Pakistan Journal of Medical Sciences最新文献

Objective: To investigate the relationship between cognitive impairment and oxidative stress markers in patients with early-onset schizophrenia(EOS).

Methods: This was a retrospective study. A total of 42 patients with EOS admitted to The Eighth Hospital of Shijiazhuang from December 2021 to December 2023 and 42 healthy volunteers were included in this study and classified as the observation group and the control group. Cognitive impairment and oxidative stress markers were assessed in both groups. The Measurement and Treatment Research to Improve Cognition in Schizophrenia(MATRICS) Consensus Cognitive Battery(MCCB) was used to evaluate cognitive function, and the serum levels of superoxide dismutase(SOD), malondialdehyde, glutathione peroxidase(GSH-Px), catalase, homocysteine, and nitric oxide(NO) were measured. Pearson correlation analysis was conducted to clarity the relationship between cognitive function and oxidative stress markers.

Results: The SOD and GSH-Px levels in the observation group were lower than in the control group, while homocysteine, catalase, malondialdehyde, and NO levels were higher in the observation group. Compared to the control group, patients in the observation group scored significantly lower for information processing speed, attention/vigilance, working memory, verbal learning, visual learning, reasoning and problem solving, and social cognition (P< 0.01, respectively). SOD and malondialdehyde levels were found to have a significant negative correlation with information processing speed, with r values of -0.342 and -0.350, respectively (P < 0.05).

Conclusion: Cognitive impairment in patients with EOS appears to be associated with oxidative stress. There is a significant negative correlation between the levels of SOD and malondialdehyde and information processing speed.

Losartan, commonly used as an angiotensin receptor II inhibitor for hypertension, has recently revealed additional therapeutic properties. Studies demonstrate its potential in treating liver fibrosis, mitigating heart disease secondary to radiation, reducing skin scar formation, and even reversing renal cortical fibrosis. In a specific case, a female patient suffering from persistent bilateral nummular keratitis and corneal opacities experienced significant improvement in her left eye after using 0.8mg/ml Losartan eye drops. Untreated right eye showed no change. Based on the positive outcome, patient was offered same treatment in her right eye as well with monthly follow-ups, which she happily accepted. The stark contrast between the treated and untreated eye highlights the promising role of Losartan in treating corneal opacities.

Objective: To compare the differences between clinical characteristics, therapeutic management, and prognosis of mycoplasma pneumonia (MP) and drug-induced Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) in children.

Methods: This was a retrospective study. The clinical data of SJS and TEN patients admitted to Hebei Children's Hospital from 2014-2024 were retrospectively analyzed and divided into the MP group and the drug group based on laboratory findings and the ALDEN algorithm for comparative study.

Results: A total of 42 cases were included in the study. Among them, 20 cases were in the MP group and 22 cases were in the drug group. The median age of MP group was 108.0 (54.0, 129.0) months, which was greater than drug group with 42.0 (22.5, 75.0) months, and the difference was statistically significant (P < 0.05). Ten cases (50.0%) in the MP group had chest CT suggestive of consolidation of lung/pleural effusion, which was higher than the two cases (9.1%) in the drug group, with a statistically significant difference (P<0.05). Both groups were given systemic corticosteroids (Cs) treatment, and the proportion of children receiving Cs shock therapy combined with intravenous immunoglobulin (IVIG) in the MP group was significantly lower than that in the drug group, with a statistically significant difference (P<0.05). When SCORTEN score ≧3, the proportion of the MP group receiving Cs shock therapy and IVIG application increased. The median SCORTEN score in both groups was two, corresponding to a predicted mortality rate of 12.2%, whereas all children in the MP group survived and three died in the drug group, with an actual mortality rate of 13.6%.

Conclusion: MP infection and drugs constitute the predominant triggers of SJS/TEN in children, with non-steroidal anti-inflammatory drugs (NSAIDs) and Chinese patent medicines (CPMs) as the main sensitizing drugs. For those with SCORTEN≦2 points, macrolides combined with conventional dose Cs may be the first-line treatment option for them.

Objectives: To investigate the epidemiology, spectrum and ethno-demographic attributes of congenital anomalies (CA) in Okara district of Pakistan.

Methods: In this cross-sectional study, individuals affected by CA were identified through door-to-door visits, surveys of public places, and district hospitals during the period 2015 to 2022 in Okara district of Punjab, Pakistan. Descriptive statistics were employed, and CA were classified using the International Classification of Diseases (ICD-10) and Online Mendelian Inheritance in Man (OMIM) databases.

Results: A total of 709 individuals/families with certain types of CA were ascertained. These anomalies were categorized into eight major and 95 minor entities. Limb defects predominated among the major groups (21%), followed by neurological disorders (16%), neuromuscular disorders (15%), sensorineural/ear defects (15%), ectodermal defects (9%), musculoskeletal defects (7%), and others (4%). Parental consanguinity was observed in 67% of the cases and 55% anomalies had familial occurrence. There were statistically significant differences among the major categories with respect to rate of parental consanguinity and familial/sporadic nature. Marked disparities were also observed in the distribution of CA with respect to ethnic groups, economic quartiles and age categories of index cases.

Conclusions: Neurological and neuromuscular defects which accounted for 31% of the sample, were of severe nature and cause of disability, whereas limb defects were mainly of minor nature. There is wide variation in the prevalence of CA across the ethno-demographic variables. A multifaceted strategy that explicitly includes marginalized and minority populations in health services and addresses environmental, genetic, and maternal health factors is necessary to prevent CA.

Objective: To summarize the existing evidence on the association between non-alcoholic fatty liver disease (NAFLD) and the probability of microvascular complications in Type-2 diabetes mellitus (T2DM).

Methods: PubMed, EMBASE and Scopus databases search (from inception until October 31, 2023) was done for reports with cross-sectional, cohort or case-control design that included adult participants with T2DM and a documented NAFLD status. The selected studies were required to report on at least one microvascular outcome. Studies reporting adjusted associations were included. Random-effects models were used for all analysis. The pooled effect sizes for the associations were reported as odds ratio (OR) with 95% confidence intervals (CI).

Results: Sixteen studies were analysed. T2DM patients with associated NAFLD had similar risk of neuropathy (OR 1.08, 95% CI: 0.97, 1.21), compared to those without NALFD. NAFLD was associated with slightly lower risk of retinopathy (OR 0.86, 95% CI: 0.75, 0.98; N=10, I²=82.6%) an increased incidence of nephropathy (OR 1.21, 95% CI: 1.14, 1.29; N=12, I²=82.5%), compared to patients with T2DM but no NAFLD.

Conclusion: Diagnosis of NAFLD in patients with T2DM appears to increase the incidence of nephropathy and decrease the risk of retinopathy. Future studies are needed to confirm these observations.

Objective: To investigate the effect of different levels of positive end-expiratory pressure (PEEP) in patients undergoing laparoscopic cholecystectomy under general anesthesia.

Methods: This retrospective study included patients who underwent laparoscopic cholecystectomy under general anesthesia in the Xuzhou Hospital of Traditional Chinese Medicine from January, 2023 to March, 2024. Based on the PEEP levels, patients were grouped into 0cm group (0cmH₂O), 5cm group (5cmH₂O), 8cm group (8cmH₂O), and 10cm group (10cmH₂O). Mean arterial pressure (MAP), mean airway pressure (P_mean), peak airway pressure (P_peak), and blood gas status levels (oxygenation index[OI], arterial partial pressure of oxygen [PaO₂], and arterial partial pressure of carbon dioxide [PaCO₂]) of all four groups were measured at five minutes after the intubation (T1), five minutes after pneumoperitoneum (T2), and 30 minutes after pneumoperitoneum (T3).

Results: A total of 84 patients (37 males and 47 females) were included in this study. The number of patients in the 0cm group, 5cm group, 8cm group, and 10cm group were 24, 24, 21, and 15, respectively, and there were no significant differences in the baseline data among the four groups. There were significant differences in P_mean, P_peak, and MAP between the four groups at T2 and T3. The increase in PEEP was accompanied by a gradual increase in P_mean and P_peak (P<0.05). There were significant differences in OI, PaCO₂, and PaO₂ among the four groups at T2 and T3. With the increase in PEEP, OI and PaO₂ values continued to increase while PaCO₂ continued to decrease (P<0.05).

Conclusions: During laparoscopic cholecystectomy under general anesthesia, PEEP = 5cmH₂O can inhibit a significant decrease in MAP while ensuring the patient's blood gas and respiratory mechanics status, which can ensure hemodynamic stability.

The Hep-Net position paper comes at a significant time in the history of Metabolically Associated Fatty Liver Disease (MAFLD) due to the rapid rise in this disease entity in the past decade. Metabolically Associated Fatty Liver Disease, by its very name, encompasses several common metabolic disease entities, top among those being diabetes and obesity. For Pakistan, the situation is serious as it is among the top 10 countries globally regarding the prevalence of obesity and number one in terms of diabetes, with over a quarter of adults affected. There remains slight ambiguity as regards the nomenclature of MAFLD, with western societies preferring to remove the word "fatty" and substitute with `'steatotic" i.e. MASLD. Regardless of names/titles the metabolic nature of the disease and its management remains the same and fortunately, that is something where universal consensus is present. Under the umbrella of Hep-Net, eminent hepatologists from all over Pakistan have pooled their efforts to formulate guidelines that are specifically tailored to the Pakistani population, its specific lifestyle and relevant interventions that are needed to treat fatty/steatotic liver disease. By virtue of its multi-systemic consequences, metabolic fatty liver disease represents the most significant and expensive disease entity, globally. Prevention, through public education and timely intervention in diagnosed cases will serve to avert a healthcare storm that will far outweigh viral hepatitis.

Objective: To explore the clinical efficacy of antibiotic-loaded bone cement in the treatment of lower limb soft tissue infection.

Methods: A retrospective analysis was carried out on 40 patients with lower limb soft tissue infection who were admitted to Sichuan Orthopedic Hospital from January 1, 2022 to December 1, 2023. The enrolled patients were divided into two groups according to different therapies, including the bone cement treatment (the study group) group and the conventional treatment group (the control group), with 20 cases in each group. Further comparison was made on the number of operations, wound healing time, Grade-A wound healing rate, recurrence rate, and recovery rate of inflammatory indicators between the two groups.

Results: Patients in both groups were followed up, and there was no statistically significant difference in the number of operations between the two groups (P>0.05). The study group had shorter wound healing time (P<0.05), higher Grade-A wound healing rate (P<0.05), lower recurrence rate (P<0.05), and higher normal rate of inflammatory indicators (P<0.05) than those in the control group.

Conclusion: Antibiotic-loaded bone cement showed a clear effect on treating lower limb soft tissue infection, with good wound healing and low recurrence rate.

Objectives: This study intended to determine the frequency of anxiety in outpatients of Type-2 diabetes mellitus (T2DM) and to evaluate its associated characteristics.

Methods: This cross-sectional observational study was accomplished from July 1, 2023, to December 31, 2023, at the Department of Endocrinology at Hayatabad Medical Complex, Peshawar. The study comprised of individuals with T2DM who were at least 18 years of age and of either gender and who presented to the outpatient department for various reasons. The Beck Anxiety Inventory (BAI) was utilized to assess the respondents' level of anxiety.

Results: A total of 306 patients with T2DM were enrolled, of whom, 116 (37.9%) were males and 190 (62.1%) were females. The mean age and HbA1c of the participants were 50.7 ± 11.2 years and 12.02 ± 2.03%. Majority (40.2%) of the participants had moderate anxiety while low anxiety and severe level of anxiety were reported by 30.4% and 29.4% participants, respectively. There was a statistically significant association of anxiety with gender, education, employment, family history, comorbidities, and HbA1c. Educated patients (OR=2.7, 95% CI 1.5 to 5.01 p=0.001), and those with comorbidities (OR= 2.3, 95% CI 0.91 to 5.98, p=0.01) had higher odds for occurrence of anxiety.

Conclusion: Almost 70% of the outpatients of T2DM had moderate to severe anxiety, with most of the clinicodemographic characteristics as potential associated factors. It is crucial for informing clinical practice, enhancing patient care, and promoting better mental health outcomes in this population.

This study explores how interventions focused on digital health literacy (DHL) can improve access to healthcare and contribute to achieving Sustainable Development Goal-3 (SDG- 3). We scrutinized information from PubMed (MEDLINE), Scopus, and Web of Science released search articles from March 1, 2020 to January 31, 2024. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the review concentrated only on experimental studies that assessed how DHL initiatives have influenced enhancing patient health outcomes and access to healthcare. Research that did not cover DHL or the availability of healthcare, was not included. The analysis was primarily qualitative, focusing on thematic patterns and insights rather than statistical outcomes. Our results showed that DHL interventions typically result in enhanced health literacy, improved medication adherence, and higher self-confidence, particularly benefiting marginalized communities. Limitations to safe & accessible healthcare underscore the need for more focused and culturally appropriate strategies. This review shows that interventions by DHL can greatly enhance healthcare results, highlighting the need to tackle inequalities to ensure marginalized communities also benefit.