Pakistan Journal of Medical Sciences最新文献

Objectives: To investigate the relationship between anthropometric measurements indices (chest and arm size) and health metrics (BMI, blood pressure, pulse rate, and glycemia) in healthy adults and to explore the influence of blood groups on these parameters.

Methodology: A cross-sectional study was conducted with 157 nursing students of the University of Lahore from December 2022 to April 2023. In this study measurements of arm and chest circumference were taken from 157 nursing students. Blood pressure (BP) and pulse rate were measured per standard procedure. Blood typing was tested via agglutination, and glycemia was tested using biochemical assay techniques. Independent sample t-test and one-way ANOVA were applied to compare means between genders and blood groups respectively. Pearson-correlation was used for association of anthropometric measures with health metrics within each gender and blood group.

Results: Participants reported a direct association between BMI and arm size (r=0.236, p=0.003), in A+ (r=0.296, p=0.043) and B+ blood (r=0.362, p=0.022); this association was significant. BMI was directly associated with chest size in total participants (r=0.299, p<0.001), males (r=0.618, p<0.001), females (r=0.231, p=0.012), A+ (r=0.387, p=0.007), and B+ blood (r=0.397, p=0.011). Chest size was directly associated with glycemia in females (r=0.220, p=0.017) and total participants (r=0.187, p=0.019); in males, arm size was directly associated with glycemia (r=0.400, p=0.012). Arm size was inversely associated with diastolic-BP in B-blood (r=-0.742, p=0.035). Chest size was inversely associated with diastolic-BP in O-blood (r=-0.710, p=0.014).

Conclusion: Anthropometry and BMI were directly related, particularly in A+ and B+, suggesting these blood types are at higher risk for BMI-related cardiometabolic concerns. Males exhibited correlation of larger chest circumference with higher fasting glucose, indicating greater susceptibility to diabetes.

Background and objective: Neoplastic lesions of the brain and spinal cord have been on a steady rise in low- and middle-income countries. In recent years, there has been an uprise in neuro-oncology encompassing surgery, oncology, radiology, infectious diseases, and artificial intelligence. However, a comprehensive bibliometric analysis in this field is scarce. The objective of the study was to analyze neuro-oncology publications from Pakistan and quantify the contributions of Pakistani individuals and institutions.

Methodology: A bibliometric analysis of all neuro-oncology research conducted by Pakistani authors or institutions over the last 25 years (2000-2024) was performed using PubMed Central. All relevant case reports, case series, original articles, and review articles were included. The studies conducted in non-Pakistani institutions and collaborative studies were excluded. The data were stratified according to predefined keywords. A total of 210 articles were included in the final analysis.

Results: Among provinces, Sindh contributed the most publications 66.67%(152), followed by Punjab 16.67%(38). Aga Khan University leads from the front with 132 publications. Publications ranged from original articles (37.4%) to review articles (31.1%). Gliomas were among the most common tumours discussed (25.8%). The Journal of Pakistan Medical Association was the most significant contributor (34.7%), followed by Surgical Neurology International (7.14%). Maximum number of studies (53) were published in the year 2024.

Conclusion: An exponential rise in publications in the year 2024 compared to previous years signifies the growing perception of neuro-oncology. However, the dominance of a single institution underscores the need for broader research development across Pakistan.

Background & objective: High-grade gliomas (HGG) and glioblastomas are the most prevalent types of primary brain tumors. Despite aggressive treatment, recurrence is almost inevitable with significantly poor prognosis. We aimed to determine the factors associated with morbidity and mortality in patients with glioblastoma after surgical excision.

Methodology: In this retrospective observational study, data regarding patient demographics, clinical features, tumor characteristics and treatment outcomes was recorded for all patients who underwent glioblastoma multiform tumor excision surgery at Punjab Institute of Neurosciences between 2022 and 2024. Multiple predictor variables were identified using univariate and multivariate analysis. The relationship between overall survival and predictor variables was presented in the form of Kaplan Meir survival curves. Data was analyzed using SPSS version 29.

Results: The mean age of study participants was 47.0±15.8 years with 82% (41) males. The mean preoperative Glasgow coma scale (GCS) and Karnofsky Performance Status (KPS) was 13.2±2.8 and 65.2±17.6 respectively. The medial overall survival was 381.5 days. Obesity, tumor origin, preoperative and post-operative GCS and KPS score, and extent of resection were identified as significant predictor variables using univariate analysis (p<0.05). On multivariate analysis, extent of resection was a significant positive predictor of survival, HR=0.041 (95% CI: [0.003-0.581]).

Conclusion: Majority of gliomas undergo gross total resection and had a median survival of one year. Extent of resection is a significant independent predictor of survival in glioblastomas, where gross total resection is associated with a lower risk of mortality.

Objectives: This study investigates discrepancies between histopathologic, intraoperative, and radiologic diagnosis of paediatric posterior fossa tumours and evaluates whether combining diagnostic modalities improves the accuracy of the final diagnosis.

Methodology: This retrospective study was conducted at the Department of Neurosurgery, Lady Reading Hospital, Peshawar. Hospital Management Information System (HMIS) records of all paediatric patients, aged birth to 16 years, who underwent surgery in the department for paediatric posterior fossa tumours between January 2020 and December 2024, were reviewed. Radiologic diagnosis, surgeon intraoperative diagnosis and combined diagnosis (surgeon diagnosis + radiologic diagnosis) were compared with the final histopathologic diagnosis to calculate discrepancy rates.

Results: A total of 112 paediatric patients were enrolled in the study. The discrepancy rate for radiologic diagnosis, surgeon (intraoperative) diagnosis and combined diagnosis (radiologic diagnosis + surgeon diagnosis) remained 19.64%, 21.43% and 7.14% respectively. The concordance analysis using Cohen's Kappa statistic concluded that radiologic diagnosis and surgeon (intraoperative) diagnosis both showed moderate agreement with histopathology having Cohen's kappa (k) values of 0.738 and 0.714 respectively while combined diagnosis exhibited the highest concordance (κ = 0.905) with histopathology.

Conclusion: Combining radiologic and intraoperative surgeon diagnoses enhances accuracy in paediatric posterior fossa tumours, achieving the highest concordance with histopathology and reducing discrepancies. This combined approach represents best practice to improve diagnostic precision, especially in LMICs where multidisciplinary tumour boards are not readily available.

Objective: To assess how pre-operative Edema Index (EI) affects surgical outcomes, complications, and hospital stay in patients with supratentorial meningiomas and its role as a predictor for surgical planning and prognosis.

Methodology: A retrospective observational study was conducted at the Department of Neurosurgery Unit-II, Punjab Institute of Neurosciences, Lahore, over 14 months (January 2024-February 2025). 31 patients with supratentorial meningiomas were included through non-probability consecutive sampling.

Results: Mean age was 41.39 years (range: 18-64 yrs), with male-to-female ratio of 1:1.82. 58.1% (18) were located in the convexity, followed by Parasagittal 12.9% (4), olfactory groove 6.5%(2) , parafalcine 6.5%(2), sphenoid wing 6.5%(2), tuberculum sellae 6.5%(2) and temporal 3.2%(1) regions. Based on size. 3.2% (1) of the tumors were small (<2cm), 35.5% (11) were medium (2-4cm), 38.7% (12) were large (4.1-6 cm) and 22.6% (7) were giant (>6cm). EI was <1 in 38.7% (12), 1-2 in 12.9% (4), and >2 in 32.3% (10); 16.1% (5) had no edema. Higher edema (EI >2) was more common in males (54.5%) than females (20%). Expansion duraplasty was required in 58.1% (18), bone removal in 9.7% (3) and bleeding occured in 6.5% (2). Grade I-II resections were achieved in 90% of patients with EI>2. Neurological deficits occurred in 6 (19.4%). 22.6%(7) had hospital stay exceeding 10 days.

Conclusion: Pre-operative EI and tumor location significantly influences surgical complexity, extent of resection, complications, and hospital stay. Incorporating EI into preoperative evaluation can improve surgical planning and outcomes.

Ependymomas are neuroepithelial tumors that may arise from the ependymal cells of the cerebral ventricles, the central canal of the spinal cord, or cortical rests. This case report is of a 13 years old girl with no prior health issues who presented with symptoms of blurred vision, intermittent diplopia, tinnitus, vomiting, and vertigo that had worsened over three months. Except for these symptoms, her neurological examination was normal. Brain MRI revealed a large cystic tumor in the right parietal lobe, with enhancing nodules and surrounding edema that caused midline shift. The patient underwent surgical excision of the tumor that later came out to be ependymoma on histopathology. This case report aims to contribute to the medical literature by highlighting the rare occurrence of an ependymoma solely within the brain parenchyma. By sharing this unusual case, we hope to enhance understanding of this rare pathology and provide valuable insights regarding its occurrence in rare locations.

Objective: To evaluate the cognitive and emotional burden of benign and malignant brain tumors on patients in resource-limited settings to improve quality of life.

Methodology: This prospective, cross-sectional study was conducted by the Punjab Institute of Neurosciences (PINS) in Lahore, Pakistan. Patients aged 18 years and older, diagnosed with at least one primary solid tumor and undergoing treatment at two major public hospitals in Lahore and Islamabad, were interviewed between March and April 2025 to assess their levels of mental strain and distress. The results were then analyzed descriptively.

Results: The mean age of participants in this study was 36.72 years (SD = 15.74). Among the total sample, 62% (31) were male and 38% (19) were female. Tumors were benign in 66% (33) of cases and malignant in 34% (17). A majority, 56% (28), reported that the tumor had changed their outlook on life, while 16% (8) felt it somewhat changed, 24% (12) remained unchanged, and 4% (2) were unsure. For anxiety, 22% (11) reported daily feelings of nervousness and anxiety, while 30% (15) experienced daily worries. Concentration levels varied, with 50% (25) able to concentrate normally, 30% (15) having some trouble, 6% (3) unable to concentrate on anything, and 14% (7) unable to read, watch TV, or focus at all. In terms of financial burden, 48% (24) perceived a very high burden, 20% (10) felt it was somewhat high, 12% (6) reported a minimal burden, and 20% (10) experienced no burden.

Conclusion: A brain tumor diagnosis presents significant challenges for patients, affecting them physically, mentally, and financially. In Pakistan, where mental health is often stigmatized, understanding these challenges becomes even more crucial. By addressing both the physical and mental health needs of patients, especially in resource-limited settings, targeted support can help patients cope more effectively with this devastating illness.

Background and objective: Primary Intracranial DICER1-Mutant Sarcoma (PIDMS) is a rare brain tumor with limited data available on its clinical presentation, treatment, and prognosis. This review aimed to analyze the literature on PIDMS, focusing on its presenting features, imaging findings, genetic profiling, surgical treatment, and outcomes.

Methodology: Our systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. PubMed and Google Scholar were searched to identify the studies published between 2000 and 2024. Only the studies with biopsy-proven PIDMS cases were included. Studies on animals, metastatic, and extracranial sarcomas were excluded. The Joanna Briggs Institute (JBI) critical appraisal tools were used for the quality assessment.

Results: Eight studies comprising 10 patients met the inclusion criteria. Five of the cases (50%) occurred in the pediatric group, while five (50%) in the adult age group (mean age: 15.91 ± 17.71 years). Six patients (60%) were males, and the most common symptoms included headaches and seizures. The frontal and frontoparietal lobes were the most common tumor locations, and the molecular profiling in all 10 cases revealed DICER1 mutation. Gross total resection (GTR) was achieved in 50% of the cases. The mean follow-up duration was 17.5 months, and seven patients underwent combined adjuvant treatment with radiotherapy and chemotherapy. Five patients (50%) had stable disease after undergoing surgical resection and adjuvant therapy.

Conclusion: PIDMS is an aggressive neoplasm with non-specific clinical features overlapping with other brain tumours. Extensive genetic profiling and large-scale clinical trials are needed to develop optimized treatment protocols.

Objective: To identify risk factors for urinary retention after radical hysterectomy for cervical cancer (CC) and establish a nomogram model to facilitate individual treatment decisions.

Methodology: In this retrospective study, records of 438 patients with CC undergoing radical hysterectomy between December 2011 and December 2018 at Fujian Maternity and Child Health Hospital, China were analyzed. Patients were divided into the abdominal operation group (196 cases) and the laparoscopic group (242 cases) based on the surgical method. Short-term outcomes were compared. Independent risk factors for postoperative urinary retention identified by multivariate logistic regression were used to develop a nomogram. The performance of the nomogram was assessed using the receiver operating characteristic (ROC) curve and area under the curve (AUC) analyses.

Results: The mean age of patients in the abdominal group was lower than that in the laparoscopic group (P < 0.05). Operation time and the number of dissected lymph nodes were higher in the laparoscopic group, whereas postoperative hospital stay and blood loss were lower (P < 0.05). The incidence of urinary retention in the laparoscopic group (53.7%) was significantly higher than in the abdominal group (38.2%; P < 0.05). Multivariate logistic regression results identified surgical approach, operation time, lympho-vascular invasion, and age as independent risk factors for postoperative urinary retention (P < 0.05). Calibration curve for the urinary retention nomogram aligned with the ideal curve. AUCs of the training and the validation sets were 0.819 (95% CI, 0.798-0.895) and 0.795 (95% CI, 0.782-0.824), respectively.

Conclusion: Surgical approach, operative time, lymphovascular invasion, and age were identified as independent risk factors for urinary retention after hysterectomy in CC patients. The developed nomogram based on these independent risk factors had good accuracy and predictive ability.

Objective: To assess nutritional status and influencing factors in stable chronic obstructive pulmonary disease (COPD) patients.

Methodology: This retrospective study of 280 stable COPD patients from Beijing Hospital of Integrated Traditional Chinese and Western Medicine and the First Affiliated Hospital of Tsinghua University (June 2022 to June 2024). Collected data included demographics, body mass index (BMI), smoking history, lung function, nutritional risk, six-minute walk distance (6MWD) test, COPD Assessment Test (CAT) scores, and traditional Chinese medicine (TCM) syndrome patterns. Statistical analysis compared nutritionally normal (NN) and at-risk (NAR) groups.

Results: Significant differences (p< 0.05) between NN and NAR groups included age, BMI, smoking history (active/passive), CAT scores, lung function, 6MWD, and TCM syndromes (spleen/kidney deficiency, qi/yin deficiency). Logistic regression identified key factors: sex, age, BMI, smoking (history/index), CAT/6MWD/lung function classifications, and TCM patterns (spleen/kidney involvement, qi/blood stasis).

Conclusion: Nutritional risk in stable COPD is significantly influenced by age, BMI, smoking, disease severity (CAT/lung function), physical capacity (6MWD), and TCM syndromes (deficiency/stasis patterns). These factors should guide nutritional interventions.