A Comparison of RAMP Troponin Test Results with Highly Sensitive Laboratory Troponin in Patients Suspected of Acute Myocardial Infarction

Introduction: Current guidelines recommend using high-sensitivity troponin (hs-cTnl) assays to manage patients with acute coronary syndrome (ACS) symptoms. Despite this, bedside testing (POC) is commonly used in the emergency room, as it reduces the patient's response time and hospital stay. This study seeks to compare the results of the RAMP- cTnI test with the results of laboratory troponin (hs-cTnl) as the gold standard.Methods: The present study was performed on 148 patients with suspected acute coronary syndrome referred to Shiraz Namazi Hospital between March and July 2021. Blood samples were taken immediately from patients referred to the emergency department for POC and high-sensitivity troponin test (as gold standard). Enzyme-Linked Fluorescent Assay (ELFA) was used to evaluate troponin (cTnl). The POC test was performed using a RAMP device, which allows the rapid measurement of cTnl in the patient's bedside within 10 minutes using a whole blood sample.Results: Of the 148 patients, 35 were hs-cTnI positive. Sensitivity, specificity, the positive and negative predictive values of RAMP- cTnI compared to high sensitivity test with 95% confidence interval were 91.42 (93.63-85.84), 94.69% (97.95%-87.55), 84.21% (93.56-77.82) and 97.27% (99.56-87.82), respectively.Conclusion: The study showed that the quantitatively new RAMP- cTnI method was statistically acceptable with hs - cTnI regarding the accuracy of acute myocardial infarction. RAMP- cTnI was found to be suitable for detecting acute myocardial infarction in the emergency department

Risk stratification of diabetic patients with unusual cardiac symptoms using a myocardial perfusion scan

Background: Autonomic nervous system dysfunction in diabetic patients can result in an atypical presentation of cardiovascular disease that can be missed. We aimed to use single-photon emission computed tomography (SPECT) to assess cardiovascular disease (CAD) in diabetic patients with atypical pain to determine whether the pain above reflects the CAD. Methods: Diabetic patients with atypical cardiac symptoms were referred to the SPECT department. Demographic data such as age, gender, diabetes status, and other underlying diseases were gathered. A myocardial perfusion scan was then performed. The results were recorded to evaluate the risk of myocardial ischemia and the degree of coronary artery involvement in a non-invasive manner. Results: The study included 222 (177 female) subjects with mean ages of 63.01±11.62 and 59.41±9.19 in positive and negative SPECT, respectively. The most common symptoms were atypical chest pain (51.8%), followed by shortness of breath (50.5%), nausea, and syncope (0.9%). Cardiac parameters, such as the summed stress score (SSS), summed rest score (SRS), total perfusion deficit in stress (TPD-s), total perfusion deficit in rest (TPD-r), were significantly higher in the group with coronary artery involvement (P<0.001). However, ejection fraction (EF), end-diastolic volume (EDV), and end-systolic volumes (ESV) parameters were not (P=.0.328, 0.351, and 0.443, respectively).Conclusions: The mere presence of diabetes does not necessitate any additional diagnostic tests beyond those required for the general population, and it is possible to follow a diagnostic course similar to that of the general population

Face-to-face, online, or blended: which method is more effective in teaching electrocardiogram to medical students

Abstract Background Electrocardiogram (ECG) remains an important medical diagnostic and screening tool. This study aimed to compare the effectiveness of online classes instead of traditional face-to-face or blended methods in medical students’ ECG learning. Methods Two hundred and fifteen medical students (including 105 (48.8%) males and 110 (51.2%) females) were studied from February 2021 to February 2022. Regardless of their grade, participants were divided into three groups: online, face-to-face, and blended. Then all participants sat for an ECG interpretation exam, and their results were compared. Results Twenty-six (12.1%) participants were residents, and 189 (87.9%) were interns. Thirty-five (16.3%), 85 (39.5%), and 95 (44.2%) participants were taught ECG through face-to-face, online, and blended methods, respectively. Regarding participants’ preferences on teaching methods, 118 (54.9%) preferred face-to-face learning, and the remaining 97 (45.1%) chose online learning (p < 0.001). The blended method seemed more promising in almost half of the exam questions regarding teaching method effectiveness. The mean total exam score was also significantly higher in participants who were taught blended than in the others (7.20 ± 1.89, p = 0.017). Face-to-face (5.97 ± 2.33) and online teaching methods (6.07 ± 2.07) had similar efficacy according to the mean total score (p = 0.819). Conclusion While most students preferred face-to-face learning to online learning, a blended method seemed more promising regarding students’ skill enhancement to interpret ECG

Bariatric surgery mitigated electrocardiographic abnormalities in patients with morbid obesity

Abstract Obesity can lead to cardiovascular dysfunctions and cause electrocardiographic disruptions. Bariatric surgery plays a significant role in weight loss. To assess its benefits, this study investigated electrocardiographic changes before and after bariatric surgery. The present article describes a retrospective cohort study with a 6-month follow-up period. Electrocardiograms were interpreted and compared before and six months after surgery. The relationships between weight loss, type of surgery, and electrocardiographic alterations were analyzed. A total of 200 patients participated in the study, with 34 (17%) men and 166 (83%) women. The mean age of the participants was 44.6 ± 8.6, and their mean body mass index was 43.8 ± 5.5 kg/m2. The mean of QTc decreased after the surgery, while the Sokolow-Lyon scores increased. The statistical analysis showed that QTc dispersion (> 40) (P < 0.001), right ventricular hypertrophy (P < 0.001), abnormal R wave progression (P < 0.001), QTc (P < 0.001) and Sokolow-Lyon criteria (P < 0.001) significantly changed postoperatively. In conclusion, bariatric surgery can reduce QTc, correct poor R wave progression, and resolve right ventricular hypertrophy (RVH) in patients with morbid obesity

The potential of HEART score to detect the severity of coronary artery disease according to SYNTAX score

Abstract Clinical scoring systems such as the HEART score can predict major adverse cardiovascular events, but they cannot be used to demonstrate the degree and severity of coronary artery disease. We investigated the potential of HEART Score in detecting the existence and severity of coronary artery disease based on SYNTAX score. This multi-centric cross-sectional study investigated patients referred to the cardiac emergency departments of three hospitals between January 2018 and January 2020. Data including age, gender, risk factors, comorbidities, 12-lead ECG, blood pressure and echocardiogram were recorded for all the participants. Serum troponin I level was measured on admission and 6 h later. Coronary angiography was done via the femoral or radial route. HEART and SYNTAX scores were calculated for all patients and their association was assessed. 300 patients (65% female) with mean age of 58.42 ± 12.42 years were included. mean HEART Score was 5.76 ± 1.56 (min = 3, max = 9), and mean SYNTAX score was 14.82 ± 11.42 (min = 0, max = 44.5). Pearson correlation coefficient was 0.493 between HEART Score and SYNTAX score which was statistically significant (P < 0.001). We found that HEART Score of more than 6 is 52% sensitive and 74.7% specific to detect extensive coronary artery involvement (SNTAX score ≥ 23). The present study showed that the HEART score has a moderate and positive correlation with the SYNTAX score and HEART score with a cut-off value of 6 is a predictor for SYNTAX score of ≥ 23

Psychological Problems Among Patients With Chronic Medical Disorders During the COVID-19 Pandemic

The aim of the current study was to investigate the rates of stress, anxiety, and depression among people in south Iran (a group from the general population without a history of any chronic medical problems, and cohorts of patients were recruited from epilepsy, diabetes, and cardiac disease clinics). We surveyed a sample of people during September 2020: a group of the general population without a history of any chronic medical problems, people with epilepsy, people with diabetes mellitus (DM), and people with cardiac problems. The survey included four general questions and two COVID-19 specific questions [contracting COVID-19, relatives with COVID-19]. Furthermore, the survey included the DASS (Depression-Anxiety-Stress Scale)-21 questionnaire. 487 people were surveyed (154 people with epilepsy, 127 patients with DM, 98 people with cardiac problems, and 108 healthy individuals). Among people without a history of any chronic medical illnesses, 14% had any psychological problems. The highest rates of depression and anxiety were observed among patients with DM (52% and 57%, respectively), and the highest rate of increased stress was observed among people with cardiac problems (40%). The existence of any underlying medical problem was significantly associated with higher rates of depression, anxiety, and stress among the participants. While many patients with underlying chronic medical conditions suffer from depression, anxiety, and stress during the COVID-19 pandemic, we cannot establish a cause and effect relationship between the COVID-19 pandemic and increased psychological problems among these patients