Prognostic value of atrial strain in non-ischemic dilated cardiomyopathy.

INTRODUCTION: Left atrial function in non-ischemic dilated cardiomyopathy (DCM) has long been underestimated when studying the ultrasound parameters of DCM. Currently, several ultrasound parameters of left atrial function have been proposed as markers to detect patients at risk. AIM: To evaluate the left atriumfunctionwith 2D speckle tracking echocardiography and itsprognostic value in the dilatedcardiomyopathy. METHODS: The study prospectively recruited 40 patients with dilated cardiomyopathy, between January and June 2014, followed up at the cardiology department of Habib Thameur Hospital of Tunis. An echocardiogram was performed for all patients at the beginning of the study. After a 6-month follow-up, the primary endpoint was the occurrence of a major cardiovascular event. The patients were divided into a first group without cardiovascular events (group 1) and a second group with a cardiovascular event (group 2). RESULTS: During the follow-up, 25 patients presented a major cardiovascular event (8 ventricular arrhythmias and 17 hospitalizations for acute decompensated heart failure). There were no significant differences between the two groups regarding cardiovascular risk factors, symptoms and blood testing values.In addition, regarding results obtained from speckle tracking echocardiography, atrial peak-systolic longitudinal strain (PALS) and time to peak atrial longitudinal strain (TPALS) values were observed to be significantly lower in group 2 ( 34.6% in group 1 vs 28.4% in group 2, p=0.000; and 344.6ms in group 1 vs 349.8 ms in group 2, p=0.016 respectively). CONCLUSION: The analysis of the LA speckle tracking in the dilatedcardiomyopathymay help cardiologistto identify patients at high cardiovascular risk and thus improve their management and follow-up.

Serious Game Design with medical students as a Learning Activity for Developing the 4Cs Skills: Communication, Collaboration, Creativity and Critical Thinking: A qualitative research.

INTRODUCTION: The impact of technology in education has led to various changes in the way that different stakeholders, like students and teachers work and interact with each other. The use of the serious game design in educational contexts has been related to the development of the 21st century skills such as communication, collaboration, creativity and critical thinking. AIM: To analyze a serious game design process by third -year medical students, from the perspective of the 21st century competencies engaged in the game design process. Those outlined key competencies are communication, collaboration, creativity and critical thinking. METHODS: This is a qualitative, descriptive, and inductive study that follows a phenomenological approach. Twelve volunteer third-year medical students participated in an activity of designing of serious games. This study, carried out during summer internship in the cardiology department of Habib Thameur Hospital. The course of the designing of serious games with students spread over 4 weeks with 10 hours face-to-face and 10 hours of remote work. RESULTS: The participants in our study were twelves third-year medical students. Of these 12 students, 10 were female. The duration of each interview depends on each participant's ability. The analysis of the data, based on the phenomenological method of Giorgi brought out four central themes: theme 1: Critical thinking skills and problems solving skills, theme 2: Communication, theme 3: Creativity, theme 4: Collaboration. The overall essence of the phenomenon is these third medical students who experienced the serious game design outlined key competencies. CONCLUSION: Using serious game development-based learning as a learning method to impart multidimensional skills and knowledge suggests a promising approach for developing clinical reasoning, creativity, communication, and collaboration in students.

Effects of Ramadan fasting on blood pressure in hypertensive patients.

INTRODUCTION: During Ramadan, repeated cycles of fasting might contribute to changes in blood pressure among hypertensive patients. Studies on the effects of fasting on the blood pressure of hypertensive patients are scarce and have provided inconclusive results. AIM: To examine the effect of fasting on ambulatory blood pressure and heart rate in treated hypertensive subjects. METHODS: The study prospectively recruited 60 hypertensive patients between April and June 2019, followed up at the cardiology department of Habib Thameur Hospital of Tunis. A 24-hour pressure monitoring was carried out during two periods: prior to Ramadan and during the last ten days of Ramadan. We compared the average values of 24 hour, awake and asleep systolic and diastolic blood pressure and 24 hour, awake and asleep heart rate. RESULTS: We studied 40 women and 20 men; mean age was 58.4 years. 33% of the patients were diabetics, 42% dyslipidemics, 15% had coronaropathy. 45% of the patients were on monotherapy, 37% on dual therapy and 18% on a triple antihypertensive therapy. During Ramadan, 74% of the patients were taking the treatment once daily, 3% twice daily, and 23% three times per day. Average 24hour ambulatory blood pressure in the whole group was 129±17/74±10 mmHg before Ramadan and 128±17/73±9 mmHg during Ramadan (p>0.05). Daytime and nighttime mean values of systolic and diastolic blood pressure as well as mean values of heart rate were not different between both periods regardless of age, gender, medical history and lifestyle. CONCLUSIONS: In this study, there were no significant changes in systolic and diastolic blood pressures as well as heart rate during the 2 periods.

Assessing medical student satisfaction and interest with serious game.

INTRODUCTION: Serious games are interactive and entertaining digital software with an educational purpose, and they are increasingly being used in undergraduate medical education. Effective serious games attempt to form positive mood in order to encourage players to continue the play, leading to increased interest in gameplay and satisfaction as well as better academic performances. AIM: To determine  the medical students' satisfaction, situational and individual interest during a serious game. METHODS: This was a prospective study performed during a 2-year period (2018-2019 and 2019-2020). A total of 108 third-year medical students participated in this study. Students were asked to play a serious game on a computer for 20 minutes. A set of questionnaires containing evaluation grids to measure the satisfaction and interest was given to students. The effectiveness of the game was assessed using pre and post-tests. RESULTS: Following the exclusion criteria of students due to missing data, complete data were available for 97 students. Satisfaction and interest experienced by the students were high. The median of the game performance of students was 418, 04 points. There was a positive relationship between ease of use and game performance. There was a negative correlation between the three scales of interest and game performance. There was a significant difference between the mean scores of pre-tests and post-tests (p<0.01). CONCLUSION: The results of this study suggest the potentials of serious game on medical student's satisfaction, interest and learning achievement.

The value of simulation in learning clinical reasoning.

BACKGROUND: Simulation allows learning in action, reflection and feedback. All these factors suggest the positive contribution of the simulation to the development of clinical reasoning. The main assessment tool for standardized testing of this skill is the script matching test. AIM: To assess the impact of teaching through high-fidelity clinical simulation on the clinical reasoning of third-year medical students, while assessing their teaching practices, satisfaction and confidence in the learning they received during this session. METHODS: We conducted an evaluative bicentric prospective study that included third-year medical students completing their cardiology internship during the first semester of the academic year 2019-2020 in the cardiology departments of Habib Thameur Hospital and Charles Nicolle Hospital, respectively. RESULTS: The study included 48 students. The students who participated in this study liked the teaching practices used in the simulation-assisted lessons. Their interest in these practices is validated by the average of 37,2±5,53 obtained for active learning, 8,04±1,85 for collaboration, 8,5±1,51 for diversity of styles and 8,02±1,72 for high expectations. In our study, the results showed that students were satisfied with the learning they had made during the simulation session. The average for the measurement of satisfaction by the 48 externals was 22,37±2,54. The results of our study indicated that students were confident that their learning would allow them to solve problems similar to those presented in the simulation in a real clinical setting. This is supported by the 31,48±4,63 average student confidence in their learning. Our study showed a progression of the students' clinical reasoning with simulation using a Script Concordance Test. The mark obtained by the students after the simulation session is significantly higher than the one obtained by the students before the simulation session with p=0.008. CONCLUSION: Simulation is an innovative pedagogical strategy and a contribution to optimizing the clinical reasoning process and improving the quality of care.