Pakistan Journal of Medical Sciences最新文献

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.

Objective: To explore the efficacy of the narrative nursing model on psychological adjustment and improvement of treatment compliance in patients with hypertension.

Methodology: A retrospective analysis was conducted on the clinical data of 120 patients with hypertension who were admitted to Hebei Provincial Hospital of Chinese Medicine between January 2022 to January 2025. The nursing interventions and pre-/post-assessments had been implemented as part of a quality improvement initiative in the hospital, and this study retrospectively reviewed the medical records and outcome data of patients who received different nursing approaches. Among them, 56 patients received routine nursing (control group) and 64 patients received the narrative nursing model on the basis of routine nursing (observation group). Psychological adjustment, treatment compliance, blood pressure levels and nursing satisfaction were compared between the two groups.

Results: After intervention, the Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) scores of both groups decreased compared to pre-intervention and were significantly lower in the observation group than the control group (P<0.05). The scores for medication compliance, exercise training, dietary regulation, stress management and blood pressure monitoring in both groups increased after the intervention, with markedly higher scores in the observation group compared to the control group (P < 0.05). Post-intervention diastolic and systolic blood pressure decreased in both groups. Patients in the observation group reported considerably lower post-intervention blood pressure levels (P<0.05). Nursing satisfaction in the observation group (96.88%) was higher than that in the control group (85.71%) (P<0.05).

Conclusion: Implementing the narrative nursing model for patients with hypertension can improve psychological status, alleviate depression and anxiety, enhance treatment compliance, optimize blood pressure control and achieve high patient satisfaction.

Objective: Penetrating brain injury (PBI) is a severe form of traumatic brain injury associated with high mortality, particularly in children. However, mortality predictors in children with PBI remain unclear. This study aimed to evaluate the association among the number of intracranial foreign bodies (FBs), brain computed tomography (CT) findings, and mortality outcomes in paediatric patients with PBI who presented to the emergency department (ED).

Methodology: This prospective observational study was conducted in the ED of Kilis State Hospital from December 2015 to December 2022. Paediatric patients with isolated penetrating head injuries from sniper gunshot wounds or barrel bomb explosions were included. Demographic data, pre-hospital interventions, Glasgow Coma Scale scores, brain CT findings, and mortality outcomes were collected and analysed.

Results: This study included 126 paediatric patients with PBI. The presence of ≥2 intracranial FBs was significantly associated with increased mortality (odds ratio 37.4; p<0.001). Other mortality predictors included Glasgow Coma Scale score ≤9, epidural haematoma, midline shift, and pre-hospital endotracheal intubation. Mortality was not significantly different between injuries from shrapnel and those from sniper gunshots.

Conclusion: In paediatric patients with PBI, having ≥2 intracranial FBs was associated with increased mortality. Therefore, FB count may be a novel and accessible prognostic factor. Further research is required to validate these findings and support their integration into clinical decision-making.

Objectives: The risk of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) is extremely high, and directly affects the early cardiac recovery and quality of life of patients. This study aimed to explore risk factors for MACE in patients with acute myocardial infarction (AMI) after PCI and to develop and validate a risk nomogram model.

Methodology: Clinical data of 396 AMI patients who underwent PCI in the Affiliated Hospital of Jiangnan University from July 2022 to July 2024 were retrospectively selected. Patients were divided into training (n=277) and validation (n=119) cohorts based on a 7:3 ratio. The data were analyzed using the Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression, and the results were transformed into a predictive nomogram. Receiver operating characteristic (ROC) curves were drawn to evaluate the efficacy of the nomogram model and calculate the area under the curve (AUC), as well as the calibration curve and clinical decision curve (DCA).

Results: The incidence of MACE was 21.2% (84/396). The identified significant predictors included no-reflow, thrombolysis in myocardial infarction (TIMI) grading, mean platelet volume and lymphocyte ratio (MPVLR), neutrophil to lymphocyte ratio (NLR), and levels of hypersensitive C-reactive protein (hs-CRP) and brain natriuretic peptide (BNP). The generated nomogram model demonstrated sufficient predictive accuracy, with AUC values of 0.961 (95% CI: 0.929-0.994) and 0.951 (95% CI: 0.894-1.000) for the training and validation cohorts, respectively. The calibration curve showed that the model's predicted values are generally consistent with the actual values, indicating good calibration. DCA further confirmed that the predictive model has good clinical utility.

Conclusions: The risk prediction nomogram model developed in this study has good predictive performance and applicability for MACE during hospitalization.

Background and objective: Primary Intracranial Rhabdomyosarcoma (PIRMS) represents a rare and poorly understood entity within brain tumours. The objective was to evaluate the clinicoradiological presentation and optimal management strategies for PIRMS.

Methodology: A comprehensive literature search was conducted in PubMed Central and Google Scholar from 2000 to 2024. Only English-language, open-access articles with confirmed human PIRMS cases were included. Quality was assessed using Joanna Briggs tools, and data synthesis followed PRISMA guidelines, registered with PROSPERO with registration number CRD42024507092. A total of 176 articles were screened, and finally, 27 were included, comprising data on 39 patients.

Result: About 22 (56.41%) patients were adults, and 17 (46.59%) were pediatric, with a male predominance of 23 cases (58.67%). Most patients (25) were Asians (64.1%). Headache, facial nerve palsy, and nausea/vomiting in 58.97% (23), 28.21% (11) and 25.64% (10) were the most common findings. Imaging showed ventriculomegaly and haemorrhage, in 10.26% (4) each on computed tomography, and hyperintensities on T1WI in 20 cases (51.28%). About 17.95% (7) of lesions were in the pineal region. Gross-total resection was performed in 15 cases (38.46%). On histopathology, rhabdomyoblasts and round cells were found in 25.64% (10) and 38.46% (15). The mean follow-up of 28 patients was 14.39 +- 17.68 months.

Conclusion: Despite limitations, PIRMS remains difficult to diagnose preoperatively, with histopathology as the gold standard. Treatment response varies, but adjuvant chemoradiotherapy and gross total resection improve outcome.

Objective: To assess the neurosurgical residents' perspectives on surgical neuro-oncology specialty training in Pakistan.

Methodology: A nationwide survey-based observational study was conducted among neurosurgery residents registered with the accredited residency programs in Pakistan. A structured questionnaire assessing knowledge, training, mentorship, and institutional support in surgical neuro-oncology was disseminated via Google Forms (Google Inc., USA). Data collection took place from January to March, 2025 across both public and private sector training institutes. Responses were analyzed using Statistical Package for the Social Sciences, with categorical variables presented as frequencies and percentages and continuous variables as means with standard deviations.

Results: A total five hudnred residents were targeted among whom one hundred residents responded, yielding a response rate of 20%. While 90% (90) rated their knowledge of brain and spinal tumors as good or excellent, only 67% (67) felt confident interpreting imaging studies. Notably, 33% (33) had received no formal training in surgical neuro-oncology. Exposure to spinal cord tumor surgeries was limited, with only 14% (14) having participated in such procedures. Mentorship and interdisciplinary collaboration were inadequate; only 20% (20) reported access to dedicated neuro-oncology mentors, and just 12% (12) rated interdepartmental collaboration as excellent. Resources were considered limited or insufficient by 69% (69) of respondents. Despite these challenges, 84% (84) supported the establishment of a dedicated neuro-oncology fellowship, and 67% (67) expressed definite interest in pursuing such training.

Conclusion: This nationwide analysis highlights critical insights into the clinical exposure, training quality, and perceptions of neurosurgical residents in Pakistan regarding surgical neuro-oncology. While the majority of residents demonstrated enthusiasm and self-reported strong theoretical knowledge, substantial gaps were identified in hands-on experience, formal training, mentorship, and access to specialized resources, particularly in spinal neuro-oncology. Limited interdisciplinary collaboration and insufficient institutional support further hinder comprehensive skill development. National-level reforms are essential to align with global standards in neurooncological education and care.

Background and objective: Cerebellopontine angle (CPA) is an important anatomical landmark hosting important neurovascular structures. Hydrocephalus presents a great challenge in CPA lesions management. We aimed to highlight the significance of intraoperative cisternostomy and without the need of preoperative and postoperative cerebrospinal fluid (CSF) diversion.

Methodology: This retrospective observational study was conducted at Punjab Institute of Neurosciences involving consecutive, single-surgeon led cases of CPA space occupying lesions (SOL) between 2022 and 2024. Data was collected for demographic and clinical presentation, extent of resection and the need for post-operative CSF diversion while making use of intraoperative cisternostomy in all cases.

Results: A male preponderance of 51.90% (42) patients was identified with an overall mean age of 39.13±13.18 years. Eighty-one patients underwent intra-operative cisternostomy of which 98.80% (80) cases were adult patients. The commonest clinical manifestations at presentation were headache in 91.4% (74) and sensorineural hearing loss in 92.60% (75) cases. Mean preoperative Glasgow coma scale (GCS) score was 14.9±0.6. Mean pre-operative KPS (Karnofsky performance status) score was 81.35 ± 13.1. About 91.40% (74) patients underwent gross total resection. Schwannoma was seen in 80.2% (65) patients making it the most common CPA pathology. Mean immediate postoperative GCS was 13.93±2.26. Mean postoperative KPS score was 78.76±15.11. Only 13.80% (12) patients required post-operative CSF diversion in the form of ventriculoperitoneal (VP) shunt during first year of follow up.

Conclusion: Retrosigmoid approach with intraoperative cisternostomy for excision of cerebellopontine angle lesions is a safe and efficient approach with better outcomes, mitigating the need for pre-operative and post-operative CSF diversion.

Objective: To evaluate the effects of multimodal management for intracranial supratentorial meningioma in terms of their surgical outcome and the functional status of patients in a low-middle-income country.

Methodology: This retrospective, observational study analyzed consecutive cases of surgically excised supratentorial meningiomas at the Department of Neurosurgery, Unit-I, Punjab Institute of Neurosciences, from January 2022 to August 2024. Patients aged 18 or older with at least three months of follow-up were included, excluding those with incomplete records. Patient data, including clinical, radiological, surgical, and postoperative details, were collected via Google Forms and analyzed using SPSS for descriptive statistics.

Results: This study included 60 patients with a mean age of 45.90±13.05 years, with the majority being males (65%,39). Gross total resection was achieved in 48.3%(29) of cases. Post-operative GCS scores were 13-15 in 95%(57) of patients, and 60%(36) experienced no complications. Histopathology showed 85%(51) of meningiomas were WHO grade I, with 70%(42) meningothelial and 10% (6) fibrous. Most (90%,54) of them did not require adjuvant therapy, with average pre-treatment and post-treatment KPS of 77.17±21.64 and 83.00±28.95, respectively. WHO grade II tumors (10%,6), including atypical and clear-cell types, were treated with adjuvant therapy in 5%(3) of all cases, with KPS scores of 76.32±19.54 and 82.13±26.35. WHO grade III tumors were found in 5% (3) of cases and were all treated with adjuvant therapy, with KPS scores of 75.13±19.34 and 80.21±26.72.

Conclusion: Multimodal management of intracranial meningiomas based on comprehensive clinical assessment, timely neuroimaging workup, surgery, and appropriate referrals for adjuvant therapy based on WHO tumor grades reduces the risk of postoperative complications and improves the functional status of patients overall.

Mixed pituitary neuroendocrine tumors (pitNET)-gangliocytomas are extremely rare sellar region World Health Organisation (WHO) Grade-I tumors. We report the case of a 31-year-old Pakistani male with a presenting complaint of headache and gradual loss of vision for a period of few months. On magnetic resonance imaging (MRI), a sellar/ suprasellar and parasellar mass lesion was identified. A differential of pituitary macroadenoma was considered. The mass was excised and the surgery was uneventful. Histopathology revealed a biphasic tumor composed of small monomorphic nests and solid sheets of pitNET cells (synaptophysin and chromogranin A positive, S100 negative) and large voluminous eosinophilic cells of the gangliocytoma component (synaptophysin, chromogranin A and S100 positive). This case highlights a tumor with features of both neuronal and endocrine neoplasms. Although their presentation resembles that of pitNETs, their treatment response and behavior are more consistent with glioneuronal tumors, resulting in a highly favorable phenotype and treatment response.

Objective: To investigate the effects of infant touch on the growth and development of preterm infants.

Methodology: This was a retrospective study which included sixty-four preterm infants admitted to Maternity & Child Care Center of Qinhuangdao from June 2023 to May 2024 were recruited as study subjects and randomly assigned into the control group (n=32) and the observation group (n=32). The preterm infants in the control group received conventional monitoring measures, while those in the observation group received additional infant touch twice a day for 20 minutes each time for two months on top of the control group.. The physical development, and sleep quality indexes of preterm infants 60 days after birth were statistically compared.

Results: At day 60 of life, the weight and height of the preterm infants in the observation group were markedly higher than those in the control group (P<0.05), their levels of muscular, visual, linguistic and emotional development were significantly better than those in the control group(P<0.05) and their frequency of nocturnal awakenings and crying duration were notably lower than those in the control group(P<0.05). Moreover, infant touch showed no significant effect on head circumference, hearing and sleep quality of preterm infants at day 60 of life(P>0.05).

Conclusion: Infant touch boasts of promoting the growth and development of preterm infants in the early stages of life in multiple ways, such as promoting their weight and height growth, vision, language and emotion and enhancing their sleep quality.