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P-Wave Morphology, Amplitude, Duration and Dispersion in Atrial Arrhythmias

The detailed analysis of the P-wave duration and dispersion by means of conventional electrocardiography with the 12 standard surface leads in the stratification of patients suffering from AF is a recognized universal approach. P-wave dispersion (PWD) has received increasing attention in the field of non-invasive electrophysiology studying atrial arrhythmias and has been examined in a broad range of clinical settings including cardiovascular and non-cardiovascular diseases. It is well accepted that, not only the P-wave duration, but also the P-wave morphology and dispersion have the potential to give information about the anatomical substrate predisposing to AF. Patients with diseased atrial myocardium with fibrotic changes may develop abnormal electrophysiological alterations. Therefore, these atrial anisotropic characteristics may play an important role in creating reentry circuits by causing inhomogeneous and discontinuous propagation of the impulse in the atrial tissue. The altered atrial myocardium may generate unidirectional block, conduction delay and reentrant atrial rhythms. The P-wave of the electrocardiogram may show alterations that can be associated with atrial arrhythmias and AF. PWD is considered a noninvasive electrocardiographic marker for atrial remodeling and predictor for AF. It has been shown that increased P-wave duration and PWD reflect prolongation of intra-atrial and inter-atrial conduction time. In patients prone to develop atrial arrhythmias and AF, PWD reflects prolonged, inhomogeneous and anisotropic distribution of connections between myocardial fibers resulting in discontinuous anisotropic propagation of sinus impulses and atrial conduction. PWD is considered as a sensitive and specific ECG marker and predictor of atrial arrhythmias and paroxysmal AF

Enseñanza de técnicas quirúrgicas básicas en simuladores biológicos: Experiencia pedagógica en el pregrado The teaching of basic surgical skills in the biologic simulators: Undergraduate educational experience

Introducción: las maniobras quirúrgicas básicas que un médico generalista debería aprender en el cursado de la Carrera de Medicina, implican la adquisición de destrezas y habilidades manuales de tipo cruentas. Estos procedimientos, por su carácter de invasivos, representan una dificultad en el proceso de enseñanza-aprendizaje tradicional realizada sobre el paciente. Se propone una alternativa pedagógica para la adquisición de habilidades quirúrgicas básicas en simuladores biológicos en el pregrado. Material y Métodos: durante el año 2002 se desarrollaron en la Facultad de Medicina de la Universidad Nacional del Nordeste dos cursos teórico-prácticos de Técnicas Quirúrgicas Básicas destinados a alumnos de los dos últimos años de la carrera. Los simuladores fueron trozos de carne, intestino delgado, corazón y pulmón de vaca, alas de pollo, cerdos vivos y cadáveres de los mismos. Los alumnos practicaron diferentes procedimientos quirúrgicos guiados por un tutor. La práctica estuvo precedida por una clase teórica de la técnica, aplicada al paciente. Las condiciones para aprobar el curso fueron: asistir al 80% de las jornadas y un examen final práctico sobre simuladores, de las destrezas adquiridas. Al finalizar debieron contestar una encuesta. Resultados: el cupo de 50 alumnos por curso fue cubierto completamente. El 100% de los alumnos aprobó el examen final práctico. La encuesta catalogó la modalidad pedagógica como excelente en un 96% y muy buena en el 4%. Conclusiones: en la búsqueda de una solución pedagógica de cómo adquirir habilidades y destrezas en maniobras quirúrgicas básicas, esta metodología resultó ser una excelente alternativa en el pregrado.<br>Background: learning basic surgical procedures in medical school, involves acquisition of certain bloody skills. Therefore, to teach this kind of procedure on the patient is becoming more difficult nowadays. An educational alternative is proposed to teach basics surgical skills in undergraduate students in Medical School. Methods: during entire 2002, two theoretical-practical courses on Basic Surgical Maneuvers were developed in the Medicine School of UNNE. These courses were assigned to the 5th and 6th year’s students. Used models included meet piece, bovine’s bowel, heart and lungs, chick’s wings; additionally live anesthetized swine and cadavers. All the students had to practice different procedures leaded by an instructor. Before performing these procedures theoretical explanation was supplied in the classroom. Attend to al least 80% of all given class, and to pass a practical final test were the only conditions to pass these courses. All the students had to fill up a survey to assess the perfomance of these courses. Results: the quota of 50 students by each course was completely covered. All the students (100%) passed successfully the courses. The survey reflected this experience as excellent (96%) or very good (4%) in teaching basic surgical procedures. Conclusion: the training in Biologic Models has shown as an excellent strategy to undergraduate surgical education