Assessment of factors affecting the sleep hygiene of medical students in Bahawalpur, Pakistan: a cross-sectional study.

OBJECTIVE: To identify the factors which have a statistically significant association with sleep hygiene of medical students. MATERIAL AND METHODS: This study was done on 100 medical students. The questionnaire that was used for the collection of data had two parts. First was related to demographic variables and second was a validated Pittsburgh sleep quality index (PSQI). All participants were from the first to fifth years of Bachelor of Medicine and Bachelor of Surgery (MBBS). Data were analysed using SPSS 23. The association was found by applying chi-square test. RESULTS: Our study revealed that out of 100 students, 61% had poor sleep hygiene (PSQI ≥ 5). Global PSQI scores among women were slightly higher than males. A statistical association was found between the residence and habit of studying at night of medical students with their sleep hygiene. DISCUSSION: Medical students should ensure good sleep hygiene in order to maintain their academic performance, physical health, and mental health.

Carotid artery endarterectomy in patients with contralateral carotid artery occlusion: perioperative hazards and late results.

The aim of this study was to analyze and compare the perioperative hazards and late results of internal carotid endarterectomy (CEA) in patients with and without contralateral internal carotid artery occlusion. From March 1980 to April 1990, 375 consecutive patients underwent 439 CEAs at the First Department of Vascular Surgery of Padova Medical School. Patients were divided into two groups; group 1 (61 patients) had contralateral internal carotid artery occlusion and group 2 (314 patients) did not (378 CEAs, 64 bilateral). Indications for CEA were similar in both groups. The only significant difference in patient characteristics was a higher rate of previous stroke in group 1 (11% vs. 3%, p < 0.001). General anesthesia, continuous EEG monitoring, selective intraluminal shunt, and arteriotomy closure with a polytetrafluoroethylene patch (PTFE) were used routinely in both groups. An intraluminal shunt was inserted more frequently in group 1 than in group 2 (69% vs. 17%, p < 0.001). Major perioperative stroke occurred in one patient in each group (1.7% vs. 0.31%, respectively; NS). Early fatal stroke rates were 0% and 0.95% in groups 1 and 2, respectively (NS). All patients had neurologic examinations and duplex scans every 6 months (range 6 to 118 months; mean 42 months). Kaplan-Meier survival curves were virtually identical in the two groups; the majority of deaths were caused by myocardial infarction and cancer. There were no stroke-related deaths in group 1 as compared with 8.2% in group 2 (NS). New neurologic symptoms appeared in 4.7% of patients in group 1 and 6% in group 2 (NS) whereas the late stroke rates were 0% and 3.1%, respectively (NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical management of extracranial vertebral artery occlusive disease.

Thirty-seven consecutive patients underwent vertebral artery (VA) reconstruction over a 6 years period (1983-1989). Detailed neurologic, medical, and angiographic information was obtained for all patients. Indications for surgery were as follows: (1) stenosis of VA with symptoms of vertebrobasilar insufficiency; (2) very tight stenosis (greater than 75%) of the dominant VA with stenosis or occlusion of the contralateral VA; (3) very tight stenosis of VA with bilateral occlusion of the internal carotid artery (ICA); (4) very tight stenosis of VA with homolateral ICA lesion eligible for simultaneous repair; (5) very tight stenosis of VA and very tight stenosis of the homo or contralateral carotid siphon. There were 15 isolated vertebral lesions (group I), and 22 were VA lesions associated with lesions of the supraaortic trunks which were simultaneously treated (group II). The reconstructions of the first portion of the VA were 30 (12 of group I and 18 of group II) and reimplantation of the VA into the common carotid artery was the procedure of choice. There were 7 revascularizations of the third portion of the VA at C1-C2 level (3 of group I and 4 of group II): carotid-vertebral bypass, using an autogenous vein graft, was the procedure of choice. Three patients in group II died in the immediate postoperative period from myocardial infarction but no patient presented immediate postoperative neurologic deficits. All symptomatic patients but one were relieved of their symptoms in a median follow-up of 31 months. No postoperative complications were observed. Long-term results were satisfactory in all the 28 patients at their last follow-up visit.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of polymyositis in autoimmune thyroiditis with hyperthyroidism]. / Su un caso di polimiosite in corso di tiroidite autoimmune con ipertiroidismo.

A young woman, during an autoimmune thyroiditis with hyperthyroidism, suffered from progressive proximal weakness at her four limbs. The diagnosis of a concomitant polymyositis was indicated by a marked increase of plasma CPK, myopathic findings at EMG and a clearcut picture of inflammatory alterations at muscle biopsy. Steroid therapy brought a full recovery of both thyroid and muscular symptoms. In the following months, the patient suffered from a second episode of thyroiditis and subsequently from another poussée of polymyositis. The possible pathogenesis underlying the unusual association of an autoimmune thyroiditis with a polymyositis is discussed.

[Carotid stenosis and obliteration of the contralateral carotid. A prospective study of the risks of a carotid endarterectomy intervention and its long-term results]. / Stenosi carotidea ed obliterazione della carotide controlaterale. Studio prospettico sui rischi dell'intervento di endoarteriectomia carotidea e sui risultati a distanza.

From March 1980 to July 1988 a consecutive series of 256 patients (p.) underwent 301 carotid endarterectomy + patch with routine use of continuous intraoperative EEG monitoring and selective use of an intraluminal shunt (IS) for the presence of an atherosclerotic plaque concerning the internal carotid artery (ICA). Patients were divided in two groups: the first (42 p.) marked by contralateral ICA occlusion, the second (214 p.) without contralateral ICA occlusion (259 CEA). Immediate peroperative, long term and global (immediate and long term) outcomes were prospectively and comparatively studied. A temporary IS was inserted in 27 p. (64%) of the group I and in 38 p. (14%) of the group II. Immediate permanent postoperative neurological deficit occurred in 1 p. of group I (2.38%) and in 2 p. (0.9%) in group II. Immediate postoperative mortality was 0% and 0.9% in group I and II respectively. All p. had neurological valuation and Echo-Doppler of operated ICA and of the contralateral ICA every 6 months (middle follow-up 44 months). New neurological symptoms compared in 5.8% of p. of group I and in 5.23% of p. of group II with a stroke rate of 0% and 2.32% respectively. There were 2 restenosis of operated ICA, both of them in p. of group I, that underwent reoperation. In the two groups the principal causes of deaths were myocardial infarct and cancer; in the group I no death was due to stroke versus 1.86% in the group II.

EEG monitoring, selective shunting and patch graft angioplasty in carotid endarterectomy. Early and longterm results.

From March 1980 to July 1986 at the Department of Vascular Surgery of the University of Padua, 182 patients underwent 210 carotid revascularizations for atherosclerotic stenosis involving the carotid bifurcation (28 operations were bilateral). Carotid endarterectomies (CE) and patch graft angioplasty totalled 192 (166 patients); an enlarging patch graft angioplasty of the internal carotid artery (ICA) without CE was performed in 14 cases (13 patients); in the remaining four surgical procedures (3 patients), for technical reasons prohibiting CE, the operation consisted of a great saphenous vein bypass between a donor vessel and the ICA distal to the lesion. The preoperative symptoms in 182 patients were as follows: TIAs (98 cases, 54%), non-hemispheric symptoms (21 cases (12%) and fixed stroke or TIAIR (10 cases, 5%). Fifty-three patients (29%) were asymptomatic. In all cases, continuous EEG monitoring was employed. The operation was performed without a temporary intraluminal shunt in the patients showing tolerance to carotid clamping. The protection of the shunt was required only in patients with EEG changes (47 cases). The arteriotomy was routinely closed with a PTFE patch graft angioplasty. Early results of the operation were excellent: none of the patients presented permanent or transient neurological deficits in the immediate postoperative period and none of them died. All patients were reassessed with C.W. Doppler sonography and Duplex scanning in the postoperative period. In all cases, the success of the operation was demonstrated. Longterm follow-up (6-72 months, mean follow-up: 35 months) was done in 121 patients (142 operations): 107 patients were completely asymptomatic, 5 remained stable or slightly improved the preoperative status. Five patients had a new or recurrent TIAs, 3 suffered a stroke, one showed a recurrence of non-hemispheric symptoms. With the exception of two patients suffering a stroke, all had a second arteriography but none of these patients showed extracranial lesions. Two patients presented an asymptomatic restenosis of the ICA. Eight patients (8.8%) revealed a significant evolution of the disease of the contralateral unoperated ICA.(ABSTRACT TRUNCATED AT 400 WORDS)

Stroke risk reduction in asymptomatic and symptomatic patients treated surgically: the effectiveness of carotid endarterectomy with patch graft angioplasty.

From March 1980 to March 1987, 217 consecutive patients underwent 252 carotid revascularisations with routine use of continuous EEG monitoring and selective use of an intraluminal shunt for symptomatic (70%) or asymptomatic (30%) internal carotid artery (ICA) atherosclerotic stenosis. All carotid endarterectomies were routinely performed with a patch graft angioplasty. None of the patients suffered permanent or transient neurological deficits in the immediate postoperative period and none of them died. There was an 0.8% stroke rate and 0.4% mortality rate in the early postoperative course. Neurological assessment, Doppler and Echo doppler sonography of both the operated and the contralateral ICA was performed every 6 months. One-hundred and twenty-one patients (142 carotid revascularisations) operated on up to December 31st 1985 were reassessed in July 1986. The mean follow-up time was 35 months (range: 6 months to 6 years). New neurological symptoms were present in 7.4% of the patients; 2.5% of patients developed a stroke and 8.9% showed progression of stenosis in the contralateral ICA. One patient had a common carotid artery stenosis 2 years after surgery. Re-stenosis of the ICA was found in two patients who underwent re-operation without difficulty. The late mortality was 21.4% (11.9% of the overall series). In only two patients (7.6%) was stroke the cause of death.

MR imaging in a case of Hallervorden-Spatz disease.

Magnetic resonance using a 0.5 T system and a T2-weighted spin-echo pulse sequence revealed symmetric areas of marked hypointensity of the globi pallidi in a case with a family history of and presenting with clinical features consistent with Hallervorden-Spatz disease. No such findings were seen in any of 16 normal volunteers of similar age. Magnetic resonance may be useful for diagnosing Hallervorden-Spatz disease.

The rationale for patch-graft angioplasty after carotid endarterectomy: early and long-term follow-up.

A prospective study was undertaken in March 1980, at the Vascular Surgery Department of the Padua University, Medical School, to establish whether patch graft angioplasty is useful in preventing restenosis after carotid endarterectomy (CE). Seventy-four patients underwent 86 CE (bilateral in 12 cases) for atherosclerotic disease involving the carotid bifurcation. Thirty-eight (51.4%) patients presented TIA's or non hemispheric symptoms of cerebrovascular insufficiency; 30 (40.5%) were asymptomatic and 6 (8.1%) had partial nonprogressing or fixed strokes. All operations were performed under general anesthesia, with pharmacologic hypertension and systemic heparinization; in all cases, continuous EEG monitoring and 'stump pressure' measurement were employed. The operation was performed without a temporary intraluminal shunt in the patients showing tolerance to carotid clamping. The protection of the shunt was required only in patients with EEG monitoring changes (17). All carotid arteriotomies were extended into the internal carotid artery to overpass the end of the endarterectomy. Overpass was also used in the proximal edge of the arteriotomy, in the common carotid artery. The distal intima was never fixed with stitches and the arteriotomy was routinely closed with a PTFE patch graft angioplasty. Early results of cerebral protection were excellent. No patient presented permanent or transient postoperative neurological problems and no patient died in the postoperative period for causes related to the operation. This is substantiated by results we achieved during the period 1970-1979 in 192 patients, when all carotid endarterectomies were routinely performed without a shunt, with figures of 2.5% of postoperative stroke and 1.5% of mortality. Longterm follow-up (from 6 to 36 months) was completed in 51 patients (60 operations).(ABSTRACT TRUNCATED AT 250 WORDS)

Continuous intraoperative EEG monitoring during carotid surgery.

Continuous intraoperative EEG monitoring and stump pressure measurements were studied during 85 carotid revascularizations performed in 40 symptomatic cerebrovascular patients and in 32 asymptomatic subjects with a cervical bruit. The decision to place a temporary shunt was made on the basis of intraoperative EEG abnormalities regardless of stump pressure values. 11 patients with contralateral carotid lesions showed marked EEG alterations, at the moment of clamping, which returned to normal after the placement of an indwelling shunt. Stump pressure values showed a wide variation and a poor correlation with intraoperative EEG changes. In the early postoperative period there were no deaths; no new neurological deficits were detected. In the follow-up there was only 1 asymptomatic carotid rethrombosis, not revealed by the EEG, which was suspected by Doppler sonography and confirmed by angiography. The authors conclude that EEG gives valuable information about cerebral functions during carotid revascularization and can reduce the intraoperative complications of the procedure. Stump pressure measurement cannot be used alone as a safe indicator of cerebral ischemia during carotid cross-clamping.

Subclavian steal diagnosis: Doppler sonography vs. angiography.

Continuous-wave Doppler sonography is a reliable technique for the diagnosis of subclavian steal. This tool also allows us to identify incipient steals, characterized by either alternating flow or systolic flow deceleration in the vertebral artery, which might escape detection by conventional angiography. Diagnostic criteria are reported and results of a 48-patient study are compared with angiographic data. The different patterns of vertebral flow depend on the degree of proximal subclavian or innominate artery functional stenosis. The Doppler examination is a useful method because it is non invasive, harmless to the patient and allows for the evaluation of associated lesions in other extracranial vessels. It is of particular interest for the diagnosis when the clinical picture is still apparently normal and in the absence of both neurological findings and asymmetrical blood pressure in the arms.

The Prader-Willi syndrome: neuroendocrine study of identical twins.

Identical twins with the Prader-Willi syndrome are reported. Apart from hypogonadism, hypomentia, hypotonia and obesity, they presented shorter than normal stature and the peculiar facies of this syndrome. Both twins also suffered from arterial hypertension with secondary hyperaldosteronism, an abnormality never previously recorded. The endocrinological study showed the presence of hypogonadotrophic hypogonadism in both twins. The GnRH and clomiphene tests suggested a hypothalamic disorder. Although the vast majority of cases with the Prader-Willi syndrome are isolated, the expression of this disorder in two identical twins enhances the possibility of a genetic determination.

[EEG in transient ischemic attacks (author's transl)]. / Aspetti elettroencefalografici negli episodi ischemici cerebrali transitori.

60 patients under 65 years of age with one or more episodes of reversible ischemic attacks lasting less or more than 24 hours (T.I.A. or R.I.N.D.) were studied. Each patient had a complete clinical assessment and an EEG, followed by an arteriogram. 35 patients had an EEG activation with digital carotid compression. EEG abnormalities were present in 26 cases while 34 patients had normal records. No correlation was found between EEG abnormalities and arteriographic alterations. EEG activation by digital carotid compression is a valuable hemodynamic test but cannot necessarily indicate a controlateral carotid artery occlusion.

[Ophthalmodynamometry in transitory cerebral ischemic episodes]. / L'oftalmodinamometria negli episodi ischemici cerebrali transitori.

The authors examine the diagnostic accuracy of ophthalmodynamometry in detecting extracranial internal carotid artery stenosis. 58 patients with T.I.A.s or R.I.N.D.s are studied. The test, compared with angiography, is positive only in 50% of patients presenting unilateral internal carotid artery occlusion.

Carotid Doppler examination: a correlation with angiography.

The Doppler ultrasound technique is a useful tool for the screening and follow-up of patients with extracranial atheromatous lesions of the carotid tree. Doppler examination was performed on 654 patients and compared with angiographic visualization of a total of 261 carotid arteries in 171 patients. The Doppler diagnostic criteria and their reliability are reported and discussed. This technique is not alternative but complementary to angiography.