Pakistan Journal of Medical Sciences最新文献

Objective: To investigate the clinical efficacy and safety of drug-eluting bead transarterial chemoembolization(DEB-TACE) combined with targeted therapy and immune checkpoint inhibitors(ICIs) in patients with intermediate-to-advanced hepatocellular carcinoma(HCC).

Methodology: The clinical data of one hundred patients with intermediate-to-advanced HCC treated at The Affiliated Hospital of Hebei University between January 2021 to January 2024 were retrospectively analyzed. Patients were divided into the control group(n = 50) and the observation group(n = 50) according to the treatment regimen. The control group received DEB-TACE plus the targeted therapy lenvatinib, whereas the observation group was administered DEB-TACE plus lenvatinib and the ICI pembrolizumab. Clinical efficacy was assessed, adverse reactions occurring during the treatment period were recorded. Progression-free survival(PFS), overall survival(OS) and the cumulative survival rate (CSR) were compared between groups.

Results: The observation group demonstrated significantly higher ORR and LCR compared with the control group (both P < 0.05). After treatment, serum CEA, CA199 and AFP levels were significantly reduced in both groups (all P < 0.05), with greater reductions observed in the observation group (P < 0.05). Post-treatment CD3⁺, CD8⁺ and CD4⁺ T-cell levels increased significantly in both groups (all P < 0.05), with higher levels in the observation group than in the control group(P < 0.05). The ARR did not differ significantly between groups (P > 0.05). No significant differences were observed in PFS or PFSR between groups(both P > 0.05).

Conclusion: The combined use of DEB-TACE, targeted therapy and an ICI demonstrates superior clinical efficacy and a favorable safety profile, which can reduce tumor marker levels, enhance immune function and prolong OS in patients with intermediate-to-advanced HCC.

Background & objective: Feedback literacy (FL) is the ability to seek, interpret and apply feedback. It is critical for dental students' clinical competence and professional growth. Despite its importance, empirical research on FL in dental education remains limited. The objective of the study was to assess FL among undergraduate dental students from two private dental institutions in Lahore using Student Feedback Literacy Scale (SFLS).

Methodology: A cross-sectional study was conducted at two private dental colleges in Lahore from March to May 2025. A structured questionnaire including the validated SFLS was used to collect data. Participants included 245 Bachelor of Dental Surgery (BDS) students from first to final year while house officers were excluded. Statistical analyses included descriptive statistics, non-parametric tests for inferential analysis.

Results: Internal consistency of the SFLS and its six subscales was strong, with Cronbach's alpha values >0.80 across all domains. Participants demonstrated a high overall feedback literacy score (FLS), with a median of 3.79 (IQR=0.58). The eliciting domain score was lowest (median=3.75) indicating reluctance to seek feedback. Only 25.3% had received formal feedback training. Verbal feedback was the primary mode (51.8%). FLS differed significantly by perceived usefulness (p < 0.001) and by academic year (p = 0.011).

Conclusions: Considerable variation was observed in feedback practices, including frequency, sources, and modes of feedback received. Dental students reported high FL but lower scores in the eliciting domain highlight the need for structured feedback training to support self-directed learning.

Objective: To investigate the sensitivity and safety of contrast-enhanced cystosonography in the diagnosis of primary vesicoureteral reflux (VUR) after urinary tract infection (UTI) in infants.

Methodology: This was a retrospective study. Infants diagnosed with VUR after UTI in Baoding Hospital, Beijing Children's Hospital Affiliated to Capital Medical University were selected from July 2019 to May 2024. All the infants were subjected to contrast-enhanced cystosonography and voiding cystourethrography(VCUG). The detection rate of VUR by contrast-enhanced cystosonography and VCUG, as well as the consistency of VUR classification were analyzed.

Results: The proportion of VUR diagnosed by contrast-enhanced ultrasonography(CEUS) was 32.00%, which was significantly higher than 18.00% by VCUG(P< 0.05). The incidence of VUR was 38.23% and 43.75% in male and female infants, respectively, without statistically significant differences(P> 0.05). Among the male infants, the proportion of VUR diagnosed by CEUS was 20.58%, while the proportion by VCUG was 17.65%(P> 0.05). In the female infants, the proportion of VUR diagnosed by CEUS was 50.00%, which was significantly higher than 18.75% by VCUG (P< 0.05). VUR was diagnosed in 31.00% (31/100) pyelo-ureter units(PUUs) by CEUS, and in 18.00% (18/100) PUUs by VCUG, with good consistency(Kappa value, 0.547). The consistency of both methods in diagnosing VUR at different degrees was good, with higher diagnostic rates of Grade-II and III VUR.

Conclusion: Both contrast-enhanced cystosonography and VCUG have high diagnostic value in the detection of infants with VUR after UTI. The value of contrast-enhanced cystosonography in the diagnosis of infants with UTI and VUR is higher.

Objective: First rib fractures (FRFs) have traditionally been considered indicators of severe blunt trauma. This study aimed to evaluate whether FRFs reliably reflect the severity of such trauma.

Methodology: The study was conducted at the Emergency Department (ED) of Tokat Gaziosmanpaşa University Medical School Hospital between August 1, 2020 and August 1, 2023. It included patients who presented to the ED with blunt trauma and had rib fractures either isolated or in association with injuries to other organs or skeletal structures. Patients were categorized into two groups. The Injury Severity Score (ISS) was calculated for both groups..

Results: Of 313 patients, 53 had FRFs (Group-A) and 260 had other rib fractures (Group-B). Vehicle-related accidents were the leading cause in both groups. ISS >15 was found in 22 Group-A and 57 Group-B patients.

Conclusion: Although FRFs do not independently increase mortality, they may be associated with vascular and neurological injuries, and are considered reliable indicators of severe trauma in polytrauma patients.

Objectives: To assess the clinical and functional outcome of Tibialis Anterior Tendon Transfer in Recurrent Relapsed Idiopathic Clubfoot Deformity associated with peroneal nerve dysfunction.

Methodology: This observational study included 16 (2.11%) of 756 Idiopathic Clubfoot Deformity (CFD) patients with recurrent and relapse deformity following Ponseti management, treated during January 1, 2011 to December 31, 2023 at Ziauddin Hospital Clifton, Karachi, Pakistan. Included patients had evertors and toe extensors weakness associated with concomitant Peroneal Neuropathy. Following an initial Ponseti re-casting, Extended Posterior Release (EPR) and Tibialis Anterior Tendon Transfer (TATT) was performed. Clinical and functional outcomes were assessed on Nogueira and Songs satisfaction protocols.

Results: All 16 patients had bilateral idiopathic Clubfoot deformity at initial treatment, who developed Iatrogenic Complex Clubfoot deformity with concomitant Peroneal nerve dysfunction, four of these had recurrent relapse on left side only. Their muscle charting revealed peroneal and toe extensor muscles weakness, while Tibialis Anterior strength was grade IV. Five patients had flexible deformity, while 11 patients had fixed severe deformities. Thirteen patients underwent EPR and TATT, while three had Posterio-Medial Release and TATT. At 3-10 years of follow-up, six patients improved from Nogueira Poor to good Nogueira outcome and Satisfied on Song's Scale. While three patients achieved Nogueira's "Poor" and "Very dissatisfied" on Song's criteria.

Conclusion: A small and rare sub-set of iatrogenic complex clubfoot deformity with peroneal nerve dysfunction, is undoubtedly difficult to treat. Early diagnosis and treatment prevents extensive surgical interventions, which is required mostly in late presenting, rigid deformities. The association between peroneal neuropathy and preserved tibialis anterior muscle strength in these patients remains poorly understood.

Background & objective: This study aimed to assess the burden of neck pain from 1990 to 2021 and predict its trends over the next three decades, providing evidence for targeted interventions.

Methodology: This study is a secondary analysis of publicly available national-level estimates for China from the Global Burden of Disease (GBD) 2021 study released by the Institute for Health Metrics and Evaluation, covering 1990-2021, with projections to 2050. The age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized disability-adjusted life years (DALYs) rate for neck pain were calculated. Temporal trends were evaluated using estimated annual percentage changes (EAPC). The age-period-cohort (APC) model was employed to explore underlying drivers of disease burden, while the Bayesian-APC (BAPC) model was applied to predict future trends.

Results: In 2021, the ASIR, ASPR, and age-standardized DALYs rate for neck pain in China were 567.23 (95% uncertainty interval [UI]: 448.497 - 699.796, per 100000 population), 2549.87 (95% UI: 2007.887 - 3141.637, per 100000 population), and 254.77 (95% UI: 166.889 - 357.934, per 100000 population), respectively. Between 1990 and 2021, the EAPCs for ASIR, ASPR, and age-standardized DALYs rates were 0.08% (95%CI: 0.06 - 0.11), 0.13% (95%CI: 0.10 - 0.16), and 0.13% (95%CI: 0.10 - 0.16), respectively. APC analysis identified age as the dominant contributing factor, with the highest burden observed in the 70 - 74-year age group and a consistently greater burden among females. Projections from the BAPC model suggest that ASIR, ASPR, and age-standardized DALYs rates will decline by 2025, although sex-based differences are expected to persist.

Conclusion: Neck pain remains a significant public health concern in China, particularly among elderly individuals and females.

Objectives: Congenital anomalies (CA) have a high prevalence in Pakistan, but regional and ethnic differences remain less appreciated. This study was aimed to observe the pattern and ethno-demographic distribution of CA in the extended Dera Ismail Khan region of Pakistan.

Methodology: In a descriptive clinico-epidemiological study, families/subjects with CA were recruited from a variety of sources, including district headquarters hospitals, community centers, rural organizations, and door-to-door surveys. Phenotypic and biodemographic data were recorded. Descriptive statistics was applied. This study was conducted from June 2022 to May 2024.

Results: This study included 637 independent individuals (73% males) with certain types of CA. Pediatric patients were 70% of the sample; the majority originated from rural areas (71%) and Saraiki background (88%) and belonged to Jaat and Pathan ethnicities (40%). CA were classified into nine major and 90 minor entities. Among major categories, neuromuscular disorders were most frequent (32%), followed by neurological disorders (24%), sensorineural/ear defects (15%), limb defects (9%), eye/visual impairments (6%) musculoskeletal defects (4%), blood disorders (4%), ectodermal anomalies (3%), and others (4%). Sporadic occurrence was witnessed in 51% of the cases and parental consanguinity in 71%. There were statistically significant differences in the distribution of major categories of CA with respect to rural/urban origin, mother tongue, and ethnicities.

Conclusion: Neuromuscular and neurological disorders, and sensorineural/ear defects had the highest burden in the study population and also showed remarkable disparities across various ethnic groups. The impact of such defects can be reduced through improved health, education, antenatal and prenatal care, pre-marital counseling, and molecular diagnosis of CA.

Objective: To determine the frequency of Acute Stress Disorder (ASD) and postnatal depression in mothers of preterm neonates hospitalized in the neonatal intensive care unit (NICU) of the Aga Khan University Hospital.

Methodology: It is a cross-sectional study. It was conducted in a 24-bed level-3 NICU at a tertiary care hospital in Karachi. Mothers of preterm newborns under 34 weeks' gestational age admitted to the NICU were included in the study.

Results: Among 123 postpartum women, 43.1% (n=53) met criteria for Acute Stress Disorder (ASD), with significantly lower gestational age in this group: median 29.9 weeks (IQR: 27.6-31.0) vs. 33.0 weeks (IQR: 32.0-33.0) in non-ASD cases (difference in medians: 3.1 weeks, 95% CI: 2.1-4.0). Infants of mothers with ASD had a less mean birth weight (1.3 ± 0.4 kg) compared to those without ASD (1.8 ± 0.5 kg), with a mean difference of 0.5 kg (95% CI: 0.34-0.66). Median NICU stay was significantly prolonged in the ASD group: 20.0 days (IQR: 12.0-28.0) versus 10.0 days (IQR: 7.0-15.0), with an estimated median difference of 10.0 days (95% CI: 6.0-14.0). A higher number of mothers with a miscarriage history (n=23/53, 43.4%) experienced ASD compared to those without (n=17/70, 24.3%), yielding a risk difference of 19.1% (95% CI: 4.3%-33.8%). Mothers with ASD also reported increased Edinburgh Postnatal Depression Scale scores (median 19.0, IQR: 17.0-21.0) than those without ASD (median 11.0, IQR: 9.0-15.0), with a median difference of 8.0 points (95% CI: 6.0-10.0).

Conclusion: A significant proportion of mothers of preterm infants screened positive for acute stress disorder and postpartum depression hence, Preterm delivery appears to be a traumatic event, increasing the risk of stress-related and depressive disorders in mothers.