Pakistan Journal of Medical Sciences最新文献

Objective: To determine the frequency and determinants of Hypoferritinemia without anemia (HWA) among women of reproductive age in Lahore, Pakistan.

Methodology: This cross-sectional study was conducted in four tertiary-care hospitals and their adjoining areas. Using simple random sampling, 1,347 women between the ages of 18-45 were selected. Patients from hospital OPDs who met the eligibility criteria and provided informed consent were selected to participate in the study. A structured questionnaire was filled out for each participant and blood samples were collected for CBC and serum ferritin evaluation.

Results: HWA was present in 399 (29.6%) of the participants. Lethargy/feeling of tiredness was the most common symptom (90.7%). Regression analysis showed that rural residence (AOR = 3.04, p = 0.016), unemployment (AOR = 3.54, p = 0.004), use of medication (AOR = 15.02, p < 0.001), heavy menstrual bleeding: including duration >7 days (AOR = 7.49, p < 0.001), and use of > 2 pads/day (AOR = 3.21, p = 0.040), low meal frequency (<2/day) (AOR = 9.45, p < 0.001), breakfast skipping (AOR = 4.67, p = 0.029), and low dietary diversity (AOR = 3.29, p = 0.003) remained significant predictors of HWA.

Conclusion: Hypoferritinemia without anemia was prevalent among participants, with lethargy as the primary symptom. Residing in a rural area, being unemployed, use of medication, prolonged menstrual days, and poor dietary intake all significantly raised the risk of HWA. These results show that vulnerable groups need more targeted nutritional education, reproductive health awareness, and better access to health care.

Objective: This study investigates the correlation of TLR4 rs2149356, LTA rs2229094 and RFP175 rs1585110 genes single nucleotide polymorphisms (SNPs) with invasive bacterial infections (IBIs) in neonates and young infants.

Methodology: We conducted a prospective, case-control study at Ege University Faculty of Medicine, Izmir, Turkiye, between January 2021 to December 2023. Infants under 90 days of age admitted with confirmed IBIs (cases) or non-infectious conditions (controls) were included. Genomic DNA was extracted from peripheral blood samples and next-generation sequencing was used to analyze selected SNPs in TLR4, LTA and RFP175 genes. Clinical and demographic characteristics, as well as SNP frequencies, were compared between groups.

Results: A total of 200 infants were enrolled (100 cases, 100 controls). Most infections were urinary tract infections (n=84), 84%), with smaller numbers of gastroenteritis (n=6, 6%), bacteremia (n=5, 5%), pneumonia (n=3, 3%), and meningitis (n=2, 2%). No significant differences were found in clinical characteristics or SNP frequencies between groups.

Conclusions: This study found no association between the investigated SNPs in TLR4, LTA and RFP175 and susceptibility to IBIs in infants under three months. Larger studies are needed to clarify the genetic contribution to early-life infections. Clinical Trial Registration: NCT06985160.

Objective: To evaluate the serum concentrations of Aquaporin 1-3, which are thought to be critical modulators of water transfer, and risk factors affecting them in neonates.

Methodology: This prospective study was conducted in term neonates in a research hospital, from October 2023 to October 2024. Demographic data of infants and mothers were collected and high risk neonates were excluded. The neonates were divided into three groups based on birth weight percentiles as small for gestational age, appropriate for gestational age, and large for gestational age. Umbilical cord blood samples were obtained by umbilical artery puncture and blood gases, hemoglobin, Na, K, Cl, glucose, insulin, Aquaporin 1-3 were measured. The relationship between Aquaporin levels and risk factors was analyzed.

Results: A total of 85 healthy term neonates were included in our study. The mean gestational age and birth weight of infants were found as 38.2 ± 1.1 weeks and 3245 ± 749 g. The mean Aquaporin 1-3 levels for all infants were found as 11.1 ± 5.6 and 22.8 ± 11.6 ng/ml, respectively. There was a strong correlation between Aquaporin 1-3 levels (r = 0.769). No significant difference was found in Aquaporin levels in terms of birth weights, but Aquaporin 1 levels of infants born by cesarean section were significantly higher than those born vaginally (p = 0.02).

Conclusions: In this study, we determined serum Aquaporin 1-3 levels in term neonates and found that serum levels increased in cesarean-born infants, especially Aquaporin 1. These results provide preliminary reference values for serum Aquaporin 1-3 in term neonates and suggests a possible association with the mode of delivery.

Background and objective: Meningiomas follow schwannoma as the second common space occupying lesions (SOL) in the cerebellopontine angle (CPA). Tissue-based differences in outcomes for these neoplasms using retrosigmoid approach have not been studied previously. We aimed to evaluate tumor characteristics and surgical outcomes based on tumor histopathology.

Methodology: This retrospective observational study was conducted at the Department of neurosurgery in Punjab Institute of Neurosciences, involving consecutive, single-surgical team led cases of CPA space occupying lesions (SOL) between 2021 and 2024. Chi-square test was used to determine any significant differences between Schwannomas and meningiomas in terms of tumor consistency, vascularity, extent of resection and postoperative complications. Fischer's exact test was applied when expected cell counts were low.

Results: Of the hundred patients included, 63 were the cases of Schwannoma and 37 were meningioma of CPA. A male preponderance of 57.1% (36) with an overall mean age of 37.7±13.4 years was noted in the Schwannoma group. Contrastingly, 56.8% patients were females with an overall mean age 39.3±13.1 years in the meningioma group. A significant association in occurrence of postoperative facial nerve weakness and loss of gag reflex between Schwannomas and meningiomas was seen i.e., χ²(1)= 6.52 p = 0.007 and χ²(1) = 12.94, p = 0.000, respectively (with significant results for Fischer exact test as well i.e., p<0.05). Gross total resection was achievable in 88.9% (56) cases of Schwannoma and 100% (37) of meningioma, but no significant differences in tumor consistency, vascularity and extent of resection were observed between Schwannomas and meningiomas i.e., χ²(2)= 5.40 p= .067, χ²(3)= 5.89 p= .117 and χ²(2)= 4.42 p= 0.11, respectively.

Conclusion: Schwannomas were more likely to have postoperative facial nerve weakness and loss of gag reflex in comparison to meningiomas. However, there are no significant differences between Schwannomas and meningiomas in terms of tumor consistency, vascularity and extent of resection.

Cerebellopontine angle (CPA) is an anatomical space of posterior cranial fossa bounded by tentorium superiorly, pons and cerebellum posteriorly and temporal bone anterolaterally. Glial cell tumors are located frequently in the cerebral hemispheres, while vestibular Schwannoma, meningioma and epidermoid cysts frequently affect the CPA. Low-grade gliomas (LGGs) presenting as a space occupying lesion (SOL) in cerebellopontine angle (CPA) is an extremely rare occurrence. This study reports a 43-year-old female, with no comorbidities, who presented with the chief complaints of headache and walking difficulty for six weeks, associated with left-sided facial numbness and hearing impairment. Neuro-imaging revealed left CPA SOL, which was excised via retrosigmoid craniectomy. Pathological work up was suggestive of diffuse low-grade glioma. The development of atypical SOLs, like glioma in this case, should be considered in the differential diagnosis of cerebellopontine angle tumors. The standard treatment is maximum safe resection in case of LGGs with serial neuroimaging and adjuvant management.

Objective: To compare surgical outcomes and quality of life following the endoscopic supraorbital eyebrow approach (ESOA) versus the microscopic subfrontal approach (MSFA) for anterior cranial fossa (ACF) tumor excision.

Methodology: This retrospective comparative study analyzed 48 patients (24 per group) who underwent ACF tumor excision at the Department of Neurosurgery, Unit-III, Punjab Institute of Neurosciences between 2022 and 2024. A total of 48 patients meeting the inclusion criteria were enrolled based on convenience sampling. Patient demographics, tumor characteristics, surgical parameters, complications, and quality of life outcomes were compared between groups using appropriate statistical tests.

Results: Both groups had comparable demographics, tumor sizes, and pathology distributions (predominantly meningiomas). ESOA procedures demonstrated significantly shorter operative durations (226±54 vs. 323±72 minutes, p<0.001), reduced blood loss (219.6±72 vs. 459.2±160 mL, p<0.001), and decreased hospital stays (6.6±3.2 vs. 11.6±5.1 days, p<0.001). Gross total resection rates were similar between groups (ESOA: 50.0% (12) vs. MSFA: 45.8% (11), p=0.78). While CSF leak and wound infection rates were lower in the ESOA group, only the difference in supraorbital numbness reached statistical significance (ESOA: 95.8%(23) vs. MSFA: 50.0%(12), p<0.001). Quality of life scores were significantly higher in ESOA patients (ASBQ score: 82.0±10.2 vs. 63.6±12.4, p<0.001), with better performance in social activities, reduced pain, and faster return to routine activities. Tumor recurrence rates were comparable during the 14-month median follow-up period.

Conclusion: The endoscopic supraorbital approach enhances surgical efficiency, minimizes invasiveness, shortens hospital stay, and improves quality of life, offering comparable resection outcomes and serving as a viable option with careful patient selection.

Leiomyosarcoma is a rare and aggressive malignant neoplasm arising from smooth muscle cells, commonly affecting the uterus, gastrointestinal tract, or retroperitoneum, with paraspinal involvement being extremely uncommon. Clinical symptoms include back pain, weakness, and sensory deficits due to spinal cord compression. We present a 49-year-old woman with bilateral lower extremity weakness for 15 days, lower back pain, and a left paraspinal swelling for two months. Examination showed a tender lumbar paraspinal mass, paralysis below T10, and saddle anesthesia. MRI with contrast showed large left paraspinal soft tissue mass, confirmed as grade 2 leiomyosarcoma on biopsy. Complete tumor excision was done, and postoperative recovery was uneventful. This report highlights an unusual presentation of primary lumbar paraspinal leiomyosarcoma without regional or distant metastasis in a middle-aged woman, emphasizing the importance of thorough evaluation to exclude potential primary sites. Diagnosis relies on biopsy with immunohistochemistry, while surgical excision remains the mainstay of treatment.