Primary prevention of sudden cardiac death in adults with transposition of the great arteries: A review of implantable cardioverter-defibrillator placement

Transposition of the great arteries encompasses a set of structural congenital cardiac lesions that has in common ventriculoarterial discordance. Primarily because of advances in medical and surgical care, an increasing number of children born with this anomaly are surviving into adulthood. Depending upon the subtype of lesion or the particular corrective surgery that the patient might have undergone, this group of adult congenital heart disease patients constitutes a relatively new population with unique medical sequelae. Among the more common and difficult to manage are cardiac arrhythmias and other sequelae that can lead to sudden cardiac death. To date, the question of whether implantable cardioverter-defibrillators should be placed in this cohort as a preventive measure to abort sudden death has largely gone unanswered. Therefore, we review the available literature surrounding this issue

Diaphragmatic hernia with strangulated loop of bowel presenting after colonoscopy: case report

<p>Abstract</p> <p>Background</p> <p>The incidence of diaphragmatic hernias caused or exacerbated by diagnostic colonoscopy is not well elucidated at this time, and is believed to be very rare.</p> <p>Case Presentation</p> <p>We present the case of a 57 year old man with remote history of traumatic injury who first presented with vague left shoulder pain for two weeks, mild anemia, and tested positive for fecal occult blood. Four days post colonoscopy the patient was found to have a strangulated loop of bowel herniated through the diaphragm into the left hemithorax.</p> <p>Conclusions</p> <p>In patients with previous history of serious traumatic injury and particularly those with previous splenectomy, a thorough history and physical examination before routine colonoscopy is important. A high level of suspicion for post-operative complications should also be maintained when assessing such patients.</p

Patološko-biokemijska istraživanja hepatotoksičnosti i nefrotoksičnosti nakon izlaganja pilenki klorpirifosu i imidaklopridu

The hepatotoxicity and nephrotoxicity of chlorpyrifos (CPF) and imidacloprid (IMC) insecticides were experimentally studied in layer chickens, taking into account the patho-biochemical alterations. The LD50 values estimated were 41 mg/kg bw and 104.1 mg/kg bw for CPF and IMC, respectively. The plasma cholineesterase enzyme was severely inhibited in chickens given a single dose of CPF at a rate of 55 mg/kg bw via oral gavage, while it remained unchanged in chickens given IMC at rate of 139 mg/kg bw via similar route. The activities of liver function enzymes viz. AKP, ALT and AST were significantly increased in chickens of CPF and IMC groups. Uric acid level was significantly increased and cholesterol level was only significantly reduced in the plasma of chickens administrated CPF. Plasma glucose values in chickens given CPF as well as in chickens given IMC were significantly increased at (P<0.01) and (P<0.05), respectively. Microscopically, liver tissue of CPF intoxicated chickens showed degeneration, coagulative necrosis and hemorrhages. The kidneys showed hemorrhages, vacuolar degeneration of tubular epithelial cells as well as focal coagulative necrosis. Microscopic lesions of a similar type were observed in chickens given IMC. The exposure to CPF and IMC produced histopathological changes that could be correlated with changes in the biochemical profile of layer chickens.Hepatotoksičnost i nefrotoksičnost insekticida klorpirifosa (CPF) i imidakloprida (IMC) istraživana je u pokusima na pilenkama uzimajući u obzir patološko-biokemijske promjene. Vrijednosti LD50 iznosile su 41 mg/kg tjelesne mase za CPF i 104,1 mg/kg tjelesne mase za IMC. Aktivnost kolinesteraze u plazmi bila je zakočena u pilenki kojima je peroralno bila primijenjena jedna doza CPF u količini od 55 mg/kg, dok je ostala nepromijenjena u pilenki koje su dobile IMC također peroralno u količini od 139 mg/kg. Aktivnosti enzima koji pokazuju jetrenu funkciju, tj. AKP, ALT and AST, bile su značajno povećane u pilenki obiju skupina. Razina mokraćne kiseline bila je značajno povećana, a razina kolesterola značajno smanjena u plazmi pilenki kojima je primijenjen samo CPF. Vrijednosti glukoze u plazmi pilenki koje su dobivale CPF bile su značajno veće (P<0,01), a također i u pilenki koje su dobivale IMC (P<0,05). U jetrenom tkivu pilenki kojima je bio primijenjen CPF mikroskopski je ustanovljena degeneracija, koaugulacijska nekroza i krvarenja. Povrh koagulacijske žarišne nekroze, u bubrezima su bila ustanovljena krvarenja i vakuolarna degeneracija tubularnih epitelnih stanica. Slična mikroskopska oštećenja bila su ustanovljena u pilenki kojima je primijenjen IMC. Izlaganje klorpirifosu i imidaklopridu dovelo je do patohistoloških promjena koje su usporedive s promjenama u biokemijskom nalazu pilenki

Automatic wide complex tachycardia differentiation using mathematically synthesized vectorcardiogram signals

BACKGROUND: Automated wide complex tachycardia (WCT) differentiation into ventricular tachycardia (VT) and supraventricular wide complex tachycardia (SWCT) may be accomplished using novel calculations that quantify the extent of mean electrical vector changes between the WCT and baseline electrocardiogram (ECG). At present, it is unknown whether quantifying mean electrical vector changes within three orthogonal vectorcardiogram (VCG) leads (X, Y, and Z leads) can improve automated VT and SWCT classification. METHODS: A derivation cohort of paired WCT and baseline ECGs was used to derive five logistic regression models: (i) one novel WCT differentiation model (i.e., VCG Model), (ii) three previously developed WCT differentiation models (i.e., WCT Formula, VT Prediction Model, and WCT Formula II), and (iii) one all-inclusive model (i.e., Hybrid Model). A separate validation cohort of paired WCT and baseline ECGs was used to trial and compare each model\u27s performance. RESULTS: The VCG Model, composed of WCT QRS duration, baseline QRS duration, absolute change in QRS duration, X-lead QRS amplitude change, Y-lead QRS amplitude change, and Z-lead QRS amplitude change, demonstrated effective WCT differentiation (area under the curve [AUC] 0.94) for the derivation cohort. For the validation cohort, the diagnostic performance of the VCG Model (AUC 0.94) was similar to that achieved by the WCT Formula (AUC 0.95), VT Prediction Model (AUC 0.91), WCT Formula II (AUC 0.94), and Hybrid Model (AUC 0.95). CONCLUSION: Custom calculations derived from mathematically synthesized VCG signals may be used to formulate an effective means to differentiate WCTs automatically

Computerized electrocardiogram data transformation enables effective algorithmic differentiation of wide QRS complex tachycardias

BACKGROUND: Accurate automated wide QRS complex tachycardia (WCT) differentiation into ventricular tachycardia (VT) and supraventricular wide complex tachycardia (SWCT) can be accomplished using calculations derived from computerized electrocardiogram (ECG) data of paired WCT and baseline ECGs. OBJECTIVE: Develop and trial novel WCT differentiation approaches for patients with and without a corresponding baseline ECG. METHODS: We developed and trialed WCT differentiation models comprised of novel and previously described parameters derived from WCT and baseline ECG data. In Part 1, a derivation cohort was used to evaluate five different classification models: logistic regression (LR), artificial neural network (ANN), Random Forests [RF], support vector machine (SVM), and ensemble learning (EL). In Part 2, a separate validation cohort was used to prospectively evaluate the performance of two LR models using parameters generated from the WCT ECG alone (Solo Model) and paired WCT and baseline ECGs (Paired Model). RESULTS: Of the 421 patients of the derivation cohort (Part 1), a favorable area under the receiver operating characteristic curve (AUC) by all modeling subtypes: LR (0.96), ANN (0.96), RF (0.96), SVM (0.96), and EL (0.97). Of the 235 patients of the validation cohort (Part 2), the Solo Model and Paired Model achieved a favorable AUC for 103 patients with (Solo Model 0.87; Paired Model 0.95) and 132 patients without (Solo Model 0.84; Paired Model 0.95) a corroborating electrophysiology procedure or intracardiac device recording. CONCLUSION: Accurate WCT differentiation may be accomplished using computerized data of (i) the WCT ECG alone and (ii) paired WCT and baseline ECGs

Soil organic carbon and biological indicators of uncultivated vis-à-vis intensively cultivated soils under rice–wheat and cotton–wheat cropping systems in South-Western Punjab

Soil carbon (C) pools and biological indicator plays an important role in maintaining soil quality. Land use change from naturally undisturbed to intense cultivation had significant impact on C storage due to change in soil biological properties. The present study was conducted to understand the impact of land use change from the uncultivated to intensively cultivated soils under rice–wheat and cotton–wheat cropping system on labile and stable C pools, soil microbial and enzymatic activity, and a change in nutrient availability. The Olsen’s P concentration was significantly (p < 0.05) higher in soils under rice–wheat, while ammonium acetate (NH4OAc)-K was higher in the uncultivated soils, compared with others. Soils under cotton–wheat cropping system had significantly lower total organic carbon (TOC) in contrast to rice–wheat soils. The uncultivated soils had the highest TOC concentration, which was ∼20.2% higher than rice–wheat and ∼46.4% than the cotton–wheat soils. The water extractable organic carbon (WEOC) was the smallest organic C fraction (∼0.31%–0.40% of TOC), and was significantly lower in cotton–wheat soils. The basal soil respiration (BSR) and mineralization quotient (qM) were significantly higher for rice–wheat, compared with the cotton–wheat soils. These microbial indices were improved due to increased alkaline phosphates (Alk-P) and dehydrogenase (DHA) enzymatic activity in soil. Soil microbial biomass C (MBC) was significantly higher (by ∼31.7%–57.3%) in the uncultivated than the cultivated soils which has increased the C mineralization in soil. The stable C pool comprised ∼68.8% of TOC in the uncultivated soils, almost similar to rice–wheat soils (∼68.5%), but higher than cotton–wheat soils (∼61.9%). The stable C pool leads to C rehabilitation indicated by higher C management index for rice–wheat soils. The principal component analysis (PCA) distinct the uncultivated soils from the cultivated soils under two cropping systems based on BSR and labile C (Fract. 2) in PC1 (explaining ∼82.7% of total variability), and the microbial (qmic) and mineralization (qM) quotient in PC2 (∼17.3% variability). These indicators were most influential for studying C dynamics of the natural ecosystem and restoring the cropland ecosystem by suitable soil management practices

Visiting and Communication Policy in Intensive Care Units during COVID-19 Pandemic: A Cross-sectional Survey from South Asia and the Middle East.

Purpose The coronavirus disease-2019 (COVID-19) pandemic had affected the visiting or communicating policies for family members. We surveyed the intensive care units (ICUs) in South Asia and the Middle East to assess the impact of the COVID-19 pandemic on visiting and communication policies. Materials and method A web-based cross-sectional survey was used to collect data between March 22, 2021, and April 7, 2021, from healthcare professionals (HCP) working in COVID and non-COVID ICUs (one response per ICU). The topics of the questionnaire included current and pre-pandemic policies on visiting, communication, informed consent, and end-of-life care in ICUs. Results A total of 292 ICUs (73% of COVID ICUs) from 18 countries were included in the final analysis. Most (92%) of ICUs restricted their visiting hours, and nearly one-third (32.3%) followed a "no-visitor" policy. There was a significant change in the daily visiting duration in COVID ICUs compared to the pre-pandemic times ( = 0.011). There was also a significant change ( <0.001) in the process of informed consent and end-of-life discussions during the ongoing pandemic compared to pre-pandemic times. Conclusion Visiting and communication policies of the ICUs had significantly changed during the COVID-19 pandemic. Future studies are needed to understand the sociopsychological and medicolegal implications of revised policies. How to cite this article Chanchalani G, Arora N, Nasa P, Sodhi K, Al Bahrani MJ, Al Tayar A, . Visiting and Communication Policy in Intensive Care Units during COVID-19 Pandemic: A Cross-sectional Survey from South Asia and the Middle East. Indian J Crit Care Med 2022;26(3):268-275