Effectiveness of residents as teachers, researchers and role models: a unique program at SUMS

Background and purpose: Residents across the world spend several hours every week teaching medical students and junior residents. Workshops developed with the aim of improving resident teaching skills are becoming increasingly common in the various fields of medicine. The objectives of this study were to evaluate the effect of a resident-as-teacher educational intervention on the resident's knowledge of medical education

Methods: The study was performed in SUMS, Iran, in 2010-2011 on all the junior residents from the different fields, including 104 men and 66 women. For data collection, a questionnaire [pre-test, post-test] was used with 40 questions on medical education. The data were analyzed using descriptive statistics, tables and t test employing the SPSS software

Results: In total, 120 participants completed the questionnaires. According to the pre-test and post-test results, residents received extremely low scores in different subjects before the course implementation, whereas after it was implemented their scores had significantly increased fairly well. The comparison between the participants, average scores before and after the program indicates that the "resident-as-a-teacher, researcher and role model" course has been meaningful and significantly effective in improving their knowledge in this area

Conclusions: A few residency programs had instituted the resident teacher training curricula. A resident teacher training workshop was perceived as beneficial by the residents, and they reported improvement in their teaching skills

Research priorities in medical education in the Eastern Mediterranean Region

Ways are needed to effect quality improvement in medical education research in the Eastern Mediterranean Region [EMR]. This study aimed to determine the principle themes and to draw up a list of priorities in medical education research in EMR. Using the nominal group technique with a group of 30 experts, a list of major themes in medical education research was prepared. In a 2-round Delphi survey the list was sent to another 47 experts in the Region with a questionnaire that included open questions about change and reform in medical education. In the final list of 20, the 5 highest priorities identified were: training physicians to be effective teachers; community-driven models for curriculum development; clinical teaching models; education about professionalism and ethics; and education for evidence-based medicine. Themes determined by this survey can help researchers in EMR to focus on priority areas in research

Short- and mid-term results of atrial septal defect and patent foramen ovale occlusion with starway septal occluder device

With a prevalence of almost 7% of all congenital heart diseases, atrial septal defect [ASD] is a common condition. Patent foramen ovale [PFO] is also a congenital heart disease which is frequently sustained into adulthood. To study the feasibility of closure of ASD and PFU by Starway septal occluder device and the incidence of its inherent complications and procedural failure in 62 patients referred to our center. Starway septal occluder device was used for closure of ASD and PFO in 62 patients. After left and right heart catheterization, transesophageal echocardiography-guided closure was done for the patients with immediate recording of the results. Patients were followed for 6 months by transesophageal echocardiography for observing short- and mid-term complications. The 62 studied patients were categorized into 2 groups. Group 1 included 31 patients [64% females] with ASD [mean +/- SD age: 26.7 +/- 7.6 years]. Group 2 consisted of 31 patients [35.6% females] with PFO [mean +/- SD age: 53.5 +/- 12.4 years]. Size of the right ventricle [RV] annulus was significantly [P=0.005] decreased after the intervention in the ASD group. Overall 5 [8%] patients developed post-intervention complications [transient ischemic attack, leg edema, and residual shunt] and procedural failure-4 [13%] in ASD group and 1 [3%] in PFO group. None of the patients developed device-related thrombosis, significant arrhythmia, aortic regurgitation and pericardial effusion after intervention. Starway occluder device is effective and safe with very low short- and mid-term complication rates

Talents for future: report of the second national medical science Olympiad in Islamic Republic of Iran

This report describes a unique experience of Second National Medical Science Olympiad that was held in August 2010 in Shiraz, Islamic Republic of Iran. The history of medical science Olympiad in Iran and the development, process and domains in the Olympiad and the way for future will be discussed

improvement of myocardial function by granulocyte colony stimulating factor following acute anterior myocardial infarction: a double blind placebo controlled study

In patients with acute myocardial infarction [AMI], reperfusion of the occluded infarct-related artery significantly improves acute and late clinical outcome. There is increasing evidence that transplantation of autologous stem cells improves cardiac function after AMI. For propagation of peripheral blood stem cells, application of granulocyte-colony stimulating factor [G-CSF] has been shown to be feasible, effective, and safe. Ten patients in the treatment group and 10 patients in the control group were enrolled in this prospective, randomized controlled and double blind study. Two weeks after myocardial infarction that was followed by successful recanalization and stent implantation, the patients of the treatment group received 10 micro g/kg body weight per day [divided BID] G-CSF subcutaneously for a maximum duration of 5.0 days. In both groups, ejection fraction was evaluated with echocardiography and cardiac perfusion scans 10 days and 6 months after myocardial infarction. The Tei index was measured by echocardiography. No severe side effects of G-CSF treatment were observed. There was no significant improvement of left ventricular ejection fraction when the G-CSF treated group was compared to the control group [P=0.821 for cardiac scan and P=0.705 for echocardiography]. Changes in Tei index was not significant in the treatment group [P=0.815]; however, it was significantly deteriorated in the control group [P=0.005]. In patients with acute anterior myocardial infarction, treatment with G-CSF, is feasible and safe and seems to be effective in improving global cardiac function without affecting the ejection fraction under clinical conditions

outcome of six-month clinical trial with Eucatax paclitaxel eluting stent compared with Eucastsflex bare metal stent in patients undergoing de novo coronary stenting

Superiority of paclitaxel-eluting stents over bare metal stents in angiographic and clinical outcomes have been shown in many trials. Eucatax stents is a newly developed paclitaxel eluting stent using biodegradable polymer matrix. To our knowledge there have been no studies directly comparing Eucatax paclitaxel eluting stents with EucaSTSflex bare metal stents. The aim of this study is to evaluate short-term benefits of Eucatax in comparison with EucaSTSflex in patients undergoing denovo coronary stenting. A retrospective comparison of Eucatax versus EucaSTSflex was conducted among 89 consecutive patients [44 Eucatax, 45 EucaSTSflex] in Kowsar heart institute, with at least one successfully deployed stent in de novo lesions over a 6-month period. Outcomes included death ,nonfatal MI, CABG, late stent thrombosis at six month, as well as functional evidence of ischemia evaluated by exercise treadmill test[ETT] or cardiac scan [SPECT]. From April to July 2008, a total of 89 patients [44 Eucatax, 45 EucaSTSflex] were evaluated after PCI for de novo coronary lesions. After six month follow up no difference was observed in term of death ,MI,CABG and late stent thrombosis between Eucatax compared with EucaSTSflex. Also a non-statistically significant lower rate of positive ETT [or SPECT] was found in Eucatax group after six month. Paclitaxel eluting stents[Eucatax]are not superior to bare metal stents [EucaSTSflex] in regard to short-term clinical outcome

Assessment of BNP level in patients with single chamber and Dual chamber pacemakers

Recent years, have witnessed extended and continuous indication of cardiac pacing. However, increasing number of patients suffered new congestive heart failure [CHF] and aggravated CHF after pacing therapy. We used blood B type nutriuretic peptide [BNP] to predict the occurrence of CHF in patients with different types of pacemakers. To assess single N-terminal brain nutriuretic peptide [NT-pro BNP] as a predictor tool for ventricular dysfunction in different cardiac pacing mode. Out of 480 consecutive patients with pacemaker more than 6 months, 79 patients with average age of 65 +/- 13, and more than 90% ventricular pacing participated in the present study. Those with CHF prior to pacemaker insertion were excluded. The patients underwent medical history and examination, echocardiography [M-mode, Doppler, and Tissue imaging] and blood sampling for pro-BNP. Twenty five, 12, and 42 patients had Dual chamber [DDDR], single chamber pacing with dual chamber sensing [VDDR], and Single chamber [VVIR] pacemakers respectively Single pro-BNP level in patient with DDDR and VDDR pacing was lower than in those with VVIR pacing [P< 0.0001] but in Echocardiography left ventricular [LV] dysfunction was not lower in DDDR than VDDR and VVIR pacing patients [P= 0.190]. Single level of pro-BNP is lower in double chamber pacing in comparison with single chamber pacing. Therefore, it seems that dual chamber pacing causes less LV dysfunction

Association between serum levels of Hs-CRP and LDL-C with degree of coronary artery stenosis in patients with stable angina pectoris

Over the past decade, several studies have revealed the role of high sensitivity C-reactive protein [hs-CRP], an acute inflammatory marker, as a prognostic factor in the setting of myocardial infarction, predicting future cardiac outcome of patients suffering from an acute coronary event. This study compares hs-CRP and low density lipoprotein-cholesterol [LDL-C] in predicting degree of coronary stenosis in patients with chronic stable angina. One hundred and five patients with chronic stable angina undergoing angiography were evaluated regarding known cardiovascular risk factors including age, sex, smoking habit, exercise, parental history of premature CAD, history of diabetes mellitus, hyperlipidemia, and hypertension, total-cholesterol, LDL-C, HDL-C and triglyceride. hs-CRP was measured by nephlometery and degree of coronary involvement was quantified by using an angiographic scoring scale. Results showed that hs-CRP was not correlated with angiographic score. When all traditional risk factors were entered as independent variables, age, sex, and history of hyperlipidemia were significant predictors of degree of coronary stenosis, and neither hs-CRP nor LDL-C were statistically significant. It was shown that hs-CRP was only related to sex and HDL-C. We conclude that larger studies with better set points for hs-CRP should be conducted, but our study indicates that traditional CAD risk factors including age, sex and history of hyperlipidemia still predict degree of coronary artery stenosis better than hs-CRP and hs-CRP measurement doesn't add any information in this regard. Association of low HDL and hs-CRP may warrant further studies, too

Prevalence and risk factors of acute renal failure after cardiac surgery in Southern Iran

Acute renal failure requiring renal replacement therapy after cardiac surgery is still a cause of major morbidity and mortality worldwide. A number of risk factors for the development of acute renal injury after cardiac surgery have been previously described and based on these variables; several scoring algorithms were proposed. Predictive value of these algorithms in Iran is not described. This study investigates these risk factors among our patients in southern Iran. Two hundred and forty patients with normal kidney function who were candidates for cardiac surgery were enrolled and their baseline data were collected. Diabetes mellitus and age were selected as more controversial preoperative risk factors. Clamp and pump time were also selected as intra-operative risk factors and the type of operation was also considered as an independent risk factor. The patients were categorized in two groups including group 1: Patients with post-operation normal kidney function and group 2: Patients with post-operation ARF. All patients were followed with serial measurement of serum creatinine post-operation. The incidence of acute renal failure was 11.25%. Mean age of the patients in group 1 was 54.24 +/- 15.88 and in group 2 was 52.85 +/- 18.20 years. There was not any significant correlation between duration of clamp time and post operation acute renal failure. Clamp time in group 1 was 51.49 +/- 11.88 and in group 2 was 53.48 +/- 13.40 min. Duration of pump time in group 1 was 63.31 +/- 12.56 min and in group 2 was 78.07 +/- 10.85 min. The difference was statistically significant. Forty two [20%] of the patients in group 1 and 13 [50%] in group 2 were diabetic. Although several scoring algorithms are available for prediction of post-cardiac surgery complications, these can also be matched with our patients' criteria enhancing their accuracy for our situation

Hydatid cyst presented as pulmonary stenosis

A 27-years-old woman, presented with progressive dyspnea on exertion and chest pain. Transthoracic echocardiography revealed severe pulmonary stenosis. Her transsophageal echocardiography [TEE] showed a single, large, well-defined thin wall cystic mass with pressure on the main pulmonary artery at the level of pulmonic valve that caused severe pulmonary stenosis. Computed tomography [CT] scan of chest and abdomen confirmed presence of hydatid cyst in mediastinum and liver. Serologic test using Eliza was positive for echinococcal infection. Albendazol was started for the patient and she was referred to surgeon for resection of cystic mass but the patient refused the operation

Percutaneous transluminal coronary angioplasty and use of drug-eluting stent in Shiraz catheterization centers during 2006

The dominant role of percutaneous transluminal coronary angioplasty [PTCA], especially with drug-eluting stent is obvious in alleviating symptoms and improving life quality of patients with coronary artery disease.We analyzed a total 2267 angioplasty cases [906 women, and 1361 men] in six public and private catheterization centers in Shiraz, from January 2006 to January 2007. A] Pure old balloon angioplasties were performed only in 12 cases [0.52%]. B] Drug-eluting stents [53.7%] were placed more frequently than Bare-metal stents [46.3%]. There was 13% increase in placing drug-eluting stent during 2005. C] Drug-eluting stents were used in 50.0% and 54.9% of patients in public and private hospitals, respectively. D] In Shiraz centers, Cypher model was used more often than other models [29.1%]. E] Single-vessel disease PTCAs were done in 65.5% of patients followed by two [27.0%], and three-vessel diseases [7.5%]. We recommend the increasing use of drug-eluting stents especially in patients with three-vessel disease. However, the use of first generation of drug-eluting stents would increase the chance of subacute thrombosis. It is also essential to carry out especial surveys about drug-eluting stents in Iran and Middle East

Aortic distensibility in beta-Thalassemia major

Any unfavorable effect of beta-Thalassemia major on aortic distensibility will contribute to the adverse effects of beta-Thalassemia major on the cardiovascular system. To evaluated aortic distensibility in patients with beta-Thalassemia major. The study comprised eighty [46 males] consecutive beta-Thalassemia major patients and 80 control subjects matched for age and gender were selected. Aortic distensibility was approximately two-fold lower in patients compared with control subjects [aortic distensibility: 1.4 +/- 0.8 vs 3.6 +/- 1.2, cm[2] dyn[-1] 10[-6], P = 0.01]. Beta-Thalassemia major causes significant decrease in aortic distensibility

Ischemic preconditioning and atrial fibrillation after coronary artery bypass grafting surgery

Atrial fibrillation is the most common arrhythmic complication after coronary artery bypass grafting. Ischemic preconditioning has proved to be a potent endogenous factor in suppressing ischemia- reperfusion induced arrhythmia. In this prospective study, 101 patients were randomly selected and divided into two groups including 50 patients with ischemic preconditioning protocol and 51 patients in the control group. Data were collected from 24 hour electrocardiogram from 1 day before the operation to 3[rd] post-operative day. Atrial fibrillation was registered as positive, if it lasted longer than 30 seconds. The postoperative atrial fibrillation was significantly lower in the ischemic preconditioning group that was 8% in ischemic preconditioning and 23.52% in control groups [P=0.033]. Control group had a longer stay in intensive care unit and longer mechanical ventilation support. This study suggests that ischemic preconditioning is a useful prophylactic protocol to decrease the prevalence of post-cardiac surgery atrial fibrillation