Pakistan Journal of Medical Sciences最新文献

Objective: To compare the perceptions of participants before and after a one-day workshop on Simulation-based Education. The other objective was to determine the feedback of participants about the one day workshop on Simulation-based Education.

Methods: In March 2023, a one-day workshop on Simulation-Based-Education (SBE) was conducted by the Department of Medical Education of Fazaia Ruth Pfau Medical Education in collaboration with the foreign guest faculty through zoom. This workshop was conducted with the participants (faculty members) of the Certificate program. The study adopted quasi experimental (pretest posttest) research design. For data collection we used a validated questionnaire which compromises of three parts. Data was analyzed using SPSS 23. This is a semi-structured questionnaire which consists of four parts. The first part entails the demographic data of the participants. The second structured part collects the perception of participants through 26 statements on 5 points Likert scale (strongly disagree = 1, disagree = 2, agree to some extent = 3, agree = 4, strongly agree = 5).

Results: The mean difference in participant perceptions was significant (P<0.05)on 13 statements: Improves communication skills (pretest 3.05±1.050, posttest 4.20±1.056; p=0.004), enhance teamwork (pretest 3.30±0.979, posttest 4.30±0.923; p=0.004), overcomes the challenge of uncooperative patients during real practice (pretest 3.80±0.696, posttest 4.30±0.470; p= 0.008), enact live patients (pretest 2.70±0.923, posttest 3.65±1.040; p=0.004), incopororation into medical education (pretest 3.20±0.894, posttest 4.40±0.503; p=0.000), provide safe, reliastic and conducive learning environment (pretest 2.85±0.875, postest4.00±0.795; p=0.000), provide easy learning (pretest 2.75±0.716, posttest 4.05±0.605 p=0.000), decrease ethical issues with more repeated practice (pretest 2.75±0.716, posttest 3.90±0.788; p=0.000), reduces the effort put in by a faculty in clinical teaching (pretest 2.80±0.696, posttest 3.45±0.999; p=0.039), supplement to clinical practice (pretest 2.75±0.444, posttest 4.55±0.510; p=0.000), evidence required for simulation activities (pretest 2.95±0.605, posttest 4.10±0.641; p=0.000), able to add simulation in clinical subject (pretest 3.15±1.089, posttest 3.80±0.834; p= 0.055), can instruct complex skills without simulation (pretest 2.55±0.887, posttest 3.40±0.883; p=0.018).

Conclusions: The study signifiacnaty changed the faculty members' perceptions of simulation-based education.These encouraging findings may influence their future practice in simulation-based education, allowing them to provide safe, high-quality health care in the workplace and, eventually, enhance patient outcomes.

Objective: To synthesize contemporary evidence of the impact of contralateral prophylactic mastectomy (CPM) on survival outcomes in patients with unilateral breast cancer (UBC).

Methods: PubMed, EMBASE and Scopus databases were searched for observational studies published up to November 15, 2023. Random-effects model was used to obtain pooled effect estimates that were reported as hazards ratio (HR) with 95% confidence intervals (CI). The outcomes of interest were overall survival (OS), breast cancer-specific survival (BCSS), recurrence free survival (RFS) and risk of contralateral breast cancer (CBC).

Results: Twenty-one studies were included. Most studies had a retrospective design. CPM was associated with significant improvement of OS (HR 0.80, 95% CI: 0.75, 0.85), BCCS (HR 0.82, 95% CI: 0.74, 0.90), and RFS (HR 0.72, 95% CI: 0.60, 0.86) and significantly reduced risk of CBC (HR 0.05, 95% CI: 0.03, 0.09) in patients with UBC. No evidence of publication bias was detected.

Conclusion: Our results provide strong evidence supporting the positive impact of CPM on survival outcomes in patients with UBC. Further research and long-term follow-up studies are warranted to validate these findings.

Objective: Goal of the study was to systematically review competitive advantages of medical devices for glucose monitoring in diabetic patients.

Method: The review is done systematically according to SALSA criteria and PRISMA guidelines. The search for eligible articles was held from February 16^th 2023 to March 1^st 2023 in Russian and English languages. The results were synthesized narratively, tabularly, and visually. The search was conducted in the following databases of scientific literature: PubMed, IEEE Xplore, Google Scholar, CyberLeninka, and eLibrary.

Results: Twenty-two out of fifty-two manuscripts met the inclusion criteria. The most promising and advantageous characteristics of the evaluated devices, as identified by researchers, include the following: the capability for noninvasive examination; features that facilitate use by patients with fine motor, hearing, and visual impairments; add-ons and software designed to improve patient compliance, including in pediatric populations; and device attributes that enhance the speed and accuracy of analysis while being free of iatrogenic effects.

Conclusions: With increasing prevalence of diabetes, glycemic control is crucial for preventing complications. The market offers numerous glucose monitoring devices (GMDs) with varying features, making selection challenging. Our study systematically categorized the strengths of each GMD model for diabetic patients, aiding informed device selection.

Objectives: To compare the outcomes of modified extended right lobe graft (MERLG) and modified right lobe graft (MRLG) in living-donor liver transplantation (LDLT).

Methods: This retrospective study was performed at the Liver transplant department of the Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences Hospital, Gambat, Pakistan, from March 2019 to September 2020. The outcomes of 20 MERLG donors and recipients were compared to those of 74 MRLG donors and recipients. Demographics, operative parameters, complications, hospital stay, and one-year survival were compared between the two groups.

Results: The mean graft volume of the MERLG group was more (637.10 ± 71.35 g) than in the MRLG group (562.27 ± 57.77 g), (p= 0.001). Donor blood loss was higher in the MERLG group (680.10±170.60 ml) compared to the MRLG group (650.23±190.65 ml), p=0.527. In addition, the operative time was longer in the MERLG group (345.80±76.90 min) than in the MRLG group (318.12±100.80 min) (p= 0.257). The MERLG recipients were sicker (mean MELD score of 22.54±3.67) than the MRLG (18.86±4.37) (p=0.001). The drain output was higher in the MRLG group (1340 ± 470.32 ml) than in the MERLG group (1110 ± 450.60 ml) (P =0.045). No significant difference was found when comparing postoperative laboratory results and complications between the donor and recipient groups (p >0.05). Kaplan-Meier analysis showed a 95% one-year survival in MERLG group compared to 90.7% in the MRLG group (p=0.549).

Conclusion: With appropriate technical expertise, MERLGs are technically safe and feasible in LDLT donors without any added risks. MERLGs also yielded better outcomes in sick recipients.

Objective: This laboratory study evaluated the effect of Salvadora persica (S. persica) root extracts and Chlorhexidine Digluconate (CHX) on the antibacterial and surface hardness properties of glass ionomer cement (GIC).

Methods: The in vitro experimental study was conducted at the Baqai Institute of Pharmaceutical Sciences of Baqai Medical University, Karachi, Pakistan, from October 2022 to March 2023. There were a total four experimental groups. The first group consisted of ethanol extract (GIC-SPEE) and second group consisted of hexane extract as (GIC-SPHE) both prepared from Salvadora persica root respectively, and mixed with liquid of GIC separately. The third group comprised chlorhexidine (GIC-CHX) that was also mixing into liquid portion of GIC and the last group was Control i.e. (cGIC). The GIC samples were prepared by using stainless steel metallic moulds with dimension (5mm x 2mm), following the manufacturer guidelines. Antibacterial activity against Streptococcus mutans was done by disc diffusion test (DDT), and surface hardness test was done by Vickers hardness tester. Statistical analysis was performed using One-Way ANOVA and Tukey's post hoc tests (p<0.05).

Results: The antibacterial activity against S. mutans reported that the maximum zone of inhibition was obtained at 3 wt% by the GIC-SPEE, when compared with other experimental groups. For surface hardness, the highest mean and standard deviation and significant findings was reported by the group GIC-SPEE.

Conclusions: Considering the outcome of this in vitro study, it can be concluded that the addition of 3 wt% GIC-SPEE increased the surface hardness and antibacterial activity against Streptococcus mutans.

Background and objectives: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired treatable autoimmune disorder. Due to limited availability and affordability of IV immunoglobulins and therapeutic plasma exchange in Pakistan, oral immunosuppressive drugs (ISDs) are used despite limited role in literature. The study aimed to determine the response to ISDs in CIDP patients by assessing the frequency of remission, reduction of disability using a neuropathy related disability score called Inflammatory Neuropathy Cause and Treatment score (or INCAT score), as well as reduction in steroid maintenance dose.

Methods: The retrospective observational study of six months duration (May to October, 2020) was carried out in Aga Khan University Hospital, Karachi, Pakistan. Medical record of all the patients with idiopathic CIDP taking oral ISDs in last five years was selected which included bio-data, clinical signs and symptoms, medication details, and INCAT scores. Descriptive statistics were described i.e. frequency, percentages, mean/standard deviation using Microsoft Excel v.2021.

Results: Out of thirteen patients, Azathioprine was used in nine, Mycophenolate mofetil in two and Cyclosporine in two, with remission (INCAT score improvement ≥ 1) achieved in eight, one and zero patients respectively. Duration of ISDs ranged from three to twenty-four months (average 15.8 months). Patients with monoclonal paraproteinemia and prior exposure to ISDs had a poor response to the introduction of subsequent ISDs.

Conclusion: The study describes preliminary experience of the potential role of relatively cheaper and more convenient oral ISDs (especially Azathioprine) as an alternative or sparing agent to first line agents for CIDP and sets the stage for larger scale studies and randomized controlled trials.

Background and objective: Percutaneous Nephrolithotomy (PCNL) is recommended for large Kidney Stones. It is mostly done in prone position. However, PCNL in Supine position is another safe option. Only few centers in country are doing it and so it is challenging task to adopt supine PCNL approach in an institution initially. In this study our purpose was to assess initial experience of Supine PCNL in our center.

Methods: It is a preliminary retrospective study of our first fifty-one supine PCNL procedures, performed by a single Surgeon, over Twelve months period, from April 2021 to April 2022. We managed a retrospective review of patients' records. Analysis was completed by utilizing SPSS version 20. Implementation of Mean along with standard deviation values was utilized for continuous variables. While frequency/percentages represented categorical factors.

Results: Patients mean age was 39 years, comprising of 62.74% male and 37.25% female patients. Thirty patients had their stones treated on the left side. Mean Stone burden was 3.2 cm. Most of the stones were GUYs score one and two (complexity wise). The mean procedure time 147minutes. Mean hospital stay of 2.17 days was observed in this study. Forty patients were stone free. Only seven patients (14%) had level I-II complications (Clavien-Dindo classification).

Conclusion: Supine PCNL can be adopted safely in an institute if careful selection of patients is done before surgery. In our center it had acceptable success rates and few complications.

Objective: To apply the more accurate technique for mandibular superimposition and provide a valuable reference for the assessment of mandibular tooth movement and condylar remodeling before and after orthodontic treatment.

Methods: This retrospective study involved 38 adult patients who underwent two cone beam computer tomography (CBCT) scans at different stages of treatment at Fujian Provincial People's Hospital between September, 2020 and December, 2022. The software Dolphin was used for mandible segmentation, enabling voxel-based mandibular superimposition with the mandibular ramus as the reference region. The Geomagic Wrap software was employed to process surface-based mandibular superimposition with the mandibular ramus as a reference. Additionally, the voxel and surface-based methods were compared for precision, with the mandibular ramus being the reference.

Results: After voxel-based mandibular superimposition using the mandibular ramus as a reference, with all measurement errors (< 0.20 mm). In contrast, the results of surface-based mandibular superimposition with the same reference, and the measurement errors were all less than 0.10 mm. The Wilcoxon signed-rank test revealed statistically significant differences between AS1 and BS1, AS2 and BS2, AS3 and BS3, and AS4 and BS4 (all r< 0.05). Moreover, the absolute mean distances of AS1-AS4 were all greater than those of BS1-BS4.

Conclusion: All mandibular superimposition procedures, including the voxel- and surface-based ones using the mandibular ramus as a reference, have acceptable surface errors (< 0.20 mm), indicating the good reliability of these techniques. Under the specified conditions, surface-based mandibular superimposition appears to yield a higher degree of precision compared with the voxel-based technique.

Objective: This study sought to quantify the link between low density lipoprotein (LDL) and cholesterol, glycemic control as measured by Hemoglobin A1c (HbA1c) level, and the impact of weight changes on subsequent risk of chronic heart disease in type-2 diabetes mellitus patients.

Methods: This study was conducted at Primary Care Clinics from April to September 2023. The data were retrieved from the e-SiHi (a patient care management system). Appropriate parametric tests and non-parametric analysis were applied following the normality of the data.

Results: In diabetes mellitus (DM) patients, the Pearson correlation between the cholesterol and LDL relationship was found to be strongly positive and statistically significant (r = .877, p <.001). HbA1c and cholesterol were moderately positive and statistically significant (r =.330, p =.003). Pearson correlation between DM and weight was found to be positive and statistically significant (r =.212, p =.05). Chi-square analysis showed an association of DM with Hypertension, and this association was also significant; X2 (1, n = 83; 11.877; P <.001).

Conclusion: Diabetes mellitus regardless of gender, has a strong association with hypertension and weight gain. In DM patients, cholesterol and HbA1c are positively correlated. There is a strong need that primary care physicians should persistently advise for lifestyle changes in all their consultations with DM patients.