Unexpected case of Graves` disease induced myocarditis: a case report.

Myocarditis due to Graves` disease is rare and has a clinical presentation that mimics acute coronary syndrome. In this case report, a 50-year-old woman was admitted with a clinical presentation of very high-risk non-ST segment elevation myocardial infarction, new-onset atrial fibrillation, and acute heart failure. Normal coronary angiography and the presence of intra-myocardial late gadolinium enhancement based on cardiac MRI led to the diagnosis of myocarditis. The presence of thyroid nodules and elevated thyrotropin receptor antibodies indicated Graves` disease as the underlying cause of myocarditis. Management using Propylthiouracil and the guideline-directed medical therapy for heart failure successfully improved the patient's condition. Early diagnosis, effective care, and adequate knowledge of the relationship between hyperthyroidism and myocarditis, improve outcomes in Graves' disease-induced myocarditis.

The Influence of Special Military Training on Left Ventricular Adaptation to Exercise in Elite Air Force Soldiers.

Purpose: The purpose of this study was to observe the influence of level physical training intensity on left ventricular (LV) adaptation in elite air force soldiers compared to regular basic military training. Methods: The LV adaptation of special military physical training for elite air force soldiers was compared with basic military training for regular troops. A group of the nonmilitary subject was also evaluated as a control group. The presence of LV adaptation was evaluated using some echocardiography parameters, including LV mass index (LVMI), LV ejection fraction (LVEF), global longitudinal strain (GLS), and myocardial work index. The parameters of the myocardial work index include global constructive work (GCW), global wasted work (GWW), global work index (GWI), and global work efficiency (GWE). Results: Forty-three elite air force soldiers underwent special military training, 43 regular troops underwent basic military training, and 23 nonmilitary subjects as a control group. Age, heart rate, blood pressure, and Cooper test results significantly differed among the three groups. Multivariate analysis among all groups showed that the level of physical training was associated with the LVMI (coefficient ß = 6.061; 95% confidence interval [CI] = 1.91-10.22; P = 0.005), LVEF (coefficient ß = -1.409; 95% CI = -2.41-[-0.41]; P = 0.006), LVGLS (coefficient ß = 1.726; 95% CI = 1.20-2.25; P < 0.001), GWW (coefficient ß = -13.875; 95% CI = -20.88-[-6.87]; P < 0.001), GWE (coefficient ß = 0.954; 95% CI = 0.62-1.26; P < 0.001), GCW (coefficient ß = 176.128; 95% CI = 121.16-231.10; P < 0.001), and GWI (coefficient ß = 196.494; 95% CI = 144.61-248.38; P < 0.001). Conclusions: Higher intensity of physical training observed in a special military training is associated with higher LV GLS, GWE, GCW, GWI, and lower GWW value suggesting greater physiological adaptation than the lower intensity training.

Trainees' perceptions and expectations of formal academic mentoring during the COVID-19 pandemic in Indonesian cardiology residency programs.

PURPOSE: During medical residency programs, physicians develop their professional identities as specialists and encounter high expectations in terms of achieving competencies. The responsibilities of medical trainees include caring for patients, balancing work with personal life, and weathering stress, depression, and burnout. Formal academic mentoring programs strive to ease these burdens. The coronavirus disease 2019 (COVID-19) pandemic has altered the trainee­academic mentor relationship, and solutions are needed to address these challenges. The present study aimed to evaluate the formal academic mentoring process through trainees' perceptions and expectations of formal mentoring programs during COVID-19 in Indonesian cardiology residency programs. METHODS: This cross-sectional study used a self-administered online questionnaire to capture trainees' perceptions and expectations regarding academic mentoring programs in 3 cardiology residency programs in Indonesia from October to November 2020. The questionnaire was developed before data collection. Perceptions of the existing mentoring programs were compared with expectations. RESULTS: Responses were gathered from 169 out of 174 residents (response rate, 97.3%). Most trainees reported having direct contact with COVID-19 patients (88.82%). They stated that changes had taken place in the mode and frequency of communication with their academic advisors during the pandemic. Significant differences were found between trainees' perceptions of the existing mentoring programs and their expectations for academic mentoring programs (P<0.001). CONCLUSION: Despite the challenges of interacting with their academic mentors, trainees still perceived academic mentors as a vital resource. Study programs need to consider trainees' expectations when designing academic mentoring programs.