Crew Resource Simulation was introduced in the aviation industry during NASA workshop in 1979, designed as a training program to improve air safety and reduce the increasing number of fatal accidents attributable to human error. The primary cause of the majority of aviation accidents occurring at that time were due to human error 85% and the leading causes of which were failures of interpersonal communication, leadership, and decision making in the cockpit. David Gaba, American anesthetist, trained as a pilot recognized similarities in high stake environment of the operating theatre and cockpit and so developed anesthesia crises simulation resources management. Medical simulations aim to imitate real patients, anatomic regions, clinical tasks, virtual reality devices and electronic manikins or to mirror real-life situations in which medical services are rendered. Simulation – based learning (SBL) applies these modalities.

Benefits of medical simulation includes safe environment, mistake forgiving, trainee focused vs. patient focused, controlled, structured, proactive clinical exposure, reproducible, standardized, debriefing, deliberate and repetitive practice. Medical simulation can assess professional competence as patient care, medical knowledge, practice-based learning & improvement, communication skills, professionalism and systems-based practice. Patient safety priorities are at the forefront of health providers' concerns. Best summarized by “simulators have the potential to take the early and dangerous part of the learning curve away from patients”. Simulation has rapidly evolved as a learning tool and technology over the past 15 years, and has been shown to be an effective method for teaching. Despite this, the field of cardiovascular medicine is still in the primitive stages of adopting simulation. The reasons cited for this include: the high cost of simulators, a dearth of didactic curricula to accompany the psychomotor skill learned on a simulation, the wide variability and/or lack of consistency that exists among the simulation platforms, and a complete absence of large trials showing that this expensive technology actually improves operators' skill in the angiography suite and presumably enhances patient outcomes. Despite all this, the ACGME now mandates that cardiovascular fellowship training programs must have simulation as part of fellow training. Cardiac simulation training ranges from as simple as training on listening to normal and abnormal heart sounds, differentiating different types of heart murmurs, interpreting ECG findings, utilizing high fidelity manikins for different cardiac scenarios such as heart failure and cardiogenic shock apply team work as crew resource management, practicing transthoracic echocardiogram plus transoesophegeal echo (TEE), cardiac catheterization and central line insertion up to different cardiac interventional procedures.

On June 2017-  May 2018, we conducted once per month a one day simulation cardiac course for pediatric residents whom had attended different  simulation courses at CRESENT, KFMC. All candidates went through pre course knowledge and clinical skills evaluation followed by the end of the day with post course knowledge and  clinical skills evaluation similar to the pre course.125 candidates were involved, 100% of the candidates had significant improvement in their knowledge and skills at post course test compared to pre course and non had declined in their scores beside 100% of them found these courses are enjoyable, safe, not stressful and very useful training methods, 97% enjoyed it mostly because it is repetitive and mistakes are forgiven with zero hazards to patients.100% feels video debriefment following cardiac medical scenarios is very helpful as it clarify areas for improvement much better than conventional training.

In conclusion, although cardiac Simulation courses is expensive but it plays important role in patient safety so at the end it is cost effective so would encourage to make it mandatory in the curriculum for cardiac residents and fellows.


            


 

Primary cardiac tumors are rare disease and most of them are benign in nature, although these lesions are benign histopathologically, and they are potentially fatal because they  may cause sudden hemodynamic obstruction and death of patient.

The aim of this study: to report these rare cases to study their clinical, echocardiographic feature and their prognosis.

Patients and methods: twenty pts with primary cardiac tumors were studied from period of February 1994 to march 2018 clinically and by echocardiography.

16 pts  were female, four pts were male. 16 pts were between third and sixth decade of life four pts were teenage. Myxoma was the commonest cardiac tumors. it is more common in the left atrium(14 pts) than right atrium (2 pts). malignant pericardial mesothelioma was reported in two pts, and left ventricular angiosarcoma in one pt. histopathologically not  diagonsed Rv tumour in one pt.

Non of pt referred for echocardiographic study with suspicion of cardiac tumors in mind because of the non specific and different mode of presentation. Shortness of breath was the commonest presenting symptoms were occurred in10 (50%)pts follow by cerebral embolization and stroke 5(25%)pts. One pt present with picture mimic acute pericarditis.  One pt present with right sided heart failure. One Pt with impaired renal function.one refer because of fatigue.

Cardiac tumors had different presentations and without complete surgical excision, these tumors whether begnin or malignant histopathologically, they were carried high morbidity and high mortality. Transthorasic  echocardiography is the most sensitive diagnostic tool.


 

Attenuation of cardiac activity by soft tissue during acquisition by the gamma camera is one source of difficulty with interpretation of Myocardial Perfusion Imaging (MPI). Prone imaging has been used as a method to eliminate attenuation artifacts and consequently improving the diagnostic accuracy. The aim of this study is to observe the effects of prone position during Gated SPECT cardiac acquisition in improving the accuracy of the diagnosis through elimination of inferior wall attenuation artifacts and the impact on various cardiac parameters particularly ventricular volumes and ejection fraction.

32 patients selected randomly underwent two-day protocol for stress and rest MPI in supine and prone positions. Acquisition was done in a 180° elliptical orbit, starting at 45° (RAO) for supine and prone positions, in 64 steps, 15 sec each, and 8 frame gating per step. Percentage uptake of the tracer was calculated using 17-segment model and level of agreement were calculated to assess MPI.

Higher inferior wall activity was observed in prone position compared to supine position in stress and rest MPI (63%±15.13% vs. 55.6%±12.7%) and (62%±11.7% vs. 56.6±10.71), respectively. Level of agreement between both positions in stress and rest MPI was moderate (К=0.56 and К=0.60, respectively). EDV, ESV and SV for prone acquisitions were significantly lower than supine acquisitions in the stress and rest MPI (P < 0.024 and P < 0.002 respectively).

Prone Gated SPECT MPI can be utilized as an effective way for attenuation correction along with supine MPI if required. The differences in quantitative cardiac parameters in both positions were attributable to physiological alterations.
 

As for high prevalence and incidence of heart failure, it can impose huge health, economic, and social burden on society. Education and self-care are important aspects of management in patients with heart failure, which can control the disease complications. This study aimed to investigate the effect of family-centered education approach on self-care behaviors of the patients with heart failure.

This research is a randomized clinical trial. The study has been conducted on 72 patients with heart failure hospitalized in Shahid Rajai cardiovascular, medical, and research center, Tehran, Iran, in 2015. Patients were randomly assigned into the intervention (family-centered) and control groups. The self-care behaviors were measured before and two months after intervention using questionnaires of the self-care behaviors. Data analysis was done using paired t test and independent t test by SPSS.

Before intervention, mean (SD) values of self-care scores were 23.88 (4.71) and 21.50 (3.30) in the control and family-centered groups, respectively, with no statistically significant difference between two groups (P = 0.064). Two months after the intervention, mean (SD) values of self-care scores in control and intervention groups were 22.94 (4.71) and 42.31 (4.60), respectively. Statistical analysis showed that self-care behaviors in the family-centered group had a significant increase compared to the control group (P < 0.001).

Education with family-centered approach has a positive impact on the self-care behavior of patients with heart failure. With regard to our culture and the importance of family, it is suggested that this approach be used in addition to other training methods to improve self-care behaviors in patients with chronic diseases such as heart failure.

Congenital and acquired heart diseases are the primary cause of death in children and young adults year after year around the world. Two million patients are diagnosed each year with the simplest and non-invasive tool, Echocardiography. 

The invention of Echo machines in 1950s and later the developing curve in 1970s by Swedish doctors and engineers, helped the medicine to save the life of millions of patients.

Echocardiography has become routinely used in the diagnosis, management, and follow-up of patients with any suspected or known heart diseases. It is one of the most widely used diagnostic tests in cardiology, cardiac surgery and cardiac anesthesia. An excellent diagnosis of congenital and acquired heart disease is the first step for an inclusive correction of pathology and of course the prognosis.

Long distance live Echocardiography, is a new diagnostic tool, created and developed recently by La Chaine d’Espoir known as ‘echoes’. The first live sessions were done in February 2015. There are two main objective behind this project: Training and capacity building of teams, second opinion and discussion for the selection of type of management.

The main appliance of action is the connection between the experts from one side and the patient and cardiac team in another side through Live-Streaming, the images are transferred live and directly from the echo-machine, and 2 extra webcams fixed:  one on the patient and one fixed on the position of probe to make sure the experts have an excellent information in forward-facing them.  The live verbal conversation between to two sides is vital which the case in our method. Three things are important for the success: Technical implantation, Internet Boundaries, experienced hands for performing Echocardiography.

The project took place immediately after the first opening sessions between FMIC cardiac services and CDE headquarters in Paris, France.

Since then until we had a more clear vision for 861 patients, on diagnostic, second opinion and surgical indications.  All patients went under surgical correction in FMIC, Kabul.

Nanoparticles (NPs) of Fe₃O₄were produced by a chemical technique and nanoparticles of Ag, Au, CuO, NiO, Mn₃O₄,  PbO, ZnO, TiO₂, SiO₂, Al₂O₃  -  by laser ablation. In some experiments, we compared particles of a given chemical composition having different diameters, while in others – equidimensional NPs of different metals or metal oxides (Me-NPs). We used two experimental models: (a) a single intra-tracheal instillation of Me-NPs 24 h before the bronchoalveolar lavage to obtain a fluid for cytological and biochemical assessment; (b) repeated intra-peritoneal injections during 6-7 weeks in non-lethal doses to assess the thus induced subchronic intoxication by a lot of functional, biochemical and morphological indices. Besides, we carried out long-term inhalation experiments with Me-NPs of Fe₂O₃, SiO₂ and NiO. We demonstrated that Me-NPs are much more noxious as compared with their fine micrometric or even submicron counterparts and are usually the more toxic the smaller their dimensions within the nano-scale range. However, for the RES-rich organs this dependence is not so unique due to intricate and contra-directional influences of the Me-NP’s size on toxic dynamics and toxicokinetics. We found also that toxicity of Me-NPs strongly depends on their chemical nature, solubility and specific mechanisms of action characteristic of a given metal in any chemical form.   Solubilization of Me-NPs in biological milieus plays an important part in their toxicokinetics which can prevail over that of the physiological mechanisms controlling their distribution, retention and elimination. On the other hand,  thanks to the high activity of these mechanisms, the organism is not  defenseless against the impact of Me-NPs.  However they are one of the most dangerous occupational and environmental hazards due to their high toxicity and virtually obligatory genotoxicity. Therefore standards of presumably safe Me-NP concentrations in workplace and ambient air should be very strict. As an additional protective measure, the toxicity and even genotoxicity of Me-NPs can be significantly attenuated by adequately composed combinations of some bioactive agents in innocuous doses.

This present report is about the couple of genetic polymorphism CYPIAI and GSTTI, GSTMI study in addicted male sewage workers. Additionally, whole blood Selenium (Se) concentration and intensity of DNA damage in each polymorphic group population were also examined. Results indicate that about 50.72% of total number of experiment subject (N=138) were with normal genotype and rest are with polymorphism of at least one gene. Here population group consisting of GSTTI null, GSTMI null had the most elevated whole blood Se concentration and it is significantly (p<0.05) higher than all other group. Further another group comprising with GSTMI null, CYPIAI mutated (heterozygous/ homozygous) with highest degree of intensity of DNA damage which is statistically significant (p<0.05) than any other discussed group. From this study it is clear that these couple of group with a genetic make-up of GSTTI null, GSTMI null and CYPIAI wild type andGSTMI null , CYPIAI mutated ( heterozygous/ homozygous) are the most alarming conditioned group. Here population with normal genotype was considered as control because an intragroup study has performed for a patch of occupationally exposed workers so they are matched in every respect and a comparison has performed and reported about the essential elemental status like Se and intensity of DNA damage. This is important for these study population to investigate few extra health status coupled with genetic make up.

The distribution of heavy metals in coastal sediments of three Polish beaches was assessed. Core sediments collected in the central part of the Polish coast were characterized by seasonally increased concentration of Cd, Ag, Ba, Al, Cu, Cr and Bi. Despite the fact the majority of dredge material collected could be classified as light or trace contaminated by Cr, Cu, Zn, Ca and Hg among the studies beaches the highest content of Cd and Ag was discovered in Czolpino, located in the area of national park. It was discovered that 13 km of the beach in Czolpino was incidentally contaminated by an unidentified substance probably originated from chemical munitions dumped in the Baltic Sea after World War II. Chemicals originating from chemical warfare materials can spread from the disposal sites of the containers due to the impact of waves and sea currents. The behaviour of warfare agents in the marine environment is additionally influenced by the

Physical properties of the agents. All warfare agents react with sea water, but reaction rates can vary enormously depending on the chemical structure. Such reaction products are usually less or no longer toxic. Some compounds, however, show an extremely low solubility and slow degradability and this is why  wide-scale  threat  to  the  marine  environment  from  dissolved  chemical  warfare agents still exists.

Amplification of Polymorphic DNA (RAPD) test for DNA fragmentation. The same features were assessed in control rats infected intraperitoneally with water with or without administration of the BPC. The copper oxide nanoparticles proved adversely bio-active in all respects considered in this study, their active in vivo solubilisation in biological fluids playing presumably an important role in both toxicokinetics and toxicodynamics. The BPC proposed and tested by us attenuated systemic and target organs toxicity, as well as genotoxicity of this substance. Judging by experimental data obtained in this investigation, occupational exposures to nano-scale copper oxide particles can present a significant health risk while the further search for its management with the help of innocuous bioprotectors seems to be justified.

The distribution of heavy metals in coastal sediments of three Polish beaches was assessed. Core sediments collected in the central part of the Polish coast were characterized by seasonally increased concentration of Cd, Ag, Ba, Al, Cu, Cr and Bi. Despite the fact the majority of dredge material collected could be classified as light or trace contaminated by Cr, Cu, Zn, Ca and Hg among the studies beaches the highest content of Cd and Ag was discovered in Czolpino, located in the area of national park. It was discovered that 13 km of the beach in Czolpino was incidentally contaminated by an unidentified substance probably originated from chemical munitions dumped in the Baltic Sea after World War II. Chemicals originating from chemical warfare materials can spread from the disposal sites of the containers due to the impact of waves and sea currents. The behaviour of warfare agents in the marine environment is additionally influenced by the

Physical properties of the agents. All warfare agents react with sea water, but reaction rates can vary enormously depending on the chemical structure. Such reaction products are usually less or no longer toxic. Some compounds, however, show an extremely low solubility and slow degradability and this is why  wide-scale  threat  to  the  marine  environment  from  dissolved  chemical  warfare agents still exists.