Pakistan Journal of Medical Sciences最新文献

Objective: To explore the impact of levothyroxine (L-T4) administration at different time points on pregnancy outcomes and offspring development in patients with subclinical hypothyroidism (SCH).

Methods: In this retrospective study, medical records of 107 patients with SCH treated in Huzhou Nanxun District People's Hospital from February 2021 to March 2023 were retrospectively reviewed. Of them, 55 patients received treatment before eight gestational weeks (Early group), and 52 patients received treatment after eight gestational weeks (Mid group). Levels of thyroid function indicators, occurrence of adverse pregnancy outcomes, occurrence of adverse reactions, and development of offspring before and after the treatment were compared.

Results: After the treatment, the thyroid function indicators in both groups improved compared to before treatment, and the improvement in the Early group was significantly better than that in the Mid group (P<0.05). The incidence of adverse pregnancy outcomes in the early group (5.45%) was lower than that in the mid group (19.23%) (P<0.05). There was no significant difference in the incidence of adverse reactions between the groups (P>0.05). The scores of fine motor, gross motor, language, personal-social behavior, and adaptability in offspring of patients the Early group were higher than those of the mid group (P<0.05).

Conclusions: Early administration of L-T4 is safe and can effectively improve thyroid function in SCH patients, reduce adverse pregnancy outcomes, and ensure growth and development of offspring.

Objective: To develop a risk model based on LncRNAs associated with disulfidptosis to forecast the prognosis and assess immune infiltration of Lung adenocarcinoma (LUAD).

Methods: This study employed a bioinformatics approach. The study was conducted from March 29, 2023 and concluded on July 1, 2023 at Guangzhou University of Chinese Medicine, Guangzhou, China. Transcriptomic data specific to LUAD were collected from TCGA database. Disulfidptosis-related LncRNAs were preliminarily screened using co-expression analysis, followed by screening using Lasso regression and Cox regression to identify LncRNAs. Subsequently, prognostic prediction models were constructed. To assess the model, survival analysis, subject operating characteristic curves, and calibration curves were employed. To evaluate the tumor microenvironment, the "estimate" package was used, while the "ggpubr" package was utilized to visualize the variations. Additionally, we employed CIBERSORT to examine immune cell infiltration abundance.

Results: A prognostic prediction model was constructed using five LncRNAs. The high-risk group displayed a shorter overall survival and progression-free survival (P<0.05). The concordance index was calculated as 0.704 (95.

Ci: 0.654-0.754). GSEA analysis reveals that high risk group is associated with the cell cycle pathway and steroid hormone biosynthesis pathway, while the low-risk group is associated with hematopoietic cell pathway and allograft rejection pathway. Immune cell infiltration analysis indicated associations between the prognostic model and activated T cells CD4 memory, T cells CD8, etc.

Conclusions: The risk model of Disulfidptosis-related LncRNAs can predict the prognosis of LUAD and evaluate the immune infiltration, providing a new direction for the treatment of LUAD.

Objective: To explore the expression characteristics and clinical value of immune function indicators in patients with human immunodeficiency virus (HIV) infection.

Methods: In this retrospective study, clinical data of 196 patients with HIV infection (observation group) and 196 health examinees (control group) admitted to our hospital from November 2021 to March 2023 were retrospectively analyzed. Patients in the observation group were further classified based on the staging as acute phase (n=53), asymptomatic phase (n=65), and acquired immunodeficiency (AIDS) phase (n=78). Levels of immune function indicators in the observation group and the control group were compared, and the correlation between immune function index levels and disease staging was analyzed.

Results: Levels of CD3⁺, CD4⁺, CD4⁺/CD8⁺, B cells, and NK cells were lower in the observation group (P<0.05), were significantly lower in asymptomatic patients compared with patients in the acute phase (P<0.05), and were significantly lower in patients with AIDS than those in asymptomatic patients (P<0.05). The results for CD8⁺ were in contrast to the above(P<0.05). Spearman analysis confirmed that levels of CD3⁺, CD4⁺, CD4⁺/CD8⁺, B cells and NK cells significantly negatively correlated, and levels of CD8+ significantly positively correlated with the stages of HIV (P<0.05).

Conclusions: The immune function indicators of patients with HIV infection are markedly abnormal, which is mainly manifested by the decreased levels of CD3⁺, CD4⁺, CD4⁺/CD8⁺, B cells and NK cells, and the increased levels of CD8⁺. The profile of the immune function indicators correlates with the progressive severity of the disease.

Background & objective: Patient's family satisfaction is a crucial but often overlooked indicator of the quality of the intensive care unit (ICU). The goal was to assess how satisfied patients' families were with the treatment they received for terminally ill patients, where we worked with them to create a care plan.

Methods: The study was conducted in ICU at Pakistan Kidney and Liver Institute and Research Center (PKLI & RC), Lahore, Pakistan which is a quaternary care center between December 1^st 2022 and April 30^th 2023. We used the Family Satisfaction in the Intensive Care Unit 24 (FS-ICU 24) questionnaire to interview the next of kin of patients who passed away in our ICU.

Results: Of the 330 patients admitted to the intensive care unit (ICU) between December 1, 2022, and April 30, 2023, 42 patients (12.7%) passed away. Mean age was 46.8 ± 14.5 years, with 28 men (66.7%) and 14 females (33.3%). Mean length of ICU stay was 5.57 ± 5.84 day. On a scale of 1-5 (1 = very Dissatisfied; 5 = fully satisfied) the overall family's satisfaction score was 4.21 ± 0.52 with ICU consultants received a high satisfaction rating for informing families about their patients' conditions and involving them in the decision-making process.

Conclusion: The study showed involving family members in the care plan and helping them prepare for death not only helps them deal better but also makes them feel satisfied with the treatment they received in the intensive care unit, It makes them appreciate that they were able to participate in the decision-making process.

Objective: To explore a link between the use of proton pump inhibitor (PPI) and the risk of stroke.

Methods: Comprehensive literature search in PubMed, EMBASE, and Cochrane CENTRAL Library databases was carried out for observational studies establishing the link between PPI and a risk of stroke. Data extraction and quality assessment were performed by two reviewers. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) using random-effects models were plotted. Subgroup analyses were conducted based on age, gender, PPI type, duration of follow-up, and propensity score matching (PSM).

Results: The analysis included 12 studies, with considerable heterogeneity (I2 = 95%). PPI use did not affect the incidence of ischemic stroke (HR: 1.11, 95% CI: 0.98-1.26). Subgroup analyses revealed that PPI use correlated with the risk of ischemic stroke, in particular in patients<65 years old (HR: 1.25, 95% CI: 1.07-1.45), both males (HR: 1.12, 95% CI: 1.02-1.24) and females (HR: 1.21, 95% CI: 1.10-1.33). The correlation varied depending on the PPI type, with pantoprazole showing elevated risk (HR: 1.66, 95% CI: 1.43-1.93). Duration of follow-up or propensity score matching (PSM) did not impact the association.

Conclusion: PPI use may be linked with ischemic stroke, particularly in individuals <65 years old and of all genders. The specific PPI type may also influence the risk. However, the cumulative analysis did not find any statistically significant association, and heterogeneity among studies was substantial.

Background & objectives: BI-RADS (Breast Imaging-Reporting and Data System) is a standard radiological risk assessment for breast lesions, including six categories, of which category four is the widest range of likelihood cancer risk (2% to 95%). This study aimed to evaluate the effect of patient age and ACR breast density on the positive predictive value (PPV) of BI-RADS 4 subcategorization (4A, 4B, and 4C).

Methods: A retrospective study was conducted at King Fahed Hospital (KFH) between September 1, 2021, and June 30, 2022. PPV was calculated based on a histopathological report for all lesions. The correlation was made with patients' age groups ranging from < 45 years, 45-55 years, and > 55 years and four types of breast density on mammography. We used IBM-SPSS for data synthesis. The Chi-square test was used to assess any correlation between variables. A p-value < 0.05 was considered statistically significant.

Results: The mean age was 44.62 ±14.32. Of the 248 cases, 81% were benign, 17% were malignant, and 2% were high-risk lesions. The age-related PPV of each BI-RADS category showed no significant differences among all age groups. However, the breast composition-related PPV cases with BI-RADS categories differed significantly within subcategory 4C (p-value<0.001).

Conclusions: There were no positive relationships between increasing age and PPV in BI-RADS 4 subcategories 4A, B, and C. Breast composition-related PPV showed significant differences with BI-RADS 4C subcategories.

Objective: To determine the effectiveness of video-based teaching in surgery residents by comparing it to the routine operating room traditional teaching.

Methodology: The randomized control trial was done at four institutions from September 2022 to March 2023. Interventional group underwent video-based instruction of basic surgical skills whereas the control group was taught through traditional operating room teaching. Pre and post-test mean scores were analyzed on SPSS version 20 through paired t-test. Learning gain was calculated. Supervisors' perceptions were recorded on survey form regarding direct observations and recorded video evaluations of resident skills on post-test.

Results: Out of sixty (n=60), fifty-five newly inducted surgical residents completed the study including both females (n=13) and male residents (n=42). Video intervention Group (27.93±3.72) and control group (23.07±4.62) both showed improvements in their post-test scores as compared to pretest scores of 13.68±3.25 and 13.52±3.60 respectively. Mean score difference improvement was more in video intervention group (13.9±3.8) in comparison to control group (9.5±4.3) provided both groups exhibits improvements in all seven domains of the global rating system (reflected by the p <0.0001). However, learning gain of 65% was observed in intervention group as compared to learning gain (41%) of control group. Evaluators(n=5) observed that recorded video evaluations helped to provide integrated feedback, despite being time (40%) and resource intensive (60%).

Conclusion: Video-based teaching has higher learning gain irrespective of the fact that both groups exhibit statistically significant results in all seven domains of the global rating system. Recorded video evaluation was found feasible and reliable tool for formative assessment.

Objective: To investigate the correlations of cognitive function with serum levels of homocysteine (Hcy), sex hormone binding globulin (SHBG), and leptin in patients with schizophrenia.

Methods: This was retrospective study. This study included 58 patients with schizophrenia (SCZ) as observation group and 60 clinically healthy individuals as control group admitted to Xiangshan County Hospital of Traditional Chinese Medicine Medical and Health Group Third Hospital from March 2022 to June 2023. Serum levels of Hcy, SHBG, and leptin in the two groups were measured, and Pearson correlation analysis was conducted to investigate the correlations between the Hcy, SHBG, and leptin levels and the psychiatric symptoms and cognitive function in the observation group.

Results: The Hcy and SHBG levels in the observation group were significantly higher than those in the control group (p<0.05, respectively), and the leptin level was lower than that in the control group (p<0.05). The observation group scored significantly lower than the control group for each dimension of the MCCB (p<0.05, respectively). In the observation group, Hcy was positively correlated with negative symptoms and the PANSS total score (p<0.05, respectively) and was negatively correlated with scores for the leptin was negatively correlated with negative symptoms and the PANSS total score (p<0.05, respectively) and was positively correlated with scores for speed of processing (SOP), WMS-III, BVMT, and MSCEIT (p<0.05, respectively).

Conclusions: Increased levels of Hcy and SHBG and decreased leptin are strongly associated with the occurrence of cognitive impairment in SCZ cases. Therefore, clinical observation and monitoring of these markers can help identify changes in patient conditions.

Background & objective: Autosomal recessive cerebellar ataxias (ARCA) are rare heterogenous neurodegenerative disorders characterized by degeneration of the cerebellum and spinal cord with an early onset before the age of 20 years. PMPCA (MIM: 613036), is a key enzyme in mitochondrial protein processing which is critical for cell survival and growth. Our objective was to investigate Peptidase, Mitochondrial Processing Subunit Alpha (PMPCA) mutations linked with Spinocerebellar ataxia, autosomal recessive 2 (SCAR2).

Method: In the current study, Whole Exome Sequencing (WES) was done followed by Sanger sequencing for the validation of the WES results.

Results: WES results identified a novel homozygous variant, NM_015160.2: c.802C>T p.(Arg268Trp) in PMPCA gene. Mutation in this gene leads to progressive cerebellar ataxia with fine motor skills difficulties, intentional tremors, slow slurred speech and learning difficulties in a 12-year-old Saudi patient. WES results were further validated by Sanger sequencing technique.

Conclusions: Identified phenotype in our case was similar as previously described for SCAR2 related conditions. To our knowledge, this is the first reported mutation in PMPCA gene leading to SCAR2 in Saudi Arabia. These findings will enrich the scarce literature, further provide a new insight on the role of PMPCA gene-related disorders leading to SCAR2 and expand the disease concept. In addition, this will help to establish a database for the disease and its causative factors will further help in controlling diseases resulting from consanguinity in Saudi population.