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Students at the Monastir Faculty of Dental Medicine were required to remain inside during the COVID-19 pandemic for their own safety and in accordance with official directives. It is evident that learners' perceptions are a recognized indicator of the efficiency of any teaching approach. Therefore, we focused on students' input on the validity of online biochemistry laboratories to assure their preferences with the finest teaching approaches. The study included 116 undergraduate dental students from the Faculty of Dental Medicine of Monastir. The survey has 40 questions. This investigation covered (i) information technology tool accessibility, (ii) course presentation, interactions in a virtual classroom, teachers' availability, and (iii) preferred learning styles. The percentages were then determined for each item and assessed. Our results showed that almost students were equipped with computers, smartphones and tablets but have encountered some connectivity issues. Moreover, participants find courses well presented, approved class interactions, and were satisfied with teachers' availability. Nevertheless, students were not already prepared for entirely online learning. Despite, the overall positive perception among students toward remote education during the COVID-19 outbreak; they preferred considering shared learning between face-to-face and online once the pandemic is over.

Key Clinical Message: Caseous mitral annulus calcification is a rare benign condition that can be misdiagnosed on echocardiography especially when it presents as a mass. This report highlights the contribution of cardiac MRI and computed tomography to the diagnosis through the case of a patient previously treated for breast cancer. We report the case of a patient, previously treated for breast cancer, in whom echocardiography suggested the diagnosis of a cardiac tumor due the presence of a mass on the posterior mitral annulus. Cardiac magnetic resonance was inconclusive. Computed tomography confirmed the diagnosis of caseous mitral annulus calcification. [ABSTRACT FROM AUTHOR]

The article presents a study on the impact of Zearalenone (ZEN) and Ochratoxin A (OTA) toxins on the health of living organisms. The study examines the substances' molecular aspects and its effects including cell viability, heat shock protein (Hsp) and oxidative damage. It also investigates the serious health problems that the substances might cause to the organisms. Findings of the study indicate that both ZEN and OTA inhibit cell proliferation and they generated a significant reactive oxygen species (ROS) amount. It notes that the major part of cell mortality caused by ZEN can be restored by antioxidant supplements, but the supplements did not have substantial effect on OTA-induced cell mortality. It concludes that oxidative damage is the most frequent impact of the toxins.

Introduction: Dyslipidemias are a major cardiovascular risk factor. The control of LDLc level is one of the major targets in patients admitted for an acute coronary syndrome (ACS)., Aim: To study the lipid profile after ACS and to assess the degree of applicability of the European guidelines in Tunisia., Methods: This was a prospective, multicentric, non-randomized study involving consecutive patients admitted for ACS between October 2019 and March 2020; for whom a lipid assessment was carried out on admission and checked after four to six weeks under high dose of statin., Results: One hundred patients were included. The mean age of our population was 58.7 years and the sex ratio was 5.7. Obesity was present in 15%, Diabetes in 35%, hypertension in 34% and smoking in 61% of cases. Our patients presented with ST segment elevation myocardial infraction in 51%. The mean total plasma LDLc level was 1.04±0.26g/L. A reduction in LDLc levels of more than 50% was noted in 33% of patients. A value less than 0.55g/L of LDLc was noted in 46% of patients. The therapeutic target (LDLc.

Background: Non-invasive examination of coronary artery disease is an attractive and rapidly evolving possibility. In certain clinical situations ,multi-detector computed tomography coronarography (MDCT) is currently considered as a promising technique alternative to conventional coronary angiography (CCA)., Purpose: We suggest from our personal study and from a review of the literature, to analyze diagnostic accuracy of MDCT , its limits and to deduct, its practical implications and its indications., Methods: 105 patients underwent 64-slice MDCT . Coronary angiography was performed every time when the MDCT was pathologic. In two cases the MDCT was realized in complement of inconclusive coronary angiography .Study of coronary arteries was based on "per -segment" and "per- patients" analyse Results : The mean age was 63,3 years., sex ratio was 0 ,7. Hypertension was noted in 63% of cases 29 ,9 % of patients had mellitus diabetes.The initial clinical presentation was unusual chest pain in 46 patients, exercise chest pain in 40 cases. the MDCT was done for the detection of silent ischemia In 5 cases, for screening of CAD in patients with dilated cardiomyopathy in 5 cases , before cardiac surgery in 3 case and before non cardiac surgery in 2 cases. MDCT was normal in 30 patients ( 28% ) so coronary angiography was avoided in 60% of patients with unusual chest pain, and in 50% of patients with dilated cardiomyopathy and in also in 50% of patients selected for cardiac or non cardiac surgery. In per-segment study the sensitivity, specificity, positive and negative predictive value of the MDCT in detecting coronary stenosis were respectively 89 %,98% , 91% and 97% versus, 98%,89%,94%, 95% the per-patient evaluation .The MDCT was inclusive in10 patients because .of calcifications in 8 cases and because uncontrolled unchecked heart rate in 40 cases Conclusion : our results for negative predictive value of MDCT are similar to reports from the literature. This suggests that in this clinical setting , MDCT may replace coronary in patients with low probability of coronary artery diseases, its is also useful for assessment of cardiomyopathy and before cardiac or non cardiac surgery.

Background: Echocardiographic parameters of mechanical dyssynchrony may improve patients selection for cardiac resynchronisation therapy in chronic heart failure., Aim: This study aimed to define the prevalence of inter, intra and atrio-ventricular dyssynchrony in heart failure patients with different QRS duration and to evaluate inter and intra-observer variability in collecting different echocardiographic dyssynchony parameters., Methods: Twenty patients with chronic heart failure of any origin, NYHA functional class II-III with LVEF < 40%, were evaluated by complete echocardiographic examination including tissue Doppler imaging (DTI) and Tissue Tracking., Results: Three patients had an atrio-ventricular dyssynchrony with a mean left ventricular filling time to cardiac cycle of 33 +/- 5%. Six patients had an interventricular mechanical delay (IVMD) > or = 40 milliseconds, all of them had a QRS duration > or = 120 milliseconds. Overall, no statistically significant correlation was found between IVMD and QRS duration (r = 0.35, p = 0.4). The mean septal to posterior wall-motion delay (SPWMD) was 83 +/- 64 ms. 7 patients had SPWMD > or = 130 ms. The baseline QRS duration did not correlate with SPWMD (p = 0.7). The mean LV dyssynchrony determined by deltaS-peak was 74 +/- 42 ms. Seven patients had LV dyssynchrony. Linear regression did not demonstrate a relation between QRS width and intraventricular dyssynchrony (p = 0.34). There was no concordance between intra-ventricular spatial or longitudinal dyssynchrony determined by DTI method and by Tissue Tracking (p = 0.3 and 0.6 respectively). The intraobserver reproducibility of LVFT/RR, IVMD and deltaS-peak (ICC = 0.99, 0.98 and 0.99, respectively), as well as the interobserver reproducibility (ICC: 0.96, 0.94 and 0.92, respectively), were very high. However, we observed a high variability for SPWMD measure (ICC = 0.27, p = 0.31)., Conclusion: Mechanical dyssynchrony did not correlate with QRS duration, despite the poor variability in collecting different echocardiographic parameters.

Background: Classic echocardiographic methods to estimate mitral valve area (MVA) in the mitral stenosis (MS) has several limitations. Recently, the proximal isovelocity surface area (PISA) method has been shown to be accurate for calculating MVA., Aims: This study sought to 1) compare the accuracy of the PISA method to planimetry and Doppler pressure half-time (PHT) methods for echocardiographic estimation of MVA and 2) to evaluate the effect of atrial fibrillation (AF) and significant mitral regurgitation (MR) on the accuracy of the PISA method., Methods: In 35 patients with rheumatic mitral stenosis, the mitral valve areas were determined by two-dimensional echocardiographic planimetry, pressure half-time and proximal flow convergence region. 19 patients had atrial fibrillation and 15 had associated mitral insufficiency > or = 2., Results: The correlaton between PISA and planimetry areas was significant (r=0.83, p<.001). The intraclass correlation coefficient was of 0.85 but with a large confidence interval (IC 95% [0,68-0,9]) explaining the significant underestimation of MVA by PISA method: 1,42 +/- 0,47 cm2 versus 1,56 +/- 0,41 cm2 respectively, (p<.001). There was no signicant difference between PISA and PHT areas : 1,42 +/- 0,47 cm2 versus 1,43 +/- 0,46 cm2. Underestimation of MVA par PISA method didn't have real clinical implication: the sensibility of diagnosing severe MS (MVA < or = 1.5 cm2) was 90% vith a negative predictive value of 83%. The correlation was good in patients with AF (r=0,84, p<.001) and with significant MR (r=0,83, p<.001)., Conclusion: The PISA method may be considered as reliable alternative method for estimation of the MVA in MS. Its accuracy is good in AF and associated MR.

Ochratoxin A (OTA) is a mycotoxin currently detected in stored animal and human food supplies as well as in human sera worldwide. OTA has diverse toxicological effects; however, the most prominent one is the nephrotoxicity. The present investigation was conducted to determine the molecular aspects of OTA toxicity in cultured human hepatocellular carcinoma cells. With this aim, we have monitored the effects of OTA on (i) cell viability, (ii) heat shock protein expressions as a parameter of protective and adaptive response, (iii) oxidative damage, and (iv) cell death signaling pathway. Our results clearly showed that OTA treatment inhibits cell proliferation, downregulates Hsp 70 and Hsp 27 protein and mRNA levels, and did not induce a significant reactive oxygen species generation. We have also demonstrated a decrease in mitochondrial membrane potential, a cytochrome c release, and an activation of caspase 9 and caspase 3 in response to OTA exposure. Moreover, OTA activates p53 expression, while some of its transcriptional target genes (Bax, Bak, PUMA, and p21) were found to downregulate. According to these data, we concluded that OTA may exert an inhibitory action on the transcriptional process. Besides, oxidative damage is not a major contributor to OTA toxicity. This mycotoxin induces a mitochondrial and caspase-dependent apoptotic cell death, which seems to be mediated by p53 transcriptional independent activities., ((c) 2009 Wiley Periodicals, Inc.)