Pakistan Journal of Medical Sciences最新文献

Objective: To evaluate the clinical efficacy, immune function effects and safety of lenvatinib combined with immune checkpoint inhibitors (sintilimab) in treating advanced primary liver cancer.

Methodology: A retrospective cohort study was conducted on 80 patients with advanced liver cancer in Shijiazhuang People's Hospital from January 2023 to June 2024, who were divided into an observation group (lenvatinib + sintilimab, n=40) and a control group (lenvatinib monotherapy, n=40). Specifically, the overall response rate (ORR), immune function indicators (CD3+, CD4+, CD4+/CD8+, IgM/IgG/IgA), quality of life (SGRQ scores) and adverse reactions were compared between the two groups.

Results: The ORR in the observation group (72.5%) was significantly higher than that in the control group (50.0%), with statistically significant differences (P=0.039). After treatment, the improvement in levels of CD3+, CD4+, CD4+/CD8+ and immunoglobulins (IgM, IgG, IgA) in the observation group significantly outperformed those in the control group, with statistically significant differences (all P<0.05). Additionally, the observation group reported more substantially improved SGRQ scores than the control group and differences were statistically significant (P<0.001). In terms of safety, no statistical differences were observed regarding the incidence of adverse reactions in both groups (P=0.369).

Conclusion: Lenvatinib combined with immune checkpoint inhibitors can significantly improve the objective response rate in patients with advanced liver cancer, enhance their immune function and improve their quality of life, demonstrating satisfactory safety.

Background & objective: Infertility is a significant concern worldwide, affecting millions of couples, yet often under-recognized. In Pakistan, approximately 22% of couples experience infertility, with male factors contributing in 20-25% of cases. Despite advances in reproductive medicine, male infertility remains poorly understood, often requiring specialized interventions. This study aimed to investigate the underlying causes and contributing factors of male infertility in Pakistani men presenting at a specialized infertility unit in Karachi, Pakistan.

Methodology: A retrospective observational study was conducted at the Baqai Institute of Development Sciences (BIRDS), Baqai Medical University, Karachi, from 2015 to 2022. The study included all male patients of reproductive age (18-50 years) who were married, cohabiting and attempting to conceive for over a year without success. For the present analysis, data from couples in whom male factors were identified as the predominant cause of infertility were included. Clinical characteristics, demographic variables, lifestyle habits, comorbid conditions and relevant laboratory parameters were retrieved from medical records. Data were entered and analyzed using SPSS Statistics, version 25.0.

Results: A total of 809 infertile males aged 18-50 years were evaluated. Primary infertility was more common (79.4%) compared to secondary infertility (20.6%). Among the study population, notable comorbidities included diabetes (41.1%) and hypertension (21.3%). Lifestyle factors were also prevalent, with 34.2% reporting smoking, 39.7% using tobacco and 34.7% having a history of testicular surgery. Semen analysis revealed azoospermia in 16.7% of cases, asthenoteratozoospermia in 8.3% and normozoospermia in only 0.4%. A considerable number of participants had a history of sexually transmitted diseases (STDs) and varicocele was identified in 19.4% of cases. Additionally, a family history of infertility was present in 21.9% of individuals.

Conclusion: Male infertility in Pakistan is influenced by a complex interplay of metabolic, infectious and lifestyle factors. Diabetes, sexually transmitted infections and prior testicular surgeries were key contributors. These findings call for greater awareness and accessible fertility services, along with multicenter research to guide health policies and optimize management in resource-limited settings.

Gastroptosis is a clinical condition in which the stomach is displaced downward from its normal position in the belly. The reasons for its present prevalence are not clear due to the availability of scarce medical literature. Giardia affects almost two hundred million people per annum, making it the most common intestinal parasite. In this paper, we report on a 30 years old female who presented with abdominal pain, vomiting, weight loss, and loose stools and was diagnosed with gastroptosis on a barium meal. The diagnosis of giardiasis was established based on a duodenal biopsy, and the patient was followed till complete resolution of symptoms after treatment.

This study is a retrospective case series exploring the clinical and radiological parameters with surgical approach and its outcome for Intraosseous Meningioma (IM), a rare benign tumor primarily affecting the craniofacial bones. It was conducted at the Department of Neurosurgery Unit-III, Punjab Institute of Neurosciences (PINS) from January 2022 to December 2024. The study included five surgically treated patients through non-probability consecutive sampling. A descriptive analysis was done for clinical-radiological and outcome-based variables. The cohort included four females and one male, with a mean age of 34±15.77 years. Most presented with painless progressive swelling, predominantly in the frontal and parietal bones. CT scan consistently revealed hyperostosis and MRI dural enhancement. All patients underwent craniectomy and complete excision, with four requiring cranioplasty. Histopathological analysis confirmed WHO Grade I Meningioma in all cases. No postoperative complications or recurrences were noted during 3-6 months of follow-up. The study underscores the importance of early diagnosis and complete surgical resection in managing IM and contributes to the limited existing literature.

Craniopharyngioma (CPG) is a rare benign brain tumor often affecting the sellar/parasellar region in children. Giant variants can cause severe intracranial pressure and hydrocephalus and require ventriculoperitoneal (VP) shunting. A seven-year-old boy presented with a two-year history of headaches, as well as recent visual deterioration, altered sensorium, and vomiting. MRI brain revealed a cystic mass in the sellar and suprasellar regions causing mild hydrocephalus. After tumor excision and VP shunt placement, he developed abdominal CSF ascites, requiring shunt revisions, including ventriculoatrial shunt, and later suffered from a pseudomonas infection, leading to death from acute respiratory distress syndrome and hospital-acquired pneumonia. This case highlights the rare but critical complication of CSF ascites following VP shunting in a child with giant craniopharyngioma, emphasizing the importance of early recognition and timely intervention. Clinicians should be aware of this potential complication, as it requires careful diagnostic workup and management strategies, including shunt modifications and consideration of alternative shunting options.

Objective: Primary CNS lymphoma (PCNSL) in children is a rare disease, and this study aimed to document the experience of dealing with this in our geographical and resource settings.

Methodology: It was an ambidirectional cohort study conducted at the Department of Pediatric Hematology/Oncology and the Department of Pediatric Neurosurgery at the University of Child Health Sciences, The Children's Hospital Lahore, Pakistan from March 2024 to December 2024. This study included seven suspected and confirmed cases of PCNSL in children under the age of 16 years who presented to a public-sector specialized center in Pakistan over the three-year study period.

Results: A total of seven cases of suspected PCNSL were included in the study. The median age at presentation was eight years, with a female-to-male ratio of 2.5:1. Most commonly presenting with a focal neurological deficit, with a median duration of symptoms of 12 weeks, and a median Lansky performance score of 50. Only 57% (04) of patients underwent surgical resection followed by adjuvant chemotherapy. Overall, 57% (03) of patients died, 29% (02) were lost to follow-up, and only 14% (01) are under treatment.

Conclusion: PCNSL in children is equally rare in our part of the world, but has a dismal survival rate. Timely surgical intervention, improved supportive care, and a reduction in treatment abandonment might improve the prognosis.

Objective: To assess the functional outcomes in patients with intradural spinal neoplasms following neurorehabilitation.

Methodology: This retrospective case series was conducted in the Physiotherapy Department of Punjab Institute of Neurosciences, from July 2024 to December 2024. Data was collected from medical records of patients who underwent surgical resection of intradural spinal cord space-occupying lesions (SOL) followed by neurorehabilitation. Neurorehabilitation in this study comprised individualized, structured programs incorporating evidence-based manual therapy techniques, neurodevelopmental approaches, and task-specific training, delivered by specialized physical therapists. The treatment plans were designed according to patient needs and focused on restoring mobility, reducing spasticity, improving muscle strength, and enhancing independence in daily activities. Functional outcomes were assessed using the Numeric Pain Rating Scale (NPRS), Modified Ashworth Scale (MAS), Oxford Manual Muscle Testing (MMT), and Spinal Cord Independence Measure (SCIM). Assessments were performed following neurorehabilitation.

Results: A total of 10 patients were included, with a mean age of 38.33 ± 23.71 years; 80% (8) were female. Most participants, 70% (7) had intradural extramedullary (IDEM) tumors, while 30% (3) had intradural intramedullary (IDIM) tumors. Post-rehabilitation, NPRS scores significantly decreased from 6.70 ± 0.95 to 2.50 ± 0.85. MAS scores improved from 2.80 ± 0.42 to 1.60 ± 0.52, indicating reduced spasticity. MMT scores increased from 2.00 ± 0.47 to 3.30 ± 0.48, demonstrating improved muscle strength. SCIM scores improved from 31.40 ± 4.99 to 63.50 ± 8.89, highlighting enhanced functional independence.

Conclusion: Neurorehabilitation particularly early initiation and frequent, structured sessions using manual therapy and neurodevelopmental techniques significantly improves pain levels, muscle tone, strength, and functional independence in patients following surgical resection of intradural spinal tumors. Early and structured rehabilitation programs do play a crucial role in optimizing post-operative recovery in these patients.

Objective: To compare the impact of open abdominal radical hysterectomy (ARH) and laparoscopic radical hysterectomy (LRH) on stress response and urodynamic status of early cervical cancer (CC) patients.

Methodology: Clinical data of 115 patients with early-stage cervical cancer (CC) who underwent surgery at Beijing Shijitan Hospital, Capital Medical University, between December 2021 and June 2024 were retrospectively analyzed. Based on the surgical approach, patients were divided into the ARH group (n = 59) and the LRH group (n = 56). Perioperative status, stress response, and urodynamic indicators before and after the surgery, and the incidence of complications were compared between the two groups.

Results: The perioperative indicators (surgical duration, intraoperative blood loss, anal exhaust duration, number of dissected lymph nodes, and the length of hospital stay) of patients in the LRH group were better than those of the ARH group (P<0.05). After the surgery, the levels of serum angiotensin II (Ang II), growth hormone (GH), and cortisol (Cor) increased in both groups compared to preoperative levels and were significantly lower in the LRH group than in the ARH group (P<0.05). After the surgery, bladder capacity and maximum urethral pressure (MUP) increased, whereas residual urine volume (RUV) decreased in both groups compared with preoperative levels. Patients who underwent LRH had greater bladder capacity and MUP and lower RUV compared to the ARH group (P < 0.05). The incidence of complications in the LRH group was significantly lower than that in the ARH group (P < 0.05).

Conclusions: Compared with ARH, LRH for early CC provides greater benefits in the early postoperative period, including a lower stress response and better improvement in short-term urodynamic indicators.