Pakistan Journal of Medical Sciences最新文献

Objective: To explore the efficacy of Traditional Chinese Medicine (TCM) acupuncture-assisted blind insertion of bullet nasointestinal tube method in patients with ischemic stroke.

Methods: This is a retrospective study using clinical records of 180 patients with ischemic stroke, hospitalized in the Department of Neurology of the Zhejiang Province Tertiary Class A Hospital, Huzhou, China from July 2022 to June 2023. The patients were divided into two groups on the basis of the nasogastric tube insertion method. We selected 90 patients for each group from the database of records by using a random list method. Patients in the observation group underwent TCM acupuncture-assisted blind insertion of nasointestinal tube and those in the control group underwent the traditional bedside blind insertion of bullet nasointestinal tube. Success rate of tube insertion, average tube insertion time, intragastric insertion time, stomach time to jejunal insertion, patient comfort, and patient satisfaction in both groups were compared.

Results: The success rate of nasointestinal tube insertion was significantly higher in the observation group compared to the control group (96.6% and 88.9%, p<0.05). There was no statistically significant difference in the time of nasoenteral tube insertion into the stomach (p>0.05). The insertion time from stomach to jejunum in the observation group was significantly shorter than in the control group (p<0.05). The patient comfort and satisfaction levels were significantly higher in the observation group compared to the control group (p<0.05).

Conclusion: TCM acupuncture-assisted blind insertion of bullet nasointestinal tube method improves the success rate of tube insertion, shortens the average catheterization time from the stomach to the jejunum and improves patient's comfort and satisfaction.

Objectives: Using magnetic resonance imaging (MRI), we analysed the clinical manifestations of granulomatous lobular mastitis (GLM) before and after treatment with traditional Chinese medicine (TCM).

Methods: This was a retrospective study. Clinical manifestations and imaging features of patients with biopsy-proven GLM before and after treatment were retrospectively analysed from April 2021 to April 2023 at Xiyuan Hospital, China Academy of Chinese Medical Sciences.

Results: Among 29 women of childbearing age (mean age, 34.3±3.6 years), Compared to pre-therapy, the number of patients with lumps, ruptures, pain, and menstrual irregularities was significantly reduced (P < 0.05). The Chinese medicine staging demonstrated a transition from bulk to ulcerated (P=0.041). Pre- and post-treatment MRI changes included lesion number, distribution, maximal diameter, time-signal intensity curves (TIC), apparent diffusion coefficients (ADC), and BI-RADS categories 3 and 4a (all P<0.05). Furthermore, substantial changes were seen in chest wall invasion, nipple discharge, increased feeding arteries, and skin edema (all P<0.05).

Conclusion: Combining internal and external Traditional Chinese Medicine (TCM) therapy proved successful for GLM. A reliable assessment of therapy efficacy is provided by MRI examination of lesion changes before and after treatment.

Benign tumors of the esophagus are uncommon, and primary esophageal schwannoma of the esophagus is even rarer, accounting for 2% of cases. Less than 30 cases have been reported in the literature. Here we report a case of a young man with a symptomatic giant esophageal schwannoma, which was completely removed by laparoscopic three-staged esophagectomy. This is the first case of such a large lesion being removed by a minimally invasive approach. Our patient was a 22-year-old male, presented with dysphagia and dyspnea for five years. An endoscopy and CT scan suggested a giant leiomyoma. Postoperative biopsy revealed a primary esophageal schwannoma. We present our case of benign esophageal tumor measuring about 10.5 cm in greatest dimension. This is the first schwannoma resection performed with the Mckeown technique among the limited case reports in the literature. Esophageal schwannoma must be kept as a possible diagnosis in patients presenting with benign esophageal tumors. Esophagectomy is the mainstay of treatment for giant esophageal schwannomas. Minimally invasive esophagectomy can be safely performed for giant benign esophageal tumors.

Objective: To investigate the effects of supraglottic airway tools such as classical laryngeal mask (cLMA) and I-gel, which can be used without the need for muscle relaxation in the airway management of general anesthesia patients, on the otolaryngeal system.

Methods: This prospective randomised study was conducted at Karadeniz Technical University Hospital, Faculty of Medicine, Trabzon, Turkey, during November 2020 to December 2021. Eighty-nine patients in the American Society of Anesthesiologists (ASA) grade I-II group, who would undergo elective surgery under general anesthesia, were randomized into two groups, namely Group cLMA and Group I-gel. cLMA and I-gel were used for airway management of the patients. After anesthesia induction, tympanometric measurements were taken at regular intervals for middle ear pressures of both ears.

Results: While air way pressures, SpO₂ and EtCO₂ values were within normal limits, there were no differences in terms of complications. In tympanometric measurements, middle ear pressure increase was statistically higher in the cLMA group than in the I-gel group (p <0.001).

Conclusions: We think that I-gel may be a more advantageous supra glottic airway device in terms of otolaryngeal effecs and middle ear pressure in theair way management during short surgical procedures.

Objective: To determine the diagnostic accuracy of Ultrasound (US) and 99m-Tc Sestamibi scan in patients with primary hyperparathyroidism (PHPT) for the localization of parathyroid adenoma before surgery keeping Parathyroid histopathology as reference standard.

Method: This three years retrospective study was performed in the Department of Endocrinology, Hayatabad Medical Complex, Peshawar. Patients with PHPT who underwent parathyroidectomy from July 2019 to June 2022 were included in the study. Information relating to localization studies prior to surgical management like US and 99m-Tc Sestamibi scan was documented. These imaging findings were subsequently compared with the findings of parathyroid surgery and histopathology results which were taken as reference standard.

Results: The sensitivity, positive predictive value (PPV) and overall accuracy of US for the preoperative localization of parathyroid adenoma was 77%, 95.7% and 75%, respectively. Whereas the sensitivity, PPV and accuracy of 99m-Tc Sestamibi scintigraphy was 89.5%, 95% and 86% respectively.

Conclusion: Ultrasound despite its cost effectiveness has a lower sensitivity compared to 99m-Tc Sestamibi scintigraphy. Similarly, the sensitivity and overall accuracy of US and 99m-Tc Sestamibi scan when taken in combination is higher compared to either modality. It is thus recommended that the combination of these modalities should be employed to localize the adenomas accurately for surgery of the parathyroid gland for a better outcome.

Background & objective: Police officials who participated in war on terror were exposed to high frequency of traumatic exposures. Previous research suggests that exposure of war trauma can results in negative changes like stress and positive changes like growth. Our objective was to study the role of post-traumatic stress in relationship between war trauma and post traumatic growth among police officials.

Methods: In this cross-sectional study conducted from January 2019 to December 2022. The sample consisted of 400 police officials (having direct and indirect exposure of war trauma) who participated in war on terror in FATA Pakistan. Non probability purposive sampling technique was used for sample selection. Relationship among trauma, PTS (Post traumatic stress) and PTG (Post traumatic growth) was assessed.

Results: Findings from the present study indicated that stress played vital role in paving pathway from trauma to growth (β =0.08). Study results also confirmed that moderate level of stress is linked with positive changes like posttraumatic growth. R-square change in linear relationship among stress and posttraumatic growth was 0.59 but in curvilinear relationship among stress and posttraumatic growth R-square change was 0.77 which is higher than linear relationship which confirmed the curvilinear relationship between stress and growth and these findings proved that moderate level of stress after war trauma exposure produced higher levels of post traumatic growth. Conditional indirect effect of exposure to trauma on growth is highly significant (***p < .001) so the role of stress as mediator has been confirmed.

Conclusion: The study provided initial evidence that after trauma exposure levels of posttraumatic stress which is experienced play a significant role in the promotion of PTG.

Background & objective: Acute coronary syndrome (ACS) can be divided into subgroups of ST-segment elevation myocardial infarction (STEMI), Non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (USA). Patients diagnosed with NSTEMI are either treated conservatively or early invasive strategy is adopted. In NSTEMI it is believed that either one or more vessel is transiently occluded or that the blood flow is critically reduced in a patent vessel i.e. subtotal occlusion. This study was conducted to find the angiographic characteristics of NSTEMI patients undergoing coronary angiography.

Methods: This study was conducted in Department of Cardiology, Lady Reading Hospital Peshawar. It was Cross Sectional Study. Data was collected from 8th November 2022 to 8th May 2023. Consecutive non-probability sampling technique was used to collect data from the patients.

Results: Total of 300 patients were studied. The mean age was 56.95 years ±1.176 standard deviation. Male patients were 201 (67%) and remaining were female. It was found that 51(17%) of total NSTEMI patients were having totally obstructed coronary artery (OCA) in one or more coronary arteries. In NSTEMI, non-obstructive CAD (<50%) were found in 81 (27%) of patients whereas 219 (73%) were having significant CAD. It was found that 40% were having single vessel CAD, 32% were having double vessel CAD and 28% were having triple vessel CAD. TVCAD was present significantly higher in advance age, Diabetes mellitus, hyperlipidemia and family history of CAD.

Conclusion: Patients having NSTEMI are usually having multiple risk factors and having usually severe and multivessel CAD.

Objective: Tibia plateau fractures account for 1-2% of all fractures and might adversely affect the knee joint. The current research aimed to evaluate the effect of surgical procedures, age, and gender on proximal tibia fracture functional outcomes.

Methods: The present data for the retrospective analysis was obtained from an observational longitudinal cohort trauma registry study, initiated at a tertiary care hospital in June 2015. A total of 51 isolated tibia plateau fracture patients were routinely treated with open reduction internal fixation or external fixator and assessed for functional outcomes till twelve months by the Rasmussen scoring scale. Patients were divided into five age groups. The functional outcome association to gender, age groups, and surgical procedures was assessed by the Fisher Exact test and logistic regression analysis.

Results: The mean age of the total 51 patients was 40±11 years. Patients operated with Open Reduction and Internal Fixation (74.5%) or with an external fixator (25.5%). Road traffic accidents were the common mechanism of injury. There were non-significantly different functional outcomes observed among age groups or between surgical procedures at all follow-ups but significantly different between genders at three-month follow-ups. Males recovered better than females (p=0.02).

Conclusion: Tibia Plateau fracture patients respond almost equally to both external fixation and Open Reduction Internal Fixation procedures. Age does not influence the outcome. However, males had better functional outcomes at three months post-surgery indicating that gender could affect the outcomes. Further exploration might assist in planning gender-based proximal tibia fracture treatment strategies for optimum outcomes.

Objective: There are different clinicopathological features between early and late onset colorectal cancer. We aimed to characterize the histological features of colorectal cancer (CRC) at different age groups in our institution.

Methods: Total 232 patients with histologically proven colorectal cancer between ages 13-99 were included. This is retrospective study. Data collected from tumour registry Shifa International Hospital from January 1^st 2018 to December 31^st 2020. Pearson Chi square test was used for significance of categorical variables. P-values less than 0.05 were considered significant.

Results: Mean age at diagnosis was 55.49+/-16.43 years. Out of total 232 patients 58.6% were male and 41.3% were females (p value= 0.16). 150 (64.9%) were aged > 50 years and 81 (35.1%) were age < or equal to 50 years (p value = 0.44). Most common histological subtype was adenocarcinoma that was found in 188 (81%) cases. One hundred fifty five (66.8%) patients had Grade-II tumor, 67(28.9%) with Grade-III and 10 (4.3%) with Grade-I tumor. Fifty eight (25%) patients presented with metastatic disease. A significantly higher percentage of patients with signet ring cell cancer presented with a high-grade tumor when compared with patients with adenocarcinoma and mucinous carcinoma (93.7% vs 21.8%, p-value- <0.001%; 93.7% vs 39.2%, p-value <0.001). A significantly higher percentage of patients with mucinous adenocarcinoma and signet ring cell carcinoma presented at age less than 50 as compared to those with adenocarcinoma (60.7%, 56.2% and 30.8% respectively; p-value <0.05).

Conclusion: This study signifies that mucinous and signet ring cell type CRC present at an early age and with a higher proportion of patients with high tumour grade. Early diagnosis is key to help improve outcomes in these patients.

Objective: To access the frequency of depression and anxiety among the various blood groups of medical and physiotherapy students.

Method: A cross-sectional study on 215 MBBS and DPT students was conducted at Aziz Fatimah Medical and Dental College (AFMDC) from November 2022-May 2023. Google Form containing sections for relevant information concerning participants and fourteen items- Hospital anxiety and depression Scale (HADS) questionnaire for evaluation of anxiety and depression, was administered among the MBBS and DPT students through social media. The data was analyzed using SPSS version 26. Mean ±SD was calculated for continuous variables like HADS score and age. Frequency and percentage were calculated for categorical variables such as blood groups, anxiety and depression. ANOVA was used to compare HADS score among various blood groups. P-value ≤0.05 was taken statistically significant.

Result: Mild anxiety was found in A>O>B>AB, while severe anxiety was found in B>A>AB>O. Mild depression was found in A>B>O>AB, while severe depression was found in A>O>B>AB. However, on ANOVA, when comparing anxiety and depression scores with blood groups, they were found to be higher in blood Group-A. Rhesus factor positive blood groups have severe anxiety and mild depression while Rhesus factor negative blood groups have mild anxiety and severe depression.

Conclusion: Severe anxiety was common in blood Group-B while severe depression was common in people with blood Group-A. While mild anxiety and mild depression was found in blood Group-A, however, sever anxiety was common in positive Rhesus factor blood types while severe depression was found in negative Rhesus factor blood types.