Efficacy of post exercise pulsed wave tissue velocity imaging in diagnosing more than 70% coronary artery stenosis

BackgroundTo evaluate efficacy of post exercise tissue velocity imaging in diagnosing more than 70% coronary artery stenosis.MethodTwenty patients with angiographically proved significant coronary artery disease and 26 healthy controls were evaluated. Pulsed wave tissue velocity imaging was performed at rest and immediately after treadmill stress test. Medial and lateral part of mitral annulus and medial and lateral part of tricuspid annulus were evaluated.ResultNo change or reduction in systolic annular velocity after exercise at any of the four sites identified patients of significant coronary artery disease with 75% sensitivity and 73% specificity. Rise in the ratio of early diastolic inflow velocity to the corresponding early diastolic annular velocity above the identified site-specific cut-off value had sensitivity of 85% but specificity of 34.6%. A combination of no change or decrease in late diastolic annular velocity and no change or decrease in systolic annular velocity at any of the four sites had sensitivity of 75% and specificity of 88.46%.ConclusionPost exercise tissue velocity imaging can provide a useful, objective parameter for detection of ischemic heart disease on stress testing.     

Spontaneous migration of bullet from arm to forearm and its ultrasound guided removal

Spontaneous migration of a retained bullet is rare. We are presenting here a case of a 24-year-old male with spontaneous migration of bullet from arm to forearm. At the time of initial injury, bullet was left inside the arm as it was deep and patient had no complaints. Three months after injury, he started complaining of pain over forearm and tingling sensations in the forearm and hand over median nerve distribution. Radiographs showed bullet in the proximal forearm. The bullet was than precisely localized and removed under ultrasound guidance. This case report emphasizes the fact that spontaneous migration of bullet in extremities may occur and have the potential to cause neurovascular damage. Removal under ultrasound guidance is a viable option in such locations.     

Recent progress and prospects in the electrode materials of flexible sodium-ion battery

1. Download : Download high-res image (311KB)
2. Download : Download full-size image

     

Ankylosing spondylitis diagnosis in US patients with back pain: identifying providers involved and factors associated with rheumatology referral delay

This study aimed to identify providers involved in diagnosing ankylosing spondylitis (AS) following back pain diagnosis in the USA and to identify factors leading to the delay in rheumatology referrals. The Truven Health MarketScan® US Commercial Database was searched for patients aged 18–64 years with back pain diagnosis in a non-rheumatology setting followed by AS diagnosis in any setting during January 2000–December 2012. Patients with a rheumatologist visit on or before AS diagnosis were considered referred. Cox regression was used to determine factors associated with referral time after adjusting for age, sex, comorbidities, physician specialty, drug therapy, and imaging procedures. Of 3336 patients included, 1244 (37 %) were referred to and diagnosed by rheumatologists; the others were diagnosed in primary care (25.7 %), chiropractic/physical therapy (7 %), orthopedic surgery (3.8 %), pain clinic (3.6 %), acute care (3.4 %), and other (19.2 %) settings. Median time from back pain diagnosis to rheumatology referral was 307 days and from first rheumatologist visit to AS diagnosis was 28 days. Referred patients were more likely to be younger (hazard ratio [HR]?=?0.986; p?<?0.0001), male (HR?=?1.15; p?=?0.0163), diagnosed with uveitis (HR?=?1.49; p?=?0.0050), referred by primary care physicians (HR?=?1.96; p?<?0.0001), prescribed non-steroidal anti-inflammatory drugs (HR?=?1.55; p?<?0.0001), disease-modifying antirheumatic drugs (HR?=?1.33; p?<?0.0001), and tumor necrosis factor inhibitors (HR?=?1.40; p?=?0.0036), and to have had spinal/pelvic X-ray prior to referral (HR?=?1.28; p?=?0.0003). During 2000–2012, most patients with AS were diagnosed outside of rheumatology practices. The delay before referral to rheumatology was 10 months; AS diagnosis generally followed within a month. Earlier referral of patients with AS signs and symptoms may lead to more timely diagnosis and appropriate treatment.     

Spectrum of ocular firework injuries in children: A 5-year retrospective study during a festive season in Southern India

Purpose:

Ocular trauma is a major cause of acquired monocular blindness in children. Firework injuries account for 20% of ocular trauma. The purpose of our study was to document the profile of ocular firework injuries in children during the festive season of Diwali and to determine the prevalence of unilateral blindness in them.

Materials and Methods:

A retrospective chart analysis of ocular firework injury in children during the festival of Diwali from 2009 to 2013, conducted in a tertiary care eye center in Tamil Nadu, Southern India. Children below 18 years of age with ocular firework injuries who presented to the emergency department for 3 consecutive days - the day of Diwali, 1 day before, and 1 day after Diwali - were included in this study.

Results:

Eighty-four children presented with firework-related ocular injuries during the study period. Male to female ratio was 4:1 with mean age 9.48 ± 4 years. Forty-four percentage required hospitalization. The prevalence of unilateral blindness in children due to fireworks was found to be 8% (95% confidence interval - 2–13%).

Conclusion:

Vision 2020 gives high priority to avoidable blindness, especially in children. In our study, for every 12 children who presented with firecracker injury, one resulted in unilateral blindness. This is an avoidable cause of blindness. Awareness needs to be created, and changes in policy regarding sales and handling of firecrackers including mandatory use of protective eyewear should be considered.