Higher stress scores for female medical students measured by the Kessler Psychological Distress Scale (K10) in Pakistan / 보건의료교육평가

The aim of this study was to determine the stress level of medical students and the relationship between stress and academic year. A cross-sectional, descriptive study was conducted at an undergraduate medical school with a five-year curriculum, in Pakistan, from January 2014 to April 2014. Medical students in the first four years were included in the study. The Kessler Psychological Distress Scale (K10), a self-administered questionnaire, was distributed to the students. A total of 445 medical students completed the questionnaire. The average stress score was 19.61 (SD=6.76) with a range from 10 to 43. Stress was experienced by 169 students (41.7%). The scores of female students were higher than scores of males, indicating a higher stress level (P=0.011). The relationship between stress and academic year was insignificant (P=0.392).

Value of dobutamine stress echocardiography [DSE] in assessment of coronary artery disease in high risk obese female patients with normal EF and stable angina pectoris. comparative study to coronary angiography

Study carried to determine the value of DSE in assessment of the presence of CAD in obese female patients with stable angina pectoris and normal EF>55% +/- other risk factors [diabetes mellitus, hypertension, hyperlipidaemia, and/or smoking] versus patients performing coronary angiography. Sensitivity and specificity. Chest pain with suspected CAD may be screened with non-invasive test that has high sensitivity and specificity. We studied 200 female obese patients in the period between 1/1/2007 until 31/12/2008 with stable angina referred to the National Heart Institute with suspected coronary artery disease. Obesity was defined as body weight>110kg in these patients with body waist>44 and body mass index was not considered. Transthoracic echocardiography at rest revealed EF>55% with no segmental wall motion abnormality at rest in 102 +/- 22 patients, paradoxical septal wall motion in 13 +/- 15 patients, left ventricular dilatation in 10 +/- 12 patients, no history of myocardial infarction and variable risk factors [diabetes mellitus, hypertension, hyperlipidaemia, and/or smoking] are present. All patients were subjected to dobutamine stress echocardiography [DSE]: 4 stages; 5 micro g/kg/min, 10 micro g/kg/ml 15 micro g/kg/min and high dose 40ug/kg/min +/- atropine injection 1mg IV in the last stage. Coronary angiography was done in 148 patients. The results are compared to the data obtained from DSE with evaluation of sensitivity and specificity in these classes of patients. Group A: 153/200 patients completed the full dose of DSE with no wall motion abnormality or other factors that necessitate stopping the examination as chest pain, angina equivalent, hypotension or life threatening arrhythmia. Their tests were considered negative. 124/153 patients of them has done coronary angiography and revealed no coronary artery disease. 25/153 patients had one vessel disease or minimal 2or3 vessel that does not recommend any intervention. 4/153 patients had one vessel disease or significant 2or3 vessel that does recommend intervention or CABG. Group B: 40/200 patients had equivocal results because positivity of the test can not be proved after full dose of DSE and recommended coronary angiography to further evaluate coronary arteries. 31/40 patients had one vessel disease or minimal 2or3 vessel that does not recommend any intervention. 9/40 patients had one vessel disease or significant 2 or 3 vessel that does recommend intervention or CABG. Group C: 7/200 patients had positive dobutamine stress echocardiography and coronary angiography revealed significant coronary artery disease. Sensitivity was 84% and specificity 90% with P value 0.0001. Dobutamine stress echocardiography is a simple screening test in high risk obese female patients with suspected CAD compared to invasive coronary angiography with high sensitivity and specificity

GTN ointment in the treatment of anal fissures: audit of local experience in Mubarak Al-Kabeer Hospital, Kuwait

To evaluate the role of topical glyceryl trinitrate [GTN] ointment as a non-surgical treatment for anal fissure. Anal fissure is an ischemic disease caused by spasm of internal anal sphincter. Nitric oxide from GTN causes chemical sphincterotomy and improves blood flow, thus healing the anal fissure. Prospective study conducted from May 2003 to April 2004. Surgical outpatient clinic, Department of Surgery, Mubarak Al-Kabeer Hospital, Kuwait. Eighty-six patients [42 male and 44 female] were recruited. Thirty seven patients had acute and 49 had chronic anal fissure. All patients were treated with topical 0.2% GTN ointment twice daily with additional application after defecation. An independent observer assessed the patients until full healing of fissures. Patient compliance was good. One patient developed transient mild headache. All patients achieved great reduction in pain score from a mean of 5.3 pre-treatment to 0.92 after one week and nearly zero at 4-6 weeks' treatment. Complete healing occurred at four weeks in all cases from the acute anal fissure group [100%] and in 37 patients [75.5%] from the chronic anal fissure group. Twelve [24.4%] unsuccessful patients with chronic anal fissure underwent surgical sphincterotomy. Recurrence occurred at two months in three patients [8.1%] with acute anal fissure requiring another course of GTN ointment, and in one patient [2.04%] with chronic anal fissure who required surgery. GTN ointment for anal fissure should be considered as a first line treatment prior to surgical intervention in order to reduce complications of surgery