Mapping the Conduction System in Patients Undergoing Transcatheter Device Closure of Perimembranous Ventricular Septal Defect: A Proof-of-Concept Study.

Earlier studies that investigated the relation of atrioventricular (AV) conduction system to perimembranous ventricular septal defect (pmVSD) were based on cardiopathological specimens. To study the relationship of conduction system to pmVSD using 3-dimensional electroanatomic mapping system (EAMS) in patients undergoing device closure. Fifteen consecutive cases of pmVSD from January 2014 to July 2017 (age > 2 years and weight > 8 kg) were included in the study. The course of conduction system and its relationship with the pmVSD was mapped before and after device closure, with the use of EAMS. Median age and weight of the cohort was 10 years (range 4-21 years) and 25 kg (range 13-55) respectively. Device implantation was successful in all patients except 1. The course and relation of the conduction system were posteroinferior to the pmVSD in all cases (100%), and away from the defect in 67% (10/15). In patient with baseline RBBB, the right-sided conduction system was in close proximity to the pmVSD. Two patients had part of left-sided conduction system in close proximity to pmVSD or device edges. Two patients developed RBBB following device deployment, which reverted to normal on follow up. No patient developed high grade AV block during the median follow-up of 34 months (range 24-62). This experimental study has shown the feasibility of 3D EAM of conduction system during device closure of pmVSD. This novel concept can be utilized to understand the anatomy of conduction system in other congenital heart diseases.

Impact of the inflammation on the outcomes of catheter ablation of drug-refractory ventricular tachycardia in cardiac sarcoidosis.

INTRODUCTION: Catheter ablation (CA) of ventricular tachycardia (VT) in cardiac sarcoidosis (CS) has been reported with varying success. However, there is a scarcity of data on the outcomes of CA based on ongoing inflammation. OBJECTIVE: We hypothesized that the response to VT ablation depends upon the stage of the disease. METHODS: Between July 2004 and December 2018, 24 patients of CS presented with drug-refractory VT at CARE Hospital (Hyderabad) and the University of Minnesota (Minneapolis, MN). Patients were classified into two groups based on cardiac magnetic resonance imaging and positron emission tomography: (a) inflammatory phase, (b) scar phase. All patients underwent 3D electro-anatomic mapping guided CA. RESULTS: The clinical VT was ablated in all but one patient. In 16 patients (66.6%), both the clinical and nonclinical VTs were ablated (complete success), while in seven patients (29.1%) nonclinical VTs was still inducible. In patients with inflammation (group A), complete success for VT ablation was achieved in 10 out of 17 (58.8%). In patients without inflammation (group B), complete success was achieved in six out of seven patients (85.7%). Eleven patients (45.8%) had a recurrence of VT. Among patients in the inflammatory phase (group A): 10 out of 17 patients had a recurrence of VT, while only one out of seven patients in the scar phase (group B) had VT recurrence over a mean follow-up of 5.7 ± 3.9 years. Epicardial ablation was performed in 10 (41.6%) patients. CONCLUSION: CA of drug-refractory VT in CS is effective, often requiring the epicardial approach. Incomplete success and recurrence of VT were higher in the inflammatory phase of the disease.

Need of Palliative Care Services in Rural Area of Northern India.

BACKGROUND: Palliative care is comprehensive care that provides symptomatic relief and enhances the quality of life for people experiencing serious health-related suffering. There is an increasing need for palliative care services in India. Estimates for population requiring these services are essential in order to meet the increasing need for palliative care services. OBJECTIVES: The objective was to assess the proportion of population requiring and receiving palliative care services. MATERIALS AND METHODS: A descriptive cross-sectional research design was adopted for the study. The study was carried out in the village, Dhanas, Chandigarh. All the residents residing in the selected rural area were included in the study. Tools used for data collection were a screening questionnaire consisting of three questions, a sociodemographic sheet, a clinical profile, the Barthel Index of activities of daily living (ADL), and a pain rating scale. Analysis of the data was done using SPSS version 19 (IBM SPSS Statistics for Windows, Version 19.0.: IBM Corp). RESULTS: A total of 10,021 people from 884 households were screened in the study. The results revealed that the prevalence of need for palliative care services was 2/1000 population. None of the 19 participants with unmet palliative care needs were receiving any home- or institutional-based palliative care services at the time of assessment. Nearly, one-fourth of the participants had total dependency on caregivers for ADL. CONCLUSION: The study concluded that there is a need of palliative care services in the studied rural community of Chandigarh. These data can be used for planning and implementing community-based palliative care services in the studied area.

Effect of incorporation of ozone prior to ECF bleaching on pulp, paper and effluent quality.

The pulp and paper industry is highly dependent on forest and water resources. It has more concerns on fair utilization of these resources and their conservation for its further expansion. Present study emphasizes on the use of rice straw (agro waste) in papermaking to protect wood based resources. It further deals with ozone bleaching (Z) prior to elemental chlorine free bleaching that proved to be significant in terms of reducing the effluent load specially the reduction in toxic, recalcitrant and carcinogenic compounds. Z based sequences resulted in pulp brightness of ∼85% that was 3.6% higher than the elemental chlorine free bleaching. Bleached pulps of Z based sequences were found to be having better strength properties than elemental chlorine based sequence and thus may be adopted as improved bleaching technology. The analysis of handsheets prepared after pulp bleaching was performed using X-Ray diffraction, ATR-FTIR and SEM. Incorporating ozone stage resulted in marked reduction of 58% and 63% in total solids in bleaching wastewater. Reduction of more than 80% in BOD, COD and adsorbable organic halides was achieved in Z based bleaching in comparison to chlorine bleaching. The amount of chlorophenols, guaiacols, catechols, vanillins and syringols became negligible (approx. 90% reduction) in effluents of Z based bleaching sequences. The chlorine dioxide followed by peroxide bleaching after Z stage was found to be the most promising to reduce the effluent load.

Pleomorphism during Ventricular Tachycardia: A Distinguishing Feature between Cardiac Sarcoidosis and Idiopathic VT.

BACKGROUND: Ventricular tachycardia (VT), a common manifestation of cardiac sarcoidosis (CS), is associated with high morbidity and mortality. It could be mistaken for idiopathic VT (IVT) in the absence of systemic manifestations and overt cardiac structural abnormality. We studied the electrocardiogram (ECG) characteristics of VT in CS that may distinguish from IVT and also explored the relationship of the ECG characteristics with imaging findings in patients with CS. METHODS AND RESULTS: Twelve-lead ECG characteristics of VT in CS patients (Group I = 37) were compared with IVT (Group II = 49). QRS duration, axis, morphology, VT cycle length, and cycle length variation (CLV) were analyzed. In Group I, 18 (49%) had pleomorphic VT (PLVT) and none in Group II. CLV was seen only in Group I (24%). Mean QRS duration (milliseconds) and cycle length (milliseconds) were greater in Group I (QRSd 152.49 [39.3] vs 140.9 [19.2]) and (332.2 [136.5] vs 312.9 [56.2]), the differences not statistically significant. In Group I, myocardial scar was present in 22 of 25 patients and myocardial inflammation in 28 of 29 patients as assessed by cardiac magnetic resonance imaging (delayed enhancement) and 18-fluorodeoxyglucose positron emission computed tomography, respectively. PLVT was seen more commonly in patients with involvement of >1 myocardial region than focal involvement (58% and 30%, respectively, with myocardial scar and 50% and 40%, respectively, with myocardial inflammation). CONCLUSION: Pleomorphism and CLV during VT may be distinguishing features between IVT and VTs of CS origin.

Epicardial ablation of focal atrial tachycardia arising from left atrial appendage in children.

Focal left atrial tachycardia (FLAT) although a common cause of supraventricular tachycardia(SVT) among children, the one's arising from left atrial appendage (LAA) present a unique challenge for successful ablation because of anatomical location. We present two children with FLAT arising from the epicardial LAA, successfully mapped and ablated through percutaneuous epicardial approach.

Post-COVID-19 manifestations: A study of analyzing symptoms, complications following hospitalization.

Background: Post-COVID-19 symptoms and diseases appeared on recovered from COVID-19. Hence, the study aims to investigate and characterize the manifestations which appear after recovery from the corona virus infection. Objectives: To investigate the post-COVID-19 Manifestation, to demonstrate different symptoms or signs that appeared during COVID and after recovery from the disease and to see association of independent factors (like age, sex, BMI, Comorbidities) with Post-COVID complication. Methods: The study was conducted using cross-sectional study among COVID positive patients admitted and then recovered in Bangur Hospital, Pali, Rajasthan, including ICU and Isolation wards from March to December 2020. Sample size calculated was 423 with simple random sampling. Findings: In our study of these 421 COVID-19 cases, median age was 36 year (Interquartile Range: 26-55 years). Post-COVID manifestation (at least one symptom) significantly associated with age of subjects (p = 0.001), subjects who were in ICU during COVID-19 positive (p = 0.003), symptomatic subjects (p = 0.009) during COVID positive and SPO2 level at the time of admission during COVID positive (p = 0.01). Conclusion: The recovered subjects should be highly vigilant in maintaining and monitoring their health status as there is a risk of future complications after recovery.

Lingual Cysticercosis: A Case Series with Review of Literature.

Cysticercosis is a condition in which humans are infected by the larval form of Pork Tapeworm Taenia solium. Isolated lingual cysticercosis is a rare entity due to the high muscular activity and metabolic rate of tongue which prevents the development of larva. We present a series of three patients with isolated lingual cysticercosis. One patient was treated by medical management while the other two were treated with surgical excision followed by medical therapy. All patients are asymptomatic after repeated follow ups.

Schwannoma of the Brachial Plexus: A Rare Case Report.

INTRODUCTION: Brachial plexus schwannomas are extremely rare tumours of the head and neck region accounting for less than 5 % overall. Due to its rarity and anatomic complexity of the brachial plexus, schwannomas in this region present a diagnostic and surgical challenge to the surgeon. CASE REPORT: We present a case of a 56-year-old female who presented with a slow growing right sided neck swelling associated with pain and tingling in the distal end of the right forearm. According to FNAC, imaging studies results, a diagnosis of benign neurogenic tumour possibly schwannoma was made. After taking proper consent patient underwent surgical excision of the tumour. Postoperatively, patient developed numbness and tingling in right arm and stiffness at elbow joint, which is showing improvement after regular physiotherapy sessions. CONCLUSION: Although brachial plexus schwannomas are extremely rare head and neck tumours they should be kept as a differential diagnosis in patients presenting with supraclavicular neck swellings. These are potentially curable lesions. As such, detailed history and examination together with imaging studies is important in establishing a preoperative diagnosis for proper management.

Permanent HIS bundle Pacing Feasibility in Routine Clinical Practice: Experience from an Indian Center.

There is a paucity of experience regarding His bundle pacing (HBP) at laboratories initially attempting the procedure, especially in the Indian scenario. Patient who underwent HBP were selected for pacing therapy or in lieu of cardiac resynchronization therapy (CRT) at a single center. Among 22 patients attempted, 19 patients underwent successful implant, achieving selective HBP in 14 patients. There was a significant improvement in left ventricular ejection fraction (LVEF) (49.3 ± 9.3 vs. 36.7 ± 9.2) in the LV dysfunction subgroup (n = 6). Over a follow-up of 15 ± 6.5 months, thresholds were stable in all except one patient, and there was no requirement of lead revision. In summary, we found that HBP is a feasible option for achieving physiological pacing.

Improvement in rice straw pulp bleaching effluent quality by incorporating oxygen delignification stage prior to elemental chlorine-free bleaching.

Environmental degradation by industrial and other developmental activities is alarming for imperative environmental management by process advancements of production. Pulp and paper mills are now focusing on using nonwood-based raw materials to protect forest resources. In present study, rice straw was utilized for pulp production as it is easily and abundantly available as well as rich in carbohydrates (cellulose and hemicelluloses). Soda-anthraquinone method was used for pulp production as it is widely accepted for agro residues. Bleaching process during paper production is the chief source of wastewater generation. The chlorophenolic compounds generated during bleaching are highly toxic, mutagenic, and bioaccumulative in nature. The objectives of study were to use oxygen delignification (ODL) stage prior to elemental chlorine-free (ECF) bleaching to reduce wastewater load and to study its impact on bleached pulp characteristics. ODL stage prior to ECF bleaching improved the optical properties of pulp in comparison to only ECF bleaching. When ODL stage was incorporated prior to bleaching, the tensile index and folding endurance of the pulp were found to be 56.6 ± 1.5 Nm/g and 140, respectively, very high in comparison to ECF alone. A potential reduction of 51, 57, 43, and 53% in BOD3, COD, color, and AOX, respectively was observed on adding the ODL stage compared to ECF only. Generation of chlorophenolic compounds was reduced significantly. Incorporation of ODL stage prior to bleaching was found to be highly promising for reducing the toxicity of bleaching effluents and may lead to better management of nearby water resources. Graphical abstract ᅟ.

Prospects of rice straw as a raw material for paper making.

Pulp and paper mills are indispensable for any nation as far as the growth of the nation is concerned. Due to fast growth in population, urbanization and industrialization, the demand and consumption of paper has increased tremendously. These put high load on our natural resources and force the industry to look for alternative raw material. Rice straw is a lignocellulosic material abundantly available in wood short countries like China, India, Bangladesh, etc. and can be used as raw material for this industry. Open burning of rice straw releases noxious green house gases to the air and poses serious threats to global air chemistry and human health. So, it is a dual benefit option (for farmers and industries) to use rice straw as a raw material in pulp and paper industry. Organosolv pulping using acids are the prominent choices of researchers to convert this residue into valuable pulp but in developed countries only. Developing world favours the soda and soda-AQ processes as these are economical. As a virtue of less lignin content in comparison to wood, rice straw requires less harsh conditions for cooking and can be easily pulped. Bleaching is a crucial step of paper making but also responsible for causing water pollution. Many studies revealed that during the process more than 500 chlorinated compounds are released that are highly toxic, bioaccumulative and carcinogenic in nature. Most of the industries over the globe switch on to the elemental chlorine free short sequence bleaching methods using chlorine dioxide, hypochlorite and hydrogen peroxide. This paper presented the effective need of ecofriendly, economically reliable pulping and bleaching sequences in case of rice straw to eliminate the problems of chlorinated compounds in wastewater of paper mills. Such approach of using waste as a raw material with its environmentally safe processing for making paper can prove to be valuable towards sustainable growth.

Safety and efficacy of epicardial approach to catheter ablation of ventricular tachycardia - An institutional experience.

BACKGROUND AND AIM: Epicardial approach to VT ablation increases the success rate of ablation but is not without complications. We studied the safety and efficacy of epicardial VT ablations performed at our institute. METHODS: All patients who underwent epicardial VT ablation at our institute were studied retrospectively. The outcome of VT ablation was among three groups: ischaemic cardiomyopathy (ICM), non-ischaemic cardiomyopathy (NICM) and granulomatous myocarditis (GM). Safety outcomes assessed included all complications considered to be due to pericardial access or epicardial mapping/ablation. RESULTS: A total of 54 patients (total 119 VTs, mean 2.2 (0.9)) were taken up for ablation procedure through epicardial access. Mean age: 47 (10) years, males: 83%. All patients had drug resistant recurrent VTs. The epicardial procedure was abandoned in three patients due to access issues; percutaneous sub-xiphoid access was employed in 48 and surgical approach in four patients. Complete success was achieved in 59% and partial success in 76%. The outcomes were poor in ICM patients as compared to those with GM and NICM. Overall success rates for all clinical VTs were 89% in GM, 90% in NICM and 67% in ICM. Success rates for epicardial VT ablation were 94%, 85% and 78% respectively for GM, NICM and ICM. Procedure related complications occurred in six patients. CONCLUSION: Epicardial ablation for VT offers good immediate outcomes with acceptable safety profile.

Evaluation of Yucca schidigera extract as feed additive on performance of broiler chicks in winter season.

AIM: Yucca schidigera extract has been successfully used as feed additives in the poultry industry. It enhances the growth and productivity in broiler production. Hence, the present study was designed to analyze the effect of Y. schidigera extract in growth, carcass quality and behavior along with its economical utility in broiler rearing. MATERIALS AND METHODS: Total, 120 numbers of day-old broiler chicks of equal sex ratio were randomly divided into Yucca supplemented treatment and control group, each having 60 birds in three replications of 20 numbers. The feeding management and rearing conditions were similar for all the groups as per the standard except the Yucca supplementation in the treatment group @ 125 mg/kg of feed. The parameters with respect to growth, carcass, behavior, and litter content were recorded as per standard procedures. RESULTS: The Yucca supplementation can effectively enhance growth of 173 g in 6(th) week by utilizing lesser feed intake than control group, which ultimately proves better feed conversion rate, protein efficiency ratio, and energy efficiency ratio in broiler production. Eviscerated weight of 58.50% for the treatment group was significantly higher (p<0.05) than 54.10% in the control group. The breast meat yield of Yucca group (32.23%) was significantly higher (p<0.05) than control (30.33%). More frequency of agonistic behavioral expressions was noticed in the control group than the treatment group. A profit of 43.68% was received by usage of Yucca supplementation in the diet on live weight basis. Numerically, lower percentage of moisture was present in Yucca treated group than the control. CONCLUSION: From this study, it can be concluded that Yucca supplementation has an important role in augmenting broiler's growth performance, efficiency to utilize feed, protein and energy, and survivability. Hence, use of Yucca powder in broiler ration could be beneficial to maintain the litter quality, which directly enhances the productivity in broiler production without any adverse effect.