ECG Artifact by a Spinal Cord Neurostimulator: A Case Report

Background: Neurostimulator devices produce electrical oscillations that may prevent accurate diagnosis of an ECG. The Case: We present the case of a 68-year-old man who came to the emergency department with chest pain and a spinal cord neuromodulator device in situ to treat his polymyalgia rheumatica. A 12-lead ECG was obtained to determine the cause of the chest pain, and atrial fibrillation was wrongly diagnosed. Conclusion: This case reiterates the value of recognizing this uncommonly encountered ECG artifact to avoid unnecessary mistakes in interpretation of heart rhythms

Development and validation of scale for self evaluation of soft skills in postgraduate dental students

Objective: To develop and validate a soft skills questionnaire, and to use it for self-evaluation by postgraduate dentistry students.Methods: The cross-sectional descriptive study was conducted at University College of Dentistry, , University of Lahore, Lahore, Pakistan, from February 2020 to April 2020 and comprised of residents from first to final year of training for either Masters in Dental Surgery or Fellowship of the College of Physicians and Surgeons Pakistan programmes. A soft skills questionnaire was generated and was validated through exploratory factor analysis of the elements and items of the questionnaire using SPSS 23.Results: Of the 60 subjects, 37(61.7%) were MDS residents and 23(38.3%) were Fellowship residents. The mean age of the sample was 29.650±2.815 years, and 26(43.3%) subjects were males. The questionnaire was validated (p\u3c0.001). Three domains measured the attitude of dentists, with 7 scenarios having 5 items per scenario. Both categories of trainees had high agreement in understanding and application of non-technical skills, with the exception of leadership skills. However, the difference between the groups was non-significant (p\u3e0.05).Conclusions: A self-generated questionnaire was successfully validated

Fluoroless catheter ablation of atrial fibrillation: integration of intracardiac echocardiography and cartosound module

Objective: To evaluate the feasibility, safety, and clinical efficacy of non-fluoroscopic radiofrequency catheter ablation of atrial fibrillation (AF) in comparison to traditional fluoroscopy-guided ablation in a local Canadian community cohort. Methods: We retrospectively studied consecutive patients with paroxysmal and persistent AF undergoing pulmonary vein isolation (PVI) guided by intracardiac echocardiography (ICE) and Carto system (CartoSound module). ICE-guided PVI without fluoroscopy (Zero-fluoro group) was performed in 116 patients, and conventional fluoroscopy-guided PVI (Traditional group) was performed in 131 patients. Results: Two hundred and forty-seven patients with AF (60.7% male; mean age: 62.2 ± 10.6 years; paroxysmal AF =63.1%) who underwent PVI were studied. Mean procedure times were similar between both groups (136.8±33.4 minutes in the zero-fluoro group vs. 144.3±44.9 minutes in the traditional group; p=0.2). Acute PVI was achieved in all patients. Survival from early AF recurrence was 85% and 81% in the zero-fluoro and traditional groups, respectively (p = 0.06). Survival from late AF recurrence (12-months) between the zero-fluoro and traditional groups was also similar (p=0.1). Moreover, there were no significant differences between complication rates, including hematoma (p = 0.2) and tamponade (p = 1),between both groups. Conclusions: Zero-fluoroscopy ICE and CartoSound-guided AF ablation may be safe and feasible in patients undergoing PVI compared to conventional fluoroscopy-guided ablation

Metabolomics Work Flow and Analytics in Systems Biology

Metabolomics is an omics approach of systems biology that involves the development and assessment of large-scale, comprehensive biochemical analysis tools for metabolites in biological systems. This review describes the metabolomics workflow and provides an overview of current analytic tools used for the quantification of metabolic profiles. We explain analytic tools such as mass spectrometry (MS), nuclear magnetic resonance (NMR) spectroscopy, ionization techniques, and approaches for data extraction and analysis

Rate‐dependent aberrancy and cardiac resynchronization therapy

Left bundle branch block (LBBB) can result in significant dyssynchrony in left ventricular (LV) contraction, ultimately leading to cardiac remodeling. LBBB can be rate dependent and may appear with LV systolic dysfunction. Cardiac resynchronization therapy (CRT) has been demonstrated to improve hemodynamics as well as clinical symptoms in patients with LBBB. We describe the case of a 57-year-old man who underwent CRT implantation due to exertional dyspnea, rate-dependent LBBB, and impaired left LV systolic function

Rate-dependent aberrancy and cardiac resynchronization therapy

Left bundle branch block (LBBB) can result in significant dyssynchrony in left ventricular (LV) contraction, ultimately leading to cardiac remodeling. LBBB can be rate dependent and may appear with LV systolic dysfunction. Cardiac resynchronization therapy (CRT) has been demonstrated to improve hemodynamics as well as clinical symptoms in patients with LBBB. We describe the case of a 57-year-old man who underwent CRT implantation due to exertional dyspnea, rate-dependent LBBB, and impaired left LV systolic function

Retrograde Snaring for Left Ventricular Lead Placement in the Presence of a Persistent Left Superior Vena Cava

Left ventricular lead positioning is technically demanding in cardiac resynchronization therapy (CRT) device implantation, especially in patients with complex cardiac venous anatomies. We report a case in which retrograde snaring was employed to successfully deliver the left ventricular lead through a persistent left superior vena cava for CRT implantation

Venoplasty of a chronic venous occlusion with ‘diathermy’ for cardiac device lead placement

Venous revascularization is an approach used in patients with total venous occlusion requiring venous access for cardiac device lead placement. Several percutaneous approaches to venous revascularization have been proposed. For the first time, we describe the case of a 69-year-old male with total venous occlusion who was successfully revascularized using a ‘diathermy’ technique. Keywords: Diathermy, Venoplasty, Venous occlusio

Women and Alcohol: Limitations in the Cardiovascular Guidelines

Patients and physicians rely on evidence-based guidelines to guide alcohol consumption recommendations, but significant discrepancies in alcohol consumption limits are found between different international societies. Current American Heart Association (AHA) preventive management guidelines on hypertension, transient ischemic attack, stroke, and stable ischemic heart disease recommend sex-specific daily alcohol consumption limits which are inconsistent from other international society recommendations. In this focused review of current American Heart Association guidelines and their sources, we evaluate the evidence behind sex-specific alcohol consumption cut-offs. We found insufficient experimental and epidemiologic evidence to conclude that women should have a reduced daily alcohol consumption limit as compared to men; further studies are required to determine whether sex-specific differences exist in alcohol metabolism and its related cardiovascular impact

Assessing adaptive capacity of climate-vulnerable farming communities in flood-prone areas: Insights from a household survey in South Punjab, Pakistan

Climate change poses a significant threat to agricultural systems worldwide. In Pakistan, an agrarian country where the majority of the population relies on agriculture for their livelihoods, the impacts of climate change can be particularly devastating. Understanding the adaptive capacity of farmers is crucial in order to identify effective strategies for coping with the impacts of climate change. This study aimed to assess the adaptive capacity of farmers in Rajanpur and Dera Ghazi Khan, two flood-prone districts of South Punjab, Pakistan. Data were collected in October 2022 from 448 farmers through multistage stratified random sampling, and multivariate regression and bivariate probit models were used to analyze the likelihood of farmers adopting certain joint strategies and the impact of socioeconomic factors on their decision-making. Results indicated that concern for climate change and knowledge of market value of crops were significant determinants for farmers adopting joint strategies, while farmers with more experience and alternate sources of income were less likely to do so. Increased irrigation was a top strategy used despite its potential negative environmental impacts. Findings highlight the need for a holistic approach to climate adaptation that considers complex social, economic, and environmental factors and appreciates the complex decision-making process that farmers undergo. Understanding the local context is key to developing effective interventions to support climate resilience and sustainable livelihoods in agricultural communities