Benefits in quality of life following an obstructive sleep apnea screening and treatment program in patients with acute ischemic stroke. / Beneficios en la calidad de vida de un programa de cribado y tratamiento de apnea obstructiva del sueño en pacientes con ictus isquémico agudo.

INTRODUCTION: Obstructive sleep apnea (OSA) has been proposed as a factor that worsens stroke prognosis. Our aim was to determine if an OSA intervention could improve quality of life (QOL, first objective) and modified Rankin score (mRS, second objective). PATIENTS AND METHODS: The intervention group of this quasi-experimental study included patients with acute ischemic stroke <72 hours who underwent polygraphy and Continuous Positive Airway Pressure (CPAP) and hygienic-dietary measures if required. The control group followed routine clinical practice. The Short Form 36 Health Survey (SF-36) and mRS were applied at the sixth month after stroke in both groups. RESULTS: Fifty-five vs. sixty-two patients were included in the intervention and control group respectively. In the intervention group, 64.71% of patients accepted the proposed CPAP (16 cases with a good adherence). An improvement in SF-36 items was detected in the intervention group: physical functioning (p = 0.008), role physical (p = 0.002), bodily pain (p = 0.008), general health (p <0.001), vitality (p = 0.001) and role emotional (p = 0.015). In a per-protocol analysis, all these improvements were verified in the group of patients treated with good CPAP adherence (p < 0.05 in all the same SF-36 items). The percentage of patients with physical component summatory = 50 was higher in the intervention group (p = 0.003). There were no differences in the median of mRS (p = 0.262). CONCLUSIONS: Although more evidence is needed, a significant improvement in QOL was suggested after our OSA intervention, particularly in patients with good CPAP adherence.

TITLE: Beneficios en la calidad de vida de un programa de cribado y tratamiento de apnea obstructiva del sueño en pacientes con ictus isquémico agudo.Introducción. La apnea obstructiva del sueño (AOS) se ha propuesto como un factor de mal pronóstico en el ictus. Pretendemos determinar si una intervención sobre la AOS puede mejorar las escalas de calidad de vida (primer objetivo) y de discapacidad (segundo objetivo). Pacientes y métodos. El grupo de intervención de este estudio cuasi experimental incluye a pacientes con ictus isquémico agudo menor de 72 horas de evolución a quienes se les realizó poligrafía, así como presión positiva continua en las vías aéreas (CPAP) y medidas higienicodietéticas si se requerían. En el grupo de control se siguió la práctica clínica habitual. Se aplicaron las escalas Short Form 36 Health Survey (SF-36) y modified Rankin Score (mRS) en el sexto mes del ictus en ambos grupos. Resultados. Se incluyó a 55 y a 62 pacientes en el grupo de intervención y en el de control, respectivamente. En el grupo de intervención, el 64,71% de los pacientes aceptó la CPAP indicada (16 casos con buena adhesión). Se detectó una mejoría en los ítems de la escala SF-36 en el grupo de intervención: funcionamiento físico (p = 0,008), rol físico (p = 0,002), dolor corporal (p = 0,008), salud general (p menor de 0,001), vitalidad (p = 0,001) y rol emocional (p = 0,015). En un análisis por protocolo, todas estas mejorías se comprobaron en el grupo de pacientes tratados con CPAP con buena adhesión (p menor de 0,05 en todos los ítems de la SF-36). El porcentaje de pacientes con el sumatorio del componente físico = 50 fue más alto en el grupo de intervención (p = 0,003). No había diferencias en la mediana de la mRS (p = 0,262). Conclusiones. Aunque se necesitan más evidencias, nuestro estudio sugiere una mejoría significativa de la calidad de vida tras nuestra intervención en la AOS, especialmente en pacientes con buena adhesión a la CPAP.

Medical students' clerkship experiences and self-perceived competence in clinical skills.

INTRODUCTION: In a traditional curriculum, medical students are expected to acquire clinical competence through the apprenticeship model using the Halstedian "see one, do one, and teach one, approach". The University of Zambia School of Medicine used a traditional curriculum model from 1966 until 2011 when a competence-based curriculum was implemented. OBJECTIVE: To explore medical students' clerkships experiences and self-perceived competence in clinical skills. METHODS: A cross-sectional survey was conducted on 5th, 6th, and 7th year medical students of the University of Zambia, School of Medicine two months prior to final examinations. Students were asked to rate their clerkship experiences with respect to specific skills on a scale of 1 to 4 and their level of self-perceived competence on a scale of 1 to 3. Skills evaluated were in four main domains: history taking and communication, physical examination, procedural, and professionalism, team work and medical decision making. Using Statistical Package for Social Scientist (SPSS), correlations were performed between experiences and self-perceived competence on specific skills, within domains and overall. RESULTS: Out of 197 clinical students 138 (70%) participated in the survey. The results showed significant increase in the proportion of students performing different skills and reporting feeling very competent with each additional clinical year. Overall correlations between experience and self-perceived competence were moderate (0.55). On individual skills, the highest correlation between experience and self-perceived competence were observed on mainly medical and surgical related procedural skills with the highest at 0.82 for nasal gastric tube insertion and 0.76 for endotracheal intubation. CONCLUSION: Despite the general improvement in skills experiences and self-perceived competence, some deficiencies were noted as significant numbers of final year students had never attempted common important procedures especially those performed in emergency situations. Deficiencies in certain skills may call for incorporation of teaching/learning methods that broaden students' exposure to such skills.

Educational status and dietary fat and anti-oxidant intake in urban subjects.

To assess correlation of dietary atherogenic and anti-atherogenic factors with socio-economic status (SES) we performed nutritional survey among 182 (122 men, 60 women) randomly selected individuals using 24 hour diet recall and a food-frequency questionnaire. SES was assessed by educational level which strongly correlated with occupational class (r = 0.55) and income levels (r = 0.88). There was significant (p < 0.05) positive correlation (r values) of educational level with intake of calories (0.55), proteins (0.19), fat (0.45), fat derived energy (en%) (0.14), saturated fat en% (0.45), linoleic acid (0.17), vitamin A (0.14), vitamin C (0.16), vitamin E (0.44), fruits and vegetables (0.34) and fibre (0.24) and negative correlation with intake of linolenic acid (-0.35), monounsaturated fat (MUFA) en% (-0.15), polyunsaturated fat (PUFA)/saturated fat (SFA) (-0.33) and MUFA/SFA (-0.42). In persons of highest educational level (> 15 years education) vs illiterates, the daily intake of SFA (29.1 +/- 15 vs 7.8 +/- 6), SFA en% (13.2 +/- 5 vs 6.7 +/- 4), linoleic acid en% (5.4 +/- 3 vs 3.9 +/- 2) and n6/n3 (24.0 +/- 58 vs 4.5 +/- 5) was more and intake of linolenic acid en% (0.7 +/- 1 vs 1.6 +/- 1), MUFA en% (8.6 +/- 7 vs 15.6 +/- 9), PUFA/SFA (0.6 +/- 1 vs 1.0 +/- 1) and MUFA/SFA (0.7 +/- 1 vs 4.0 +/- 5) was less. Intake of antioxidant vitamins A, C and E and fruits and vegetables was significantly more in better educated.

Estudio comparativo entre parto vaginal y cesárea en presentacion de nalgas

Se realiza un estudio retrospectivos de 133 partos con feto en presentación de nalgas en el hospital provincial de Cotopaxi (HPC) en un período comprendido entre enero de 1993 hasta diciembre de 1995. Se excluyó del estudio a los embarazos gemelares. Se obtuvo una incidencia de 1.99 por ciento de presentación pelviana con respecto al total de partos. El 57.14 por ciento de pacientes fueron atendidos por cesárea. Se realiza luego un estudio comparativo entre nacidos por vía vaginal y por vía abdominal. En cuanto a variables como edad materna, paridad, edad gestacional y peso al nacimiento no hay diferencia significativa, pero sin en el apgar que fue mejor en nacidos por cesárea y la morbimortalidad fetal que está aumentada en nacidos por vía vaginal.

Congenital absence of the internal carotid artery.

A case of a 27 year old male who was found to have the unusual congenital absence of one internal carotid artery is presented. A second case with similar but slightly different X-ray findings due to occlusion of the internal carotid is presented for comparison. Only forty cases of agenesis of the internal carotid artery have been found by us in the literature and this appears to be the first from Africa.