Pakistan Journal of Medical Sciences最新文献

Objective: To explore clinical efficacy of donepezil combined with nerve growth factor (NGF) in the treatment of Parkinson's disease dementia (PDD) and its potential impact on serum levels of adiponectin (APN) and soluble tumor necrosis factor receptor-1 (sTNFR-1).

Methods: Clinical data of 140 patients with PDD treated in Taizhou First People's Hospital from March 2021 to December 2023 were retrospectively analyzed. Patients were grouped based on the treatment received. Patients who received donepezil alone (n=68) comprised the Donepezil group, and patients who were treated with a combination of donepezil and NGF (n=72) were assigned into the Donepezil & NGF group. Treatment effects, symptom improvement before and after the treatment, APN and sTNFR-1 levels, and incidence of adverse reactions were compared between two groups.

Results: The overall efficacy of the combination therapy was higher than that of donepezil regimen alone (P<0.05). After treatment, symptom improvement in the Donepezil & NGF group was significantly better than that in the Donepezil group (P<0.05). Post-treatment serum levels of APN in the Donepezil & NGF group were significantly higher than that of Donepezil group, while the level of sTNFR-1 was significantly lower (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).

Conclusion: Combined regimen of donepezil and NGF is more effective than donepezil monotherapy in improving cognitive function, neurological function, and severity of the condition of patients with PDD, and is associated with the suppression of the inflammatory response without a significant increase in the incidence of adverse reactions. The study provides a basis for the clinical application of the combined regimen, but it still needs to be confirmed by more basic and clinical research.

Background and objective: Children living in low and middle-income class settings exhibit varied nutritional status ranging from healthy to malnourished. Differences in socioeconomic conditions and Infant & young child feeding practices may be responsible for nutritional disparities among them. This case-control study aimed to explore these differences among healthy and malnourished children aged 0-23 months.

Methods: This was a hospital-based, case-control study. The study was conducted in the outpatient department of The Indus Hospital, Karachi from June 2022 till December 2022. A total of 380 children aged 0-23 months were recruited from the outpatient department.. Compliance to different IYCF indicators, ranging from breastfeeding to complementary feeding, was. assessed by taking 24 hours food recall. Mid-upper arm circumference was used to categorize the nutritional status of children.

Results: The dominant food groups consumed were roots, grains, and tubers, while consumption of vitamin A-rich fruits, flesh food, eggs, fruits, and vegetables were relatively low in both groups. Multivariate logistic regression analysis revealed that low paternal education (COR = 3.64; 95% CI: 2.07, 6.40), employment of mother (COR = 2.27; 95% CI: 1.19, 4.36), and achieving minimal meal frequency (AOR = 2.41; 95% CI: 1.09, 5.31) had a negative association with the nutritional status of children while male gender (COR = 0.52; 95% CI: 0.35, 0.79) and maternal education (AOR = 0.20; 95% CI: 0.06, 0.60) and paternal employment (COR = 0.29; 95% CI: 0.14, 0.59) were positively associated with nutritional status.

Conclusion: We conclude that lack of parental education, father unemployment, maternal employment, and minimal meal frequency were significantly associated with malnutrition in children.

Background and objective: The prevalence of neurodevelopmental disorders (NDs) and allergic diseases(ADs) has increased in recent years. This study aimed to analyse the association between them among children registered at primary healthcare units in Izmir.

Methods: For this retrospective cross-sectional study, primary healthcare units in Izmir were selected by randomisation conducted between January 1, 2023 and December 31, 2023. The dependent variables are attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). The risk factors are respiratory allergies and skin allergies. Logistic regression models were adjusted for age, sex, socioeconomic level.

Results: There were 20,557 children registered in 26 primary healthcare units. Skin allergy was detected in 7.8%, respiratory allergy in 6.8%, ADHD in 1.2% and ASD in 0.0%. ADHD comorbidity was found to be high in both children with respiratory allergies and children with skin allergies (p<0.001). The rate of ASD comorbidity was 1.8% in boys with respiratory allergies and 1.6% in boys with skin allergies (p>0.01). The analysis could not be performed due to the low number of girls with ASD. The logistic regression models showed a higher odds ratio for respiratory allergies (OR:6.2, 95% CI: 4.6-8.3) than for skin allergies (OR:2.2, 95% CI: 1.5-3.2) for ADHD.

Conclusion: It would be beneficial to increase awareness among healthcare providers and parents about the co-occurrence of NDs and ADs.

Objective: To explore the perceptions of medical students about the effects of financial stresses.

Method: A qualitative exploratory study was conducted in March - August of 2023. Data were taken from a purposive sample of twelve undergraduate medical students from various medical colleges in Peshawar. Semi-structured in-depth interviews were conducted using a validated interview guide to explore the effects of financial stress on medical students. The audio recordings of the interviews were transcribed. Because the data was sensitive, anonymity and confidentiality were guaranteed to the participants. Thematic analysis was then used and authors of the study agreed on themes and subthemes after a manual thematic analysis was completed.

Results: This study reveals five themes about the effects of financial stress among medical students. The five themes include financial stressors in medical education, their effects on academic performance and achievement, future career choices, healthcare and well-being practices, and educational policies and interventions suggesting potential solutions to overcome the financial challenges.

Conclusion: This study highlights the multifaceted nature of financial stress among medical students, its significant influence on academic achievement and career decisions, and the negative health implications it presents. It also explores potential strategies for alleviating this burden. In addition to the suggestions given by medical students, there is a need to adopt specific strategies for medical institutions, policymakers, and future research endeavors to deal with the financial challenges faced by medical students.

Objective: To determine the frequency and pattern of dyslipidemia and its association with other risk factors among Type-2 diabetics.

Methods: This cross-sectional study was conducted in Diabetic Clinic of Shaikh Zayed Postgraduate Medical Institute Lahore from January-October 2023. Type-2 diabetics regardless of age were evaluated by fasting lipid profile and were further evaluated by BMI, HbA1c and smoking. Exclusion criteria was patients taking lipid lowering drugs and all other causes of secondary dyslipidemias other than diabetes. Data for normally distributed quantitative variables was presented by Mean±SD, and for skewed measures were presented by using median (IQR). Dyslipidemia was described for each trait by using frequency and percentages.

Results: A total of two hundred and twelve subjects were included in the study with the mean age of 53.4±9.1 years. About 96.6% patients were found to have different patterns of dyslipidemia that also showed positive association with smoking, uncontrolled HbA1c and obesity (p < 0.001).

Conclusion: There is very high prevalence of dyslipidemia among Type-2 diabetics especially those who are smokers, with poor glycemic control and overweight/obese. Early screening of patients for dyslipidemia with lifestyle modifications and treatment of dyslipidemia can reduce risk of CVD.

Objective: To explore the influencing factors of polyspermy in long-term fertilization during in vitro fertilization (IVF) with antagonist protocol.

Methods: This was a retrospective case-control study. Patients with secondary infertility undergoing assisted reproductive treatment in the Department of Reproductive Medicine of Maternity & Child Care Center of Qinhuangdao between January 2020 and May 2023 were selected. Five hundred and thirty-six ovulation induction cycles with antagonist protocol were included and divided into the control group (multiple pronuclei(PN) rate= 0%, n=347) and the polyspermy group (multiple PN: 2PN ≥20%, n=189) according to the incidence of polyspermy. The general data and embryonic development of the two groups were statistically analyzed.

Results: There were no statistically significant differences in male age, infertile duration, body mass index (BMI), basal follicle-stimulating hormone (FSH) level, number of follicles with a diameter of ≥16mm, total dose of gonadotropin (Gn), total Gn stimulation days, and sperm concentration between the two groups (all P>0.05). Similarily no statistically significant differences in female age, levels of estradiol (E2), LH, and progesterone (P) and number of follicles with a diameter of ≥14 mm on human chorionic gonadotropin (hCG) injection day, the total number of eggs retrieved, amount of Gn/egg, and fertilization concentration (sperms/egg) were observed between the two groups (all P<0.05). The results of logistic binary regression analysis showed that the level of LH on hCG injection day was an independent risk factor for the incidence of polyspermy in antagonist protocol.

Conclusion: In the process of ovulation induction in antagonist protocol, the appropriate addition of LH can improve embryo outcomes.

Objectives: Emergency primary anastomosis following sigmoidectomy is one of the main treatment options in sigmoid volvulus (SV). However, during this procedure, the role of intraoperative colonic lavage (ICL) is controversial. Our aim was to evaluate the role of ICL in 175-patient SV series.

Methods: In Ataturk University Faculty of Medicine Department of General Surgery, ICL was applied in 76 cases (43.4%), while it was not used in the remained 99 patients (56.6%) in 58.5-year period. In a partial retrospective (first 20 years, from June 1966 to June 1986) and prospective (later 38.5 years, from June 1986 to December 2024) evaluation, some preoperative, operative, and postoperative findings were utilized.

Results: As preoperative data, mean age (56.4 years vs. 57.1 years, P>0.05), male/female ratio (4.8 vs. 4.2, P>0.05), and rate of shock (5.3% vs. 6.1%, P>0.05) were statistically similar in both groups, while mean ASA score (3.1 vs. 2.9, P<0.05) was significantly lower in ICL group. Among operative findings, rates of bowel gangrene (67.1% vs. 63.6%, P>0.05) and perforation (1.3% vs. 1.0%, P>0.05) were statistically similar in both groups, while mean operation time (205.4 minutes vs. 176.8 minutes, P<0.005) was significantly longer in ICL group. As surgical outcomes, rates of mortality (13.2% vs 12.1%, P>0.05) and morbidity (39.5% vs. 28.3%, P>0.05) were statistically similar in both groups, while mean hospitalization time (14.7 days vs. 9.4 days, P<0.001) was significantly longer and mean cost (3,455.4 USD vs. 2,752.1 USD, P<0.001) was significantly higher in ICL group.

Conclusion: When compared with that of primary anastomosis with ICL, primary anastomosis without ICL provided shorter operation and hospitalization times, and less cost in addition to similar mortality and morbidity rates in the emergency treatment of SV.

Objective: We reviewed the evidence on the impact of non-alcoholic fatty liver disease (NAFLD) and liver fibrosis on mortality, functional dependence, and recurrence after acute ischemic stroke (AIS).

Methods: This PROSPERO registered review searched PubMed, Embase, CENTRAL, and Web of Science databases from inception of databases to 30^th July 2023 for studies comparing outcomes of AIS based on the presence of NAFLD and liver fibrosis. Adjusted data on mortality, functional dependence and risk of recurrent AIS was pooled to obtain odds ratio (OR) with 95% confidence intervals (CI) in a random-effects model.

Results: Ten studies were included. Descriptive analysis showed conflicting effects of NAFLD on AIS outcomes with some studies showing better functional outcomes with the presence of NAFLD. Meta-analysis showed that the presence of liver fibrosis was associated with a significantly increased risk of mortality (OR: 2.22 95% CI: 1.02-4.86 I²=92%) and functional dependence (OR: 1.89 95% CI: 1.27-2.82 I²=53%) as compared to no fibrosis. Meta-analysis found that liver fibrosis did not increase the risk of recurrent AIS (OR: 1.32 95% CI: 0.74-2.37 I²=74%).

Conclusion: Scant evidence exists for the effect of NAFLD and liver fibrosis on AIS outcomes. A paradoxical effect of NAFLD on functional outcomes has been noted which needs confirmation by future studies. Liver fibrosis was found to increase the risk of mortality and functional dependence in AIS.

Objective: To observe the predictive value of prenatal screening markers combined with serum placental growth factor(PLGF) in early pregnancy for preeclampsia(PE).

Methods: This was a prospective study. A total of 369 pregnant women undergoing early pregnancy examinations were selected at Jingmen Central Hospital from August 2024 to January 2025 and divided into the PE group(n=43) and the normal group(n=326) according to the presence of PE during the follow-up. The levels of prenatal screening markers alpha-fetoprotein(AFP), serum PLGF, β-human chorionic gonadotropin(β-hCG) and pregnancy-associated plasma protein-A(PAPP-A) were compared between the two groups.

Results: There were 43 patients experiencing PE, with an incidence of 11.65%. The levels of PLGF, β-hCG and PAPP-A were significantly decreased in the PE group compared with those in the normal group, and the differences between the groups were statistically significant (all P<0.05). Logistic regression analysis showed that increased prenatal screening markers AFP, serum PLGF, HCG and PAPP-A were independent risk factors for PE, with statistically significant differences between the groups (all P<0.05). Finally, the results of ROC curve analysis showed that the AUCs of AFP, PLGF, β-hCG and PAPP-A were 0.618, 0.645, 0.690, and 0.645, respectively, and the AUC of combined prediction was 0.825, which was significantly increased compared with that of each marker alone, with statistically significant differences(P<0.05).

Conclusion: The development of PE in pregnancy is closely related to the levels of AFP, PLGF, β-hCG and PAPP-A. The predictive efficiency of combined detection of AFP, PLGF, β-hCG and PAPP-A for PE in pregnancy significantly increases.Project Title: sFlt-1/PlGF based combined early pregnancy prenatal screening marker Nursing Strategies and Application in Preeclampsia Risk Assessment, Project Number: 2024YFYB111, Year: 2024.