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Methods for testing the presence of a virus in the blood are of interest to researchers and doctors because they determine how rapidly a virus is detected. In general, virus detection is a major scientific problem due to the serious effects of viruses on the human body. At present, only one virus can be detected in a single test. This potentially costs the medical establishment more time and money that could be saved if blood testing was more efficient. This study presents a qualitative method to enable doctors and researchers to detect more than one virus simultaneously. This was performed using quartz nanoparticles. Using polymer thin films of polydimethylsiloxane (PDMS), each chip emits a different frequency for each specific type of virus on the chip. The multiplicity of these chips allows for the detection of a number of viruses with the same number of nanoscale chips simultaneously. Blood flow around quartz nanoparticles was modelled. In this model, several conventional Quartz Crystal Microbalance (QCM) with nanostructures (Nano-QCM) particles are inserted into the three main types of blood vessels. The results showed that the best location for the Nano-QCM is the large artery and that it is possible to test for a number of viruses in all types of blood vessels.

Infective endocarditis (IE) can lead to significant morbidity and mortality without appropriate treatment. Modified Duke Criteria are accepted by many professional societies to establish the diagnosis of IE, and cardiac imaging is one of the major diagnostic criteria. Transesophageal echocardiography is an algorithmic escalation to diagnose IE when transthoracic echo does not appreciate a positive finding. In patients with contraindications to transesophageal echocardiography, cardiac magnetic resonance imaging, cardiac computed tomography (CT), cardiac CT angiography, and fluorodeoxyglucose positron emission tomography with CT or CT angiography may be alternative diagnostic tools. However, these imaging modalities have their own limitations such as local unavailability, the presence of non–magnetic resonance imaging compatible implants, or impaired renal function. Intracardiac echocardiography could be a considerable alternative under those circumstances.

Cardiac contractility modulation (CCM) is an investigational device-based therapy to enhance ventricular contractility in systolic heart failure patients who are not candidates for cardiac resynchronization therapy (CRT) owing to the absence of wide QRS complexes or who have failed to respond on CRT. The principal mechanism is based on the stimulation of cardiac muscles by nonexcitatory electrical signals to augment the influx of calcium ions into the cardiomyocytes. The majority of patients receiving CCM therapy have concurrent implantable cardioverter defibrillators, and the manufacturer declares both devices can be used in parallel without any interactions. Nevertheless, proper lead positioning of both devices are crucial, and it is mandatory to check device-device interactions during each and every cardiac electronic implantable device-related procedure to prevent adverse outcomes.

Bidirectional ventricular tachycardia (BVT) is a rare variety of tachycardia with morphologically distinct presentation: The QRS axis and/or morphology is alternating in the frontal plane leads. Since its original description in association with digitalis,1 numerous cases of this fascinating tachycardia with disparate etiologies and mechanisms have been postulated. We report a patient with BVT in association with non-ST elevation myocardial infarction and severe cardiomyopathy in the absence of digoxin toxicity.

Electromagnetic interference (EMI) includes any electromagnetic field signal that can be detected by device circuitry, with potentially serious consequences: incorrect sensing, pacing, device mode switching, and defibrillation. This is a unique case of extracardiac EMI by alternating current leakage from a submerged motor used to recycle chlorinated water, resulting in false rhythm detection and inappropriate ICD discharge. A 31-year-old female with arrhythmogenic right ventricular cardiomyopathy and Medtronic dual-chamber ICD placement presented after several inappropriate ICD shocks at the public swimming pool. Patient had never received prior shocks and device was appropriate at all regular follow-ups. Intracardiac electrograms revealed unique, high-frequency signals at exactly 120 msec suggestive of EMI from a strong external source of alternating current. Electrical artifact was incorrectly sensed as a ventricular arrhythmia which resulted in discharge. ICD parameters including sensing, pacing thresholds, and impedance were all normal suggesting against device malfunction. With device failure and intracardiac sources excluded, EMI was therefore strongly suspected. Avoidance of EMI source brought complete resolution with no further inappropriate shocks. After exclusion of intracardiac interference, device malfunction, and abnormal settings, extracardiac etiologies such as EMI must be thoughtfully considered and excluded. Elimination of inappropriate shocks is to “first, do no harm.”

Abstract Objective This systematic review of literature aimed to evaluate the safety and efficacy of dual‐chamber ICDs for LBBAP in patients with left bundle branch block (LBBB). Methods Digital databases were searched systematically to identify studies reporting the left bundle branch area pacing (LBBAP) with implantable cardioverter defibrillator (ICD) placement in patients with LBBB. Detailed study and patient‐level baseline characteristics including the type of study, sample size, follow‐up, number of cases, age, gender, and baseline characteristics were abstracted. Results In a total of three studies, 34 patients were included in this review. There was a significant improvement reported in QRS duration in all studies. The mean QRS duration at baseline was 170 ± 17.4 ms, whereas the follow‐up QRS duration at follow‐up was 121 ± 17.3 ms. Two studies reported a significant improvement of 50% in LVEF from baseline. No lead‐related complications or arrhythmic events were recorded in any study. The findings of the systematic review suggest that dual‐chamber ICD for LBBAP is a promising intervention for patients with heart conditions. Conclusion The procedure offers significant improvements in QRS duration and LVEF, and there were no lead‐related complications or arrhythmic events recorded in any of the studies.

Introduction: Emergency medicine (EM) residents are at high risk for burnout syndrome. The professional quality of life scale (ProQOL) is a validated survey that measures compassion satisfaction (CS) and compassion fatigue, which is comprised of burnout and secondary traumatic stress (STS) scales. This study sought to evaluate CS and fatigue among Turkish EM residents using the ProQOL survey. Methods: This was a cross-sectional study of Turkish EM residents who are part of the EM Residency Association of Turkey. The ProQOL survey version 5 was E-mailed in Turkish to all 150 EM residents. Participants were currently employed as EM residents. Demographics and satisfaction with quality of life were also collected. Results: Eighty residents completed the survey. Almost half of the respondents were either very dissatisfied or dissatisfied with their overall quality of life. Turkish EM residents not only had moderate levels of CS (scoring 33.9 ± 7.9), but also suffered moderate burnout (27.0 ± 5.9) and STS (24.7 ± 5.3). Conclusions: Turkish EM residents have moderate levels of CS and moderate levels of burnout and secondary traumatic stress.

Background: Congenital Insensitivity to Pain (CIPA), otherwise known as Hereditary Sensory and Autonomic Neuropathy Type IV (HSAN IV), is a rarely occurring autosomal recessive disorder encompassed by a group of hereditary and sensory autonomic neuropathies, which was initially described as pure analgesia present congenitally. Its clinical manifestation includes recurrent episodes of infections with unexplained behavior, anhidrosis, mental retardation, and damage to oral structures. Case Presentation: In this case report, we have demonstrated the signs and symptoms of a 7-year-old boy presented to the pediatric out-patient department of Memon Medical Institute Hospital with complaints of multiple fluid-filled blisters since the age of 1 year. He had a history of multiple hospital admissions due to infections, where he was diagnosed with a case of CIPA. Management & Results: Since the diagnosis of this medical condition, the child has undergone multiple debridements of his wound and amputations. The treatment plan was aimed to manage the blisters, prevent self-injuries, and treat orthopedic problems by regular dermal and orthopedic follow-ups. Conclusion: There is no cure for CIPA patients, the families that have CIPA patients must undergo prenatal testing and screening to prevent the birth of another affected child.

Abstract Compound nanoparticle drug delivery system plays an important role in the interaction with lymph nodes. There are three primary types of lymphocytes: B cells, T cells, and natural killer cells. When the cells of the immune system turn carcinogenic, they assault body cells. The lymph fluid plays an important role in attacking healthy cells of the body; hence, this paper aimed to design a drug delivery system, which can efficiently direct nanoparticles to target the infected cells, helping in high-speed elimination of such cells. The proposed design depends on the interaction between these molecules, and the intelligent nano-controller has the ability to guide the nanoparticles by anaerobic contact. The proposed design proved that the smaller the nanoparticle size and density, the less dynamic viscosity of the liquid would be, which would reflect its resistance to flow. In addition, it was concluded that hydrogen molecules play a significant role in reducing lymphatic fluid resistance due to their low density.