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).
Cross-Sectional Studies ; Curriculum ; Female ; Humans ; Male ; Pakistan* ; Schools, Medical ; Stress, Psychological ; Students, Medical* ; Surveys and Questionnaires

BACKGROUND: Barium swallow is performed following esophagectomy to evaluate the anastomosis for detection of leaks and to assess the emptying of the gastric conduit. The aim of this study was to evaluate the reliability of the barium swallow study in diagnosing anastomotic leaks following esophagectomy. METHODS: Patients who underwent esophagectomy from January 2000 to December 2013 at our institution were investigated. Barium swallow was routinely done between days 5-7 to detect a leak. These results were compared to clinically determined leaks (defined by neck wound infection requiring jejunal feeds and or parenteral nutrition) during the postoperative period. The sensitivity and specificity of barium swallow in diagnosing clinically significant anastomotic leaks was determined. RESULTS: A total of 395 esophagectomies were performed (mean age, 62.2 years). The indications for the esophagectomy were as follows: malignancy (n=320), high-grade dysplasia (n=14), perforation (n=27), benign stricture (n=7), achalasia (n=16), and other (n=11). A variety of techniques were used including transhiatal (n=351), McKeown (n=35), and Ivor Lewis (n=9) esophagectomies. Operative mortality was 2.8% (n=11). Three hundred and sixty-eight patients (93%) underwent barium swallow study after esophagectomy. Clinically significant anastomotic leak was identified in 36 patients (9.8%). Barium swallow was able to detect only 13/36 clinically significant leaks. The sensitivity of the swallow in diagnosing a leak was 36% and specificity was 97%. The positive and negative predictive values of barium swallow study in detecting leaks were 59% and 93%, respectively. CONCLUSION: Barium swallow is an insensitive but specific test for detecting leaks at the cervical anastomotic site after esophagectomy.
Anastomotic Leak* ; Barium* ; Constriction, Pathologic ; Esophageal Achalasia ; Esophagectomy* ; Esophagus ; Humans ; Mortality ; Neck ; Postoperative Period ; Sensitivity and Specificity ; Wound Infection

Transcranial direct current stimulation (tDCS) is a noninvasive method that may increase the rehabilitation effects in stroke. The objective of the study was to test whether tDCS priming with training on an arm ergometer boosts motor performance in chronic stroke patients. Three chronic subcortical stroke patients had continued a sole unilateral stroke 30–36 months formerly. They had some voluntary control of the arm in the affected side underwent a cycling training on an arm ergometer for 20 minutes a day, during 5 days a week priming with cathodal tDCS stimulation of unaffected hemisphere. They were tested during 4 sessions 1 week before, at the beginning, at the end, and 1 week after the end of the training priming with tDCS. We executed; 1) Rivermead Motorik Assessment (global function, arm and leg), 2) the Modified Ashworth Scale of the elbow flexors and extensors, 3) the minimum torque on the lesion side, 4) grip strength, and 5) pegboard performance at each time of testing the patients. All patients tolerated tDCS very well during experiment. Patients showed significant (p = 0.01) improved of force and spasticity (p = 0.03). The grip strength and pegboard performance improved significantly too after DCS priming with training. These results showed that cathodal tDCS is a useful device for rehabilitation when priming with motor training in stroke patients. These patients proved the clinical relevance of the results.
Arm* ; Elbow ; Hand Strength ; Humans ; Methods ; Muscle Spasticity ; Neuronal Plasticity ; Paresis ; Pilot Projects* ; Rehabilitation ; Stroke ; Torque ; Transcranial Direct Current Stimulation*