Investigation of Retrieved Cardiac Devices

Damage assessment of lead and pulse generator with various exposure times is important in the development of cardiac devices. Approximately, 92.1 million patients in the US suffer from cardiovascular diseases with an estimated healthcare cost of over $300 billion and at least one million with implantable cardiac devices. These devices are complex and composed on multiple levels and present challenges while assessing the damage. However, the study on the analysis of cardiac devices may lend insight into common damage patterns and improve future cardiac devices design. The objective of this work is to perform a thorough in vivo damage assessment of retrieved 65 cardiac devices and 136 leads from different manufacturers (Medtronic, St. Jude Medical-Abbott and Boston Scientific). The examined damage features were surface deformation, burnishing, pitting, scratching, discoloration, delamination, insulation defects, coil damage, and abrasion. Methods to collect and compile data were performed, and statistical models were used to assess the sensitivity of measured parameters with in vivo performance. The devices from Medtronic and Boston Scientific were affected by the damage modes but these damages could not have affected the functionality of the devices and the therapy. The main damage mode observed was scratching, and the anterior side was more exposed to damage than the posterior side. Medtronic leads showed significant resistant to different damage modes when compared to Boston Scientific and St. Jude Medical, and the middle part was more exposed to damage than the proximal part. Medtronic leads showed failure rates lower than other manufacturers based on the 65 devices that were examined in this paper

Variation of PEFR with height, weight and waist-hip ratio in medical students

OBJECTIVE: The primary aim of our study was to assess the variation of PEFR with various medical students of Karachi, PakistanDESIGN: Cross-sectional studySetting: Medical students of Karachi Medical and Dental CollegeParticipants: 276 non-smoker healthy medical students composed of 168 females and 108 males.VARIABLE PARAMETERS: They include mean age, body height and body weight and PEFR. They were marked separately for each genderRESULTS: The mean waist hip ratio in females was observed to be 0.843±0.111in relation with that of mean PEFR value 452.97±65.84 L/min, whereas in males the mean waist hip ratio was 0.864±0.028 in relation with that of mean PEFR value 445.93±66.49 L/min. Also there is a statistically significant variation in PEFR with an increase in waist hip ratio. The mean height of males was 173.63 ±7.5 cm and weight was 61.81 ±11.25 Kg while mean height of females was 158.56±7.3 cm and weight was 49.33±9.04 Kg. PEFR is positively correlated with increase in height and weight up to a certain limit.CONCLUSION: The study concludes that PEFR is affected positively by variation in waist hip ratio; moreover young females have more waist hip ratio and PEFR values than their young male counterparts. A large sample size with accurate peak flow meter is required along with ethnic consideration of the study population for better, accurate and clear results

Personal Branding on the practical example of Dr. Dre

Diese Bachelorarbeit beschäftigt sich mit den einzelnen Faktoren des Personal Brandings in der Musikbranche. Im Fokus dabei steht der Einsatz von berühmten Persönlichkeiten, die als Testimonials fungieren. Bereits im 18. Jahrhundert prägte Friedrich Schiller mit dem Leitsatz „Wer nicht mit der Zeit geht, geht mit der Zeit“, die Wichtigkeit für Unternehmen, gewisse Schlüsselreize zu setzen, um sich von der stetig ansteigenden Konkurrenz abzugrenzen. Zudem wird in der folgenden Arbeit überprüft, wie sich der Mensch als Personal Brand vermarktet und wie werbetreibende Unternehmen diese für ihre Markenkommunikation zum Gebrauch machen. Warum der Rapper, Hip-Hop-Produzent und Unternehmer Dr. Dre mit seiner Eigenmarke Beats by Dr. Dre als bestmögliches Beispiel zu benennen ist, wird im Laufe der Arbeit aufgeklärt. Das Ergebnis dieser Bachelorarbeit wird in Form von Erfolgsfaktoren und Handlungsempfehlungen zusammengefasst

Outcomes Associated With Subcutaneous Implantable Cardioverter Defibrillators

To the Editor We read with interest the article by Friedman et al1 titled, “Trends and In-Hospital Outcomes Associated With Adoption of the Subcutaneous Implantable Cardioverter Defibrillator in the United States.” They reported that a high proportion of patients in their study had elevated creatinine levels and that 20.1% were on dialysis. A decreasing trend in defibrillation threshold testing (DFT) was noted. Defibrillation threshold was performed in only three-fourths of patients, despite carrying a class I indication. Among patients who had periprocedural cardiac arrest, 5 of them were undergoing dialysis. Among these 5 patients, 1 had high DFT, but DFT was not performed in 3 other patients. Overall, in patients with subcutaneous implantable cardioverter defibrillators, an increased rate of periprocedural cardiac arrest was observed

Inappropriate Defibrillator Shocks due to Mechanical Inference from an Investigational Device

Cardiac contractility modulation (CCM) is an investigational device-based therapy to enhance ventricular contractility in systolic heart failure patients who are not candidates for cardiac resynchronization therapy (CRT) owing to the absence of wide QRS complexes or who have failed to respond on CRT. The principal mechanism is based on the stimulation of cardiac muscles by nonexcitatory electrical signals to augment the influx of calcium ions into the cardiomyocytes. The majority of patients receiving CCM therapy have concurrent implantable cardioverter defibrillators, and the manufacturer declares both devices can be used in parallel without any interactions. Nevertheless, proper lead positioning of both devices are crucial, and it is mandatory to check device-device interactions during each and every cardiac electronic implantable device-related procedure to prevent adverse outcomes

Outcomes Associated With Subcutaneous Implantable Cardioverter Defibrillators

To the Editor We read with interest the article by Friedman et al1 titled, “Trends and In-Hospital Outcomes Associated With Adoption of the Subcutaneous Implantable Cardioverter Defibrillator in the United States.” They reported that a high proportion of patients in their study had elevated creatinine levels and that 20.1% were on dialysis. A decreasing trend in defibrillation threshold testing (DFT) was noted. Defibrillation threshold was performed in only three-fourths of patients, despite carrying a class I indication. Among patients who had periprocedural cardiac arrest, 5 of them were undergoing dialysis. Among these 5 patients, 1 had high DFT, but DFT was not performed in 3 other patients. Overall, in patients with subcutaneous implantable cardioverter defibrillators, an increased rate of periprocedural cardiac arrest was observed

Bidirectional ventricular tachycardia with myocardial infarction: A case report with insight on mechanism and treatment

Bidirectional ventricular tachycardia (BVT) is a rare variety of tachycardia with morphologically distinct presentation: The QRS axis and/or morphology is alternating in the frontal plane leads. Since its original description in association with digitalis,1 numerous cases of this fascinating tachycardia with disparate etiologies and mechanisms have been postulated. We report a patient with BVT in association with non-ST elevation myocardial infarction and severe cardiomyopathy in the absence of digoxin toxicity