Pakistan Journal of Medical Sciences最新文献

Objective: To explore the effects of sentinel lymph node biopsy (SLNB) combined with breast-conserving surgery on surgical-related indexes, serum tissue polypeptide antigen (TPA) level and recurrence rate in patients with early breast cancer.

Methods: This was retrospective study. A total of 112 patients with early breast cancer who underwent surgical treatment in The First People's Hospital of Changde City from January 2020 to January 2024 were enrolled. According to different surgical methods, they were divided into control group (49 cases, modified radical mastectomy) and observation group (63 cases, SLNB combined with breast-conserving surgery). The perioperative indexes, levels of serum tumor markers, postoperative complications, long-term survival and recurrence were compared between the two groups.

Results: The operation time, intraoperative blood loss, postoperative drainage volume, hospitalization time in observation group were significantly lower than those in control group (P<0.05). Before surgery and at three months after surgery, there were no significant differences in the levels of serum cancer antigen 153(CA153), carcinoembryonic antigen (CEA), and tissue polypeptide antigen (TPA) between the two groups(P>0.05). After three years of follow-up, there were no significant differences in the recurrence rate and survival rate between the two groups (P>0.05).

Conclusion: Compared with modified radical mastectomy, SLNB combined with breast-conserving surgery may have better surgical procedures and outcomes, and significantly reduce the incidence of upper limb edema. The effects of surgical method choice are fewer on the long-term prognosis and postoperative levels of tumor markers such as serum TPA.

Background & objective: Pediatric acute leukemias can present with aberrant immunophenotypes characterized by a different pattern of antigen expression on malignant cells, unlike the process of usual hematopoietic maturation. The objective of this study was to determine the aberrant immunophenotype expressions in newly diagnosed pediatric acute lymphoblastic and acute myeloid leukemias.

Methods: This cross-sectional study was carried out at University of Child Health Sciences, The Children's Hospital, Lahore, from October 2022 to December 2022 after IRB approval. After taking informed consent from parents/guardians, 290 children diagnosed with acute leukemia were included in the study. Peripheral blood or bone marrow samples in EDTA vial were used for flowcytometric analysis by using BD FACS Canto II flow-cytometer. The data was collected on a pre-designed proforma and analyzed by using IBM-SPSS V-23.

Result: Among 290 cases, Acute Lymphoblastic Leukemia (ALL) constituted 221(76.2%) cases and 69(23.7%) were Acute Myeloid Leukemia (AML). Out of the total, the aberrant antigens were present in 32(11%) patients with 40 total events (18.1% immunophenotype aberrancy rate). The most common aberrant antigens were reported in B-ALL and the most common aberrant expression was of CD13 (62.5%). In AML, the most common aberrant antigen seen was CD19 (55.6%) and in T-ALL the most common were CD117 and HLA-DR (26.6%).

Conclusion: The most aberrant immunophenotypic markers were seen mostly in B-ALL pediatric cases followed by AML and T-ALL. Such abnormal expressions should be kept in mind while diagnosing the children with acute leukemia as they may affect the prognosis.

Objective: This study investigates resistance to a newly available drug Ceftazidime-Avibactam (CAZ-AVI) in carbapenem-resistant gram-negative organisms (GNOs) in the Pakistan's pediatric population.

Methods: This was a prospective study carried out in the Department of Microbiology at The Children's Hospital, Lahore from May 2023 to July 2023. A sum of 7491 specimens of blood, cerebrospinal fluid (CSF), urine, pus, nasal swabs, central venous catheter (CVP) tips and tracheal secretion were analyzed for presence of carbapenem resistant gram-negative organisms which were then further screened for CAZ-AVI resistance. Analytical profile index and Kirby-Bauer disk diffusion methods were used for the identification of organisms.

Results: A total of 217(n) carbapenem-resistant bacterial species, including 165(n) Klebsiella sp., 32(n) Pseudomonas sp., and 20(n) Escherichia coli (E. coli) strains, were tested for sensitivity against CAZ-AVI. Approximately, 70.5% (153 out of 217) of carbapenem-resistant bacteria exhibited resistance to CAZ-AVI. Among the resistant bacterial species, 80% (122/153) were Klebsiella sp., 14% (21/153) were Pseudomonas sp., and 6% (10/153) were E. coli. These findings suggest pre-existing resistance mechanisms may be responsible for exhibiting resistance to CAZ-AVI in these organisms.

Conclusion: Taking into account the results of this study, which depicted high resistance rates to CAZ-AVI among carbapenem resistant GNOs, and the high cost of this drug, it is suggested that a cautious selection for its use as monotherapy in sepsis and other infections should be made. It should be made mandatory to check the resistance to CAZ-AVI before its empiric use. The findings of the study also emphasize the challenges of combating new drug resistance and further research to adapt treatment strategies to the evolving antimicrobial resistance in the region.

Objectives: To study the characteristics and their influence on outcomes of ICU patients with multi drug resistant infections with and without prior antibiotic use before admission.

Methods: This single center study included 365 patients admitted to Medical and Surgical ICUs of KRL Hospital, Islamabad, from January 2023 to January 2024, who acquired a multi drug resistant infection 48 hours post-admission to the ICU. This was an observational study and purposive sampling was done. Kolmogorov-Smirnov test was employed to test the normality of data. The chi-square test was used to observe the association between categorical variables. The Mann-Whitney U test was used for continuous variables. Multivariate analysis was employed to compare the effect of different parameters on mortality.

Results: A total of 365 patients were included. The mean age was 62.2 ± 17.1, (<65 years = 54.2% and >65 years = 45.8%) with 185 (50.7%) males. Males, diabetics, those with chronic kidney disease, DCLD, CVA, hospitalization in last 6 months had a greater frequency of prior antibiotic exposure. Similarly, this group also showed increased frequency of thrombocytopenia and prolonged ICU stay than those with no previous antibiotic exposure. Longer duration of indwelling lines, hospital stay, ICU stay and Mechanical ventilation was associated with increased mortality.

Conclusion: Previous antibiotic use is linked to longer ICU and hospital stays, extended use of indwelling lines, and increased duration of mechanical ventilation, all of which contribute to greater financial burdens. However, there was no significant difference in mortality between the antibiotic and non-antibiotic groups. Further studies conducted on a larger scale across multiple ICUs could provide deeper insights into this relationship.

Objective: To investigate the clinical efficacy and safety of transarterial chemoembolization(TACE) combined with targeted therapy and PD1 inhibitors in patients with advanced liver cancer.

Methods: This was a retrospective study. A total of 120 patients with advanced primary liver cancer admitted to Affiliated Hospital of Hebei University were randomly divided into two groups, with 60 patients in each group from May 2020 to May 2023. Patients in the control group received conventional TACE, and those in the experimental group received 200 mg camrelizumab once every 21 days and oral lenvatinib mesylate capsules once daily in addition to TACE. Compared the clinical efficacy, levels of tumor markers, T lymphocyte subsets, and adverse drug reactions after treatment and the improvement of quality of life(QOL) before and after treatment between the two groups of patients.

Results: The overall response rate(ORR) was 80% in the experimental group and 62% in the control group, and the difference was statistically significant(p=0.03); the incidence of adverse reactions was 28% in the experimental group and 25% in the control group, with no significant difference between the two groups(p=0.68); the improvement rate of QOL score was significantly increased(p=0.03) and the deterioration rate was significantly decreased(p=0.01) in the experimental group compared with those in the control group, respectively.

Conclusion: TACE combined with targeted therapy and PD1 inhibitors is significantly effective to improve the cellular immune function with no significant increase in the incidence of adverse reactions, making it an effective and safe treatment option for patients with liver cancer.

Objective: MCQ exams are part of end-module assessments in undergraduate medical institutions. Item Analysis (IA) is the best tool to check their reliability and validity. It provides the Reliability Coefficient KR20, Difficulty Index (DI), Discrimination Index (DISC), and Distractor Efficiency (DE). Almost all research papers on IA are based on single exam analysis. We examined the IA of multiple exams of the same module, taken in four years. We aimed to explore the required consistency over the years and the effectiveness of IA-based post-exam measures.

Methodology: Item Analysis of eight final MCQ exams of the Pediatric module from 2020-21 to 2023-24, at the Faculty of Medicine in Rabigh, King Abdulaziz University, Saudi Arabia, were included in the study.

Results: All exams had KR20 of 90 and above indicating excellent reliability. Difficulty levels were consistent except for a single year. Discriminative ability was maintained over the years. Only 28 out of 800 MCQs had a negative DISC. All exams maintained good DE. Only 15 MCQs over four years had zero DE. The practice of reviewing all Non-Functional Distractors yielded a gradual improvement in exam quality.

Conclusion: Besides the IA of individual exams, it is also recommended that IA of the same exam be evaluated over 4-5 years to see consistency and trends towards improvement. It helps in improving the reliability and validity by addressing deficiencies and deviations from the recommended standards.

Objective: To explore the impact of the academic center for evidence-based practice (ACE) star model on the door-to-needle times (DNT) in patients with acute ischemic stroke (AIS).

Methods: Clinical data of 159 patients with AIS, treated in Sir Run Run Shaw Hospital Afffliated to Zhejiang University School of Medicine Alar Hospital from March 2022 to March 2024, were retrospectively analyzed. Seventy-eight patients received routine care (routine group), and 81 patients were treated using a combination of routine care with the ACE star model (ACE star group). Operating time, intervention effects, activities of daily living (ADL), neurologic outcomes, and incidence of adverse events of the two groups were compared.

Results: The duration of venous opening, computed tomography (CT) examination, and DNT in the ACE star group were shorter than those in the routine group (P<0.05). The DNT<45 minutes compliance rate, thrombolytic efficacy, and vascular recanalization in the ACE star group were higher than those in the Routine group (P<0.05). After the intervention, the ADL score of the ACE star group was significantly higher than that of the control group, while the NIHSS score was significantly lower than that of the control group (P<0.05). There was no significant difference in the incidence of adverse events between the two groups (P>0.05).

Conclusions: Adopting routine nursing care and intervention based on the ACE-star model for patients with AIS can shorten DNT, improve thrombolytic effect and vascular recanalization rate. ACE-star model is beneficial for restoring ADL ability and improving neurological function, without significant changes in the occurrence of adverse events.

Objective: Atrial fibrillation (AF) prevalences have risen globally due to the increasing aging populations posing significant health challenges. Frailty, a state characterized by weak physiological reserves, has emerged as a crucial factor influencing cardiovascular disease outcomes, including those in patients with AF. With this systematic review and meta-analysis, we aimed to elucidate the impact of frailty on mortality, and the incidences of stroke, major bleeding events, and other outcomes in elderly patients with AF.

Method: A comprehensive search of PubMed, EMBASE, and Scopus databases yielded 1302 relevant records from inception until January 2024. We screened them to assess their eligibility for our study. We included data from 23 studies into our analysis, covering a diverse global population. We also assessed the quality of the included studies by assigning Newcastle- Ottawa Scale scores.

Results: Frailty demonstrated a consistent association with increased all-cause mortality (Hazards ratio [HR] 2.46 in frail individuals). Frailty also correlated with elevated risks of stroke (HR, 1.46) and major bleeding events (HR, 1.34). Our analysis also revealed non-significant associations with cardiovascular death and intra-cranial hemorrhage.

Conclusion: Frailty significantly increases the frequency of adverse outcomes in elderly patients with AF; thus, these patients should be managed with tailored risk stratification tools. Integrating frailty assessments into clinical decision-making should aid in optimizing care strategies and enhance outcomes in this vulnerable population.

Objective: To evaluate the correlation between ultrasound (US) examination parameters and pathological characteristics of papillary thyroid carcinomas (PTC).

Methods: A retrospective analysis was conducted using clinical data from 89 patients with PTC (malignant group) and 89 patients with benign thyroid nodules (benign group) who underwent US at Chengdu Shuangliu Hospital of Traditional Chinese Medicine between February 2021 to February 2023. The correlation between ultrasound parameters and pathological features of PTC was analyzed.

Results: Ultrasound parameters in the malignant group were significantly different from those in the benign group (P<0.05). Peak systolic blood flow velocity (PSV), pulsation index (PI), and resistance index (RI) were significantly higher in patients with malignant lymph node metastasis (LNM) and stage III-IV PTC. In contrast, peak intensity (Peak), mean transit time (MTT), time to peak (TTP), and area under curve (AUC) were significantly lower than those in patients without LNM and stage I-II (P<0.05). Spearman's analysis revealed significant correlations between ultrasound parameters, LNM, disease staging, and gene mutations (P<0.05). Of the 89 PTC patients, 27 had disease recurrence, and five died during the follow-up. The poor prognosis group had significantly higher PSV, PI, and RI and lower Peak, MTT, TTP, and AUC compared to the good prognosis group (P<0.05).

Conclusions: Ultrasound is a valuable tool for diagnosing and evaluating papillary thyroid carcinoma (PTC). It shows strong correlations between ultrasound parameters and pathological features, including lymph node metastasis and disease staging, aiding early diagnosis and prognosis prediction.