Accuracy of Physical Examination in Distinguish Pathologic Murmur of non Pathologic

Abstract Background & aim: Cardiac auscultation is one of the most useful investigative tools that the physician may use at the bedside to detect alterations in cardiovascular anatomy and physiology. However, the sensitivity and specificity vary substantially with the expertise of the examiner. The aim of this study comparing the initial evaluations of heart murmurs in neonates between neonatologist and pediatric cardiologist. Methods: This cross-sectional study was conducted on 108 neonates admitted in Be’sat and Fatemieh Hospitals of Hamadan, Iran, in 2010. First, a neonatologist recorded their clinical evaluation (Pathologic, Likely pathologic, Innocent). Then, a Pediatric cardiologist recorded the infants’ clinical evaluation. Finally, echocardiography study was performed by the cardiologists for final diagnosis. The data were analyzed by SPSS version 16 and the using Chi-square. Results: In this study, 67 patients (62%) had pathologic murmur. Clinical findings of pathological murmur by neonatologist and cardiologist are 98% sensitivity versus 87/2% 84/2% specificity vs. 100% 94/1% the positive predictive value vs. 100% and 94% negative predictive value vs. 85.4%, respectively. Conclusion: Evaluations of examination show no significant difference between neonatologists and cardiologists. Hence, echocardiography is the standard for establishing the cause of murmur. Key words: Murmur, Echocardiogram, Physical Examinatio

Tectono-metamorphic evolution of the Neyriz metamorphic complex, Quri-Kor-e-Sefid area (Sanandaj-Sirjan Zone, SW Iran)

International audienceThe Neyriz region includes outcrops of metamorphic rocks that are thrust over the Neotethyan ophiolites. These rocks are affected by a major deformational event, the result of which includes a shearing polyphase foliation present in gneissic core domes, overprinted by a crenulation cleavage. These fundamental structures developed contemporaneously with a medium-pressure metamorphism which is characterized by the syn-kinematic crystallization of kyanite and the beginning of anatexis, followed by the development of retrometamorphic mineral parageneses. The major deformation phase in the area occurred during the Early-Cimmerian orogeny in the Late Triassic. Following the orogeny, the gneiss domes started to rise into the upper levels of the crust. From the geodynamic point of view, after the Mid-Permian the studied area was situated at southern passive margin of the Iranian plate; the central Iranian microcontinent at that time was separated by the Neotethys ocean from the Gondwanian supercontinent. After the Late Triassic the region became an active margin associated with an accretionary prism. The margin was finally involved in an orogenic wedge after the closure of the Neotethyan oceanic basin in the Late Mesozoic. Closure of the basin resulted in a major thrusting of the metamorphic rocks of the southern Iranian margin over the Neotethyan ophiolites