ABSTRACT
The aim of medical education is to teach the essence of practical skills alongside with the theoretical knowledge. Teaching anatomy, as the center of medical education, should be leading to use this knowledge as a skill during clinical period. According to the rising numbers of dentistry faculties' experiences, inappropriate education results in misguidance during clinic. Thus, this study was conducted to find about the pre-clinical and clinical dentistry students' points of view on the helpfulness of anatomy classes in achieving clinical goals. Present descriptive cross-sectional study evaluated Guilan University of Medical Sciences' pre-clinical and clinical dentistry students' opinions on the effectiveness of anatomy classes during their clinical period in 2017. The sampling method used here was census via questionnaire and scoring was according to Likert scaling system. Analyses showed that anatomy of the nervous system was the most assistive course, which helped dentistry students during their clinical period (P<0.001). The least scored course was visceral organs and that means they did not use most of their learnings from classes with this topic (P<0.001). They also stated that other important factors such as using cadavers and moulages in practical sessions, teaching clinical skills theoretically before practical sessions and performing group activities are crucial for them to recall important details of the relevant courses during clinical period. Results of this study suggests that alongside with the various topics of anatomy courses, other factors like professors' characteristics and their teaching methods are also of important factors helping the dentistry students throughout clinic.
Subject(s)
Humans , Cadaver , Censuses , Clinical Competence , Cross-Sectional Studies , Dentistry , Education , Education, Medical , Learning , Methods , Models, Anatomic , Nervous System , TeachingABSTRACT
Cardiac resynchronization therapy [CRT] has been introduced as a promising therapeutic choice in heart failure [HF] patients with ventricular dyssynchrony, shown with a wide QRS. In previous study, we showed a positive effect of CRT on ejection fraction. This study aimed to evaluate the effect of CRT on the severity of mitral regurgitation [MR] quantitatively using the volumetric Doppler method in HF patients. In this prospective before-after survey, 22 HF patients with wide QRS [>/=120 ms] and NYHA class III who were included. All patients were evaluated initially for QRS width, NYHA class, MR volume, MR fraction and mitral valve area [MV area]. Biventricular pacing was done through cardiac-resynchronization device along with three pacing leads and same evaluations were done after CRT. The mean [SD] QRS width and NYHA class were significantly decreased after CRT in HF patients [p<0.001]. Also MR volume [46.9 +/- 30.2 mL vs. 27.0 +/- 26.4 mL, p<0.001] and fraction [40.1 +/- 25.5% vs. 26.8 +/- 22.7%, p=0.002] were improved following CRT. The decrease of MV area after CRT was also significant [10.6 +/- 3.0 cm[2] vs. 8.6 +/- 2.6 cm[2], p<0.001]. As MR is associated with morbidity and mortality in HF patients and the standard surgical therapy may not be practical for a majority of them, this novel treatment may improve their disease condition significantly
ABSTRACT
Coronary artery anomalies are rare, with their incidence varying from 1 to 5%. Angiography is a commonly used modality for the assessment of coronary artery anomalies. Based on previous reports, a majority of coronary artery anomalies are of origin or distribution, with separate ostia of the left anterior descending artery and left circumflex artery. Coronary artery anomalies may cause myocardial ischemia secondary to atherosclerosis in the same artery. We present a rare case of duplicated right coronary artery with a separate ostium, which caused myocardial ischemia. Our patient was a 51-year-old diabetic woman with typical chest pain and dyspnea on exertion. Electrocardiography showed left axis deviation, poor R progression, andbiphasic Twave in the precordial leads. Echocardiography revealed left ventricular ejection fraction of 30-35% and global hypokinesia. Coronary angiography demonstrated three-vessel disease and a double ostial right coronary artery. We recommended coronary artery bypass graft surgery, but the patient refused it and we continued her treatment with anti-ischemic drugs
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QT interval parameters have been suggested as a predictor of lethal arrhythmia and mortality in patients with myocardial infarction. The aim of the present study was to compare the value of QT interval indices in patients presenting with non-ST-segment elevation myocardial infarction [NSTEMI] between a group of patients with type 2 diabetes mellitus and a nondiabetic group of patients. This case-control study evaluated QT interval parameters in 115 patients [47 diabetic and 68 nondiabetic patients] diagnosed with NSTEMI between September 2011 and July 2012. The following QT interval indices were analyzed: maximum [max] and minimum [min] QT interval; max and min corrected QT interval [QTc]; QT dispersion [QTd]; and corrected QT dispersion [QTcd]. All the patients were observed for ventricular arrhythmia during their hospital course and underwent coronary angiography. They were selected to undergo coronary artery bypass surgery [CABG] or percutaneous coronary angioplasty [PCI] based on their coronary anatomy. The mean age of the patients was 60.8 +/- 11.4 years. The patients were 40.0% female and 60.0% male. There were no significant differences in clinical characters between type 2 diabetic and nondiabetic patients with NSTEMI. Compared with post-myocardial infarction patients without diabetes, those with type 2 diabetes had higher QTc max, QTd and QTcd [p value < 0.05]. There was a significant difference in QTd and QTcd in the patients needing coronary revascularization with diabetes as opposed to the nondiabetics [p value = 0.035 and p value = 0.025, respectively] as well as those who had ventricular arrhythmia with diabetes [p value = 0.018 and p value = 0.003, respectively]. QTcd was higher in the patients who had higher in-hospital mortality [p value = 0.047]. The QTc max, QTd and QTcd were significantly [all p values < 0.05] associated with ventricular arrhythmia, QTcd with need for revascularization and QTc max with in-hospital mortality in the diabetic patients. Based on the findings of this study, it seems that type 2 diabetics with NSTEMI have greater QTc max, QTd, and QTcd and these QT parameters may have a relationship with worse cardiac outcomes and poorer prognoses
ABSTRACT
Left ventricular [LV] twist is due to oppositely directed apical and basal rotation and has been proposed as a sensitive marker of LV function. We sought to assess the impact of chronic pure mitral regurgitation [MR] on the torsional mechanics of the left human ventricle using tissue Doppler imaging. Nineteen severe MR patients with a normal LV ejection fraction and 16 non-MR controls underwent conventional echocardiography and apical and basal short-axis color Doppler myocardial imaging [CDMI]. LV rotation at the apical and basal short-axis levels was calculated from the averaged tangential velocities of the septal and lateral regions, corrected for the LV radius over time. LV twist was defined as the difference in LV rotation between the two levels, and the LV twist and twisting/untwisting rate profiles were analyzed throughout the cardiac cycle. LV twist and LV torsion were significantly lower in the MR group than in the non-MR group [10.38° +/- 4.04° vs. 13.95° +/- 4.27°; p value = 0.020; and 1.29 +/- 0.54 °/cm vs. 1.76 +/- 0.56 °/cm; p value = 0.021, respectively], both suggesting incipient LV dysfunction in the MR group. Similarly, the untwisting rate was lower in the MR group [-79.74 +/- 35.97 °/s vs.-110.96 +/- 34.65 °/s; p value = 0.020], but there was statistically no significant difference in the LV twist rate. The evaluation of LV torsional parameters in MR patients with a normal LV ejection fraction suggests the potential role of these sensitive variables in assessing the early signs of ventricular dysfunction in asymptomatic patients
ABSTRACT
Cardiac resynchronization therapy [CRT] has introduced as new treatment strategy in heart failure [HF] patients and some of its effects have been investigated. The aim of this study was to study the effectiveness of CRT in the improvement of left ventricular systolic function indicated by left ventricular ejection fraction [LVEF] in HF patients. In our prospective study 22 HF patients with NYHA class III and above, QRS duration>120 ms and EF [ejection fraction]
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Coronary artery disease causes changes in biomechanical parameters and function of myocardial. Recently, torsion angle is one of the most important mechanical parameters. Therefore in this study, torsion angle in healthy subjects and LAD significant coronary artery disease patients, using echo tracking method in short axis view, was evaluated. In cross sectional study, 14 healthy subjects and 10 patients with significant stenosis of LAD were evaluated. Two dimensional echocardiography images were scanned in apical and basal parasternal short axis view were recorded. Successive ultrasonic images were processed by echo tracking under block matching algorithm and peak torsion angle were estimated. Difference between healthy group and patient group were extracted by using peak torsion angle by the confidence level of 95%. In this study, basal rotation angle, apical rotation angle and torsion angle in short axis view in significant coronary artery disease patients significantly decreased 33%, 44% and 38% relative to healthy subjects, respectively. Also time to reach peak torsion angle in LAD coronary artery stenosis patients increased 19% relative to healthy group. It seems, torsion angle in short axis view, can diagnose LAD coronary artery stenosis patients reative to healthy subject
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Left ventricular twist/torsion is believed to be a sensitive indicator of systolic and diastolic performance. To obtain circumferential rotation using tissue Doppler imaging, we need to estimate the time-varying radius of the left ventricle throughout the cardiac cycle to convert the tangential velocity into angular velocity. The aim of this study was to investigate accuracy of measured LV radius using tissue Doppler imaging throughout the cardiac cycle compared to two-dimensional [2D] imaging. A total of 35 subjects [47 +/- 12 years old] underwent transthoracic echocardiographic standard examinations. Left ventricular radius during complete cardiac cycle measured using tissue Doppler and 2D-imaging at basal and apical short axis / levels. For this reason, the 2D-images and velocity-time data derived and transferred to a personal computer for off-line analysis. 2D image frames analyzed via a program written in the MATLAB software. Velocity-time data from anteroseptal at basal level [or anterior wall at apical level] and posterior walls transferred to a spreadsheet Excel program for the radius calculations. Linear correlation and Bland-Altman analysis were calculated to assess the relationships and agreements between the tissue Doppler and 2D-measured radii throughout the cardiac cycle. There was significant correlation between tissue Doppler and 2D-measured radii and the Pearson correlation coefficients were 0.84 to 0.97 [P<0.05]. Bland-Altman analysis by constructing the 95% limits of agreement showed that the good agreements existed between the two methods. It can be concluded from our experience that the tissue Doppler imaging can reasonably estimate radius of the left ventricle throughout the cardiac cycle
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Nowadays, myocardial perfusion imaging [MPI] plays an important role in the early diagnosis of patients with coronary artery disease [CAD]. This study sought to assess the performance of MPI alongside chest paint and ST-segment changes during the stress test by comparison with angiography in the diagnosis of coronary artery stenosis. To that end, the accuracy of these modalities in terms of sensitivity and specificity and the degree of greement between their results in the diagnosis of coronary artery stenosis were evaluated. The study population, selected from those with known or suspected CAD, was comprised of 85 patients [67 males] at a mean age of 53.7 +/- 9.6 years. All the patients were subjected to SPECT imaging of the blood supply to the heart muscle during a two-day state of stress [either pharmacologically with Dipyridamole or through exercise test] and during rest via the injection of 99m Tc - MIBI. ST-segment changes during stress as well as clinical symptoms were recorded. All the patients underwent coronary angiography within two weeks, and coronary artery stenosis >50% was considered positive. Finally, the results of chest pain, ECG changes, and MPI for the evaluation of coronary artery involvement were compared with those of angiography as the gold standard. Of the 85 patients, who underwent angiography, 10 patients had normal coronary angiography, 22 single-vessel disease, 28 two-vessel disease, and 25 three-vessel disease. ST- segment depression and ST-segment elevation were observed in 40 and 6 patients, respectively. The ECG had sensitivity of 57% and specificity of 70% in the diagnosis of coronary artery stenosis. Fifteen patients had chest pain during stress; all of them had coronary involvement according to angiography. Of the 70 patients with no chest pain, coronary angiography was positive in 62 cases; accordingly, chest pain had sensitivity of 20% and specificity of 100% in the diagnosis of coronary artery stenosis. There were 80 patients with abnormal MPI, including 387 fixed and reversible defects. Therefore, MPI had sensitivity of 79%, specificity of 70%, and diagnostic accuracy of 76% in the diagnosis of coronary artery stenosis. MPI enjoyed higher diagnostic accuracy and agreement coefficient than did chest pain and ST-segment changes in the diagnosis of coronary artery stenosis. Given the acceptable results of MPI in the diagnosis of coronary artery stenosis, this modality could be valuable in the management of CAD patients
Subject(s)
Humans , Female , Male , Electrocardiography , Coronary Angiography , Chest Pain , Myocardial Perfusion Imaging , Tomography, Emission-Computed, Single-PhotonABSTRACT
T-wave overs ens ing occurs when the counter starts giving dual beeps for every cardiac cycle instead of one. This usually happens when the monitoring lead displays a tall T wave, which is also sharp. R wave sensing algorithms of the devices do not sense Twave because the slow rate of the Twave is much less than that of the R wave. But the slow rate of'T'waves may change with time and also because of parameters like potassium levels and hyperglycemia. We present a 67-year-old female who underwent the implantation of cardiac resynchronization therapy [cardiac resynchronization and implantable cardioverter defibrilator [CRT-D]] because of severe left ventricular systolic dysfunction and ventricular dyssynchrony experienced recurrent inappropriate implantable cardioveYter-defibrillator [ICD] shocks and CRT failure. Device analysis showed that the CRT failure was in consequence of T-wave oversensing due to hyperglycemia. Elimination of the T-wave oversensing after hyperglycemia control conferred good biventricular pacing and good response to CRT during a 6-month follow-up period
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More diagnostic techniques require a better understanding of the forces and stresses developed in the wall of the left ventricle. The aim of this study was to differentiate significant coronary artery disease [CAD] patients using a non-invasive quantification of myocardial wall stress in the diastole phase. Sixty male subjects with sinus rhythm [30 patients with significant and 30 with moderate left anterior descending coronary artery stenosis in the proximal portion] as well as 35 healthy subjects as the control group were recruited into the present study. By two-dimensional, pulsed wave, and tissue Doppler echocardiography, the average end-diastolic wall stress was calculated at the left ventricle anterior and interventricular septum wall segments using regional wall thickness, meridional and circumferential radii, and non-invasive left ventricular end-diastolic pressure. A comparison of the calculated end-diastolic myocardial wall stress between the patients with significant and moderate coronary stenosis on the one hand and the healthy subjects on the other showed statistically significant differences in the anterior and septum wall segments [p value < 0.05]. The patients with significant left anterior descending coronary artery stenosis had higher end-diastolic myocardial wall stress than did those with moderate stenosis and the healthy group in all the anterior and septum wall segments. It is concluded that non-invasive end-diastolic myocardial wall stress in coronary artery disease patients is an important index in evaluating myocardial performance
Subject(s)
Humans , Male , Middle Aged , Echocardiography , Myocardium , Stress, Mechanical , Diastole , Heart VentriclesABSTRACT
The recent developments in tissue Doppler imaging [TDI] now more than ever permit the quantification of the myocardial function. In the current systems, tissue tracking or displacement curves are generated from color tissue Doppler data through the instantaneous temporal integral of velocity-time curves. The purpose of the present study was to assess regional myocardial displacement via spectral TDI. Maximum myocardial velocities were extracted from spectral pulsed tissue Doppler images using a developed computer program and were integrated throughout the cardiac cycle. Spectral tissue Doppler echocardiography was performed to evaluate longitudinal and radial functions in 20 healthy men, and the calculated end-systolic displacements were subsequently compared with the displacements measured from the same areas via color tissue tracking. According to the Bland-Altman analysis between spectral tissue tracking and color tissue tracking, the significant arithmetic mean was 7.34 mm with SD mean differences of +/- 2.24 mm in all of the evaluated segments. Despite significant differences [p < 0.001], there was a good significant correlation between the two methods [r=0.79, p < 0.001]. A verification study showed that the proposed approach had the ability to assess regional myocardial displacement using spectral TDI, which can be used in a wider range of equipment than is currently possible