Pakistan Journal of Medical Sciences最新文献

Objective: In patients with non-small cell lung cancer (NSCLC) complicated by pulmonary embolism (PE), the clinical manifestations become more complex and the diagnosis is more difficult. We aimed to develop and validate an individualized nomogram for differentiating the PE of NSCLC.

Methodology: Patients with NSCLC at the First People's Hospital of Linping District, Hangzhou were enrolled from September 2021 to March 2024. Least Absolute Shrinkage and Selection Operator (LASSO) and multivariate logistic regression analyses were performed to recognize risk factors. An individualized nomogram was subsequently developed. The model's performance was validated using the receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA).

Results: We enrolled 390 NSCLC patients, of whom 89 (22.8%) had PE. Using multivariate logistic regression, we finally identified seven independent risk factors for PE: pathological type, tumor-node-metastasis (TNM) staging, indwelling central venous catheter (CVC), chemotherapy, hemoglobin, white blood cell count (WBC), and neutrophil-to-lymphocyte ratio (NLR). The model showed good predictive ability, with an area under the ROC curve of 0.909 (95% CI: 0.875-0.942). The calibration curves of the model showed good agreement between actual and predicted probabilities. The ROC and DCA curves demonstrated that the nomogram exhibited a good predictive performance.

Conclusions: The nomogram model for predicting the risk of PE in NSCLC has good predictive performance and is potentially useful for screening of high-risk patients in clinical practice.

Objective: To estimate the prevalence and evaluate the surgical outcomes of dorsolumbar junction spinal tumors at a tertiary care center in Pakistan.

Methodology: This retrospective cohort study was conducted at Punjab Institute of Neurosciences, Lahore, including 35 patients operated for dorsolumbar junction (D11-L2) tumors between January 2021 and October 2024. Data extracted from records and PACS included demographics, presentation, imaging, operative details, histopathology, extent of resection, and outcomes. Tumors were classified by compartment and resection status, and primary outcomes were symptomatic improvement and complications. Data were analyzed descriptively using Microsoft Excel.

Results: The cohort comprised patients with a mean age of 36.25 ± 16.7 years, with male predominance (54.3%, n=19). Intradural extramedullary tumors were most prevalent (80.0%, n=28), with neurofibromas being the most common histological type (51.4%, n=18). Predominant presenting symptoms included backache radiating to lower limbs (80.0%, n=28) and neurological deficits. A posterior surgical approach was used in all patients achieving gross total resection(GTR) and near total resection (NTR) in 85.7% of patients. Immediate symptom relief was reported in 57.1% (n=20) of patients, with a tumor recurrence rate of 8.6% (n=3). Complications included new neurological deficits (5.7%, n=2) and cerebrospinal fluid leakage (5.7%, n=2).

Conclusion: This study highlights that dorsolumbar junction tumors in our Pakistani cohort were predominantly intradural-extramedullary, mainly neurofibromas and schwannomas, most often at D12-L1/L1-L2. Standard posterior approaches achieved effective resections with low complications and early symptomatic improvement. These findings demonstrate that with modern imaging and surgical expertise, centers in Pakistan can deliver care comparable to international standards, while larger multicenter studies are needed to validate and extend these results.

Background and objective: Thalamic tumors are rare, deep-seated tumors with a paucity of literature globally, and yet no existing literature based on the Pakistani population. The objective of this study was to evaluate the clinical presentations and radiological findings of thalamic space-occupying lesions (SOLs) and analyze the outcomes of management practices.

Methodology: A bi-departmental retrospective observational case series of 13 patients who underwent surgical excision or cerebrospinal fluid (CSF) diversion for thalamic SOLs at the Punjab Institute of Neurosciences (PINS) Hospital from 1^st January 2022 to 31^st December 2024. A descriptive analysis was done for clinical-radiological and outcome-based variables.

Results: The cohort comprises 33% (4) pediatric patients (mean age, 8.75±6.07 years) and 67% (9) adults (mean age, 33.67±14.82 years), with a male predilection of 56.3% (9). The most common presentation was focal neurological deficit in 77% (10). Magnetic Resonance Imaging (MRI) revealed that tumors were hypointense on T1-weighted images (T1WI) in 77% (10) of patients and hyperintense on T2-weighted images (T2WI) in 92% (12), with 77% (10) of them being contrast enhancing. Ventriculoperitoneal Shunt (VPS) was required in 15% (2) of patients, improvement of Glasgow Coma Scale (GCS) was in 15% (2), and Karnofsky Performance Status (KPS) after surgery was improved in 23% (3). Glioblastoma 61.5% (8) was the most common diagnosis on histopathology.

Conclusion: High-grade thalamic gliomas usually affect adult males and present with focal neurological symptoms in the Pakistani population, requiring MRI with Gadolinium contrast evaluation for the diagnosis. Neuronavigation-guided (NNG) biopsy is the common modality of neurosurgical intervention, with minimal improvement, and glioblastoma, the common histopathological diagnosis for thalamic tumors.

Objective: To evaluate how pre-operative trans-arterial embolization (TAE) affects the surgical outcomes of patient undergoing excision of vascular head and neck tumors.

Methodology: This retrospective observational study was conducted at Department of Neuroendovascular Surgery, Punjab Institute of Neurosciences, Lahore, Pakistan from February 2024 to January 2025. It is a non-probability based consecutive case series, including 16 patients in accordance with the inclusion criteria.

Results: Out of the 16 Patients enrolled in the study, 14 were male and 2 females with a mean age of 19.7±7.71 Years (Range; 14-37 Years). Except two patients with meningioma, all of the patients had JNA. The mean time between surgical excision and embolization was 38.6±18.9 hours, with most operations performed within 24-48 hours. Devascularization was graded as good in 12 patients (75%), fair in 2 (12.5%), and poor in 2 (12.5%). Mean operative times were 4.3 hours for good, 5.0 hours for fair, and 6.0 hours for poor devascularization. Corresponding ICU stays were 30, 48, and 72 hours, while ward stays averaged 2.2, 2.5, and 3.0 days, respectively. Better devascularization correlated with shorter surgery duration, reduced ICU time, and earlier discharge.

Conclusion: Preoperative TAE is effective for highly vascular head and neck tumors, enabling shorter surgeries, easier debulking, and reduced blood loss. Polyvinyl alcohol (PVA) particles provide clear tumor margins and satisfactory devascularization.

Objective: To evaluate the efficacy of combined lung and heart treatment (CLHT) for Yang deficiency with water overflowing type chronic obstructive pulmonary disease (COPD).

Methodology: This is a prospective cohort study. A total of 92 patients with this TCM subtype COPD admitted to Ningbo Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University were randomly assigned to treatment (n = 46) and control (n = 46) groups from December 2020 to February 2023. The control group received standard Global Initiative for Chronic Obstructive Lung Disease guideline-based inhaled therapy. The treatment group received oral Traditional Chinese Medicine (TCM) decoction for twelve weeks. TCM symptom scores, COPD Assessment Test (CAT) scores, forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), FEV₁/FVC, serum concentrations of interleukin-6 (IL-6) and -8, annual acute exacerbation frequency and adverse events were used for treatment evaluation.

Results: Baseline characteristics were comparable (P > 0.05). Post-treatment, both groups showed significant reductions in TCM symptom scores, CAT scores, IL-6 and -8 levels and annual acute exacerbation frequency (P < 0.05), with greater improvements in the treatment group (P < 0.05). FEV₁, FVC and FEV₁/FVC showed significant improvement only in the treatment group (P < 0.05), with FEV₁ and FEV₁/FVC higher in the treatment group than the control (P < 0.05). Furthermore, the treatment group achieved a higher total efficacy rate (90 % vs. 64. 1%; χ² = 7.258; P < 0.05) without drug-related adverse events.

Conclusion: The CLHT method improved the clinical efficacy of Yang deficiency with water overflowing type COPD treatment, alleviated clinical symptoms, enhanced patients' quality of life, improved pulmonary function and reduced annual acute exacerbation frequency.

Objective: To explore the efficacy of synergistic nursing and flexible play-based mode in children with bronchial asthma.

Methodology: The clinical data of 120 children with bronchial asthma, treated in Children's Hospital of Hebei Province from February 2023 to April 2025, were retrospectively selected. Based on the nursing approach, patients were divided into the control (routine nursing) and the study group (synergistic nursing and flexible play-based mode in addition to the routine nursing). The recovery RATE, negative emotions before and after intervention (assessed using Screen for Child Anxiety Related Disorders [SCARED] and Depression Self-Rating Scale for Children [DSRSC], quality of life (assessed by Asthma Quality of Life questionnaire [AQLQ]) and nursing satisfaction of the family members were compared.

Results: The duration of wheezing, the disappearance of cough episodes and the hospitalization time were significantly shorter in the study group than in the control group (P<0.05). After intervention, the SCARED and DSRSC scores in the two groups were considerably lower than before intervention (P<0.05). The scores of emotional function, restricted activity, environmental irritation and symptoms in the two groups after intervention were higher than preintervention and markedly higher in the study group compared to the control group (P<0.05). The nursing satisfaction of the family members of the study group (95.24%) was higher than that of the control group (82.46%) and the difference was statistically significant (P<0.05).

Conclusion: Synergistic nursing and flexible play-based mode in children with bronchial asthma can shorten the time of symptom relief, alleviate negative emotions, improve the quality of life, promote the early recovery and discharge of children and is associated with higher family satisfaction levels.

Objective: To evaluate whether changes in end-tidal carbon dioxide (EtCO₂) following passive leg raise (PLR) can predict fluid responsiveness and guide fluid therapy in patients undergoing Lung Resection Surgery (LRS).

Methodology: This prospective randomized controlled trial was conducted at Istanbul University-Cerrahpasa Medical Faculty Hospital, Istanbul, Turkey, between August 2020 and March 2021. Fifty patients undergoing elective LRS were enrolled. After anesthesia induction, EtCO₂ was measured before and one minute after PLR. A ≥2 mmHg increase was considered responsive. Responders were randomized into a study group (fluid bolus) and a control group (maintenance fluid only); non-responders formed a third group. Hemodynamic parameters, fluid balance, urea, creatinine and lactate levels were recorded perioperatively.

Results: The proportion of fluid responders was 62%. The study group received significantly more intravenous fluid and showed no cases of acute kidney injury (AKI), while AKI was observed in the control and unresponsive groups. Postoperative urea levels increased significantly only in the control group. Lactate levels rose intraoperatively in all groups but normalized within 24 hours. A positive correlation was found between surgical duration and lactate levels. EtCO₂ and heart rate did not differ significantly between groups.

Conclusion: EtCO₂ changes in response to PLR may provide a simple, non-invasive indicator of fluid responsiveness in thoracic surgery. Targeted fluid supplementation in responsive patients appears to improve renal outcomes. Further studies are needed to validate these findings.Registration No. ClinicalTrials.gov (Identifier: NCT06855966).

Objective: To identify the association between chronic otitis media (COM) and temporal bone (mastoid part) pneumatization in normal and diseased ear with chronic otitis media.

Methods: This cross-sectional study consisted of human subjects from ten to seventy five years of age with unilateral diseased ear (COM) along with opposite normal ear without any fracture of temporal bone, pathology, or anomaly of ear. The duration of the study was from January to July 2024. The data was collected at PNS Shifa Hospital Karachi. A total ninety-two High Resolution Computed Tomography (HRCT) scans of both ears of forty-six human subjects, with one healthy and opposite ear with COM were used in this research by using purposive sampling technique. Dimensions were noted by using software "Vitrea" and readings obtained were filled in the subject evaluation form. Patients were divided into group of 6, according to the age, including both genders. Pneumatization was categorized into hyper, good, moderate and hypo. Pneumatization of right and left ear was compared having disease (COM) and healthy ears.

Results: In this comparative cross-sectional study, HRCT of patients when compared for pneumatization showed highly significant result (p=0.000). Hypo-pneumatization was found in those ears having COM and hyper or good pneumatization was found in healthy ears of the individuals.

Conclusion: Pneumatization was found to be decreased in ears with chronic otitis media as compared to healthy ears.

Objective: To investigate the clinical efficacy of azithromycin in treating pediatric mycoplasma pneumonia and its effects on platelet count, D-dimer levels, and serum inflammatory factors.

Methodology: This was a retrospective study. Eighty children with mycoplasma pneumonia admitted to Anhui Children's Hospital between June 2022 to June 2024 were selected as study subjects. They were divided into an observation group(n=40) receiving azithromycin and a control group(n=40) receiving erythromycin according to different treatment strategies. Clinical efficacy, time to resolution of symptoms, platelet count, D-dimer levels, serum inflammatory factor levels, and incidence of adverse reactions were compared between the two groups.

Results: The overall response rate of the observation group(95.00%) was significantly higher than that of the control group(72.50%)(χ²=7.440,P<0.05). The time to fever subsidence, cough resolution, hospitalization duration, and disappearance of pulmonary moist rales in the observation group were all significantly shorter than those in the control group(t=14.208,9.639,13.628,31.677, P<0.05). After treatment, the platelet count(PLT) and D-dimer(D-D) levels in the observation group were significantly lower than those in the control group (t=3.079, 7.847, P<0.05 for both). The serum levels of TNF-α, CRP, and IL-6 in the observation group were also significantly lower than those in the control group(t=6.540,10.406,9.688,P<0.05). The incidence of adverse reactions in the observation group (5.00%) was significantly lower than that in the control group(20.00%) (χ²=4.114, P<0.05).

Conclusion: Azithromycin offers multiple benefits in treating pediatric mycoplasma pneumonia, including rapid symptom resolution, potent anti-inflammatory effects, regulation of coagulation-fibrinolysis balance, reduction in serum inflammatory factor levels, and a lower incidence of adverse reactions.

Objective: This study aimed to compare the surgical outcomes, as well as the intraoperative and postoperative complications, of colpocleisis and sacrospinous ligament fixation (SSLF) in the management of vaginal vault prolapse (VVP) among post-hysterectomy patients.

Methods: A retrospective, observational study was conducted on 49 patients who underwent surgery for VVP at Ankara Bilkent City Hospital between January 2020 and December 2024. Of the 49 patients, 26 (53.1%) underwent colpocleisis surgery and 23 (46.9%) underwent SSLF surgery. Data collected included patient demographics, preoperative and postoperative hemoglobin levels, operation time, hospital stay, and postoperative complications. The study also assessed treatment success and recurrence rates.

Results: The mean age of the patients was significantly higher in the colpocleisis group than the SSLF group (71.5 years vs. 59.9 years, p=0.01). There were no significant differences in hemoglobin drop levels, previous hysterectomy indications and types, or operation times between the two groups (p≥0.05). The mean hospital stay was significantly longer in the colpocleisis group than in the SSLF group (3.2 days vs. 1.6 days, p=0.02). Kaplan-Meier analysis revealed no significant difference in VVP recurrence requiring reoperation between the colpocleisis and SSLF groups (3.8% vs. 13.1%, respectively; p = 0.13).

Conclusion: SSLF and colpocleisis have demonstrated high efficacy in the treatment of vaginal vault prolapse. These surgical approaches are particularly appropriate for elderly patients with significant comorbidities, as they are associated with low complication rates, shorter operative times, and reduced recurrence rates.