Left Atrial Appendage Closure in Atrial Fibrillation: A World without Anticoagulation?

Atrial Fibrillation (AF) is a common arrhythmia with an incidence that is as high as 10% in the elderly population. Given the large proportion of strokes caused by AF as well as the associated morbidity and mortality, reducing stroke burden is the most important part of AF management. While warfarin significantly reduces the risk of AF-related stroke, perceived bleeding risks and compliance limit its widespread use in the high-risk AF population. The left atrial appendage is believed to be the “culprit” for thrombogenesis in nonvalvular AF and is a new therapeutic target for stroke prevention. The purpose of this review is to explore the evolving field of percutaneous LAA occlusion. After briefly highlighting the risk of stroke with AF, problems with warfarin, and the role of the LAA in clot formation, this article discusses the feasibility and efficacy of various devices which have been developed for percutaneous LAA occlusion

Asymptomatic wide complex tachycardia: a case report

Wide complex tachycardias are a commonly encountered entity in coronary care units, intensive care units and emergency departments. Though, these arrhythmias are potentially fatal, they need to recognized first and treated appropriately. Associated physical signs are helpful in this. We present a case of a 54-year-old-female who recently underwent placement of an implantable cardioverter-defibrillator for cardiomyopathy and developed tachycardia

Kinematic discrimination of ataxia in horses is facilitated by blindfolding

BACKGROUND: Agreement among experienced clinicians is poor when assessing the presence and severity of ataxia, especially when signs are mild. Consequently, objective gait measurements might be beneficial for assessment of horses with neurological diseases. OBJECTIVES: To assess diagnostic criteria using motion capture to measure variability in spatial gait-characteristics and swing duration derived from ataxic and non-ataxic horses, and to assess if variability increases with blindfolding. STUDY DESIGN: Cross-sectional. METHODS: A total of 21 horses underwent measurements in a gait laboratory and live neurological grading by multiple raters. In the gait laboratory, the horses were made to walk across a runway surrounded by a 12-camera motion capture system with a sample frequency of 240 Hz. They were made to walk normally and with a blindfold in at least three trials each. Displacements of reflective markers on head, fetlock, hoof, fourth lumbar vertebra, tuber coxae and sacrum derived from three to four consecutive strides were processed and descriptive statistics, receiver operator characteristics (ROC) to determine the diagnostic sensitivity, specificity and area under the curve (AUC), and correlation between median ataxia grade and gait parameters were determined. RESULTS: For horses with a median ataxia grade ≥2, coefficient of variation for the location of maximum vertical displacement of pelvic and thoracic distal limbs generated good diagnostic yield. The hoofs of the thoracic limbs yielded an AUC of 0.81 with 64% sensitivity and 90% specificity. Blindfolding exacerbated the variation for ataxic horses compared to non-ataxic horses with the hoof marker having an AUC of 0.89 with 82% sensitivity and 90% specificity. MAIN LIMITATIONS: The low number of consecutive strides per horse obtained with motion capture could decrease diagnostic utility. CONCLUSIONS: Motion capture can objectively aid the assessment of horses with ataxia. Furthermore, blindfolding increases variation in distal pelvic limb kinematics making it a useful clinical tool

Peaked T - Waves and Sinus Arrhythmia Before Prolonged Sinus Pauses and Atrioventricular Block in Guillain-Barre Syndrome

An 18-year-old woman presented with a rapidly progressive ascending flaccid paralysis and numbness requiring mechanical ventilation after an upper respiratory infection. Guillain-Barre Syndrome was diagnosed based on albumino-cytologic dissociation in the cerebrospinal fluid (elevated proteins with normal white blood cell count) and a demyelinating sensory-motor polyneuropathy pattern on the electromyogram. She was initially treated with intravenous immunoglobulin, but later required plasmapheresis for non-resolution of symptoms

Policy implementation in Indian Olympic sport:Exploring the potential for policy transfer

An important factor affecting sports development in India has been a longstanding issue with deploying policy initiatives introduced as early as 2001. Consequently, this paper explores policies implemented in India till today, highlighting two main issues; inadequate consideration of certain aspects of policy formulation and lack of effective implementation. Policy transfer is then explored as an option to overcome formulation issues of lack of feasibility, financial assistance and knowledge. The success of policy transfer (both external and internal) would, however, depend on how effectively India manages to implement the policies. India can formulate the best policies but, if they are not implemented effectively, the return might remain low. Consequently, we highlight the need for India to prioritise effective policy implementation whilst considering policy transfer as an option to overcome formulation issues

Augmenting realm of 3D printing in restorative dentistry and endodontics - A review

ABSTRACT : 3D printing is entrenching itself as an advancing forefront  in the field of dentistry. It works  on the concept of additive manufacturing ,which has its own advantages over in contrast to subtractive manufacturing process.  Advancement of this technology have improved diagnostic accuracy,easy treatment delivery and reduced chairside time allowing dentist to provide treatment effectively and with high precision. Educational programs which utilize 3D printed models stimulate better training of dental skills in students and trainees. Thus 3D printing enables to provide a holistic approach to ameliorate health and wellbeing of patients. This review article provides an overview on different methods of 3D Printing and its applications focusing  on Restorative dentistry and Endodontics. &nbsp

Solving the Rubik’s cube of Indian sport: exploring impactful factors and alternative ways to facilitate success

The heavy investment of nations in high-performance sport seems justified by the belief that high-performance sporting success can lead to national pride and mass participation. This would then provide a larger pool of talent for selection of future successful athletes, whilst also promoting participation and greater physical activity for others. Although India too seems to follow a similar philosophy, and has consistently been investing in sport, its performance at international sport, especially the Olympic Games has not been impressive. This is particularly distressing when considered against the country’s large population. Given that India sees worth in investing in high-performance sport, potential ways to facilitate sporting success need to be explored. Consequently, this thesis adopted a pragmatic approach to explore sport development in India. Specifically, potential factors contributing to the limited success were explored and potential alternatives to facilitate India’s ongoing efforts of achieving sporting success on the international stage were proposed. The first step involved exploring Indian sport from a policy viewpoint to gain deeper knowledge about potential reasons that might be limiting the impact of numerous policies implemented so far. A long-standing issue with policy implementation and a potential lack of policy learning were concluded as two of the main reasons impacting sporting success. A potential for India to adopt bottom-up and top-down approaches to policy implementation and policy transfer were proposed as alternative ways for India to overcome the policy issues. There was, however, a need to gather a rich picture of the current scenario of Indian sport. Therefore, perceptions of high-level key stakeholders were explored through a semi structured interview to gain in-depth knowledge about Indian sport. Reflecting the challenges of size and scope, and the consequent need to triangulate and generalise the conclusions, further exploration was completed through a quantitative survey. Significant findings from these empirically driven studies included: i) a lack of sporting culture; ii) a need to develop quality Indian coaches and a coaching system; and iii) a need to increase use and knowledge of sport science support. Of these conclusions, coach development was prioritised for three main reasons, its significance in the wider literature, the fact that India lacked a coaching system and Indian coaches being criticised for their relatively poor knowledge (including misconceptions and limited use of sport sciences). Therefore, an India-specific model aimed at developing quality Indian coaches and a coaching system was proposed. Given the policy implementation issues, however, the feasibility of the model was tested through another empirically driven study. Finally, a revised model for coach development was offered that might contribute to India’s efforts of succeeding at international sports

Cutaneous leukocytoclastic vasculitis due to anti-tuberculosis medications, rifampin and pyrazinamide

Anti-tuberculosis drugs frequently result in cutaneous adverse reactions, including pruritus, maculopapular exanthems, and urticaria. However, anti-tuberculosis drug-associated cutaneous leukocytoclastic vasculitis (CLV) has been rarely reported. We describe a case of CLV induced by rifampin and pyrazinamide. A 38-year-old male had been diagnosed with pulmonary tuberculosis two months ago and then he started standard anti-tuberculosis therapy with isoniazid, rifampin, ethambutol, and pyrazinamide. Purpuric lesions developed in the extremities after 1.5 months of anti-tuberculosis medication; the lesions progressively spread over the entire body. Histopathology of the purpuric skin lesion was consistent with leukocytoclastic vasculitis. The skin lesion improved after cessation of anti-tuberculosis medications and treatment with oral corticosteroids and antihistamines. Anti-tuberculosis drugs were rechallenged one at a time over 3 days. Purpura recurred on the right forearm and forehead after taking 300 mg of rifampin. The skin lesion disappeared after taking oral prednisolone. Finally, 1,500 mg of pyrazinamide was readministrated, and then purpuric lesions recurred on both forearms. This report describes a case of leukocytoclastic vasculitis secondary to rifampin and pyrazinamide therapy