Pakistan Journal of Medical Sciences最新文献

Objective: To determine the effect of educational interventions on knowledge and approach of Allied Health Sciences Students regarding blood groups and blood donation.

Methods: It was a cross-sectional study conducted at the department of Hematology and Transfusion Medicine, University of Child Health Sciences, The Children's Hospital, Lahore from October 2022-January 2023. A self-designed questionnaire was used to assess the baseline knowledge of students followed by educational interventions in the form of small group discussions, video lectures and practical demonstrations. Post-interventions assessment was done using the same questionnaire 30 days later. Data obtained was analyzed using SPSS-23 software. A p-Value <0.05 was considered significant. The reliability of the questionnaire was checked after the pilot study by using the SPSS-23 software and calculated Cronbach's Alpha was 0.82.

Results: Of the 99 participants, there were 13 males and 86 females with mean age of 21.41±1.478 years. Pre-interventions, majority participants had moderate knowledge (81.8%). Medical Lab technologists showed better baseline knowledge than the rest. Post-interventions, the level of knowledge among students increased to 94.9%. Pre-interventions, knowledge about blood groups and donation ranged from 14.1-79% and 25.5-77.8% correct responses respectively while post-interventions it went up to 92-100% for both aspects. The willingness to donate blood in future raised from 46.4% to 92.9%.

Conclusions: Educational interventions were effective in improving the knowledge of Allied Health Sciences students about blood groups and blood donation. The enlightenment strategies positively influenced students towards the active participation in blood donation campaigns.

Objective: To investigate the effects of probiotics combined with enteral nutrition therapy on intestinal flora, digestive tract symptoms and endogenous environment in patients with gastric cancer undergoing chemotherapy.

Methods: In this retrospective study, eighty patients with gastric cancer undergoing chemotherapy admitted to Affiliated Hospital of Hebei University from January 2021 to September 2023 were included and divided into two groups by random number table method: the enteral nutrition group and the probiotics combined enteral nutrition group (n=40 each group). The differences in the number of intestinal flora, nutritional indicators, immune function, endotoxin, D-lactic acid levels between the two groups, and the digestive tract symptoms of the two groups before and after treatment were compared and recorded.

Results: The levels of serum total protein (TP), prealbumin (PAB), albumin (ALB) and transferrin (TF) in both groups were higher than those before treatment, and those in the probiotics combined with enteral nutrition group were higher than those in the enteral nutrition group (p< 0.05). The levels of immunoglobulin A (lgA), immunoglobulin M (lgM) and immunoglobulin G (lgG) in the two groups were lower than before treatment, and those in the probiotics combined with the enteral nutrition group were lower than those in the enteral nutrition group (p< 0.05).

Conclusion: Probiotics combined with enteral nutrition results in various benefits in the treatment of patients with gastric cancer undergoing chemotherapy, improving immunity, and reducing gastrointestinal symptoms.

Objective: Acetaminophen (Paracetamol) is the most widely used analgesic. We aimed to determine its efficacy in labour with varying pain intensity, to make labour less painful for women.

Methods: This randomized controlled trial was conducted on primigravida's in their active phase of first stage of labour at Pharmacology department of Army Medical College, National University of Medical Sciences in collaboration with Gynecology department of Pak Emirates Military hospital, Rawalpindi. It was a registered trial with trial number of IRCT20220308054220N1. Duration of study was from May 2022 to October 2022. Patients were divided into two groups, Group-I received two doses of I/V 100 ml normal saline whereas Group-II received I/V two doses of 1000 mg acetaminophen in 100 ml normal saline. Calculated sample size was 130, 65 in each group. Visual analogue scale was used as a tool for data measurement. Data was analysed using split plot anova test.

Results: Mean VAS in acetaminophen infusion group was found to be less than placebo for 1^st dose, but this effect was apparent only one hour after 2^nd dose intervention. The difference in means between groups was statistically significant only for 1^st dose with p-value of 0.003 (for second dose p-value 0.21). In acetaminophen infusion group, for both doses mean VAS decreased as an immediate effect of drug, but then it increased with time. The difference in VAS between intervals had p-value of <0.001 for 1^st dose and 0.005 for 2^nd dose.

Conclusion: Acetaminophen is an effective non opioid labour analgesic in active phase of first stage of labour.

Objective: Propofol is more effective than inhalational anesthesia; however, the results for the management of acute pain remain controversial. Therefore, this study aimed to determine the incidence of acute pain after inhalation anesthesia and total intravenous anesthesia among patients who underwent thoracotomy at our hospital.

Methods: We conducted a single center retrospective observational study using data from electronic medical records. Sixty patients aged ≥20 years with American Society of Anesthesiologists physical status class I or II who underwent regular and emergency thoracotomy between January 1, 2016, and January 1, 2020, at Chungbuk National University Hospital were included in this study. The anesthesia and postoperative pain records of those who received total intravenous anesthesia (n=30) and inhalation anesthesia (n=30) were retrospectively reviewed. The pain score on the numeric rating scale (NRS) was evaluated at 2, 8, 24, and 30 hours postoperatively.

Results: The average NRS score of patients who received total intravenous anesthesia was lesser than that of those who received inhalational anesthesia. Moreover, the difference in the NRS scores at eight hours postoperatively was statistically significant (P <0.05). Patients who received inhalational anesthesia had a higher pain score and experienced more severe pain than those who received intravenous anesthesia.

Conclusions: Total intravenous anesthesia with propofol-remifentanil provided better analgesia for acute postoperative pain in patients who underwent thoracotomy than inhalational anesthesia, suggesting it may be considered the combination of choice for thoracic surgery.

Objective: To explore the clinical value of computed tomography (CT) liver-to-spleen (L/S) attenuation ratio in patients with non-alcoholic fatty liver disease (NAFLD) accompanied by atherosclerotic plaque (AP).

Methods: This was a single-center, retrospective, observational study of patients who were diagnosed with NAFLD undergoing CT scans at Beijing Changping Hospital of Chinese Medicine from April 2020 to April 2022. Patients were grouped according to whether they had a diagnosis of AP or not. Healthy individuals without NAFLD undergoing CT scans during the same period were also included as a control group. The patients were matched for gender, age, and BMI in a 1:1:1 ratio. Correlations between the CT L/S attenuation ratio, liver function indicators, and blood lipid levels were assessed in the three groups. The predictive value of the CT L/S attenuation ratio was evaluated using the receiver operating characteristic (ROC) curve and the area under the curve (AUC) analyses.

Results: Eighty-nine cases in each group. The three groups had significant differences in liver function and blood lipid levels (P<0.05). The CT L/S attenuation ratio in the NAFLD+AP and NAFLD groups was lower than that in the control group and was the lowest in the NAFLD+AP group (P<0.05). There was no significant correlation between the CT L/S attenuation ratio and liver function indicators (P>0.05), but it positively correlated with high-density lipoprotein (HDL) and negatively correlated with low-density lipoprotein (LDL), triglycerides (TG), and total cholesterol (TC) (P<0.05). The CT L/S attenuation ratio had a high predictive value for NAFLD patients with AP (AUC=0.859).

Conclusions: The CT L/S attenuation ratio in NAFLD patients with AP is significantly reduced and is closely related to the levels of blood lipid indicators. The CT L/S attenuation ratio has a high predictive value for NAFLD patients with AP.

Objective: Concept Maps (CM) aid in the acquisition of new information, and comprehend prior knowledge with better retention. Their use is not explored in undergraduate surgical education in our country, hence this study aimed to compare the surgery test scores of undergraduate medical students taught by concept maps and interactive lectures.

Methods: This quasi-experimental study was carried out at the Department of Surgery, at a Private University Hospital among 60 students of fourth year MBBS from 2017-2018. The students were divided into Group-A taught by interactive lectures and Group-B taught by CM. Post class Multiple Choice Questions test was taken and scores were compared for immediate effects on knowledge and short term knowledge retention using the Unpaired t- test. A P-value of < 0.05 was considered significant.

Results: Our study reported a mean test score of 19.5 (2.75 ± 0.49) for the Group-A, while 21.1 (3.49 ± 0.65) for Group-B with a negative t value of 2.003 with a significant p-value of 0.05. This showed that the test scores of Group-A were lower than the scores of Group-B.

Conclusions: Concept Maps is an effective and promising way to give learners better understanding of complex concepts in short amounts of time. providing valuable evidence for instituting the use of concept maps as a continuous teaching strategy for medical students.

Objective: Micro implant anchorage (MIA), as a new orthodontic treatment technique, has the characteristics of simple operation, light trauma, and high stability, and has been widely used in clinical practice. This study compared the therapeutic effects of MIA and the traditional straight wire appliance (SWA) in orthodontic practice.

Methods: Clinical data of 119 patients who underwent orthodontic treatment in Yulin First Hospital from January 2022 to January 2023 were retrospectively analyzed. According to the treatment records, 61 patients received MIA orthodontic treatment (MIA group), and 58 patients received traditional straight wire appliance (SWA) orthodontic treatment (SWA group). Treatment effect, periodontal index, and levels of osteoprotegerin (OPG), interleukin-6 (IL6) and high-sensitivity C-reactive protein (hsCRP) of the two groups were compared.

Results: The total efficacy of MIA group was significantly higher than that of SWA group (P<0.05). After the treatment, bleeding index (BI), plaque index (PLI), probing depth (PD) and looseness in the MIA group were significantly lower than those in the SWA group (P<0.05). After the treatment, levels of OPG were significantly higher, while IL6 and hsCRP levels were significantly lower in the MIA compared to the SWA group (P<0.05). MIA was associated with significantly lower complication rate compared to the SWA (P<0.05).

Conclusions: Compared with SWA, MIA is associated with better orthodontic effect. This mode of treatment can increase OPG levels, reduce inflammation, and lower the risk of complications.

Objectives: To elucidate the burden and clinico-epidemiological attributes of congenital and hereditary anomalies (CA) in the extended Peshawar Valley of Pakistan.

Method: This is a multicenter cross sectional study carried out in Buner, Charsadda, Mardan, Nowshera, Peshawar and Swabi districts, during 2017-2021. The pediatric and adult patients with CA were recruited from hospitals, public places and through door-to-door surveys. The anomalies were classified with the help of specialized clinicians. Descriptive statistics was employed.

Results: In this study, 1065 independent subjects with certain types of CA from independent households were included. The index males were 71%; the majority of subjects originated from rural areas (72%), and spoke Pashto (96%). The CA were categorized into 10 major and at least 104 minor categories. There was highest representation of neurological disorders, n=375 (proportion.: 0.352; 95% CI: 0.323-0.381), followed by limb defects (n=281; prop.: 0.264), sensorineural defects (n=128; prop.: 0.120), musculoskeletal defects (n=84; prop.: 0.079), visual impairments (n=67; prop.: 0.063), hemoglobinopathies (n=40; prop.: 0.038), ectodermal disorders (n=34; prop.: 0.032), cardiovascular anomalies (n=19; prop.: 0.018), and orofacial anomalies (n=19; prop). Among the neurological disorder, intellectual disabilities and cerebral palsy were highly prevalent. The majority of the cases had a sporadic presentation (68%), and isolated occurrence (72%), whereas parental consanguinity was witnessed in 58% of cases.

Conclusion: A wide range of CA were witnessed in this cohort with a preponderance of neurological disorders. The majority of the anomalies are of severe nature rendering a high morbidity burden in the population and requiring early detection, intervention and management.

Objective: To evaluate the efficacy of titanium locking plate combined with suture anchor (SA) repair in the treatment of ankle fractures (AF).

Methods: Retrospective analysis of clinical data of 170 patients with AF who underwent surgical treatment at the Department of Traumatology and Orthopedics of Wuhan Fourth Hospital, China from May 2020 to June 2023 was conducted. A total of 83 patients underwent conventional open reduction and internal fixation (control group); 87 patients received titanium locking plates combined with SA repair (observation group). Ankle joint functional recovery (measured using the Mazur Ankle Grading Scale), quality of life (measured using the Generic Quality of Life Inventory-74), and incidence of complications were compared between two groups. Active range of motion and muscle strength of the ankle joint in plantar flexion and dorsiflexion states, and medial clear space and talar tilt angle were also analyzed.

Results: The rate of excellent recovery of ankle joint function in the observation group was significantly higher than that in the control group (P<0.05). Six months after surgery, active range of motion and muscle strength of the ankle joints in the plantar flexion and dorsiflexion states in the observation group was significantly higher than that in the control group (P<0.05). The medial clear space and talar tilt angle of the observation group was significantly smaller compared to the control group (P<0.05). The quality of life in the observation group was significantly higher than that in the control group, and the incidence of complications in the observation group was significantly lower than that in the control group (P<0.05).

Conclusions: Titanium locking plates combined with SA repair for the treatment of AF can significantly improve ankle joint functional recovery, improve the quality of life of patients, and is associated with a lower incidence of complications.

Background & objective: Pregnancy related acute kidney injury (Pr-AKI) is coupled with adverse feto-maternal outcomes. Adverse perinatal outcome comprising of still births, intrauterine growth retardation, neonatal deaths are indicators of severity of underlying obstetrical conditions ending on Pr-AKI. These perinatal outcomes can also serve as potential predictors for long term outcomes of Pr-AKI. Our study aimed to determine frequencies of adverse perinatal outcomes and to evaluate adverse perinatal outcome as predictor for persistent renal injury in patients with pregnancy induced acute renal injury (Pr-AKI).

Method: A descriptive case series including 100 women with Pr-AKI, was conducted in a tertiary care hospital of Peshawar from 1st August 2021 to 31st July 2022. Included patients were followed for three months period, from their date of delivery. Adverse perinatal outcome included stillbirths, and early neonatal deaths.

Results: The mean age of study sample was 29.20±6.40. The pre dominant etiology for Pr-AKI was primary postpartum hemorrhage, occurring in 52% women. Still births were seen in 48% cases, while early neonatal deaths were seen in 7% cases. Adverse perinatal outcome had statistically significant association with persistent renal failure (p-0.01). Other factors having statistically significant association with persistent renal injury (PRF) were multiparity and cesarean births. (p<0.05) Association of adverse perinatal outcome with persistent renal injury persisted on multivariate logistic regression. a OR 6.14; CI 1.15-32.29, p-0.033.

Conclusion: Almost half of the cases with Pr-AKI have still births. Still birth in patients with Pr-AKI is associated with persistent renal injury at 12 weeks follow up period.