Pakistan Journal of Medical Sciences

Journal Citation Report 2024 and Impact Factor of Pakistani Biomedical Journals: Grading impact and analysis

Sultan Ayoub Meo — 2024-06-27

doi: https://doi.org/10.12669/pjms.40.7.10399

How to cite this: Sultan Ayoub Meo1, Shaukat Ali Jawaid2. Journal Citation Report 2024 and Impact Factor of Pakistani Biomedical Journals: Grading impact and analysis. Pak J Med Sci. 2024;40(7):1315-1318. doi: https://doi.org/10.12669/pjms.40.7.10399

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The Clarifying Hackathon in Health Profession Education

Azadeh Rooholamini — 2024-06-15

doi: https://doi.org/10.12669/pjms.40.7.10104

How to cite this: Rooholamini A, Khan JS, Rezaei-Gazki P, Salajegheh M. Clarifying Hackathon in Health Profession Education. Pak J Med Sci. 2024;40(7):1319-1320. doi: https://doi.org/10.12669/pjms.40.7.10104

Comparison of different preoperative fasting times for pediatric elective surgical procedures: A randomized controlled trial

Humna Jasarat — 2024-06-24

Objective: To compare the mean residual gastric volume and gastric pH with standard and liberal fasting in children undergoing general anesthesia for elective procedures.

Methods: A randomized controlled trial (NCT 05922072) was conducted at Department of Pediatric Surgery, Mayo Hospital Lahore from June 2021 to December 2021 and 120 patients undergoing elective daycare surgical procedures under general anesthesia were enrolled. Patients were divided into Group-A (Standard fasting) and Group-B (Liberal fasting). Group-A with 6-, 4- and 2-hours Nil per oral (NPO) for solids/ formula milk, breast milk and clear fluid, while Group-B with six, four and one hour NPO for solids/ formula milk, breast milk and clear fluid respectively. Residual gastric volume and pH were measured after anesthetizing the patient. Effect modifiers like age, gender, duration of anesthesia and procedure were controlled through stratification. Post-stratification, t-test was applied and p-value less than 0.05 was taken as statistically significant.

Results: In Group-A, mean age was 6.1±4.5 years and 6.4±4.6 years in Group-B. Mean residual gastric volume with standard fasting was 0.67±0.48 ml and liberal fasting 0.80±0.44 ml (p value 0.13). Mean gastric fluid pH with standard fasting was 1.72±0.78 as compared to liberal fasting 1.63±0.70 (p value 0.53).

Conclusion: Free fluid fasting allows for significantly shorter fasting times, though statistically insignificant higher residual gastric volume was recorded in liberal fasting group with a lower pH.

doi: https://doi.org/10.12669/pjms.40.7.8403

How to cite this: Jasarat H, Naumeri F. Comparison of different preoperative fasting times for pediatric elective surgical procedures: A randomized controlled trial. Pak J Med Sci. 2024;40(7):1321-1325. doi: https://doi.org/10.12669/pjms.40.7.8403

Fast-Track surgery protocol in perioperative care for gynecological laparoscopy

Hongping Zhu — 2024-06-27

Objectives: This study aimed to compare fast-track surgery (FTS) and traditional perioperative care protocols in laparoscopic gynecological surgeries, assessing their impact on length of stay (LOS), recovery time, and postoperative complications.

Methods: A case-control retrospective study was conducted at Suzhou Hospital of Integrated Chinese and Western Medicine, involving 167 patients undergoing laparoscopic gynecological surgery from June 2021 to June 2023. Of them, 81 patients underwent surgery based on the FTS protocol (FTS group) and 86 patients received a traditional perioperative management (control group). Patients in both groups underwent gynecologic laparoscopic procedures, including uterine, ovarian and tubal surgeries. Data were collected on general patients’ characteristics, including age, BMI, surgery type and time, intestinal recovery and out-of-bed activity time, LOS, pain levels, and postoperative complications. Wilcoxon rank sum test with continuity correction was used to assess the difference in operative characteristics and postoperative pain levels. Fisher’s exact test was used to assess the difference in overall frequency of postoperative complications between groups.

Results: Patients in the FTS group exhibited faster intestinal recovery, shorter mobilization time, and reduced LOS compared to the control group. Pain levels were significantly lower at one, six and twelve hours post-surgery in the FTS group. Overall, the proportion of postoperative complications was significantly lower in the FTS group than in the control group.

Conclusions: Implementing the FTS protocol in laparoscopic gynecological surgeries for benign conditions can reduce LOS, accelerate recovery, and minimize pain without increasing postoperative complications. Further research with more diverse patient populations is warranted to validate these findings.

doi: https://doi.org/10.12669/pjms.40.7.9117

How to cite this: Zhu H, Xu X. Fast-Track surgery protocol in perioperative care for gynecological laparoscopy. Pak J Med Sci. 2024;40(7):1326-1331. doi: https://doi.org/10.12669/pjms.40.7.9117

Clinical Efficacy of a Novel Titania Nanoparticle-Reinforced Bonding Agent in Reducing Post-Restorative Sensitivity: A randomized clinical trial

Nehal Amir — 2024-06-27

Objective: To evaluate the clinical efficacy of novel titania-nanoparticle reinforced bonding agent on post-restorative sensitivity in patients.

Methods: This triple-blinded, randomized clinical trial included participants (n = 60) having Class- I and II cavitations with a minimum cavity depth of 3mm at Department of Operative Dentistry & Endodontics, School of Dentistry, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad from January 5, 2023, to June 20, 2023. They were randomly assigned into two groups A and B (n = 30). After informed consent, restorative intervention was accomplished using an etch-and-rinse adhesive strategy. In Group-A, titania-nanoparticle-incorporated bonding agent was used for composite restoration, while in Group-B, bonding agent without nanoparticles was used. The primary outcome was assessed using Visual Analogue Scale mean score. Participants were instructed to rate their sensitivity status at follow-ups: 24 hours, one week, and one month. Mann-Whitney U test was employed to compare sensitivity between the two groups.

Results: According to results of this trial, a significant difference was observed between two groups after 24 hours (p = 0.004) and one week (p = 0.002). However, no discernible difference was observed after one month (p = 0.643).

Conclusion: Post-restorative sensitivity in patients with composite restorations was reduced using titania-reinforced bonding agents as compared to bonding agents without nanoparticles. This shows that inclusion of titania nanoparticles into adhesive dentistry could be beneficial in resolving post-restorative sensitivity occurring with composite restorations.

doi: https://doi.org/10.12669/pjms.40.7.8779

How to cite this: Amir N, Mansoor A, Noor N, Hussain K. Clinical Efficacy of a Novel Titania Nanoparticle-Reinforced Bonding Agent in Reducing Post-Restorative Sensitivity: A randomized clinical trial. Pak J Med Sci. 2024;40(7):1332-1337. doi: https://doi.org/10.12669/pjms.40.7.8779

Effect of different doses of Budesonide combined with Tiotropium bromide inhalation on elderly patients with chronic obstructive pulmonary disease

Jianhong Yu — 2024-06-27

Objective: To explore the clinical effect of various doses of Budesonide combined with Tiotropium bromide in the treatment of elderly patients with chronic obstructive pulmonary disease (COPD).

Methods: Clinical data of elderly patients with COPD, admitted to Affiliated Hospital of Shaoxing University from April 2021 to February 2023, were retrospectively analyzed. Based on the dosage of Budesonide combined with Tiotropium bromide, patients were divided into Low-dose group (Budesonide = 1mg), Medium-dose group (Budesonide = 2mg), and High-dose group (Budesonide = 3mg). All groups were matched for age, gender, course of disease, and BMI. Patients treated with Tiotropium bromide alone were assigned to the Control group. The clinical effect, pulmonary function index level, symptom improvement, inflammatory factor index level and adverse reactions in all groups were analyzed and compared.

Results: A total of 88 patients were included in this study with 22 patients in each group. The total efficacy of Medium-dose (90.91%) and High-dose group (90.91%) was significantly higher than that of Low-dose group (63.64%) and the Control group (59.09%) (P<0.05). After the treatment, levels of pulmonary function, symptom improvement and inflammatory factors in the High-dose and the Medium-dose groups were better than those in the Low-dose group and the Control group. Pulmonary function, symptom improvement and levels of inflammatory factors was significantly better in the Low-dose group compared to the Control group (P<0.05).

Conclusions: Budesonide combined with tiotropium bromide is better than tiotropium bromide alone in the treatment of elderly patients with COPD. Compared with low (1mg) dosage, medium (2mg) and high (3mg) dosage of budesonide are more effective in improving lung function, alleviating symptoms, reducing inflammatory response,, and are not associated with increased rate of adverse reactions.

doi: https://doi.org/10.12669/pjms.40.7.9209

How to cite this: Yu J, Ni J, Chen X, Fang Y, Fu S. Effect of different doses of Budesonide combined with Tiotropium bromide inhalation on elderly patients with chronic obstructive pulmonary disease. Pak J Med Sci. 2024;40(7):1338-1344. doi: https://doi.org/10.12669/pjms.40.7.9209

COVID-19 vaccination and menstrual disturbances: A prospective study from Pakistan

Nuzhat Parveen — 2024-06-27

Objective: To evaluate whether or not immunization against COVID-19 is associated with changes in the duration and frequency of the menstrual cycle.

Methods: This prospective analysis included the menstrual cycle data of 154 females after COVID-19 vaccination from August 2021 to March 2022. This study included Pakistani females aged 18 to 45 years and who had taken at-least one dose of COVID-19 vaccination. After two months of COVID vaccine the participants were interviewed again about the timing and duration of their menstrual cycle. The increase in menstrual length for >eight days was labelled as increased menstrual cycle duration.

Results: Mean age of participants was 33.53±8.52 years. Among 154, 113 (73.4%) were married. Among 154 females, menstrual abnormality was reported by 59 (38.3%) females, increase in cycle duration was reported by 25 (16.2%) patients and decrease by 22 (14.3%), increase in number of bleeding days by 20 (13%) females and decrease by 15 (9.7%), increase in pain intensity was reported by 19 (12.3%) females and decrease by 17 (11.0%), increased intensity of blood flow was reported by 20 (13.0%) patients and decreased intensity by 19 (12.3%) females.

Conclusion: COVID-19 vaccination is not associated with menstrual abnormalities in a significant number of females.

doi: https://doi.org/10.12669/pjms.40.7.8709

How to cite this: Parveen N. COVID-19 vaccination and menstrual disturbances: A prospective study from Pakistan. Pak J Med Sci. 2024;40(7):1345-1348. doi: https://doi.org/10.12669/pjms.40.7.8709

Exploring maternal and neonatal outcomes in women with Type-1 Diabetes: A study from Pakistan

Musarrat Riaz — 2024-06-28

Background & Objective: Pregnancy in women diagnosed with Type-1 diabetes mellitus poses a higher risk of experiencing complications related to the health of the fetus, the mother, and the newborn, along with potential obstetric issues. The objective of this study was to examine the maternal and fetal outcomes, as well as complications faced by pregnant women with type-1 diabetes, and to identify potential preventable factors.

Methods: This retrospective cohort study, conducted at Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University, Karachi, Pakistan (January 2022 - January 2023), focused on registered pregnancies of women with Type-1 diabetes. A predesigned questionnaire recorded demographic information, diabetes and obstetric history, clinical details, treatment specifics, maternal, perinatal, and neonatal outcomes.

Results: This study included 100 women with pre-existing Type-1 diabetes (mean age: 15.11 ± 5.64 years at diabetes diagnosis). Of these, 72% reported unplanned pregnancies, with a mean HbA1C at conception 8.29%. Median gestational age at delivery was 32.15 ± 10.82 weeks. Delivery outcomes included 40% normal vaginal deliveries and 60% C-sections (9% emergency, 51% elective). Stillbirths occurred in 14 cases, while 16 women experienced one miscarriage, seven had two, and 10 had three miscarriages. Glycemic targets (fasting) were achieved in 55 women, and post-meal targets only in 29, whereas, neonatal complications included hypoglycemia in 13 and low birth weight in 12 neonates.

Conclusion: The high frequency of unplanned pregnancies and cesarean sections along with poor management of pre-pregnancy care and poor glycemic control results in compromised maternal and perinatal outcomes in this high-risk group.

doi: https://doi.org/10.12669/pjms.40.7.9199

How to cite this: Riaz M, Askari S, Naseem R. Exploring maternal and neonatal outcomes in women with Type-1 Diabetes: A study from Pakistan. Pak J Med Sci. 2024;40(7):1349-1354. doi: https://doi.org/10.12669/pjms.40.7.9199

Pathogenic features and clinical characteristics of acute community-acquired lower respiratory tract infections

Na Li — 2024-06-28

Objective: To investigate the pathogen distribution and clinical characteristics of acute community-acquired lower respiratory tract infections (CALRTIs).

Methods: This was a retrospective study. The clinical data of 218 patients with CALRTIs admitted to Baoding No.1 Central Hospital from December 2021 to December 2022 were retrospectively collected and were divided into two groups according to the results of polymerase chain reaction(PCR) testing using a nasopharyngeal swab: streptococcus pneumoniae positive group(observation group) and non-streptococcus pneumoniae positive group(control group). Clinical symptoms, blood gas analysis indicators were compared between the two groups.

Results: Haemophilus influenzae and Staphylococcus aureus, as well as virus and atypical pathogen infection, were the predominant pathogenic bacteria in both groups. No statistically significant differences were observed in the positive rates of sputum smear, sputum culture, respiratory virus detection and atypical pathogen detection between the two groups(P>0.05). However, the control group had a higher detection rate of gram-positive bacteria, gram-negative bacteria and Legionella pneumophila in sputum smears than the observation group, with a statistically significant difference(P<0.05). One death occurred in each group, with no significant difference in mortality and six in each group left the hospital or were transferred due to deterioration, with no significant difference in improved discharge rates.

Conclusion: Acute community-acquired lower respiratory tract infections(CALRTIs) take bacteria, viruses and atypical pathogens as its leading pathogenic bacteria. In the treatment of patients with acute CALRTIs, early pathogenic examination should be performed to assist in guiding antibiotic therapy for rapid control, early recovery and ameliorated clinical outcomes.

doi: https://doi.org/10.12669/pjms.40.7.7899

How to cite this: Riaz A, Sughra U, Jawaid SA, Masood J. Measurement of Service Quality Gaps in Dental Services using SERVQUAL in Public Hospitals of Rawalpindi. Pak J Med Sci. 2024;40(7):1355-1360. doi: https://doi.org/10.12669/pjms.40.7.7899

Ultrasound evaluation of scar thickness for prediction of uterine dehiscence in term women with previous caesarean sections

Shaista Afzal Saeed — 2024-06-28

Objective: To determine the role of ultrasound in evaluation of scar thickness for prediction of uterine dehiscence.

Method: This retrospective cross-sectional study was conducted in the Radiology department of Aga Khan University Hospital from 1st July to 31st December 2021 after approval from the University Ethic Committee. In this study pregnant women 18 to 40 years with a live singleton fetus with vertex presentation, at term, with history of prior caesarean section and availability of medical record were included. Using a curvilinear ultrasound transducer with optimally distended urinary bladder, the myometrial thickness was measured in the sagittal plane. The intraoperative visual findings of the lower uterine segment outcome at the time of C-section were recorded and categorized into two groups i.e., with and without dehiscence for statistical analysis.

Results: A total of 126 women were included. The mean age of the study participants was 29.8±4.1. The median gestational age was 35 (34-37) weeks. The highest AUC 0.58 was recorded for the scar thickness of ≤2.5mm with a sensitivity, specificity, PPV and NPV of 80.9%, 36.4%, 36.3% and 80.8% respectively. Similarly, the AUC for the scar thickness of ≤2mm was 0.55 with a sensitivity, specificity, PPV and NPV of 93%, 18.2%, 18.2% and 93% respectively.

Conclusion: Transabdominal Sonography is a safe technique to determine the LUS thickness during antenatal ultrasound at term. A cutoff value of ≤2mm showed a high sensitivity and negative predictive value of 93% for evaluating the risk of uterine dehiscence.

doi: https://doi.org/10.12669/pjms.40.7.8712

How to cite this: Afzal S, Masroor I, Amin A, Majeed A. Ultrasound evaluation of scar thickness for prediction of uterine dehiscence in term women with previous caesarean sections. Pak J Med Sci. 2024;40(7):1361-1366. doi: https://doi.org/10.12669/pjms.40.7.8712

Comparison of the effectiveness of ultrasound-guided radiofrequency ablation and conventional open thyroidectomy in the treatment of benign thyroid nodules

Yuehe Fu — 2024-06-28

Objective: To compare the effectiveness of ultrasound (US)-guided radiofrequency ablation (RFA) and conventional open thyroidectomy (OT) in the treatment of benign thyroid nodules (BTN).

Methods: Medical records of 103 patients with BTN undergoing surgical treatment at The Affiliated Jiangning Hospital of Nanjing Medical University from March 2019 to March 2022 were retrospectively analyzed. Records show that 53 patients underwent US-guided RFA (observation group) and 50 patients underwent conventional OT (control group). Perioperative indicators (operation duration, intraoperative blood loss, postoperative hospital stay, incision length, and VAS score 12h and 24h after surgery), complications, thyroid function, and nodule recurrence in both groups were compared and analyzed.

Results: Perioperative indicators of patients in the observation group were better, and the visual analogue scale (VAS) scores at 12 and 24 hours after the surgery were lower than those of the control group (p<0.05). The incidence of complications in the observation group was significantly lower than that in the control group (p<0.05). There was no statistically significant difference in the preoperative levels of thyroid-stimulating hormone (TSH), serum free thyroxine (FT4) and serum free triiodothyronine (FT3) between the two groups (p>0.05). The postoperative TSH levels in the observation group increased compared to the preoperative levels and were higher than those in the control group, while FT4 and FT3 levels decreased after surgery and were lower than those in the control group (p<0.05).

Conclusions: Compared to conventional open thyroidectomy, US-guided RFA is associated with less trauma, faster recovery, fewer complications, and less impact on thyroid function in the treatment of patients with BTN.

doi: https://doi.org/10.12669/pjms.40.7.9486

How to cite this: Fu Y, Xia Y, Wang H, Zhang G. Comparison of the effectiveness of ultrasound-guided radiofrequency ablation and conventional open thyroidectomy in the treatment of benign thyroid nodules. Pak J Med Sci. 2024;40(7):1367-1371. doi: https://doi.org/10.12669/pjms.40.7.9486

CBCT based investigation of frequency of Middle Mesial Canal in Mandibular First Molars of Saudi Sub-population

Ayman M. Abulhamael — 2024-06-28

Objective: One key factor in determining endodontic treatment outcome is the clinicians’ comprehension of tooth anatomy, as missed canals may harbor bacteria ultimately leading to apical periodontitis. The study aimed to investigate the prevalence of middle mesial canal (MMC) in Mandibular first molars (MFMs) of Saudi subpopulation.

Methods: The cross-sectional retrospective study was conducted at Qassim University Dental College from June to August 2023. Overall, 302 CBCT images with 604 bilateral lower first molars were examined by two calibrated assessors. The existence of MMC was noted. The data were coded, and analysis was done in SPPS-24. The reliability of inter-evaluator and intra-evaluator agreement for detecting MMC were estimated using Cohen’s kappa.

Results: The patients’ average age was 30.95±11.61years. The sample’s female to male ratio was 1:1.75. The overall frequency of MMC was 14.2%. The differences in the frequency of MMC on the basis of gender, quadrants and age groups were found to be insignificant. Inter-evaluator and intra-evaluator reliability was noted to be 0.78 and 0.74, depicting acceptable reliability.

Conclusions: The MMC is an uncommon occurrence with rare bilateral presentation in MFMs of Saudi population. Endodontists performing endodontic treatment in such subjects should mindfully investigate inter mesiobuccal- mesiolingual canals area for locating, negotiating, and managing any present MMC’s.

doi: https://doi.org/10.12669/pjms.40.7.9101

How to cite this: Abulhamael AM, Javed MQ, Hassan S, Atique S, Habib SR. CBCT based investigation of frequency of Middle Mesial Canal in Mandibular First Molars of Saudi Sub-population. Pak J Med Sci. 2024;40(7):1372-1377. doi: https://doi.org/10.12669/pjms.40.7.9101

Predictors of limb saving in diabetic foot ulcer

Nizamud Din — 2024-06-28

Objectives: This study was aimed to determine the various factors which could serve as predictor of saving of lower limb from amputation in patients with diabetic foot ulcer (DFU).

Method: This three-year retrospective study was conducted in the Diabetes and Endocrinology Unit of Hayatabad Medical complex Peshawar, Pakistan. Demographic, clinical, laboratory and radiological information of the diabetic patients with DFU admitted between January 2020 to December 2022 was retrieved from the hospital files. Information regarding initial and final decision regarding amputation and the outcome of the ulcer was also recorded.

Results: A total of 502 patients of diabetes mellitus (DM) with DFU were included in the study, of whom there were 279 (55.6%) males and 223 (44.4%) females. The mean age of the study population, mean duration of DM and mean HbA1c were 55.2 ± 9.8 years, 13.7 ± 6.7 years and 11.2 ± 2.4 %, respectively. Patients who had an amputation of their lower limbs had an increased age (p= 0.034), raised total leucocyte count (TLC) (p= <0.001), higher HbA1c (p= 0.025), had osteomyelitis (p= <0.001), and had a higher-grade ulcer (p= <0.001). On binary logistic regression analysis, ulcer grade (OR=7.4, p= <0.001), osteomyelitis (OR=11.8, p= <0.001), and initial decision of no amputation at the time of admission (OR=33.6, p=<0.001) were independently associated with the lower limb salvage.

Conclusion: DFU which were of grade I to II, had no evidence of osteomyelitis and for which an initial decision was of no amputation were more likely to be salvaged.

doi: https://doi.org/10.12669/pjms.40.7.9182

How to cite this: Din N, Kanwal S, Aamir AH, Ghaffar T. Predictors of limb saving in diabetic foot ulcer. Pak J Med Sci. 2024;40(7):1378-1383. doi: https://doi.org/10.12669/pjms.40.7.9182

Clinical features of thymoma with and without myasthenia gravis

Yaxuan Wang — 2024-06-28

Objective: To explore the clinical features of thymoma with and without myasthenia gravis (MG).

Methods: This was a retrospective study. Two hundred and thirty-three patients with mediastinal masses who were initially diagnosed in People’s Hospital of Shijiazhuang, China, between January 2014 and June 2022 and had complete clinical data and underwent surgical treatment at People’s Hospital of Shijiazhuang were retrospectively analyzed.

Result: The age of patients with thymoma alone was significantly older than that of thymoma patients complicated with MG. The number of female patients was slightly more than males for both groups. Proportions of type A, AB, B1, B2, and B3 thymomas in Group-A were 0.77, 11.54, 11.51, 33.85, and 31.54%, respectively, and the proportions in Group-B were 9.68, 22.58, 12.90, 32.26, and 22.58%. The size of tumors in patients with thymoma alone was larger than that of patients with thymoma complicated with MG. The proportion of patients with tumor size of more than 10 cm in the thymoma alone group was significantly higher than that in the MG group. There were no relapses in patients with type A disease and relapses were noted in a few patients with type B1, B2 and B3 diseases. The same survival rates were reported for the two groups.

Conclusion: MG rarely occurs in type A and type C diseases. The prognosis of thymoma with MG is similar to that of thymoma alone. The main causes of death may be myasthenia crisis in thymoma patients with MG and advanced tumor stage in patients with thymoma alone.

doi: https://doi.org/10.12669/pjms.40.7.8698

How to cite this: Wang Y, Qi G, Yang Y, Yang H. Clinical features of thymoma with and without myasthenia gravis. Pak J Med Sci. 2024;40(7):1384-1390. doi: https://doi.org/10.12669/pjms.40.7.8698

Clinical value of Vitamin-D combined with budesonide/formoterol and theophylline sodium glycinate sustained-release tablets in the treatment of chronic obstructive pulmonary disease patients

Xiuyuan Ni — 2024-06-28

Objective: To explore the clinical value of Vitamin-D combined with budesonide/formoterol (BF) and theophylline sodium glycinate (TSG) sustained-release tablets in the treatment of patients with chronic obstructive pulmonary disease (COPD).

Methods: Medical records of 114 patients with CODP, treated in Wenzhou Geriatric Hospital from October 2020 to February 2023, were retrospectively analyzed. Of them, 59 received treatment with Vitamin-D combined with BF and TSG sustained-release tablets (Group-A), and 55 patients received treatment with BF combined with TSG sustained-release tablets (Group-B). Lung function indicators, blood gas status, inflammatory factors, fractional exhaled nitric oxide (FeNO), and 25-hydroxyvitamin D [25(OH)D] levels before and after the treatment in both groups were collected.

Results: After the treatment, lung function indicators, blood gas status, inflammatory factors, FeNO, and 25 (OH) D levels in both groups were significantly improved compared to pretreatment levels, and were significantly better in the Group-A compared to Group-B (P<0.05).

Conclusions: The combination of Vitamin-D, BF, and TSG sustained-release tablets can effectively regulate the blood gas status of patients with COPD, improve lung function, regulate FeNO and 25 (OH) D, and effectively downregulate the levels of inflammatory factors, thus reducing the degree of inflammatory response.

doi: https://doi.org/10.12669/pjms.40.7.9495

How to cite this: Ni X, Zhou S, Wang C, Chen S, Hu J, Zhang S. Clinical value of Vitamin-D combined with budesonide/formoterol and theophylline sodium glycinate sustained-release tablets in the treatment of chronic obstructive pulmonary disease patients. Pak J Med Sci. 2024;40(7):1391-1396. doi: https://doi.org/10.12669/pjms.40.7.9495

Effect of Infra Low Frequency (ILF) neurofeedback training on EEG in children with autism spectrum disorders

Shemaila Saleem — 2024-06-28

Objective: To investigate whether Infra-low frequency Neurofeedback (ILF-NFB) training can improve brain electrical activity in children with autism spectrum disorders ASD.

Method: This single arm pre and post intervention study was carried out at IBMS (Institute of Basic Medical Sciences), Khyber Medical University, Peshawar and Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad from January 2021 to December 2022. A purposive sampling technique was used. Thirty-five ASD children (male=24; female=11; 7-17 years) were provided with 30 sessions of infra low frequency (ILF) neurofeedback training for 15-20 minutes, during 10 weeks. Childhood Autism Rating Scale (CARS) scoring was done and electroencephalogram (EEG) activity was compared before and after ILF-NF training sessions.

Results: Around 62.9% participants had mild-moderate autism and 37.1% had severe autism. Wilcoxon Signed rank test revealed a significant decline in delta (Pre-test=47.31±19.22, Post-test=22.07±6.83; p=<0.001), theta (Pre-test=24.75±16.62, Post-test=12.37±3.59; p=<0.001) and alpha (Pre-test=12.01±9.81, Post-test=4.03±1.61; p=< 0.001) waves. Mann Whitney U test exhibited no significant gender differences in EEG pattern before and after neurofeedback except in theta waves (p=0.03) before the intervention.

Conclusion: Decline in delta, theta, beta and alpha waves propose that ILF-NF training can be effective in improving the EEG activity. ILF-NFB can be perceived as a valuable non-invasive, non-pharmacological intervention for improving EEG pattern via reintegration of brain activity resulting in increased the attention and focus, enhanced mental stability and cognitive engagement.

doi: https://doi.org/10.12669/pjms.40.7.8246

How to cite this: Saleem S, Habib SH. Effect of Infra Low Frequency (ILF) neurofeedback training on EEG in children with autism spectrum disorders. Pak J Med Sci. 2024;40(7):1397-1402. doi: https://doi.org/10.12669/pjms.40.7.8246

Effect of inhalation drug therapy on inflammatory factors and quality of life on stable chronic obstructive pulmonary disease

Guang-ming Dai — 2024-06-28

Objective: To investigate the clinical efficacy of inhaled triple therapy in the treatment of stable chronic obstructive pulmonary disease (COPD).

Methods: This is a clinical comparative study. A total of 80 patients with COPD admitted to the First People’s Hospital of Suining City from June 2020 to June 2023 were included and randomly divided into the study (conventional COPD treatment + inhaled triple therapy) and control (conventional COPD treatment) groups. The clinical efficacy of inhaled triple therapy and adverse reactions of the two groups to the treatment were observed. Clinical efficacy was assessed through changes in pulmonary function indexes, and comparisons of T lymphocyte subsets and serum inflammatory markers were conducted. In addition, St George’s Respiratory Questionnaire (SGRQ) was employed for the quality-of-life assessment.

Results: The study group showed a significantly higher total efficacy than the control group (P < 0.05), with no significant difference in terms of adverse reactions between them (P > 0.05). After treatment, the study group showed better improvement in pulmonary function indexes, such as forced expiratory volume in one second (FEV1), FEV1 as a percentage of the expected value, forced vital capacity (FVC) and FEV1/FVC, compared with the control group (all P < 0.05). In addition, the study group presented higher levels of T lymphocyte subsets CD3+, CD4+ and CD4+/CD8+ than the control group(all P < 0.05). After treatment, the levels of inflammatory markers tumour necrosis factor-α, leukotriene B4 LTB4 and interleukin-6 in the study group decreased more than those in the control group (all P < 0.05). Moreover, the study group attained a lower SGRQ score than the control group (all P < 0.05).

Conclusion: Triple inhalants further improve the clinical efficacy of the treatment of COPD.

doi: https://doi.org/10.12669/pjms.40.7.7106

How to cite this: Dai G, Wang H. Effect of inhalation drug therapy on inflammatory factors and quality of life on stable chronic obstructive pulmonary disease. Pak J Med Sci. 2024;40(7):1403-1409. doi: https://doi.org/10.12669/pjms.40.7.7106

Effect of Atorvastatin combined with Irbesartan in the treatment of early diabetic nephropathy

Xiaojing Zhong — 2024-06-28

Objective: To explore the effect of Atorvastatin combined with Irbesartan in the treatment of early diabetic nephropathy (DN).

Methods: Clinical data from 153 patients with early DN, admitted to Huzhou Central Hospital from January 2020 to December 2022, was retrospectively selected. Patients were divided into two groups based on the treatment they received: patients received Irbesartan treatment alone were assigned to Irbesartan group (n=74); patients received Irbesartan combined with Atorvastatin were assigned to combined group (n=79). Levels of renal function indicators, renal fibrosis indicators, micro inflammatory status indicators, and incidence of adverse reactions were compared between the two groups before and after the treatment.

Results: After the treatment, indicators of renal function, renal fibrosis and micro-inflammation in both groups significantly decreased compared to pretreatment levels (P<0.05), and were significantly lower in the combined group compared to Irbesartan group (P<0.05). There was no significant difference in the incidence of adverse reactions between the groups (P>0.05).

Conclusions: Compared with Irbesartan alone, Atorvastatin combined with Irbesartan is more effective in the treatment of early DN. Combined treatment regimen is able to effectively reduces the micro-inflammatory state, improve renal function and fibrosis, and is not associated with the increased risk of adverse reactions.

doi: https://doi.org/10.12669/pjms.40.7.9214

How to cite this: Zhong X, Fan J. Effect of Atorvastatin combined with Irbesartan in the treatment of early diabetic nephropathy. Pak J Med Sci. 2024;40(7):1410-1414. doi: https://doi.org/10.12669/pjms.40.7.9214

Comparison between Intra-Articular Steroid Injection and Supra-Scapular Nerve Block in the Management of Frozen Shoulder

Zeeshan Khan Nazim — 2024-06-28

Objective: To compare the efficacy of intra-articular steroid injection with ultrasound-guided supra-scapular nerve block in the management of frozen shoulder in terms of shoulder pain and disability index score and range of motion.

Method: This randomized controlled trial was conducted in orthopedic department, PIMS, Islamabad from 1st January, 2020 to 30th June, 2020. A total of 72 patients were randomly equally (n=36 each) allocated to Group-A (intra-articular steroid injection) and Group-B (supra-scapular nerve block). Adults above 18 years of both genders having diffuse shoulder pain were included. Cases of shoulder pain localized because of bicipital tendinitis, rotator cuff tear, pain due to acute trauma and those with osteoarthritis were excluded. Data was analyzed in SPSS version 22.0.

Results: Patients average age was 60.1 ± 6.29 in IASI and 58.0 ± 5.83 years in SSNB group and there were 19 (52.8%) males in IASI group compared to 15 (41.7%) in SSNB. At three weeks mean pain was significantly less in SSNB (57.1 ± 9.53 vs 49.4 ± 9.02) compared to IASI group (p-value, <0.001). The mean disability index was significantly low in SSNB (51.5 ± 5.10 vs 63.9 ± 5.14) versus IASI group (p-value, <0.001). At one week, three weeks and six weeks, mean external rotation was better in SSNB than IASI group (p-value, <0.001). The mean abduction was also better in SSNB group.

Conclusion: Ultrasound guided supra-scapular nerve block is better than intra-articular steroid injection in managing frozen shoulder.

doi: https://doi.org/10.12669/pjms.40.7.8531

How to cite this: Nazim ZK, Farhat MF, Abbasi S. Comparison between Intra-Articular Steroid Injection and Supra-Scapular Nerve Block in the Management of Frozen Shoulder. Pak J Med Sci. 2024;40(7):1415-1419. doi: https://doi.org/10.12669/pjms.40.7.8531

Effects of psychological support intervention on patients with nasopharyngeal carcinoma undergoing radiotherapy

Ce Wang — 2024-06-28

Objective: To find out the effects of psychological support intervention on patients with nasopharyngeal carcinoma undergoing radiotherapy.

Methods: This was a retrospective study. Sixty six patients with nasopharyngeal carcinoma who received radiotherapy in the Affiliated Hospital of Hebei University from March 2021 to March 2022 were included and randomly divided into the observation group and the control group, with 33 cases in each group. Patients in the control group were given conventional care measures, while those in the observation group were given psychological support intervention on top of conventional care measures. The nursing effects between the two groups were compared.

Results: After the intervention, the psychological resilience score of the observation group was significantly higher than that of the control group, with a statistically significant difference (P<0.05). The psychological resilience scores after the intervention were significantly higher in the observation group than before the intervention, and those in the control group were higher than before the intervention, with a statistically significant difference(P<0.05). The overall health score of quality of life in the observation group was significantly higher than that in the control group after the intervention, with a statistically significant difference(P<0.05). Moreover, the skin reaction in the observation group after radiotherapy was significantly better than that of the control group (P<0.01).

Conclusion: Psychological support intervention is an effective means to treat patients with nasopharyngeal carcinoma, which results in various benefits such as improving patients’ mental resilience and quality of life and reducing the incidence of adverse reactions after radiotherapy.

doi: https://doi.org/10.12669/pjms.40.7.7875

How to cite this: Wang C, Liu X, Li Y, Liu D, Yang L, Wang Y. Effects of psychological support intervention on patients with nasopharyngeal carcinoma undergoing radiotherapy. Pak J Med Sci. 2024;40(7):1420-1424. doi: https://doi.org/10.12669/pjms.40.7.7875

Medical management of first trimester missed miscarriages - A cross-sectional study

Shatha Nasser — 2024-06-28

Background & Objective: Miscarriage, a common complication of early pregnancy before 12 completed weeks of gestation, is typically managed medically. We aimed to estimate the success and complication rate of medical management in women with first-trimester missed miscarriages. Our objective was to calculate the rate of complete uterine evacuation within three weeks of treatment, rate of infection, significant blood loss, re-admission, or surgical evacuation.

Methods: It was a retrospective cross-sectional study that included women diagnosed with miscarriage at less than 13 weeks’ gestation in Latifa Hospital’s Gynecology Department from January 2019 to December 2019 in Dubai. These patients were given vaginal misoprostol, 400-800 mcg every 6-8 hours until expulsion of pregnancy.

Results: There were 294 women included in the study. The success rate was 60.5% (178/294). Twenty women developed significant blood loss (6.8%), four women developed infection (1.4%), 76 required readmission (25.9%), 12 women received blood transfusion (4.1%), and 74 women required a surgical evacuation (25.2%). Nulliparity, unscarred uterus, and the presence of abdominal pain with vaginal bleeding before treatment were significantly associated with the successful medical treatment (p<0.05).

Conclusion: The success rate of the medical regimen studied lies on the lower end of what is quoted in the literature. The difference in the success rate could be attributed to the different definitions of success in other studies. Nulliparity, unscarred uterus and presence of abdominal pain with vaginal bleeding were associated with higher success.

doi: https://doi.org/10.12669/pjms.40.7.8751

How to cite this: Nasser S, Makhdoom T, Alhubaishi LYA, Elbiss HM. Medical management of first trimester missed miscarriages -A cross-sectional study. Pak J Med Sci. 2024;40(7):1425-1429. doi: https://doi.org/10.12669/pjms.40.7.8751

Efficacy, safety, and quality of life profile of Genotype-3 Chronic Hepatitis-C Pakistani patients receiving ledipasvir plus sofosbuvir treatment

Zahid Yaseen Hashmi — 2024-06-28

Objective: This study aimed to assess the overall treatment response of Genotype-3 Chronic HCV Pakistani Patients with or without cirrhosis to Ledipasvir plus Sofosbuvir combination.

Method: In this observational study, HCV Genotype-3 patients were enrolled from Liver Center, DHQ Hospital, Faisalabad and divided into two groups, i.e., non-cirrhotic and compensated cirrhotic patients. The study spanned for a period of 24 months (November 2019 - November 2021) from the first enrollment to the last follow up. Non-cirrhotic patients received Ledipasvir/Sofosbuvir (LDV/SOF) 90/400mg for 12 weeks and cirrhotic patients received LDV/SOF with Ribavirin (RBV) for 12 weeks and without RBV for 24 weeks. The treatment efficacy in terms of sustained virological response (SVR12) was monitored 12 weeks post-treatment. The safety profile, and health-related quality of life (HRQoL) were monitored from baseline to follow-up visits.

Results: Two hundred and ninety out of 309 (93.85%) non-cirrhotic and 31 out of 33 (93.94%) compensated cirrhotic patients achieved SVR-12. The safety profile of the non-cirrhotic and compensated cirrhotic patients was comparable throughout the study duration. Fatigue was the most commonly reported adverse event (AE) in non-cirrhotic and compensated cirrhotic patients, followed by headache, nausea, and fever. The HRQoL improved from baseline to follow-up visits among patients of both groups.

Conclusion: It is concluded that LDV and SOF combination regimen is safe and effective for treating Genotype-3 HCV patients without cirrhosis/compensated cirrhosis, and also improves the patient’s HRQoL.

doi: https://doi.org/10.12669/pjms.40.7.7869

How to cite this: Hashmi ZY, Hashmi S, Raza A. Efficacy, safety, and quality of life profile of Genotype-3 Chronic Hepatitis-C Pakistani patients receiving ledipasvir plus sofosbuvir treatment. Pak J Med Sci. 2024;40(7):1430-1436. doi: https://doi.org/10.12669/pjms.40.7.7869

Research on evaluation indicators of healthspan for veterans: A single-center exploratory study

Jianbo Zhu — 2024-06-28

Objective: To explore a definition of healthspan that based on actual situation of veterans is of significance for improving their health status and life quality.

Methods: This was a retrospective study. Based on the medical data of veterans from the Chinese PLA General Hospital. Total of 1,421 subjects were enrolled to this study, among which 441 deceased cases were further analyzed. The indicators of healthspan of the subjects was calculated from four dimensions (the status of chronic diseases, physical function, social function and psychological function). The risk factors for death were analyzed in a population cohort from 2008 to 2021 (including 763 subjects, among which 372 were deceased).

Results: The average lifespan and adjusted healthspan of the subjects were 93.3 years and 75.1 years, respectively. The four dimensions of healthspan were: adjusted healthspan without chronic diseases was 76.3 years, social function-related healthspan was 88.8 years, physical function-related healthspan was 91.5 years, and psychological function-related healthspan was 92.7 years. By analyzing the cohort in 2008, it was inferred that the main risk factors for the death of veterans were poor nutritional status, renal function injury, high blood pressure, high blood sugar, and aging.

Conclusions: This study proposed four dimensions related to “healthspan” for Chinese veterans (adjusted healthspan without chronic diseases, physical function-related healthspan, social function-related healthspan, and psychological function-related healthspan). Besides, poor nutritional status, renal function injury, and high blood pressure were the most important risk factors affecting the death of veterans.

doi: https://doi.org/10.12669/pjms.40.7.8714

How to cite this: Zhu J, Zhang J, Liu T, Zhang Y, Xu G. Research on evaluation indicators of healthspan for veterans: A single-center exploratory study. Pak J Med Sci. 2024;40(7):1437-1442. doi: https://doi.org/10.12669/pjms.40.7.8714

Clinical Study on the treatment of chronic infectious ulcers using Platelet-Rich technology combined with moist dressings

Xu Zhang — 2024-06-28

Objective: To explore the clinical efficacy of platelet-rich technology combined with moist dressings in the treatment of chronic infectious ulcers.

Methods: This was a retrospective study. The subjects of the study were 48 patients with chronic infectious ulcers in Sichuan Provincial Orthopedics Hospital from January 2019 to June 2022. Enrolled patients were randomly divided into four groups(n=12), and received different treatment methods respectively. Further analysis and comparison were performed on the changes in wound volume, wound healing status, wound bacterial culture results, and the incidence of adverse reactions among the four groups.

Results: Three months after debridement, the wound volume of all four groups of patients was significantly reduced compared with that before debridement, with a statistically significant difference in intra-Group-Comparison(P<0.05). The inter-Group-Comparison revealed a statistically significant difference in wound volume in Group-A, Group-B, and Group-C than that in Group-D(P<0.05). After treatment, the wound healing status of patients in groups A, B, and C was significantly better than that of patients in Group-D, with a statistically significant difference(P<0.05). During treatment, patients in all four groups had decreased count of would bacteria, and showed negative results of wound bacterial culture by the three-month follow-up. No serious adverse reactions were observed in the four groups during treatment, and all improved after management, with no statistically significant difference in the incidence of adverse reactions(P>0.05).

Conclusion: Platelet-rich technology combined with moist dressings may effectively promote the repair of chronic infectious ulcer wounds, with good clinical safety.

doi: https://doi.org/10.12669/pjms.40.7.8468

How to cite this: Zhang X, Lang Z. Clinical Study on the treatment of chronic infectious ulcers using Platelet-Rich technology combined with moist dressings. Pak J Med Sci. 2024;40(7):1443-1447. doi: https://doi.org/10.12669/pjms.40.7.8468

Frequency of urinary incontinence and attitudes towards urinary incontinence of women in Mersin, Turkey

Nazife Akan — 2024-06-28

Objectives: Urinary incontinence (UI) is the involuntary loss of urine or the inability to control urination. The International Continence Society defines UI as any complaint of involuntary loss of urine. UI is a very important health problem that affects women’s quality of life. It can lead to a decrease in women’s self-confidence and prevent them from participating in social activities. This study was conducted to investigate the prevalence of UI in women living in Turkey, the factors affecting it, and women’s attitudes toward UI.

Methods: This descriptive and cross-sectional study included 903 women who applied to 17 family health centers in Mersin, Turkey, between May 10th to June 10th 2019 for any reason. The data of the study were obtained using the descriptive information form and the Urinary Incontinence Attitude Scale (UIAS). Data analysis was performed with SPSS-21 using percentiles, mean±standard deviation, and Pearson chi-square tests.

Results: According to the results obtained, 28.9% of the women had UI problems, more than half (54.6%) of the women with UI did not present to a health institution for this problem, and 54.8% did not receive any treatment. In addition, the frequency of experiencing UI was higher in those with a chronic disease (59.2%) than in those without any chronic disease, and the difference was significant.

Conclusion: The demographic and fertility characteristics of the women influenced the frequency of experiencing UI. In addition, among the women participating in the study, those with negative attitudes toward UI experienced more UI problems. There should be greater efforts to raise awareness among women on this subject.

doi: https://doi.org/10.12669/pjms.40.7.8134

How to cite this: Akan N, Sancar B. Frequency of urinary incontinence and attitudes towards urinary incontinence of women in Mersin, Turkey. Pak J Med Sci. 2024;40(7):1448-1453. doi: https://doi.org/10.12669/pjms.40.7.8134

Evaluating iodine deficiency and goiter in hilly areas of District Poonch Azad Jammu Kashmir

Abdul Khaliq — 2024-06-28

Background & Objectives: Iodine deficiency is considered as a global challenge, even after decades of efforts to solve the issue. Our objective was to assess the iodine deficiency status and associated prevalence of goiter in population groups (school-age children and women) from rural areas of District Poonch, and to assess the determinants of iodine deficiency in the area.

Methods: Cross-sectional study was conducted in District Poonch Azad Jammu and Kashmir from 25 April 2022 to 30 June 2023. A total of 150 goiter patients from different villages of the District Poonch was included. Their urinary iodine concentration and goiter prevalence was assessed. Using palpation techniques, a trained and experienced public health officer assessed the presence of goiters based on WHO/ UNICEF/ICCIDD criteria. Descriptive statistics were computed for continuous variables and presented in frequency and percentage, based on the distributional characteristics of the data. chi-square was used to check association between socio-demographic factors and goiter. It was a HEC Project No.: 20-16988/NRPU/R&D/HEC/2021.

Results: Iodine status and associated goiter prevalence was high and 59.3% of them were severely iodine deficient. Within the district, the highest severe iodine deficiency was observed in 81.1% goiter patients of the Rawalakot subdivision, Hajira and Abbaspur subdivisions. Regarding goiter status 40% of the patients were classified with palpable-visible goiter and 56% were characterized with visible but nodular goiter.

Conclusion: Study showed that there was a severe iodine deficiency and associated goiter prevalence in the area. Policymakers should take actions for future to overcome iodine deficiency in future.

doi: https://doi.org/10.12669/pjms.40.7.8784

How to cite this: Khaliq A, Fayaz M, Hayat I, Abbas M. Evaluating iodine deficiency and goiter in hilly areas of District Poonch Azad Jammu Kashmir. Pak J Med Sci. 2024;40(7):1454-1459. doi: https://doi.org/10.12669/pjms.40.7.8784

Strength of motivation of 1st year dental students of a dental institution: A cross-sectional study

Fizzah Ali — 2024-06-28

Objective: The study aims to evaluate the motivation levels of dental students, with an emphasis on first-year BDS students, by utilizing the Strength of Motivation for Medical School (SMMS) questionnaire.

Methods: It was a descriptive cross-sectional quantitative study targeting 89 first-year BDS students enrolled at Lahore Medical and Dental College from 5th June to 18th August 2023. The Strength of Motivation for Medical School (SMMS) questionnaire was given to the participants after ethical board approval. Data analysis was done through SPSS version 26. The SMMS score was presented as the means standard deviation and an independent t-test was used to find the difference between the groups. The maximum score possible is 80 and the minimum is 16. The higher the score, the greater the strength of motivation.

Results: In this study, a total of 89 first-year BDS students completed motivation questionnaires, with 34.8% males and 65.2% females. The average age was 19.92±3.13. The overall Strength of Motivation Score (SMMS) averaged 45.53±6.82. Results indicated 9% low, 89.9% moderate, and 1.1% strong motivation. Females had a slightly higher mean SMMS (45.93±6.88) than males (44.80±6.76), but the difference was deemed insignificant (p = 0.462) via independent t-test.

Conclusion: Motivation is vital to achieving excellence in academic pursuits. Nevertheless, there isn’t a single criterion that can be utilized to assess success and motivation. Our primary focus must be on every possible outcome of success, not just the scoring criteria.

doi: https://doi.org/10.12669/pjms.40.7.9112

How to cite this: Ali F, Ehsan MT, Suhaib F, Fatima M. Strength of motivation of 1st year dental students of a dental institution: A cross-sectional study. Pak J Med Sci. 2024;40(7):1460-1465. doi: https://doi.org/10.12669/pjms.40.7.9112

Clinical efficacy of vestibular assessment and rehabilitation training in peripheral vestibular vertigo

Huan Wang — 2024-06-28

Objective: To evaluate the clinical efficacy of vestibular assessment and rehabilitation training in patients with peripheral vestibular vertigo.

Method: This was a retrospective study. A total of 169 patients diagnosed with peripheral vestibular vertigo, admitted to Cangzhou People’s Hospital between January 2020 and January 2023 were divided into control group (83 cases) and observation group (86 cases). The control group received medication-based treatment, while the observation group was provided with combined treatment of medication and vestibular rehabilitation training. Assessment of recovery included the Dizziness Handicap Inventory (DHI), Vestibular Symptom Index (VSI), and Activities-specific Balance Confidence (ABC) scale before and at two, four, and eight weeks post-treatment. Psychological status, sleep quality, and life quality were evaluated. Both groups underwent the Fukuda stepping test and timed balance test.

Result: At two, four, and eight weeks post‐treatment, both groups exhibited significantly lower DHI‐P, DHI‐F, DHI‐E, VSI, and ABC scores compared to pre‐treatment (p<0.05). The observation group showed significantly lower DHI‐P, DHI‐F, DHI‐E, VSI, and ABC scores than the control group at two and four weeks post‐treatment (p<0.05). After treatment, both groups demonstrated reduced body deviation angles and increased time without falling in the Fukuda stepping test (p<0.05). Notably, the observation group had significantly better outcomes (p<0.05).

Conclusion: In comparison to medication‐based treatment alone, a combined approach involving medication treatment and vestibular rehabilitation training may demonstrate early improvements in vertigo symptoms, enhance balance capabilities, and ameliorate psychological well‐being, sleep quality, and overall quality of life for patients.

doi: https://doi.org/10.12669/pjms.40.7.8662

How to cite this: Wang H, Zheng J, Li F, Feng C, Zhang N. Clinical efficacy of vestibular assessment and rehabilitation training in peripheral vestibular vertigo. Pak J Med Sci. 2024;40(7):1466-1472. doi: https://doi.org/10.12669/pjms.40.7.8662

Effects of ganciclovir combined with recombinant human interferon-α on clinical efficacy and immune function in children with infectious mononucleosis

Ling Sun — 2024-06-28

Objective: To evaluate the effects of ganciclovir combined with recombinant human interferon on clinical efficacy and immune function of children with infectious mononucleosis(IM).

Methods: This was a retrospective study. Children (n=120) with IM hospitalized in Beijing Children’s Hospital Affiliated to Capital Medical University Baoding Hospital from January 2020 to January 2022 were selected and randomly divided into study group and control group((n=60). Patients in the control group were treated with ganciclovir by intravenous infusion, and patients in the study group were given ganciclovir+recombinant human interferon-α1b. The time for eliminating clinical symptoms, the levels of inflammatory cytokines, immune function condition and T-lymphocyte subsets between the two groups were compared and analyzed.

Results: After treatment, the time for body temperature returned to normal, time for recovery from cervical lymphadenopathy, time for recovery from hepatosplenomegaly and time for disappearance of angina and oral mucosal congestion in the study group were significantly shorter than those in the control group(p= 0.00); after treatment, the levels of TNF-a and IL-6 in the study group were significantly lower than those in the control group; the indexes of CD3+ and CD8+ in the study group were significantly lower than those in the control group; after treatment, the levels of CD4+ and CD4+/CD8+ in the study group were significantly higher than those in the control group.

Conclusion: Ranciclovir combined with recombinant human interferon-α1b, rapid improvements of clinical symptoms, significantly decreased inflammatory cytokines, improved T-lymphocyte function and no significant increase in adverse drug reactions were found in children with IM.

doi: https://doi.org/10.12669/pjms.40.7.8705

How to cite this: Sun L, Bi J, Zhen W, Wang M, Song H. Effects of ganciclovir combined with recombinant human interferon-α on clinical efficacy and immune function in children with infectious mononucleosis. Pak J Med Sci. 2024;40(7):1473-1478. doi: https://doi.org/10.12669/pjms.40.7.8705

Clinical pattern, neuroimaging findings and outcome of Acute Disseminated Encephalomyelitis in children: A retrospective study

Khairunnisa Mukhtiar — 2024-06-28

Objective: To determine the clinical spectrum, neuroimaging findings, and outcome of Acute Disseminated Encephalomyelitis (ADEM) in children.

Method: We conducted a descriptive cross sectional study of all children aged 6 months to 18 years, diagnosed with ADEM at Aga Khan University Hospital, Karachi from January 2018 till December 2022.

Results: This retrospective study enrolled 30 cases of ADEM, with a mean age of 6.43 ± 4.079, including 13 males and 17 females. The average hospital stay was 7.29 ± 4.379 days. The most common clinical features were fever, headache, and altered consciousness, while motor deficit was observed in 15 (53.5%) patients. Abnormal cerebrospinal fluid was found in 14 (46.6%) patients. Brain MRI identified bilateral and multifocal lesions in 22 (78.6%) patients, with brainstem lesions detected in 7 (25%) patients. Treatment included IV methylprednisolone (22; 73%), IVIG (9; 30%), or both (6; 20%). Clinical improvement was observed in 25 (89.3%) patients, with residual weakness present in eight (26%) patients at discharge. There was one reported death. Long-term complications included motor deficits, seizures, poor scholastic performance, and behavioral issues.

Conclusion: The clinical presentation of ADEM is variable, but the most common symptoms are fever, headache, and altered consciousness. Despite generally favorable outcome, long-term monitoring revealed that patients may experience motor deficits, seizures, cognitive impairment, and academic difficulties.

doi: https://doi.org/10.12669/pjms.40.7.8015

How to cite this: Mukhtiar K, Raza M, Ishaque S, Maha Q, Noor A. Clinical pattern, neuroimaging findings and outcome of Acute Disseminated Encephalomyelitis in children: A retrospective study. Pak J Med Sci. 2024;40(7):1479-1484. doi: https://doi.org/10.12669/pjms.40.7.8015

Alteration of Maternal Serum Ferritin in Pregnancy and Maternal-fetal Infections: A retrospective cohort study

Xing Liao — 2024-06-28

Objectives: To investigate the association of altered serum ferritin during pregnancy with chorioamnionitis and neonatal sepsis.

Methods: This retrospective cohort study included 78,521 pregnant women who attended antenatal check-ups at maternal and child health centers in Fujian Province, China. Study lasted from January 2014 to January 2019. A total of 59,812 pregnant women were followed up. Patients with suspected infection before the delivery were selected and divided into the chorioamnionitis and non-chorioamnionitis groups according to placental pathology. Differences in late and early pregnancy serum ferritin between the two groups were compared. Multiple logistics regression was used to adjust for confounding factors and to analyze the association between serum ferritin changes and pregnancy outcomes. Importance of altered serum ferritin during pregnancy was assessed by receiver operating characteristic (ROC) curve and net reclassification index (NRI).

Results: Clinical records of 8506 pregnant women were included in the study. there were 1010 (11.9%) cases of confirmed chorioamnionitis and 263 (3.1%) cases of neonatal sepsis. There was a significant difference in maternal serum ferritin changes between the groups with and without chorioamnionitis. No significant difference was detected in cases with or without neonatal sepsis. Multiple logistic regressions, corrected for confounding factors yielded similar conclusions. Maternal serum ferritin difference NRI 12.18% (p = 0.00014) was similar to the ROC results in predicting the occurrence of chorioamnionitis.

Conclusion: Differential serum ferritin during pregnancy may predict chorioamnionitis but does not correlate well with neonatal sepsis.

doi: https://doi.org/10.12669/pjms.40.7.9160

How to cite this: Liao X, Xiu X, Xu G, Wu L, Fang Z, Huang H. Alteration of Maternal Serum Ferritin in Pregnancy and Maternal-fetal Infections: A retrospective cohort study. Pak J Med Sci. 2024;40(7):1485-1492. doi: https://doi.org/10.12669/pjms.40.7.9160

A study of critically ill obstetric patients admitted to intensive care unit of a tertiary care hospital

Wajeeha Syed — 2024-06-28

Objectives: To evaluate characteristics, indications, complications and outcome of obstetric patients admitted to ICU of tertiary care hospital in KPK, Pakistan.

Methods: This descriptive study was conducted in department of OBGYN of Lady Reading Hospital, Peshawar from January 2021 till December 2021. A total of 62 patients were enrolled into the study using nonprobability consecutive sampling technique. Their data were collected on a proforma. All patients were followed till their death or discharge home from hospital.

Results: The mean duration of ICU stay of patients, was 6.85±4.82 days. Out of 62 patients 17 (27.41%) expired in ICU, while 45 (72.58%) patients survived and were discharged. Pre-eclampsia and Eclampsia was the commonest primary diagnosis, accounting for 28 cases (45.2%) with a case fatality rate of 25%, followed by 13 cases (21%) of primary postpartum hemorrhage (PPH) as the second commonest reason for ICU admission and a case fatality rate of 38%. The underlying primary diagnosis had no statistically significant association with outcome of the patient. Acute Renal failure had statistically significant association with outcome of the patient with adjusted OR 4.79, CI:1.17-19.66, p-0.02. Similar positive association with mortality existed for patients having DIC (aOR:6.59; CI:1.34-32.34, p-0.02).

Conclusion: Pre-eclampsia/Eclampsia is the commonest reason for intensive care admission, however PPH has the highest case fatality rate. The outcome of critically ill obstetric patients is dependent on complications and not primary underlying diagnosis.

doi: https://doi.org/10.12669/pjms.40.7.7734

How to cite this: Syed W, Liaqat N, Ashraf MS, Khan N. A study of critically ill obstetric patients admitted to intensive care unit of a tertiary care hospital. Pak J Med Sci. 2024;40(7):1493-1496. doi: https://doi.org/10.12669/pjms.40.7.7734

Clinical effects of basic nursing combined with psychological intervention on treatment compliance of patients with Influenza-A(H1N1)

Yaning Feng — 2024-06-28

Objective: To investigate the effects of basic nursing combined with psychological intervention on treatment compliance, self-care ability, clinical efficacy, lung function and nursing satisfaction of patients with Influenza-A(H1N1).

Method: This was application research. Eighty patients with influenza-A (H1N1) admitted to The First Affiliated Hospital of Hebei North University from January 2020 to December 2022 were included as subjects and randomly divided into the observation group(n=40) and the control group(n=40). Patients in the control group were given routine basic nursing intervention, while those in the observation group were treated with combined psychological intervention in addition to basic nursing. The differences in treatment compliance, self-care ability, clinical efficacy, lung function and nursing satisfaction were compared between the two groups.

Results: After the intervention, the treatment compliance score and the total self-care ability score of the observation group were higher than those of the control group, with statistically significant differences(P<0.05). After treatment, the clinical efficacy of the observation group was significantly higher than that of the control group(P<0.05). Before treatment, no significant difference was observed between the two groups in terms of various indexes of lung function, which were better in the observation group than in the control group after treatment(P<0.05).

Conclusion: Basic nursing combined with psychological intervention results in a variety of benefits in the treatment of patients with Influenza-A(H1N1), such as improved treatment compliance and self-care ability, ameliorated lung function, as well as enhanced treatment outcomes and nursing satisfaction, which needs to be promoted in clinical practice.

doi: https://doi.org/10.12669/pjms.40.7.8675

How to cite this: Feng Y, Ma C, Feng Z, Bian Y, Zhu Y, Li K. Clinical effects of basic nursing combined with psychological intervention on treatment compliance of patients with Influenza-A(H1N1). Pak J Med Sci. 2024;40(7):1497-1502. doi: https://doi.org/10.12669/pjms.40.7.8675

Financial burden and social implications of chronic liver disease in a patient population group in Pakistan

Adnan Salim — 2024-06-28

Objective: To assess economic and social issues faced by cirrhotic patients & its financial burden for developing nations like Pakistan.

Method: This cross-sectional study was carried out at the Department of Gastroenterology & Hepatology, Shaikh Zayed Hospital, Lahore, Pakistan during the period between July & December 2019. Patients with liver cirrhosis were recruited and information regarding disease, financial status, treatment expenses & dependency was recorded.

Results: A total of 450 patients were recruited, 272 (60%) were males & 178 (40%) were females, with mean age 55.4±6.2 years. HCV was cause of cirrhosis in 86% of cases, 65% were diagnosed incidentally and 39.6% were illiterate. About 82.7% were urban while only 28.7% own their own home. Co-morbid conditions including diabetes, hypertension & ischemic heart disease were present in 54% of cases. Monthly income was <PKR 45,000 in 23% of cases while 47% were non-earning.

Conclusions: Our study shows the financial difficulties & dependency faced by patients with liver cirrhosis. Aggressive national screening is required to discover infected patients before cirrhosis develops.

doi: https://doi.org/10.12669/pjms.40.7.7976

How to cite this: Salim A, Farooq MO, Saleem S, Malik K. Financial burden and social implications of chronic liver disease in a patient population group in Pakistan. Pak J Med Sci. 2024;40(7):1503-1508. doi: https://doi.org/10.12669/pjms.40.7.7976

Combination of anlotinib and second-line chemotherapy as surrogate to reduce immunosuppression in patients with advanced non-small cell lung cancer

Zhai Lou — 2024-06-28

Objective: To study the clinical effects of anlotinib combined with second-line chemotherapy (SLC) on immunosuppression in patients with advanced non-small cell lung cancer (NSCLC).

Methods: In this retrospective study, the medical records of 106 patients with advanced NSCLC admitted to the Lianyungang First People’s Hospital from November 2020 to March 2022 were retrospectively analyzed. Amongst 106 patients, 53 patients received second-line single-agent chemotherapy regimens (SLC group), and 53 patients received anlotinib combined with SLC (ASLC group). Prognosis, levels of immune cells and inflammatory cytokine, and adverse reactions were analyzed.

Results: Clinical efficacy of the ASLC group was significantly higher than the SLC group (p<0.05). After treatment, patients in the ASLC group exhibited significantly higher levels of CD4+/CD8+ and CD4+ compared to those in the SLC group (p<0.05), while the difference in CD8+ level between the two groups was not statistically significant (p>0.05). After treatment, levels of tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10), interleukin-8 (IL-8), interleukin-6 (IL-6) in the ASLC group were lower compared to the SLC group (p<0.05).

Conclusion: In patients with advanced NSCLC, anlotinib combined with SLC is associated with higher levels of immune cells and reduced inflammatory factors. This treatment regimen, thus, can reduce immunosuppression and improve the prognosis of NSCLC patients.

doi: https://doi.org/10.12669/pjms.40.7.9681

How to cite this: Lou Z, Wang X, Hu C, Liu W, Ji Y. Combination of anlotinib and second-line chemotherapy as surrogate to reduce immunosuppression in patients with advanced non-small cell lung cancer. Pak J Med Sci. 2024;40(7):1509-1515. doi: https://doi.org/10.12669/pjms.40.7.9681

Comparing contribution of bony and cartilaginous endplate changes to intervertebral disc degeneration

Amber Salman — 2024-06-28

Objective: To compare the degenerative features of cartilaginous endplate with bony endplate in association with intervertebral degeneration in local population at radiographic, macroscopic and microscopic level in human motion segments.

Methods: This cross-sectional descriptive study examined 59 lumbar spine motion segments from adult male cadavers at the Department of Anatomy, University of Health Sciences, Lahore, between May and September, 2022. Radiographic assessment observed bony endplate (BEP) for the presence of sclerosis & osteophytes and degeneration scores from 1-8 were assigned. Macroscopic assessment was done to evaluate BEP, cartilaginous endplate (CEP) and IVD, and scores ranged from 1to 28 for BEP, 1-4 for CEP and 1-64 for IVD were assigned. Microscopic assessment revealed degeneration scores of CEP ranged from 1-42 and 1-30 for IVD. Segments with BEP defects were also identified on radiographs & macroscopy.

Results: Significant correlations were observed between the total degeneration scores of BEP with IVD and CEP scores (r=0.88 and r=0.909, respectively, p<0.001). Similarly, the total degeneration scores of the CEP is also significantly correlated with total IVD (r=0.86, p<0.001). Additionally, the samples with BEP defects were having higher IVD degeneration scores (p<0.001).

Conclusion: This study, for the first time identifies that there exists a critical association of bony and cartilaginous endplate with intervertebral disc degeneration individually in the same tissue sections using multi-dimension assessment methods. Degeneration in any of the components of VEP is consonantly associated with IVD degeneration. The BEP & CEP, though, they are unique structures but are interlinked with each other structurally and functionally.

doi: https://doi.org/10.12669/pjms.40.7.8762

How to cite this: Salman A, Khawaja AS, Baig K, Zehra U. Comparing contribution of bony and cartilaginous endplate changes to intervertebral disc degeneration. Pak J Med Sci. 2024;40(7):1516-1522. doi: https://doi.org/10.12669/pjms.40.7.8762

Effect of Gegen Qinlian Decoction combined with dietary management on patients with damp-heat Type-2 diabetes mellitus and metabolic syndrome

Bin Nie — 2024-06-28

Objective: To explore the effect of Gegen Qinlian Decoction (GQD) combined with dietary management in the treatment of patients with Type-2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) (T2DM MetS).

Methods: This is a retrospective analysis of 102 cases of T2DM in the Brain Hospital of Hunan Province, China from April 2020 to February 2023. Of them, 49 patients received conventional drug treatment (control group), and 53 patients received GQD combined with dietary management on the basis of conventional drugs (observation group). Treatment efficacy was calculated, and blood glucose levels before and after the treatment, blood lipid-related indicators, tumor necrosis factor-α (TNF-α) and adiponectin (ADP) levels, and incidence of adverse reactions were compared between the two groups.

Results: The total efficacy of the observation group (92.45%) was significantly higher than that of the control group (75.51%) (P<0.05). After the treatment, blood glucose and lipid indicators in both groups were significantly improved compared to pretreatment levels, and were significantly better in the observation group than in the control group (P<0.05). After the treatment, TNF-α levels in both groups decreased compared to before the treatment, and were significantly lower in the observation group compared to the control group. Levels of ADP after the treatment increased, and were significantly higher in the observation group compared to the control group (P<0.05).

Conclusions: When taken as an adjunct to the conventional drug regimen, GQD combined with dietary management can effectively regulate blood glucose and lipid metabolism in patients with T2DM and MetS (T2DM MetS), improve TNF-α and ADP levels, and enhance disease treatment effectiveness.

doi: https://doi.org/10.12669/pjms.40.7.9476

How to cite this: Nie B, Liu X, Xiao Y, Liu C, Zhao Q. Effect of Gegen Qinlian Decoction combined with dietary management on patients with damp-heat Type-2 diabetes mellitus and metabolic syndrome. Pak J Med Sci. 2024;40(7):1523-1528. doi: https://doi.org/10.12669/pjms.40.7.9476

Root canal morphology of permanent mandibular anterior teeth in a Pakistani population: A cone beam computed tomography assessment

Saqib Naeem Siddique — 2024-06-28

Objective: To investigate the incidence of accessory canals and the variation in root canal morphology of permanent mandibular incisors and canines in Pakistani population using Cone Beam Computed Tomography (CBCT).

Methods: A cross-sectional study was conducted in University College of Dentistry, The University of Lahore, Pakistan after getting institutional ethical permission from January 2020 to September 2022. The data included records of 111 patients consisting of 444 permanent mandibular incisors and 222 permanent mandibular canines. Accessory root, root canals and Vertucci canal configuration for each tooth was recorded. Data analysis was done using SPSS v20. Descriptive statistics were calculated for each anatomical parameter. Chi-square test was applied to determine association of gender with the presence of accessory roots and root canals.

Results: Among the 111 records evaluated, 48.6% were males and 51.4% were females. No accessory root was found in the central and lateral incisors. However, an accessory root was found in 4.9% of the canines. The incidence of accessory canals in the central incisors, lateral incisors and canines was 18.9%, 25.2% and 10.4% respectively. The most common canal configuration in teeth with accessory canals was Type-III, followed by Type-II and Type-V.

Conclusion: None of the central or lateral incisor showed accessory root while it was detected in 4.9% canines. The frequency of accessory root canal was found to be 18.9%, 25.2% and 10.4% in central incisors, lateral incisors and canines respectively. The most common canal configuration was Type-I, followed by Type-III and Type-II. Type-V, VI and VII were less common.

doi: https://doi.org/10.12669/pjms.40.7.8744

How to cite this: Siddique SN, Babar P, Ghazanfar Z, Kayani JA. Root canal morphology of permanent mandibular anterior teeth in a Pakistani population: A cone beam computed tomography assessment. Pak J Med Sci. 2024;40(7):1529-1532. doi: https://doi.org/10.12669/pjms.40.7.8744

Study on the clinical efficacy, safety and compliance of quality nursing intervention in the treatment of chronic heart failure combined with respiratory tract infections

Yinan Jia — 2024-06-28

Objective: To evaluate the clinical efficacy, safety and compliance of quality nursing intervention in the treatment of chronic heart failure combined with respiratory tract infections.

Methods: This was a retrospective study. One hundred and twenty patients with chronic heart failure combined with respiratory tract infections were recruited at Baoding No.1 Central Hospital from June 2021 to March 2023 and randomly divided into the control group (n=60) and the experimental group (n=60). Patients in the control group were given regular specialist care on the basis of basic treatment, while those in the experimental group were given a quality care intervention model. The differences in clinical efficacy, improvement time of symptoms after treatment, etc. between the two groups were compared and analyzed.

Results: The response rate of the experimental group was 88%, which was significantly higher than that of the control group (73%), with a statistically significant difference (P=0.04). The time of fever reduction, cough subsidence and lung rales disappearance in the experimental group were significantly shorter than those of the control group, with statistically significant differences (P<0.05). The incidence of nursing related adverse events in the experimental group was 8%, which was lower than that of 23% in the control group, with a statistically significant difference(P=0.03).

Conclusion: Quality nursing intervention is an effective treatment for patients with chronic heart failure combined with respiratory infections, boasting a variety of benefits such as reduced nursing risk, improved quality of nursing, and increased patient compliance and satisfaction. It contributes to rapid symptom improvement and significant clinical efficacy.

doi: https://doi.org/10.12669/pjms.40.7.7873

How to cite this: Jia Y, Li N, Zhang X, Lu Z, You X, Xu Q. Study on the clinical efficacy, safety and compliance of quality nursing intervention in the treatment of chronic heart failure combined with respiratory tract infections. Pak J Med Sci. 2024;40(7):1533-1538. doi: https://doi.org/10.12669/pjms.40.7.7873

Frequency of occupational health hazards and factors responsible among the waste handlers at the tertiary care hospitals of Karachi

Eshwar Das — 2024-06-28

Background & Objectives: Hospital waste handlers (HWHs) are in contact with contaminated waste that put them at risk for occupational health hazards. The objective of the study was to determine the frequency of occupational health hazards and identify factors contributing to them among the HWHs at tertiary care hospitals of Karachi.

Methods: A cross sectional survey was conducted from January 2021 till June 2022 on 417 conveniently selected HWHs of the public and private tertiary care hospitals of the Karachi including three Public sector hospitals (Civil Hospital Karachi, National Institute of Child Health, Jinnah Post Graduate Medical Center) and five private sector hospitals (Sohail University Hospital, Darulsehat Hospital, Kharadar General Hospital, Patel Hospital and Hamdard University Hospital) using a structured questionnaire. Chi Square test was applied to determine the differences in occurrence of different hazardous outcomes (Needle stick injury, Sharp Injury, Eye Symptoms, Skin symptoms, Cough) between different groups of age, gender, type of hospitals and status of being trained in Hospital Waste Management (HWM).

Results: Around half of the HWHs (52.6%) labeled the bins of the waste according to their level of hazard. Only 17.9% disinfected the infected waste. The proportion of participants who experienced needle stick and sharp injury in the last six months was 16.3% and 15.8% respectively. Majority of them used disposable gloves (95.7%) and face masks (94.3%). One thirds had access to aprons while only 10.5% had access to protective shoes at their work place. HWHs of private sector were significantly less likely to experience Needle stick injuries, skin symptoms, cough, breathing difficulty and throat burning.

Conclusion: The HWM practices in tertiary care hospitals of Karachi is far from being satisfactory. HWHs must be trained and monitored for safe disposal of waste.

doi: https://doi.org/10.12669/pjms.40.7.9113

How to cite this: Das E, Shaikh S, Umm-e-Rabab, Kumar D. Frequency of occupational health hazards and factors responsible among the waste handlers at the tertiary care hospitals of Karachi. Pak J Med Sci. 2024;40(7):1539-1544. doi: https://doi.org/10.12669/pjms.40.7.9113

Effect of early pulmonary rehabilitation therapy on the pulmonary function of patients with stroke-associated pneumonia and analysis of its effectiveness

Zhanjun Liao — 2024-06-28

Objective: This study aimed to evaluate the clinical effectiveness of early pulmonary rehabilitation (PR) treatment methods for stroke-associated pneumonia (SAP).

Methods: This is a prospective, randomized controlled intervention study. Eighty SAP patients admitted to the rehabilitation department of Liuzhou People’s Hospital from June 2020 to December 2021 were selected and divided into an intervention group (40 cases) and a control group (40 cases) using the random number table approach. Patients in both groups received conventional treatments. Patients in the intervention group received early PR interventions, while patients in the control group received conventional rehabilitation treatment. The clinical effectiveness and pulmonary function indexes were compared.

Results: The intervention group showed shorter durations of stay in the intensive care unit, relief from symptoms, and mechanical ventilation compared to the control group following treatment (P < 0.05). The total clinical efficacy after intervention in the treatment group was 82.50%, significantly higher than the control group's rate of 47.50% (P < 0.05). After 21 days of treatment, the forced expiratory volume in one second (FEV1)/predicted value in the intervention group was 64.92 ± 8.53, while it was 52.69 ± 7.08 in the other group. The FEV1/forced vital capacity in the intervention group was 59.73 ± 7.18, compared to 50.36 ± 6.54 in the control group. The intervention group had a clinical pulmonary infection score of 2.62 ± 1.13, while the control group had a score of 4.17 ± 2.08. The intervention group showed a significant improvement in lung function, with statistically significant differences compared to the other group (P < 0.05). Moreover, the intervention group had significantly lower levels of interleukin-4 and interleukin-10 compared to the control group, with statistical significance (P < 0.05). The average National Institute of Health Stroke Scale score of the intervention group was significantly lower than that of the control group in the second and third weeks after treatment (P < 0.05).

Conclusion: Early comprehensive pulmonary rehabilitation can significantly enhance the pulmonary function and respiratory status of SAP patients and facilitate the early recovery of brain function. This approach archives significantly better outcomes compared to conventional PR; therefore, it is worth clinical implementation.

doi: https://doi.org/10.12669/pjms.40.7.8113

How to cite this: Liao Z, Liao F. Effect of early pulmonary rehabilitation therapy on the pulmonary function of patients with stroke-associated pneumonia and analysis of its effectiveness. Pak J Med Sci. 2024;40(7):1545-1550. doi: https://doi.org/10.12669/pjms.40.7.8113

Relationship of adhesion molecules (ICAM-1 and E-selectin) with ABO blood groups in patients hospitalized with acute myocardial infarction

Mohammad Perwaiz Iqbal — 2024-06-28

Objectives: Adhesion molecules, sICAM-1 and sE-selectin appear to have a major role in the pathogenesis of coronary artery disease (CAD). The focus of this study was to investigate the relationship of sICAM-1 and sE-selectin with ABO blood groups in Pakistani patients hospitalized with acute myocardial infarction (AMI).

Methods: In a case-control study, 116 patients of acute myocardial infarction (AMI) and 116 healthy controls (age range for both: 30 years to 70 years; both males and females) were randomly selected from the Aga Khan University and National Institute of Cardiovascular Diseases, Karachi with informed consent. The blood samples were obtained and analyzed for ABO blood groups and serum levels of sICAM-1 and sE-selectin using kit methods. Statistical tests including independent sample t-test and Two-way ANOVA were used to study the association of these adhesion molecules with blood groups in AMI patients and healthy controls. Duration of the study was from July 2021 to June 30, 2023.

Results: Mean serum levels of sICAM-1 were significantly higher in AMI patients compared to healthy controls (342±159 mg/dl vs. 227±104 mg/dl; p-value <0.001). Similarly, serum levels of sE-selectin were also significantly higher in AMI patients compared to healthy controls (53.6±26.9 mg/dl vs. 40.7± mg/dl; p-value <0.001). Moreover, mean concentrations of sICAM-1 and sE-selectin for the interaction between subject type (cases and control) and blood groups were statistically significant (p-value = 0.007 and p-value = 0.035, respectively).

Conclusion: There is an association of adhesion molecules, sICAM-1 and sE-selectin with ABO blood groups in Pakistani patients hospitalized with AMI.

doi: https://doi.org/10.12669/pjms.40.7.8978

How to cite this: Iqbal MP, Azam I, Yousuf FA, Kazmi K. Relationship of adhesion molecules (ICAM-1 and E-selectin) with ABO blood groups in patients hospitalized with acute myocardial infarction. Pak J Med Sci. 2024;40(7):1551-1555. doi: https://doi.org/10.12669/pjms.40.7.8978

Clinical effects of neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy on complications and recurrence in patients with advanced gastric cancer

Rui Wang — 2024-06-28

Objective: To compare the clinical effects of neoadjuvant chemoradiotherapy (NCRT) and neoadjuvant chemotherapy (NCT) on complications and recurrence in patients with advanced gastric cancer (AGC).

Method: This was a retrospective study. A total of 83 patients with AGC admitted to Chengde Central Hospital between Jan. 2019 and Jun. 2021 were selected and divided into the observation group(n=41) and the control group(n=42) using a random number table. Patients in the control group received XELOX chemotherapy, and those in the observation group received intensity-modulated radiotherapy (IMRT) with concurrent XELOX chemotherapy. Compared efficacy, pathological complete response rate (pCR), R0 resection rate, adverse reactions, and quality of life (QOL) before and after treatment between the two groups.

Results: The efficacy, pCR, and R0 resection rate of the observation group were significantly increased compared with those of the control group. Comparison of complications showed the number of patients experiencing gastrointestinal (GI) reactions, increased BUN, increased GPT, alopecia, and pigmentation in the observation group was decreased compared with that in the control group, with no statistically significant differences(p>0.05), and the number of patients experiencing myelosuppression was statistically significant between the two groups(p<0.05). There were no significant differences in sub-scores of physical, role, emotional, cognitive, and social functions and the overall score of QOL between the two groups(p>0.05) before treatment.

Conclusion: NCRT is safer and more effective in patients with AGC compared with NCT, and can significantly improve the QOL of patients. It can be widely used in clinical practice.

doi: https://doi.org/10.12669/pjms.40.7.9052

How to cite this: Wang R, Li M, Zheng Y, Zhang W, Song J, Yang F. Clinical effects of neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy on complications and recurrence in patients with advanced gastric cancer. Pak J Med Sci. 2024;40(7):1556-1560.
doi: https://doi.org/10.12669/pjms.40.7.9052

Comparison of linear distance of glenoid fossa to frontomaxillary nasal suture in skeletal Class-II and skeletal Class-I malocclusion

Sadaf Siddiqui — 2024-06-28

Objective: To compare linear distance of glenoid fossa to frontomaxillary nasal suture in skeletal Class-I and II malocclusions.

Methods: This cross-sectional study was conducted at the Department of Orthodontics, Altamash Institute of Dental Medicine, Karachi Pakistan. The duration of study was one year from January, 2019 to January, 2020. After taking informed consent from patient and hospital ethical committee a total of 60 patients were included in the study using WHO sample size calculator. Two groups comprising 30 patients each i.e., Skeletal Class-I malocclusion and Skeletal Class-II malocclusion with mandibular retrusion both having normal vertical relationship were included in the study. The cephalometric measurements SNA, SNB, SNMP, FHMP, GF-FMN, CO-GO, CO GN on lateral cephalograms were measured and compared between the two groups. Independent t test was applied and p value ≤ 0.05 was considered as significant.

Results: In skeletal Class-I malocclusion the mean linear distance of GF-FMN was 70.2 ± 4.02 mm and in skeletal Class-II malocclusion it was 73.4 ± 4.04 mm (p value .004). Glenoid fossa was 3.2 mm distally placed in patients with Class-II malocclusion.

Conclusion: Glenoid fossa position is a diagnostic feature of Class-II malocclusion associated with mandibular retrusion. One of the effective cephalometric measurements to check glenoid fossa position is the distance from the glenoid fossa(GF) to the frontomaxillary nasal suture FMN (GF-FMN).

doi: https://doi.org/10.12669/pjms.40.7.8506

How to cite this: Siddiqui S, Ehsan AA, Sakrani H, Samdani SA . Comparison of linear distance of glenoid fossa to frontomaxillary nasal suture in skeletal Class-II and skeletal Class-I malocclusion. Pak J Med Sci. 2024;40(7):1561-1565. doi: https://doi.org/10.12669/pjms.40.7.8506

Risk factors and nomogram predictive model of severe postoperative complications in elderly patients with intertrochanteric fractures

Ping Xu — 2024-06-28

Objective: To analyze risk factors of severe postoperative complications in elderly patients with intertrochanteric fractures (ITF), and to construct a predictive model.

Methods: The medical records of 316 elderly patients with ITF who underwent surgical treatment in Suzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2020 to December 2022 were retrospectively analyzed. Univariate and multivariate logistic regression analyses were performed to identify risk factors of severe postoperative complications. A nomogram prediction model was constructed using the RMS package of R4.1.2 software. Accuracy and stability of the model was assessed using the receiver operating characteristic (ROC) curve, Hosmer-Lemeshow goodness-of-fit test, and decision curve analysis.

Results: Age, American Society of Anesthesiologists (ASA) grading, combined medical diseases, preoperative bedridden condition, frailty, and preoperative albumin levels were all risk factors for severe postoperative complications in ITF patients were noted. These factors were then used to build a risk prediction model that had an area under the ROC curve (AUC) of 0.899 (95% confidence interval (CI): 0.846-0.951). The internal validation results of the Bootstrap method showed that the C-index value of the model was 0.899, and the calibration curve had a good fit with the ideal curve.

Conclusions: Age, ASA grading, combined medical diseases, preoperative bedridden condition, frailty, and preoperative albumin levels were independent risk factors for severe postoperative complications in elderly ITF patients. The constructed prediction model based on the above risk factors has a high predictive value.

doi: https://doi.org/10.12669/pjms.40.7.9242

How to cite this: Xu P, Xu Y. Risk factors and nomogram predictive model of severe postoperative complications in elderly patients with intertrochanteric fractures. Pak J Med Sci. 2024;40(7):1566-1571. doi: https://doi.org/10.12669/pjms.40.7.9242

Bridging the Gap: A narrative review of osteoporosis disability, adipokines, and the role of AI in postmenopausal women

Saba Tariq — 2024-06-28

Osteoporosis is a global health concern characterized by reduced bone density and compromised bone quality, resulting in an increased risk of fractures, particularly in postmenopausal women. The assessment of bone mineral density (BMD) plays a pivotal role in diagnosing osteoporosis, as it accounts for approximately 70% of overall bone strength. The World Health Organization (WHO) has endorsed BMD measurement as a reliable method for diagnosing this condition. In Pakistan, the incidence of bone fractures is on the rise, largely attributable to an aging population and a range of contributing factors. Understanding the global and local prevalence of osteoporosis, its impact on morbidity and mortality, and the contributing factors is vital for developing effective preventive and therapeutic strategies.

The role of adipokines, including chemerin, vaspin, and omentin-1, in bone metabolism is an emerging area of investigation. These adipokines play diverse roles in physiology, ranging from inflammation and metabolic regulation to cardiovascular health. Understanding their potential impact on bone health is a topic of ongoing research. The intricate relationship between bone density, bone quality, and overall bone strength is central to understanding the diagnosis and management of osteoporosis. Current innovation in machine learning and predictive model can bring revolution in the field of bone health and osteoporosis. Early identification of people with osteoporosis or risk of fracture through machine learning can prevent disability and improve the quality of life.

doi: https://doi.org/10.12669/pjms.40.7.9072

How to cite this: Tariq S, Jabbar S, Ahmad A, Tariq S. Bridging the Gap: A narrative review of osteoporosis disability, adipokines, and the role of AI in postmenopausal women. Pak J Med Sci. 2024;40(7):1572-1577. doi: https://doi.org/10.12669/pjms.40.7.9072

Vaccine a promising immunotherapy option for head and neck cancer patients

Syed Fareed Mohsin — 2024-06-28

Head and neck cancer (HNC) is a diversified group of tumors arising from the upper aerodigestive tract, encompassing the oral cavity, larynx, and pharynx. Globally, this particular cancer ranks sixth in prevalence, resulting in an annual mortality rate above 325,000 individuals. Surgery, radiation, and chemotherapy are the primary therapeutic options for HNC, which are frequently used in combination. Despite their extensive use, these treatments are typically unsuccessful and can significantly impair patient quality of life. Therapeutic vaccinations are administered to cancer patients instead of preventative immunizations administered to a healthy population. The efficacy of this modality has considerably transformed the application and success of cancer management by providing an additional and effective therapeutic option for patients. Cancer treatment has been revolutionized by introducing Immune Checkpoint receptors inhibitors (ICR), such as anti-CTLA4, anti-PD-1, and anti-PD-L1.3. ICR have also established immunity against self-generated cancerous cells. Cancer vaccines have shown extraordinary synergistic potential with checkpoint inhibitors to maximize tumor-specific CD8+ expansion and activity, which detects and destroys tumor cells. Personalized neoantigen vaccination therapies can potentially combat the heterogeneity of each patient’s tumor. The findings of this review suggest that recent advances in cancer immunology and genetics imply that cancer vaccination can be a promising alternative treatment for head and neck cancer patients. This review conducted a comprehensive literature search to identify relevant studies on immunotherapy options for head and neck cancer patients. The search strategy was designed to capture a wide range of peer-reviewed articles, conference proceedings, and grey literature from 2013 to 2023. The databases searched to ensure comprehensive coverage of the literature included PubMed, Web of Science, and Google Scholar; to include grey literature and articles not indexed in traditional databases.

doi: https://doi.org10.12669/pjms.40.7.8791

How to cite this: Mohsin SF. Vaccine a promising immunotherapy option for head and neck cancer patients. Pak J Med Sci. 2024;40(7):1578-1583. doi: https://doi.org/10.12669/pjms.40.7.8791

Seizures as the only presentation of Pulmonary Embolism in the absence of Respiratory Symptoms

Omair Farooq — 2024-06-28

Pulmonary embolism is a life-threatening emergency. Seizure as the clinical presentation of pulmonary embolism is extremely rare. In this case report a 47-year-old female had an episode of seizure after undergoing total abdominal hysterectomy with bilateral salpingo-oophorectomy due to myometrial uterine fibroids. The patient had no past history of seizure or cardiovascular disease. Based on raised D-Dimers and echocardiography a provisional diagnosis of pulmonary embolism was made, which was confirmed on CT angiogram that showed bilateral saddle pulmonary embolism. Clinicians need to be aware that Pulmonary embolism is a possibility as the differential diagnosis for unexplained, new-onset of seizure activity.

doi: https://doi.org/10.12669/pjms.40.7.9426

How to cite this: Farooq O, Maqsood A, Ahmad M, Sohail MI, Rashid M. Seizures as the only presentation of Pulmonary Embolism in the absence of Respiratory Symptoms. Pak J Med Sci. 2024;40(7):1584-1586. doi: https://doi.org/10.12669/pjms.40.7.9426

Right-sided infective endocarditis with ventricular septal defect

Fatina Munawar — 2024-06-28

Infective endocarditis (IE) affects the endothelium of the heart, with the heart valves most commonly involved. It has been documented that the annual incidence of infective endocarditis is 3-10 per 100,000 patient-years1. However, it can be underestimated since the incidence in developing countries cannot be determined accurately. Here, we present a case of a 37-year-old male who was referred from a local health facility with shortness of breath on presentation; the patient was anuric for one day and initial laboratory investigations showed metabolic acidosis, hyperkalemia, sepsis, and deranged renal function tests. The patient had received a three-week course of intravenous (IV) piperacillin-tazobactam at the previous health facility, being diagnosed as a case of infective endocarditis. An initial transthoracic echocardiogram (TTE) showed vegetation on the pulmonary valve; however, the patient was neither an IV drug abuser nor did he have any history of implantation of intracardiac devices or central venous catheters. There was no recent or remote history of dental or surgical procedures. Due to the acute kidney injury, hemodialysis sessions and IV imipenem were started. As the patient’s hemodynamic profile improved by the fifth day of admission, TTE was repeated, revealing a small ventricular septal defect (VSD). This case report highlights the importance of even small VSD that could potentially lead to right-sided IE. Surgical correction of VSD could prevent such a life-threatening condition.

doi: https://doi.org/10.12669/pjms.40.7.8219

How to cite this: Munawar F, Ahmed I. Right-sided infective endocarditis with ventricular septal defect. Pak J Med Sci. 2024;40(7):1587-1590. doi: https://doi.org/10.12669/pjms.40.7.8219

Drug resistant typhoid fever: A clinical challenge and a potential solution

Muhammad Aliyan Ahmed — 2024-06-28

doi: https://doi.org/10.12669/pjms.40.7.10052

How to cite this: Ahmed MA, Ahmad Y, Saad M. Drug resistant typhoid fever: A clinical challenge and a potential solution. Pak J Med Sci. 2024;40(7):1591. doi: https://doi.org/10.12669/pjms.40.7.10052

Acknowledgement August 2024

Shaukat Ali Jawaid — 2024-06-29