Pakistan Journal of Medical Sciences最新文献

Objective: To review the contributions to the ophthalmic research from the SAARC region in the top twenty ophthalmology journals.

Methods: This was a bibliometric study and the top 20 ophthalmology journals, as ranked by the Scimago Journal Rankings (SJR) from 2021 and 2022 (two years), were selected for analysis. Only original research articles were included in the analysis. Articles were analysed based on authorship, corresponding authorship, and research centres within the South Asian Association for Regional Cooperation (SAARC) region (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka). The main research topics were also examined. This data was recorded on Microsoft excel sheet and then descriptive analysis were calculated.

Results: Of the total 4952 articles reviewed, 208 (4.2%) had authorship from the SAARC region. Of the 38079 authors in total, 1133 (2.97%) were from the SAARC region and 715 (63.1%) were male. The authors from India contributed the most (n=1074, 94.8%) articles. Of the 155 corresponding authors from SAARC, 150 (96.78%) were from India. Research centres from India were the leading contributors, (n=166, 93.26%). Out of all the publications, medical retina accounted for 1546 (31.22%) of the total articles.

Conclusions: Compared to its share of the world's population, the SAARC region's research contribution to the top twenty ophthalmology journals is nominal.

Objective: To study the predictive value of placental growth factor (PLGF) combined with uterine ultrasound artery blood flow characteristics in preeclampsia (PE).

Methods: The retrospective cohort study included singleton pregnant women who admitted for prenatal examinations at the Yongkang First People's Hospital between February 2021 to November 2023. Based on whether the pregnant women had PE and the severity of PE, they were divided into Control group, Severe PE group and Mild PE group. Levels of PLGF and ultrasound arterial blood flow parameters were compared between the groups, and the sensitivity and specificity of the above indicators were calculated.

Results: This study included one hundred pregnant women with PE in the analysis, with 29 in the Severe PE group and 71 in the Mild PE group. Additionally, 100 healthy pregnant women without PE were included in the control group. Levels of PLGF, resistance index (RI), pulsatility index (PI), and systolic/diastolic blood flow ratio (S/D) were statistically different between the groups (P<0.05). Logistic analysis showed that PLGF, RI, PI, and S/D were risk factors for the onset of PE (P<0.05). Receiver operating characteristic (ROC) curve analysis showed that the combined prediction value of PLGF, RI, PI, and S/D for PE was significantly higher than the individual prediction of each indicator (P<0.05).

Conclusions: PE was significantly associated with decreased levels of PLGF and increased RI, PI, and S/D in pregnant women. These indexes can serve as important indicators for predicting the onset of preeclampsia, especially when they are combined.

Objective: To determine the effects of Wii Fit-based exercises and proprioceptive training on balance and fall risk in diabetic neuropathy patients.

Methods: This randomized clinical trial was conducted in Riphah Rehabilitation Centre, Lahore, between March 2022 to August 2022 (duration six months). Thirty-four participants were included, twenty males and fourteen females. Participants were randomly allocated into two groups. Group-A received Wii Fit-based exercises thrice a week for six weeks and Group-B received Proprioceptive training thrice a week for six weeks. Pre and post-measurements of balance and risk fall were assessed through Berg Balance Scale (BBS), Modified Fall Efficacy Scale (MFES), and Timed Up and Go test (TUG).

Results: Thirty-four participants (20 males and 14 females) were allocated in each group, with a mean age of 62±9.21. The normality test (Shaphiro-Wilk Test, p>0.05) of BBS, MFES, and TUG summarized that data was normally distributed. Six weeks of treatment sessions have shown no significant difference between both groups (p>0.05). However, the within-group comparisons showed significant results that indicate the clinical effects of both treatments (p<0.05).

Conclusion: It was concluded that there was no difference between Wii Fit exercises and proprioceptive training on balance and risk of falls in diabetic neuropathic patients. Trial Registration Number: This study was registered at ClinicalTrials.gov ID: NCT05282602 on date 16/03/2022.

Objective: To explore the gendered experiences of medical faculty in tertiary care hospitals in Pakistan.

Method: A qualitative exploratory study was conducted using a semi-structured interview guide in Lady Reading Hospital, Peshawar from 1st April to 30th September 2023. A purposive sampling technique was employed, and data was interpreted using Ackers's theory of Gendered Organization. Two Focus Group Discussions (FGDs) and six interviews were conducted and transcribed for data analysis. Braun and Clark's thematic analysis was used for data analysis.

Results: Five themes and twelve sub-themes emerged after data analysis. Most male faculty accepted that gender disparity exists in medical institutions and found an element of ignorance in their responses. On the other hand, most females declared the existence of gender bias in administration, career opportunities, working environment, and basic facilities. Findings revealed the dependency of females on males. A huge gap was also found in policy regarding gender disparity.

Conclusion: Gender disparity exists everywhere because of patriarchal structures. Study unmasked the workplace realities of both genders within medical institutes. Mainly found that females become more victims of this issue. Women lag behind due to the disparity prevalent among both genders.

Objective: To retrospectively evaluate the comparative efficacy and safety of percutaneous catheter drainage (PCD) combined with antibiotic therapy versus emergency laparoscopic surgery (ELS) for treating periappendiceal abscesses.

Methods: A retrospective study was conducted on 90 patients diagnosed with periappendiceal abscesses at Harbin Hospital of Traditional Chinese Medicine between March 2022 and December 2023. The study compared clinical outcomes between two groups: one receiving percutaneous catheter drainage (PCD) with antibiotic therapy and the other undergoing emergency laparoscopic surgery. The comparison encompassed key outcomes such as operative time, gastrointestinal function recovery, length of hospital stays, postoperative complication rate, recurrence rate, and the need for additional interventions.

Results: The PCD group exhibited a significantly shorter operative time (P=0.02) and fewer postoperative complications (P=0.008) compared to the ELS group. During outpatient follow-up, six patients in the PCD group had a recurrence of appendicitis, which was statistically significant compared to the ELS group.

Conclusion: Ultrasound-guided PCD has been shown to be effective and safe in the management of periappendiceal abscesses in our single-center clinical study. It offers several benefits over ELS, such as reduced operative time and a decreased incidence of postoperative complications. Our results suggest that PCD, in conjunction with antibiotic therapy, is a feasible alternative to surgery, significantly reducing patient discomfort and healthcare resource consumption. However, these findings are specific to our center, and further multicenter studies are required to confirm these results and to establish guidelines for the optimal application of PCD in clinical practice.

Objective: To analyze the risk factors associated with the occurrence of death during the treatment of patients with hemodynamically unstable pelvic fractures.

Methods: The present study is a retrospective research design, which selected 136 patients with hemodynamically unstable pelvic fractures admitted to China Resource & WISCO General Hospital from March 2020 to March 2022 as the subjects of the study. They were divided into a survival group (113 cases) and a death group (23 cases) according to whether the patients died during treatment. The general clinical data and laboratory test indexes of the two groups were compared to analyze the risk factors affecting the death of pelvic fracture patients. Receiver operator characteristic (ROC) curves were plotted, and the area under the curve was calculated.

Results: The two groups were significantly different in aspects of age, systolic blood pressure, rapid emergency medicine score, injury severity score (ISS), sequential organ failure assessment (SOFA) score, prothrombin time, activated partial thromboplastin time, and percentages of patients with bleeding volume > 2,000 mL, shock index > 2, and minimum oxygenation index < 200 (P<0.05). Logistic regression analysis suggested that shock index > 2, ISS, SOFA score, and bleeding volume > 2,000 mL were independent risk factors for patient death. ROC analysis showed that the area under the curve for shock index > 2, ISS, SOFA score, and bleeding volume > 2,000 mL was 0.656, 0.732, 0.907, and 0.798, respectively.

Conclusions: Severe shock, increased ISS and SOFA score, and bleeding are independent risk factors for death in patients with hemodynamically unstable pelvic fractures. Implementation of rapid and efficient targeted management during treatment of high-risk patients with these factors is key to reducing their risk of death.

Objective: To determine frequency of post-transplant metabolic syndrome (PTMS) after liver transplantation (LT), its pre-transplant predictors and its association with cardiovascular events.

Methods: In this observational, analytical cross-sectional study done at Gastroenterology Department, Shaikh Zayed Post Graduate Medical Institute Lahore from January 2021 to March 2023, pre-transplant data of patients having LT for > 1 year including etiology of liver disease, presence of metabolic syndrome (MS), diabetes mellitus (DM), hypertension (HTN) and obesity were noted. Post-transplant evaluation was done to document DM, HTN, Dyslipidemia, obesity, PTMS and cardiovascular events after LT. Student's t test and chi square were used for correlation and linear regression for multivariate analysis.

Results: Total of 111 post LT patients with mean age 45.2 (±10.45) and male to female ratio 6.4/1 (96/15) were included. Before LT, 15(13.5%) patients had DM, 11 (9.9%) had HTN, 48(43.2%) were obese and MS was present in 13 (11.7%) patients. Median duration since LT was three years. Post LT, PTMS developed in 60(54.1%) patients, 64(57.7%) had DM, 27(24.3%) had HTN, dyslipidemia was noted in 60(54.1%) patients and 69(62.2%) were obese. Presence of DM (OR 15.21; p< 0.001), HTN (OR 10.00; p=0.01) and MS (OR 12.50; p=0.003) before transplant was significantly associated with development of PTMS. No significant difference in development of cardiovascular events was noted in patients with and without PTMS.

Conclusion: Post transplant metabolic syndrome develops in majority of LT patients, risk is higher in those with diabetes mellitus, hypertension and metabolic syndrome before liver transplantation.

Background & objective: Transabdominal ultrasonography (TAUS) remains the initial imaging modality in diagnosis of bile duct obstructive lesions. The purpose of this study was to investigate the predictive value of TAUS in detecting bile duct obstructive lesions in comparison with endoscopic retrograde cholangiopancreatography (ERCP) as the standard method.

Methods: This retrospective descriptive study analyzed the electronic records of the patients diagnosed with obstructive jaundice from April 2017 to November 2022 at Alsafwa Consultative Medical Center in Almukalla City, Hadhramout, Yemen. All patients involved were diagnosed by TAUS and the diagnosis was confirmed by ERCP. A comparison of the diagnoses was performed.

Results: TAUS and ERCP demonstrated high compatibility in bile duct obstructive lesions, with substantial agreement in detecting cholangiocarcinoma, bile duct stricture, stones, pancreatic cancer, and ampulla of Vater mass (compatibility ranging from 71.4% to 100%, Cohen's Kappa = 0.748, p < 0.001). Pearson correlation indicated strong agreement between the two methods (r=0.856). TAUS showed high sensitivity, and positive predictive value (PPV), particularly for bile duct stones (99.4% sensitivity, 86.7% PPV), and pancreatic carcinoma (94.3% sensitivity, 82.5% PPV), with significant effectiveness in identifying other conditions like bile duct stricture (42.6% sensitivity, 88.5% PPV) and cholangiocarcinoma (70.6% sensitivity, 100% PPV). (p<0.001). Overall, TAUS and ERCP displayed excellent compatibility across various diagnoses, with near-perfect agreement in determining the causes in the ampulla of Vater and bile duct (Kappa= 0.899, p<0.001).

Conclusion: TAUS is a reliable and highly valuable imaging modality for detecting and determining the cause and level of bile duct obstruction in patients with obstructive jaundice which offers a non-invasive approach, radiation free, with minimal risk of serious complications.

Objective: To investigate the prognostic value of chest computed tomography (CT), platelet count (PLT), serum C-reactive protein (CRP) level, and oxygenation index (OI) in patients with severe community-acquired pneumonia (CAP).

Methods: We conducted a retrospective analysis of clinical data collected from 226 patients with CAP who received treatment in Huzhou Central Hospital from February 2022 to November 2023. Patients were divided into two groups based on pneumonia severity: Severe group (patients with severe CAP, n=113) and Typical group (patients with typical pneumonia, n=113). Differences in CT score, PLT, CRP, and OI levels between the two groups were analyzed, as well as the prognostic value of the combined CT score, PLT, CRP, and OI levels in severe CAP.

Results: The CT Score and CRP level in the Severe group were significantly higher than those in the Typical group, whereas PLT and OI were significantly lower (P<0.05). Of 113 patients with severe pneumonia, 42 died and 71 survived. The CT Score and CRP level in the death group were significantly higher, whereas PLT and OI were lower compared to the survival group (P<0.05). The area under the ROC curve of the combined CT Score, PLT, CRP, OI for the prediction of death in patients with severe CAP was 0.970, sensitivity was 85.7, and specificity was 93.0, which was higher than that of each index alone.

Conclusions: The combined chest CT, PLT, CRP, and OI have high prognostic value for severe CAP.

Objective: The present study was aimed to screen the Herpes simplex virus (HSV) infection in cervical smears of clinically suspicious to asymptomatic pregnant women of local population.

Method: This descriptive cross-sectional study was conducted at the Department of Histopathology, University of Health Sciences Lahore, Pakistan from August 2021 to September 2022. A total of N=120 cervical smears were taken from the pregnant females of gestation age 18-38 weeks, visiting the outpatient department (OPD) of Gynecology & Obstetrics, Jinnah Hospital Lahore. Endocervical smears were taken; cell block and cytospin preparations were prepared. The cytological changes were categorized according to the updated Bethesda Classification System 2014 and the samples were screened for the presence of HSV 1 & 2 through immunocytochemistry (ICC), immunohistochemistry (IHC) and Immunofluorescence (IF). SPSS version 25.0 was used to analyze the data and p-Value of ≤ 0.05 was considered as statistically significant.

Results: Out of N=120 pregnant females, 12.5% were positive for HSV on ICC while 2.5% cases showed positive nuclear staining for HSV on cell block by IHC. On IF staining, around 7.5% samples were positive for HSV by cytospin method whereas 15% cases showed positivity for HSV on cell block method. Typical herpetic genital lesions were observed in 13% of HSV positive females (p=0.043). Pap staining of cervical smears revealed negative for intraepithelial lesion or malignancy (NILM) in 90% of the samples while 10% of the cases were suggestive of atypical squamous cells of undetermined significance (ASCUS). Moreover, 13% cases showed candida albicans on culture test. None of the subjects showed positive Trichomonas vaginalis on wet smears.

Conclusion: Early and effective diagnosis of sub-clinical cervico-vaginal HSV infection in pregnant females by adopting minimally invasive cytological techniques and immunofluorescent staining may lead to reduced morbidity and mortality.