T-Peak to T-End Abnormality in Pediatric Patients with Syncope

Objective: The purpose of this study was to examine the relationship between T-peak-to-T-end interval and its dispersion in children with syncope to detect possible repolarization abnormalities in these patients. Methods: We enrolled 19 patients with a positive tilt test for syncope (7 boys, 12 girls) and 35 participants with normal results on the test. Findings: Mean age was 11.4±3.1 years in patients and 10.0±5.1 years in controls (P =0.27). The T-peak-to-Tend interval in lead V1 was significantly longer in patients with a positive tilt test (0.36±0.062 vs. 0.32±0.071, P=0.007). T-peak-to-T-end interval dispersion was significantly greater in the group of patients (0.15±0.07 vs. 0.11±0.04, P±0.003). Conclusion: The T-peak-to-T-end interval in lead V1 and T-peak-to-T-end dispersion were significantly larger in patients with a positive tilt test. Our findings suggest a depolarization abnormality in children with syncope

Comparison of the training status of medical students of pediatric ward based on their logbooks

Introduction: Logbooks show whether medical students have been exposed to a particular disease and whether they are able to perform particular practices or not. To evaluate the training status of the medical students in the pediatric ward of Shiraz University of Medical Sciences, the data about the students’ knowledge of different diseases in different parts of the pediatric ward in 2011 was collected based on their logbooks and compared with similar data in 2005. Methods: In this descriptive study, medical students’ electronic notes were designed and completed by 90 medical students trained in the pediatric ward in 2011. Then the information was compared with the data of the previous study conducted in 2005. Results: In the pediatric outpatient clinic, neonatal emergency room, pediatric emergency room, and general pediatric ward, 50% of the diseases listed in the diaries were observed by the students. However, 19% of the patients were observed by the students in subspecialty wards. Conclusion: Using daily notes (logbooks) is a useful method for educational evaluation of the students. It can show the education acquired by the students, and clarify the defects and inadequacies in education. It seems that using electronic diaries in data collection increases the students’ participation and facilitates training. In general, expansion and development of new wards facilitate the exposure of medical students to more diseases and this fact has been shown about pediatric neurology ward in the present study

Making a Transcutaneus Icterometer in Neonates

Objective:Approximately 50% of newborn develop jaundice, however only 6% of them have significant hyperbilirubinemia that need more evaluation. Actually, most of sampling (50-90%) for detection of hyperbilirubinemia is not necessary and cause some problems such as infection, tissue injury, pain, discomfort, wasting time and money. So non-invasive methods is desirable to decrease unnecessary sampling. Material & Methods: This study performed on neonates who referred to Shiraz University of Medical Science affiliated Nemazee hospital neonatal emergency room due to jaundice. Initially 92 neonates were selected. After taking digital images and calculating mean and 95 percentile yellow wave's lengths of forehead skin and detection of total serum bilirubin, the correlation between wave's lengths and serum total bilirubin were determined. 95 percentile of skin yellow wave lengths that determined bilirubin level of 5, 10, 15 and 20 mg/dl were used for making 4 yellow strips of the icterometer. This icterometer was used for screening of 209 neonates who referred for evaluation of jaundice. Findings: Using icterometer in evaluation of 209 neonates with jaundice demonstrated sensitivity 94.7%, specificity 55.2%, positive predictive value of 85%, negative predictive value of 95% and accuracy 87%. Conclusion:This Icterometer can be applied as a screening tool in neonatal hyperbilirubinemia to detect less significant degree of hyperbilirubinemia that doesn't need sampling in Shiraz and even other regions of Iran with the same skin color

Transcatheter Closure of Partially Ligated Vertical Vein after Surgical Correction of Supracardiac Total Anomalous Pulmonary Venous Connection

Total anomalous pulmonary venous connection (TAPVC) is an anomaly in which the pulmonary veins are directly connected to one of the systemic veins or drain into the right atrium. Management of pulmonary hypertension after the total correction of this congenital cardiac anomaly is very important. Unligation of the vertical vein in the supracardiac type of this anomaly can be a draining pathway for the prevention of postoperative pulmonary hypertension crisis. Late onset transcatheter closure of the unligated vertical vein after a decrease in pulmonary pressure with the Amplatzer vascular plug type 1can prevent residual left-to-right shunting. Here we describe two patients who previously underwent surgical correction of supracardiac TAPVC and their vertical veinwas partially ligated due to severe pulmonary hypertension. Consequently, because of increased left-to-right shunting in the follow-up period, transcatheter occlusion of the vertical vein was done for them and this procedure seemed safe and less invasive compared to the surgical approach.At 2 years'follow-up, there was marked pulmonary artery pressure and clinical improvement

Bifurcation in a 3-DOF Airfoil with Cubic Structural Nonlinearity

AbstractLimit cycle oscillations (LCOs) as well as nonlinear aeroelastic analysis of a 3-DOF aeroelastic airfoil motion with cubic restoring moments in the pitch degree of freedom are investigated. Aeroelastic equations of an airfoil with control surface in an incompressible potential flow are presented in the time domain. The harmonic balance (HB) method is utilized to calculate the LCO frequency and amplitude for the airfoil. Also the semi-analytical method has revealed the presence of stable and unstable limit cycles, along with stability reversal in the neighborhood of a Hopf bifurcation. The system response is determined by numerically integrating the governing equations using a standard Runge-Kutta algorithm and the obtained results are compared with the HB method. Also the results by the third order HB (HB3) method for control surface are consistent with the other numerical solution. Finally, by combining the numerical and the HB methods, types of bifurcation, be it supercritical, subcritical, or divergent flutter area are identified

Estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava in pediatric patients

Objective: Paucity of data exists between mean right atrial pressure (RAP) and inferior vena cava (IVC) size and collapsibility in pediatric patients with congenital heart disease. Methods: In a prospective study, fifty consecutive pediatric patients with different congenital heart diseases who had right side cardiac catheterization were studied, comparing right atrial pressure with simultaneous M-mode echocardiographic measurement of inferior vena cava diameter. Mean age of the patients was 4.96±4.05 years (30 male and 20 female). Patients were categorized into two groups according to their right atrial pressure (RAP) as measured by cardiac catheterization: Group 1 (40 patients) were those with mean RAP <8 mmHg and group 2 (10 patients) who had a mean RAP≥ 8 mmHg. Findings: In M-mode echocardiography IVC size was statistically different (P=0.004 and 0.009) in inspiration and expiration in the two groups. Mean RAP was estimated to be > 8 mmHg when IVC diameter in inspiration was >3.6 (sensitivity of 100%, specificity of 47.5%, +LR=1.9) or if IVC diameter was >6mm in expiration (sensitivity of 70%, specificity of 87%, +LR=4.67). Conclusion: This study showed that measurement of IVC size in inspiration and expiration can be used as a reliable method for estimation of mean right atrial pressure

Relation of Mean Right Atrial Pressure to Doppler Parameters of Right Atrial and Hepatic Venous Flow in Pediatric Patients with Congenital Heart Disease

Objective: A paucity of data exists regarding the relation of mean right atrial pressure (RAP) to Doppler parameters of right atrial and ventricular filling in pediatric patients with congenital heart disease. Methods: Fifty patients (30 male and 20 female) with mean age of 4.96±4.05 who were admitted in the pediatric cardiology ward of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, were included in this study. Patients were categorized into two groups according to their RAP measured by cardiac catheterization: Group 1 (40 patients) were those with mean RAP <8 mmHg and group 2 (10 patients) who had mean RAP ≥8 mmHg. Data gathered from hepatic venous flow, tricuspid diastolic flow and pulse tissue Doppler of lateral tricuspid annulus of each patient were then compared with right atrial pressure obtained by cardiac catheterization. Findings: If change of peak S wave velocity of hepatic vein in respiration was more than 38%, sensitivity and specificity of a RAP more than 8 mmHg was 90% and 51.3% respectively with likelihood ratio (LR) equal to 1.85; a peak S wave velocity of less than 70 mm/sec also showed a RAP more than 8 mmHg with sensitivity and specificity of 70 and 82.1 respectively (LR=3.9). A peak expiratory D wave velocity of hepatic vein more than 63 mm/sec was indicator of RAP more than 8 mmHg with sensitivity and specificity of 60% and 92.3% respectively (LR=7.8). Conclusion: This study showed that hepatic venous flow can be valuable for estimation of mean RAP in pediatric patients with congenital heart disease