Pakistan Journal of Medical Sciences

May - June 2024 Content

Wed, 24 Apr 2024 11:14:44 +0200

Wars, Conflicts & Mental Health

Afzal Javed — Mon, 18 Mar 2024 04:50:08 +0100

doi: https://doi.org/10.12669/pjms.40.5.9505

How to cite this: Javed A. Wars, Conflicts & Mental Health. Pak J Med Sci. 2024;40(5):797-799.
doi: https://doi.org/10.12669/pjms.40.5.9505

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.

Effectiveness of early pharmaceutical interventions in symptomatic COVID-19 patients: A randomized clinical trial

Mon, 18 Mar 2024 05:38:52 +0100

Objective: We assessed the effectiveness of oral Hydroxychloroquine (HC), Azithromycin (AZ) and Oseltamivir (OS), alone or combined, among patients hospitalized with mildly symptomatic coronavirus infectious disease (COVID-19).

Methods: Following the approval of the National Bioethics Committee and prospective registration (clinicaltrials.gov NCT04338698), a multicenter randomized clinical trial of adaptive design was conducted at 10 multispecialty hospitals in Pakistan. Patients were randomized into seven treatment groups. Starting April 15, 2020, consenting, eligible, otherwise healthy adult patients or those with co-morbidities under control, were recruited if they presented with mildly symptomatic COVID-19 (scored 3 on a 7-point ordinal scale anchored between 1 = not hospitalized, able to undertake normal activities, to 7 = death) confirmed by quantitative Real-Time Polymerase Chain Reaction (qRT-PCR). Two primary outcomes were assessed by day seven: Turning qRT-PCR negative; and clinical improvement of two points from the baseline. Outcome rates were compared using a chi-square test. Multiple imputations were applied to handle missing data. An interim data analysis was carried out on July 19, 2020, following which the study continued without treatment group changes. Data Safety and Monitoring Board advised to stop recruitment due to its futility on January 18, 2021.

Results: Of 471 patients randomized, a total of 426 (90.4%) completed the follow-up for primary outcomes. Based on imputed data analyses at day seven: Total qRT-PCR negative cases were 137/471 (29%, 95% CI 25.0 - 33.4). By day seven, a total of 111/471 (23.5%, 95% CI 19.8 - 27.6) showed clinical improvement. No serious or non-serious adverse event was reported.

Conclusions: Among patients with mild COVID-19, there was no statistically significant difference in the effectiveness of oral antimalarial, antiviral, or antibiotic treatments.

Clinicaltrials.gov ID: NCT04338698.

doi: https://doi.org/10.12669/pjms.40.5.8757

How to cite this: Azhar S, Akram J, Latif W, Ibanez NC, Mumtaz S, Rafi A, et al. Effectiveness of early pharmaceutical interventions in symptomatic COVID-19 patients: A randomized clinical trial. Pak J Med Sci. 2024;40(5):800-810. doi: https://doi.org/10.12669/pjms.40.5.8757

Esophageal cancer patient survival: A retrospective study from a tertiary care hospital in Pakistan

Sajida Qureshi, Sumayah Khan, M.Saeed Quraishy , Sidra Zaheer — Mon, 25 Mar 2024 08:39:26 +0100

Objective: To determine the pattern, tumor characteristics of esophageal cancer (EC) and survival of esophageal carcinoma patients presenting to upper GI Unit at Dr. Ruth K.M. Pfau Civil Hospital Karachi.

Methods: We conducted a retrospective analysis of histologically confirmed EC patients from 2016 to 2021 at Upper GI Unit – Dr. Ruth K.M. Pfau Civil Hospital, Karachi. Data were collected using a filled Proforma, medical records, pathology reports and surgical notes, and patients or their family members were contacted for informed consent. Statistical analyses were performed using STATA version 16.0. Time to event was measured from the date of diagnosis to the date of the last follow-up or recorded death. Descriptive statistics and survival analyses, including Kaplan–Meier method and log-rank test, were employed. Univariate and multivariate Cox regression analyses were conducted to assess independent predictors of survival.

Results: Total 152 patients with a median age of 45 (range 80-15) years were enrolled in this study. Clinical stages-III, IV-A and IV-B were identified in 35.5% (n = 54), 23.7% (n = 36) and 34.2% (n = 52), respectively. Total of 62% (n=94) had died at median follow up of 9.56 months and three years overall survival rate was 10.0%. Univariate survival analysis revealed that patients with clinical stage-II (p-value 0.002) and patients treated with combined surgery plus chemo-radiotherapy (p-value 0.040) was significantly associated with lower risk of mortality among other stages and treatment modality groups. Conversely, patients having metastasis (p value <0.001) and those with vascular involvement >90 degrees (p value <0.001) showed worse survival outcomes.

Conclusion: Our study reveals a three years survival rate of 10.0%, emphasizing the formidable challenge of advanced-stage malignancies. Clinical stage, vascular involvement, and metastasis emerged as significant predictors of mortality. Moreover, integrating surgery with chemo-radiotherapy significantly improved three years survival (36.8% vs. 14.2%). Despite single-center limitations, our findings provide crucial regional insights into esophageal carcinoma outcomes.

doi: https://doi.org/10.12669/pjms.40.5.7582

How to cite this: Qureshi S, Khan S, Quraishy MS, Zaheer S. Esophageal cancer patient survival: A retrospective study from a tertiary care hospital in Pakistan. Pak J Med Sci. 2024;40(5):811-819. doi: https://doi.org/10.12669/pjms.40.5.7582

Multifactorial analysis of willingness to undergo subcutaneous allergen immunotherapy in pediatric patients

Bo Ding, Jie Zhong, Chun Jiang, Tian Ma, Qiuzhi Shen, Yanming Lu — Tue, 16 Apr 2024 11:47:43 +0200

Objective: To explore factors influencing the acceptance of allergen immunotherapy (AIT) for the treatment of allergic respiratory diseases by pediatric patients and their families.

Methods: A total of 406 children (210 males and 196 females) attending the pediatric outpatient clinics and wards of the Renji Hospital, Shanghai Jiao Tong University School of Medicine from June 2020 to April 2022. Those who met the criteria for the AIT treatment, were included in the survey. An online 20-item questionnaire was developed. Data on patient’s general characteristics, allergic disease status, family history of allergies, general family information, parental knowledge of allergic diseases, and whether the AIT treatment was recommended by a physician, were collected. The patients were divided into two groups according to their willingness to receive AIT: a reluctant or neutral group (n = 182), and a willing group (n = 224). A univariate analysis of the willingness to undergo AIT was done to detect parameters that significantly differed between the groups, and the identified factors were used as independent variables in the multifactorial logistic regression analysis.

Results: The severity of allergic disease, presence of drug allergy, occurrence of severe allergic reactions, mother’s education, distance from home to the hospital, parental knowledge of allergic diseases, and whether the doctor recommended AIT were all statistically different between the groups (p < 0.05). Multifactorial logistic regression analysis showed that the degree of allergic rhinitis (AR), or asthma (AS), parental knowledge of allergic diseases, and doctor’s recommendation of AIT were the factors that influenced the willingness of pediatric patients to receive AIT.

Conclusions: The severity of AR and AS, parental knowledge of allergic diseases, and doctor’s recommendation influenced the willingness of pediatric patients to receive AIT.

doi: https://doi.org/10.12669/pjms.40.5.8581

How to cite this: Ding B, Zhong J, Jiang C, Ma T, Shen Q, Lu Y. Measurement of Service Quality Gaps in Dental Services using SERVQUAL in Public Hospitals of Rawalpindi. Pak J Med Sci. 2024;40(5):820-828. doi: https://doi.org/10.12669/pjms.40.5.8581

Safety of high-risk diabetic patients during Ramadan at a tertiary care hospital in Pakistan, practicing updated IDF DAR guidelines

Qaisar Farooq, Tahir Ghaffar, Suleman Elahi Malik, Azizul Hasan Aamir — Tue, 16 Apr 2024 12:11:02 +0200

Objective: To determine trend of following medical advice and safety of high-risk diabetic patients during Ramadan practicing updated IDF DAR guidelines.

Methods: The cross-sectional study was conducted at Outpatient Department of Diabetes, Endocrinology and Metabolic Disorders Hayatabad Medical Complex Peshawar, Pakistan from April to June 2022, and comprised of high-risk diabetic patients (>6.0) based on updated IDF-DAR guidelines 2022 intending to fast. A questionnaire was designed to document patient risk factors score, type and duration of diabetes, HbA1c, comorbidities and complications developed during Ramadan. Data was analyzed using SPSS 20.

Results: Among all 130 participants, 78(60%) followed medical advice and did not fast and 52(40%) patients fasted against medical advice during month of Ramadan. Out of 130 participants, 89.2% were having type-2 diabetes Mellitus, 55.4% were female and mean age of participants was 52+14.6.40%. In fasting group, 57.7% were in the age range of 16 to 50 years while in non-fasting group 69.2% participants were more than 50 years old (P-value 0.031). There were 80.8% female participants in fasting group versus 38.5% in non-fasting group (P-value 0.001). Hypoglycemia occurred in 58.3% patients in fasting group and 29.3% non-fasting group. (P-value 0.021). On the other hand, 27.8% patients in fasting group and 55.2% of non-fasting group had hyperglycemia (P-value 0.025).

Conclusion: Despite advised against fasting in these high-risk patients as per IDF DAR guidelines, almost half of patients fasted considering fasting a religious obligation. Those who fasted had significant hypoglycemia despite adjustment of medications as in guidelines. There is need of more intensive education before fasting, especially in high-risk diabetic patients.

doi: https://doi.org/10.12669/pjms.40.5.8007

How to cite this: Farooq Q, Ghaffar T, Malik SE, Aamir AH. Safety of high-risk diabetic patients during Ramadan at a tertiary care hospital in Pakistan, practicing updated IDF DAR guidelines. Pak J Med Sci. 2024;40(5):829-834. doi: https://doi.org/10.12669/pjms.40.5.8007

The possible protective role of HLA B27 and relevant immune markers in Juvenile Idiopathic Arthritis patients

Farhana Shahzad, Romeeza Tahir, Faheem Shahzad, Nadeem Afzal — Tue, 16 Apr 2024 12:12:45 +0200

Background & Objectives: JIA is a disease with different immunological characteristics and a complicated genetic foundation. HLA B27 is a risk factor for the development of JIA, and its impact on immunopathogenesis of the disease is also an area of interest. To determine whether HLA B27 and immune markers varied between JIA patients and healthy population.

Methods: This comparative cross-sectional study was conducted at Immunology Department of University of Health sciences (UHS), Lahore from February 2018 till August 2021. A total of (71) JIA patients and (34) healthy controls were enrolled. B cells were enumerated by flowcytometry, ELISA was used for serum cytokines estimation and HLA B27 allele was detected by SPSS polymerase chain reaction.

Results: The HLA B27 allele was significantly more in the control group than in the patient group, suggesting it is a protective allele to prevent JIA. Peripheral blood B cell counts and percentages were significantly lower in the HLA B27 positive group than in the HLA B27 negative group of control population. Serum cytokine levels were not significantly different between the HLA B27 positive and HLA B27 negative allele of the two study populations.

Conclusion: In this study B cells are different between the two groups of control population however; serum cytokines are comparable between the study groups. Though, it was indicated that HLA B27 may be a preventive allele in the onset of JIA.

doi: https://doi.org/10.12669/pjms.40.5.7915

How to cite this: Shahzad F, Tahir R, Shahzad F, Afzal N. The possible protective role of HLA B27 and relevant immune markers in Juvenile Idiopathic Arthritis patients. Pak J Med Sci. 2024;40(5):835-840. doi: https://doi.org/10.12669/pjms.40.5.7915

Ethical leadership behaviors of senior managers perceived by the junior managers working in public hospitals in Hail, Saudi Arabia

Tue, 16 Apr 2024 12:42:58 +0200

Objective: To examine junior managers experiences of ethical leadership behaviors exhibited by their senior managers.

Methods: In this cross-sectional study, 263 junior health care managers working in public hospitals in Hail, Saudi Arabia were surveyed using a self-administered questionnaire between 20 November, 2022 and 15 February, 2023. Descriptive statistics and regression analysis were employed in the analysis. Statistical Package for Social Sciences (SPSS) version 25 (IBM, Armonk, NY, USA) was used to conduct statistical analyses.

Results: The sample consisted of 118 men (44.9%) and the majority (66.6%) of the respondents were below the age of 36 years. In case of working environment, nearly 84% of the participants were satisfied with the relationships that they have had with their supervisors. Regression analysis indicate that women were more likely than men to experience healthy ethical leadership behaviors of their seniors (β = -0.163, p < 0.05). Ethical leadership behaviors of senior health care managers would not influence by the age or work experience of their juniors.

Conclusion: Ethical leadership behavior of senior health care managers was satisfactory. Longitudinal research is needed to investigate how cultural and environmental factors affect the ethical leadership behavior of healthcare managers in Saudi Arabia.

doi: https://doi.org/10.12669/pjms.40.5.8996

How to cite this: Aldhmadi BK, Kumar R, Perera B, Algarni MA, Raguindin SM, Attar AA, et al. Ethical leadership behaviors of senior managers perceived by the junior managers working in public hospitals in Hail, Saudi Arabia. Pak J Med Sci. 2024;40(5):841-845. doi: https://doi.org/10.12669/pjms.40.5.8996

A comparison of the clinical features of molar pregnancy in adolescents and adults

Tue, 16 Apr 2024 12:56:47 +0200

Objective: To compare the age-specific clinical features of molar pregnancy and to describe the risk factors associated with this situation.

Method: This retrospective case-control study was conducted at the Department of Obstetrics and Gynecology. Tepecik Education and Research Hospital, Izmir, Turkey. The participants included both adolescents (≤ 19 years) and adults with histologically confirmed hydatidiform moles in our institution between January 2015 and January 2022. The interventions and main outcome measures of this study involved evaluating the clinical and ultrasonographic features, as well as the risk factors, associated with molar pregnancies in adolescents.

Results: This study of 137 patients with molar pregnancy found that adults had a higher incidence of partial molar pregnancy (20 patients versus seven patients) and lower beta-hCG levels than adolescents (176.890.71 mIU/ml versus 253.734.47 mIU/ml). Adolescents had a higher likelihood of hyperthyroidism (25.4% versus 9.2%). bleeding on admission (4.2% versus 1.51%),. longer hospital stays (5.44 ± 2.73 days versus 3.59 ± 3.08 days). Higher rates of uterine enlargement and postoperative bleeding (15.5% versus 1.5%). Adolescents also required more analgesia (97% versus 89.4%).

Conclusions: Adolescents with Gestational trophoblastic diseases (GTD) may present with more severe symptoms compared to adults, which can lead to delayed diagnosis and treatment. Further research is needed to better understand the underlying mechanisms and risk factors for GTDs in this population. Increased awareness and education can help improve recognition and management of GTDs in adolescents and improve their overall health outcomes.

doi: https://doi.org/10.12669/pjms.40.5.8383

How to cite this: Ozer M, Ozer PT, Karaca I, Karaca S, Ileri A, Budak A. A comparison of the clinical features of molar pregnancy in adolescents and adults. Pak J Med Sci. 2024;40(5):846-850. doi: https://doi.org/10.12669/pjms.40.5.8383

Gestational diabetes mellitus as a risk factor for future Type-2 diabetes mellitus: An experience from a tertiary care diabetes hospital, Karachi - Pakistan

Musarrat Riaz, Nazish Waris, Akifa Saadat, Asher Fawwad, Abdul Basit — Tue, 16 Apr 2024 13:12:41 +0200

Objective: To evaluate the history of gestational diabetes mellitus and other risk factors in women presenting with Type-2 diabetes mellitus at a tertiary care hospital.

Methods: This cross-sectional study was carried out at Baqai Institute of Diabetology & Endocrinology (BIDE), Baqai Medical University (BMU), Karachi-Pakistan from July 2019 to May 2022. Women with Type-2 diabetes mellitus (T2DM) visiting outpatient department of BIDE with a previous history of GDM were recruited. Details were obtained on pre-designed questionnaire after taking informed written consent.

Results: A total of 378 women who had a prior history of GDM were included. Mean age (years) was 43.53±10.17. Mostly women were obese (BMI = 30.53±6.08) and have sedentary lifestyle. Mean HbA1c (%) was 9.08±2.24. This study found family history of T2DM and hypertension were common risk factors in women with GDM history. Mostly, women were diagnosed as GDM during 2nd trimester 153(42%) and was mainly seen in multiparous women (occur in 4th and above pregnancy). We found hypertension as common complication during pregnancy. Around 46% women developed T2DM within one year of GDM diagnosis, and 29.6% between one to five years.

Conclusion: Majority of women with GDM developed T2DM within five years of diagnosis. The potential associated risk factors were age, family history of diabetes, insulin use during pregnancy, trimester of GDM diagnosis, and hypertension during pregnancy. Awareness and life style modifications along with regular post-partum follow up with screening for T2DM should be part of GDM management to prevent or delay the occurrence of this serious complication.

doi: https://doi.org/10.12669/pjms.40.5.7507

How to cite this: Riaz M, Waris N, Saadat A, Fawwad A, Basit A. Gestational diabetes mellitus as a risk factor for future Type-2 diabetes mellitus: An experience from a tertiary care diabetes hospital, Karachi - Pakistan. Pak J Med Sci. 2024;40(5):851-856. doi: https://doi.org/10.12669/pjms.40.5.7507

Facial morphology analysis of children with non-syndromic cleft lip and palate in a local population

Rabia Anjum, Saqib Mahmood, A H Nagi, Saima Chaudhry — Tue, 16 Apr 2024 13:37:24 +0200

Objectives: To study the facial morphology in children with non-syndromic cleft lip and palate by applying numerical facial analysis on photographs for planning and evaluating treatment outcomes.

Methods: This descriptive study was conducted from March 2020 to July 2020 in the Department of Oral Pathology, University of Health Sciences and Cleft Lip and Palate Hospital, Lahore Pakistan. A total of 104 patients of both genders with an age range from three months to thirteen years were included. Photographs of the participants were taken to measure facial anthropometrical landmarks including facial height, nose width, mouth width and inter canthal distance. The association between facial measurements with gender and phenotype and across age groups were computed keeping the confidence level at 95%.

Results: Mean age of the children was 72.43±44.2 months with slight male predominance. Thirty-one percent presented with bilateral cleft lip and palate followed by unilateral cleft lip and plate. Total mean facial height, nose width and mouth width were found to be 143.46±21.52mm, 32.24±5.03mm and 33.71±4.38mm respectively. Intercanthal distance was measured to be 31.04±5.99mm. Statistically significant association was observed between gender and facial height, nose width, mouth width and Intercanthal distance.

Conclusion: Facial anthropometric measures done on frontal photographs can be used to identify the facial landmarks in children with non-syndromic cleft lip and palate in low resource stings that may help surgeons in getting better aesthetic outcomes. These landmarks vary between ethnic groups therefore these should be specific to a particular race and ethnicity so as to ensure proper aesthetics and improved quality of life for the children of all nations.

doi: https://doi.org/10.12669/pjms.40.5.8485

How to cite this: Anjum R, Mahmood S, Nagi AH, Chaudhry S. Facial morphology analysis of children with non-syndromic cleft lip and palate in a local population. Pak J Med Sci. 2024;40(5):857-863. doi: https://doi.org/10.12669/pjms.40.5.8485

Association of single nucleotide polymorphism rs3213119 variant of IL-12B gene in diagnosed Rheumatoid Arthritis patients

Tue, 16 Apr 2024 13:41:00 +0200

Objective: To identify the IL12B gene variant (rs3213119) and to find its association in Pakistani clinical population of Rheumatoid Arthritis.

Methods: It was a population association (unrelated) case control study, performed from January - December 2022 at Laboratory of Department of Biochemistry and Molecular Biology, Army Medical College, Rawalpindi. Blood samples were collected from all 150 study participants, followed by DNA extraction and Allele-specific polymerase chain reaction performed at Center for Research in Experimental and Applied Medicine (CREAM) Laboratory of Department of Biochemistry and Molecular Biology, Army Medical College Rawalpindi. Statistical analysis was done using ‘SPSS’ (version-22), followed by gene analysis on ‘SNPstat’.

Results: About 28.0% of RA patients were smokers, 38.7% had history of RA in a first degree relative and 70.7% had positive history of consanguinity. Considering rs3213119 variant of IL12B gene, frequency of major allele C was 100%, minor allele A was 21%, genotype C/C was 79% and C/A was 21%. Applying the log additive model, the odds ratio of the genotype C/C was 1.00 (adjusted by age and gender with 95 % CI) and the odds ratio of the genotype C/A was 0.00, 52.0% of RA patients originated from four predominant ethnic groups, namely Awaans (18.7%), Rajputs (14.7%), Pathans (12.0%) and Araeens (6.7%).

Conclusion: The study findings suggest the role of minor allele ‘A’ as risk allele in our clinical population. CA genotype confers susceptibility towards the RA development.

doi: https://doi.org/10.12669/pjms.40.5.7671

How to cite this: Mushtaq I, Rashid A, Fakhr A, Majeed A, Rathore A, Baig ZA. Association of single nucleotide polymorphism rs3213119 variant of IL-12B gene in diagnosed Rheumatoid Arthritis patients. Pak J Med Sci. 2024;40(5):864-869. doi: https://doi.org/10.12669/pjms.40.5.7671

Enoxaparin sodium combined with magnesium sulfate in the treatment of severe preeclampsia

Dawei Lu, Jie Yu, Lin Sang — Tue, 16 Apr 2024 13:41:59 +0200

Objective: To observe the treatment of severe preeclampsia in newborns with enoxaparin sodium combined with magnesium sulfate.

Methods: A retrospective analysis was conducted on the clinical data of 80 patients with severe preeclampsia admitted to Hefei Second People’s Hospital, China from January 2019 to December 2020. Treatment records showed that 40 cases received magnesium sulfate treatment (single group), and 40 cases received enoxaparin sodium combined with magnesium sulfate treatment (combination group). Levels of D-dimer, soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PLGF), Apgar scores of newborns delivered before and after treatment were compared. Gestation weeks and incidence of adverse reactions were analyzed.

Results: After treatment, levels of D-dimer, sfit-1 and adverse reactions in the combination group were significantly lower than those in the single group (P<0.05), and the level of PLGF, newborn Apgar score and length of gestation were significantly higher than those in the single group (P<0.05).

Conclusion: Compared to magnesium sulfate alone, the combination of enoxaparin sodium and magnesium sulfate in the treatment of pregnant women with severe preeclampsia can more effectively regulate the cytokine level of patients, improve pregnancy outcome, and improve neonatal Apgar score. The incidence of adverse reactions is low, making it a safe and efficient treatment modality.

doi: https://doi.org/10.12669/pjms.40.5.9001

How to cite this: Lu D, Yu J, Sang L. Enoxaparin sodium combined with magnesium sulfate in the treatment of severe preeclampsia. Pak J Med Sci. 2024;40(5):870-874. doi: https://doi.org/10.12669/pjms.40.5.9001

Densitometry of STR-PAGE for donor chimerism in acute leukemia’s: A simple method for routine use

Ayesha Nayyar, Suhaib Ahmed — Tue, 16 Apr 2024 13:43:12 +0200

Objective: To evaluate a PCR based method of polyacrylamide gel electrophoresis of short tandem repeats and its quantification for detecting donor chimerism after haematopoietic stem cell transplantation in acute leukaemias.

Methods: The descriptive study was conducted at Genetic Resource Centre (GRC) Lab Rawalpindi from Feb 2018 - Nov 2020. A total of twenty patients with acute leukaemias having undergone HSCT were selected and assessed for the analysis of chimerism status. DNA extraction from the whole blood was done by chelex method and short tandem repeats were amplified by using conventional STR- PCR assay. Electrophoresis was carried out and 6% polyacrylamide gels were used for the resultant amplified DNA products and then followed by their densitometry. These patients had undergone HSCT from Pakistan Institute of Medical Science and Armed Forces Bone Marrow Transplant Centre.

Results: The peaks in the PAGE densitometry represented the donor chimerism in all post transplant samples of the patients.

Conclusion: Our study showed that densitometry of STR PCR PAGE is a useful and cheaper method for demonstration of donor chimerism in acute leukaemia patients having undergone HSCT. Hence this method can be a valuable option in the monitoring of chimerism status in these patients and therefore helps in preventing graft failure by fast and early treatment strategies for these patients.

doi: https://doi.org/10.12669/pjms.40.5.9216

How to cite this: Nayyar A, Ahmed S. Densitometry of STR-PAGE for donor chimerism in acute leukemia’s: A simple method for routine use. Pak J Med Sci. 2024;40(5):875-878. doi: https://doi.org/10.12669/pjms.40.5.9216

Outcomes of AV fistula formation for dialysis patients using interrupted sutures one-year single center study

Farah Naz, Rana Hassan Javaid, Sara Noor, Hira Katpar — Wed, 17 Apr 2024 06:24:40 +0200

Objectives: To document the Outcomes of AV fistula formation for dialysis patients using interrupted sutures.

Methods: In this Cross-sectional study conducted at PNS Shifa Karachi, from June 2022 to June 2023, patients above 18 years of age, male or female, with ESRD/CKD were included. After clinical screening and ultrasound doppler, the distal most part of wrist was considered as a site for radio cephalic AVF. Operation was performed under surgical loupe with 4.5x magnification. Standard incision of about 4-5 cm oblique proximal to the wrist crease was given at the volar surface on the radial side of Distal forearm, extending till the lateral side up to the snuffbox. Subcutaneous tissue was incised and dissection was done to identify the cephalic vein and radial artery. Distal most end of the cephalic vein was ligated using vicryl 4-0 suture and cephalic vein dissected free from the underling tissue to mobilize it up to the radial artery.

Results: During the study N=35 patients who required AVF creation visited the department. The mean age of the study participants was 59.34±15.48. If thrill at the site of AVF and backflow at cut end of cephalic vein were present the surgeons were satisfied, higher satisfaction among the surgeon was achieved in the AVF created at brachiocephalic artery while the diameter of vessels didn’t contribute in surgeon satisfaction.

Conclusion: Presence of thrill at the site of AVF and backflow at cut end of cephalic vein have strong association with good prognosis of AVF.

doi: https://doi.org/10.12669/pjms.40.5.8990

How to cite this: Naz F, Javaid RH, Noor S, Katpar H. Outcomes of AV fistula formation for dialysis patients using interrupted sutures one-year single center study. Pak J Med Sci. 2024;40(5):879-883. doi: https://doi.org/10.12669/pjms.40.5.8990

Urdu Receptive Language Scale (URLS): Modification & development of protocol for administration in Urdu

Ghazal Awais Butt, Nazia Mumtaz, Ghulam Saqulain — Wed, 17 Apr 2024 06:29:46 +0200

Objective: To conduct pretesting of Urdu Receptive Language Scale (URLS) for scale modification and development of protocol for administration on children.

Methods: This exploratory research was conducted from December 2021 to June 2022 in Lahore, Pakistan. Objective was achieved by pretesting in three steps including literature review, expert review and pilot testing on infants, toddlers and children aged 0-6 years utilizing purposive sampling technique. For expert review five experts’ speech language pathologists with minimum five years of experience and for pilot study 48 normal developing children age range birth to six years were recruited. The analysis was done using content validity ratio, content validity index and Cronbach alpha. Protocol for administration of test items and stimulus with minimum three correct responses among four children’s responses were finalized.

Results: Of the 59 items, 57 with CVR = 0.99 were retained. Item number 3 (age 6-11 months) and item 5 (age 3.6-3.11 years) were eliminated as CVR was <0.99. CVI was one for retained items indicating acceptable validity. Cronbach’s alpha was 0.95 indicating high level of internal consistency for the scale. Task groups of protocol of administration directions included: Selection of scale items, testing environment, seating arrangements, rapport building and involving the caregiver, handling the scale material and scoring the task responses.

Conclusion: The modified 57 items has high validity and internal consistency with suitable protocol of administration. It is linguistically appropriate for the application on larger scale with children of different cultural backgrounds in Pakistan.

doi: https://doi.org/10.12669/pjms.40.5.7471

How to cite this: Butt GA, Mumtaz N, Saqulain G. Urdu Receptive Language Scale (URLS): Modification & development of protocol for administration in Urdu. Pak J Med Sci. 2024;40(5):884-890. doi: https://doi.org/10.12669/pjms.40.5.7471

Effect of Clopidogrel combined with aspirin in the treatment of acute progressive cerebral infarction: A retrospective single-center analysis

Huiying Huang, Shan Zhang, Hong Du, Yonghua Guo, Hui Zheng — Wed, 17 Apr 2024 06:30:52 +0200

Objective: To explore the effect of clopidogrel combined with aspirin in the treatment of acute progressive cerebral infarction (APCI).

Methods: We retrospectively analyzed the records of 190 patients with APCI admitted to Chengdu First People’s Hospital from September 2020 to April 2023. The records were divided into an aspirin group (76 cases), a clopidogrel group (72 cases), and a clopidogrel plus aspirin group (42 cases) according to the treatment records. We compared the efficacy of the three treatment outcomes by analyzing the National Institutes of Health Stroke Scale (NIHSS) scores, and the levels of serum inflammatory factors (IL-8, TNF-α, and IL-1β), cone like protein-1 (VILIP-1), and caveolin-1 (Cav-1).

Results: The total efficacy of the combination group (97.62%) was significantly higher than those of the aspirin group (73.68%) or the clopidogrel group (79.17%) (p<0.05). After treatment, the NIHSS scores, inflammatory factor levels, serum VILIP-1 and Cav-1 levels were significantly lower than those before treatment in the three groups, but all the levels were significantly lower in the combination group (all p<0.05).

Conclusions: Our results indicate that compared with aspirin alone or clopidogrel alone, the combination of aspirin and clopidogrel is more effective for the treatment of APCI. The combination regimen effectively lowers serum inflammatory factors (IL-8, TNF-α, and IL-1β), as well as the VILIP-1 and Cav-1 levels.

doi: https://doi.org/10.12669/pjms.40.5.9206

How to cite this: Huang H, Zhang S, Du H, Guo Y, Zheng H. Effect of Clopidogrel combined with aspirin in the treatment of acute progressive cerebral infarction: A retrospective single-center analysis. Pak J Med Sci. 2024;40(5):891-895. doi: https://doi.org/10.12669/pjms.40.5.9206

Analysis of human ABO Blood Group as a risk factor with knee osteoarthritis at tertiary care hospital in Pakistan

Shazia Rahman Shaikh, Aneela Atta Ur Rahman, Asadullah Makhdoom — Wed, 17 Apr 2024 06:32:56 +0200

Objective: To investigate the association and risk estimation of ABO blood group distribution and clinical attributes in patients with Knee Osteoarthritis.

Method: This was a hospital-based study conducted at, Liaquat University Hospital Hyderabad from December, 2019 to December, 2022 to investigate this least researched area of highly prevalent musculoskeletal disease in Pakistan. Non-Probability Convenience Sampling was used for selecting 190 cases of confirm Knee Osteoarthritis patients diagnosed by Orthopedic surgeon based on standard clinical and radiographic criteria. Data were analyzed using IBM-SPSS version 23.0. Percentages and frequencies were counted for categorical data. Pearson Chi Square test and fisher’s exact test were used to check the association and Multinomial Logistic Regression was used to estimate the risk for moderate and severe kellgren grading Knee Osteoarthritis (KOA) cases with ABO blood grouping in comparison of mild Kellgren grading.

Results: A total of 190 cases of Knee Osteoarthritis (KOA) were included in the study. Females (61.6%) and patients with age 50 and above were 40.5 % were found in greater proportion. Majority (41.6%) were classified radiologically as mild cases with O group (39.5%) and positive Rh antigen (95.8%). Strong association (p = <0.01) was found between gender, age group and ABO blood group with KOA radiological Kellgren and Lawrence score.

Conclusion: There is strong relation in between radiological grading of knee osteoarthritis severity and A blood group, gender and age.

doi: https://doi.org/10.12669/pjms.40.5.8865

How to cite this: Shaikh SR, Atta Ur Rahman A, Makhdoom A. Analysis of human ABO Blood Group as a risk factor with knee osteoarthritis at tertiary care hospital in Pakistan. Pak J Med Sci. 2024;40(5):896-900. doi: https://doi.org/10.12669/pjms.40.5.8865

Assessing the predictive validity of Provincial Medical & Dental College Admission Test (MDCAT)

Saira Rahim, Mahwish Arooj — Wed, 17 Apr 2024 06:34:32 +0200

Objective: To assess the predictive validity of Punjab Provincial Medical & Dental College Admission Test (MDCAT).

Methods: A retrospective correlational study was conducted at the Fatima Memorial Hospital College of Medicine & Dentistry in Lahore, Pakistan. Data were analysed from 415 medical students who had completed the MBBS program from 2018-2020. Bivariate and multivariable regression models were used to adjust for confounders such as age, gender, city of origin, and pre-medical performance. A novel performance-trajectory analysis was used to evaluate whether students with different preadmission MDCAT scores had different performance trajectories in medical school.

Results: On simple bivariate analysis, there was a weak but significant (correlational coefficient 0.22-0.33, p<0.001) correlation between MDCAT scores and professional exam scores for all years of medical college. However, multivariable analysis of Matric/Fsc track showed no significant correlation (p > 0.05) between MDCAT and professional exam scores after the first two years. For O/A level students, there was no correlation between MDCAT and professional exam scores for any year of medical college (p>0.05). Trajectory analysis showed that students with exceptionally high MDCAT scores had a superior performance trajectory compared to those with the lowest quartile of MDCAT scores while students with average MDCAT scores had overlapping performance trajectories.

Conclusion: For students from the Matric/FSc track only, there is a weak but significant correlation between MDCAT scores and professional exam scores for the first two years. No such correlation exists for O/A level students. Exceptionally high MDCAT scores are predictive of higher achievement in professional exam scores.

doi: https://doi.org/10.12669/pjms.40.5.7766

How to cite this: Rahim S, Arooj M. Assessing the predictive validity of Provincial Medical & Dental College Admission Test (MDCAT). Pak J Med Sci. 2024;40(5):901-906. doi: https://doi.org/10.12669/pjms.40.5.7766

Evaluation of the relationship between oral glucose tolerance test, blood sugar levels and cholesterol levels in prediabetic individuals

Esra Aksoy Oduncu, Egemen Tural, Akin Dayan — Wed, 17 Apr 2024 06:36:00 +0200

Objective: This study aimed to investigate whether there is a difference in lipid levels between prediabetic individuals with one-hour post-Oral Glucose Tolerance Test (OGTT) plasma glucose (PG) values > 155 mg/dl and those with one-hour PG values ≤ 155 mg/dl.

Methods: This retrospective cross sectional study was initiated on August 2020 and concluded on June 2021, and conducted with 229 prediabetic patients who presented to the Diabetes Clinic of the Research Hospital. A correlation analysis was performed to investigate the relationship between OGTT values and serum lipid levels. Additionally, the patients were divided into two groups based on the one-hour post-OGTT PG value of 155 mg/dl, and the presence of any difference in serum lipid levels between the two groups was examined using the Mann-Whitney U test. The SPSS 20 software was used for statistical analysis, and a statistical significance level of P < 0.05 was considered.

Results: Out of the 229 prediabetic patients included in the study, 172 were female. The number of patients with one-hour post-OGTT PG ≤ 155 mg/dl was 86, while those with values > 155 mg/dl were 143. A statistically significant difference was found between the group with one-hour post-OGTT PG > 155 mg/dl and the group with ≤ 155 mg/dl in terms of high-density lipoprotein (HDL-C) and triglyceride (TG) levels. There was a statistically significant negative correlation between one-hour PG and HDL-C.

Conclusion: The evaluation of HDL-C and TG levels is important in prediabetic patients with a one-hour OGTT PG level greater than 155 mg/dL.

doi: https://doi.org/10.12669/pjms.40.5.8292

How to cite this: Oduncu EA, Tural E, Dayan A. Evaluation of the relationship between oral glucose tolerance test, blood sugar levels and cholesterol levels in prediabetic individuals. Pak J Med Sci. 2024;40(5):907-912. doi: https://doi.org/10.12669/pjms.40.5.8292

Intrinsic motivation between face-to-face and blended learning in surgical clinical education

Masood Jawaid, Zubia Masood, Nazish Imran — Wed, 17 Apr 2024 06:50:02 +0200

Objective: The variability and opportunistic nature of surgical clinical education is the main problem for effective teaching and training of medical students. Incorporating online mediums including discussion forums, interactive videos/scenarios, static pages, and quizzes is known as blended learning (BL). This study aimed to compare the intrinsic motivation of surgical students enrolled in blended learning to those enrolled in face-to-face teaching (f2f teaching).

Methods: A quasi-experimental, cross-over study was conducted in Surgical Unit-I and Surgical Unit-II of Dow University Hospital, Karachi, from March to August 2014. A total of 31 students participated and were exposed to two different teachings. For the first four weeks, Group A was posted in Surgical-I (f2f teaching) and Group B in Surgical-II (BL). Both groups were taught the same contents with the same schedule. The F2F group had clinical exposure to real patients, and small group discussions (SGDs) while The BL group students were exposed to an additional online learning component. Intrinsic Motivation Inventory (IMI) was administered at the end of four weeks and groups were swapped. Exchanged groups were again taught the same contents with the same schedule for another four weeks and IMI was administered.

Results: Fifty-eight students completed IMI; 28 in f2f and 30 in BL group. There was a significant difference in all four subscales of IMI between the two groups. In three subscales, students in BL were more motivated as compared to f2f (p<0.01). Students in f2f experienced more perceived tension than in BL (p<0.048).

Conclusion: This study concluded that blended surgical learning programs keep medical students more intrinsically motivated to learn. By utilizing online learning, superior educational opportunities for students can be cultivated. It can result in enhanced faculty effectiveness and efficiency as well.

doi: https://doi.org/10.12669/pjms.40.5.1048

How to cite this: Jawaid M, Masood Z, Imran N. Intrinsic motivation between face-to-face and blended learning in surgical clinical education. Pak J Med Sci. 2024;40(5):913-917. doi: https://doi.org/10.12669/pjms.40.5.1048

Demographic characteristics and short-term outcomes of laparoscopic colon cancer surgeries at a newly developed cancer center in Peshawar, Pakistan

Riaz Ahmad, Hussain Jan Abbasi, Irfan Ul Islam Nasir, Muhammad Fahd Shah — Wed, 17 Apr 2024 07:13:29 +0200

Objective: In Pakistan, colon cancer ranks fourth in incidence, exhibiting survival rates of 90% to 14%, contingent on TNM staging and early detection. This research focuses on the demographic involvement and short-term outcomes of elective colon cancer resections at a newly established tertiary care cancer center utilizing laparoscopic procedures.

Method: A retrospective analysis of elective laparoscopic colorectal resections at Shaukat Khanum Memorial Cancer Institute and Research Centre, Peshawar, from April 2021 to February 2022 was conducted. Out of 157 cases, 79 had colon cancer. Criteria included patients >18 years old with positive biopsies; consent non-providers were excluded. Statistical analysis employed descriptive statistics and cross-tabulations using SPSS-22.

Results: The study encompassed biopsy-confirmed colon cancers in patients >18 years. 157 colorectal cases were performed, including 79 colon cancers. The sample comprised 61 males (77.2%) and 18 females (22.7%), mean age 42 years. Most patients (33%) were in the 36-45 age group. Majority were from KPK (69.6%), followed by Afghanistan (24%). Tumors were predominantly in the ascending colon (30.3%). Most were moderately differentiated (70.8%). Mean lymph node yield was 19.0, with 1.2% requiring open laparotomy. Post-discharge, one readmission occurred within 30 days. Mortality within 90 days was 2%, attributed to aspiration pneumonia and chemotherapy-related effects.

Conclusions: Elective laparoscopic colonic surgery exhibits safety and efficacy in treating colon cancer. The study provides evidence of minimal morbidity and mortality, low readmission rates, and absence of anastomotic leaks. Hence, elective laparoscopic colonic surgery should be favored due to fewer post-operative complications and superior short-term outcomes. Larger studies on colon cancer are imperative for enhanced healthcare delivery.

doi: https://doi.org/10.12669/pjms.40.5.8732

How to cite this: Ahmad R, Abbasi HJ, Nasir II, Shah MF. Demographic characteristics and short-term outcomes of laparoscopic colon cancer surgeries at a newly developed cancer center in Peshawar, Pakistan. Pak J Med Sci. 2024;40(5):918-921. doi: https://doi.org/10.12669/pjms.40.5.8732

Weight reduction among females undergoing laparoscopic ventral hernia repair: The role of Calcium and Vitamin D3

Wed, 17 Apr 2024 08:03:59 +0200

Objective: To evaluate the role of Vitamin-D and calcium supplementation on preoperative weight reduction in obese women before laparoscopic ventral hernia repair.

Methods: This double-blind clinical trial was conducted at the affiliated health centers of King Faisal University, Al-Ahsa, Saudi Arabia from January 2021 to December 2021. It included forty-five obese women aged 24-56 years, with body mass index (BMI) of 34.0–48.0 kg/m2. They were randomly allocated into two groups; the Group-A (N=22) included obese women who received supplementation of 5000 IU cholecalciferol (Vitamin-D3), and 1000 mg calcium daily for 12 months, while the Group-B (N=23) received no treatment. Measurement of change in weight and BMI and comparison of their pre-operative weight reduction, laparoscopic operative time, and length of hospital stay was done.

Results: There were no differences in patients’ biographic data between the two groups. During the study, Vitamin-D level in the patients increased and there was a significant positive association with weight loss. In group-A, the mean weight loss was 11.8±3.5 kg. At the end of first year, their BMI decreased from 36.1±1.6kg/m2 at baseline to 29.7±2.6 kg/m2, whereas in-group-B, the mean weight loss was 6.8±3.1 kg and their BMI decreased from 36.9±2.69kg/m2 at baseline to 32.7±0.93kg/m2. The operation time and the length of hospital stay were shorter in group-A (107 vs.128.min) and (3 vs. 5 days) respectively as compared to Group-B.

Conclusion: Vitamin-D and calcium supplementation contributes to a remarkable weight reduction of preoperative obese female patients, which in turn is associated with significantly better outcome of laparoscopic repair of ventral hernia.

doi: https://doi.org/10.12669/pjms.40.5.9047

How to cite this: AlMulhim SA, AlNaim MM, Khan AS, Memon AQ, AlArfaj HM, Al Abdulqader AA, et al. Weight reduction among females undergoing laparoscopic ventral hernia repair: The role of Calcium and Vitamin D3. Pak J Med Sci. 2024;40(5):922-926. doi: https://doi.org/10.12669/pjms.40.5.9047

Comparison of doses of Nebulized Magnesium sulphate as an adjuvant treatment with salbutamol in children with Status Asthmaticus

Rabia Asif, Heena Rais, Prinka Bai, Ramsha Aziz — Wed, 17 Apr 2024 08:33:59 +0200

Objectives: To compare the response between different doses of nebulized magnesium sulphate along with Salbutamol in children between two to 12 years of age with status asthmaticus.

Methods: This single blinded, randomized clinical trial was carried out at the Department of Pediatrics, Dr. Ziauddin University Hospital, Karachi, Pakistan during October 2021 to September 2022. A total of 104 children aged between 2-12 years, with the diagnosis of asthma having “Pediatric Rapid Assessment Measure (PRAM)” score>4 and with reactive airways were included. Children either received three back-to-back nebulization with salbutamol solution only (n=50) or salbutamol and MgSO4 with three different doses (250mg, 500mg or 750mg) after every 20 minutes for 60 minutes. The PRAM score was used as an assessment tool to clinically score asthma.

Results: In a total of 104 children, 53 (51.0%) were girls. The mean age was 5.25±2.86 years. No statistically significant difference was found in PRAM scores at baseline (p=0.448) and at 20-minutes (p=0.072) but significant differences were observed at 40-minutes (p=0.009), 60-minutes (p=0.011), 120-minutes (p=0.010), 6-hours (=0.034), 12-hours (p=0.018), 18-hours (p=0.033) and at 24-hours (p=0.029). The reduction in PRAM scores from baseline to 24-hours following treatment among Salbutamol, Salbutamol+ MgSo4 250mg, Salbutamol+ MgSo4 500mg and Salbutamol+ MgSo4 750mg group were 6.53±1.09, 7.22±1.09, 6.85±1.43 and 7.57±1.06 respectively (p=0.007).

Conclusion: While children with status asthmaticus managed using salbutamol, with or without nebulized MgSO4, showed improved clinical outcomes, combining salbutamol with higher dosages of nebulized MgSO4 resulted in even greater clinical improvement.

Clinical Trial Registry: https://clinicaltrials.gov/ct2/show/NCT04929626.

doi: https://doi.org/10.12669/pjms.40.5.7682

How to cite this: Asif R, Rais H, Bai P, Aziz R. Comparison of doses of Nebulized Magnesium sulphate as an adjuvant treatment with salbutamol in children with Status Asthmaticus. Pak J Med Sci. 2024;40(5):927-932. doi: https://doi.org/10.12669/pjms.40.5.7682

Predictors of cognitive impairment and its association with mortality in maintenance hemodialysis patients: A prospective follow-up study

Muhammad Anees, Shahabaz Pervaiz, Samreen Aziz, Irfan Elahi — Wed, 17 Apr 2024 08:42:49 +0200

Objective: To determine predictors of cognitive impairment (CI) and its association with mortality in maintenance haemodialysis (MHD) patients.

Methods: This prospective follow up study was conducted at HD Department, Mayo Hospital, Lahore from September, 2021 to November, 2022. All patients undergoing MHD for more than three months and having age between 18-65 years were included while those with dialysis duration less than three months, history of neuropsychiatric illness was excluded. Cognitive function was assessed using British Columbia Cognitive Complaints Inventory (BC-CCI) questionnaire. CI was defined on Likert scale as mild, moderate, and severe. Patients were followed up to one year regarding outcome measures.

Results: One hundred and four patients were included in the study. Mean age was 45.86±11.11 years and Diabetes Mellitus (DM) was the most common cause of End Stage Renal Disease (ESRD) in 39(37.5%) patients. CI was found in 86(82.7%) patients in following order of severity: mild 61(58.7%), moderate 19(18.3%) and severe 6(5.9%). Increasing age (≥50 years), gender (female), Diabetes Mellitus (DM), unemployment and education <10th grade were found as significant predictors of CI (p<0.05). Significant positive correlations of CI score with age (r=0.338, p<0.001) and MHD duration (r=0.211, p=0.032) were found. However, the CI was not significantly associated with mortality (p=0.302).

Conclusion: CI was common in MHD patients. Factors affecting CI were increasing age, female gender, DM, unemployment and low education level. CI was not associated with mortality in MHD patients.

doi: https://doi.org/10.12669/pjms.40.5.7836

How to cite this: Anees M, Pervaiz MS, Aziz S, Elahi I. Predictors of cognitive impairment and its association with mortality in maintenance hemodialysis patients: A prospective follow-up study. Pak J Med Sci. 2024;40(5):933-938. doi: https://doi.org/10.12669/pjms.40.5.7836

Up-regulation of systemic and local BDNF in non-allergic Nasal Polyps in China

Xiangmin Zhou, Qian Zhang, Yuzhu Wan Yuzhu Wan, Li Shi — Wed, 17 Apr 2024 09:27:21 +0200

Objective: Although the role of brain-derived neurotrophic factor (BDNF) in allergic rhinitis and/or nasal polyps (NPs) development has been studied, the contribution of BDNF in non-allergic NPs has not been evaluated yet. This study was to investigate the possible role of BDNF in non-allergic NPs pathogenesis.

Methods: The study was carried out at The Second Hospital of Shandong University from December 2020 to November 2021. The non-allergic NPs patients (n=26) and the control group (n=22) were included. Lund-Mackay CT scores, nasal endoscopy scores, and pulmonary function testing were evaluated before surgery. Tissue and serum levels of BDNF, eosinophil cationic protein (ECP), and cytokeratins 5 (CK5) were assessed between different groups.

Result: The BDNF level in serum and tissue, CK5 count, and eosinophil infiltration in tissue were higher in non-allergic NPs. The eosinophils infiltration, ECP mRNA expression level, as well as BDNF mRNA level were increased in the BDNFhigh subgroup compared with BDNFlow subgroup. Significantly negative correlations between BDNF count and the situation of airway obstruction were found in non-allergic NPs.

Conclusion: BDNF may have both local and systemic effects in non-allergic NPs pathogenesis. BDNF may be a possible therapeutic target or an indicator for eosinophilic NPs management.

doi: https://doi.org/10.12669/pjms.40.5.7907

How to cite this: Zhou X, Zhang Q, Wan Y, Shi L. Up-regulation of systemic and local BDNF in non-allergic Nasal Polyps in China. Pak J Med Sci. 2024;40(5):939-945. doi: https://doi.org/10.12669/pjms.40.5.7907

Outcome of the incarcerated abdominal wall hernias managed by open and laparoscopic approaches

Hamed A AlWadaani, ABDUL QADEER MEMON — Wed, 17 Apr 2024 09:29:10 +0200

Background & Objective: Laparoscopic surgery is generally considered as better than open surgery in terms of less complications, minimal hospital stays and quick healing of the wounds. Our objective was to compare the immediate and early outcome of the different incarcerated hernias of anterior abdominal wall operated on as emergency cases by open and laparoscopic approach.

Methods: This is a retrospective comparative study which was conducted at two hospitals of AlAhsa city of the Eastern region of the Kingdom of Saudi Arabia from July, 2017 to June, 2022. The data were retrieved from the medical records of the hospitals. All male and female patients having different types of incarcerated hernias of anterior abdominal wall presenting to the emergency room were included in the study. The patients were divided in two groups; those who were operated on by open approach (Group-I) and those who were operated on by laparoscopic approach (Group-II).

Results: Out of total 70 male and female patients, 42 were in Group-I and 28 in Group-II. The variety of the incarcerated hernias in both groups overall was para-umbilical 26(37.14%), incisional 18(25.71%), inguinal (right & left) 17(24.28%) and epigastric 9(12.86%). The mean operative time taken by Group I and II was 126.07 (±9.728) and 98.57 (±10.079) minutes respectively with a difference of 27.50 minutes (p=0.807). The mean hospital stay of the patients in Group I and II was 1.36(±0.719) and 1.57(±0.997) days respectively (p=0.482). The post-operative complications rate in Group-I was 6(14.28%) and in Group-II, 6(21.43%) (p=0.658). Overall, 12(17.14%) patients developed the complications in both groups. When the number of the complications is compared, it shows that there was no significant difference between the two groups (p=0.583).

Conclusion: Laparoscopic approach is not superior to the open approach in the terms of the immediate and early outcome/complications of the incarcerated hernias of the anterior abdominal wall operated as emergency cases in this study.

doi: https://doi.org/10.12669/pjms.40.5.8899

How to cite this: AlWadaani HA, Memon AQ. Outcome of the incarcerated abdominal wall hernias managed by open and laparoscopic approaches. Pak J Med Sci. 2024;40(5):946-950. doi: https://doi.org/10.12669/pjms.40.5.8899

Correlation of uric acid with microalbuminuria in Type-2 diabetic patients with normal creatinine

Saima Zeb, Bakht Babar, Samina Bibi, Muhammad Akbar Shah — Wed, 17 Apr 2024 09:31:45 +0200

Objective: To find the correlation of serum uric acid with microalbuminuria in Type-2 diabetic patients with normal creatinine.

Methods: This cross-sectional study was conducted in the Department of Diabetes, Endocrinology and Metabolic diseases, Hayatabad Medical Complex, Peshawar, Pakistan from 1st April, 2022 to 30th September, 2022. Total 160 diabetic patients between the age of 30 and 65 years were enrolled in the study. Type-2 diabetic patients with microalbuminuria between 2.5 and 30 mg/mmol were included. The demographic details of patients were recorded in the questionnaire after taking consent. Fasting Uric acid, lipid profile and glucose along with creatinine and HbA1C were estimated from patient’s venous blood samples. Ratio of albumin to creatinine (ACR) in the random spot urine sample was used to detect microalbuminuria.

Results: Out of 160 participants enrolled in the study there were 86 (54%) males and 74 (46%) females with the mean age of 50.15 ± 11.1 years and BMI of 20.93 kg/m2. Ninety six (60%) of the patients had Type-2 DM for less than five years, while remaining 64 (40%) were more than five years diabetic. Mean serum uric acid calculated was 6.85±2.06(mg/dl), while microalbuminuria was calculated as 8.02±0.78 (mg/mmol). The Pearson correlation of serum uric acid and microalbuminuria based on sex and age was statistically significant(p<0.05).

Conclusion: We found that uric acid level was significantly associated with microalbuminuria in people with Type-2 diabetes with normal serum creatinine. Uric acid level can be a potential screening tool for early detection of DKD.

doi: https://doi.org/10.12669/pjms.40.5.8208

How to cite this: Zeb S, Babar B, Bibi S, Shah MA. Correlation of uric acid with microalbuminuria in Type-2 diabetic patients with normal creatinine. Pak J Med Sci. 2024;40(5):951-955. doi: https://doi.org/10.12669/pjms.40.5.8208

Analysis of factors affecting the clinical efficacy and quality of life in the treatment of pediatric acute lymphoblastic leukemia

Dan Liu, Yi-fei Zhang — Wed, 17 Apr 2024 09:33:22 +0200

Objective: To analyze the factors affecting the long-term clinical efficacy and quality of life in the treatment of pediatric acute lymphoblastic leukemia (ALL).

Methods: This is a retrospective study. One hundred children with ALL were collected before June, 2018 at The First Affiliated Hospital of Yangtze University and followed up for five years. Not only were their five-years survival rates analyzed, but univariate and multivariate analyses were also performed for factors that might affect their five-year survival rates. The MOS 36-Item Short Form of Health Survey (SF-36) was utilized to investigate the surviving children after five years in order to analyze the factors that may affect the quality of life of the children.

Results: The five-years survival rate of one hundred children with ALL after treatment was 91.00% (91/100). Univariate and multivariate Logistic regression analyses were performed on the factors that may affect the long-term efficacy of pediatric ALL. The results showed that white blood cell count at first diagnosis, prednisone response test, treatment compliance and recurrence were independent risk factors for the long-term efficacy of pediatric ALL(p<0.05). The SF-36 survey of 91 surviving children after five years showed that prednisone response test and treatment compliance were independent risk factors affecting the quality of life of pediatric ALL (p<0.05).

Conclusion: In the initial diagnosis of pediatric ALL, sufficient attention and control should be given to the factors that may affect the long-term clinical efficacy and quality of life, and appropriate treatment plans should be adopted. Meanwhile, the treatment compliance of children should be improved during treatment to improve the survival rate and quality of life of pediatric ALL.

doi: https://doi.org/10.12669/pjms.40.5.8619

How to cite this: Liu D, Zhang Y. Analysis of factors affecting the clinical efficacy and quality of life in the treatment of pediatric acute lymphoblastic leukemia. Pak J Med Sci. 2024;40(5):956-961. doi: https://doi.org/10.12669/pjms.40.5.8619

The antibacterial efficiency of Chitosan photodynamically activated Phycocyanin, and Morinda Oleifera against S.mutans and the bonding strength between composite resin and caries-affected dentin

Wed, 17 Apr 2024 09:55:26 +0200

Objective: Evaluation of contemporary disinfection techniques, Moringa Oleifera (M.Oleifera), Phycocyanin activated by photodynamic therapy (PDT), and Chitosan, on S.mutans survival rate and bond integrity of composite to carious-affected dentin (CAD).

Methods: The in vitro study was conducted at King Saud University and concluded within three months. Sixty mandibular teeth with cavities extending to the middle third of the dentin were sterilized. S.mutans was inoculated onto the CAD surface of twenty samples. The samples were randomly divided into four groups (n: 15) based on various disinfection regimes. Group-1 received 2% CHX, Group-2 Phycocyanin activated by photodynamic therapy (PDT), Group-3 Chitosan, and Group-4 M.oleifera. S.mutans survival rate was calculated. Ten CAD samples from each group were restored using composite. The bond integrity of samples was assessed using a Universal testing machine (UTM) and failure mode using a stereomicroscope. Analysis of variance (ANOVA) and Tukey’s Post Hoc test were used to calculate statistical significance (p=0.05).

Results: Group-2 samples subjected to Phycocyanin activated using PDT, displayed minimal survival rate (0.24 ± 0.05 CFU/ml) of S.mutans.Group-1 samples treated with CHX exhibited the highest count of S.mutans (0.69 ± 0.12 CFU/ml). The most robust bond was observed in Group-3 (Chitosan) samples (19.33 ± 0.47 MPa). In contrast, SBS values were lowest in Group-1 (CHX) treated study samples (13.17 ± 1.88 MPa).

Conclusion: Chitosan, Phycocyanin activated by PDT, and Moringa Oleifera extract exhibit potential as viable substitutes for chlorhexidine (CHX) in clinical settings, presenting the possibility of better eradication of S.mutans and greater adhesive strength to CAD.

doi: https://doi.org/10.12669/pjms.40.5.8800

How to cite this: Alanazi AM, Khan AA, Mahmood A, Kamal MA, Baig EA. The antibacterial efficiency of Chitosan photodynamically activated Phycocyanin, and Morinda Oleifera against S.mutans and the bonding strength between composite resin and caries-affected dentin. Pak J Med Sci. 2024;40(5):962-966. doi: https://doi.org/10.12669/pjms.40.5.8800

Needs analysis for an undergraduate dental curriculum in KPK, Pakistan: Gap identification and general needs assessment

Bushra Mehboob, Usman Mahboob, Brekhna Jamil, Neelofar Shaheen — Wed, 17 Apr 2024 11:41:08 +0200

Objective: Dental institutes continue to face challenges in making the transition from a discipline-based to an integrated curriculum. The need analysis is often the first step in the development and implementation of any curriculum. This study intends to carry out a needs analysis for a contemporary dental curriculum in private and public sector dental colleges of Peshawar, KPK, Pakistan.

Methods: The mixed method study was carried out at public and private dental institutes in Peshawar from April to July 2022. To guarantee triangulation, data were gathered from three sources. The first source was an analysis of the Pakistan Medical and Dental Council’s dental curriculum accreditation standards. The second source was gathering the experts’ perspectives, and the final source was a systematic literature search to explore the necessity for an integrated undergraduate dental curriculum from the experiences and expertise of contemporary curricula.

Results: Thematic analysis identified the need for the dental curriculum to be a five-year BDS program, involvement of students, and inclusion of digital dentistry and environmental sustainability in the dental curriculum. PMDC accreditation standards focus on alignment in mission, vision, curricular outcomes, an integrated curriculum, and a quality assurance system for assessment. Experts identified the need for a patient-centered curriculum focusing on integrated patient care. They also identified that the current educational environment should be improved to sustain a contemporary dental curriculum in Pakistan. For the literature review, nine articles were included in the final review.

Conclusion: The current dental curriculum is not accommodating to the needs of the students in Peshawar. The current dental education environment lacks the infrastructure, logistics, and teacher training to sustain the standards set by PMDC.

doi: https://doi.org/10.12669/pjms.40.5.8364

How to cite this: Mehboob B, Mahboob U, Jamil B, Shaheen N. Needs analysis for an undergraduate dental curriculum in KPK, Pakistan: Gap identification and general needs assessment. Pak J Med Sci. 2024;40(5):967-973. doi: https://doi.org/10.12669/pjms.40.5.8364

Clinical efficacy of cyclosporin and natamycin for fungal keratitis

Chengwen Yang, Jingjing Cai, Qiuhong Wei, Huifang Lian, Lin An — Wed, 17 Apr 2024 11:47:23 +0200

Objectives: To investigate the clinical efficacy of cyclosporin (CYSP) and natamycin (NAT) as a combination therapy in patients with fungal keratitis.

Methods: This is a retrospective study. A total of 64 patients (64 eyes) with fungal keratitis treated by Baoding No.1 Central Hospital between December 2018 and May 2022 according to their treatment methods were divided into a monotherapy (MT) group receiving NAT eye drops solely and a combination therapy (CT) group given CYSP eye drops in addition to the exact treatment provided for the MT group. The clinical responses, visual acuity changes, severity of eye symptoms, and adverse reactions were compared between the two groups.

Results: At two and four weeks post-treatment, the CT group had an overall response rate (ORR) significantly higher than that of the MT group (P< 0.05, respectively); both groups showed improved visual acuity and eye symptoms compared with the pre-treatment condition, and these improvements were more pronounced in the CT group (P < 0.05, respectively). Compared with the MT group, the CT group experienced a significantly shorter duration of eye symptoms (P < 0.05). The adverse reaction rate(ARR) was 9.38% in the CT group and 6.25% in the MT group, and the difference was not significant (P > 0.05).

Conclusion: Using CYSP and NAT as a combination therapy for fungal keratitis can substantially heighten the therapeutic effects, promote visual acuity recovery, and induce rapid remission of eye symptoms without increasing the risk of adverse reactions.

doi: https://doi.org/10.12669/pjms.40.5.7777

How to cite this: Yang C, Cai J, Wei Q, Lian H, An L. Clinical efficacy of cyclosporin and natamycin for fungal keratitis. Pak J Med Sci. 2024;40(5):974-978. doi: https://doi.org/10.12669/pjms.40.5.7777

Early response and outcomes of bone marrow to chemotherapy in T-Cell Acute Lymphoblastic Leukemia

May AlMoshary, Shatha Mahmoud Altahan, Aziza Fayez Alswayyed — Wed, 17 Apr 2024 11:57:00 +0200

Objectives: To evaluate the outcomes (relapse and mortality rate) and response of the bone marrow in early stages after combination chemotherapy in patients with T-cell Acute Lymphoblastic Leukemia (T-ALL).

Methods: A descriptive cross-sectional study was conducted at King Fahad Medical City, from January 2021 to December 2022, to evaluate bone marrow findings at the time of diagnosis and post-chemotherapy in 26 patients diagnosed with T-ALL. The study included all patients diagnosed with T-ALL of any age group during the study period. The patients’ bone marrows were examined at 0 days of treatment (diagnosis work-up), followed by examination at day 15 post induction therapy, and day 30 after treatment.

Results: In this study, 26 cases of T-lymphoblastic leukemia were analyzed. The mean age at diagnosis was 15.69±14.28 years, and eight cases had central nervous system involvement. The majority of cases (88.5%) were positive for Cytoplasmic-CD3 and CD7. Positive findings by fluorescence in situ hybridization (FISH) were: T cell receptor (TCR) α/δ in 6 (23.1%) of the patients, CDNK2A/CEP9 in five (19.2%), and TRCB in one (3.8%). Examination of the bone marrow on day 15 revealed a decrease in blasts to ≤1% in nine patients, and to ≤1% in 19 patients on day 30 post-therapy. Relapse was recorded in five (19.23%) patients. Three (11.53%) patients did not survive during treatment, of which two were <10 years old. The relapse rate for T-ALL was 19.23%, with an overall survival rate of about 64%. The overall mortality rate was 11.53%.

Conclusion: The relapse rate for T-ALL in our study was approximately 19%, but the mortality rate was 11.5%. A substantial decrease in blast percentages was observed, suggesting a favorable initial reaction of the bone marrow to the combined chemotherapy. This suggests that the use of aggressive and more effective chemotherapy has led to better outcomes.

doi: https://doi.org/10.12669/pjms.40.5.7584

How to cite this: AlMoshary M, Altahan SM, Alswayyed AF. Early response and outcomes of bone marrow to chemotherapy in T-Cell Acute Lymphoblastic Leukemia. Pak J Med Sci. 2024;40(5):979-984. doi: https://doi.org/10.12669/pjms.40.5.7584

Diversity of uropathogens and their antibiotic resistance among diabetic patients presented to MTI-Lady Reading Hospital, Peshawar

Adeela Masood, Muhammad Bilal, Salim Badshah, Yaseen Khan — Wed, 17 Apr 2024 11:59:05 +0200

Objective: Our objective was to quantify the number of various bacteria that frequently cause UTI in diabetes patients as well as to gauge their susceptibility and resistance to antibiotics.

Method: A cross-sectional study was conducted at the Internal Medicine Ward of Lady Reading Hospital, Peshawar, Pakistan from June 2021 to December 2021, Patients with confirmed diabetes were included in the study; however, participants receiving antimicrobial medications for a maximum of 14 days were excluded from the study. Resistance of Escherichia coli, Candida, Pseudomonas, E. faecalis, Klebsiella, P. mirabilis and Staphylococcus was asssessed using ciprofloxac, ceftazidime and meropenem.

Results: The findings highlighted the the prevalence of Escherichia coli in 38.8% of patients, Candida in 19% of patients, Enterococcus faecalis in 11.8% of patients, Pseudomonas in 10%, Klebsiella in 9.5% patients, Proteus mirabilis 6.2% patients and Staphylococcus was found in 5.2% patients. According to the overall sensitivity and resistance of antibiotics in microorganisms, Meropenem showed 89.6% sensitivity and 10.4% resistance. Ciprofloxacin showed 38.9% sensitivity and 61.1% resistance and ceftazidime showed 22.7 sensitivity and 77.3% resistance.

Conclusion: UTIs were very common in diabetes patients, and Escherichia coli was the most common uropathogen found. Compared to male patients, more female patients had infections. The uropathogens showed a significant degree of resistance to ceftizidime and ciprofloxacin.

doi: https://doi.org/10.12669/pjms.40.5.8275

How to cite this: Masood A, Bilal M, Badshah S, Khan Y. Diversity of uropathogens and their antibiotic resistance among diabetic patients presented to MTI-Lady Reading Hospital, Peshawar. Pak J Med Sci. 2024;40(5):985-988. doi: https://doi.org/10.12669/pjms.40.5.8275

Frequency of psychosocial stress and its relationship to safety attitude towards nurse’s performance at tertiary care hospitals

Abdul Wahid , Badil, Washdev, Sabir Hussain — Wed, 17 Apr 2024 12:01:43 +0200

Background & Objectives: Psychosocial stress has a detrimental effect on nurses’ work performance. A safe working environment is significant in providing nurses with safe and satisfactory care. The objective of study was to assess the frequency of psychosocial stress of nurses and determine the relationship between psychosocial stress of nurses and safety attitude towards nurses’ performances at Tertiary Care Hospital, Karachi.

Methods: Analytical cross-sectional study was conducted at Dr. Ruth KM Pfau Civil Hospital, Karachi, and Dow University Hospital Karachi for six months, from December 2020 to May 2021.
A total 260 participants were approached by a non-probability purposive sampling. Pearson’s correlation was used to establish the relationship between the psychosocial stress of nurses and different parameters of their safety attitude. The Chi-square test was applied for the association between demographic factors of nurses with their psychosocial stress levels. A p-value of ≤0.05 was considered as significant.

Results: The majority of nurses, 180 (69.2%), described poor health, while 54 (20.8%) had good health, and only 10% (26) of nurses reported their best health status. Three parameters were negatively correlated and statistically significant with psychosocial stress, namely: teamwork (r-0.13<0.002), job satisfaction (r-0.15<0.028), and perception of management (r-0.34<0.000). The result of the study indicated that gender (P-value<0.000), marital status (P-value<0.0037), and institution (P-value <0.005) were significantly associated with safety attitude score.

Conclusion: Most of the nurses had poor health, which was significantly related to teamwork, job satisfaction and perception of management, and stress recognition.

doi: https://doi.org/10.12669/pjms.40.5.7913

How to cite this: Wahid A, Badil, Washdev, Hussian S. Frequency of psychosocial stress and its relationship to safety attitude towards nurse’s performance at tertiary care hospitals. Pak J Med Sci. 2024;40(5):989-994. doi: https://doi.org/10.12669/pjms.40.5.7913

Clinical value of combined detection of Carcinoembryonic Antigen and CA125 in the diagnosis of non-small cell lung cancer combined with Malignant Pleural Effusion

Wanyu Yan, Yakun Li, Zhanxian Peng — Wed, 17 Apr 2024 12:05:59 +0200

Objective: To investigate the clinical value of combined detection of carcinoembryonic antigen(CEA) and CA125 in the diagnosis of non-small cell lung cancer(NSCLC) combined with malignant pleural effusion.

Methods: This was retrospective research. Fifty-six NSCLC patients combined with malignant pleural effusion in Baoding No.1 Hospital, China, from January 2020 to January 2022 were recruited as the malignant group, and another 56 NSCLC patients combined with pleural effusion in the same period were recruited as the benign group. Pleural effusion and serum specimens were collected from both groups and their carcinoembryonic antigen (CEA), carbohydrate antigen 125(CA125) and SP70 antigen levels were measured respectively. The differences in index levels between the two groups were compared, and the value of the index in diagnosing NSCLC combined with malignant pleural effusion was analyzed.

Results: The positive rates of CEA, CA125 and SP70 antigen in pleural effusion were higher in the malignant group than in the benign group (p>0.05); The positive rates of CEA and CA125 in the malignant group were higher than those in the benign group (p>0.05), with no statistically significant difference between the two groups in the positive rates of SP70 antigen (p>0.05). ROC curve analysis revealed the value of serum CEA and CA12 in the diagnosis of NSCLC combined with malignant pleural effusion, while serum SP70 antigen had no diagnostic value (p>0.05).

Conclusion: The combined detection of CEA, CA125 and SP70 antigen boasts a higher diagnostic value for NSCLC-mediated pleural effusion, with higher diagnostic value than the combined detection of serum indexes.

doi: https://doi.org/10.12669/pjms.40.5.7956

How to cite this: Yan W, Li Y, Peng Z. Clinical value of combined detection of Carcinoembryonic Antigen and CA125 in the diagnosis of non-small cell lung cancer combined with Malignant Pleural Effusion. Pak J Med Sci. 2024;40(5):995-1000. doi: https://doi.org/10.12669/pjms.40.5.7956

Acceptance of team-based learning by students and faculty: A pilot study

Rehana Rehman, Saara Ahmad, Syeda Pinar Nasir, Rahila Ali — Wed, 17 Apr 2024 12:08:00 +0200

Background & Objective: Team-Based Learning (TBL) is an interactive instructional approach characterized by collaborative peer teaching in both large and small group settings. The study aims to assess usefulness of the TBL in enhancing student learning outcomes and engagement in graduate classes.

Methods: This mixed method study was conducted from January 2023 till July 2023 at the Department of Biological & Biomedical Sciences at Aga Khan University, Karachi, Pakistan, a questionnaire was distributed to graduate students in Endocrine and Reproductive course after TBL on ‘Hormonal changes in Pregnancy’. Focus group discussion (FGD) was held with facilitator of this TBL and the students; results of both arms were then triangulated.

Results: All (four) students responded affirmatively regarding guided self-preparation, quality of application exercises, satisfaction in terms of student’s engagement, a positive attitude and self-accountability. Themes identified by FGD of both students and facilitators were ‘Students Engagement in Peer Learning, ‘Conducive Learning Environment’, “Time is Capital in TBL’ and ‘Conceptual learning.’

Conclusion: The pilot study confirmed the utility of TBL by students as well as the facilitators. Students came with prior preparation, got engaged in problem-solving activities and received feedback from peers and the expert facilitators. The conducive environment enhanced their engagement, enabled them to actively apply the content and benefit from guided supervision.

doi: https://doi.org/10.12669/pjms.40.5.8515

How to cite this: Rehman R, Ahmad S, Nasir SP, Ali R. Acceptance of team-based learning by students and faculty: A pilot study. Pak J Med Sci. 2024;40(5):1001-1005. doi: https://doi.org/10.12669/pjms.40.5.8515

Comparison of effectiveness between transthoracic echocardiography and X-ray guided closure of patent foramen ovale: A retrospective analysis

Haijing Song, Yanzhi Yao — Wed, 17 Apr 2024 12:18:57 +0200

Objective: To compare the effectiveness of transthoracic echocardiography (TTE) and X-ray guided closure of patent foramen ovale (PFO).

Methods: In this retrospective study, clinical data from 90 patients who underwent PFO occlusion surgery in the First People’s Hospital of Yongkang from January 2020 to December 2022 were retrospectively reviewed. Among them, 43 patients underwent X-ray guided PFO occlusion surgery (X-ray group) while 47 patients underwent TTE guided PFO occlusion surgery (TTE group). Perioperative, cardiac function related indicators were measured before and after treatment, along with right-to-left shunting status, and incidence of complications in both groups.

Results: There was no significant difference in the duration of surgery or hospitalization between the TTE group and the X-ray group (p>0.05). After treatment, the cardiac function indicators of both groups increased compared to before treatment (p<0.05), and there was no significant difference between the groups (p>0.05). After treatment, right-to-left shunting in the two groups improved compared to before treatment (p<0.05), with no significant difference between the groups (p>0.05). There was no significant difference in complications between the two groups (p>0.05).

Conclusions: TTE guided PFO occlusion is as effective as X-ray guided PFO occlusion in the treatment of PFO. TTE surgery is clinically beneficial for reducing radiation damage with a good safety profile.

doi: https://doi.org/10.12669/pjms.40.5.8994

How to cite this: Song H, Yao Y. Comparison of effectiveness between transthoracic echocardiography and X-ray guided closure of patent foramen ovale: A retrospective analysis. Pak J Med Sci. 2024;40(5):1006-1010. doi: https://doi.org/10.12669/pjms.40.5.8994

Seroprevalence of Hepatitis-E Virus-Immunoglobulin G and its association with Chronic Liver Disease

Muhammad Sadik Memon, Bushra Kadir, Lubna Kamani, Ayaz Ahmed Chandio — Wed, 17 Apr 2024 12:29:28 +0200

Background & Objective: Viral hepatitis is a major public health concern in low-middle income countries. Hepatitis-E infection (HEV) is found globally but most prevalent in low-income countries especially those with poor sanitation systems, access to clean drinking water and health services. Superinfection with HEV in patients with chronic liver disease (CLD) can cause severe hepatic decompensation leading to increased morbidity and mortality. To determine the frequency of seroprevalence of Hepatitis-E virus Immunoglobulin g (IgG) and its association with chronic liver disease.

Methods: A cross-sectional study was conducted in Asian Institute of Medical Sciences, Hyderabad, Pakistan from January till May 2022. A total of 196 patients of aged ≥ 18 years, presenting in gastroenterology clinics were included in the study after informed consent.

Result: Among 196 patients, one third of patient were male (73.5%). Out of which 162 (82.7%) had liver disease and 34 (17.3%) were without liver disease. The median age of patient was 45 (33-51) years. The overall seroprevalence of HEV IgG among study population was 69.4%. HEV IgG was present in 114 and 22 in CLD and non CLD patients respectively. Multivariable regression shows no association between seroprevalence of HEV in CLD and non-CLD patient (AOR 1.02, 95% CI 0.45-2.313).

Conclusion: Our study showed high frequency of HEV seropositivity. No difference was observed in HEV seropositivity among CLD and non-CLD patients.

doi: https://doi.org/10.12669/pjms.40.5.8448

How to cite this: Memon MS, Kadir B, Kamani L, Chandio AA. Seroprevalence of Hepatitis-E Virus-Immunoglobulin G and its association with Chronic Liver Disease. Pak J Med Sci. 2024;40(5):1011-1016. doi: https://doi.org/10.12669/pjms.40.5.8448

Effect of Self-developed Ye’an Analgetic Decoction/Jiawei Shaoyao Gancao Decoction Combined with Tramadol on TCM Symptom Scores and RLS Severity of patients with Restless Legs Syndrome

Bowen Zhou, Wei Li, Yajun Li, Dongkai Sun, Xin Du — Wed, 17 Apr 2024 12:47:51 +0200

Objective: To investigate the effect of self-developed Ye’an Analgetic Decoction/Jiawei Shaoyao Gancao Decoction on Traditional Chinese Medicine (TCM) symptom scores and RLS Severity of patients with restless legs syndrome (RLS).

Methods: This was a clinical comparative study. Eighty patients with RLS admitted to Baoding No.1 Central Hospital from January 2022 to December 2022 were randomly divided into observation group and control group(n=40). Patients in the control group were given basic and oral tramadol treatment, while those in the observation group were given self-developed Ye’an Analgetic Decoction/Jiawei Shaoyao Gancao Decoction based on the treatment in the control group. The differences of TCM symptom scores, RLS severity (IRLS), quality of life (QOL-RLS), sleep quality (PSQI) and clinical efficacy between the two groups were compared.

Results: Before treatment, no statistically significant differences were observed in the TCM symptom scores, IRLS scores, QOL-RLS scores and PSQI scores between the two groups (p>0.05). After treatment, the above scores decreased significantly in both groups, with a higher degree of decrease in the observation group than in the control group, indicating statistically significant differences (p<0.05). The QOL-RLS scores were significantly higher in the observation group than in the control group, with a statistically significant difference (p<0.05). The overall response rate in the observation group was 95.00%, which was higher than that in the control group (80.00%), with a statistically significant difference (p<0.05).

Conclusion: Self-developed Ye’an Analgetic Decoction/Jiawei Shaoyao Gancao Decoction leads to numerous benefits in the treatment of RLS, such as obviously ameliorating patients’ clinical symptoms, reducing RLS severity, and improving their quality of life and sleep quality.

doi: https://doi.org/10.12669/pjms.40.5.8400

How to cite this: Zhou B, Li W, Li Y, Sun D, Du X. Effect of Self-developed Ye’an Analgetic Decoction/Jiawei Shaoyao Gancao Decoction Combined with Tramadol on TCM Symptom Scores and RLS Severity of patients with Restless Legs Syndrome. Pak J Med Sci. 2024;40(5):1017-1021. doi: https://doi.org/10.12669/pjms.40.5.8400

Effect of ABO blood group on the severity and clinico-pathological parameters of COVID-19

Lareb Asad, Talat Mirza, Santosh Kumar, Ambrina Khatoon — Wed, 17 Apr 2024 13:29:10 +0200

Background and Objective: The COVID-19 pandemic has highlighted the need to understand the factors affecting disease severity. Prior research has indicated the potential roles of the ABO blood group system in disease susceptibility and progression. Our objective was to investigate the association between ABO Blood groups and the severity of COVID-19 and clinicopathological parameters.

Methods: An analytical cross-sectional study was conducted across three locations of Ziauddin University Hospital, including COVID-19 outpatient departments (OPDs), wards, and intensive care units (ICUs) from May 2020 to December 2020.The study utilized a non-probability convenient sampling technique with a sample size of 120 PCR-positive adult patients, as calculated by OpenEpi with a 95% confidence interval. Patients were excluded if they were under 14, intellectually impaired, post-chemotherapy or radiotherapy, or had a malignant condition. Disease severity was determined based on clinicopathological parameters and associated with blood group data using ANOVA and Chi-square tests in SPSS version 21.

Results: A significant association was found between the ABO blood groups and COVID-19 severity. Blood group-A was notably overrepresented in patients with severe COVID-19 and correlated with higher inflammatory markers and coagulation parameters.

Conclusion: ABO blood group, particularly Blood Group-A significantly associates with the severity of COVID-19. This finding suggests the potential utility of ABO blood group typing as a predictive marker for disease severity, which could contribute to personalized patient management strategies. Further research is necessary to understand the mechanisms underlying this association.

doi: https://doi.org/10.12669/pjms.40.5.9037

How to cite this: Asad L, Mirza T, Kumar S, Khatoon A. Effect of ABO blood group on the severity and clinico-pathological parameters of COVID-19. Pak J Med Sci. 2024;40(5):1022-1029. doi: https://doi.org/10.12669/pjms.40.5.9037

Evaluation of continuous blood purification in patients with urosepsis caused by ureteral calculi and heart failure after catheterization

Xing Fan, Zhe Li, Yan Gao, Hai-song Zhang, Zhao-yu Bi — Wed, 17 Apr 2024 13:43:52 +0200

Objective: To detect the continuous blood purification (CBP)’s application value in patients with urosepsis caused by ureteral calculi and heart failure after catheterization.

Methods: This is a clinical comparative study. Sixty patients with ureteral calculi complicated with heart failure and urosepsis were admitted at Affiliated Hospital of Hebei University from January 2021 to March 2023 randomly split into control and experimental group(n=30). Based on conventional treatment after indwelling the DJ tube, the experimental group was treated with CBP therapy. The control group dealt with conventional anti-inflammatory, oxygen inhalation and other treatments only. Compared and analyzed in terms of alterations in blood inflammatory factors, cardiac function, BNP prior to and after therapy, blood pressure, blood WBC recovery time, and so on.

Results: TNF-a, CRP, and PCT levels in the control and experimental groups were substantially more prominent than the average reference value prior to treatment. They decreased considerably at distinct time points after therapy, with substantial distinctions (p< 0.05). A more meaningful decrease was noticed in the experimental group in comparison with the control group (p< 0.05). BNP and cardiac function were improved in both groups prior to and after therapy, and the amelioration of indexes in the experimental group was more substantial than that in the control group after therapy, with statistically considerable distinctions. The improvement time in experimental group was earlier than in the control group, with statistically substantial differences.

Conclusion: Patients with urosepsis complicated with heart failure after indwelling DJ tube have their inflammatory factors improved significantly, with more thorough excretion by using conventional treatment combined with CBP therapy.

doi: https://doi.org/10.12669/pjms.40.5.8386

How to cite this: Fan X, Li Z, Gao Y, Zhang H, Bi Z. Evaluation of continuous blood purification in patients with urosepsis caused by ureteral calculi and heart failure after catheterization. Pak J Med Sci. 2024;40(5):1030-1034. doi: https://doi.org/10.12669/pjms.40.5.8386

Postoperative intussusception in children operated for primary intussusception - A very rare entity

Muhammad Amjad Chaudhary, Chandni, Aisha Jamil, Sadia Asmat Burki — Mon, 25 Mar 2024 08:30:13 +0100

Postoperative intussusception (POI) after abdominal and non-abdominal operations is a rare but recognized condition discussed several times in literature. There are scarce reports regarding POI in children operated primarily for intussusception. We discuss three such cases that were seen in our institution in the last two years. The patients showed symptoms of atypical ileus that failed to resolve two to eight days following primary surgery. Ultrasound reported intussusception and surgical intervention was sought. All patients had ileoileal intussusception. Manual reduction was successful in two cases. One had intestinal necrosis and underwent resection and anastomosis. Recovery was satisfactory without recurrence. POI should be suspected in patients who show signs of intestinal obstruction in early postoperative period. A second POI should be kept in mind after surgical reduction of the first intussusception. Ultrasound should be performed to aid diagnosis followed by urgent surgical intervention.

doi: https://doi.org/10.12669/pjms.40.5.8276

How to cite this: Chaudhary MA, Chandni, Jamil A, Burki SA. Postoperative intussusception in children operated for primary intussusception - A very rare entity. Pak J Med Sci. 2024;40(5):1035-1038. doi: https://doi.org/10.12669/pjms.40.5.8276

Bilateral inguinoscrotal swelling: An uncommon presentation of omental cystic lymphangioma

Sana Viqar, Chandni, Muhammad Amjad Chaudhary — Tue, 19 Mar 2024 05:46:00 +0100

Abdominal cystic lymphangioma is a rare benign tumour in children. It is often difficult to diagnosis pre-operatively due to a varied spectrum of symptoms. We report a case of a male infant who presented with gross bilateral inguinoscrotal swelling. Provisional diagnosis of congenital communicating hydrocele was made and investigation revealed a large abdominal cyst. Patient underwent explorative laparotomy and the cyst arising from greater omentum, extending into bilateral scrotum, was excised and bilateral herniotomy done. Mass was confirmed to be lymphangioma on biopsy. This case is unique as an abdominal lymphangioma presented solely as inguinoscrotal swelling, with no abdominal symptom. To our knowledge, this is the first case of omental cystic lymphangioma involving both inguinoscrotal regions. Our case suggests that abdominal cystic lymphangioma should be a part of the differential diagnosis in any child with gross inguinoscrotal swelling in whom initial impression is of communicating hydrocele.

doi: https://doi.org/10.12669/pjms.40.5.8255

How to cite this: Viqar S, Chandni, Chaudhary MA. Bilateral inguinoscrotal swelling: An uncommon presentation of omental cystic lymphangioma. Pak J Med Sci. 2024;40(5):1039-1041. doi: https://doi.org/10.12669/pjms.40.5.8255

ANCA-associated systemic vasculitis initially mimicking peripheral neuropathy in an elderly woman

Xiaojie He, Yaqing Wang, Xiaodong Li — Tue, 19 Mar 2024 05:50:44 +0100

Anti-neutrophil cytoplasmic antibodies (ANCA)-associated systemic vasculitis (AASV) is a rare systemic immunological condition that predominantly impacts small arteries, veins, and capillaries, often leading to kidney damage and pulmonary injury. It is important to note that individuals primarily presenting with peripheral neuropathy (PN) are uncommon in AASV, which can result in significant misdiagnosis or undiagnosed cases. The severity and location of PN can vary among patients. In this article, we present a case of an AASV patient initially showing signs of PN. This case highlights the significance of considering AASV as a potential cause of unexplained neurological symptoms. Timely identification and proper treatment are essential for improving the survival rate and functional prognosis of AASV patients.

doi: https://doi.org/10.12669/pjms.40.5.9070

How to cite this: He X, Wang Y, Li X. ANCA-associated systemic vasculitis initially mimicking peripheral neuropathy in an elderly woman. Pak J Med Sci. 2024;40(5):1042-1045. doi: https://doi.org/10.12669/pjms.40.5.9070

The alarming link between metabolic disease and sugar-sweetened beverage consumption

Shahreen Ansar Khan, Musarrat Riaz — Mon, 25 Mar 2024 08:23:32 +0100

doi: https://doi.org/10.12669/pjms.40.5.9256

How to cite this: Khan SA, Riaz M. The alarming link between metabolic disease and sugar-sweetened beverage consumption. Pak J Med Sci. 2024;40(5):1046. doi: https://doi.org/10.12669/pjms.40.5.9256

The First Year of Successful Execution & Examination of Integrated Modular Curriculum 2k23 by UHS Pakistan

Nadia Naseem — Wed, 17 Apr 2024 13:50:42 +0200

doi: https://doi.org/10.12669/pjms.40.5.9951

How to cite this: Naseem N. The First Year of Successful Execution and Examination of Integrated Modular Curriculum 2k23 by UHS Pakistan. Pak J Med Sci. 2024;40(5):1047.
doi: https://doi.org/10.12669/pjms.40.5.9951