Prevalence and correlates of imposter syndrome and self-esteem among medical students at Jazan University, Saudi Arabia: A cross-sectional study.

Imposter syndrome (IS) and low self-esteem (SE) are common issues affecting medical students that can impact their well-being and development. This study aimed to assess the prevalence and factors associated with IS and SE among medical students at Jazan University, Saudi Arabia. In this cross-sectional study, 523 medical students in years 2-6 at Jazan University, Saudi Arabia, completed validated questionnaires on IS (Young Imposter Scale) and SE (Rosenberg Self-Esteem Scale). Sociodemographic factors were also collected. Descriptive statistics and logistic regression analyses were used to analyze IS and SE prevalence and correlates. Five hundred twenty-three students with a mean age of 22.09 ± 1.933 participated. The prevalence of low SE and positive IS was 17.6% and 24.3%, respectively. IS and SE had a significant negative correlation (p<0.001). Several sociodemographic factors were associated with increased IS, including 2nd and 4th-year students, forced study choice, and a grade point average (GPA) of 3.0-3.49 (P<0.05). Paternal education beyond high school was associated with lower IS (P<0.05). Logistic regression analyses confirmed that 2nd-year students had a 3.88 times higher odds ratio (OR) (95% confidence interval (CI); 2.19-6.88), and 4th-year students had a 2.37 times higher OR (95% CI; 1.40-4.02) of IS than other years. For SE, advanced academic years, forced study choice, 7+ hours of sleep, and a GPA above 3.5 were associated with higher levels (P<0.05). Negative self-appraisals were associated with lower SE, while positive attitudes were associated with higher SE (P<0.05). Our study reveals that IS and low SE are prevalent among Jazan University, Saudi Arabia, medical students. Therefore, intervention courses that address these issues in medical education at Jazan University, Saudi Arabia, may be necessary to support medical students' well-being and academic success

Abstract 233: First‐line Techniques for Endovascular Therapy of Primary Distal medium Vessel Occlusion Stroke: A Matched Analysis

Introduction Previous studies did not show a difference in terms of safety and efficacy among first‐line stent retriever (SR), contact aspiration (CA), or combined techniques for proximal large vessel occlusion strokes. However, the optimal reperfusion therapy in patients with primary distal medium vessel occlusion (DMVO) strokes is uncertain. We aimed to compare the clinical and procedural outcomes among first‐line SR, CA and combined techniques in patients with primary DMVO. Methods This is a retrospective analysis of a prospectively maintained database from 14 comprehensive stroke centers in the US and Europe. Patients were included if they had a primary DMVO stroke due to MCA‐M3/M4, ACA‐A1/A2‐3, or PCA‐P1/P2‐3 and underwent mechanical thrombectomy with first‐line SR, CA, or combined technique. The primary outcome was FPE defined as eTICI 2c/3 on the first pass. Secondary outcomes included mFPE defined as eTICI 2b/3 on the first pass, successful reperfusion defined as eTICI 2b/3 at the end of the procedure. Clinical outcomes included 90‐day mRS0‐1 and 90‐day mRS0‐2. Safety measures included procedural complications, symptomatic intracranial hemorrhage (sICH), and 90‐day mortality. The secondary analysis aimed to identify the procedural and clinical outcomes in 3 matched cohorts: (SR vs. CA), (SR vs. combined technique), and (CA vs. combined technique). Results A total of 365 patients were eligible for analysis; 38.1% were female, with a mean age of 69.3 years and a median NIHSS score of 11 [7‐18]. The first‐line SR group consisted of n=74 (20.3%), CA group n=142 (38.9%), and combined technique group n=149 (40.8%). Patients with first‐line SR or combined technique had a lower median NIHSS score, less frequent MCA‐M3 segment occlusion, and less usage of the rescue strategy compared to those with first‐line CA, P<0.05. Patients with first‐line CA had less frequent BGC usage and lower rates of FPE and procedural complications compared to first‐line SR or combined technique, P<0.05. Successful reperfusion at the end of the procedure was similar among the 3 groups (Figure). On multivariable analysis, there was no difference in terms of primary, secondary outcomes, or safety measures among the 3 first‐line techniques, except for higher procedural complications in patients who underwent the first‐line combined technique compared to those with first‐line CA (aOR 3.66, 95% CI [1.25‐10.75], P=0.02). The matched analyses did not show any difference in the primary outcome: (1) (SR, n=54 vs. CA, n=54) FPE; 31.5% vs. 26.9%, P=0.61, aOR 1.33, 95% CI [0.57‐3.11], P=0.52), (2) (SR, n=72 vs. combined technique, n=54) FPE; 37.5% vs. 31.9%, P=0.48, aOR 1.48, 95% CI [0.73‐3.03], P=0.28), and (3) (CA, n=109 vs. combined technique, n=109) FPE; 24.1% vs. 25.7%, P=0.78, aOR 0.94, 95% CI [0.50‐1.74], P=0.84). Similarly, there was no difference in terms of secondary outcomes and safety measures. Conclusion Our study suggests that in patients with primary DMVO, first‐line SR, CA, and combined techniques have a similar rate of FPE with no differences in final reperfusion or clinical outcomes. Randomized clinical trials are warrante

Safety and efficacy of balloon-mounted stent in the treatment of symptomatic intracranial atherosclerotic disease: a multicenter experience

BackgroundRandomized clinical trials have failed to prove that the safety and efficacy of endovascular treatment for symptomatic intracranial atherosclerotic disease (ICAD) is better than that of medical management. A recent study using a self-expandable stent showed acceptable lower rates of periprocedural complications.ObjectiveTo study the safety and efficacy of a balloon-mounted stent (BMS) in the treatment of symptomatic ICAD.MethodsProspectively maintained databases from 15 neuroendovascular centers between 2010 and 2020 were reviewed. Patients were included if they had severe symptomatic intracranial stenosis in the target artery, medical management had failed, and they underwent intracranial stenting with BMS after 24 hours of the qualifying event. The primary outcome was the occurrence of stroke and mortality within 72 hours after the procedure. Secondary outcomes were the occurrence of stroke, transient ischemic attacks (TIAs), and mortality on long-term follow-up.ResultsA total of 232 patients were eligible for the analysis (mean age 62.8 years, 34.1% female). The intracranial stenotic lesions were located in the anterior circulation in 135 (58.2%) cases. Recurrent stroke was the qualifying event in 165 (71.1%) while recurrent TIA was identified in 67 (28.9%) cases. The median (IQR) time from the qualifying event to stenting was 5 (2–20.75) days. Strokes were reported in 13 (5.6%) patients within 72 hours of the procedure; 9 (3.9%) ischemic and 4 (1.7%) hemorrhagic, and mortality in 2 (0.9%) cases. Among 189 patients with median follow-up time 6 (3–14.5) months, 12 (6.3%) had TIA and 7 (3.7%) had strokes. Three patients (1.6%) died from causes not related to stroke.ConclusionOur study has shown that BMS may be a safe and effective treatment for medically refractory symptomatic ICAD. Additional prospective randomized clinical trials are warranted

Tissue Clock Beyond Time Clock: Endovascular Thrombectomy for Patients With Large Vessel Occlusion Stroke Beyond 24 Hours

BACKGROUND AND PURPOSE: Randomized trials proved the benefits of mechanical thrombectomy (MT) for select patients with large vessel occlusion (LVO) within 24 hours of last-known-well (LKW). Recent data suggest that LVO patients may benefit from MT beyond 24 hours. This study reports the safety and outcomes of MT beyond 24 hours of LKW compared to standard medical therapy (SMT). METHODS: This is a retrospective analysis of LVO patients presented to 11 comprehensive stroke centers in the United States beyond 24 hours from LKW between January 2015 and December 2021. We assessed 90-day outcomes using the modified Rankin Scale (mRS). RESULTS: Of 334 patients presented with LVO beyond 24 hours, 64% received MT and 36% received SMT only. Patients who received MT were older (67±15 vs. 64±15 years, P=0.047) and had a higher baseline National Institutes of Health Stroke Scale (NIHSS; 16±7 vs.10±9, P\u3c0.001). Successful recanalization (modified thrombolysis in cerebral infarction score 2b-3) was achieved in 83%, and 5.6% had symptomatic intracranial hemorrhage compared to 2.5% in the SMT group (P=0.19). MT was associated with mRS 0-2 at 90 days (adjusted odds ratio [aOR] 5.73, P=0.026), less mortality (34% vs. 63%, P\u3c0.001), and better discharge NIHSS (P\u3c0.001) compared to SMT in patients with baseline NIHSS ≥6. This treatment benefit remained after matching both groups. Age (aOR 0.94, P\u3c0.001), baseline NIHSS (aOR 0.91, P=0.017), Alberta Stroke Program Early Computed Tomography (ASPECTS) score ≥8 (aOR 3.06, P=0.041), and collaterals scores (aOR 1.41, P=0.027) were associated with 90-day functional independence. CONCLUSION: In patients with salvageable brain tissue, MT for LVO beyond 24 hours appears to improve outcomes compared to SMT, especially in patients with severe strokes. Patients\u27 age, ASPECTS, collaterals, and baseline NIHSS score should be considered before discounting MT merely based on LKW