Pakistan Journal of Medical Sciences最新文献

Objective: Enhanced Recovery After Surgery (ERAS) aims to reduce patients' stress response during the perioperative period through a series of evidence-based optimization measures, promoting rapid rehabilitation. This study aimed to evaluate the effectiveness and safety of ERAS in this high-risk group, with particular attention to the recovery of liver function, gastrointestinal function, and postoperative complications, all of which are critical to improving outcomes in elderly patients and have not been thoroughly investigated in previous studies.

Methodology: The clinical data of elderly patients with hepatolithiasis who underwent partial hepatectomy in Hunan Provincial People's Hospital from October 2022 to October 2024 were retrospectively analyzed. Patients were divided into the ERAS and the control groups according to whether they received ERAS during the perioperative period. The perioperative indexes, liver function indexes, and complications were compared between the two groups.

Results: A total of 141 patients met the inclusion criteria: 73 patients in the ERAS group and 68 patients in the control group. After operation, the first exhaust time and postoperative hospital stay in the ERAS group were significantly lower than in the control group (P<0.05). Five days after the operation, levels of aminotransferase (ALT) in the ERAS group were significantly lower, and albumin (ALB) levels were significantly higher than those in the control group (all P<0.05). ERAS was associated with considerably lower total number of postoperative complications (P<0.05).

Conclusions: The application of the ERAS concept in the perioperative period of partial hepatectomy in elderly patients with hepatolithiasis is safe and effective.

Background and objective: Extended-release levetiracetam offers pharmacokinetic advantages over immediate-release formulations, including stable plasma concentrations and once-daily dosing, which may improve seizure control and reduce psychiatric side effects. This study aimed to evaluate the clinical efficacy, tolerability, and psychiatric side effect profile of LEV ER in epilepsy patients, either newly initiated or switched from LEV IR.

Methodology: A retrospective multicenter cohort study was conducted at two tertiary neurology centers in Istanbul, Turkey. Medical records of 40 patients with epilepsy treated with LEV ER for 12-18 weeks were reviewed. Demographic data, seizure frequency, EEG/MRI findings, prior LEV use, treatment type, and psychiatric comorbidities were analyzed.

Results: The cohort included 27 females and 13 males (mean age 37.6 years). Mean seizure frequency decreased from 1.66 to 0.6 per month after LEV ER initiation (p < 0.001). Of the 36 patients switched from LEV IR, 88.4% with psychiatric adverse effects showed clinical improvement. Among four patients who initiated LEV ER as first-line therapy due to a preference for once-daily dosing, two discontinued treatment because of adverse effects. Clinical improvement was observed in the complaints of 83.3% of patients who switched from LEV IR to ER form due to psychiatric medication use.

Conclusions: LEV ER was associated with a significant reduction in seizure frequency and demonstrated a favorable tolerability profile, particularly with respect to psychiatric adverse effects. Transitioning from LEV IR to LEV ER may offer clinically meaningful advantages in selected patient populations. Nevertheless, further prospective studies with larger cohorts are warranted to confirm these findings.

Objectives: The present study evaluates the shear bond strength (SBS) of metallic brackets bonded to enamel conditioned with Phosphoric acid (PA) and enamel conditioned with Er:Cr: YSGG laser in combination with prophylactic measures, i.e., silver diamine fluoride (SDF) and Self-assembling peptides (P114).

Methodology: The present in vitro lab-based study was approved by the ethical board of King Khalid University. The study duration was three months. Total 48 maxillary premolar teeth were disinfected and categorized into four groups following different surface conditioning regimes (n=12). Group-I (Control), Group-II ECL, Group-III-ECL+SDF, and Group-IV ECL+P114. Following the enamel conditioning with different conditioning regimes, brackets were bonded, and all samples were thermally aged. A pair of bonded samples from each conditioned group was assessed for enamel bracket interface via Scanning Electron Microscopy (SEM). The remaining ten bonded samples were evaluated for SBS testing and failure analysis. Intergroup comparisons between the investigated groups were performed using one-way analysis of variance (ANOVA) and Tukey's post-hoc test.

Results: Enamel pretreated with PA demonstrated SBS values significantly higher than Group-II, Enamel conditioned with ECL only (p<0.05) but lower than Group-III- enamel conditioned with ECL+SDF and Group-IV, ECL+P114 (p<0.05).

Conclusion: ECL laser combined with 38% SDF or with P114, exhibits SBS values that are notably superior to those achieved with PA.

Objective: This study aimed to determine the efficacy and safety of low-frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) combined with risperidone in the treatment of schizophrenia patients with auditory verbal hallucinations (AVH).

Methodology: This retrospective cohort study was conducted in Wenzhou Seventh People's Hospital and included data from 100 schizophrenia patients with AVH, treated from May 2022 to May 2024. Among them, 50 patients who received low-frequency rTMS combined with risperidone were matched with the cohort of patients who received risperidone alone in a ratio of 1:1. The scores of the Psychotic Symptom Rating Scale (PSYRATS), Auditory Hallucination Rating Scale (AHRS) and Positive and Negative Syndrome Scale (PANNS) were compared between the two groups at baseline, at the end of treatment (five weeks) and after one month of follow-up.

Results: PSYRATS, AHRS, and PANSS scores of the two groups decreased with time (p<0.05). After treatment, the general psychopathological symptoms, positive symptom scores, and PANSS total scores of the rTMS/risperidone group were lower than those of the risperidone group (p < 0.05). There was no difference between the two groups at one-month follow-up (p > 0.05). The incidence of adverse reactions during treatment was comparable in the two groups (p > 0.05).

Conclusions: The results of this study showed that risperidone, combined with 1Hz rTMS, showed no benefit in improving the auditory hallucination symptoms of schizophrenia patients with AVH. However, the combined regimen could significantly improve the positive symptom scores of patients during treatment.

Objectives: Many causes have been put forward in the etiology of pneumothorax, but the specific atmospheric factors causing this condition have been a popular topic of discussion. Our study aimed to investigate the effects of atmospheric parameters on the occurrence of spontaneous pneumothorax, as well as the effects of the lunar cycle, important astrological events, and superstitions.

Methodology: We conducted a retrospective review of 302 patients with primary spontaneous pneumothorax who applied to Kocaeli University Hospital between January 2013 to December 2022. The study time period was divided into two as days with and without pneumothorax, and the effects of climatic parameters, the moon, important astrological events, zodiac signs, and superstitions such as Friday the 13th on spontaneous pneumothorax were investigated.

Results: It was determined that between days with and without pneumothorax, the maximum temperature on the day of the event, as well as one and two days before, and the minimum temperature on the day of the event, as well as one, two and three days before, were statistically significantly low. Although numerical differences in other parameters, no statistically significant difference was detected. On lunar days, the highest number of pneumothorax cases was observed on the 28th day, 17 (13.7%) and the lowest number of pneumothorax cases was observed on the 13th day, 2 (1.6%) (p=0.310). The highest number of pneumothoraces was in the waning crescent phase 68 (%25.37); the lowest number of pneumothoraces was in the first quarter phase 6 (%2.99). No significant difference was found in pneumothorax numbers in relation to the date ranges of zodiac signs or superstitions.

Conclusions: Atmospheric parameters are associated with the occurrence of pneumothorax. The effect of the moon, on spontaneous pneumothorax increases during certain periods. Astrological conditions, zodiac date ranges, and superstitions are not associated with the occurrence of spontaneous pneumothorax.

Objective: The objective of this study was to assess patients' satisfaction regarding anaesthetic care at our tertiary care center and to evaluate the common reasons for dissatisfaction.

Methodology: This cross-sectional survey was conducted for a period of seven months from 1^st January 2023 to 31^st July 2023 at the surgical wards of our tertiary care hospital through a self-completed questionnaire filled by patients themselves. The data was entered and analyzed using SPSS. Frequency and percentages were used to assess the responses and calculate the degree of satisfaction.

Results: The duration of study was seven months included responses from 378 patients. The results were divided into satisfaction regarding preoperative (SA), intraoperative (SB), post operative (SC) care and overall satisfaction (SO). The mean age of patients was 40.6 years. The majority were females who required general surgical procedures, had preoperative workup at anaesthesia clinic and were labeled as ASA-II. Most of them had general anaesthesia. Patients' satisfaction at SA, SB, and SC was 92.7%, 97%, 94.5% respectively. Two major factors contributed to dissatisfaction were process of taking informed consent (6.4%), and explanation of possible risks and complications (10.4%) associated with anaesthetic care. The commonly reported adverse events in the postoperative period were pain (60%), nausea and vomiting (39.4%), sore throat (24.6%), somnolence (23%), limitations in movement (23.5%) and shivering (15.1%). Amongst them, shivering was the greatest reason for dissatisfaction (14%). Overall, 3.6% of patients were dissatisfied with the anaesthesia care.

Conclusion: Overall, patients' satisfaction at mentioned intervals was high. The factors associated with dissatisfaction were insufficient counselling about consent, risks, complications and postoperative shivering related to anaesthesia.

Objective: The aim of this study was to compare the patients who were evaluated as forensic cases in the emergency department during Ramadan according to the month before and after Ramadan and to examine the effect of this process on forensic case management.

Methodology: This study was conducted retrospectively using patient data from the emergency department of Nevsehir State Hospital in Turkiye. Within the scope of the study, patients admitted to the emergency department between 2020 to 2024 who were recorded as forensic cases were evaluated. The demographic data of the patients, time of admission, reason for admission, discharge status in the emergency department and diagnoses of inpatients were analyzed.

Results: In the study, 4020 forensic cases were evaluated. 69.4% of the patients were male. The mean age was 32.57±17.52 years. There were more admission (38.8%) after Ramadan. The most common reason for admission was traffic accidents (47.5%). There was no significant difference in the number of patient admissions between the defined periods (p=0.078). The number of patient admissions was significantly higher between the hours of Iftar to Imsak (p<0.001).

Conclusion: Comparison between before and after Ramadan, the number of patient admissions evaluated as forensic cases increased significantly after Ramadan. There was no significant difference between the hours of admission. It was observed that there was a significant increase in traffic accident-related admissions close to Iftar time.

Objective: To evaluate the efficacy of traditional Chinese medicine (TCM) fumigation and washing combined with Acanthopanax senticosus injection in patients with sleep disorders.

Methodology: The clinical data total of 106 patients with sleep disorders treated at Yan'an Traditional Chinese Medicine Hospital from January 2023 to January 2025 were retrospectively analyzed. Patients were divided into two groups: the control group (n=51) received routine care with dexzopiclone; the study group (n=55) received additional TCM fumigation and Acanthopanax senticosus injection. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), sleep structure was monitored via polysomnography (PSG), and quality of life was evaluated using the GQOLI-74 scale. Safety indicators and adverse events were also recorded.

Results: After the intervention, the study group showed significantly greater improvements in PSQI scores compared to the control group (P<0.001). PSG parameters indicated fewer nocturnal arousals, shorter arousal time and sleep latency, and higher sleep efficiency in the study group (P<0.05). Quality of life scores across physical, psychological, social, and mental domains also improved significantly more in the study group. No adverse events were reported during the study.

Conclusions: TCM fumigation and washing combined with Acanthopanax senticosus injection may serve as an effective, well-tolerated, and non-invasive therapy for improving sleep quality and life quality in patients with sleep disorders. The therapy may be particularly beneficial for individuals with poor tolerance to hypnotic medications or stress-related insomnia. Further prospective randomized trials with longer follow-up are warranted to confirm long-term efficacy.

Objective: We present the first systematic review and meta-analysis examining the association between systemic immune inflammation index (SII) and systemic inflammation response index (SIRI) for predicting prognosis of cervical cancer.

Methodology: Cochrane CENTRAL library, Embase, Medline (PubMed), Scopus and Web of Science databases were explored up to 25^th October 2024 for all study types examining if SII or SIRI could predict overall survival (OS) and/or disease-free survival (DFS) in cervical cancer.

Results: We included 13 studies with 15 cohorts. We noted that high SII scores were associated with statistically significant increased risk of poor OS (HR: 2.15 95% CI: 1.48, 3.14 I²=78%) and worse DFS (HR: 2.05 95% CI: 1.21, 3.46 I²=83%) in cervical cancer. Meta-analysis also showed a statistically significant association between SIRI and OS (HR: 1.47 95% CI: 1.02, 2.13 I²=67%) but not for DFS (HR: 1.59 95% CI: 0.96, 2.64 I²=79%). Subgroup analysis based on country of the study, sample size, cancer stage, treatment, cut-off, use of adjusted data and study quality showed variables results.

Conclusions: SII can be used to predict OS and DFS in cervical cancer. However, SIRI was found to predict only OS and not DFS with less robust results. Further studies shall provide better evidence. Registration No: PROSPERO: CRD42024603478.