Pakistan Journal of Medical Sciences最新文献

Objective: Exploring the clinical efficacy of scraping therapy with Astragalus membranaceus (AMS, Huang Qi) ointment combined with tuina (Chinese Therapeutic Massage) in patients with upper limb spastic hemiplegia after hemorrhagic stroke.

Methodology: This retrospective analysis examined clinical data of 106 patients with upper limb spastic hemiplegia after hemorrhagic stroke who received treatment at Suzhou Integrated Traditional Chinese and Western Medicine Hospital from January 2023 to June 2025. According to different treatment methods, patients were divided into a tuina group (n = 53, tuina massage treatment) and a scraping + tuina group (n = 53, scraping therapy with AMS ointment combined with tuina). The modified Ashworth Spasm Assessment Scale (MAS) was used to evaluate the degree of spasticity in the affected limb. The Simplified Fugl Meyer Upper Limb Function Assessment Scale (FMA-UE) was used to assess the motor function of the affected limb and the Modified Barthel Index Assessment Scale (MBI) was used to evaluate Activities of Daily Living (ADL).

Results: After treatment, the improvement in the MAS score in the scraping + tuina group was better than that in the tuina group (P<0.05). The post-treatment FMA-UE score and MBI score of both groups of patients significantly improved and were markedly higher in the scraping + tuina group compared to the tuina group (P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05).

Conclusions: Scraping therapy with AMS ointment combined with tuina massage treatment can effectively alleviate upper limb spasticity. The combined regimen is associated with improved motor function and ADL in patients with upper limb spastic hemiplegia after hemorrhagic stroke.

Objective: To analyze risk factors of enteral nutrition (EN) diarrhea in intensive care unit (ICU) patients and to construct nomogram model.

Methodology: A retrospective analysis was conducted on 402 patients who received EN treatment in the ICU of Shanghai Blue Cross Brain Hospital from January 2022 to January 2025. They were divided into diarrhea group and non-diarrhea group based on the occurrence of EN diarrhea. We used univariate and multivariate logistic regression analysis to identify risk factors for EN diarrhea. Construct a nomogram model for the occurrence of EN diarrhea in ICU patients based on independent risk factors and conduct goodness of fit tests.

Results: The incidence of EN diarrhea in ICU patients was 29.85% (120/402). Hypoproteinemia, abdominal surgery in the last five days, fasting time > 5 days, antibiotic use > 2 weeks, no gradual increase in EN preparations, oral potassium preparations, EN liquid infusion rate ≥ 100ml/h, albumin level ≥ 35g/L were identified as risk factors for EN diarrhea (p<0.05). Based on the above influencing factors, a nomogram model was constructed and internally validated using the Bootstrap method. The nomogram model basically fitted with the ideal model. ROC area under curve (AUC) was 0.860 (95% CI: 0.820-0.901), indicating a certain predictive value for EN diarrhea.

Conclusions: The nomogram model has high predictive power in predicting the risk of EN diarrhea in ICU patients. It is beneficial for screening high-risk patients and further adjusting nutritional therapy.

Objectives: To evaluate the clinical efficacy of Huoxue Tongqiao (blood-invigorating and orifice-unblocking) Decoction (HXTQD) combined with aniracetam in the treatment of post-ischemic stroke cognitive impairment (PISCI) in elderly patients and its effects on related serum biochemical markers.

Methodology: This was a retrospective study. A total of 80 elderly patients with PSCI admitted to Baoding No.1 Central Hospital between January 2022 to December 2024 were enrolled and randomly assigned to either the control group or the observation group using a random number table. All patients received standard internal medicine management. The control group was treated with aniracetam, while the observation group was orally administered HXTQD in combination with aniracetam. TCM syndrome, MoCA, MMSE, ADL scores, cerebral hemodynamic parameters and serum biochemical markers were assessed before and after treatment. The overall response rate was compared between the two groups.

Results: After treatment, both groups showed significant improvements in MoCA, MMSE and ADL scores, Vm and serum levels of SOD, GSH-Px and NO(all P< 0.05), with the observation group demonstrating significantly greater improvements than the control group (P< 0.05). TCM syndrome scores, RI and PI decreased in both groups, with more pronounced reductions noted in the observation group (P< 0.05, respectively). The ORR in the observation group was significantly higher than in the control group (P< 0.05). No adverse reactions were reported in either group.

Conclusion: The combination of HXTQD and aniracetam can significantly improve cognitive function and cerebral perfusion in elderly patients with post-ischemic stroke cognitive impairment, potentially by regulating serum SOD, GSH-Px and NO levels.

Objective: To evaluate the continuation rates and factors influencing the discontinuation of postpartum etonorgestrel contraceptive implants over a three-year period.

Methodology: A prospective cohort study was conducted from November 2017 to December 2022 in the Department of Obstetrics and Gynecology, Services Hospital, Lahore, Pakistan. The patients coming to OPD and emergency were counselled for insertion of long-acting reversible contraception. Those who opted for postpartum etonorgestrel implants were enrolled after informed consent and implant was placed within 48 hours of birth. The patients were followed for three years post insertion. The primary outcome was the continuation rate at three years, and secondary outcomes included reasons for discontinuation. Statistical analysis was performed using SPSS version 23, and p-values < 0.05 were considered statistically significant.

Results: Of 424 participants the cumulative continuation rates for year 1,2 and 3 were 91.9%, 82.7% and 75% respectively and 106 (25%) removals at the end of year 3. Doctors counselling played role in choosing implant in 177(41.7%) patients. Continuation was higher among women with prior contraceptive knowledge AOR: 3.73; 95% CI (1.20-6.21), previous contraceptive use AOR: 8.1; 95%CI (4.2-31.1), and antenatal counselling AOR: 2.24; 95% CI (1.16-3.54). The most common reasons for discontinuation were side effects in 77(45.2%) and family pressure 55(32.3%) patients. Women with no side effects were 18 times more likely to continue AOR: 18.1; 95% CI (7.5-48).

Conclusion: The postpartum insertion of etonorgestrel implant has high continuation rates. Side effects of bleeding irregularities and family pressure were main reasons for discontinuation.

Objective: To evaluate the clinical efficacy of spleen aminopeptide(SAP) combined with budesonide nebulization(BN) in the treatment of pediatric bronchial asthma, and its impact on the immune function and inflammatory cytokines of the affected population.

Methodology: This was a retrospective study. A total of 120 children with bronchial asthma admitted to Baoding Hospital, Beijing Children's Hospital Affiliated to Capital Medical University from December 2022 to October 2024 were enrolled and randomly divided into the control group(received symptomatic treatment along with BN) and study group(received additional oral SAP based on the control group regimen), with 60 cases in each group. After treatment, the clinical efficacy, adverse drug reaction(ADR) rate, changes in immune markers, and inflammatory cytokines were compared between the two groups.

Results: The overall response rate was 93% in the study group and 78% in the control group, with a statistically significant difference(p= 0.02). The ADR was 15% in the study group and 12% in the control group, with no significant difference between the groups(p= 0.60). After treatment, levels of CD3⁺, CD4⁺, and CD4⁺/CD8⁺ ratio were significantly higher in the study group compared to the control group(p= 0.00, respectively). Additionally, post-treatment levels of TNF-α, CRP, and IL-6 were significantly lower in the study group than in the control group(p = 0.00, respectively).

Conclusion: The combination therapy using SAP and BN demonstrates significant clinical efficacy in treating pediatric bronchial asthma. SAP plus BN can effectively enhance immune function and reduce levels of inflammatory cytokines without significantly increasing adverse reactions.

Objectives: To determine the factors influencing the selection of anesthesiology as a future career by the residents at Postgraduate Medical Institute Quetta (PGMIQ).

Methodology: After obtaining ethical approval from Post Graduate Medical Institute (PGMI), Quetta this sequential mixed-method study was conducted for a period of six months from 1^st of January, 2024 to 30^th June, 2024, to investigate the factors influencing the selection of anesthesiology by Postgraduate residents. In the first phase 36 postgraduates were administered a questionnaire to quantify the influencing factors. Chi-square tests (p<0.05) assessed gender associations. This was followed by a second phase in which in-depth interviews were conducted to get the qualitative insight of the first quantitative phase.

Results: Out of 36 residents of PGMIQ, 19 (53%) showed personal interest, 11 (31%) showed mentor influence as the primary motivating factor. As far as practice was concerned, 33(91%) preferred practice in academic facility and 26 (72%) were motivated to integrate research in their future practice. It was also noted that 33 (91.7%) were planning for specialization in subspecialities of anesthesia with significant gender association. The plan for future practice varied, 18(50%) were planning to pursue in same institution, 4(11%) wanted to move to different institutions but within the province, whereas 5(13.9%) intended to move to other provinces and 9(25%) wanted to leave for abroad. During Qualitative phase, four key themes were revealed. First theme was career motivation which was driven by global deficiency of anesthetists and lifesaving aspects of anesthesia during difficult procedures. Second theme emerged as the professional deterrent "inequity & dependency" which was supported by their response as poor remuneration, dependency on surgeon and stigmatized labels like "نشے والا ڈاکٹر". Thirdly, Systemic improvements were suggested, such as student mentorship and government support for subspecialties and equipment. Finally, Professional Standards emphasized the urgent need to ban unqualified practitioners to ensure patient safety and elevate the specialty.

Conclusion: Analysis revealed that the primary driving factor in selecting anesthesiology as a specialty was the residents' intrinsic fascination with the field, coupled with their desire to pursue a career in research and academia.

Objective: To explore the influence of combined endodontic-orthodontic treatment on the recovery of masticatory function in patients with crown-root fractures of permanent maxillary anterior teeth.

Methodology: This retrospective analysis included clinical data of 118 patients with crown-root fractures of permanent maxillary anterior teeth admitted to Yulin First hospital from March 2020 to March 2024. Among them, 56 patients who received conventional restoration treatment were set as the control group, and 62 patients who received combined endodontic-orthodontic treatment were set as the study group. The treatment effects, oral-related indicators before and after treatment [gingival index (GI), periodontal probing depth (PPD), tooth mobility (TM)], bite force, masticatory efficiency, and subjective satisfaction were analyzed.

Results: The total efficacy of the study group (95.16%) was higher than that of the control group (83.93%) (P < 0.05). After treatment, the levels of GI, PPD, and TM in both groups decreased compared to pre-treatment, and were considerably lower in the study group (P < 0.05). The excellent-good rate of bite force in the study group (93.55%) was higher than that in the control group (80.36%) (P < 0.05). Similarly, combined endodontic-orthodontic treatment was associated with a higher excellent-good rate of masticatory efficiency (93.55%) than that of the conventional restoration (78.57%) (P < 0.05). The subjective satisfaction in the study group (95.16%) was higher than that in the control group (82.14%) (P < 0.05).

Conclusion: The combined endodontic-orthodontic treatment for crown-root fractures of permanent maxillary anterior teeth can effectively improve the oral condition, enhance the bite force and masticatory efficiency, with higher treatment effects and subjective satisfaction. This approach may represent a promising treatment option for patients with crown-root fractures of permanent maxillary anterior teeth, pending further validation through prospective and multicenter studies.

Objective: To evaluate the clinical utility of serum inflammatory mediators in assessing the severity of sepsis and predicting patient prognosis.

Methodology: A retrospective analysis was conducted on 72 patients diagnosed with sepsis and admitted to the Tianjin Union Medical Center between January 2024 to January 2025, who were stratified into three groups based on disease severity: sepsis(n= 24), severe sepsis(n= 24) and septic shock(n= 24). An additional 24 individuals without sepsis were recruited as the control group. Within 24 hours of hospital admission, serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10) and heparin-binding protein(HBP) were measured, analyzed for their correlation with Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores and their predictive performance for 28-day mortality.

Results: Significant differences were observed in serum TNF-α, IL-10, HBP levels and APACHE-II scores across the four groups(all P< 0.05). All three sepsis subgroups showed significantly elevated levels of TNF-α, IL-10, HBP and higher APACHE-II scores compared with the control group (all P < 0.05). Moreover, a graded increase in these biomarkers and APACHE-II scores was observed across the sepsis subgroups, following the trend: septic shock > severe sepsis > sepsis, with all pairwise comparisons reaching statistical significance(P< 0.05, respectively). When stratified into survival and non-survival groups, the non-survivors exhibited significantly higher levels of TNF-α, IL-10, HBP and APACHE-II scores(P< 0.005, respectively).

Conclusion: Serum levels of TNF-α, IL-10 and HBP are positively correlated with sepsis severity. The combined measurement of these inflammatory mediators can provide a robust and objective approach for evaluating disease severity and predicting prognosis in patients with sepsis.

Objective: Our aim was to determine the changing anatomy of the retroperitoneal organs in the Unilateral Congenital Renal Agenesis (UCRA) and Renal Hypoplasia (RH) groups and to investigate the presence of morphological biomarkers by evaluating the functional capacity of the kidney in the patient groups.

Methodology: The study was conducted retrospectively at Istanbul Dr. Lütfi Kırdar City Hospital, in collaboration with the Departments of Radiology, Nephrology and Anatomy. CT images of individuals with UCRA and RH followed in the nephrology clinic were retrospectively reviewed and anatomical-topographic evaluations were performed. Biomarkers indicating renal function were obtained from laboratory test results. Statistical significance was accepted as p<0.05.

Results: The study included 18 individuals in the agenesis group, 30 in the hypoplasia group, and 25 in the control group. Compensatory hypertrophy was significantly observed in all renal morphometric measurements in the healthy side kidney. It was observed that the estimated glomerular filtration rate (eGFR) decreased from the control group to the agenesis group. The anteroposterior diameter of the inferior vena cava was narrower in individuals with CAKUT (n=48) than in controls (n=25) (CAKUT: 14.50±3.83, Control 17.10±3.80, p=0.007). Cortex thickness was positively correlated with eGFR and negatively correlated with creatinine in both the UCRA group and the HP group. The cortex thickness/mediolateral diameter ratio was negatively correlated with urea, uric acid, creatinine and positively correlated with eGFR.

Conclusions: A narrowing of the VCI-AP diameter was notable in patients with CAKUT. Cortical thickness was considered important in the assessment of renal function, and the ratio of cortical thickness to mediolateral diameter (Cx/ML) could be used as a potential reference.

Objective: CHA₂DS₂-VASc is a validated scoring system used to calculate the risk of stroke and thrombus in atrial fibrillation (AF) conditions. In this study, we aimed to evaluate the relationship between the development of postoperative atrial fibrillation (PAF) and CHA₂DS₂-VASc score in patients undergoing elective anatomical lung resection.

Methodology: In this retrospective cohort study, the records of patients who underwent elective anatomic lung resection at a single center between January 2015 to December 2024 were reviewed. The CHA₂DS₂-VASc score of all patients was calculated. Mann-Whitney U, Chi-square and ROC analyses, as well as binary logistic regression, were used for statistical analysis.

Results: Among one hundred patients (80 males), the incidence of PAF was 11%. Patients with PAF had significantly higher CHA₂DS₂-VASc scores (p<0.001). ROC analysis showed an AUC of 0.797 (p<0.001), with a cut-off of 1.5 yielding 90.9% sensitivity and 34.8% specificity. Logistic regression identified the CHA₂DS₂-VASc score as a significant predictor of PAF (OR=4.33, p=0.039).

Conclusion: The CHA₂DS₂-VASc score may be a valuable tool not only to assess thromboembolic risk but also to predict the development of PAF after thoracic surgery. With this scoring, high-risk patients can be identified in advance, appropriate prophylactic measures can be taken, and postoperative morbidity and mortality can be reduced.