rarely, the presentation is delayed until adulthood. We herein report two cases of CCAM in adult patients. 22 years old healthy female with pre-employment health screening chest x-Ray showed a lesion in the upper lobe of the right lung. In another case, a computed tomographic scan of the thorax (CT) confirmed a mass in the upper right lung. A 28-year-old male presented with recurrent respiratory tract infection resistant to antimicrobial therapy. CT scan of the thorax showed a mass in the left lung upper zone. Surgical resection was performed in both cases, and histopathology of the resected specimen showed both cases were consistent with the CCAM.
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The role of denial on emotional correlates of childhood trauma in a non-clinical population

Published on: 30th November, 2022

Background: A large body of evidence suggests that child abuse and neglect by a caregiver is a recurrent event linked to increased psychopathology symptoms. The Childhood Trauma Questionnaire (CTQ) is commonly used to assess abuse/neglect during childhood. However, even though the Minimization-Denial (MD) subscale was originally designed to assess response bias (i.e., underreporting of childhood maltreatment), it is possible that the scale may reflect coping strategies that play an effective role in the relationship between childhood trauma and their negative outcomes. Also, even though MD has been associated with decreased psychopathology symptoms, it is also strongly associated with other scales of the CTQ. Method: This study (n = 133) examined whether (1) the MD-scale is negatively associated with alexithymia, emotion dysregulation and psychopathology, if (2) these associations will hold when adjusting for different subtypes of abuse and neglect and (3) and the role of MD as a possible moderator in these relationships. Results: The analyses showed that, although MD scores have relatively strong and (mostly) significant (negative) associations with the CTQ, emotion dysregulation strategies and psychopathology symptoms, these associations were weak and failed to remain significant when adjusting for the effect of CTQ. Conclusion: Our findings suggest that the MD scores should be viewed as an accurate reflection of the absence (or little) of exposure to childhood abuse/neglect. 
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A look at polyploidy and plant breeding

Published on: 28th November, 2022

Polyploidization is a process that generates genetic variability and therefore one of the engines of biological evolution. Since polyploidization produces important changes in the phenotype, mainly an increase in the size of the organs (i.e.: flowers and fruits), it is also a very important and powerful tool for plant improvement. Despite its intense use in breeding programs for various species, very little is known so far about the nature of this phenomenon. This work presents a brief review of the results obtained by the use of this tool in plant breeding and also raises some reflections on its mechanism of action.
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Ecology of vital activity as an element of antistress therapy on the example of the organization of the work of a medical center with industrial enterprises under the VMI program

Published on: 29th November, 2022

The pandemic the new Coronavirus infection has brought changes in the health status of a large number of our citizens. The consequence of this has been a higher rate of employees seeking medical care and subsequent sick leave. Crisis phenomena in the economic and social life of society are associated with the consequences of the pandemic, moreover, the stress burden on the population increases with the consequences of the pandemic. All this affects the level of performance. The transferred COVID-19 has increased the number of patients with complaints of pain in joints and muscles, with the phenomena of cardiovascular pathology, as well as in breathing, increased frequency of asthma attacks, etc. That is, complications affected a wide range of diseases [1-4]. All this is the consequence, including neurological pathology, which is closely related to stress. According to surveys of several large industrial enterprises, 31.7% of those seeking medical help report anxiety, sleep problems, and a feeling of fatigue [5]. Exacerbation of chronic diseases was recorded in more than 50% of patients with COVID-19. The figures show that more than 1/3 of the population is chronically unwell, and more often than usual they apply for sick leave, which inevitably leads to a decrease in economic indicators [6-10].
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Pain and culture - on cultural communications of suffering

Published on: 29th November, 2022

The impact of culture on the communication of pain becomes visible in a comparative perspective when individuals with two different cultures meet.Regardless of the physiological cause, it is through lived experience, in social life, that it is decided how, where, when and for whom pain is to be communicated. Age and gender, situation and context as well as the type of pain are essential ingredients in communication. The communication is always adapted to expectations from those present, their own experiences of pain and the specific circumstances, the cause of the pain. The impact of culture on the communication of pain becomes visible in a comparative perspective when individuals with two different cultures meet.
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Oncocardiology: Far beyond the cardiotoxicity

Published on: 29th November, 2022

Approximately 73.4% of global deaths are caused by chronic non-communicable diseases, among them, cardiovascular and cerebrovascular diseases, tumors, and chronic respiratory diseases ranked in the top 3 respectively [1]. An accumulating body of evidence showed that the risk of all-cause mortality in cancer patients with cardiovascular disease (CVD) was 3.78 times higher than that of those without CVD and 8.8% of cancer survivors died of CVD [2]. Heart failure (HF) is a serious manifestation or terminal stage of various heart diseases. Although myocardial damage and dysfunction are the main causes of HF, the cardiovascular injury caused by the tumor itself and the detrimental effect of cancer treatment also play an important role. More recently, the data has suggested that up to 25% - 30% of patients with HF have histories of cancer for about 10 years; and cancer also determines the prognosis of heart HF [3]. 
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The smart agriculture applications (current and future)

Published on: 5th December, 2022

Smart agriculture applications (monitoring, sensing, automation and control) of micro-climate and environmental conditions for different agriculture production sectors and scales, decision-makers and researchers need to take it into consideration to strengthen the efforts of mitigation and adaption of climate change impacts as well as maximize the natural resources use efficiencies and food production. Motivate the farmers to implement smart agriculture applications, especially in developed and poor countries, strong cooperation for technology transfer and build up the technology infrastructure of information and communication (ICT) plus the internet of things (IoT).
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Integrated vermicomposting and green roof techniques for food production in urban and rural areas

Published on: 5th December, 2022

Thousands of tons of biodegradable organic waste generates in urban and rural areas every day, creating disposal problems. Urban organic waste can be converted into valuable output products (vermicompost, vermin-liquid, and earthworms) by applying a vermicomposting technique that had different. Implementing green roofs via soilless culture systems as micro-scale farms led to increasing natural resource use efficiencies as well as producing fresh food. The integration of both techniques will create not just reduce pollution and climate change impacts but also for increasing food production and security in urban, enhance the lifestyle and increase public awareness of environmental issues. This process is profitable at any scale of operation.
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Validation of Kinetic Stem Cell (KSC) counting algorithms for rapid quantification of human hematopoietic stem cells

Published on: 28th November, 2022

Specific quantification of therapeutic tissue stem cells (TSCs) is a major challenge. We recently described a computational simulation method for accurate and specific counting of TSCs. The method quantifies TSCs based on their unique asymmetric cell kinetics, which is rate-limiting for TSCs’ production of transiently-amplifying lineage-committed cells and terminally arrested cells during serial cell culture. Because of this basis, the new method is called kinetic stem cell (KSC) counting. Here, we report further validations of the specificity and clinical utility of KSC counting. First, we demonstrate its quantification of the expected increase in the hematopoietic stem cell (HSC) fraction of CD34+-selected preparations of human-mobilized peripheral blood cells, an approved treatment product routinely used for HSC transplantation therapies. Previously, we also used the KSC counting technology to define new mathematical algorithms with the potential for rapid determination of TSC-specific fractions without the need for serial culture. A second important HSC transplantation treatment, CD34+-selected umbilical cord blood (UCB) cells, was used to investigate this prediction. We show that, with an input of only simple population doubling time (PDT) data, the KSC counting-derived “Rabbit algorithms” can be used to rapidly determine the specific HSC fraction of CD34+-selected UCB cell preparations with a high degree of statistical confidence. The algorithms define the stem cell fraction half-life (SCFHL), a new parameter that projects stem cell numbers during expansion culture. These findings further validate KSC counting’s potential to meet the long-standing unmet need for a method to determine stem cell-specific dosage in stem cell medicine.
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How to manage balloon entrapment during percutaneous coronary intervention of a calcified lesion “Case report”

Published on: 2nd December, 2022

Percutaneous coronary angioplasty is a minimally invasive procedure aimed at unclogging a coronary artery with a low complication rate (with a serious complication rate of 3% to 7% and a mortality rate of 1.2%). Device entrapment during PCI is a rare but life-threatening complication that occurs in < 1% of PCIs and balloon entrapment comes second after coronary guidewires. We present the case of 68-years-old man, smoker, hypertensive and type2 diabetic that presents angina with evidence of ischemia on myocardial tomoscintigraphy and in whom the radial coronary angiography reveals a tight calcified mid LAD stenosis. During his PCI and after dilatation with an NC balloon 2.5 × 12 the latter refuses to deflate and remains trapped in the lesion with the appearance of pain and ST-elevation despite several attempts to dilute the product in the inflator and to burst it by overexpansion. Traction on the balloon resulted in the deep intubation of the guiding-catheter, which comes in contact with the trapped balloon, and the rupture of the latter’s hypotube, which remains inflated at the site of the lesion and mounted on the 0.014 guidewire. We put a second 0.014 guidewire distally in the LAD and twisted with the distal part of the first guidewire, then we introduced a second balloon 2.0 × 20 over the second guidewire until the distal part of the guiding-catheter and inflated to trap the stucked balloon. We gradually removed this emergency assembly that allowed us to retrieve the trapped balloon. The control injection revealed a thrombotic occlusion of the LAD treated by thrombectomy and anti-GPIIbIIIa followed by a DES 2.75 × 28 placement. The patient was discharged 48 hours later with a good LVEF. The possible balloon entrapment mechanisms are an acute recoil of a highly calcified lesion with compression of the incompletely deflated balloon, which seems to be the case in our patient, strangulation of the proximal balloon end by the guiding-catheter if the balloon is removed before complete deflation and break or bend of the hypotube. The solutions in case of undeflatable balloon entrapment are to dilute the product in the inflator, to burst it by overexpansion, to pierce it through a stiff guidewire (or through its other end on a Microcatheter or OTW balloon), to cut its outer part and let it empty passively, to introduce a second guide-wire and perform a Buddy-Balloon or to transfer the patient to Surgery. Material entrapment remains a rare but life-threatening complication, its eviction requires the choice of material size and gentle manipulations (small balloons in the event of a calcified lesion) and its management uses different techniques, the choice of which depends on the clinical and anatomical situation. 
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