Coronary artery disease potentiates response to dofetilide for rhythm control of atrial fibrillation.

BACKGROUND: Dofetilide, a class III antiarrhythmic, is one of the few alternatives to amiodarone in patients with atrial fibrillation (AF) and heart failure or coronary artery disease (CAD). While amiodarone has been extensively studied, little is known about predictors of response to dofetilide. We sought to identify clinical parameters associated with dofetilide success in a large cohort of patients with AF. METHODS/RESULTS: A total of 287 patients with AF started on dofetilide between 2001 and 2008 were included. Dofetilide was deemed "completely effective" if the patient remained on dofetilide at follow-up and had no recurrences of AF clinically or by electrocardiogram. Dofetilide efficacy was analyzed in relation to clinical variables relevant to AF and AF recurrence. After a follow-up of 10.2 ± 7.7 months, 54.7% of the patients remained on dofetilide and it was completely effective in 26.8%. The discontinuation rate during initial hospitalization was 13.3% from excessive QT prolongation and one patient with torsades de pointes (successfully treated). A history of CAD was the only univariate predictor of efficacy (odds ratio [OR] 2.27, 95% confidence interval [CI] 1.29-4.01, P < 0.05). CAD remained the only significant factor associated with efficacy of dofetilide in a multivariate regression model (OR 2.01, 95% CI 1.11-3.70, P < 0.05, n = 270). The overall efficacy of dofetilide in patients with CAD was 41.1%, compared to 23.5% in those without CAD (P < 0.05). CONCLUSIONS: In this large cohort of patients with AF, underlying coronary disease was significantly associated with dofetilide success. This finding may have utility for clinical decisions regarding initiation of dofetilide.

Effect of micro osteo-perforations (MOP) on the rate of tooth movement and levels of interleukin- 1ß - a split mouth study.

Introduction: Various procedures are available today to enhance tooth movement, with relative success rates, one among them being micro osteo-perforation (MOP). Our aim is to assess the rate of tooth movement and interleukin-1ß levels in gingival crevicular fluid levels (GCF) after MOPs. Methods: A group of 22 patients were selected, who required first premolars extraction and were designated for the split mouth study with equal allocation. MOP was performed on the right side, three vertical MOPs were given using 1.2 X 8 mm mini implants with the gap of 2 mm between them and surgical depth of the implant insertion was 5 mm. The left side was used as control. The individual canine retraction was initiated with placement of 150 grams on 19*25 SS wire. The case was evaluated at different timelines for canine retraction and interleukin-1ß levels. Results: There was a significant difference in the rate of canine movement at 45 days (1.42 mm) and end of canine retraction on experimental side (2.61 mm). The GCF levels were raised at T1 and T2 intervals on the side of MOP and were statically significant (p=0.00). Conclusion: MOP is a minimally invasive procedure which accelerates the tooth movement by 20%. The increase in IL-1ß levels indicates a higher rate of chemical interaction on the surgically assisted side. For enhanced efficiency MOPs should be repeated every 6-8 weeks.

Dermatoglyphics as a Novel Method for Assessing Intelligence Quotient in Children Aged 5-11 Years: A Cross-sectional Study.

AIM: To measure the IQ and record dermatoglyphic patterns of children including intellectually disabled aged between 5 years and 11 years and to correlate them. MATERIALS AND METHODS: The present study was a cross-sectional study conducted in two private schools in the city corporation limits. A total of 300 children aged between 5 years and 11 years were equally allocated into three groups based on IQ using covariate adaptive randomization. IQ of the children was measured using Raven's Coloured Progressive Matrices. Bilateral palmar and finger prints were obtained on A4-size papers by ink method using rolling technique. Prints thus obtained were analyzed for dermatoglyphic variables using magnification lens and are read based on Cummins and Midlo classification for fingertip patterns and Bali and Chaube classification for palmar flexion creases. The data were entered and statistically analyzed. For statistical significance, a two-tailed probability value of less than 0.05 was taken as significant. RESULTS: The current study suggests a relationship between different fingertip patterns of digits of I, II, III, and IV of left and right hand and also digit V of right hand with various levels of IQ. CONCLUSION: Hence, dermatoglyphics can be considered as a preliminary noninvasive approach for the determination of IQ. Also, it plays an imperative role, especially in distinguishing genetic intellectual disabilities. HOW TO CITE THIS ARTICLE: Tharay N, Nirmala SVSG, Bavikati VN, et a l. Dermatoglyphics as a Novel Method for Assessing Intelligence Quotient in Children Aged 5-11 Years: A Cross-sectional Study. Int J Clin Pediatr Dent 2020;13(4):355-360.

The relationship of bipolar left ventricular pacing stimulus intensity to cardiac depolarization and repolarization in humans with cardiac resynchronization devices.

BACKGROUND: Myocardial depolarization can be altered by varying pacing stimulus output. This may have implications on response rates for cardiac resynchronization therapy (CRT). The purpose of our study was to determine the relationship of left ventricular (LV) pacing stimulus intensity to measures of depolarization and repolarization in humans with CRT devices. METHODS: In 37 patients with a CRT device and bipolar LV leads, bipolar LV-only pacing from maximum output to threshold was performed. The presence of changes in depolarization was defined by predetermined changes in ECG morphology that accompanied a change in bipolar stimulus amplitude. ECG parameters and the EGMs were analyzed at various LV pacing stimulus intensities. RESULTS: Changes in ECG morphology were apparent in 70% of patients. These occurred at a mean LV stimulus amplitude of greater than 2.7 +/- 0.8 V at 1 ms. Of the patients with changes in surface ECG, the transventricular conduction time decreased from 155 +/- 41 ms at low output to 141 +/- 39 ms at high output (P < 0.01). Despite a significant reduction in QRS duration with high output, mean QTc and JTc interval increased with increasing LV stimulus strength (539 +/- 45 vs 559 +/- 46 ms (P < 0.01) and 353 +/- 31 ms vs 377 +/- 32 (P < 0.01)). CONCLUSION: Increased LV stimulus intensity, independent of RV anodal capture, is associated with faster transventricular conduction time, changes in myocardial depolarization, and longer QT intervals. These findings have important implications on the relationship of programmed LV pacing output to pacing-induced proarrhythmia and clinical CRT response rates.

Utility of three-dimensional echocardiography in percutaneous closure of paravalvular leak.

The images and videos presented in this case report demonstrate the utility of live three-dimensional (3D) transoesophageal echocardiography (TEE) in guiding the percutaneous closure of paravalvular leak (PVL). This method provides high-quality real time assistance for transseptal puncture and deployment of the closure device through the PVL.

Evaluation of Mechanical and Physical Properties of Clinically Used and Recycled Superelastic NiTi Wires.

INTRODUCTION: The initial leveling and aligning phase has been simplified with the introduction of superelastic nickel-titanium archwires. The relatively high cost of these wires has prompted some of the clinicians to reuse them after sterilization. The quantitative changes in the surface properties of superelastic 'NiTi' wires after clinical application and recycling by autoclave method have not been established in earlier studies. AIM: To quantify the changes in mechanical and physical properties of four different commercially available superelastic nitinol (NiTi) archwires after clinical usage and recycling. MATERIALS AND METHODS: The superelastic 'NiTi archwires obtained from four different manufacturers: Group I-GAC (McMinnville, USA); Group II- 3M Company (California, USA); Group III- G&H Company(Franklin, USA) and Group IV- American Orthodontics (AO) (Sheboygan, USA) were selected for the study. Each of the four groups comprised of 20 samples of wire with 10 of them selected randomly as control and remaining 10 as test specimen in each group. The experimental archwires were placed on selected patients for a period of three months followed by Standard Autoclave sterilization at 121°C and 15 to 20 psi pressure for 20 minutes and were retrieved. The tensile strength was evaluated by Instron-Universal Testing Machine. The quantification of changes in surface roughness was investigated by grid method using Scanning Electron Microscope (SEM). The Control Wires (C) were evaluated at initial time "T1" where as the Experimental sample of wires (T) were subjected to testing at an initial time 'T1' and after clinical usage and sterilization at 'T2'. STATISTICAL ANALYSIS: Paired t-test was used for intra-group comparison and one way ANOVA and Post Hoc Tukey tests were used for inter-group comparison. RESULTS: There was significant decrease in tensile strength (p = 0.0015 to 0.001) and surface roughness (p< 0.001) between control and experimental arch wires within each group when properties at T1 and T2 were compared. CONCLUSION: The study suggests discouraging the use of clinically used and sterilized superelastic NiTi archwires.

Stimulus intensity in left ventricular leads and response to cardiac resynchronization therapy.

BACKGROUND: Increased left ventricular (LV) stimulus intensity has been shown to improve conduction velocity and cardiac output. However, high-output pacing would shorten device battery life. Our prospective trial analyzed the clinical effects of high- versus low-output LV pacing. METHODS AND RESULTS: Thirty-nine patients undergoing initial cardiac resynchronization therapy device implantation with bipolar LV leads were assigned to 3 months of either high-output LV pacing (Hi) or low-output LV pacing (Lo) in a randomized, blinded crossover fashion. Hi and Lo settings were determined with a rigorous intraoperative protocol specific to each patient. Clinical and echocardiographic data were obtained at randomization, at 3 months, and a subsequent 3 months after crossover. Mean age was 66.4±9.8 years, and mean QRS duration was 159.3±23.1 ms. Compared to baseline, both arms had significant improvements in Minnesota Living With Heart Failure score (given as mean [95% confidence interval]) (baseline versus Lo: 43.3 [35.5 to 51.1] versus 21.3 [14.6 to 28.0], P<0.01; baseline versus Hi: 43.3 [35.5 to 51.1] versus 23.6 [16.1 to 31.1], P<0.01) and 6-minute walk distance (baseline versus Lo: 692 ft [581 to 804] versus 995 ft [876 to 1114], P<0.01; baseline versus Hi: 699 ft [585 to 813] versus 982 ft [857 to 1106], P<0.01). Although both Hi and Lo arms had some echocardiographic parameters that significantly improved compared to baseline (baseline end-diastolic diameter 5.7 cm [5.5 to 6.0] versus Lo 5.5 cm [5.1 to 5.8], P<0.01; baseline end-systolic diameter 4.9 cm [4.6 to 5.3] versus Hi 4.7 cm [4.3 to 5.0], P<0.05), there were no significant differences observed when comparing the Hi- versus Lo-output arms. CONCLUSIONS: Low-output LV pacing with a relatively narrow safety margin above capture threshold affords significant improvement from baseline and is clinically equivalent to high-output LV pacing. These data support a strategy of minimizing the programmed LV safety margin to increase battery life in cardiac resynchronization therapy devices. CLINICAL TRIAL REGISTRATION INFORMATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01060449.

Surgical Orthodontic Treatment of Severe Skeletal Class II with Vertical Maxillary Excess.

This paper describes an adult male patient who presented with a severe skeletal class II deformity with severe gummy smile. The case was managed with a combination of presurgical orthodontic treatment followed by a double jaw orthognathic surgery and then another phase of orthodontic treatment for final occlusal detailing. Extraction of the upper fives and lower first premolars was done during the presurgical orthodontic phase of treatment to decompensate upper and lower incisors and to give room for surgical setback of the maxillary anterior segment. Double jaw surgery was performed: bilateral sagittal split ramus osteotomy (BSSO) for 6mm mandibular advancement combined with Le Fort I maxillary osteotomy with 8mm impaction of the maxilla. Although the anteroposterior discrepancy and the facial convexity were so severe, highly acceptable results were obtained, both esthetically as well as occlusally.

Distraction Osteogenesis - A Review.

Distraction osteogenesis (DO) one of the recent and most successful treatment option for various skeletal deformities. Initially it was mainly used for correction of axial skeleton, but its introduction to the craniofacial skeleton has revolutionized the mode of treatment of craniofacial deformities and congenital syndromes. Currently DO in dentistry have a wide range application starting from, rapid canine retraction, alveolar distraction, treatment of cleft palate, and correction of many mandibular disorders.

Prehypertension: detection, evaluation, and management.

Prehypertension was defined as a discrete category in 1993. There is evidence to support active management of this entity given the increased risk of hypertension, cardiovascular disease, heart failure, and stroke. There have been few comprehensive summaries on the management of this population. Therefore, this article summarizes the latest guidelines and studies on the detection, evaluation, and management of prehypertension.

Effect of comprehensive therapeutic lifestyle changes on prehypertension.

Although national clinical guidelines promulgate therapeutic lifestyle changes (TLC) as a cornerstone in the management of prehypertension, there is a perceived ineffectiveness of TLC in the real world. In this study of 2,478 ethnically diverse (African Americans n = 448, Caucasians n = 1,881) men (n = 666) and women (n = 1,812) with prehypertension and no known atherosclerotic cardiovascular disease, diabetes mellitus, or chronic kidney disease, we evaluated the clinical effectiveness of TLC in normalizing blood pressure (BP) without antihypertensive medications. Subjects were evaluated at baseline and after an average of 6 months of participation in a community-based program of TLC. TLC included exercise training, nutrition, weight management, stress management, and smoking cessation interventions. Baseline BP (125 +/- 8/79 +/- 3 mm Hg) decreased by 6 +/- 12/3 +/- 3 mm Hg (p or=30 kg/m(2). In conclusion, the present study adds to previous research by reporting on the effectiveness, rather than the efficacy, of TLC when administered in a real-world, community-based setting.