Malposition of Transvenous Pacing Lead in the Left Ventricle

Malposition of pacemaker leads has been described in several locations but rarely in the left ventricle. The incidence and clinical course of this pacemaker complication are unknown. We describe clinical, electrocardiographic, chest X ray, and echocardiographic findings in four patients in whom the transvenous pacing lead was inadvertendy placed through the interatrial septum and mitral valve into the left ventricle, in these patients, lead misplacement was not recognized at the time of implantation and lead malposition was diagnosed a mean of 2 years later. All four patients had right bundle branch block configuration paced complexes. In retrospect, chest X rays suggested atypical lead position in all, but the initial posterioranterior and lateral chest X rays were misinterpreted and contributed to the delay in diagnosis. When lead misplacement in the left ventricle was considered it was confirmed by two-dimensional echocardiography. One patient subsequently presented with a stroke and the remainder were diagnosed when they presented with other unrelated problems. Pacing thresholds were normal at the time of implantation and behaved normally during follow-up. The patient presenting with stroke was anticoagulated and the other three have been managed expectantly without anticoagulafion. Diagnosis of left ventricular lead malposition is not difficult but requires a high index of suspicion. A 12-lead ECC and posterior-anterior and lateral chest X rays after implantation can be diagnostic. Patients with pacing lead in the left ventricle may remain asymptomatic with normal lead function during long-term follow-up. Anticoagulation should be considered when this problem comes to attention for the first time during follow-up.     

CHRONIC CUTANEOUS LEISHMANIASIS: LEISHMANIA PARASITES IN BLOOD

Two patients with chronic cutaneous leishmaniasis had positive blood cultures. The diagnosis was established by the clinical picture, skin biopsy, and culture for Leishmania major and tropica.     

The vibratory pattern of ultrasonic files driven piezoelectrically

The pattern of oscillation of a Piezon-Master 400 ultrasonic file driven by a piezoelectric transducer was studied in air and on water. In addition, the displacement amplitudes of the files were measured. The findings were compared with those observed with the Cavi-Endo unit reported in another study (Ahmad 1969). It was observed that the file vibrated such that a standing wave was formed on the file and it exhibited points of maximum deflection (antinode) and points of minimum deflection (node) with the largest deflection occurring at the apical end. This pattern of oscillation was similar to that exhibited by the Cavi-Endo file which employed a magnetostrictive transducer. However, the displacement amplitudes were very much higher than those exhibited by the Cavi-Endo. It is considered that the 120° angle of the file holder inherent in the Piezon- Master 400 unit and the more effective power transmission with the piezoelectric transducer may have contributed to the large amplitudes.     

Late Evolution of Giant Verruciform Xanthoma in the Setting of CHILD Syndrome

Abstract: Congenital hemidysplasia with ichthyosiform erythroderma and limb defects (CHILD) syndrome is a rare X‐linked dominant disorder that is characterized by peculiar cutaneous features commonly associated with skeletal and internal organ involvement. Cutaneous verruciform xanthoma is an uncommon cutaneous manifestation of congenital hemidysplasia with ichthyosiform erythroderma and limb defects syndrome. We present a case presenting with a late onset of a large verruciform xanthoma of the right foot, in addition to the more typical cutaneous features of congenital hemidysplasia with ichthyosiform erythroderma and limb defects syndrome.     

A laboratory examination of the behaviour of cast cobalt-chromium clasps

Cast cobalt-chromium clasps, long and short, tapered and untapered, were studied. It is shown that the behaviour of apparently identical clasps is inconsistent. Permanent deformation appears to commence during the first month of wear, and after 6 months' wear the retentive quality of almost all of the clasps is impaired.     

A systematic review on noncommunicable diseases among working women

The increasing involvement of women in the paid-labor market has led to multifactorial exposure towards the development of noncommunicable diseases (NCDs). This review aims to identify the prevalence of NCDs and the associated risk factors among working women. A systematic review was performed using PubMed and Scopus databases. Twelve articles published between 2015 and 2019 satisfied the inclusion and exclusion criteria and were selected for qualitative synthesis. Among working women, the prevalence of NCDs was as follows: coronary heart disease, 0.3%–5.9%; metabolic syndrome, 52.0%; diabetes mellitus, 8.9%–16.0%; hypertension, 16.6%–66.4%; non-skin cancer, 3.7%. The prevalence of NCD risk factors was as follows: overweight/obesity, 33.8%–77.0%; low physical activity, 51.0%; unhealthy diet, 44.9%–69.9%; dyslipidemia, 27.8%–44.0%. The factors associated with NCDs were long working hours, double work burden, and stress. NCD is an important burden of working women that will lead to reduced work quality and affect family well-being. Disease prevention approaches, such as the intervention of common workplace risk factors and specific work schedule design, are among the strategies for improving the situation.     

Some clinical investigations on retention forces of maxillary complete dentures with the use of denture fixatives

The aim of this study was to evaluate objectively and clinically the relative improvement in retention forces of complete dentures with the use of three proprietary denture fixatives. Using the UCL Retentiometer, retention forces of ill-fitting maxillary complete dentures were measured with saliva alone as the interface medium and with the use of the three test denture fixatives in edentulous subjects over a peroid of 6 h. Results showed that forces with saliva alone were consistently and significantly lower when compared with the forces measured at any test period with the use of the test fixatives. A sixfold improvement in forces from the salivary baseline values was observed when these materials were used. However, the test fixatives showed substantial variations in retention forces depending on the physical formulation of the material. Whilst the powder Variety was effective immediately after its application, retention forces with the liquid and paste materials did not peak until 3 h post-insertion. Measurements at 6 h post-insertion stage showed that the powder fixative was the least effective of the three materials. This was mainly attributed to the rapid washing of the active ingredients by saliva because of the absence of oily base present in the paste and liquid materials.