Comparison of VVIR, DDD, and DDDR Pacing

In the past several years there has been continued improvement in pacemaker technology, resulting in the availability of a large variety of pacemaker generators and pacing modes. The introduction of single-chamber rate modulated pacemakers provided a further improvement in pacing therapy. With the recent introduction of dual-chamber rate responsive pacemakers, it is now possible to more closely restore physiological function with pacing in a large number of patients. In deciding which pacing mode is most beneficial to a given patient, it is essential to understand the various characteristics of the different pacing modes that are available. It is essential to have knowledge of the underlying electrophysiological characteristics of the patient and how they would be affected by the different modes available. The VVIR mode will control bradycardia and provide rate adaptation but at the expense of AV synchrony. The DDD mode will control bradycardia and provide AV synchrony, but will not provide rate adaptation in patients with chronotropic incompetence. The DDDR mode will control bradycardia, maintain AV synchrony, and provide far rate adaptation in the presence of chronotropic incompetence. The chronotropic response to physiological stress and/or pacemaker syndrome are major determining factors in the choice of the best pacing mode. The primary goal of pacing therapy is to restore the heart function as close as possible to normal. When at all possible, this should include provision of both AV synchrony and rate modulation. The DDDR mode is preferable in most patients since it is capable of providing both AV synchrony and rate response (except those with chronic supraventricular arrhythmias). The VVIR mode is as effective in patients who have chronic atrial fibrillation or frequent episodes of supraventricitar arrhythmias.     

Circulating autoantibodies as serological markers in the differential diagnosis of pulmonary renal syndrome

Abstract. Objectives . Pulmonary renal syndrome (lung haemorrhage and glomerulonephritis) is a fulminant condition that warrants a rapid diagnosis and treatment to prevent mortality and preserve renal functions. However, the patients frequently present with non-specific pulmonary symptoms in the early phase of the syndrome and the diagnosis is often missed. Recently, several autoantibodies have been described in association with various forms of glomerulonephritis. We evaluated the association as well as the diagnostic and the prognostic significance of these antibodies in pulmonary renal syndrome. Design . Retrospective clinical study. Setting . University Hospital. Subjects . Forty consecutive patients with biopsy verified glomerulonephritis and overt haemoptysis or pulmonary infiltrates compatible with lung haemorrhage. Interventions . Analysis of proteinase 3 antineutrophil cytoplasm antibodies (PR3-ANCA), myeloperoxidase (MPO)-ANCA, antiglomerular basement membrane (GBM) and anti-entactin antibodies. Results . Thirty-six (90%) patients possessed one or more autoantibodies. Twenty-seven (70%) patients had ANCA (PR3-ANCA, MPO-ANCA or both). The remaining positive patients (n = 9) had anti-GBM antibodies. Only two patients had anti-entactin antibodies, suggesting a poor association of these antibodies with PRS. The majority of patients with anti-GBM antibodies had a very poor clinical outcome (five irreversible renal failure; three deaths). On the other hand, despite no significant difference in clinical features or renal morphology from patients with anti-GBM antibodies, 19 patients (70%) with ANCA recovered completely following treatment. Conclusions . Our study demonstrated that the presence of autoantibodies is a predominant feature of PRS and that the type of immunologic injury is of paramount importance in determining the course of illness in this syndrome. Analysis of the aforementioned antibodies can help in an early differential diagnosis and thus, in better management of PRS.     

Dual AV Nodal Pathways—Vagal Influences on AV Nodal Conduction

This 52-year-old male presented with syncope and demonstrated two distinct PR intervals on the electrocar-diogram. Electrophysiologic studies showed dual A V nodal path ways. Right-sided carotid sinus massage induced prolonged periods of sinus arrest with no change in AH interval. Left-sided carotid sinus massage produced long AH intervals (slow pathway conduction) with some slowing of sinus rate. Whenever sinus rhythm with slow pathway conduction was observed (long AH) a 20-30 mmHg drop systolic pressure was seen. Following implantation of an AV sequential pacemaker, the patient has been asymptomatic.     

Cushiongoid adrenal hyperplasia in infancy

Cushing's syndrome, a characteristic pattern of obesity with hypertension due to the hyperfunction of the adrenal cortex, is relatively rare in infancy. Thirty-six infants have been reported in world literature,^1,2 most of whom have had adrenal tumours. There are only eight reported cases of infants under the age of 1 year with adrenal hyperplasia responsible for Cushing's syndrome. This is a report of an 8 month old child with bilateral nodular adrenal hyperplasia.     

Parental stress as a predictor of early childhood caries among preschool children in India

International journal of Paediatric Dentistry 2013; 23: 160–165 Background. The health and well‐being of children are linked to their parents’ physical, emotional and social health in addition to child‐rearing practices. Objectives. To investigate the association of parental stress as a risk indicator to early childhood caries (ECC) prevalence among preschool children of Moradabad, India. Methods. A case–control study was conducted among 800 preschool children [400 cases (caries active) and 400 controls (caries free)] aged 4–5 years along with their parents. Using the Parental Stress Index‐Short Form (PSI/SF), we determined the stress of primary caregivers of young children. These children were clinically examined for dental caries using Dentition Status and Treatment needs. Student’s t‐test, Pearson’s correlation and linear regression were used for statistical analysis. Results. An overall mean parenting stress index was found to be 193.48 ± 59.63. Significantly higher mean stress scores were obtained among cases than among controls. Parental stress was significantly correlated with dmft scores and it was found to be one of the best predictors of ECC. Conclusion. This study provides data to suggest that parental stress has a pervasive impact on the children’s oral health. The practitioners should be aware of this possible relationship and be prepared to provide appropriate intervention.     

Update on Percutaneous Mechanical Mitral Commissurotomy

A reusable metallic valvotomy device has been developed with the goals of improving the results of percutaneous mitral valvotomy and increasing the cost-effectiveness of the procedure. The device consists of a detachable and reusable metallic dilator with two articulated bars screwed at the distal end of a catheter. Using transseptal catheterization, the device is placed across the valve over a traction guidewire and then opened gradually by means of pliers up to a maximum of 40 mm. To date, the device was used in 168 patients with a broad spectrum of mitral valve disease. The procedure was successful in 95% of cases and resulted in an increase in mitral valve area from 1.01 ± 0.8 to 2.20 ± 0.7 cm². No increase in mitral regurgitation was noted in 87% of cases. Bilateral splitting of the commissures was observed in 89%. Complications included the following: 2 severe mitral regurgitations (one requiring surgery), 1 pericardial tamponade, 1 transient cerebrovascular embolic event. The maximum number of consecutive patients treated with the same device was 35. The results obtained are at least comparable to those of current balloon techniques and confirm the possibility of safe multiple reuses of the device after sterilization.     

The private/public mix in health care in India

Private hospitals and private medical practitioners play a significantpart in delivering health care services in India. As the demandfor health care has increased, institutions in this sector haveexpanded widely in both urban and rural areas. The relationshipbetween patient and private practitioner considerably influencesthe perceived and actual needs about health care. This relationshipis expected to play an important role in the control of diseasepatterns and management. However, the developments in this sectorhave prompted concern about the efficiency of resources, equityand access to facilities, and the availability of financingmechanisms to support private health care. Also, the efficiencywith which the resources are used in this sector has directbearing on the cost and quality of services. The existence ofthese health care institutions therefore has profound implicationsfor the present character of the Indian health care system,and its future course. The objectives of the present study are to review the role ofthe private health care sector in India and the policy concernsit engenders. The discussion suggests that policy makers inIndia should take serious note of the growing influence of theprivate sector in providing health care in India. Policy interventionsin health should not ignore their existence and this sectorshould be explicitly involved in the health management process.It is argued that regulatory and supportive policy interventionsare inevitable to promote this sector's viable and appropriatedevelopment.     

Comparative efficacy of drug regimens in skin tuberculosis

Three antituberculous drug regimens have been employed to study the therapeutic response in 90 patients with any one of the commonly encountered paucibacillary forms of skin tuberculosis, namely lupus vulgaris, tuberculosis verrucosa cutis and scrofuloderma. The first two regimens contained rifampicin, isoniazid and either pyrazinamide or thiacetazone, and the third regimen had rifampicin and isoniazid only. The disease was clinically defined as localized when confined to one area and widespread when the lesions were disseminated. The observations revealed that the response of lupus vulgaris and tuberculosis verrucosa cutis was alike in all the three regimens, with the localized lesions subsiding completely after 4 months of therapy and the more extensive forms taking 5 months. Patients with scrofuloderma responded similarly to both the triple drug regimens. The discharge, sinuses and ulcers cleared in 6 months but the lymph nodes took longer to regress, up to 7 months in localized and 9 months in more widespread scrofuloderma. To obtain the same results with rifampicin and isoniazid, all patients with widespread scrofuloderma and one-third of those with localized forms had to be treated for 10 and 9 months, respectively. No serious drug side-effects, apart from giddiness with rifampicin and acneiform eruptions with thiacetazone, were encountered. No instances of relapse were noted in the 50% of patients who were followed-up for 3 1/2 years after therapy. Single-drug therapy with isoniazid for lupus vulgaris, as given in the past, is to be discouraged as it may promote the emergence of drug-resistant bacilli in those with an undetected focus of infection.(ABSTRACT TRUNCATED AT 250 WORDS)     

Transesophageal Echocardiographic Findings in Complete Unilateral Anomalous Pulmonary Venous Connection of Right Lung to Right Atrium

Transesophageal echocardiographic findings in a patient with anomalous drainage of both right- sided pulmonary veins into the right atrium are described. The atrial septum was intact and the left- sided veins connected normally with the left atrium.
transesophageal echocardiography, partial anomalous pulmonary venous connection of the right pulmonary veins to the right atrium     

In vitro studies on a novel micelle-forming peptide with anticoagulant activity

A novel peptide, tert-butyloxycarbonyl-L-arginine-L-proline lauryl ester laurate, synthesised by a solution-phase method, formed micelles in aqueous solutions and was observed to exhibit anticoagulant activity as shown by clotting assays such as the thrombin time (TT) test, the prothrombin time (PT) test and the activated partial thromboplastin time (APTT) test. TT and PT were found to be normal up to a particular concentration of peptide, and above that level they increased with increasing concentration of peptide, while APTT did not exhibit much significance. Conductometric and potentiometric studies showed that the peptide formed a stable micelle, and the anticoagulant activity of this peptide was also compared with a non-arginine-containing peptide (control) known to form micelles. The anticoagulant action in the micellar form could be due to the inhibition of thrombin, as seen from the decrease in amidolytic activity. The inhibitory activity of the peptide was explained in the light of micelle formation.