Pakistan Journal of Medical Sciences最新文献

Objective: In many low and middle-income countries, including Pakistan, health research often takes a backseat due to limited funding and collapsed infrastructure. Realizing this gap, Rehman Medical Institute, in collaboration with Rehman College of Dentistry, launched the International Conference on Health Research (ICHR) in 2023 to encourage a culture of evidence-based dialogue and capacity development. This study explores the evolution and impact of ICHR from 2023 to 2025, assessing trends in participation, skill development efforts, international alliances, and its influence on Pakistan's academic landscape.

Methodology: We conducted a descriptive retrospective study using data from official ICHR programs, registration records, workshop schedules, speaker lists, and institutional reports and feedback Forms. Post-conference feedback surveys provided insights into participant satisfaction, learning outcomes, and recommendations. Data were analyzed thematically and descriptively to identify trends and emergent patterns.

Results: Participation rose by 233%, from 600 in 2023 to over 2,000 in 2025. Workshops expanded by 420%, growing from 10 to 52, and trained over 1,000 professionals in 2025 alone. Speaker diversity increased with representation from over 10 countries. Post ICHR-25, the Certificate in Health Research (CHR) program saw 200+ new enrollments in one month. Innovations such as hybrid formats, AI-integrated sessions, and student-led initiatives enhanced engagement and broadened impact.

Conclusions: ICHR has emerged as a locally rooted yet globally relevant platform that promotes research training and dialogue. Its growth demonstrates how structured academic engagement can reshape institutional priorities and serve as a replicable model for academic conferencing and research capacity development across similar low- and middle-income countries.

Objective: To evaluate the effectiveness of integrating case-based learning (CBL) with the flipped classroom approach in the standardized residency training of ultrasound physicians.

Methodology: This was a retrospective study. A total of 26 residents undergoing standardized ultrasound residency training at Baoding NO.1 Central Hospital between January to August 2024 were enrolled in this study. Participants were randomly assigned to an experimental group (n= 13) and a control group (n= 13). The experimental group received CBL and flipped classroom instruction, while the control group was taught using traditional methods. Theoretical examination scores, perceived learning outcomes and teaching satisfaction were compared between the two groups.

Results: The experimental group achieved significantly higher theoretical examination scores than the control group (p< 0.05). Participants in the experimental group also demonstrated significantly improved learning outcomes and reported higher satisfaction with the teaching methods compared with those in the control group (p< 0.05, respectively).

Conclusion: The teaching approach combining CBL and the flipped classroom model may enhance clinical reasoning, stimulate learning motivation, foster innovation and contribute to the overall effectiveness of standardized ultrasound residency training.

The China-Pakistan Economic Corridor (CPEC), as a component of the Belt and Road Initiative, has progressively expanded its scope of cooperation from initial infrastructure and energy projects to encompass health and human development. This study examines the institutional evolution of bilateral health cooperation under the China-Pakistan Health Silk Road (HSR) framework from 2016 to 2025, analyzing the decade-long development of the HSR: deepening collaboration and global health governance, medical infrastructure, capacity building, and technology transfer, alongside socioeconomic and developmental implications. Findings reveal that health cooperation under CPEC pioneers a new paradigm in development diplomacy-interconnectivity extends beyond transport and trade to encompass human security and collective wellbeing. In summary, the future advancement of the 'Health Corridor' necessitates overcoming a series of challenges: addressing biosecurity concerns, bridging regional disparities in health standards, and tackling funding shortages and talent gaps in underdeveloped areas along the corridor.

Objective: To investigate prospectively the effect of testosterone treatment applied to patients with micropenis for hypospadias surgery on the depth of general anesthesia during surgery.Another objective was to make recommendations for the awareness of patients who have testosterone treatment used for sex reassignment surgery under anesthesia in the early period.

Methodology: The study was a prospective cohort study conducted by the Department of Anesthesiology, Intensive Care and Pain Management of Tekirdağ Namık Kemal University Hospital between September 2024 and December 2024 (four months). We recorded the effect of intramuscular testosterone treatment administered to patients with micropenis hypospadias two weeks prior to surgery on the depth of anesthesia (1.1-1.2 MAC), as well as intraoperative changes in bispectral index (BIS), heart rate (HR), and peak airway pressure (PIP) at 5, 15, 30, 45, and 60 minutes.

Results: Statistical differences were found between Group-C (Control) (n=30) and Group-T (Testosterone) (n=11). Although the depth of anesthesia was found to be between normal values for general anesthesia (BIS 40-60) in both groups, statistical differences were found between BIS, HR, and PIP values. (p< 0.05).

Conclusion: For surgeries requiring testosterone treatment (such as micropenis, after gender reassignment) in the acute phase or chronic phase under general anesthesia, monitoring of anesthesia depth is recommended. Clinical Trial Number: This trial was prospectively registered on September 13, 2024 in clinicaltrials.gov with trial number "NCT06606496".

Objective: To explore the efficacy and safety of Chinese Herbal Fumigation Steam Therapy (CHFST) combined with fire acupuncture in the treatment of refractory plantar warts.

Methodology: This retrospective cohort study was conducted at the Hangzhou Linping District Integrated Traditional Chinese and Western Medicine Hospital. A total of 126 patients with refractory plantar warts who received treatment from March 2022 to March 2025 were included. Of them, 63 patients who received CHFST combined with fire acupuncture (observation group) were matched with the cohort receiving cryotherapy (control group) in a 1:1 ratio. The primary outcome was the clinical efficacy assessed three months after treatment. The secondary outcome was the improvement in immune indicators and the occurrence of adverse reactions.

Results: After three-month follow-up, the clinical efficacy of the observation group was significantly higher than that of the control group (P<0.05). In both groups, the post-treatment levels of T lymphocytes (CD8⁺, CD3⁺, CD4⁺ and CD4+/CD8+) were higher than those before treatment. Post-treatment levels of CD3⁺, CD4⁺ and CD4⁺/CD8⁺ in the observation group were significantly higher than those in the control group (P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05).

Conclusions: The study confirms that CHFST, when combined with fire acupuncture, is more effective than conventional cryotherapy for treating refractory plantar warts.

Objectives: To investigate the effects of sucralfate suspension gel on gastroscopic pathology and inflammatory cytokine levels in patients with Helicobacter pylori (Hp)-positive chronic non-atrophic gastritis.

Methodology: A retrospective analysis was conducted on 80 outpatients treated at Beijing Hospital of Integrated Traditional Chinese and Western Medicine between January 2022 to January 2025. Patients were divided into a control group (n = 40) and an observation group (n = 40). The control group received standard quadruple therapy, while the observation group received additional treatment with sucralfate suspension gel on top of the standard regimen. Clinical outcomes, gastroscopic pathological scores, gastrointestinal hormone levels, inflammatory cytokine levels and incidence of adverse events were compared between the two groups.

Results: The observation group demonstrated a significantly higher overall response rate compared with the control group(P< 0.05). Post-treatment gastroscopic pathological scores were significantly lower in the observation group than in the control group(P< 0.05). Levels of gastrointestinal hormones were significantly elevated in the observation group(P< 0.05). Furthermore, post-treatment levels of interleukin-2, matrix metalloproteinase-9 and tumor necrosis factor-α were significantly reduced in the observation group compared with the control group(P< 0.05, respectively). The incidence of adverse events did not differ significantly between the two groups(P> 0.05).

Conclusion: The addition of sucralfate suspension gel to standard therapy in the treatment of Hp-positive chronic non-atrophic gastritis yields favorable clinical outcomes. It can significantly improve gastroscopic pathology, reduce inflammatory cytokine levels and enhance gastrointestinal hormone secretion without compromising treatment safety.

Objective: To investigate the expression profiles of key lipid metabolism-related genes in hepatocellular carcinoma(HCC) tissues, aiming to identify novel prognostic biomarkers for HCC.

Methodology: This was a retrospective study. Sixty patients who underwent curative hepatectomy for HCC at the Affiliated Hospital of Hebei University between January 2022 to January 2025 were enrolled in this study. Immunohistochemistry was performed to assess the expression levels of SREBF1, FASN and ACLY in both HCC tissues and normal adjacent tissues(NATs). Expression differences between HCC tissues and NATs were compared. Clinical data were compared between the positive and negative groups. Kaplan-Meier survival curves were generated to evaluate overall survival (OS).

Results: The positive expression rates of SREBF1, FASN and ACLY were significantly higher in HCC tissues compared with NATs(all P < 0.001). Compared with the SREBF1-negative group, the SREBF1-positive group had a higher proportion of tumors >5 cm and a lower proportion of CNCL stage Ia tumors(both P< 0.05). In the FASN-positive group, the proportion of poorly differentiated tumors and mean AFP level were significantly higher than in the FASN-negative group (both P < 0.05). Similarly, the ACLY-positive group had a significantly higher proportion of poorly differentiated tumors compared with the ACLY-negative group. Survival analysis showed significantly lower OS in the positive expression groups compared to their negative counterparts.

Conclusion: The expression levels of the lipid metabolism-related genes SREBF1, FASN and ACLY are significantly elevated in HCC tissues compared with NATs. These genes are considered independent prognostic biomarkers in HCC.

Background and objective: At present, ethical outrages and moral disputes are major concerns in healthcare organizations. In such situations, ethical behavior has emerged an important enabler to manage healthcare organizations. There are several beneficial outcomes that have been documented in the growing body of research on ethical leadership. Ethical behavior would cause a positive effect not only on followers' attitudes and behaviors but also on work environment in healthcare organizations. The study intended to assess the impact of ethical leadership on work environment in public hospital in Hail, Saudi Arabia.

Methodology: In this crosse sectional study, a total of 387 working health care professionals in public hospitals in Hail, Saudi Arabia filled the distributed questionnaire between March 9, 2025 to May 14, 2025. Study respondents were selected through a simple random sampling method. Version- 4 of Smart PLS was used to apply partial least squares-structural equation modeling (PLS-SEM) to validate conceptual model.

Results: In this study 55.3% of the respondents were women, 44.7% were men, and the average years of experience was 8.7 years. Study results found the statistically significant direct effect of ethical leadership on work environment (β=0.850, t=39.168, P<0.001).

Conclusion: The study revealed that ethical leadership have positive impact on work environment in public hospitals in Hail, Saudi Arabia.

Objective: To evaluate the functional result at six months for adult patients with 33A2/3 distal femur fractures treated with locking compression plates (LCP) versus retrograde intramedullary nails (RIMN).

Methodology: A Randomized Controlled Trial was conducted in Department of Trauma & Orthopedics, Lady Reading Hospital Peshawar, from February 2022 to 2024. A total number of 96 patients, aged ≥ 18 years with close AO 33A2/3 distal femur fractures were randomized. Pathological fractures, periprosthetic fractures, patients with metabolic bone or prior knee arthritis or vascular damage requiring repair or underlying deformity in the affected limb precluding use of either implant or drug abuse or unfitness for anesthesia were excluded. The functional outcome was measured through Wilde modification of Neer knee score using Mann-Whitney U test for comparisons. RUST score was used to assess fracture healing. HRQoL was assessed using PROMIS-10.

Results: Out of 96 patients, 19 were female and 77 males. Mean age of the patients was 38.68±15.45 (18-78). Mann-Whitney U test was used for treatment comparison using Wilde modification of Neer knee score and the p value was 0.968. At 6 months, the healing rate was 82.5% in RIMN group and 71.79% in LCP group, according to RUST criteria. Mann-Whiney U test was used to compare physical and mental HRQoL scores between the groups and the p value was 0.028 and 0.122 respectively.

Conclusion: There was no significant difference in functional outcome using Wilde modification of Neer knee score.Registration No.: RCT Trial (ACTRN12622000229774).

Objective: To explore the effectiveness and safety of different surgical methods based on perforation size selection for repairing tympanic membrane perforation (TMP) in elderly patients.

Methodology: This retrospective analysis included clinical data of 156 elderly patients who underwent TMP repair surgery at Tongren Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to December 2022. Patients were grouped based on the size of TMP: the Group-S (TMP size ≤ 2mm, n=48) underwent TMP repair using the butterfly technique; the Group-M (2mm < TMP size ≤ 4mm, n=62) underwent TMP repair by tragus cartilage tympanoplasty; the Group-L (TMP > 4mm, n=46) underwent repair using the tragus cartilage-perichondrium membrane composite. The surgical time, intraoperative blood loss, healing rate, air bone gap (ABG), and complications among the three groups of patients were compared.

Results: The surgical time and intraoperative blood loss in Group-S were significantly lower than those in Group-M and Group-L (P<0.05). After a six months follow-up, the tympanic membrane healing rates ranged from 87.0% to 95.8% among the three groups, with no statistically significant difference observed (P>0.05). All groups demonstrated significant postoperative improvement in air-bone gap (ABG), while the magnitude of ABG reduction was greater in Group-S and Group-M than in Group-L (P<0.05). No significant difference in the incidence of postoperative complications was observed among the three groups (P>0.05).

Conclusions: For elderly patients with TMP, different surgical procedures can be selected according to the size of the perforation, and can achieve a high tympanic membrane healing rate and satisfactory hearing improvement effect.