Pakistan Journal of Medical Sciences最新文献

Objective: To determine the relationship between sleep pattern dysfunction with stress, anxiety and depression among pregnant women in a tertiary care hospital.

Method: An analytical cross-sectional study was conducted at Dr. Ruth K. M. Pfau at Civil Hospital, Karachi from December, 2021 till January, 2022 in which total three hundred pregnant women were included. The association between maternal psychiatric symptoms with the sleep pattern was explored using the Chi- square test. The multivariable logistic regression technique was used to estimate adjusted odds ratios (ORs) and to estimate the association of sleep pattern dysfunction with psychiatric illnesses.

Results: Sleep disorder was found in 49.3% of the pregnant women. Among these women, 54.0% had antepartum depression, 31.3% had stress and 44% reported anxiety. Women with sleep pattern dysfunction were nine times more likely to develop antepartum depression as compared to women without sleep pattern dysfunction (OR: 9.25, 95% CI: 5.45-15.70). Similarly, stress was five times more likely to develop in women with sleep pattern dysfunction (OR: 5.06, 95% CI: 2.92-8.76). Furthermore, Anxiety is also four times likely to develop in women with sleep pattern dysfunction (OR: 4.76, 95% CI: 2.91-7.80) compared to women without any sleep disturbances.

Conclusions: During pregnancy, sleep disturbances were related to the increased risk of developing psychiatric illnesses. It was found that women with disturbed sleep patterns had high rates of antepartum depression followed by stress and anxiety as compared to women without disturbed sleep patterns.

Objective: To explore the efficacy of the nutritional support team (NST) management model in patients undergoing total gastrectomy combined with Roux-en-Y anastomosis.

Methods: Clinical data of 102 patients who underwent total gastrectomy combined with Roux-en-Y anastomosis in Xingtai Central Hospital from January 2020 to October 2023 were retrospectively collected. Of 102 patients, 53 received the NST model of management (NST group), while 49 were managed by the conventional nutritional support (TN group). The nutritional and immune function status of the two groups before and seven days after the surgery, postoperative rehabilitation status, and the incidence of complications were compared.

Results: After the surgery, levels of albumin and total protein in both groups increased compared to before the surgery and were significantly higher in the NST group compared to the TN group (P<0.05). Levels of CD3⁺, CD4⁺, CD4⁺/CD8⁺ in the two groups increased compared to preoperative levels and were significantly higher than the TN group compared to the NST group. In contrast, postoperative CD8⁺ levels decreased and were significantly lower in the NST group (P<0.05). The duration of anal exhaust, defecation, and hospitalization in the NST group of patients was shorter (P<0.05), but no significance was found in the incidence of complications between the two groups (3.78% versus 16.33%) (P>0.05).

Conclusions: For patients undergoing total gastrectomy combined with Roux-en-Y anastomosis, the NST nutritional management model can effectively improve nutritional status, enhance immune function, shorten the postoperative recovery process, and the incidence of complications is equivalent to that of patients receiving conventional nutritional support.

Objective: To determine the risk factors and outcomes of maternal sepsis.

Methods: This case-control study was performed at the departments of Obstetrics & Gynecology, Nishtar Hospital, Multan, and Ghazi Khan Hospital, Dera Ghazi Khan, Pakistan, from June 2023 to May 2024. Cases were comprised of females aged 18-45 years diagnosed with maternal sepsis, and admitted during the study period. Controls were randomly selected females reporting during the study period and undergoing delivery. Sepsis was labeled on the basis of positive blood culture report. Crude and adjusted odds ratio with 95% confidence interval were reported regarding various risk factors of maternal sepsis as well as maternal and fetal outcomes taking p<0.05 as significant. Mortality was noted from the onset of labor until seven days postpartum.

Results: In a total of 74 women (37 in each group), the mean age and, gestational age were 30.64±5.12 years, and 36.19±1.84 weeks, respectively. Multivariate binary logistic regression showed that gestational age below 37 weeks (AOR: 5.22; 95% CI: 1.35-19.67; p=0.015), unbooked cases (AOR: 5.34; 95% CI: 1.19-24.2; p=0.029), and anemia (AOR: 8.13; 95% CI: 1.05-63.10; p=0.045) were significant predictors of maternal sepsis. E. coli was the most common etiological agent among cases, affecting 14 (37.8%) cases. Mortality was significantly high among females with maternal sepsis versus those without maternal sepsis (32.4% vs. 2.7%, p=0.008).

Conclusion: Gestational age below 37 weeks, lack of antenatal booking, and anemia were found to be significant predictors of maternal sepsis. E. coli was the most common pathogen identified. High mortality rate in maternal sepsis highlights the need for early identification, effective management, and close monitoring to reduce maternal mortality from sepsis.

Objective: To investigate and compare the median nerve-cross sectional area at the wrist region of the dominant and non-dominant hands of high- and low- smartphone users.

Method: This descriptive cross-sectional study was based on 128 human subjects conducted at Bahria University Health Sciences Karachi Campus from January to June 2022. The sample size was calculated using the method of sample size for frequency in a population www.openepi.com which is an open-source calculator, version 3-SSPropor using the following equation: Sample size n = [DEFF*Np(1-p)]/[(d²/Z²1-α/2*(N-1)+p*(1-P)]. The subjects were from MBBS, BDS, DPT, and Dental House Officers. They were grouped into two categories: high-smartphone users and low-smartphone users, based on the smartphone addiction scale (SAS). Ultrasound was carried out on each subject's wrist regions at the carpal tunnel level. The readings were compared between the dominant and non-dominant hands of each individual.

Results: In this descriptive cross-sectional study on 128 subjects, the difference between the median nerve cross-sectional areas (MN-CSAs) of the dominant and non-dominant hand of the high-smartphone group was highly significant (p=0.007). The difference between the MN-CSAs of the dominant and non-dominant hand of the low-smartphone group was significant too (p=0.0103).

Conclusion: Smartphone overuse resulted in an enlarged median nerve, especially in the dominant hand.

Objective: To explore the therapeutic effect of titanium locking plate combined with suture anchor (SA) repair in the treatment of proximal humeral fractures (PHF).

Methods: This retrospective study was conducted by analyzing the clinical data of 113 patients with PHF admitted to Wuhan Fourth Hospital from March 2021 to October 2023. Among them, 55 patients underwent open reduction and internal fixation (OR/IF) using titanium locking plate (OR/IF group), and 58 patients underwent surgery with titanium locking plate combined with SA (SA group). Perioperative condition, treatment success rate, shoulder joint function before and after the surgery, shoulder joint range of motion, and incidence of complications were compared between the groups.

Results: Surgery duration and the length of hospital stay of patients in the SA group were significantly shorter than those in the OR/IF group, and the intraoperative blood loss was significantly lower in the SA group than in the OR/IF group (P<0.05). In terms of treatment effect, the SA group was significantly higher than the OR/IF (P<0.05). After the surgery, muscle strength, pain levels, daily living activities, and shoulder joint range of motion scores of both groups improved, and the improvement was more significant in the SA group compared to the OR/IF group (P<0.05). After the surgery, the degrees of internal rotation, forward flexion, backward extension, and external rotation of the shoulder joints in both groups increased compared to pre- surgery levels, and were greater in the SA group compared to the OR/IF group (P<0.05). The incidence of complications in the SA group was lower than that in the OR/IF group (P<0.05).

Conclusions: In patients with PHF, the combination of titanium locking plate and SA has a more significant therapeutic effect than that of titanium locking plate alone, which is associated with improved shoulder joint function and range of motion, and reduced incidence of complications.

Background & objective: Determination of axillary lymph-node status plays a pivotal role in decision making for breast cancer treatment. Biopsy is the current standard of care but hold risks of complications as well. We aimed to find out the correlation of sonographic features of lymph node and histo-pathological findings, to predict axillary lymph-node metastasis in breast cancer patients.

Method: This retrospective observational study included 176 breast cancer patients at a private tertiary care hospital from January 2019 to December 2023. The study calculated sensitivity, specificity and accuracy of ultrasound (US) in identifying ALN metastasis. Also, binary logistic regression analysis was used to demonstrate the association between suspicious findings on axillary US with pathology report. Patients who never had undergone axillary surgery or with insufficient data, were excluded from our study.

Results: In our study Axillary US was found to be 84.2% sensitive, 48.1% specific, and 67.6% accurate in identifying nodal metastases. In this context, ALN metastases was strongly and independently correlated with cortical thickness > 3 mm and the absence of a fatty hilum (P <.05).

Conclusion: Ultrasound was found to be highly sensitive but not specific in predicting metastatic lymph nodes in patients with breast cancer.

Background & objectives: Hypoferritinemia without anemia (HWA) is an under-recognized public health concern. Early identification and targeted treatment of HWA can prevent unnecessary medication use and potential drug abuse. This study aims to establish clearer guidelines for recognizing and managing HWA, improving patient's outcome. The study objectives will be to compare the treatment efficacy of oral and IV iron on patients with HWA and to check the severity of clinical indicators of HWA post treatment among reproductive age women.

Methods: We will choose a multicenter, multi-arm randomized controlled trial with a parallel assignment interventional model. About three hundred participants (n=300) aged 18-45 with hypoferritinemia without anemia and no comorbidities will be recruited. Participants will be randomized into three groups of one hundred each: Group-A will receive oral iron supplements (Iron III Hydroxide Polymaltose Complex, 100 mg elemental iron) one tablet per day for three months; Group-B will receive intravenous iron (Ferric carboxymaltose, one dose per month for three months); Group-C will receive no treatment. All groups will be followed for four months.

Conclusion: The primary outcome will be the change in serum ferritin levels among groups at four months post-intervention. Secondary outcomes will include changes in clinical symptoms post-intervention. Data will be analyzed by using independent t-tests for between-group ferritin levels, paired t-tests for within-group comparisons, Wilcoxon Rank and Friedman tests for clinical symptoms, and ANOVA for comparisons across multiple groups.

Objectives: To determine the prevalence of family planning practice among the parents of children affected with beta thalassemia major (BTM) and to determine the relationship between various factors and family planning practice in Makran division Balochistan.

Methods: A cross-sectional observational study was conducted on 190 parents having BTM children registered in thalassemia care centers throughout the Makran division from May 2023 to October 2023. The structured questionnaire was used and data was collected using the non-probability convenience technique. SPSS 20 was used for analysis.

Results: A total of 190 parents were interviewed and only 111 (58.42%) couples were practicing family planning. A significant relation was found between Family planning and monthly income, religious belief, parents with more than three children, and different districts of the Makran division. (p<0.05) The most common methods of contraception used by participating couples were oral contraceptive pills (OCPs) (18.4%) followed by barriers (16.8%). The predominant reason for not practicing family planning was the desire to have more children and religious beliefs.

Conclusion: The religious beliefs, economic status of the family, area of residence, and total number of children play a significant role in family planning practices among the parents of children affected with BTM.

Objective: We conducted a systematic review and meta-analysis of randomised studies in humans comparing the outcomes of switching to heated tobacco products (HTPs) versus continuing conventional tobacco smoking by burning.

Methods: We searched the electronic databases which included PubMed, Web of Science, Cochrane Controlled Trials Register, and Google Scholar from inception to May 2023. Randomised Controlled Trials (RCTs) in humans comparing HTPs with conventional burnt tobacco products were selected. Our search yielded 4817 search results, of which six RCTs (number of participants 1362, all from high-income countries) were selected. Five of the six included RCTs had low risk in four of five domains of bias; only one study had a high risk of bias in one domain. PRISMA guidelines were followed.

Results: There were 40 biomarkers of harm reduction reported categorised into six categories. One cancer biomarker (nitrosamine) and two cardiovascular biomarkers (eosinophils and total bilirubin) showed statistically significant harm reduction (total NNAL SMD=0·82, 95% CI 0·67-0·98, eosinophils SMD=0·38, 95% CI 0·12-0·65, total bilirubin SMD=0·71, 95% CI 0·28-1·31). The remaining biomarkers of harm in cardiovascular, inflammatory, metabolic, pulmonary, and renal categories showed imprecise findings.

Conclusions: In RCTs of moderate quality, some biomarkers show harm reduction associated with switching from burnt tobacco smoking to HTPs. The majority of the findings are imprecise due to the small sample sizes of the included studies. Sufficiently powered, robust RCTs targeting key harm reduction biomarkers within both upper and low-middle income country settings are required in the future.

Objectives: To determine the frequency of undiagnosed hypertension among the diabetic patients with micro vascular complications.

Method: This is a descriptive case series conducted at Department of Medicine, Ghurki Trust Teaching Hospital, in this six month stud which enrolled 213 patients between 18-60 years from March 28, 2021 to September 28, 2021, having diabetes with microvascular complications. These patients were not previously diagnosed as hypertensives. Patient was diagnosed as hypertensive if SBP or DBP was ≥l40 or ≥90 mmHg respectively. The frequency of undiagnosed hypertension was noted and compared across various subgroups of patients.

Results: The mean age of the patients was 49.3±9.7 years. The mean BMI of these patients was 28.3±3.5 Kg/m2 and 67 (31.5%) patients were obese. The mean duration of disease was 8.2±3.9 years. Majority (62.4%) of the patients had diabetic retinopathy while 37.6% patients had diabetic nephropathy. Undiagnosed hypertension was observed in 42 (19.7%) patients with diabetic micro vascular complications. The frequency of undiagnosed hypertension was significantly higher among obese as compared to non-obese patients (28.4% vs. 15.8%; p-value=0.032). There was no statistically significant difference in the frequency of undiagnosed hypertension across various subgroups based on patient's age (p-value=0.750), gender (p-value=0.902), type of micro vascular complication (p value=0.783) and duration of diabetes (p-value=0.763).

Conclusion: In the present study, a substantial proportion of patients with diabetic micro vascular complications suffered undiagnosed hypertension which is alarming and advocates routine blood pressure monitoring of such patients so that timely identification and anticipated management of underlying hypertension may improve the outcome of such cases in future clinical practice.