Oesophageal perforation: an unexpected complication during extraction of a pacing lead. A case report.

Background: Peri-procedural transoesophageal echocardiography (TOE) is important in monitoring and minimizing major complications during pacing lead extraction. It is a widely accepted precautionary measure, especially in extractions considered to be higher risk. Pacing lead extraction may be challenging, and it is associated with significant risk of major bleeding from vascular trauma. Case summary: We present a case of an 87-year-old woman who had an extraction of a ventricular pacing lead that had perforated to an extra-cardiac location, most likely to the left pleural space. Peri-procedural TOE was used as a precaution. The entire pacing lead was successfully extracted with gentle traction using standard equipment (mechanical technique). Extraction was followed by development of pneumomediastinum and a left pleural effusion, initially attributed to pulmonary injury from the pacing lead but which proved to be related to oesophageal injury from the TOE. Discussion: Transoesophageal echocardiography-related complications are uncommon but should be considered in cases of unexpected post-procedural deterioration. Clinical deterioration after a seemingly uneventful procedure should prompt a thorough case review. A systematic approach should be applied to identify the offending cause and enable corrective measures to be undertaken. This case report is an important reminder to all operators utilizing TOE for peri-procedural purposes that this precautionary measure itself also independently exposes the patient to additional risk

Cardiac resynchronization therapy in the real world: need to upgrade outcome research

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Cardiac resynchronization therapy in the real world: need to focus on implant rates, patient selection, co-morbidities, type of devices, and complications

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Run baby run … but not too fast! Rate control management in atrial fibrillation: a claim for personalization

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Buddhism

Buddhism has existed for around two and half millennia, and is practiced by over 500 million people in the world today. The anthropology of Buddhism spans the breadth of the Buddhist world and provides rich ethnographic accounts of the religion as lived in diverse social contexts. Anthropological studies have evolved from early taxonomic work to the study of continuities and reinterpretations of socially embedded Buddhist traditions. Today, they encompass broad considerations of politics, economics, ethics, and belief. This entry considers the biography of the Buddha before examining the tenets, organisation, and spread of Buddhism. It then provides an overview of the development of the anthropology of Buddhism and key areas of focus, paying particular attention to processes of religious reform and reconstruction, political and economic relationships, and transformations in social and ethical life

Piles of Plastic on Darkening Himalayan Peaks: Changing Cosmopolitics of ‘Pollution’ in Limi, Western Nepal

This article explores plastic and other non-compostable waste pollution in the Limi Valley, in Nepal’s impoverished Humla district along the northern-western Nepal border. The Himalaya currently undergoes rapid environmental transformation. Environmental degradation, disappearing glaciers and climate change-related floods are increasingly shaping its landscape. At the same time, motorable roads and telephone connections as well as new modes of governance are arriving to its remotest areas linking Limi to the expanding Chinese market (and to a lesser extent the Nepali and Indian ones) with the consequence that an increasing amount of plastic packaging, wrappings, containers and single-use plastic items (as well as non-degradable electronic items) are reaching these villages. This article argues that these new challenges can be best understood and addressed as part of cosmopolitical ecologies of the Himalaya. They require a significant number of decisions at multiple levels, involving different forms of knowledge and moral frameworks dealing with issues of causality, responsibility, prioritization and action. Arising out of an international project and a ‘stakeholders’ workshop as a ‘collaborative event’, this article offers an opportunity to reflect on the predicament of Himalayan people and contribute to the debate on non-compostable waste pollution as linked to a wide range of environmental challenges including those related to climate change. These issues intersect and compound requiring a wide spectrum of responses at different levels bringing together socio-economic, political and cosmological dimensions. Mediation by a wide range of operators, potentially understood as ‘cultural brokers’, turns out to be decisive in the design and implementation of any strategy

Editorial: Response to cardiac resynchronization therapy

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Naturaleza social, identidades en tensión y brechas digitales: una aproximación etnográfica al desarrollo turístico en la Argentina Serrana

In a border region between San Luis and Córdoba (Argentina), Villa de Merlo and Traslasierra have undergone major transformations due to the rapid development of tourism. While limiting extractive activities and the exploitation of natural resources, the tourism industry has nonetheless monetised the environment in line with its own agenda. The resulting socio-environmental changes in the region and competing understandings of their “collateral damage” affect the unevenly developing communities in different ways.  Using fieldwork from 2019/20 and complementary research methods, this text analyses how environmental issues are related to an already fragmented society; on one hand they increase division and on the other they create a common ground that transcends the existing differences in the social fabric. Paradigm changes brought about by the increase of social media and, more recently, Covid-19 have not only highlighted current issues but also created opportunities to act upon them. In this context a combined creative use of virtual communication and practical approaches could connect disjointed people and ideas. Only by acknowledging the difference and validity of multiple perspectives and using previously conflicting views to complement each other can solutions to these emerging and future challenges to the natural environment in this area be found.El desarrollo del turismo ha transformado significativamente una región fronteriza entre las provincias argentinas de San Luis y Córdoba. Si bien este fenómeno ha limitado la explotación de los recursos naturales, también ha propiciado un proceso de mercantilización de la naturaleza. En consecuencia, el desarrollo de las comunidades aledañas ha sido asimétrico y las diferentes formas de relacionarse con la naturaleza se han vuelto más obvias. Aunado a ello, el aumento de las redes sociales, y más recientemente, Covid-19, han tanto aumentado las tensiones existentes como propiciado oportunidades para atender tales asimetrías. A través de observaciones de campo realizadas en 2019/20 y la revisión de otros documentos, este trabajo analizarà la relación entre los problemas socioambientales y las tensiones sociales, considerando la naturaleza como elemento común que trasciende las diferencias observadas en la zona. En este contexto, parece necesario combinar un uso creativo de la sociodigitalidad y una dimensión práctica para conectar ideas desarticuladas. Por tanto, concluyo argumentando que reconocer las diferencias entre los actores que hacen vida en el territorio y los contextos que delimitan sus respectivas perspectivas, permitirá transformar puntos de vista previamente conflictivos en espacios para abordar colectivamente los desafíos actuales y futuros en la Argentina serrana.&nbsp