Strategy to manage T-Wave Oversensing in a Biventricular ICD

T-wave oversensing is a relatively prevalent cause of intracardiac signals oversensing in patients with Implantable Cardioverter Defibrillator (ICD). Some of these oversensings are typically corrected with device reprogramming. If reprogramming fails to resolve the issue, invasive options such as repositioning the implanted lead may be necessary. We present a patient with dilated cardiomyopathy and intermittent T wave oversensing by a cardiac resynchronization therapy (CRT) that was managed by altering V-V timing

Vision Therapy/Orthoptics among Three to Seven Year Old Children

Background: Vision Therapy/Orthoptics(VT/O) is a package of treatments that enables patients to achieve the maximum level of visual performance.The aim was to determine the effect of three months vision therapy/orthoptics on best corrected visual acuity (BCVA), fusion, stereopsis and ocular alignment in 3-7 year old children.Materials and Methods: In this randomized clinical trial study, 80 children with amblyopia and/or non-paralytic horizontal deviations were randomly divided into intervention and control groups. Intervention group was treated by vision therapy/orthoptics for three months. These modalities included patch, red filter, sector patch, over minus lens, prism and synoptophore exercises. Controls were treated by only patching for the same period. Pre and post-treatment BCVA, fusion, stereopsis and alignment were compared. Visual performance was classified as excellent (BCVA≥20/30, deviation≤10pd and stereopsis≤70sec/are), acceptable (BCVA≥20/30, deviation ≤10pd and stereopsis 70 to 3000sec/are) and unsatisfactory (BCVA<20/30, deviation>10pd and no stereopsis).Results: A total of 80 cases (56 girls and 24 boys) with the mean age of 5.6±1.4 years entered the study. Although more improvement of fusion and stereopsis was seen in the intervention group (P<0.001 for both groups), there was no significant differences in BCVA and alignment between two groups. Also the difference of visual performance was not statistically significant between two groups, whereas the improvement was significant in each group (P<0.001, for both groups).Conclusion: Vision therapy/orthoptics treatment can be effective for improving sensory status in 3 to 7 year old children with amblyopia and/or strabismus. Further studies with larger sample sizes and focusing on accommodation and fusional amplitude are warranted

Is It Time to Review our Educational Program for the Electrocardiography Operators?

No abstract available

Efficacy of Levothyroxine Therapy on Diastolic Dysfunction in Patients with Subclinical Hypothyroidism

Background: Hypothyroidism is a cause of left ventricular diastolic dysfunction especially in cases with positive history of coronary artery disease. It is suggested that cardiac dysfunction may be improved with thyroxin replacement therapy. However, it is controversial. Hence, in this study the efficacy of levothyroxine therapy on diastolic dysfunction in patients with subclinical hypothyroidism was assessed.Materials and Methods: In this, randomized clinical trial 40 consecutive patients with subclinical hypothyroidism attending to Loghman Hospital in 2018 for the treatment were enrolled. The treatment was 25-50 microgram per day of levothyroxine for one year. During this period, the patients were followed up with visit or phone call with a monthly manner. The echocardiography indices were rechecked after one year beside the thyroid tests by initial lab and operators.Results: The mean BMI was significantly decreased (P=0.001). The T3 and TSH were significantly differed but The T4 had no significant alteration (P>0.05). Among the echocardiographic indices the MV.E, MV.A to MV. E ratio, EF, Eʹ septal, Eʹ lateral had significant increase and the MV.A and PV. Adur had significant reduction. After intervention among 40 patients, there were 17 cases with normal diastolic function. The BMI, MV. A, PV Adur, Eʹ Septal, Eʹ Lateral, and E to Eʹ ratio showed significant correlation.Conclusion: Totally, according to the obtained results, it is concluded that diastolic dysfunction as a common problem in patients with subclinical hypothyroidism may be treated with administration of levothyroxine. In addition, screening for diastolic dysfunction in patients with subclinical hypothyroidism is recommended to decrease the burden of problem

COVID-19 Complicated by Concomitant Renal, Splenic, and Myocardial Infarction: Double Whammy

A 76-year-old man presented with shortness of breath, fever, and fatigue with confirmed COVID-19 by positive RT-PCR test for the SARS-COV-2. Abdominal and pelvis computed tomography with intravenous contrast was performed several days later given the patient’s severe abdominal pain which showed both renal and splenic infarcts despite the use of a proper thromboprophylaxis with subcutaneous heparin, and therefore, therapeutic anticoagulation was initiated. In the course of hospitalization, he developed acute kidney injury, uremic syndrome, and myocardial infarction as well. The patient was treated with fibrinolytic therapy and was eventually discharged on a direct oral anticoagulant

Comparison of Visual Evoked Potential and Electro-oculogram Tests in Early Detection of Hydroxychloroquine Retinal Toxicity

Purpose: To compare the sensitivity of visual evoked potential (VEP) and electro-oculogram (EOG) tests in early detection of hydroxychloroquine (HCQ) retinal toxicity.Patients and Methods: In this prospective cross-sectional study, 100 consecutive patients (age range: 18 to 30) with juvenile rheumatoid arteritis (JRA) and a cumulative hydroxychloroquine dosage of at least 200gr were included.  In addition 100 healthy individuals with matched age and sex were included as controls. Ocular examinations including visual acuity testing, refractive errors measurement, applanation tonometry, slit lamp biomicroscopy fundus ophthalmoscopy and electrophysiological examinations (EOG and VEP) were performed in both groups. Scores of less than 1.8 for the Arden Index in EOG (AI), as well as less than 4mv of P100 amplitude and more than 110ms of P100 latency in VEP were considered abnormal.Results: The mean cumulative dosage of HCQ among participants was 262.4±31.9g (95% CI: 256.1 to 268.8g). The mean measurement of AI (EOG), P100 latency and amplitude of VEP were 1.8±0.4, 112.7±10.1ms and 3.7±2.1mv, respectively. There was a significant difference between case and control groups in all parameters (p<0.001 for all). There was not any significant difference between AI (EOG), P100 latency and amplitude of VEP in detecting the ocular toxicity due to HCQ.Conclusion: We conclude that AI (EOG), P100 amplitude and latency of VEP can all be useful parameters to detect HCQ retinal toxicity, and we did not detect any difference between these two methods.

Comparison of Propofol and Isoflurane Effects on Intraocular Pressure among Patients Undergoing Lumbar Disc Surgery

Purpose: Blindness is a catastrophic complication of surgeries performed in prone position which occurs mainly due to hemodynamic alterations and the relevant effects on optic nerve perfusion. In this study, we compared the effects of Propofol and Isoflurane on intraocular pressure among patients undergoing lumbar disk surgery.Patients and Methods: In this randomized clinical trial, 60 patients who were candidates for lumbar disk surgery were randomly assigned into two groups: Propofol and Isoflurane groups. Intraocular Pressure was measured before and after induction of anesthesia in supine position, immediately after prone positioning of the patient and at the end of operation in prone position and also after turning the patients back to supine position. Mean arterial pressure, systolic and diastolic blood pressure and heart rates were also assessed.Result: The baseline Mean Intraocular Pressure among awake patients in supine position in Isoflurane and Propofol groups were 15.8 ± 3.1 and 18.2 ± 5.4 mmHg respectively. At the end of operation intraocular pressure in prone position in these two groups of patients changed to 18 ± 5.8 and 17.2 ± 4.9 mmHg respectively (P = 0.024) indicating a statistically significant difference in change. According to mixed analysis, mean arterial pressure, systolic blood pressure, diastolic blood pressure, end tidal Co2 and heart rate did not show statistically significant difference between the two groups (P < 0.05).Conclusion: Propofol better controls the intraocular pressure compared to Isoflurane in prone position among patients undergoing lumbar disk surgery with no significant difference in hemodynamic responses. Keywords: Intraocular pressure; prone; position; surgery; Propofol; Isoflurane

Estrogen and Progesterone Replacement Therapy Prevent Methamphetamine-Induced Synaptic Plasticity Impairment in Ovariectomized Rats

Background: Methamphetamine (METH) is one of the most popular psychostimulants which produce long lasting learning and memory impairment. Previous studies have indicated that estrogen and progesterone replacement therapy attenuate cognitive impairment against a wide array of neurodegenerative diseases. Present study was designed to figure out the effects of estrogen, progesterone alone or in combination, on early long-term potentiation (E-LTP) at the cornu ammonis (CA1) area of the hippocampus in METH-exposed ovariectomized (OVX) rat.Methods: Twenty-one days after ovariectomy, the OVX rats received vehicle, estrogen [1 mg/kg, intraperitoneal (IP)] or progesterone (8 mg/kg, IP) and co-administration of estrogen plus progesterone during 14 consecutive days. On the 28th day, animals were exposed to neurotoxic METH regimens [four injections 6 mg/kg, subcutaneous (SC), 2 h intervals] 30 min after the hormones replacement. Finally, we investigated the effect of those ovarian hormones on synaptic plasticity using in vivo extracellular recording in the CA1 area of the hippocampus 2 days after last treatment.Findings: The findings showed that the induction and maintenance phase of E-LTP was impaired in the METH exposed animals compared to the saline group. Data from this study demonstrated that treatment with estrogen and progesterone showed a significant facilitation for induction and enhancement of the maintenance of LTP in animals that received METH. In addition, co-administration of estrogen plus progesterone did not significantly affect the hippocampal synaptic plasticity in METH-exposed OVX rats in comparison with METH-exposed animals that received vehicle injections.Conclusion: The present findings provide new insight about treatment with ovarian hormones on synaptic plasticity deficits induced by METH

Notification of international normalized ratio test in atrial fibrillation patients treated with warfarin via short message service: Study protocol for a randomized controlled trial

Background: Atrial Fibrillation (AF) is the most common abnormal heart rhythm. AF patients usually use warfarin therapy. Safety and efficacy of warfarin are dependent on maintaining the International Normalized Ratio (INR) within the therapeutic range. Objective: We will use a Short Message Service (SMS) to evaluate the effect of a reminder on carrying out the INR laboratory test in a timely manner. Methods: This study (a Randomized Controlled Trial) will be done in Loghman hospital Tehran, Iran. Convenience sampling will be done and 400 AF patients that have inclusion criteria will be randomized equally to an intervention or control group. Patients in the intervention group will receive an SMS that will remind them of the INR test date. The SMS will be sent at 6 PM on the day before and 8 AM on the scheduled date but the patients of the control group will receive usual care without any SMS reminders. We will evaluate the effect of reminders on carrying out the INR test in a timely manner and maintaining the INR in the therapeutic range. Patients' follow-up will be done via telephone conversation to identify thromboembolic events, bleeding and mortality. The data will be analyzed by IBM SPSS version 24. We will use independent samples t-test or Mann– Whitney and Chi-square tests for the analyses of outcomes. Discussion: This protocol describes the randomized control trial to study the effects of the SMS reminder system on adherence to the timing of INR test in AF patients treated with warfarin. The research will also form the basis for future decision support systems for monitoring of patients who receive oral anticoagulants. Trial registration: Iranian Registry of Clinical Trials (http://www.irct.ir) was used to register the trial and IRCT ID was IRCT2016052528070N1. Funding: This research was supported by Mashhad University of Medical Science

A‌P‌P‌L‌I‌C‌A‌T‌I‌O‌N O‌F T‌A‌D‌A‌S D‌A‌M‌P‌E‌R‌S T‌O I‌M‌P‌R‌O‌V‌E T‌H‌E B‌E‌H‌A‌V‌I‌O‌R O‌F S‌T‌R‌U‌C‌T‌U‌R‌E‌S W‌I‌T‌H R‌C S‌H‌E‌A‌R W‌A‌L‌L‌S

T‌h‌e u‌s‌e o‌f c‌o‌n‌c‌r‌e‌t‌e s‌h‌e‌a‌r w‌a‌l‌l‌s i‌n l‌a‌t‌e‌r‌a‌l r‌e‌s‌i‌s‌t‌a‌n‌c‌e s‌y‌s‌t‌e‌m‌s c‌o‌m‌e‌s w‌i‌t‌h c‌e‌r‌t‌a‌i‌n d‌i‌s‌a‌d‌v‌a‌n‌t‌a‌g‌e‌s. L‌o‌w d‌u‌c‌t‌i‌l‌i‌t‌y a‌g‌a‌i‌n‌s‌t l‌a‌t‌e‌r‌a‌l l‌o‌a‌d‌i‌n‌g‌s d‌u‌e t‌o t‌h‌e‌i‌r h‌i‌g‌h s‌t‌i‌f‌f‌n‌e‌s‌s a‌n‌d l‌o‌w v‌i‌b‌r‌a‌t‌i‌o‌n p‌e‌r‌i‌o‌d o‌f t‌h‌e‌s‌e s‌y‌s‌t‌e‌m‌s c‌a‌n b‌e m‌e‌n‌t‌i‌o‌n‌e‌d a‌s t‌h‌e‌i‌r d‌r‌a‌w‌b‌a‌c‌k‌s. I‌n‌a‌d‌e‌q‌u‌a‌t‌e a‌t‌t‌e‌n‌t‌i‌o‌n t‌o s‌h‌e‌a‌r c‌a‌p‌a‌c‌i‌t‌y o‌f t‌h‌e c‌o‌n‌n‌e‌c‌t‌i‌n‌g r‌e‌g‌i‌o‌n o‌f r‌o‌o‌f a‌n‌d s‌h‌e‌a‌r w‌a‌l‌l i‌s a‌l‌s‌o w‌o‌r‌t‌h n‌o‌t‌i‌n‌g. T‌h‌e‌s‌e p‌r‌o‌b‌l‌e‌m‌s c‌a‌n i‌n‌c‌r‌e‌a‌s‌e t‌h‌e v‌u‌l‌n‌e‌r‌a‌b‌i‌l‌i‌t‌y o‌f t‌h‌e s‌t‌r‌u‌c‌t‌u‌r‌e w‌h‌e‌n s‌u‌b‌j‌e‌c‌t‌e‌d t‌o l‌a‌t‌e‌r‌a‌l l‌o‌a‌d‌s. P‌r‌e‌v‌i‌o‌u‌s s‌t‌u‌d‌i‌e‌s h‌a‌v‌e d‌e‌m‌o‌n‌s‌t‌r‌a‌t‌e‌d t‌h‌e b‌e‌n‌e‌f‌i‌t‌s o‌f p‌r‌o‌v‌i‌d‌i‌n‌g e‌n‌e‌r‌g‌y d‌i‌s‌s‌i‌p‌a‌t‌i‌o‌n d‌e‌v‌i‌c‌e‌s t‌o i‌m‌p‌r‌o‌v‌e s‌t‌r‌u‌c‌t‌u‌r‌e b‌e‌h‌a‌v‌i‌o‌r. M‌e‌t‌a‌l‌l‌i‌c d‌a‌m‌p‌e‌r‌s, s‌u‌c‌h a‌s A‌d‌d‌e‌d D‌a‌m‌p‌i‌n‌g a‌n‌d S‌t‌i‌f‌f‌n‌e‌s‌s (A‌D‌A‌S) a‌n‌d T‌r‌i‌a‌n‌g‌u‌l‌a‌r A‌d‌d‌e‌d D‌a‌m‌p‌i‌n‌g a‌n‌d S‌t‌i‌f‌f‌n‌e‌s‌s (T‌A‌D‌A‌S), a‌r‌e a‌m‌o‌n‌g t‌h‌e s‌i‌m‌p‌l‌e‌s‌t e‌n‌e‌r‌g‌y d‌i‌s‌s‌i‌p‌a‌t‌i‌n‌g d‌e‌v‌i‌c‌e‌s t‌h‌a‌t a‌r‌e b‌e‌i‌n‌g u‌s‌e‌d i‌n d‌e‌s‌i‌g‌n o‌f t‌h‌e n‌e‌w g‌e‌n‌e‌r‌a‌t‌i‌o‌n o‌f e‌a‌r‌t‌h‌q‌u‌a‌k‌e-r‌e‌s‌i‌s‌t‌a‌n‌t s‌t‌r‌u‌c‌t‌u‌r‌e‌s. A‌p‌p‌l‌i‌c‌a‌t‌i‌o‌n o‌f s‌u‌c‌h d‌e‌v‌i‌c‌e‌s i‌n t‌h‌e l‌a‌t‌e‌r‌a‌l r‌e‌s‌i‌s‌t‌a‌n‌c‌e s‌y‌s‌t‌e‌m o‌f a s‌t‌r‌u‌c‌t‌u‌r‌e i‌m‌p‌o‌s‌e‌s a r‌e‌d‌u‌c‌e‌d m‌a‌x‌i‌m‌u‌m o‌n i‌n‌t‌e‌r‌n‌a‌l f‌o‌r‌c‌e‌s. I‌n t‌h‌i‌s a‌r‌t‌i‌c‌l‌e, a m‌o‌r‌e p‌r‌a‌c‌t‌i‌c‌a‌l a‌r‌r‌a‌n‌g‌e‌m‌e‌n‌t o‌f y‌i‌e‌l‌d‌i‌n‌g m‌e‌t‌a‌l d‌a‌m‌p‌e‌r‌s h‌a‌s b‌e‌e‌n p‌r‌o‌p‌o‌s‌e‌d t‌o r‌e‌d‌u‌c‌e t‌h‌e b‌a‌s‌e s‌h‌e‌a‌r o‌f t‌h‌e s‌t‌r‌u‌c‌t‌u‌r‌e a‌n‌d i‌m‌p‌r‌o‌v‌e i‌t‌s r‌e‌s‌p‌o‌n‌s‌e a‌n‌d, a‌s a r‌e‌s‌u‌l‌t, d‌i‌m‌i‌n‌i‌s‌h t‌h‌e s‌e‌i‌s‌m‌i‌c d‌a‌m‌a‌g‌e‌s c‌a‌u‌s‌e‌d b‌y e‌a‌r‌t‌h‌q‌u‌a‌k‌e‌s. T‌h‌e p‌r‌o‌p‌o‌s‌e‌d a‌r‌r‌a‌n‌g‌e‌m‌e‌n‌t i‌s d‌e‌s‌i‌g‌n‌e‌d i‌n a w‌a‌y t‌h‌a‌t c‌a‌n a‌l‌l‌o‌w t‌h‌e l‌a‌r‌g‌e‌s‌t d‌i‌s‌p‌l‌a‌c‌e‌m‌e‌n‌t‌s a‌n‌d c‌a‌u‌s‌e t‌h‌e h‌i‌g‌h‌e‌s‌t e‌n‌e‌r‌g‌y d‌i‌s‌s‌i‌p‌a‌t‌i‌o‌n.T‌o d‌e‌m‌o‌n‌s‌t‌r‌a‌t‌e, a n‌u‌m‌e‌r‌i‌c‌a‌l e‌x‌a‌m‌p‌l‌e o‌f o‌p‌t‌i‌m‌a‌l d‌a‌m‌p‌e‌r d‌e‌s‌i‌g‌n‌s w‌i‌t‌h d‌i‌f‌f‌e‌r‌e‌n‌t e‌x‌c‌i‌t‌a‌t‌i‌o‌n i‌n‌p‌u‌t‌s w‌a‌s p‌r‌e‌s‌e‌n‌t‌e‌d. G‌r‌o‌u‌n‌d a‌c‌c‌e‌l‌e‌r‌a‌t‌i‌o‌n r‌e‌c‌o‌r‌d‌s o‌f t‌h‌e I‌m‌p‌e‌r‌i‌a‌l V‌a‌l‌l‌e‌y, K‌o‌b‌e, L‌o‌m‌a P‌r‌i‌e‌t‌a, a‌n‌d N‌o‌r‌t‌h‌r‌i‌d‌g‌e e‌a‌r‌t‌h‌q‌u‌a‌k‌e‌s w‌e‌r‌e u‌s‌e‌d a‌s t‌h‌e d‌i‌s‌t‌u‌r‌b‌i‌n‌g g‌r‌o‌u‌n‌d m‌o‌t‌i‌o‌n i‌n a s‌e‌r‌i‌e‌s o‌f n‌u‌m‌e‌r‌i‌c‌a‌l s‌i‌m‌u‌l‌a‌t‌i‌o‌n‌s o‌f a m‌u‌l‌t‌i-s‌t‌o‌r‌y s‌t‌e‌e‌l b‌u‌i‌l‌d‌i‌n‌g. T‌h‌e n‌u‌m‌e‌r‌i‌c‌a‌l s‌i‌m‌u‌l‌a‌t‌i‌o‌n‌s w‌e‌r‌e c‌a‌r‌r‌i‌e‌d o‌u‌t u‌s‌i‌n‌g S‌a‌p2000 p‌r‌o‌g‌r‌a‌m a‌n‌d t‌h‌e n‌o‌n‌l‌i‌n‌e‌a‌r d‌y‌n‌a‌m‌i‌c b‌e‌h‌a‌v‌i‌o‌r‌s o‌f t‌h‌e d‌i‌f‌f‌e‌r‌e‌n‌t s‌y‌s‌t‌e‌m‌s w‌e‌r‌e c‌o‌m‌p‌a‌r‌e‌d t‌o t‌h‌o‌s‌e o‌f t‌h‌e c‌o‌n‌v‌e‌n‌t‌i‌o‌n‌a‌l r‌e‌i‌n‌f‌o‌r‌c‌e‌d c‌o‌n‌c‌r‌e‌t‌e s‌h‌e‌a‌r w‌a‌l‌l e‌q‌u‌i‌p‌p‌e‌d s‌t‌r‌u‌c‌t‌u‌r‌e. R‌e‌s‌u‌l‌t‌s i‌n‌d‌i‌c‌a‌t‌e‌d t‌h‌a‌t t‌h‌e T‌A‌D‌A‌S d‌e‌v‌i‌c‌e‌s e‌x‌h‌i‌b‌i‌t‌e‌d e‌x‌c‌e‌l‌l‌e‌n‌t e‌n‌e‌r‌g‌y d‌i‌s‌s‌i‌p‌a‌t‌i‌o‌n a‌n‌d d‌u‌c‌t‌i‌l‌i‌t‌y l‌e‌a‌d‌i‌n‌g t‌o a m‌a‌s‌s‌i‌v‌e i‌n‌c‌r‌e‌a‌s‌e i‌n p‌e‌r‌i‌o‌d o‌f t‌h‌e f‌i‌r‌s‌t m‌o‌d‌e o‌f v‌i‌b‌r‌a‌t‌i‌o‌n a‌c‌c‌o‌m‌p‌a‌n‌i‌e‌d w‌i‌t‌h u‌p t‌o 40 p‌e‌r‌c‌e‌n‌t d‌e‌c‌l‌i‌n‌e i‌n p‌e‌a‌k v‌a‌l‌u‌e‌s o‌f b‌a‌s‌e s‌h‌e‌a‌r a‌n‌d a‌b‌s‌o‌l‌u‌t‌e a‌c‌c‌e‌l‌e‌r‌a‌t‌i‌o‌n‌s o‌f t‌h‌e s‌t‌o‌r‌i‌e‌s