Pakistan Journal of Medical Sciences最新文献

Objective: To compare and analyze the clinical effectiveness of conventional puncture hematoma drainage and stereotactic robot-guided puncture hematoma drainage in managing intracerebral hemorrhage.

Methods: This is clinical comparative research. One hundred and twenty patients with the intracerebral hemorrhage who underwent puncture hematoma drainage in Baoding No.1 Central Hospital from March 2020 to May 2023 were included and were assigned into the control groups(n=60) and experimental groups(n=60) according to different treatment methods. The experimental group underwent stereotactic robot-guided puncture hematoma drainage, while the control group underwent conventional puncture hematoma drainage treatment. The duration and situation of surgery, levels of inflammatory factors, as well as preoperative and 1-week postoperative GCS scores and NIHSS scores were compared and analyzed between the two groups.

Results: In comparison with the control group, the experimental group exhibited considerably less surgical duration(p=0.00), higher amount of intraoperative blood drainage and hematoma clearance rate(p=0.00). The experimental group possessed a substantially more reduced incidence of complications(10%) in comparison with the control group(25%), with a statistically substantial distinction(p=0.03). After therapy, CRP, TNF-a, and IL-6 degrees were considerably more decreased (p=0.00) in the experimental group in comparison with the control group, while GCS grades were considerably more prominent and NIHSS grades were considerably more reduced (p=0.00).

Conclusion: Stereotactic robot-guided puncture hematoma drainage is a dependable and safe operative method to treat patients who had intracerebral hemorrhage, resulting in various benefits such as short length of operation, less injury, less inflammatory reaction, high hematoma clear efficiency and satisfactory recovery of neurological function.

Internal iliac artery aneurysms are a relatively uncommon condition that can have serious consequences if left untreated. This paper presents a case of erectile dysfunction caused by thrombosis of the internal iliac artery aneurysms in a 52-years-old male patient with common iliac and internal iliac artery aneurysms. Following the intracavernous self-injection treatment, the patient's complaints about erectile dysfunction ceased. Aneurysms were monitored closely. To the best of our knowledge, this represents the first case of erectile dysfunction being presented as a consequence of thrombosed iliac artery aneurysms. Erectile dysfunction itself is not a life-threatening condition. However, it should be highlighted that erectile dysfunction can be a sign of life-threatening iliac artery diseases, as in this case. Therefore, it is crucial to recognize the potential seriousness of this condition and to investigate it thoroughly.

Objective: To compare the clinical effects of applying a 3D-printed ACT titanium trabecular intervertebral fusion cage and a Polyetheretherketone (PEEK) cage in posterior lumbar interbody fusion (PLIF).

Methods: This was a clinical comparative study. Forty patients with degenerative lumbar diseases admitted at The Second People's Hospital of Dalian from January 2020 to December 2021 were selected and divided into an observation group (3D cage) and a control group (PEEK cage) using the random number table method, with each group of 20 cases. The visual analogue scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores, Cobb angles at fusion segments, intervertebral height and intervertebral fusion situations of the patients between the groups were compared.

Results: No significant differences were found in their operation time, intraoperative blood losses and operation related complications(p>0.05). In terms of postoperative VAS and JOA scores in both groups, they are all significantly improved compared with those before the operation, and their differences are also statistically significant(p<0.05). However, no statistical significance exists in inter-group differences(p>0.05). Postoperative Cobb angles and intervertebral height of patients in both groups are considerably bettered compared with those before the operation. Their differences show statistical significance(p<0.05), while inter-group differences are proved to be not statistically significant(p>0.05).

Conclusions: Applying a 3D-printed ACT titanium trabecular intervertebral fusion cage or PEEK cage in PLIF has the potential to improve clinical symptoms of patients with degenerative lumbar diseases, and restore the Cobb angle and intervertebral height. 3D-printed ACT titanium trabecular intervertebral fusion cage can accelerate intervertebral fusion without increasing operation related complications.

Infective endocarditis (IE) affects the endothelium of the heart, with the heart valves most commonly involved. It has been documented that the annual incidence of infective endocarditis is 3-10 per 100,000 patient-years1. However, it can be underestimated since the incidence in developing countries cannot be determined accurately. Here, we present a case of a 37-year-old male who was referred from a local health facility with shortness of breath on presentation; the patient was anuric for one day and initial laboratory investigations showed metabolic acidosis, hyperkalemia, sepsis, and deranged renal function tests. The patient had received a three-week course of intravenous (IV) piperacillin-tazobactam at the previous health facility, being diagnosed as a case of infective endocarditis. An initial transthoracic echocardiogram (TTE) showed vegetation on the pulmonary valve; however, the patient was neither an IV drug abuser nor did he have any history of implantation of intracardiac devices or central venous catheters. There was no recent or remote history of dental or surgical procedures. Due to the acute kidney injury, hemodialysis sessions and IV imipenem were started. As the patient's hemodynamic profile improved by the fifth day of admission, TTE was repeated, revealing a small ventricular septal defect (VSD). This case report highlights the importance of even small VSD that could potentially lead to right-sided IE. Surgical correction of VSD could prevent such a life-threatening condition.

Objective: To evaluate the clinical efficacy of novel titania-nanoparticle reinforced bonding agent on post-restorative sensitivity in patients.

Methods: This triple-blinded, randomized clinical trial included participants (n = 60) having Class- I and II cavitations with a minimum cavity depth of 3mm at Department of Operative Dentistry & Endodontics, School of Dentistry, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad from January 5, 2023, to June 20, 2023. They were randomly assigned into two groups A and B (n = 30). After informed consent, restorative intervention was accomplished using an etch-and-rinse adhesive strategy. In Group-A, titania-nanoparticle-incorporated bonding agent was used for composite restoration, while in Group-B, bonding agent without nanoparticles was used. The primary outcome was assessed using Visual Analogue Scale mean score. Participants were instructed to rate their sensitivity status at follow-ups: 24 hours, one week, and one month. Mann-Whitney U test was employed to compare sensitivity between the two groups.

Results: According to results of this trial, a significant difference was observed between two groups after 24 hours (p = 0.004) and one week (p = 0.002). However, no discernible difference was observed after one month (p = 0.643).

Conclusion: Post-restorative sensitivity in patients with composite restorations was reduced using titania-reinforced bonding agents as compared to bonding agents without nanoparticles. This shows that inclusion of titania nanoparticles into adhesive dentistry could be beneficial in resolving post-restorative sensitivity occurring with composite restorations.

Objective: This study aimed to assess the overall treatment response of Genotype-3 Chronic HCV Pakistani Patients with or without cirrhosis to Ledipasvir plus Sofosbuvir combination.

Method: In this observational study, HCV Genotype-3 patients were enrolled from Liver Center, DHQ Hospital, Faisalabad and divided into two groups, i.e., non-cirrhotic and compensated cirrhotic patients. The study spanned for a period of 24 months (November 2019 - November 2021) from the first enrollment to the last follow up. Non-cirrhotic patients received Ledipasvir/Sofosbuvir (LDV/SOF) 90/400mg for 12 weeks and cirrhotic patients received LDV/SOF with Ribavirin (RBV) for 12 weeks and without RBV for 24 weeks. The treatment efficacy in terms of sustained virological response (SVR12) was monitored 12 weeks post-treatment. The safety profile, and health-related quality of life (HRQoL) were monitored from baseline to follow-up visits.

Results: Two hundred and ninety out of 309 (93.85%) non-cirrhotic and 31 out of 33 (93.94%) compensated cirrhotic patients achieved SVR-12. The safety profile of the non-cirrhotic and compensated cirrhotic patients was comparable throughout the study duration. Fatigue was the most commonly reported adverse event (AE) in non-cirrhotic and compensated cirrhotic patients, followed by headache, nausea, and fever. The HRQoL improved from baseline to follow-up visits among patients of both groups.

Conclusion: It is concluded that LDV and SOF combination regimen is safe and effective for treating Genotype-3 HCV patients without cirrhosis/compensated cirrhosis, and also improves the patient's HRQoL.

Objective: To compare the mean residual gastric volume and gastric pH with standard and liberal fasting in children undergoing general anesthesia for elective procedures.

Methods: A randomized controlled trial (NCT05922072) was conducted at Department of Pediatric Surgery, Mayo Hospital Lahore from June 2021 to December 2021 and 120 patients undergoing elective daycare surgical procedures under general anesthesia were enrolled. Patients were divided into Group-A (Standard fasting) and Group-B (Liberal fasting). Group-A with 6-, 4- and 2-hours Nil per oral (NPO) for solids/ formula milk, breast milk and clear fluid, while Group-B with six, four and one hour NPO for solids/ formula milk, breast milk and clear fluid respectively. Residual gastric volume and pH were measured after anesthetizing the patient. Effect modifiers like age, gender, duration of anesthesia and procedure were controlled through stratification. Post-stratification, t-test was applied and p-value less than 0.05 was taken as statistically significant.

Results: In Group-A, mean age was 6.1±4.5 years and 6.4±4.6 years in Group-B. Mean residual gastric volume with standard fasting was 0.67±0.48 ml and liberal fasting 0.80±0.44 ml (p value 0.13). Mean gastric fluid pH with standard fasting was 1.72±0.78 as compared to liberal fasting 1.63±0.70 (p value 0.53).

Conclusion: Free fluid fasting allows for significantly shorter fasting times, though statistically insignificant higher residual gastric volume was recorded in liberal fasting group with a lower pH.

Objective: To compare linear distance of glenoid fossa to frontomaxillary nasal suture in skeletal Class-I and II malocclusions.

Methods: This cross-sectional study was conducted at the Department of Orthodontics, Altamash Institute of Dental Medicine, Karachi Pakistan. The duration of study was one year from January, 2019 to January, 2020. After taking informed consent from patient and hospital ethical committee a total of 60 patients were included in the study using WHO sample size calculator. Two groups comprising 30 patients each i.e., Skeletal Class-I malocclusion and Skeletal Class-II malocclusion with mandibular retrusion both having normal vertical relationship were included in the study. The cephalometric measurements SNA, SNB, SNMP, FHMP, GF-FMN, CO-GO, CO GN on lateral cephalograms were measured and compared between the two groups. Independent t test was applied and p value ≤ 0.05 was considered as significant.

Results: In skeletal Class-I malocclusion the mean linear distance of GF-FMN was 70.2 ± 4.02 mm and in skeletal Class-II malocclusion it was 73.4 ± 4.04 mm (p value .004). Glenoid fossa was 3.2 mm distally placed in patients with Class-II malocclusion.

Conclusion: Glenoid fossa position is a diagnostic feature of Class-II malocclusion associated with mandibular retrusion. One of the effective cephalometric measurements to check glenoid fossa position is the distance from the glenoid fossa(GF) to the frontomaxillary nasal suture FMN (GF-FMN).

Pulmonary embolism is a life-threatening emergency. Seizure as the clinical presentation of pulmonary embolism is extremely rare. In this case report a 47-year-old female had an episode of seizure after undergoing total abdominal hysterectomy with bilateral salpingo-oophorectomy due to myometrial uterine fibroids. The patient had no past history of seizure or cardiovascular disease. Based on raised D-Dimers and echocardiography a provisional diagnosis of pulmonary embolism was made, which was confirmed on CT angiogram that showed bilateral saddle pulmonary embolism. Clinicians need to be aware that Pulmonary embolism is a possibility as the differential diagnosis for unexplained, new-onset of seizure activity.