Background Catheter ablation for persistent atrial fibrillation (AF) is associated with less favorable outcomes than for paroxysmal AF. Substrate modification is often added to pulmonary vein isolation (PVI) to try to improve success rates. Recent studies have shown improved clinical outcomes with use of regional ablation index (AI) targets for PVI. We hypothesized that prospective use of AI-guided PVI in persistent AF patients would result in a low rate of PV reconnection at repeat electrophysiology study and that a high success rate can be achieved with durable PVI alone. Methods Forty consecutive patients with persistent AF underwent AI-guided PVI with target values of 550 for anterior and 400 for posterior left atrial regions, followed by a protocol-mandated repeat procedure after 2 months. Patients were monitored for atrial tachyarrhythmia recurrence via daily plus symptom-initiated ECG recordings for 12 months. Recurrence was defined as ≥30 seconds of any atrial tachyarrhythmia after a 3-month blanking period. Results PV reconnection was seen at repeat electrophysiology study in 22% of patients, affecting 7% of PVs. Ablation on the intervenous carina was required in 44% patients to achieve durable PVI. Atrial tachyarrhythmia recurrence was documented in 8 (20%) patients, only one of whom had PV reconnection at repeat study. At 12 months, 38/40 (95%) patients were in sinus rhythm, with 4 (10%) patients having started antiarrhythmic drugs. Higher body mass index and excess alcohol consumption were the only significant factors associated with atrial tachyarrhythmia recurrence. Conclusions Use of AI targets results in a high level of durable PVI. A good clinical outcome can be achieved in the great majority of persistent AF patients with AI-guided PVI alone. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT02628730.

Background Atrial fibrillation (AF) ablation is a complex procedure, generally requiring at least one overnight hospital stay. We investigated the safety and feasibility of early mobilization and same‐day discharge following streamlined peri‐ablation management for AF. Methods From 2014, we offered same‐day discharge to selected patients who underwent uncomplicated AF ablation on the morning lists, with ultrasound‐guided femoral access, uninterrupted warfarin or minimal interruption in novel oral anticoagulants, and reversal of intraprocedural heparin with protamine. Patients were discharged 6‐8 h postprocedure and offered access to a dedicated nurse helpline. Results Of 1599 AF ablation cases performed from April 2014 to March 2017, 811 (50.7%) were performed on the morning lists and 169/811 (20.8%) were discharged on the same day. Excluding 26 research cases, 1/143 (0.7%) had transient right phrenic nerve palsy and five (3.5%) cases experienced minor problems that did not preclude same‐day discharge; three (2.1%) needed rehospitalization postdischarge: one for pericarditic chest pain and two for nausea/vomiting. Compared to 642 overnight cases, day‐case procedures were shorter, more likely to be redos, to be performed under sedation rather than general anesthesia, and less likely to involve linear lesions and electrical cardioversion. There were no significant differences in patient age, gender, body mass index, CHA2DS2‐VASc, in preprocedural anticoagulation regimen (warfarin vs novel anticoagulants vs no anticoagulation) and in choice of ablation method (cryoballoon vs radiofrequency). Conclusions Selective same‐day discharge after AF ablation is safe and feasible using a streamlined peri‐procedural care protocol. Wider adoption can potentially reduce health‐care costs while improving patient experience.

In 200 adult autopsy specimens, the arterial supply to the pancreas and spleen was studied radiologically and by manual dissection. The splenic artery divided into two or three lobar arteries, which supplied its corresponding lobe; each lobar artery subsequently divided into two to four lobular branches. Six to twelve lobular branches were observed entering the splenic substance at the hilum. Lobar arteries did not anastomose with each other, hence, the lobes of the spleen are also termed segments. The lobules, however, were not found to be independent segments and the arteries of one lobule anastomosed with those of other lobules. The branching pattern of the splenic artery varied from one specimen to another, so much so that a prevailing pattern could not be identified. Polar arteries, particularly to the superior pole, arose quite proximal to the hilum in 51% of cases and were occasionally missed. In 45% of males and 40% of females, the posterior gastric artery arose from about the middle of the splenic artery. The splenic artery was not found to be tortuous in fetuses, newborns, and young children. Tortuosity was seen in only 10% of adults; thus, the characteristic tortuosity of the splenic artery appears to develop with age.

Introduction:The role of a dentist is not only to examine and treat the oral diseases but also to assist the legal authorities by means of its branch—forensic odontology. Through forensic odontology, a dentist plays a very important role in crime investigation of any type.Objective:To analyze the knowledge, awareness, and interest of forensic odontology among the dental teaching staff who are working in the dental colleges within the Delhi NCR.Materials and Methods:A questionnaire of 12 questions (both open-ended and close-ended) was prepared and the survey was conducted with 200 dental teaching staff.Results:A sufficient knowledge but poor awareness and interest among the dental teaching staff was observed.Conclusion:The study highlighted that although dental teaching staff themselves have sound knowledge regarding forensic odontology, their awareness and interest need to be upgraded on a regular basis. The success of acquiring such extensive knowledge would be valid if better job opportunities in these fields would be increased.

Summary:Gastrointestinal disturbances like anorexia, nausea, vomiting, abdominal discomfort and diarrhoea are known adverse effects of rifampicin. We report an upper gastrointestinal bleeding due to haemorrhagic gastric erosions after ingestion of rifampicin for pulmonary tuberculosis. The cause and effect relationship between development of haemorrhagic gastric erosions and rifampicin administration was confirmed by rechallenge with rifampicin. To our knowledge no such adverse effect of rifampicin has been reported previously.