Pakistan Journal of Medical Sciences最新文献

Objective: To evaluate the efficacy and safety of Apatinib combined with epidermal growth factor receptor - tyrosine kinase inhibitor (EGFR-TKI) in the treatment of patients with non-small cell lung cancer (NSCLC) and acquired EGFR-TKI resistance.

Methods: Clinical records of 106 patients with NSCLC at Shanxi Tumor Hospital of the Chinese Academy of Medical Sciences Cancer Hospital from January 2017 to October 2020, with acquired drug resistance after EGFR-TKI treatment were retrospectively analyzed. Among them, 52 patients received Apatinib combined with EGFR-TKI (Apatinib group), and 54 patients received a standard chemotherapy (pemetrexed combined with platinum) (chemotherapy group). Clinical efficacy indicators, follow-up results, and adverse reactions in both groups were compared.

Results: There was no significant difference in the objective response rate and disease control rate between the two groups (P>0.05). The progression free survival (PFS) of the Apatinib group was significantly longer than that of the chemotherapy group (10.5 months vs. 5.7 months; P<0.05). There was no significant difference in adverse reactions between the two groups (P>0.05).

Conclusions: Compared with standard chemotherapy, Apatinib combined with EGFR-TKI has the same efficacy in treating NSCLC patients with EGFR-TKI resistance, and was associated with longer PFS with no significant increase in adverse reactions.

Objective: To evaluate the clinical effect of probiotics combined with Ulinastatin and Somatostatin in the treatment of severe acute pancreatitis.

Methods: A retrospective study was conducted on 160 patients with severe acute pancreatitis treated in the First Affiliated Hospital of Bengbu Medical College from July 2021 to June 2023. There were 78 patients received Ulinastatin and Somatostatin treatment (Control group), and 82 patients received probiotics in addition to Ulinastatin and Somatostatin treatment (Observation group). The treatment effect and the time required to alleviate clinical symptoms were compared between the two groups. Serum levels of inflammatory factors, intestinal mucosal indexes and the incidence of adverse reactions before and after treatment were analyzed.

Results: The total efficacy of the Observation group (95.12%) was higher than that of the Control group (85.90%) (P<0.05). Combined probiotic/Ulinastatin + Somatostatin treatment was associated with shorter time to remission of the clinical symptoms (P<0.05). After the treatment, serum levels of inflammatory factors in the two groups were decreased, and was significantly lower in the Observation group compared to the Control group (P<0.05). Similarly, post-treatment serum levels of intestinal mucosal indexes in the two groups were lower than before the treatment, and significantly lower in the Observation group (P<0.05). There was no significant difference in the incidence of adverse reactions between the groups (P>0.05).

Conclusions: A combined regimen of probiotics, Ulinastatin and Somatostatin is safe and can more effectively relieve clinical symptoms in patients with severe acute pancreatitis, reduce levels of inflammatory factors, lower intestinal mucosal damage and improve the overall treatment effect compared to Ulinastatin and Somatostatin regimen alone.

Objective: To assess the effect of subanesthetic dose of esketamine in combination with propofol on the incidence of postoperative fatigue syndrome (POFS) in patients who underwent gastroenterological endoscopy under anaesthesia.

Methods: Clinical data of 160 patients who underwent gastroenterological endoscopy under anaesthesia in Huzhou Maternity & Child Health Care Hospital from January to December 2022, ASA Grade- I and II, were retrospectively selected. According to the records, patients were grouped based on the administered anesthetic. Patients who received 0.2 mg/kg of esketamine and 2~2.5mg/kg of propofol comprised Group-E, and patients who were administered one μg/kg of fentanyl and 2 - 2.5mg/kg of propofol comprised Group-F. Mean arterial pressure (MAP), oxygen saturation (SpO₂) and heart rate (HR) were recorded before the operation (T₀), after anesthesia (T₁), three minutes after the gastroscope was inserted (T₂), five minutes after the colonoscope was inserted (T₃) and at the end of the operation (T₄). Operating time, recovery time, propofol dosage and incidence of adverse reactions in the two groups were recorded. The Christensen scores and the incidence of POFS of all patients on Day-I before operation and 1st, 3rd, and 5th days after the operation were recorded.

Results: Compared with T₀, MAP, SpO₂ and HR in both groups of patients decreased at T₁, T₂, T₃ and T₄ (P<0.05). MAP, SpO₂ and HR of patients in Group-E were significantly higher compared to Group-F at T₁, T₂, T₃ and T₄ (P<0.05). Compared with Group-F, the recovery time, intraoperative bradycardia and respiratory depression in Group-E were significantly lower (P<0.05), and Christensen scores and the incidence of POFS decreased significantly on the 1st, 3rd, and 5th day after the operation (P<0.05).

Conclusion: Subanesthetic dose of esketamine combined with propofol can reduce POFS and postoperative adverse reactions in patients undergoing gastroenterological endoscopy.

Objective: To determine the relative frequency of orbital lesions based on the site of origin and histopathology at a Tertiary care hospital (Mayo Hospital, Lahore Pakistan) from 1996 till 2022 (27 years).

Methods: This descriptive case series included 2651 patients of all age groups presenting with orbital lesions who initially got enrolled at Institute of Ophthalmology Mayo Hospital, Lahore from 1996 till 2022. Of these, 583 patients left against medical advice. So, clinical data of 2068 patients were completely analyzed. Lesions were managed medically and/ or surgically. Final clinical diagnosis, with the help of histopathology, was used to classify the lesions.

Results: There were 1258 (60.9%) adults and 810 (39.1%) children, 1358 (65.66%) were neoplastic while 710 (34.33%) non-neoplastic lesions. Amongst the neoplastic lesions, 405 (29.8 %) were benign and 953 (70.2%) malignant. Primary orbital lesions were 1676 (81.04%), Secondary orbital lesions were 300 (14.51%), Endocrine/ hematopoietic reticulo-endothelial system lesions were 84 (4.06%) and Metastatic lesions from distant organs were 08 (0.39%).

Conclusion: Retinoblastoma, rhabdomyosarcoma, optic nerve gliomata were common in children. Pleomorphic adenoma & adenocystic carcinoma of lacrimal gland, cavernous hemangioma, optic nerve meningioma, neurofibroma, schwannoma, squamous cell carcinoma of eyelid, carcinoma of maxillary antrum and lymphomas were more common in adults.

Objectives: To evaluate the shade selection accuracy of male dental students according to the three dimensions of color: value, hue, and chroma, using visual and instrumental shade selection methods under different lighting conditions.

Methods: This comparative cross-sectional study was instigated amongst 70 male 4^th, 5^th, and 6^th years BDS students of the Dental Clinics Complex at King Faisal University, Saudi Arabia for a duration of two months. First, the principal investigator determined the shade of tooth 11 and 46 on patient utilizing the spectrophotometer after calibration. In the next step, students were asked to select the shade of same tooth 11 and 46 using VITA 3D-Master shade guide under clinic lightening condition and corrected light. The characteristics of the color such as hue, chroma and value were recorded. The Kruskal-Wallis test was applied to find the significant difference in shade selection between visual and instrumental methods with respect to academic years.

Results: The mean of the value of instrumental shade selection of tooth # 46 was slightly higher among 4^th year students (4.41±0.73), than that of 5^th year (3.72±1.02), and 6^th year students (3.83±0.83), with a statistically significant difference among them (p= 0.024), indicating 6^th year students selected darker shades. Additionally, a statistically significant relationship was noticed among 4^th, 5^th, and 6^th year students with respect to the means of the chroma of 2.18 ±1.29, 2.92±1.11, and 3.13±1.10, respectively (p= 0.025).

Conclusion: The selection of posterior teeth shades was notably influenced by academic years, employing both instrumental and visual methods, while considering color parameters.

Objective: This study aimed to explore the perceptions of frontline Healthcare Workers (HCWs) towards managing COVID-19 in Tertiary care hospital in Pakistan.

Method: This qualitative exploratory study was conducted from January to May 2021 at a Tertiary care hospital designated for COVID-19 patients in Rawalpindi Pakistan. Semi-structured in-depth interviews were conducted from twenty six HCWs. To acquire a sample that was diverse in terms of professional capacity, degree of experience and exposure, purposive sampling technique was used. After thematic analysis, themes were generated by identifying patterns among codes.

Results: Five themes emerged. All HCWs experienced significant amount of negative emotions including fear, uncertainty, imposing social distancing and workload. There were also positive experiences such as rewarding, call of duty and professional growth. HCWs experiences related to personal protective equipment (PPE) were communication issues, physical and dermatological issues, reuse and working confidently while wearing PPE. HCWs were buoyed by cooperation and facilitation, trainings and health education from administration. Coping mechanisms were used such as seeking team support, adjusting cognition to deal with reality and resorting to religion.

Conclusion: Negative emotions predominated in the beginning and positive emotions emerged gradually. PPE and administrative support played significant role. HCWs' mental health was maintained in part by their self-coping styles. The findings of this study can be employed to inform and enhance future pandemic response initiatives.

Objective: To compare the efficacy of losartan potassium (LP) and benazepril in the treatment of hypertensive patients with insulin resistance (IR).

Methods: This is a retrospective analysis of the clinical data of 155 hypertensive patients with IR admitted to Shanghai Pudong New Area People's Hospital from March 2021 to March 2023. Of these 76 received LP treatment (LP group), and 79 received benazepril treatment (benazepril group). Blood pressure levels, blood glucose and insulin levels, treatment efficacy, and incidence of adverse reactions before and after the treatment in both groups were compared.

Results: After the treatment, diastolic and systolic blood pressure in the two groups significantly decreased compared to pre-treatment levels (P<0.05), with no significant difference between the two groups (P>0.05). After the treatment, levels of fasting plasma glucose (FPG), 2-hours plasma glucose (2hPG), fasting insulin (FINS), 2-hours insulin (2hINS), and insulin sensitivity index (ISI) in both groups significantly decreased compared to pre-treatment levels (P<0.05), with no significant difference between the two groups (P>0.05). There was no significant difference in the total efficacy and the incidence of adverse reactions between the two groups (P>0.05).

Conclusions: The efficacy of LP and benazepril in treating hypertension with IR is equivalent. Both are safe and can effectively lower blood sugar and insulin levels, alleviate IR, and lower blood pressure.

Objective: To compare frequency of caesarean section in singleton primary-para women induced at 39 week and its comparison with conventional management. The other objective was comparison of perinatal and neonatal outcomes.

Method: Open random allocation study was conducted at Gynae/Obst Department JPMC during period from 1^st June 2022 to 30^th September 2023. Primiparous women with singleton pregnancy without risk factors with gestational age 38 weeks 0 days to 38 weeks six days attending the anti-natal clinic offered to participate after consent. Non-probability convenience sampling method was used for induction. Randomization was done using random number table into one of the two groups, Group-A in which induction was done at 39 weeks while in Group-B induction was done conventionally. Mean age ±SD, gestational age and delivery time was calculated and compared by Student's t test. Frequency of CS, perinatal and neonatal outcomes was compared by χ² test.

Results: Eighty-two women were inducted in Group-A and eighty-five in Group-B. The mean delivery time in Group-A was significantly more at 8.12±2.77 hours while in Group-B was 7.0±2.62 hours (p = .005). Frequency of CS between two groups was not statistically significant, it was 5 (6.1%) in Group-A and 2 (2.4%) in Group-B (p = 0.412). No significant difference in frequency of NICU admission was seen, in Group-A 8.54% babies were admitted to NICU while in Group-B 16.47% were admitted to NICU (p = 0.122).

Conclusion: No significant difference was observed in frequencies of CS, Foetal, Neonatal, and Maternal outcomes.

Objective: Given the limited studies on types of vaccination and infection rates among health care workers (HCWs) in Türkiye, we analyzed the demographic, clinical, and vaccination characteristics as well as the attitudes of HCWs who have been infected with COVID-19.

Methods: We retrospectively analyzed demographic and clinical data on breakthrough COVID-19 infections in HCWs from hospital surveillance data collected between April 5, 2020, and November 1, 2022. The comparison was based on four subgroups that consisted of unvaccinated, one-shot-vaccinated, homologous vaccinated, and heterologous vaccinated individuals. Participants who received various combinations of Sinovac/CoronaVac and/or BioNTech/Pfizer vaccines were compared for detection of COVID-19.

Results: During a 33-month period of 744 HCWs who contracted COVID-19, women (65.3%) and nurses (28.9%) were the most affected, followed by doctors (25.8%). Of the infected HCWs, only 1.3% required hospitalization, 0.3% required ICU support, and 98.4% were outpatients. By vaccination status, 143 of the HCWs (19.2%) were unvaccinated, 292 (39.2%) were homologously vaccinated, 294 (39.5%) were heterologously vaccinated, 15 (2%) received a single shot, 206 (27.7%) received two shots, and 165 (22.2%) received three shots. All HCWs contracted COVID-19 at a mean of 134-days (range:1-539) after vaccination. While the proportions of homologously and heterologously vaccinated HCWs were similar, the time elapsed from vaccination to contracting COVID-19 varied (mean 143.4±106.7 vs.126.4±82.43 days).

Conclusions: Among both outpatients and inpatients with COVID-19, women HCWs outnumbered men HCWs. HCWs who received homologous vaccination contracted COVID-19 later than those who received heterologous vaccination.