Pseudo inappropriate shock: A technical dilemma.

With liberal availability of high end cardiac implantable devices in recent era, we frequently encounter patients who are recipients of implantable cardioverter defibrillators (ICDs) in our routine clinical practice. Despite improvements in shock detecting algorithms by various manufacturers, incidence of inappropriate shock therapy remains high, it is cause of distress to physicians and patients. Here we present an interesting case of inappropriate shock in one of patient.

Anaemia in Newly Diagnosed Patients of Rheumatoid Arthritis and its Correlation with Disease Activity.

Aim: To detect frequency of anemia in patients of Rheumatoid arthritis (RA) and to establish relationship between hemoglobin level and disease activity in RA. Method: Fifty nine patients of RA fulfilling 2010 ACR/EULAR criteria of RA having disease duration less than two years were included in the study. Haemoglobin (Hb) levels were measured. Disease activity was assessed by DAS-28 score. Results: Among 40/59 (67.80%) anemic cases, 22/40 (55%) patients had anaemia of chronic disease (ACD), 11/40 (27.50%) patients had Iron deficiency anemia (IDA), 3/40 (7.5%) patients had vitamin B(12) deficiency, 1/40 (2.50%) patient had folate deficiency and 3/40 (7.50%) patients had combined IDA and vitamin B(12) deficiency. Duration of disease, rheumatoid factor positivity and occurrence of erosive disease were not significantly different among anaemic and nonanaemic patients (p>0.05 for each). Mean ESR (p>0.02) and DAS-28 (p>0.001) were statistically significantly different among anaemic and nonanaemic patients. Haemoglobin level had significant negative correlation with disease activity (DAS28) in RA cases (r -0.5533, p<0.0001). Conclusion: Anemia was seen in higher frequency in RA patients. Haemoglobin had significantly negative correlation with disease activity (DAS 28) in RA. . Conclusion: Anemia was seen in higher frequency in RA patients. Haemoglobin had significantly negative correlation with disease activity (DAS 28) in RA.

Efficacy of RADPAD protection drape in reducing radiation exposure in the catheterization laboratory-First Indian study.

BACKGROUND: Occupational radiation exposureis a growing problem due to increasing number and complexity of interventional procedures.The RADPAD is a lead-free sterile drape containing bismuth and barium that reduces scatter radiation during fluoroscopic procedures. We aimed to study the radiation exposure reduction to operators with the use of RADPAD and also measureradiation doses in different angiographic projections. METHODS: 65 randomly selected patients undergoing elective complex percutaneous coronary intervention (PCI) procedures from January 2017 to 2017 were randomized in a 1:1 pattern with or without the RADPAD. Primary endpoint was the ratio of operator received dose in mrem to total radiation in Gyat the end of the procedure which was designated ''Relative operator exposure'', with or without RADPAD. RESULTS: Despite similar fluoroscopy times (20.4 ±â€¯9.4 min with RADPAD vs. 19.4 ±â€¯9.2 min without RADPAD, P = 0.871) and total radiation dose (3.4 ±â€¯4.3 Gy with RADPAD vs. 2.3 ±â€¯1.4 Gy, P = 0.198), the relative operator exposure was significantly less with RADPAD (1.39 ±â€¯0.95) as compared to no RADPAD group (2.27 ±â€¯1.4) (p = 0.004) amounting to a 39% reduction. Additionally mean radiation dose per shoot of recorded Left anterior oblique (LAO) oriented projections was 34.4 ±â€¯15.7mGyvs 24.9 ±â€¯12.9 mGy for a non LAO oriented projection. (p < 0.001). CONCLUSION: RADPAD significantly reduces radiation exposure to the primary operator during prolonged complex PCI procedures. Further, amongst all views, LAO views have significantly higher emitted radiation as compared to Non LAO views and need more radiation protection.

Unruptured sinus of Valsalva aneurysm mimicking as right atrial tumor.

Sinus of Valsalva aneurysm is a rare congenital cardiac abnormality and is usually diagnosed when it ruptures. An asymptomatic 55-year-old male of unruptured sinus of Valsalva aneurysm of noncoronary cusp was on medical follow-up. At 2-year follow-up, there was thrombus formation in the aneurysm, mimicking right atrium tumor on 2D transthoracic echocardiography. Cardiac computed tomography showed filling defect in the aneurysm suggestive of thrombus. Considering the high risk of systemic emboli surgery was performed, and aneurysm was repaired with Dacron patch.

Flexible electronics-compatible non-enzymatic glucose sensing via transparent CuO nanowire networks on PET films.

Diabetic individuals need simple, accurate, and cost effective means by which to independently assess their glucose levels in a non-invasive way. In this work, a sensor based on randomly oriented CuO nanowire networks supported by a polyethylene terephthalate thin film is evaluated as a flexible, transparent, non-enzymatic glucose sensing system analogous to those envisioned for future wearable diagnostic devices. The amperometric sensing characteristics of this type of device architecture are evaluated both before and after bending, with the system's glucose response, sensitivity, lower limit of detection, and effect of applied bias being experimentally determined. The obtained data shows that the sensor is capable of measuring changes in glucose levels within a physiologically relevant range (0-12 mM glucose) and at lower limits of detection (0.05 mM glucose at +0.6 V bias) consistent with patient tears and saliva. Unlike existing studies utilizing a conductive backing layer or macroscopic electrode setup, this sensor demonstrates a percolation network-like trend of current versus glucose concentration. In this implementation, controlling the architectural details of the CuO nanowire network could conceivably allow the sensor's sensitivity and optimal sensing range to be tuned. Overall, this work shows that integrating CuO nanowires into a sensor architecture compatible with transparent, flexible electronics is a promising avenue to realizing next generation wearable non-enzymatic glucose diagnostic devices.