Pakistan Journal of Medical Sciences最新文献

Background and objective: Children living in low and middle-income class settings exhibit varied nutritional status ranging from healthy to malnourished. Differences in socioeconomic conditions and Infant & young child feeding practices may be responsible for nutritional disparities among them. This case-control study aimed to explore these differences among healthy and malnourished children aged 0-23 months.

Methods: This was a hospital-based, case-control study. The study was conducted in the outpatient department of The Indus Hospital, Karachi from June 2022 till December 2022. A total of 380 children aged 0-23 months were recruited from the outpatient department.. Compliance to different IYCF indicators, ranging from breastfeeding to complementary feeding, was. assessed by taking 24 hours food recall. Mid-upper arm circumference was used to categorize the nutritional status of children.

Results: The dominant food groups consumed were roots, grains, and tubers, while consumption of vitamin A-rich fruits, flesh food, eggs, fruits, and vegetables were relatively low in both groups. Multivariate logistic regression analysis revealed that low paternal education (COR = 3.64; 95% CI: 2.07, 6.40), employment of mother (COR = 2.27; 95% CI: 1.19, 4.36), and achieving minimal meal frequency (AOR = 2.41; 95% CI: 1.09, 5.31) had a negative association with the nutritional status of children while male gender (COR = 0.52; 95% CI: 0.35, 0.79) and maternal education (AOR = 0.20; 95% CI: 0.06, 0.60) and paternal employment (COR = 0.29; 95% CI: 0.14, 0.59) were positively associated with nutritional status.

Conclusion: We conclude that lack of parental education, father unemployment, maternal employment, and minimal meal frequency were significantly associated with malnutrition in children.

Background and objective: The prevalence of neurodevelopmental disorders (NDs) and allergic diseases(ADs) has increased in recent years. This study aimed to analyse the association between them among children registered at primary healthcare units in Izmir.

Methods: For this retrospective cross-sectional study, primary healthcare units in Izmir were selected by randomisation conducted between January 1, 2023 and December 31, 2023. The dependent variables are attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). The risk factors are respiratory allergies and skin allergies. Logistic regression models were adjusted for age, sex, socioeconomic level.

Results: There were 20,557 children registered in 26 primary healthcare units. Skin allergy was detected in 7.8%, respiratory allergy in 6.8%, ADHD in 1.2% and ASD in 0.0%. ADHD comorbidity was found to be high in both children with respiratory allergies and children with skin allergies (p<0.001). The rate of ASD comorbidity was 1.8% in boys with respiratory allergies and 1.6% in boys with skin allergies (p>0.01). The analysis could not be performed due to the low number of girls with ASD. The logistic regression models showed a higher odds ratio for respiratory allergies (OR:6.2, 95% CI: 4.6-8.3) than for skin allergies (OR:2.2, 95% CI: 1.5-3.2) for ADHD.

Conclusion: It would be beneficial to increase awareness among healthcare providers and parents about the co-occurrence of NDs and ADs.

Objective: To explore the perceptions of medical students about the effects of financial stresses.

Method: A qualitative exploratory study was conducted in March - August of 2023. Data were taken from a purposive sample of twelve undergraduate medical students from various medical colleges in Peshawar. Semi-structured in-depth interviews were conducted using a validated interview guide to explore the effects of financial stress on medical students. The audio recordings of the interviews were transcribed. Because the data was sensitive, anonymity and confidentiality were guaranteed to the participants. Thematic analysis was then used and authors of the study agreed on themes and subthemes after a manual thematic analysis was completed.

Results: This study reveals five themes about the effects of financial stress among medical students. The five themes include financial stressors in medical education, their effects on academic performance and achievement, future career choices, healthcare and well-being practices, and educational policies and interventions suggesting potential solutions to overcome the financial challenges.

Conclusion: This study highlights the multifaceted nature of financial stress among medical students, its significant influence on academic achievement and career decisions, and the negative health implications it presents. It also explores potential strategies for alleviating this burden. In addition to the suggestions given by medical students, there is a need to adopt specific strategies for medical institutions, policymakers, and future research endeavors to deal with the financial challenges faced by medical students.

Objective: To determine the frequency and pattern of dyslipidemia and its association with other risk factors among Type-2 diabetics.

Methods: This cross-sectional study was conducted in Diabetic Clinic of Shaikh Zayed Postgraduate Medical Institute Lahore from January-October 2023. Type-2 diabetics regardless of age were evaluated by fasting lipid profile and were further evaluated by BMI, HbA1c and smoking. Exclusion criteria was patients taking lipid lowering drugs and all other causes of secondary dyslipidemias other than diabetes. Data for normally distributed quantitative variables was presented by Mean±SD, and for skewed measures were presented by using median (IQR). Dyslipidemia was described for each trait by using frequency and percentages.

Results: A total of two hundred and twelve subjects were included in the study with the mean age of 53.4±9.1 years. About 96.6% patients were found to have different patterns of dyslipidemia that also showed positive association with smoking, uncontrolled HbA1c and obesity (p < 0.001).

Conclusion: There is very high prevalence of dyslipidemia among Type-2 diabetics especially those who are smokers, with poor glycemic control and overweight/obese. Early screening of patients for dyslipidemia with lifestyle modifications and treatment of dyslipidemia can reduce risk of CVD.

Objective: To explore the influencing factors of polyspermy in long-term fertilization during in vitro fertilization (IVF) with antagonist protocol.

Methods: This was a retrospective case-control study. Patients with secondary infertility undergoing assisted reproductive treatment in the Department of Reproductive Medicine of Maternity & Child Care Center of Qinhuangdao between January 2020 and May 2023 were selected. Five hundred and thirty-six ovulation induction cycles with antagonist protocol were included and divided into the control group (multiple pronuclei(PN) rate= 0%, n=347) and the polyspermy group (multiple PN: 2PN ≥20%, n=189) according to the incidence of polyspermy. The general data and embryonic development of the two groups were statistically analyzed.

Results: There were no statistically significant differences in male age, infertile duration, body mass index (BMI), basal follicle-stimulating hormone (FSH) level, number of follicles with a diameter of ≥16mm, total dose of gonadotropin (Gn), total Gn stimulation days, and sperm concentration between the two groups (all P>0.05). Similarily no statistically significant differences in female age, levels of estradiol (E2), LH, and progesterone (P) and number of follicles with a diameter of ≥14 mm on human chorionic gonadotropin (hCG) injection day, the total number of eggs retrieved, amount of Gn/egg, and fertilization concentration (sperms/egg) were observed between the two groups (all P<0.05). The results of logistic binary regression analysis showed that the level of LH on hCG injection day was an independent risk factor for the incidence of polyspermy in antagonist protocol.

Conclusion: In the process of ovulation induction in antagonist protocol, the appropriate addition of LH can improve embryo outcomes.

Objectives: Emergency primary anastomosis following sigmoidectomy is one of the main treatment options in sigmoid volvulus (SV). However, during this procedure, the role of intraoperative colonic lavage (ICL) is controversial. Our aim was to evaluate the role of ICL in 175-patient SV series.

Methods: In Ataturk University Faculty of Medicine Department of General Surgery, ICL was applied in 76 cases (43.4%), while it was not used in the remained 99 patients (56.6%) in 58.5-year period. In a partial retrospective (first 20 years, from June 1966 to June 1986) and prospective (later 38.5 years, from June 1986 to December 2024) evaluation, some preoperative, operative, and postoperative findings were utilized.

Results: As preoperative data, mean age (56.4 years vs. 57.1 years, P>0.05), male/female ratio (4.8 vs. 4.2, P>0.05), and rate of shock (5.3% vs. 6.1%, P>0.05) were statistically similar in both groups, while mean ASA score (3.1 vs. 2.9, P<0.05) was significantly lower in ICL group. Among operative findings, rates of bowel gangrene (67.1% vs. 63.6%, P>0.05) and perforation (1.3% vs. 1.0%, P>0.05) were statistically similar in both groups, while mean operation time (205.4 minutes vs. 176.8 minutes, P<0.005) was significantly longer in ICL group. As surgical outcomes, rates of mortality (13.2% vs 12.1%, P>0.05) and morbidity (39.5% vs. 28.3%, P>0.05) were statistically similar in both groups, while mean hospitalization time (14.7 days vs. 9.4 days, P<0.001) was significantly longer and mean cost (3,455.4 USD vs. 2,752.1 USD, P<0.001) was significantly higher in ICL group.

Conclusion: When compared with that of primary anastomosis with ICL, primary anastomosis without ICL provided shorter operation and hospitalization times, and less cost in addition to similar mortality and morbidity rates in the emergency treatment of SV.

Objective: We reviewed the evidence on the impact of non-alcoholic fatty liver disease (NAFLD) and liver fibrosis on mortality, functional dependence, and recurrence after acute ischemic stroke (AIS).

Methods: This PROSPERO registered review searched PubMed, Embase, CENTRAL, and Web of Science databases from inception of databases to 30^th July 2023 for studies comparing outcomes of AIS based on the presence of NAFLD and liver fibrosis. Adjusted data on mortality, functional dependence and risk of recurrent AIS was pooled to obtain odds ratio (OR) with 95% confidence intervals (CI) in a random-effects model.

Results: Ten studies were included. Descriptive analysis showed conflicting effects of NAFLD on AIS outcomes with some studies showing better functional outcomes with the presence of NAFLD. Meta-analysis showed that the presence of liver fibrosis was associated with a significantly increased risk of mortality (OR: 2.22 95% CI: 1.02-4.86 I²=92%) and functional dependence (OR: 1.89 95% CI: 1.27-2.82 I²=53%) as compared to no fibrosis. Meta-analysis found that liver fibrosis did not increase the risk of recurrent AIS (OR: 1.32 95% CI: 0.74-2.37 I²=74%).

Conclusion: Scant evidence exists for the effect of NAFLD and liver fibrosis on AIS outcomes. A paradoxical effect of NAFLD on functional outcomes has been noted which needs confirmation by future studies. Liver fibrosis was found to increase the risk of mortality and functional dependence in AIS.

Objective: To observe the predictive value of prenatal screening markers combined with serum placental growth factor(PLGF) in early pregnancy for preeclampsia(PE).

Methods: This was a prospective study. A total of 369 pregnant women undergoing early pregnancy examinations were selected at Jingmen Central Hospital from August 2024 to January 2025 and divided into the PE group(n=43) and the normal group(n=326) according to the presence of PE during the follow-up. The levels of prenatal screening markers alpha-fetoprotein(AFP), serum PLGF, β-human chorionic gonadotropin(β-hCG) and pregnancy-associated plasma protein-A(PAPP-A) were compared between the two groups.

Results: There were 43 patients experiencing PE, with an incidence of 11.65%. The levels of PLGF, β-hCG and PAPP-A were significantly decreased in the PE group compared with those in the normal group, and the differences between the groups were statistically significant (all P<0.05). Logistic regression analysis showed that increased prenatal screening markers AFP, serum PLGF, HCG and PAPP-A were independent risk factors for PE, with statistically significant differences between the groups (all P<0.05). Finally, the results of ROC curve analysis showed that the AUCs of AFP, PLGF, β-hCG and PAPP-A were 0.618, 0.645, 0.690, and 0.645, respectively, and the AUC of combined prediction was 0.825, which was significantly increased compared with that of each marker alone, with statistically significant differences(P<0.05).

Conclusion: The development of PE in pregnancy is closely related to the levels of AFP, PLGF, β-hCG and PAPP-A. The predictive efficiency of combined detection of AFP, PLGF, β-hCG and PAPP-A for PE in pregnancy significantly increases.Project Title: sFlt-1/PlGF based combined early pregnancy prenatal screening marker Nursing Strategies and Application in Preeclampsia Risk Assessment, Project Number: 2024YFYB111, Year: 2024.

Objectives: To investigate the clinico-epidemiological characteristics of multiple sclerosis (MS) in the southern region of the Republic of Azerbaijan, which has a population of 930,601.

Methods: This prospective, single-center, longitudinal study was conducted from January 1, 2013, to December 31, 2022. MS patients in this region underwent examination and treatment under a State Program. During this period, 123 individuals visited the Neurological Center, and 104 confirmed MS cases were included in a digital database. Age-standardized incidence and prevalence rates per 100,000 were calculated using world and European population standards. Data analysis was performed using IBM SPSS Statistics 27.

Results: The mean diagnostic age was 36.31±6.93 years, higher than the countrywide average of 34.9 years. The average diagnostic delay was 7.01 years, significantly longer than the national average of 5.2 years. Regional MS prevalence was 10.96/100,000, with higher urban rates but no significant sex difference. The average 10-years incidence of MS was 0.94±0.32/100,000. Compared to neighboring regions, such as Iran's East Azerbaijan Province and Turkiye, the MS prevalence in this area is lower. Although MS prevalence and incidence in Azerbaijan are below European levels, they exceed those in some Asian countries.

Conclusion: This is the first study on MS epidemiology in Southern Azerbaijan. The findings underscore the need for public awareness campaigns and enhanced diagnostic training for healthcare professionals, particularly in primary care, to facilitate early symptom detection and reduce diagnostic delays. Further research is recommended to investigate regional factors affecting MS diagnosis and to improve timely healthcare access.

Objective: To compare the efficacy of subxiphoid and intercostal uniportal video-assisted thoracoscopic surgery (VATS) in patients with early-stage non-small cell lung cancer (NSCLC).

Methods: We performed a retrospective chart review of patients with early-stage NSCLC who underwent subxiphoid uniportal video-assisted thoracic surgery (SA-VATS) or intercostal uniportal VATS (IA-VATS) at Shidong Hospital in Shanghai from November 2020 to May 2023. Perioperative conditions including surgical duration, intraoperative blood loss, postoperative catheterization duration, time to first off-bed activities, and number of lymph node dissected were compared between the groups. Degree of pain, preoperative and postoperative lung function, prognosis, and incidence of complications were also compared between the groups.

Results: Records of a total of 128 patients were included. Of them, 72 patients underwent SA-VATS and 56 patients underwent IA-VATS. The duration of SA-VATS was longer, while the intraoperative blood loss and catheterization times were lower compared to those of IA-VATS (P<0.05). Visual analogue scale (VAS) score of patients after SA-VATS was significantly lower than after IA-VATS (P<0.05). There was no significant difference in forced expiratory volume in one second (FEV1) between the two groups before the surgery, and one- and 12 months after the surgery (P>0.05). The prognosis and the incidence of complications were comparable in the two groups after the surgery (P>0.05).

Conclusions: Compared with IA-VATS, SA-VATS is associated with lower intraoperative blood loss, shorter postoperative catheterization and time to first off-bed activities, and less postoperative pain in surgical treatment for early-stage NSCLC. However, there was no significant difference in prognosis and complications between the two approaches.