Pakistan Journal of Medical Sciences最新文献

Objective: CBRN (an acronym for Chemical, Biological, Radiological, and Nuclear) events are large scale disasters that differ from man- made disasters in that the involved agents additionally cause contamination and specific health hazards. As an institution, hospitals need a specific level of preparedness to enable an effective response to CBRN emergencies. The aim of this study was to assess the presence and placement of a proper hospital response plan to CBRN events.

Methods: It was an observational cross-sectional study conducted from October 2021 to December 2021 in two public tertiary level healthcare facilities selected through purposive sampling technique. Data was collected using WHO Hospital Safety Index Tool which is a checklist consisting of 151 items divided into four sections or modules. To calculate the hospitals safety index Model-1 was used.

Results: The sum of the weighted results of the three modules for both hospitals were in category A (0.66 - 1), the results depicted that it is likely that the hospitals will function in emergencies and disasters.

Conclusion: Both hospitals gave satisfactory results when evaluated on the basis of WHO Hospital Safety Index Tool for emergency preparedness.

Objectives: To examine how advanced surface pretreatment techniques - Tribochemical silica coating (TBC), Femtosecond laser (FS), and Nano-hydroxyapatite (HA) coating - affect the surface roughness (Ra) and shear bond strength (SBS) between resin luting cement and Yttria-stabilized tetragonal zirconia polycrystals (Y-TZP).

Methods: The lab-based comparative study was approved by the ethical committee of King Saud University under IRB number F98-971X9 and was completed in three months (June to September, 2024). Eighty-four YTZP zirconia discs were created and sorted into four groups based on different conditioning agents: Group-I (APA) as the control, Group-II (TBC), Group-III (FS laser), and Group-IV (Nano-HA coating). Ra was measured on five discs from each group using a profilometer, while surface topography was examined through SEM analysis. Ten specimens per group were bonded with luting cement, followed by SBS testing and fracture mode analysis using a universal testing machine and stereomicroscope, respectively. One-way ANOVA with post hoc Tukey tests (p<0.05) was used for statistical analysis of Ra and SBS means across the groups.

Results: Group-IV (Nano-HA coating) exhibited the highest Ra and SBS values. Conversely, Group II (TBC) displayed the lowest Ra and weakest bond strength.

Conclusion: Nano-HA coating and FS laser can be employed as viable alternatives to APA without compromising the physical and mechanical properties of zirconia ceramic.

Objective: The study aimed to investigate mutations and mRNA expression of the ERG3 gene in resistant Candida albicans isolates.

Methods: This cross-sectional study was conducted from October 2018 to June 2019. High vaginal swab samples were collected from Hayatabad Medical Complex and transported to Khyber Medical University. Samples were inoculated on different media and identified by 20C AUX strips. Antifungal susceptibility was determined using the disc diffusion and broth microdilution methods. The ERG3 gene was amplified and sequenced to find amino acid polymorphisms. Real-time PCR was performed to study level of ERG3 expression.

Results: A total of seventy-three (n=73) Candida albicans out of 369 samples were isolated. Among the isolates 49.3%, 54.8%, 53.4%, 47.9%, 30.1% were resistant to fluconazole, Clotrimazole, Miconazole, Voriconazole and Itraconazole, respectively. Sanger sequencing of ERG3 gene of isolates revealed six synonymous mutations. Expression level of mRNA of ERG3 gene in azoles sensitive stains (3.72±2.22) was higher than those in the resistant Candida albican strains (1.74±0.96).

Conclusion: This study revealed synonymous mutations and low expression of ERG3 gene in azole-resistant C. albican.

Academic failure is multifactorial with personal, institutional, and societal factors. Identification after high stake assessments comes too late for meaningful interventions. There is limited data to predict academic failure at an early stage. This qualitative exploratory study aimed to identify such students using a predictive framework. Using purposive sampling, twenty-seven participants (8 academic failures, 8 high achievers, and 7 medical teachers) were enrolled after informed consent and ethical approval. One-to-one interviews with eight academic failures and two focused group discussions (FGDs), one with the high achievers and the teachers were conducted online using a validated questionnaire. Thematic analysis and blended coding was done manually with member checking and triangulation. Key predictors included poor self-regulation, procrastination, emotional imbalance, low self-efficacy, cognitive overload, and non-reflective practices. Key components of the framework suggested are documentation of students' prior academic results and professional choice, at the time of admission as well as behavioral traits and performance in formative assessments. Close observation of procrastination, emotional state, and self-efficacy during small group discussions by teachers followed by feedback will identify students at risk. Reflective practices by both students and teachers during feedback sessions will uncover hidden learning gaps. In conclusion, "potential academic failures" can be identified and supported by observation, documentation, and reflective practices by teachers and students using proposed framework.

Background & objectives: The onset of menstruation heralds the beginning of feminism and fecundity. Primary amenorrhea is a distressing symptom and is often associated with late diagnosis and appropriate management. Our study aimed to find the frequency of primary amenorrhea along with its causes and subsequent management by a multidisciplinary team.

Methods: In our descriptive case series patients presenting with primary amenorrhea to the Department of Gynaecology, Khyber Teaching Hospital Peshawar from January 2018 to December 2022, were included. Gynecologist initially analyzed the cases based on history, clinical examination (secondary sexual characteristics, Body mass index) and relevant investigations including hormonal profile, pelvic ultrasound, MRI and karyotype. After final diagnosis, a multidisciplinary team comprising of plastic surgeon, endocrinologist and psychiatrist advised treatment based on cause. Relevant information was recorded on predesigned proforma. Data was analyzed using SPSS 23.

Results: The frequency of primary amenorrhea was 0.3% out of 18,504 patients seen in Gynaecology clinic. Forty-six (82%) patients were in the age group of 14-20 years. The mean body mass index was 22.8±2.4. Mullerian agenesis was seen in 22(39%) of patients, 20(35.7%) had outflow tract abnormality which were treated by vaginoplasty or hymenectomy/ resection of vaginal septum depending on cause. Ten (17.8%) patients diagnosed with gonadal dysgenesis. Four(7.1%) patients with constitutionally delayed menarche had spontaneous onset of menstruation.

Conclusions: Disorders related to Mullerian agenesis are the most common cause of primary amenorrhea. Timely diagnosis by attending gynecologist and subsequent multi-modal approach, including psychological counseling, hormonal therapy, and tailored surgical interventions like neovagina creation by vaginoplasty, hymenectomy and laparoscopic gonadectomy can ensure appropriate management of this distressing condition in young girls.

Objective: To contextualize the Conscientiousness Index and determine the relationship between burnout and the Conscientiousness Index as a measure of professionalism in postgraduate students.

Methods: This mixed-method study was done in two phases in Lahore from September 2023 to July 2024. The first phase involved contextualization of the Conscientiousness Index (CI) tool. A literature review, feedback from consultants and staff, identification of data sources, expert validation, and cognitive pretesting were conducted to contextualize the CI tool. In the second phase, a correlational study was done by collecting data using a purposive sampling technique (n=134). The CI scores were calculated from administrative records and clinical staff input. Burnout levels were assessed using the Maslach Burnout Inventory, which has three main constructs: Emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Burnout and CI scores were compiled and analyzed using SPSS v26.0. The t-test, one-way ANOVA, Chi-square test, and Pearson's correlation were used for data analysis.

Results: A six-item CI scale was contextualized with S-CVI (0.89) and CVR >0.62. Mild burnout was found in 63 (47%) participants, while 71 (53%) exhibited moderate-to-severe burnout. The overall mean CI score was 42.1 ± 5.96 (total score: 50). No significant association was found between burnout and CI scores. However, a moderate negative correlation was observed between EE and CI scores (r=-0.69), and a weak positive correlation (0.19) was found between PA and CI scores, which was statistically significant (p = 0.02).

Conclusion: The CI tool had good validity in the local context. There was a high prevalence of burnout among postgraduate students. No statistically significant association was found between burnout severity and CI scores. However, a weak correlation was found between burnout domains and CI scores. Further research is required to understand this weak correlation and validation of CI tool in different settings.

Objective: To investigate the risk of ischemic stroke, uric acid/creatinine ratio, cerebral vascular hemodynamic index (CVHI) and risk factors of stroke in physical examination population.

Methods: This was a retrospective study. Four hundred cases undergoing physical examination at physical examination center in Baoding No.1 Central Hospital from January 2023 to December 2023 were selected as subjects, and their general data were collected. They were divided into low ratio group, medium ratio group and high ratio group depending on the uric acid/creatinine ratio, and were classified as high-risk group, medium-risk group and low-risk group as per CVHI, the general data of all subjects were compared and analyzed.

Results: Multifactorial Logistic regression analysis was performed after assignment of stroke risk factors as dependent variables yielding that advanced age, smoking, alcohol abuse, hypertension, diabetes mellitus, BMI, hyperlipidemia, and hyperuricemia were risk factors for ischemic stroke(P<0.05). Those with high uric acid/creatinine ratio were markedly higher than those with medium and low ratio in the proportion of alcohol abuse, hypertension, diabetes mellitus, and hyperlipidemia, with statistically significant differences (P<0.05). Obesity, advanced age, smoking, hypertension, diabetes mellitus, and hyperlipidemia were obviously higher in the high-risk group for stroke than in the medium- and low-risk groups, with statistically significant differences (P<0.05).

Conclusion: Risk factors for ischemic stroke predispose to older age groups, and are linked to underlying medical conditions, especially in those with high uric acid/creatinine ratios and those at high risk of stroke. The SUA/Cr ratio is negatively correlated with the CVHI score.

Objective: This study aimed to investigate the nerve conduction velocity in diabetic patients and its association with diabetes duration, control and severity of diabetic polyneuropathy.

Methods: This prospective, observational study involved a hundred and thirty-nine patients who underwent nerve conduction studies in the Neurology Department at Liaquat National Hospital during the years June 2023 till May 2024. In all patients, the medical history was taken by direct interview regarding demographics, diabetes duration and recent HbA1c. For the assessment of diabetic polyneuropathy, the NDS-neuropathy disability score was used. The acquired data was entered into SPSS Statistics software for analysis of significant associations between these variables. Statistical significance was defined as a P-value below 0.05.

Results: In this study, we investigated 139 patients with a mean age of 62.20±12.03 years, comprising 60.4% males. The mean HbA1c was 7.46±1.09%, and the mean duration of diabetes was 10.78±7.75 years. Most patients (75.5%) had poor glycemic control, with 92.8% having Type-II diabetes. The mean neuropathy disability score was 5.63±2.39, with 80.6% of patients experiencing neuropathy. Nerve conduction velocity slowing was detected in 54.7% of the patients. Notably, significant associations were found between nerve conduction velocity slowing and diabetes duration (p=0.019), and neuropathy disability score (p=0.000).

Conclusion: Our findings indicate that male gender, poor glycemic control, and a longer duration of diabetes are associated with slowing of nerve conduction velocity. Additionally, the severity of neuropathy, as measured by the Neuropathy disability score, further strengthens these associations, highlighting its significance in assessing diabetic neuropathy progression.

Objective: To explore the positive effect of rapid bladder irrigation in postoperative BPH patients by collecting and analyzing the efficacy and complications of TURP and HoLEP treatments for patients with benign prostatic hyperplasia (BPH) under ERAS care.

Methods: A retrospective analysis was conducted on 197 BPH patients undergoing surgical treatment at the Second Hospital of Hebei Medical University from April 2022 to February 2024. All patients received rapid bladder irrigation under ERAS care, which involves flushing the bladder with a larger volume of saline solution in a shorter time postoperatively compared to conventional bladder irrigation care. Afterward, clinical data and postoperative irrigation indicators for each group were collected and analyzed.

Results: Patients in the T1 group were observed with larger prostate volume, longer operation time, and more intraoperative blood loss than those in the T2 group, but with shorter duration of indwelling urinary catheters, shorter irrigation time, and shorter hospital stays (P<0.05). Meanwhile, the H1 group saw lower mean irrigation volume and shorter irrigation time than the H2 group. Differences were found between the T1 and H1 groups in terms of mean irrigation volume and irrigation time (P<0.05), Additionally, patients in the T2 group had lower prostate volume than those in the H2 group, with differences in mean irrigation volume and irrigation time (P<0.05).

Conclusion: ERAS concept complements rapid bladder irrigation, which shortens the time to self-care recovery and discharge, thereby facilitating faster postoperative recovery for BPH patients.