Pakistan Journal of Medical Sciences最新文献

Objective: To explore the effects of hybrid blood purification on nutritional status and cardiovascular events in patients with end-stage renal disease (ESRD).

Methods: A total of 135 patients with ESRD who received treatment in The Affiliated Nanhua Hospital of Hengyang Medical School from March 2021 to June 2023 were included in this retrospective study. Of them, 66 patients were treated with hemodialysis purification (hemodialysis group), and 69 patients underwent hybrid blood purification (hybrid group). Renal function status, inflammatory cytokine levels, nutritional status, and incidence of cardiovascular events in two groups were compared.

Results: After the treatment, levels of urea nitrogen and blood creatinine in both groups decreased compared to before the treatment, and was significantly lower in the hybrid group compared to the hemodialysis group (P<0.05). Serum levels of interleukin 6 (IL-6), high sensitivity C-reactive protein (hs-CRP), and tumor necrosis factor α (TNF-α) in both groups decreased compared to before the treatment, and were significantly lower in the hybrid group (P<0.05). Levels of hemoglobin (Hb), albumin (Alb), and serum ferritin (SF) in both groups increased compared to pretreatment levels, and were significantly higher in the hybrid group (P<0.05). The incidence of cardiovascular events in the hybrid group (2.90%) was lower than that in the hemodialysis group (11.59%) (P<0.05).

Conclusions: Hybrid blood purification can improve nutritional status and renal function of patients with ESRD, downregulate the expression of inflammatory factors, reduce the degree of inflammatory response, and reduce the risk of cardiovascular events.

Objective: This study examined the potential link between maternal pre-pregnancy body mass index (PPBMI) with neonatal outcomes in twin pregnancies.

Methods: This retrospective analysis records of 1,270 women with twin pregnancies, delivered at the Fujian Maternity and Child Health Hospital between 2019 and 2021, were retrospectively analysed. Women were diagnosed as underweight, normal BMI, and overweight/obese according to their PPBMI. Neonatal outcomes included low birth weight (LBW), intrauterine growth retardation (IUGR), prematurity, neonatal intensive care unit (NICU) admission, neonatal mortality, and low APGAR scores. Univariate and multivariable regression analyses were performed.

Results: The proportions of neonates with LBW, IUGR, prematurity, and NICU admission were 34.7%, 2.5%, 27%, and 30%, respectively. Five neonatal deaths occurred, all born to mothers with normal BMI. Low APGAR scores at five minutes were observed in one neonate in the maternal overweight/obese group and one neonate in the normal maternal BMI group. Multivariate regression analysis showed that underweight women had an approximately twice higher risk of delivering LBW twins (OR 1.88, 95% CI: 1.26, 2.89) than women with normal BMI. No statistically significant associations were found between maternal BMI and other neonatal outcomes.

Conclusion: Low PPBMI increases the risk of delivering LBW twins, independent of other factors. Our findings emphasize the importance of pre-pregnancy nutritional status in optimizing neonatal outcomes in twin deliveries.

Objective: The survival benefit of venoarterial Extracorporeal Membrane Oxygenation (ECMO) for the management of acute high-risk pulmonary embolism (PE) remains unclear. This meta-analysis combines data from comparative studies to assess the risk of mortality after ECMO vs standard care in the management of acute high-risk PE.

Methods: Databases of PubMed, CENTRAL, Scopus, Web of Science, and Embase were searched from 01^st January 2000 to 24^th March 2023 for comparative studies with at least 10 patients/group comparing ECMO vs standard treatment. PRISMA guidelines were followed for this review. We extracted mortality data and combined it to obtain the outcome as risk ratios (RR) with 95% confidence intervals (CI) in a random-effects model.

Results: Ten studies were included. Meta-analysis showed that the risk of early mortality was not significantly different between ECMO and non-ECMO groups (RR: 0.97 95% CI: 0.78, 1.19 I²=73%). No change in significance was noted on subgroup analysis based on study location, sample size, cardiac arrest, systemic thrombolysis, and surgical embolectomy.

Conclusion: Limited evidence derived from mostly retrospective studies riddled with selection bias suggests that ECMO may not offer additional survival benefits in high-risk PE.

Background & objective: Currently, there are many implants in clinical use, making it hard to choose the right one for the patient. The success rate of an implant depends on its diameter, length, and direction of insertion in bone. In implant dentistry, Finite Element Analysis (FEA) simulates intraoral conditions in vitro and analyzes the effects of implant material, diameter, size, and other components related to oral structure on the implant and peri-implant tissues. The objective of the present systematic review was to evaluate the influence of variation in Dental Implant dimensions on Peri-implant Bone Stress/strain distribution, where Finite Element Analysis (FEA) is used as a method of analysis.

Method: Research papers published in PubMed, EBSCO, Web of Science, MEDLINE, CINAHL database from January 2012 until December 2022 using the keywords, (finite element analysis) AND (dental implant) AND (length) AND (diameter). The modified CONSORT checklist was used to assess the quality of the included research.

Result: Total hits from the original search were 402 (PubMed:127, Web of Science: 135 and CINHAL:22, EBSCO: 96, ProQuest:22). After duplicates were removed and titles and abstracts were screened, 371 articles were (n =371) selected for review. Of these, 342 were excluded and removed after initial screening, and 33 entire texts met the initial eligibility as per inclusion criteria. Four articles were further excluded in the final eligibility process and a total of 31 in vitro study articles were included for qualitative synthesis.

Conclusion: The evidence from the most recent literature suggests that the use of FEA showed promising results in understanding the stress distribution surrounding the implant. It was discovered that the material of the dental implant and the prosthesis, the type of loading, the direction and magnitude of force (axial or non-axial), the quality and quantity of the bone that surrounds the implant, as well as other factors, all play a role in the maintenance of bone around dental implants.

Objective: To investigate the correlation between endometriosis (EMs) severity and placenta accreta spectrum (PAS) risk in the subsequent pregnancy.

Method: Clinical records of 2,142 patients who underwent laparoscopic surgery for EMs at Fujian Provincial Maternal and Child Health Hospital from January 2014 to January 2018, who had achieved pregnancy and were delivered, were analyzed. Baseline data, EMs stage, The Revised American Fertility Society (R-AFS) score, levels of serum indexes, and pregnancy and neonatal outcomes were recorded. The outcome of interest was the occurrence of PAS. The correlation between the R-AFS score, endometriosis staging, and PAS was explored, and the R-AFS threshold was identified.

Results: PAS was associated with a higher incidence of chronic pelvic pain (OR = 8.68, 95% CI: 1.18-45.79, P = 0.014) and infertility for >five years (OR = 2.5, 95% CI: 1.35-4.65, P = 0.003), elevated serum levels of cancer antigens, higher incidence of postpartum hemorrhage, and placenta previa (P < 0.05). PAS rate was higher in women with higher EMs staging and R-AFS score and ovarian EMs combined with deep infiltrating endometriosis (DIE) (P < 0.001). After adjusting for confounders, both R-AFS score (AOR = 1.02, 95% CI: 1.01-1.03, P < 0.001) and ovarian EMs with DIE (AOR = 3.31, 95% CI: 1.54-6.67, P = 0.001) were independent risk factors for PAS. R-AFS score of 29 was identified as a threshold for an increased risk of PAS.

Conclusion: The risk of PAS in patients with endometriosis increases with the R-AFS score. PAS is more likely to occur in women with ovarian EMs combined with DIE. It is necessary to implement a specific monitoring program during pregnancy in patients with a history of severe EMs.

Objective: The objective of the study was to assess whether the measurement of the angle of progression in nulliparous women in labour can predict the mode of delivery.

Methods: This prospective observational study was conducted at Benazir Bhutto Hospital, Rawalpindi Medical University from 16^th February to 25^th March 2024. Nulliparous pregnant women in the active first stage of labour with singleton pregnancy and cephalic presentation were included in the study after taking informed consent. The angle of progression (AOP) was measured by trans-perineal ultrasound using the curvilinear probe. The primary outcome was the mode of delivery in relation to angle of progression.

Results: Seventy-eight patients were included in the study. Angle of progression was wider in patients who underwent vaginal delivery and narrower in patients who underwent cesarean section. AOP of 121 or more is associated with 86.6% of vaginal delivery and an angle of progression of 70 or less is associated with 83.3% of cesarean section.

Conclusion: The angle of progression is a reliable tool for predicting the mode of delivery. Wider angle is associated with vaginal delivery and a narrower angle is associated with cesarean section.

Objective: To observe the fetomaternal outcome of therapeutic versus prophylactic blood transfusions in patients with sickle cell disease (SCD) during pregnancy.

Method: This single-center retrospective observational study was conducted on consecutive pregnant women with SCD between January 2018 and December 2020. All the pregnant women with SCD were included in this study. Sickler women carrying sickle cell traits (HbAS, HbAC), multiple pregnancy, or other medical diseases were excluded from the study. We used non-random, convenience sampling and collected their demographic details, medical history, course of SCD before & during pregnancy, maternal/fetal outcome, laboratory parameters, and other information using the questionnaire. Patients were sub-grouped into three according to blood transfusion categories (therapeutic, prophylactic, or not transfused) during the pregnancy. Descriptive data were represented as numbers and mean ± SD values. The medical and obstetrical complications and fetomaternal outcomes among the three groups were analyzed by Chi-square/Fisher's Extract test.

Results: The study included 62 patients, 37 were in the therapeutic group, 11 were in the prophylactic group, and 14 were in the non-transfusion group. Hemolytic crises, painful crises, acute chest syndrome, pregnancy-induced hypertension (PIH), preeclampsia, preterm births, intrauterine growth retardation (IUGR), and neonatal ICU admission were significantly lower among the prophylactic group (P = 0.000, p = 0.000, p = 0.001, p = 0.002, p = 0.009, p = 0.007, p =0.001 & p= 0.016 respectively) compared with other two groups.

Conclusions: Our study demonstrates that prophylactic blood transfusion in SCD positively alters the course of pregnancy by reducing fetomaternal complications.

Kounis syndrome also known as allergic myocardial infarction, represents the simultaneous occurrence of acute coronary syndromes with allergic or hypersensitivity reactions. We present a case of a 58-years-old male who developed anaphylaxis following a leech bite, leading to myocardial infarction despite the absence of prior allergic history. He was entubated and cardiopulmonary resusciation had been performed for 10 minutes. The patient was successfully resuscitated and Intravenous antihistamine, prednisolone and adrenaline were given. The patient was stabilized and transferred to the intensive care unit and coronary angiography was performed, which revealed a 90% stenosis in the circumflex coronary artery. A stent was successfully implanted in the affected artery. This report emphasizes the complexity of diagnosing and managing Type-II Kounis syndrome and highlights the need for increased clinical awareness.

Background & objective: To assess the association of assisted reproductive technologies (ART) conception with postpartum hemorrhage (PPH) during the peripartum and postpartum periods.

Methods: Clinical records of 11,497 patients enrolled in Fujian Maternity and Child Health Hospital between March 2013 and December 2018 were retrospectively analyzed and divided into the ART group and the natural conception group based on the mode of conception. The incidence of PPH and blood loss at 30, 60, 90, and 120 minutes after delivery were compared.

Results: Clinical records of 2527 patients with ART-derived and 78,970 patients with spontaneous pregnancies, who delivered at Fujian Maternity and Child Health Hospital between March 2013 and December 2018, were included. The incidence of PPH (2.53%vs 1.58%, P < 0.001) was greater in the ART group than in the natural conception group. ART was associated with significantly higher rates of PPH both in women who delivered vaginally and by cesarean section (P < 0.001). Similarly, blood loss during the delivery stage was greater in the ART group than in the naturally conceived group, regardless of the mode of delivery (P<0.001). Among women who delivered vaginally, blood loss was greater in the ART group at 30 minutes and 60 minutes after the delivery. However, blood loss at 90 and 120 minutes after the delivery was comparable in all groups, regardless of the mode of delivery.

Conclusion: The use of ART was associated with poorer maternal outcomes, including increased incidence of PPH and higher blood loss at 30 and 60 minutes after the delivery.