Pakistan Journal of Medical Sciences最新文献

Objective: To evaluate the feasibility and safety of total laparoscopic hysterectomy (TLH) without uterine manipulator for patients with early-stage cervical cancer.

Methods: This study was based on retrospective analysis of clinical data of 72 patients with early-stage cervical cancer who received TLH treatment in Meizhou People's Hospital from January 2018 to December 2020. Of them, 40 patients underwent routine TLH (control group), and 32 patients received TLH without lifting the uterus using uterine manipulator (observation group). Changes in tumor marker levels, human papilloma virus (HPV) status, complications, and survival between two groups of patients were compared.

Results: There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). After the surgery, levels of squamous cell carcinoma antigen (SCC-Ag), carcinoembryonic antigen (CEA), and cancer antigen 125 (CA-125) in both groups of patients were significantly reduced compared to before the surgery, and significantly lower in the observation group compared to the control group at one and two years after the surgery (P<0.05). After three years of postoperative follow-up, there was no significant difference in cumulative survival rates between the two groups (P>0.05).

Conclusions: Compared with conventional laparoscopy, hysteroscopy without the use of uterine manipulators can significantly reduce the levels of SCC-Ag, CEA, and CA-125 in patients with early-stage cervical cancer within two years after the surgery, without increasing postoperative complications or affecting survival, and has the same safety.

Objective: In the past, brain stem was treated with surgery or placement of shunt in Pakistan. Gamma Knife surgery is currently an alternative to surgery for deep brain lesions. In the current study, we show the clinical experience of our Centre treated with Gamma Knife surgery.

Methods: This is a descriptive study conducted between February 2016 and October 2021. We had total 47 patients presented with focal brainstem gliomas which were selected for Gamma knife radiosurgery at the Neurospinal and Cancer Care Institute Karachi.

Results: Clinical Response was observed among them 20 (42.55%) patients improved, 22(46.80%) were stable, while 05 (10.63%) got worse The mean duration of symptoms was 31.9(SD10.5± 3months). Karnofsky Performance Status (KPS) scores during Gamma knife radiosurgery were 90 in 24 patients (51%), 80 in 21 patients (44.6%), and 70 in two patients (4.2%). Four patients (10.6%) had received conventional radiotherapy before Gamma knife radiosurgery.

Conclusion: Among the diverse gliomas, their peril varies not just by type but also by their intricate location within the brain. The efficacy of gamma knife radiation is excellent particularly when tackling high-grade tumors, exhibiting its prowess in both adult and pediatric cases.

Objectives: This study aims to find if any significant correlation exists between C-reactive protein and Neutrophil to Lymphocyte Ratio as an indirect measure of inflammation.

Methods: We selected 983 patients with any inflammatory condition who presented to a tertiary care hospital and were admitted in medical wards or Intensive Care Units (ICUs) of KRL Hospital Islamabad from December 2021 to December 2022. The study was a cross sectional study and convenience sampling was done. The patients were categorized into five groups depending upon their pathophysiology. Kolmogorov Smirnov test was used to assess the normality of the data, and Spearman's coefficient was used to calculate the correlation between NLR and CRP.

Results: A total of 983 patients were included. Mean CRP and NLR levels were 89.9±3.2 and 7.06±0.24, respectively. There was a significant positive correlation between CRP-NLR in the infectious, non-infectious non-inflammatory, and malignancy groups (0.420, 0.381, 0.642, p <0.01), and inflammatory group (0.322, p <0.05), and no correlation with chronic diseases.

Conclusion: A significant correlation was shown to exist between CRP and NLR in patients with malignancies, non-infective non-inflammatory, inflammatory, and infective conditions and can therefore be used interchangeably to detect the presence of inflammation. Further exploration of these associations may contribute to a more nuanced understanding of the intricate relationships between different markers of inflammation and response to treatment.

Objective: To investigate the effect of periodic nursing interventions on improving compliance behavior and health status in long-term hemodialysis patients.

Method: This was retrospective study. A total of 88 patients on long-term hemodialysis admitted to Qinhuangdao Haigang Hospital from January 2022 to April 2023 were randomly divided into the control group and the intervention group, who received routine hemodialysis nursing and periodic nursing interventions, respectively. Afterward, compliance behavior and health status were compared between the two groups, along with a comprehensive assessment of the health status using renal function indexes, complication rates, and anxiety and depression scores.

Result: Before nursing, no significant difference was observed in each index between the two groups (p > 0.05). After 16 months of nursing, the score of compliance behavior in the intervention group (88.68 ± 6.27) was significantly higher than that in the control group (70.91 ± 7.48) (p< 0.05), with the renal function indexes of BUN and SCr lower than those in the control group (p< 0.05). Meanwhile, the intervention group saw higher SAS and SDS scores than the control group (p< 0.05).

Conclusion: Periodic nursing interventions may effectively improve the compliance behavior and health status of patients, enhance the efficacy of hemodialysis treatment, and improve the quality of life of patients.

Objective: To investigate the efficacy and safety of refined nursing combined with Zhao's thunder-fire moxibustion in treating patients with gastric cancer (GC) of spleen-Qi deficiency syndrome.

Methods: This was a retrospective study. Ninety patients with GC of spleen-Qi deficiency syndrome admitted to Baoding Hospital of Traditional Chinese Medicine from February 2022 to March 2023 were randomly divided into the observation group and the control group. Patients in the control group were intervened with XELOX chemotherapeutic regimen + routine nursing. On this basis, patients in the observation group were additionally treated with refined nursing combined with Zhao's thunder-fire moxibustion. Changes in Traditional Chinese Medicine (TCM) syndrome scores, KPS scores for physical status, and quality of life (QOL) scores were observed and compared between the two groups before and after treatment.

Results: After treatment, the scores of anorexia, fatigue and weakness, postprandial abdominal bloating, loose stools, mental fatigue and laziness to speak decreased significantly in the two groups (P< 0.05), and each TCM syndrome score in the observation group was significantly lower than that in the control group (P< 0.05). After treatment, KPS and QOL scores in the observation group were significantly higher than those in the control group (P< 0.05). The overall nursing satisfaction was 93.3% (42/45) in the observation group, which was significantly higher than 71.1% (32/45) in the control group (P< 0.05).

Conclusion: Refined nursing combined with Zhao's thunder-fire moxibustion can alleviate the clinical symptoms of patients with GC of spleen-Qi deficiency syndrome, reduce chemotherapeutic-induced adverse reactions, with high clinical application value.

Objective: Lactate dehydrogenase (LDH) is an enzyme that is responsible for the production of lactic acid, which is a necessary byproduct when the body does not have enough oxygen. LDH levels in the blood can be used as a marker to predict mortality in patients with ARDS, severe COVID-19, and cancer. To analyze the clinical characteristics of COVID-19 in the elderly and the correlation between LDH and respiratory failure in COVID-19 patients, to improve the identification and management of this type of pneumonia by clinicians.

Methods: This was a single-center retrospective study. We performed routine laboratory tests in 105 COVID-19 patients admitted to the affiliated hospital of Qingdao University (Qingdao, China) from October 1, 2022 to February 1, 2023. The diagnosis of respiratory failure was established based on the results of blood gas analysis upon admission.

Results: The median age was 79 years. Among all univariable parameters, LDH, neutrophil to lymphocyte ratio (NLR) and Prothrombin Time (PT) were significantly independent risk factors of RF in elderly COVID-19 patients. LDH (AUC=0.829) also had a maximum specificity (96.5%), with the cutoff value of 280.5.

Conclusion: The levels of LDH, NLR, and PT may serve as potential indicators for elderly COVID-19 patients combined with respiratory failure. LDH, NLR and PT assays can be beneficial for patients who need closer respiratory monitoring and more aggressive supportive care to prevent a negative prognosis.

Objective: To evaluate the clinical effects of Esketamine combining Sufentanil in labor analgesia and their impacts on postpartum depression.

Methods: This was a retrospective study. One hundred and fifty primiparae with spontaneous labor were selected at SSL Central Hospital of Dongguan City from July 10, 2021 to May 10, 2022 as the research objects and randomly divided into two groups (each n=75). While the control group underwent epidural infusion of Sufentanil for analgesia, the study group was administered Esketamine combining Sufentanil. Compared analgesic effects, time of birth course, adverse reactions, pain intensity, scores assigned to depression and anxiety before analgesia and after delivery were made for pregnant women in both groups.

Results: The response rates of the study and control groups reached 100% and 93%, respectively, with statistically significant differences (p=0.02). The time of the first, second, and third stages of labor in the study group were all significantly lower than that of the control group; showing statistical significance (p=0.00). Regarding adverse reactions showed no statistically significant differences (p=0.44). Moreover, the study group showed noticeably lower pain intensity than those of the control group during delivery, 20 minutes and one hour after delivery; and their differences were statistically significant (p=0.00). After delivery, both the SAS and SDS of the study group were respectively lower than those of the control group, with statistically significant differences as well (p=0.00).

Conclusions: Applying Esketamine combining Sufentanil in epidural painless delivery produces rather favorable analgesic effects, shortens the time of the birth process, and improves postpartum anxiety and depression without leading to more adverse reactions.

Objective: To evaluate the clinical effects of intraperitoneal chemohyperthermia (IPCH) in the treatment of postoperative patients with advanced stage ovarian cancer, and its impacts on tumor markers and immune functions.

Methods: This is a retrospective study. One hundred and twenty patients with advanced stage ovarian cancer received in Shanghai 7th People's Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from May 10, 2022 to June 10, 2023 were selected and randomly divided into control and study groups (n=60 each group). Patients in the control group were administered routine intravenous chemotherapy, the study group underwent IPCH besides routine intravenous chemotherapy based on the control group. Comparatively analyzed the clinical effects, adverse reaction occurrence rates, and variations in relevant observation targets, the tumor marker after and before the treatment.

Results: Total efficacy in the study and control groups are proved to be with statistically significant differences. The occurrence of adverse reactions proved that no significant differences is seen between both groups. After the treatment, CEA, CA19-9, and CA125 levels in patients of the study group are apparently lower than those in the control group, showing statistically significant differences; expression levels of CD3⁺, CD4⁺ and CD4⁺/CD8⁺, in the study group were enormously above those in the control group after the treatment, with statistically significant differences.

Conclusions: IPCH has the potential to effectively enhance comprehensively clinical therapeutic effects among postoperative patients with ovarian cancer, significantly improve patients' immune states, and evidently reduce expression levels of various tumor markers.

Objectives: Following endoscopic detorsion, sigmoid volvulus (SV) recurs in 3%-86% of patients, approximately 13% of which are early recurrence presenting during the first admission period. Although semielective surgery is the traditional approach, elective surgery following repetitive endoscopy or percutaneous endoscopic sigmoidopexy (PES) are other alternatives in the management of early SV recurrence. Our aim was to discuss the role of semielective surgery in above-mentioned rare clinical entity.

Methods: Among our 1,076-case series, we retrospectively evaluated the records of 612 patients (56.9%) treated between June 1966 and June 1986, while we prospectively utilized the data of 464 patients (43.1%) managed between June 1986 and January 2024. We recorded the treatment option and prognosis for each patient.

Results: Early SV recurrence was determined in 34 (5.5%) of the 621 patients with successful nonoperative detorsion. We treated all of these patients by semielective surgery. The surgical procedures were detorsion in one patient (2.9%), mesopexy in 11 (32.4%), sigmoidectomy with primary anastomosis in 17 (50.0%), and sigmoidectomy with stoma in five (14.7%). In this series, mortality and morbidity rates were 2.9% (one patient) and 14.7% (five patients), respectively.

Conclusion: Semielective surgery is the traditional approach tried by most surgeons, which allows for the recovery of the general status of the patients, bowel preparation, and antibiotic prophylaxis. However, repetitive endoscopy followed by elective surgery or PES are current alternatives for some selected patients. Unfortunately, the relatively low effectuation rate of elective surgery following successful repetitive endoscopic detorsion and recurrence-related poor prognosis are still important handicaps of the latter procedure.