Pakistan Journal of Medical Sciences最新文献

Objective: The objective of the study was to explore the presentation of symptoms in patients suffering from treatment-resistant mood disorder (TRMD), and associated clinical features, including age, gender, and comorbid conditions, that lead towards the development of treatment-resistant mood disorder. Furthermore, the study analyses the available psychotherapeutic treatment modalities and evidence-based non-medical treatment approaches for TRMD.

Method: The current study utilized a systematic review approach where 37 articles were studied and three articles were theoretically sampled to authenticate and signify the findings. PRISMA guidelines were followed and the review was conducted by searching social sciences databases and electronic libraries including Google Scholar, Sage Journal, and Science Direct (1990-2020).

Results: The results suggested that psychotherapeutic interventions including cognitive behavior therapy, mindful-based cognitive therapy; and interpersonal and social rhythm therapeutic interventions are efficacious modalities for treatment when in augmentation with psychopharmacological treatment. Bipolar diathesis and comorbid conditions of anxiety and personality disorders are possible causal factors in developing the condition of treatment resistance in mood disorders. The prevalence rate of TRMD is more common in females and in late adulthood. The analysis also suggests that there are numerous risk factors contributing to making a mood disorder treatment-resistant over a period of time; the most observed conditions were physical and psychological comorbidity, inaccurate diagnosis, lack of proper medical treatment, illness severity, and late age diagnosis. In evidence-based non-medical treatment approaches aerobics demonstrated promising results in improving the condition of complex mood disorders.

Conclusion: It was concluded that psychotherapeutic interventions in augmentation with pharmacological modalities enhance the efficacy of treatment.

Objectives: To determine the impact of intravenous Dexmedetomidine (Dex) administered perioperatively on stress response markers in patients undergoing ENT surgeries.

Methods: This randomized interventional study was conducted at POFs Hospital and NUMS affiliated WMC, Wah Cantt, in collaboration with IIMC Rawalpindi, Pakistan, from October 2021 to April 2022. One hundred patients aged between 15-60 years, after satisfying the inclusion standards were randomly divided into two groups C and D. Group-C (n=50) received normal saline in addition to the standard anesthesia protocol. The intervention Group-D (n=50) was administered 1µg/kg dexmedetomidine hydrochloride intravenously over 10 minutes just before the induction followed 0.5μg/kg/hr as maintenance dose till the end of surgery. Serum inflammatory biomarkers (interleukins-6, TNF-α and cortisol) were measured in blood samples in both groups, taken at 0 (T0), 30 minutes(T1), and two hours (T2) time intervals and analyzed by using Enzyme-linked immunosorbent assay (ELISA). Data was statistically analyzed using SPSS 23.

Results: The patients receiving Dex showed marked decrease in serum levels of cortisol, TNF- α and interleukins-6, from 139.73 to10.18, 99.51 to 0.96 and 85.09 to 0.96 respectively. Comparison between C and D groups revealed significant differences (p≤0.05) in these serum biomarkers.

Conclusions: In the present study, intravenous Dex suppressed the intraoperative rise in levels of cytokine secretion and enhanced smooth recovery with no incidence of nausea and vomiting. These effects could be attributed to the anti-inflammatory effects of dexmedetomidine.

Objective: This study aims to establish the frequency of Down's syndrome which will enhance the knowledge of our local population as well to understand our genotypic patterns and variations.

Methods: Electronic Medical Records of inborn babies at the Department of Neonatology, Sheikh Saeed Memorial Campus of The Indus Hospital Karachi during the study period from 1^st January 2021 to 31^st December 2022 were retrieved. Chromosomal karyotyping was done for all babies with suspicious clinical features identified on routine new born examination by consultant neonatologists, trainee doctors and experienced nurses.

Result: There was a total of 7,433 live births during the study period, out of which 14 babies had features suggestive of DS. repetition of sentence. What about karyotyping result??

Conclusion: The frequency of DS in our study is slightly higher than the incidence reported within South East Asia. It is high time to perform effective antenatal screening and efficient prenatal diagnostic services for early detection of chromosomal numerical aberration such as Down syndrome for better management of upcoming pregnancies.

Background & objective: One third of the neonatal deaths worldwide are attributed to perinatal asphyxia. We aimed to determine the prevalence and determinants of cardiac dysfunction, through echocardiographic evaluation, in term neonates with perinatal asphyxia.

Methods: This cross-sectional study was conducted at a tertiary care setting over a period of six months from 1^st January 2021 to 30^th June 2021. Term neonates, weighing ≥ 2500 grams, born with Apgar score < 7 and admitted within 48-hours of life were consecutively enrolled. Using Levene classification neonates were grouped into moderate and severe perinatal asphyxia. All neonates underwent transthoracic echocardiographic evaluation after 24-hours of stabilization and within 72-hours of life. Descriptive statistics are calculated, and logistic regression analysis is done to determine the risk factors of myocardial dysfunction.

Results: Among 166 neonates, 53% (n=88) were males, mean gestational age was 38.1 ± 0.89 weeks. Moderate asphyxia was present in 121 (72.9%). Most common echocardiographic finding was pulmonary hypertension in 50% followed by patent ductus arteriosus (PDA) in 37.2% and mitral regurgitation in 6.6%. Myocardial dysfunction was detected in 28.9% of the neonates. Three independent determinants of myocardial dysfunction were severe asphyxia [adjusted odds ratio (aOR) 5.01, 95% CI 2.2-11.4; p-value <0.001], having patent ductus arteriosus (aOR 5.11, 95% CI 2.2-11.8; p-value < 0.001) and delivery through cesarean section (aOR 2.65, 95% CI 1.2-5.9; p-value 0.02).

Conclusions: Myocardial dysfunction among neonates with perinatal asphyxia is common and severity of asphyxia, mode of delivery and presence of patent ductus arteriosus are important determinants.

Objective: To investigate the effect of a combination of high-flow nasal oxygen therapy (HFNO) and ipratropium bromide (IB) on Th1/Th2 balance and inflammation in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure (RF).

Methods: A retrospective analysis was conducted on the clinical data of patients with COPD and RF admitted to the Affiliated Nanjing Brain Hospital of Nanjing Medical University from June 2021 to March 2023. A total of 162 patients were included, with 79 patients received respiratory support using HFNO (HFNO group) and 83 patients who were treated using combined HFNO/IB (combined group). Treatment effect, lung function, levels of Th1/Th2, and inflammatory state were compared before and after the treatment.

Results: Total effeicacy of patients in the combined group was significantly higher than that of the HFNO group (P<0.05). After the treatment, pulmonary function levels of the two groups was higher than that before the treatment, and was significantly better in the combined group compared to the HFNO group (P<0.05). The treatment was associated with a significant increase in the levels of Th1/Th2 in both groups. Post-treatment levels of these indexes in the combined group were markedly higher compared to the HFNO group (P<0.05). After the treatment, the inflammatory response of the two groups decreased, and was lower in the combined group that in the HFNO group (P<0.05).

Conclusions: In COPD patients with RF, HFNO combined with IB is efficient in alleviating the inflammatory state of patients, restoring Th1/Th2 balance, and improving lung function compared to HFNO alone.

Objective: To determine the impacts of pain nursing intervention of patients with craniocerebral trauma combined with ocular trauma after decompressive craniotomy.

Method: This was retrospective study. Eighty patients with craniocerebral trauma combined with ocular trauma who underwent unilateral decompressive craniectomy in Baoding No.1 Central Hospital from January 2023 to November 2023 were included and divided into the observation group(n=40) and the control group(n=40) according to different nursing methods. Patients in the control group received conventional nursing intervention, while those in the observation group received pain nursing intervention. The differences in sleep quality, self-care ability, quality of life, psychological state and nursing satisfaction were compared between the two groups.

Results: After intervention, the pain degree of both groups was significantly reduced compared with that before intervention, and the reduction degree of the observation group was more than that of the control group, with a statistically significant difference (p<0.05). The SS-QOL scores of both groups were significantly improved compared with before intervention, and the improvement degree of the observation group was significantly better than that of the control group, with a statistically significant difference (p<0.05). The nursing satisfaction score of the observation group was (93.35±3.83) points, which was higher than (83.38±3.59) points of the control group, with a statistically significant difference (t=12.019, P=0.000).

Conclusion: Pain nursing intervention shows a variety of benefits in the treatment of patients with craniocerebral trauma combined with ocular trauma after decompressive craniectomy, improving their quality of life, self-care ability and nursing satisfaction.

Objective: To explore the clinical efficacy of butylphthalide in treating patients with stroke attributed to intracranial artery stenosis (ICAS).

Methods: In this retrospective study, records of 163 patients with stroke attributed to ICAS admitted to Jiaxing Second Hospital from January 2021 to January 2023 were retrospectively analyzed. Patients were divided into two groups based on the treatment received: control group (patients received routine treatment, n=55) and observation group (patients treated with butylphthalide on a routine basis, n=58). Changes in levels of cerebrovascular reactivity (CVR), breath-holding index (BHI), pulsatility index (PI), and middle cerebral artery mean flow velocity (Vm) between the two groups before and after treatment were compared. In addition, cognitive function, neurological function, and living ability were compared between the two groups before and after treatment, as well as the overall clinical efficacy of the treatment.

Results: The baseline data was comparable between the two groups (P>0.05). After the treatment, CVR, BHI, and Vm indicators in the observation group were significantly higher than those in the control group, while the levels of PI indexes were significantly lower than those in the control group (P<0.05). Montreal Cognitive Assessment (MoCA) and Barthel scale scores of the observation group were significantly higher compared to the control group, while the scores of National Institutes of Health Stroke Scale (NIHSS) were significantly lower (P<0.05).

Conclusions: Butylphthalide in addition to routine treatment can effectively improve cerebrovascular reserve function, promote neurological and cognitive dysfunction recovery, and enhance daily living ability of patients with stroke caused by ICAS.

Objectives: This study was aimed to report the prevalence-pattern of hereditary and congenital anomalies (CA) in general population of Balochistan province of Pakistan, and to elucidate the familial/sporadic presentations and parental consanguinity of CA.

Methods: In a multi-center cross-sectional study, patients with CA were ascertained from various district hospitals and public places throughout Balochistan from 2019 to 2023. Online Mendelian Inheritance in Man (OMIM) and International Classification of Diseases (ICD-10) databases were utilized for uniformity in classification. Descriptive statistics was employed.

Results: A cohort of 1185 independent patients diagnosed with CA was recruited and the index males were 71%. The CA were classified into nine major and 118 minor entities. In the major categories, neurological disorders had the highest prevalence (n=317; 27%), followed by limb defects (n=161; 14%), blood-heart defects (n=159; 13%), neuromuscular anomalies (n=156; 13%), sensorineural/ear defects (n=140; 12%), eye/visual impairments (n=90; 8%), musculoskeletal defects (n=83; 7%), ectodermal defects (n=31; 3%), and others (48; 4%). Sixty one percent CA were sporadic in nature and 39% were familial; and parental consanguinity was observed in 51% cases. Several rare CA were witnessed.

Conclusions: High preponderance of sporadic presentations in neuromuscular anomalies and musculoskeletal defects and low incidence of parental consanguinity in ectodermal defects and musculoskeletal defects may depict a significant etiological role of non-genetic/environmental factors such as prenatal exposures and maternal conditions. In this context, it is important to increase health education, enhance antenatal and perinatal care, and strengthen the health-care system in Balochistan to reduce the burden of CA.

Objective: To investigate the risk factors for neonatal respiratory distress syndrome (NRDS) in late preterm infants.

Method: A retrospective analysis was performed on the clinical data of 86 late preterm infants with a gestational age of 34-36⁺⁶ weeks who were admitted to Maternity & Child Care Center of Qinhuangdao from June 2022 to June 2023 and with complete clinical records. All enrolled infants were divided into the non-NRDS group(n=51) and the NRDS group(n=35) according to the presence or absence of NRDS.

Result: No statistically significant differences were observed in birth weight, gestational age and gravidity between the two groups(p>0.05), while there were statistically significant differences in fetal gender, mode of delivery and presence or absence of asphyxia(p<0.05). Moreover, no statistically significant differences were found in advanced maternal age, anemia, multiple births, and gestational hypertension(p>0.05), while there were statistically significant differences in placental abnormalities, intrauterine distress, premature rupture of membranes, and gestational diabetes mellitus(p<0.05). Logistic regression analysis revealed that fetal gender(male), placental abnormalities, intrauterine distress, premature rupture of membranes, and gestational diabetes mellitus were risk factors for NRDS in late preterm infants(p<0.05).

Conclusion: Late preterm infants suffer from NRDS due to a variety of complex pathogenic causes, with numerous complications. Factors such as male fetal gender, placental abnormalities, intrauterine distress, premature rupture of membranes, and gestational diabetes mellitus may increase the risk of NRDS in late preterm infants. In clinical observation, it is necessary to strengthen monitoring efforts and take timely measures to intervene in the course of NRDS.