Pakistan Journal of Medical Sciences最新文献

Objective: The aim of the study was to determine the effects of transcutaneous electrical nerve stimulation (TENS) on pain and vital signs during chest tube removal (CTR).

Methodology: This randomized controlled study was conducted with a group of patients treated in the thoracic surgery unit of a university hospital between May 2023 to September 2023. Participants were equally allocated using simple randomization. This randomized-controlled study collected data 60 thoracic surgery patients using Patient Information Form (PIF) and the Numerical Rating Scale (NRS). TENS was applied for a total of one hour, 2-3 cm from the chest tube site. The pain level and vital signs of the patients were assessed at immediately before (T1), during (T2) and immediately after (T3) the CTR in all groups.

Results: Pain levels were significantly lower in the TENS group compared to the control group (p < 0.05). In addition, a significance was found between the groups at T2 for Heart Rate (HR), T2-T3 for Systolic Blood Pressure (SBP) and T2-T3 for Respiratory Rate (RR). HR, SBP and RR were statistically significant at T2 time (p<0.05) in this group.

Conclusion: TENS effectively reduces acute procedural pain and provide maintain stable vital signs as a safe complementary method in multimodal pain management.

Background & objectives: Concurrent activation potentiation (CAP) is a phenomenon of activation of one muscle area leading to activation of other body areas such as teeth clenching enhances the activity of neck and core stability muscles. The aim of this study was to investigate the effect of hand grip activation on the activation of core stability muscles and to determine the concurrent activation potentiation between hand grip strength and core stability muscles in medical university students.

Methodology: This study entails a cross-sectional research design that was been conducted at the Institute of Physical Therapy and Rehabilitation Jinnah Sindh Medical University, Karachi from January 2024 to March 2024. A total of 196 medical university students were recruited for the study. The data was collected under three conditions that is assessment of handgrip strength of dominant hand, assessment of core stability endurance and assessment of core stability with handgrip. Hand dynamometer and Pressure Biofeedback Unit was used to collect the data. A p-value of 0.05 was considered significant.

Results: The results revealed limited concurrent activation potentiation between handgrip and core stability endurance (mean Pressure Biofeedback Unit score 65.22 without hand grip and 65.28 with hand grip). Furthermore, a significant correlation (p < 0.05) between hand grip strength and concurrent core stability muscle endurance was found (r = 0.591), indicating a moderate and positive relationship.

Conclusion: The correlation between concurrent activation potentiation of hand grip strength and core stability muscle endurance is moderate and positive. Further research is required to clarify the correlation between concurrent activation potentiation of handgrip strength and core stability muscle endurance in young adults.

Objective: This study aimed to evaluate and compare the serum levels of CTRP9, CTRP15, HOMA-IR, and HOMA-B in metabolic syndrome patients, with and without coexisting coronary artery disease.

Methodology: This was a cross-sectional comparative study involving two groups, each with 40 patients. Group-A comprised metabolic syndrome patients with coronary artery disease, whereas Group-B included metabolic syndrome patients without coronary artery disease. The study was carried out from September 20^th, 2019 to August 31^st, 2020 at Department of Physiology & Cell Biology, University of Health Sciences, Lahore. After getting written informed consent clinical and biochemical characteristics of the patients were assessed. Data analysis was conducted with IBM SPSS version 26.

Results: The systolic (p=0.012) as well as diastolic (p=0.001) blood pressure and serum low-density lipoprotein cholesterol (p=0.032) was significantly higher in the Group-A when compared with the Group-B. Serum high-density lipoprotein was significantly lower (p = 0.031) in Group-A compared to Group-B. Significantly elevated levels of HOMA-IR (p=0.001), and CTRP15 (p=0.001) were present in Group-A as compared to the Group-B. A statistically significant negative correlation was observed between HOMA-B and CTRP15 serum levels (rho=-0.356, p=0.024) in Group-A.

Conclusion: In this study, decreased insulin secretion was found to correlate with increased CTRP15 levels in patients with metabolic syndrome and coronary artery disease. This finding suggests the potential role of CTRP15 in the pathophysiology of beta cell dysfunction possibly reflecting either a state of CTRP15 resistance or a compensatory response to impaired insulin secretion.

Objectives: Because thoracic solitary fibrous tumors (SFTs) are rare, there is limited information on their clinical features, treatment, and follow-up. The literature mainly comprises individual case reports. Our study aimed to analyse SFT data to identify prognosis-related factors and to compare the performance of two describing approaches and three risk stratification models.

Methodology: We conducted a retrospective review of medical data from 37 patients, including 32 patients with SFT aged 18 years and older who underwent surgical treatment and five patients diagnosed by biopsy at Kocaeli University Hospital between January 2004 and December 2024. Parameters affecting recurrence and survival were investigated, and the effectiveness of existing classification and scoring systems was compared.

Results: Factors potentially associated with recurrence included four or more mitoses (10 HPF) (p=0.023), necrosis (p=0.007), at least 10% Ki-67 positivity (p=0.012), malignancy (p=0.046), and tumor size (p=0.022). Relapses were observed only in the malignant group according to the England classification (p=0.046), only in stage-3 according to the de Perrot classification (p=0.161), only in those with scores of three or higher according to the Tapias classification (p=0.036), only in those with scores of two or higher according to the Diebold classification (p=0.021), and all in high-stage groups (p=0.001) according to the Demicco classification. All recurrences occurred at significant or high scores.

Conclusions: The Tapias, Diebold, and Demicco scoring systems are highly effective in predicting recurrence and prognosis. However, the modified Demicco system is more advantageous and offers a higher level of assessment.

Objective: This study aimed to develop and validate a nomogram for predicting the risk of threatened abortion after in vitro fertilization-embryo transfer (IVF-ET).

Methodology: Clinical records of 409 patients who underwent IVF-ET treatment due to tubal factors in Huzhou Maternity & Child Health Care Hospital from January 2017 to May 2025 were retrospectively selected. Patients were randomly assigned to the training (n=286) and validation (n=123) cohorts in a 7:3 ratio. The Least Absolute Shrinkage and Selection Operator (LASSO) method and multivariate logistic regression were applied to identify independent risk factors, which were then used to construct a nomogram for predicting the risk of threatened abortion. The nomogram was validated using the area under the receiver operating characteristic (ROC) curve (AUC) and decision curve analysis (DCA) to assess its clinical application value.

Results: Female age, endometrial thickness, number of embryos transferred, and progesterone (P) level 14 days after IVF-ET were identified as risk factors for threatened abortion (P<0.05). Based on the four independent factors, a nomogram was developed. The nomogram demonstrated sufficient predictive accuracy, with AUC values of 0.822 (95% confidence interval (CI): 0.737-0.907) and 0.822 (95% CI: 0.724-0.919) in the training and validation cohorts, respectively. The validation results showed that the consistency index (C-index) for the training and validation cohorts was 0.802 (95% CI: 0.715-0.889) and 0.807 (95% CI: 0.719-0.895), respectively. The calibration curves for the two cohorts are closer to the diagonal (the ideal curve).

Conclusions: The established nomogram for threatened abortion after IVF-ET has good predictive value and helps identify high-risk populations.

Objectives: To assess the relationship between knowledge regarding diabetes and medication adherence among diabetic patients.

Methodology: A cross-sectional study was conducted at the diabetes, primary care and internal medicine clinics in King Khalid University Hospital, Riyadh, Saudi Arabia, over a period of six months (July 2024 - December 2024). Data were collected using an electronic questionnaire incorporating two validated scales: the simplified diabetes knowledge scale and Morisky Medication Adherence Scale. Analysis was performed using SPSS version 26.0, applying the Chi-square test for categorical variables and Spearman's rank correlation to assess the relationship between knowledge and adherence. Statistical significance was set at p ≤ 0.05, with 95% confidence intervals.

Results: The mean age was 51.1± 16.5 years, with 39.6% over 60. Males constituted 52.9% of the sample, and 66.9% were married. The majority (61.5%) had Type-II diabetes and good glycemic control (HbA1c < 8) (51.1%). A weak correlation was found between diabetes knowledge and medication adherence (r = 0.118, p = 0.115). Diabetes knowledge was good in 50.7% with a positive correlation with educational attainment (p = 0.000) and employment status (p = 0.042). Medication adherence was low in 32%, medium in 36.7% and high in 31.3%. Higher adherence rates were observed in patients with Type-II diabetes (p = 0.010) and those who have good glycemic control (p = 0.006).

Conclusion: Although diabetes knowledge is important for promoting adherence, it is not sufficiently effective on its own to guarantee compliance. Targeted educational interventions, particularly for those with lower education, unemployment, or a recent diagnosis, may enhance adherence, improve outcomes and reduce the burden of diabetes in Saudi Arabia.

Objective: To explore the clinical diagnostic value of plasma heparin binding protein in diabetes nephropathy (DN) with sepsis.

Methodology: The study was a retrospective study of 82 patients with DN, carried out in Affiliated Hospital of Hebei University from April 2024 to December 2024. Information about inflammatory indicators, biochemical, glucose metabolism and urine microalbumin indicators. Patients were divided into two major groups, DN sepsis group (n=42) and DN group (n=40). Date of 40 T2DM patients were used as the normal control group. The inter group comparison was conducted using analysis of variance, Pearson correlation analysis was used to analyze the correlation between HBP and BUN, Scr, UACR, and eGFR, and receiver operating characteristic (ROC) curve analysis was used to evaluate the specificity and sensitivity of inflammatory indicators, and to evaluate their diagnostic efficiency for DN patients with sepsis.

Results: Compared with DN and T2DM groups, HBP, CRP and PCT were dramatically increased in DN sepsis group (p<0.001), ESR and NE% also higher (p<0.05). In DN group, HBP exhibited an upward trend (p<0.05) than T2DM group. The serum HBP was positively correlated with BUN, Scr and UACR, negatively correlated with eGFR in DN patients. In the early stage of sepsis in DN patients, the area under the curve (AUC) of HBP is 0.691.

Conclusion: The plasma HBP were dramatically increased in DN patients comorbid with sepsis, plasma HBP clinical testing were essential and had high-efficiency clinical diagnosis abilities of sepsis in DN patients.

A carotid body tumor (CBT) is a head and neck tumor, being the most frequent form of head and neck paraganglioma, which has its origin in specialized cells at the carotid bifurcation. They are benign, slow growing neuroendocrine neoplasia that are difficult to manage because they are located vascularly and may cause complications that make it difficult to be successfully managed without a multidisciplinary approach to the treatment. CBTs are uncommon, highly vascular tumors which develop out of the neural crest-derived paraganglia in the carotid bifurcation. They are generally harmless, but they are mostly difficult to manage due to their positioning in crucial neurovascular areas. Diagnosis should be made early as they may exhibit malignant transformation and local aggressive invasion. We present a case of a 51 years old woman who has been successfully excised of a mass in the carotid body using the multidisciplinary approach to ensure the best patient survival. The current case report is consistent with the literature results, which state that preoperative assessment, surgical planning, and a team-based way of work are crucial to the management.

Objective: Music therapy (MT) is a non-pharmacological approach that has been used for the treatment of depression, anxiety, emotional distress, and mood disorders. This study aimed to compare the intervention effects of active MT (such as singing, playing, and music composition) and passive MT (such as listening) on negative symptoms and cognitive function in patients with chronic schizophrenia.

Methodology: Clinical records of 120 chronic schizophrenia patients who received active/passive MT in the male ward of The Seventh Peoples Hospital of Wenzhou City, China, from April, 2024 to February, 2025 were retrospectively analyzed. The cohort included 60 cases of active MT and 60 cases of passive MT. The scoring results of the Positive and Negative Symptom Scale (PANSS), Scale for the Assessment of Negative Symptoms (SANS), Montreal Cognitive Assessment (MoCA), and Intrinsic Motivation Inventory for Schizophrenia Research (IMI-SR) were compared between the two groups.

Results: After intervention, the scores of PANSS general subscale, PANSS negative subscale, PANSS total score, and the SANS score in the active MT group were lower than those in the passive MT group (P<0.05). Active MT was associated with significantly higher MoCA and IMI-SR scores compared to the passive MT (P<0.05).

Conclusions: Compared with passive MT, active MT is more effective in improving negative symptoms, cognitive function, and intrinsic motivation in patients with chronic schizophrenia. Active MT can improve negative symptoms in patients with chronic schizophrenia. Active MT improves cognitive function in patients with chronic schizophrenia.- Compared with passive MT, active MT has higher benefits in treating patients with schizophrenia.

Objective: To assess the efficacy of four contemporary cavity disinfection protocols-potassium titanyl phosphate (KTP) laser, nanosilver-gold nanoparticle solution (Nanocare Gold), methylene blue-mediated photodynamic therapy (MB-PDT), and chlorhexidine gluconate (CHX)-on smear layer (SL) removal and shear bond strength (SBS) of fifth-generation adhesive bonded to caries-affected dentin (CAD).

Methodology: This in vitro experimental study was approved by the Institutional Review Board of King Saud University from July 1st, 2025, to 30th December 2025. Sixty extracted human mandibular molars with carious lesions extending into the middle third of dentin were collected. Following caries removal and surface standardization, specimens were randomly allocated into five groups: Group-I (control, no disinfection), Group-II (2% CHX gel), Group-III (KTP laser, 532 nm, 1 W), Group-IV (MB-PDT with diode laser activation at 638 nm), and Group-V (Nanocare Gold). SL removal was assessed using scanning electron microscopy according to Hülsmann's criteria. Following fifth-generation adhesive application and composite restoration, specimens underwent thermocycling. SBS was measured using a universal testing machine, and failure modes were analyzed stereo-microscopically. Statistical analysis employed one-way ANOVA with post hoc Tukey test (α=0.05).

Results: KTP laser demonstrated superior SL removal (1.26±0.032) and the highest bond strength (9.10±1.02 MPa), statistically comparable to Nanocare Gold (1.34±0.044; 8.94±0.97 MPa, p>0.05). MB-PDT showed minimal SL elimination (3.54±0.065) and the lowest bond strength (6.89±0.78 MPa), similar to CHX (p>0.05).

Conclusion: KTP laser and Nanocare Gold demonstrated optimal performance for cavity disinfection, effectively removing the smear layer while enhancing adhesive bond strength to CAD.