Comparison of risk factor profile, severity and outcome between lacunar strokes & other ischaemic stroke subtypes

Objective: Lacunar infarcts are a frequent type of stroke caused mainly by cerebral small-vessel disease.  Because of this, lacunar infarcts are likely to behave differently from other ischaemic stroke subtypes and may require a different approach in their management. Objective was to describe the differences in risk factor profile, severity and outcome between lacunar and other ischaemic stroke subtypes as this aspect had not been studied in Srilankan patients. Methods: This prospective descriptive study included 70 patients with acute ischaemic strokes admited to Colombo South Teaching Hospital during 01/06/2012 to 10/09/2012. Severity of the stroke was assessed by using The National Institutes of Health Stroke Scale (NIHSS). Assessment of the outcome was done by estimating disability using Modified Rankin Scale (MRS) by contacting the patient via telephone after one month of hospital discharge. Results: In this period of time 46 patients with lacunar strokes and 26 with other types of ischaemic stroke were evaluated. Hypertension (58.7% Vs 54.2%) and Diabetes mellitus (45.7% Vs 45.8%) were equally common in lacunar and non lacunar stroke. Hypercholesterolemia (32.6% Vs 12.5%) was more frequent in lacunar stroke and chronic atrial fibrillation (4.2% Vs 2.2%) was more frequent in non lacunar stroke patients. Regarding severity, 56.5% of lacunar stroke patients had minor stroke (NIH stroke scale 1-4) while 62.5% of non lacunar patients had moderate stroke (NIH stroke scale 5-15)(P value = 0.02). With regard to outcome following stroke, 63% of lacunar strokes and 45.8% of non lacunar strokes were independent (MRS<3) after one month. Conclusion: Lacunar strokes appear to cause less disability and their outcome too is better.  Risk factors did not show a significant difference, but a larger study is needed to confirm this

Non-cognitive characteristics predicting academic success among medical students in Sri Lanka

Abstract Background To identify non-cognitive and socio-demographic characteristics determining academic success of Sri Lankan medical undergraduates. Methods A retrospective study among 90 recently graduated students of the Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka. Students were stratified into two equal groups; ‘High-achievers’ (honours degree at the final MBBS examination) and ‘Low-achievers’ (repeated one or more subjects at the same examination). A revised version of the Non-cognitive Questionnaire (NQ) with additional socio-demographic data was the study instrument. Academic performance indicator was performance at the final MBBS examinations. A binary logistic regression analysis was performed using the dichotomous variable ‘Honours degree at final MBBS’ as the dependant factor. Results Males were 56.7%. Mean age ± SD was 26.4 ± 0.9 years. ‘High-achievers’ were significantly younger than ‘Low-achievers’. Significant proportion of ‘High-achievers’ were from the Western province and selected to university from Colombo district. A significant majority of ‘High-achievers’ entered medical school from their first attempt at GCE A/L examination and obtained ‘Distinctions’ at the GCE A/L English subject. ‘High-achievers’ demonstrated a significantly higher mean score for the following domains of NQ; Positive self-concept and confidence, realistic self-appraisal, leadership, preference of long range goals and academic familiarity. The binary logistic regression indicates that age, being selected to university from Colombo district, residency in Western province, entering university from GCE A/L first attempt, obtaining a ‘Distinction’ for GCE A/L English subject, higher number of patient-oriented case discussions, positive self-concept and confidence, leadership qualities, preference of long range goals and academic familiarity all significantly increased the odds of obtaining a Honours degree. Conclusion A combined system incorporating both past academic performance and non-cognitive characteristics might help improve the selection process and early recognition of strugglers.</p