Pakistan Journal of Medical Sciences最新文献

Objective: To explore the efficacy of probiotics combined with metformin and a calorie-restricted diet in obese patients with polycystic ovary syndrome (PCOS).

Methods: Clinical data of 141 obese PCOS patients treated in the 73rd Group Army Hospital from June 2021 to December 2023 were retrospectively analyzed. Patients were grouped according to the treatment records: metformin group (n=69), patients treated with metformin and a calorie-restricted diet) and combined group (n=72, patients treated with probiotics combined with metformin and a calorie-restricted diet). Levels of endocrine hormone indicators, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), Fasting blood glucose (FPG), gut microbiota status, and Body mass index (BMI) were compared before and after the treatment in two groups.

Results: After the treatment, the levels of endocrine hormone indicators, HOMA-IR, and FPG in both groups were significantly reduced compared to pre-treatment levels and were significantly lower in the combined group compared to the metformin group (P<0.05). Abundance of gut microbiota and Shannon Wiener diversity index in both groups significantly increased after the treatment and were markedly higher in the combined group than in the metformin group (P<0.05). Treatment led to a significant reduction in the body mass index (BMI) in all patients (P<0.05). However, post-treatment BMI was comparable in the two groups (P>0.05).

Conclusions: In obese patients with PCOS, adding probiotics to the metformin and calorie-restricted diet regimen is more effective in regulating hormone levels, improving blood sugar and insulin resistance, regulating gut microbiota status, and reducing BMI than metformin combined with calorie-restricted diet alone.

Objectives: To evaluate the impact of Type 2 diabetes mellitus (T2DM) on quality of life (QOL) and compare it with healthy subjects.

Method: This case-control study was conducted at Aziz Fatimah Hospital and Aziz Fatimah Medical and Dental College, Faisalabad, Pakistan, from May 2023 to January 2024. A total of 170 subjects were included in the study through purposive sampling technique. Fasting and random blood glucose levels were measured using an enzymatic colorimetric test. HbA1c was determined with the Bioherms A1C EZ 2.0 Glyco-hemoglobin Test Kit. QOL was assessed using the Short Form-36 version 1 questionnaire. Statistical analysis was performed using SPSS version 26, with p ≤ 0.05 considered significant.

Results: The study included 86 T2DM patients and 84 controls, with a mean age of 49.23 ± 12.59 years. Among the participants, 44.7% were male and 55.3% were female. T2DM patients scored lower in physical functioning, limitations due to physical health, bodily pain and vitality subscale compared to controls (p = 0.003, 0.050, 0.030, 0.000 respectively). Both groups had physical component summary and mental component summary (MCS) scores below 50, indicating impaired QOL. MCS scores were significantly lower in T2DM patients than in controls (p = 0.002). Females scored lower in vitality (p = 0.0005) and bodily pain (p = 0.031). T2DM patients with less than five years of duration had lower SF-36 scores than those with longer duration.

Conclusion: T2DM impairs quality of life, especially in females and those with less than five years of disease duration, who face a greater negative impact.

Objective: To explore the chemotherapy effect of albumin-bound paclitaxel combined with pirarubicin and cyclophosphamide on breast cancer and the effects of PCR, ORR and CBR.

Methods: This was a retrospective study. During the period from January 2022 to December 2023, ninety patients with breast cancer who were treated in The First People's Hospital of Changde City were included as the research objects. Based on the principle of randomized control, the above patients were divided into the control group (45 cases, treated with pirarubicin and cyclophosphamide) and the observation group (45 cases, treated with albumin-bound paclitaxel combined with pirarubicin and cyclophosphamide) by the random number table. Compared the chemotherapy effect and safety of the two groups.

Results: After treatment, the PCR, ORR and CBR of the observation group were higher than those of the control group, while the levels of CA152, CA125, TPS, HER-2, Ki-67 and EGFR were lower than those of the control group, and the differences were statistically significant (P<0.05). The incidence of adverse reactions was 33.33% (15/45), which was slightly higher than that of 28.89% (13/45) in the control group, the difference was not statistically significant (P>0.05).

Conclusion: Albumin-bound paclitaxel combined with pirarubicin and cyclophosphamide is a safe regimen that can further enhance the effect of neoadjuvant chemotherapy in the treatment of breast cancer, and it has a certain value for dissemination in the treatment of breast cancer can further enhance the effect of neoadjuvant chemotherapy in patients, which is of certain value for clinical promotion.

Objective: To determine the frequency of hematuria and lower urinary tract problems in rheumatoid arthritis cohort.

Method: This cross sectional prospective study was conducted at department of Rheumatology Indus Medical College Tando Mohammad Khan from August 1, 2022 to March 3, 2023. Total 229 patients were selected after written and informed consent; demographic details were taken. Bristol Female Lower Urinary Tract Questionaries' (BFLUTS) was filled and all male participants were asked for ultrasound scan of prostate and freshly voided midstream urine was collected for microscopic hematuria.

Results: In this study the prevalence of Lower Urinary Tract Symptoms (LUTS) was (77.3%) and microscopic hematuria (34.5%). Major symptoms of LUTS were: nocturia (69%), bladder pain (35.4%), leaking before going to toilet (40.6%), frequency of incontinence (24.5%), nocturnal incontinence (27.9%), sex life spoiled due to urinary symptoms (22.7%), avoid situation where no toilet (30.1%) and overall interference of life (32.8%) cases. A significant association of DAS-28 with LUTS and microscopic hematuria was seen (p<0.01).

Conclusion: Lower urinary tract problems and microscopic hematuria are common in both genders, and severity of RA, increases LUTS and affects quality of life.

Objective: To investigate and address challenges in faculty mentorship for sustainability of Faculty Mentorship Program (FMP) at Aga Khan University Medical College (AKU-MC).

Methods: This is a mixed method study conducted from June 2021 to December 2023 at AKU-MC. It comprises of the exploration of qualitative insights into the challenges faced by mentors, mentees, and administrators, also incorporating quantitative measures of success to evaluate the sustainability of the program over time. Data was retrieved from four Focus group discussions (FGD) with mentors and mentees, eight in depth interviews with the administrators of FMP and leadership. Challenges of faculty mentorship were further identified by a panel discussion and briefing sessions with faculty members of different departments at AKU-MC. Challenges identified by three data sets were presented to the FMP committee, discussed in forum meetings and recommendations were proposed for the sustainability of the program.

Results: During the interviews, mentors revealed 'Limited Training and 'Lack of Recognition' as key challenges whereas mentees mentioned deficient skills in planning developmental goals. Administrators mentioned the need to enhance the visibility of the program as well as to update the resources. Panel discussion highlighted the need for recognition of mentors and providing them with protected time. Departmental meetings endorsed the need for sequential training of both mentors and mentees. To address these challenges educational grand rounds, international conferences and webinar were conducted to enhance the visibility of the program. Mentors were acknowledged by appreciation emails and tokens of appreciation. A series of workshops to enhance mentoring skills were planned and executed.

Conclusion: The FMP at AKU-MC has devised a stepwise strategy to address challenges in faculty mentorship. This approach emphasizes collaboration with departments and the active involvement of leadership. By incorporating rewards, recognition, and a series of workshops, the program aims to foster a strong mentorship culture within the university. These efforts align with the objective of investigating and resolving mentorship challenges to ensure the sustainability of the Faculty Mentorship Program at AKU-MC.

Objective: Chronic postsurgical pain (CPSP) after total knee arthroplasty (TKA) is the most common postoperative complication in orthopedics. This study aims to explore the risk factors for CPSP after TKA and construct a nomogram model.

Methods: This retrospective study included clinical records of 430 patients who received TKA treatment at Wuhan Fourth Hospital between January 2020 to January 2024. Patients were randomly divided into a training cohort (n=301) and a validation cohort (n=129) in a 7:3 ratios. The Least Absolute Shrinkage and Selection Operator (LASSO) algorithm and logistic regression analysis were used to identify the independent risk factors, and a predictive nomogram model was established based on the identified risk factors. The concordance index (C-index), calibration curve, receiver operating characteristic (ROC) curve and decision curve analysis were used to assess the predictive accuracy and clinical application value of the nomogram model.

Results: Six risk factors for predicting CPSP were identified, including preoperative anxiety, preoperative depression, preoperative pain, duration of tourniquet use, pain upon discharge, and postoperative C-reactive protein levels. The nomogram model demonstrated sufficient predictive accuracy, with the area under the curve (AUC) values of 0.761 (95% CI: 0.689-0.833) and 0.806 (95% CI: 0.700-0.911) in the training cohort and validation cohort, respectively. The C-index of the training cohort and validation cohort were 0.733 and 0.761, respectively. The calibration curve shows good consistency between the predicted risk of the model and the actual risk of CPSP. Decision curve analysis (DCA) demonstrated the clinical applicability of the model.

Conclusions: The nomogram model established in this study for predicting CPSP after TKA has good predictive value and may be used in clinical practice to identify patients at high risk of developing CPSP after TKA.

Objective: This study aims to determine prevalence, risk factors and geographic distribution of Developmental Dysplasia of the Hip in Pakistan and to assess the cumulative outcomes of various treatments used and propose recommendations to establish preventive strategies and best treatment practices in Pakistan.

Methods: This multicentric retrospective study was conducted with analysis of data from DDH section of PORP registry of Pakistan. The data was uploaded by 1,3-11 authors, which were treated during last three decades. The evaluation parameters included 25 variables of basic demographics of patients, geographic prevalence, characteristics of DDH and related risk factors. The data was also analyzed to know methods of treatment used and cumulative outcomes in various age groups and severity of dysplasia.

Results: The study included 755 patients with 1,107 affected hips, aged one day to over eight years. Of these, 86.25% were diagnosed after 18 months, 11.7% were over eight years. Among 104 neonates, 23% had neonatal screening. The female-to-male ratio was 3:1. 21% had history of DDH in family, and 24% were from remote rural areas. 46.6% had bilateral DDH. 48.43% patients had significantly obtuse acetabular index >45°. The acetabular index (AI) found highly associated with age bilaterally (p=0.001). 88% of normal unilateral hips had AI <30°, and 11% have moderate dysplasia of 30°-45°. 129 patients were treated non-operatively with 83.72% success rate at minimum three years follow-up. The failure rate of Pavlik harness was 25%. Six hundred twenty six (626) patients underwent open reduction with 70.42% success rate at minimum one year follow-up. Most failures in conservative and operative treatment were on one side of bilateral cases. Late complications over 10 years follow-up was short femoral neck offset, coxa magna and residual acetabular dysplasia.

Conclusion: This study leverages PORP registry data to identify DDH demographics, risk factors, and treatment outcomes. It highlights the need for establishment of MSK screening protocols, to diagnose DDH at earliest, to prevent development of disability of late treatment and enhance best practices in DDH management.

Objective: To measure the mean total macular volume (MTMV) in primary open angle glaucoma (POAG) patients using optical coherence tomography (OCT).

Methods: This descriptive cross sectional study was carried out in the department of ophthalmology, Bahawal Victoria Hospital, Bahawalpur from October 2021 to April 2022. A total of 30 patients with POAG, of either gender, between the ages of 20-60 years were included. Patients with secondary glaucoma, having previous intraocular surgery, patients with history of trauma, patients with high myopia and macular disease were excluded. After taking systemic and ophthalmic history, examination of anterior and posterior segments was carried out including best corrected visual acuity (BCVA), intraocular pressure (IOP), central corneal thickness (CCT), gonioscopy, dilated fundus examination of optic nerve and retina, and 30-2° visual field (VF) analysis. OCT was carried out in each patient to measure RNFL thickness and MTMV.

Results: Mean age in our study was 45.50 ± 8.20 years. Majority of these patients 22 (73.33%) were between 41-60 years of age. Among these 30 patients, 20 (66.67%) were male and 10 (33.33%) were females with a male to female ratio of 2:1. MTMV in these POAG patients using OCT was 6.30 ± 1.09 mm³.

Conclusion: Our study concluded that POAG patients have a reduced MTMV and it can be easily measuresd by a non-invasive technique using OCT. MTMV loss is a useful indicator of documenting glaucoma and monitoring its progression in POAG patients.

Objective: To explore the potential of AI-powered chatbots, specifically ChatGPT, in identifying and correcting flaws in MCQs.

Methods: A three-phase-Interventional study was conducted from February to August 2023 at Riphah International University, Islamabad. In Phase-1, flawed MCQs were selected from the NBME guide and fed into ChatGPT. ChatGPT identified item flaws and suggested corrections. In Phase-2, ChatGPT was trained to detect flaws in MCQs with text data from the NBME item writing guide. In Phase-3, ChatGPT was again tested to detect flaws and correct MCQs. Data were analyzed using SPSS, Version 26 and presented using percentages and McNemar's test with exact conditional method.

Results: ChatGPT could identify and correct flaws such as use of "None of the above," "Grammatical cues," "absolute terms," and "inconsistently presented numerical data." However, it struggled with flaws related to "complicated stems," "long or complex options," and "vague frequency terms." After training, ChatGPT became better at identifying and correcting flaws related to complicated stems and absolute terms. It also struggled with recognizing "nonparallel options," "convergence," and "word repetition," both before and after training. ChatGPT's performance deteriorated during peak hours. The test of significance showed no measurable increase in ChatGPT's efficiency in detecting item flaws (p = 1.00) and correcting them (p = 0.125).

Conclusion: AI is revolutionizing industries and improving efficiency, but limitations exist in complex conversations, analysis, accuracy, and error prevention. Ongoing research is vital to unlocking AI's potential, especially in education.

Objective: The study aim was to assess correlation between social media addiction and academic procrastination among medical students at public and private medical colleges in Peshawar.

Methods: A correlational research design was employed with research protocols approved by the Advance Studies and Research Board of Khyber Medical University. Data were collected from two public and five private medical colleges. Universal sampling was then performed. Of 4716 medical students, 3366 participated in the study, with a response rate of 71.4%. This study was conducted between June and December 2023. Data were collected using the structured social media addiction scale (SMAS) and academic procrastination scale (APS).

Results: Male participants were (1775) 52.7%, and the rest (1591) 47.3% were female. Among the responders (1591) 61% resided in hostels. The mean academic achievement was 74.14%, ranging from 30% to 85%. Most medical students (63%) showed moderate and 34% showed high academic procrastination. Majority of the medical students (81%) were social media addicts and male reported higher scores. Social media addiction was highly correlated with academic procrastination (r=0.539), which was regressed and found that 29% (R²=0.289) of social media addiction contributed to academic procrastination. Medical students from the public sector, Android users, third-year students, male students, and hostel residents were more prone to social media addiction and academic procrastination.

Conclusion: Social media addiction prevails among medical students and is highly correlated with academic procrastination. Hostel residents, males, and android users were more addicted to social media than their counterparts.