Pakistan Journal of Medical Sciences最新文献

Background & objective: Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) involving continuous colonic mucosal inflammation that leads to extraintestinal manifestations (EIMs) in many patients. Understanding the prevalence, patterns and factors associated with EIMs is vital for optimizing UC patient care, making this study essential for assessing EIM frequency, distribution and stratification.

Methodology: This observational, cross-sectional study was conducted at Jinnah Postgraduate Medical Centre in Karachi from June 2022 to November 2024, involving 147 UC patients. Prospective data collection was used to assess disease severity using the standard criteria. EIMs were classified according to their type. Statistical analysis included descriptive and inferential methods using chi-square tests with p <0.05.

Results: EIMs affected 53 (36.1%) patients, with musculoskeletal manifestations in 13(8.8%) and hepatobiliary issues in 12(8.2%). Ocular involvement was observed in 8(5.4%) patients, dermatological manifestations in 09 (6.1%), renal issues (nephrolithiasis) in 5(3.4%) and systemic problems in 6(4.1%). Gender, age and disease duration did not significantly correlate with the presence of EIM (p >0.05), but severity showed a significant association (p<0.05).

Conclusion: Extra-intestinal manifestations, especially musculoskeletal and hepatobiliary manifestations, are commonly found in ulcerative colitis. EIMs are correlated with disease severity and are not related to gender and age.

Objective: This study aimed to determine the frequency of adverse feto-maternal outcomes in patients with placental abruption.

Methodology: This descriptive case series was a study carried out in the Department of Obstetrics and Gynecology, Lady Reading Hospital, Peshawar between January 26, 2022 and July 26, 2022. The sample size of the study was 136 patients who had placental abruption, who were aged between 18 and 40 years, and were more than 24 weeks of gestation and any parity. The feto-maternal outcomes of these patients were compared.

Results: The mean age of the participants was 27.65 ± 6.27 years. The adverse maternal outcomes were acute tubular necrosis (8.8%), disseminated intravascular coagulation (19.1%), postpartum hemorrhage (27.9%), and maternal admission to ICU was detected in 7 (5.1%) patients. The maternal age was significant as associated with DIC (p < 0.05). Adverse fetal outcomes included intrauterine fetal death in 6 (4.4%), preterm birth in 30 (22.1%), low APGAR score in 33 (24.3%), stillbirth in 28 (20.6%), and admission to NICU in 29 (21.3%). The maternal demographic variables were significantly related to preterm birth (p = 0.03) and stillbirth (p < 0.05).

Conclusion: Our study identified the frequency of adverse fetal and maternal outcomes in patients with placental abruption. The fetal outcomes were intrauterine fetal death, pre-term births, low APGAR score, and stillbirth. The acute tubular necrosis, disseminated intravascular coagulation and postpartum hemorrhage were maternal outcomes.

Objectives: This study aims to evaluate the efficacy of body weight-supported treadmill training (BWSTT) combined with electrical stimulation (ES) in enhancing functional ambulation and lower limb strength.

Methodology: This single-center, multi-arm randomized controlled trial with a parallel group design was conducted from July 2024 to February 2025 at the Paraplegic Center Peshawar (PCP). Eighty-one patients with incomplete traumatic spinal cord injury (SCI) were randomized into three groups: (I) BWSTT + ES + Conventional Therapy (CT), (II) BWSTT + CT and (III) CT only. Interventions were conducted for 12 weeks, with assessments at baseline, 6 weeks and 12 weeks using Walking Index for Spinal Cord Injury (WISCI-II), 6-Minute Walk Test, 10-Meter Walk Test, lower extremity muscle strength (LEMS) and spinal cord independence measure (SCIM). Repeated-measures ANOVA and post-hoc analyses with Bonferroni adjustment were performed.

Results: All groups showed significant improvements in walking ability (WISCI-II) and functional independence (SCIM) (p < 0.001), with BWSTT + ES + CT demonstrating the greatest gains. At 12 weeks, this group had significantly higher WISCI-II scores than BWSTT + CT (p = 0.030) and CT only (p = 0.005). Strength and endurance improvements were greatest in the BWSTT + ES + CT group, but between-group differences were not statistically significant. Overall, the effects on the 6MWT, 10MWT, LEMS, and strength (measured via dynamometer) were higher in the BWSTT + ES + CT group; however, no significant differences were observed between groups.

Conclusion: All three groups demonstrated improvements in ambulatory function and functional independence over time, with the BWSTT + ES + CT group showing the greatest overall gains. . Combining BWSTT with ES and CT showed superior results in walking ability and functional independence in individuals with incomplete SCI, while strength and endurance improvements were similar across different rehabilitation approaches.Registration No. (Trial ID: 70844; IRCT ID: IRCT20230615058487N1).

Objective: To evaluate the outcome of medical consultations requested at the time of pre-operative anaesthesia assessment.

Methodology: After taking exemption from ethical review committee, this descriptive cross-sectional study was conducted for one year at our tertiary care center. All adult patients scheduled for elective surgeries required consultation from anaesthesia physicians were included. Relevant clinical data was recorded prospectively on predesigned Performa. Outcomes were categorized as risk stratification, optimizing medical management or postponement of surgical procedure.

Results: Among 264 patients (mean age 59.9 years, predominantly male, ASA III), hypertension, diabetes, and IHD were the common comorbid conditions. About 47% of these consultations were requested for intermediate risk procedures, while cardiology opinion was requested in (63%) of cases. Based on these consultations, 87.5% of patients received risk prediction, medical management was advised in 64% and in only 7.2% of patients the planned surgeries were postponed. Comparison between variables showed Myasthenia Gravis (50%), Pulmonary embolism (33%) and IHD (30%) were the common reasons of falling into high-risk group. Most patients with Asthma (69%), IHD (68%) and Hypothyroidism (52%) required medical intervention preoperatively (p = 0.496). IHD was mainly responsible for the reason of delaying surgery (13.6%). Similarly, 69% of cardiac consultations ended up with case postponement, and 53.5% of patients were advised with medical management (p = 0.001).

Conclusion: The substantial disease burden and proposed risk stratification including recommendations regarding medical optimization justified the need of preoperative consultations in our patient populations. However, their impact on improving postoperative outcomes requires further evaluation.

Objective: To explore the correlation between the frequency of circulating double-negative T cells (DNT) and clinical outcomes of tumor immunotherapy in non-small cell lung cancer (NSCLC) patients.

Methodology: We conducted a retrospective, single-center study at Qingdao Central Hospital, China (from October 2020 to February 2023) involving a cohort of patients with advanced-stage NSCLC who received PD-1-targeted therapies. A basal and longitudinal analysis of peripheral DNT cells was performed on this cohort. The frequency and effector phenotypes of circulating DNT cells were examined using flow cytometry . The cytotoxicity of DNTs was assessed using DELFIA EuTDA cell cytotoxicity assay kits.

Results: Flow cytometry analyses showed a marked reduction in circulating DNTs in patients with late-stage (III/IV) NSCLC compared to those with early-stage (I/II) disease. Interestingly, we observed an increase in Ki-67+ DNT cells in approximately 57% (29/51) of late-stage NSCLC patients following the first cycle of anti-PD-1 treatment, and these proliferating DNT cells exhibited effector-like phenotypes and enhanced cytotoxicity towards the lung adenocarcinoma cell line A549. Notably, 70.27% (26/37) of patients who experienced clinical benefits showed a responsive DNT cell profile within four weeks of starting therapy, but not 82.35% (14/17) of patients who developed disease progression. Strikingly, patients with early proliferative DNT cell responses had a longer overall survival (OS) than non-responders. The frequency of DNTs was positively correlated with a good clinical prognosis in patients receiving anti-PD-1 therapy.

Conclusion: Analysis of pre- and post-treatment DNT cells revealed that a higher DNT cell count was associated with better prognosis. Our findings suggest that peripheral DNT cells may serve as valuable biomarkers for monitoring clinical responses in NSCLC patients undergoing anti-PD-1 therapy.

Objective: The aim of this study was to investigate the efficacy of intensified sensory therapy on upper extremity functions, daily activity and life quality of stroke survivors (SS).

Methodology: This randomized controlled trial included 30 chronic SS (18 males - 12 females) who were treated at Kocaeli University Hospital, Department of Physical Medicine and Rehabilitation between May 2022 and September 2022. Participants were randomly assigned to a Sensory-Training Group (STG; n = 15; mean age= 59.07±12.73 years) and a Control Group (CG; n = 15; mean age= 56.53±13.80 years). Both groups received 15 sessions of 30 minutes of physical therapy, occupational therapy (OT), and 20 minutes of activity daily living (ADL) training for three weeks. The STG also received intensified sensory therapy during each session. Thumb localization, finger shift, and stereognosis tests were performed in both groups only before the start of treatment. The Jebsen Taylor Hand Function Test (JTHFT), Modified Frenchay Scale (MFS), Canadian Occupational Performance Measure (COPM), Goal Attainment Scale (GAS), and Stroke Specific Quality of Life Scale (SS-QOL) were administered before and after treatment.

Results: A statistically significant difference was found between STG and CG in all parameters of the MFS, JTHFT, COPM (performance and satisfaction), GAS, and all parameters of SS-QOL except for the language, thinking, and seeing parameters.

Conclusion: These results suggest that sensory therapies applied with conventional treatments increased upper extremity functions, ADL performance, participation rate and quality of life of the SS. Clinical Trials Registry: NCT05133219.

Objectives: Th research examines how AI perception (AIP) affect psychological distress of healthcare professional in Kingdom of Saudi Arabia (KSA). The study also investigates the moderating role of technology readiness (TRD).

Methodology: This research adopts cross-sectional design. A self-administrative, close ended, survey was used to collect primary data. Total 411 healthcare professionals voluntarily participated from public hospitals of the Hail Health Cluster, in KSA. The survey was carried out through convenience sampling method. Data was processed through SPSS 27 version. Analysis consisted of demographic summary, descriptive analysis and regression analysis through Hayes process.

Results: A total of 411 healthcare professionals participated, with the majority being male (60.8%) and aged 36-45 (41.4%). Additionally, the descriptive statistics revealed adequate reliability for all variables including AIP, DASS-21 and TRD. Moreover, the regression analysis showed that AIP significantly influenced DASS-21 (β = -0.2194, p = 0.0099). Finally, the TRD strengthen the negative impact of AIP on DASS-21 (β = 0.1547, p = 0.0000). The model's R-Square values indicated a strong fit, with significant improvements in prediction.

Conclusion: The study highlights that AI perception significantly impacts psychological distress, particularly Depression and Anxiety, among healthcare professionals. While technology readiness significantly strengthens this relationship. Future research should explore other potential moderating factors, such as organizational support, to further understand the impact of AI perception in healthcare settings.

Objective: To consider empirically how authentic leadership (AL) effects burnout experience (BE) and the employee turnover intention (TI) in healthcare settings.

Methodology: This study followed a cross-sectional design. Furthermore, a close-ended, online survey was conducted between March to May, 2025. It concludes with the data collection from 318 healthcare professionals. The participants mainly include doctors, and nurses at leadings hospitals in Ha'il region of Kingdom of Saudi Arabia (KSA). Finally, the analysis of data includes descriptive statistics, reliability analysis, correlation matrices, regression analysis and diagnostic tests. All of these analyses were performed using SPSS 27 version.

Results: The descriptive summary volunteer participants showed that majority of them are predominantly female (e.g., nurses). Most of these participants were aged between 31-40 years and holding bachelor's qualifications. Moreover, empirical results from regression analysis revealed some interesting relationships. For example, the results indicate that AL is positively linked with BE (β = 0.0374, p = 0.006). However, a negative impact was also found for TI (β = -0.2805, p < 0.001). The model was statistically fit and provide a reasonable explained variations for BE (R ² = 0.0241, F = 7.81, p = 0.006). and TI (R ² = 0.1035, F = 36.51, p < 0.001).

Conclusion: The study concludes a strong positive impact of AL on BE while a strong negative impact of AL with TI. These results suggested a strong effort from the leadership is necessary to enhance the retention and wellbeing of employees in healthcare setting. Finally, studies can be made to further examine the cultural and organizational factors that may moderate these impacts.

Objective: To investigate the correlations between the serum levels of lactate dehydrogenase (LDH), β₂-microglobulin(β₂-MG) and free light chains (FLCs) and the prognosis of patients with multiple myeloma (MM).

Methodology: This retrospective study included a total of 180 cases, among 80 patients diagnosed with MM(MM group) at Affiliated Hospital of Hebei University between January 2020 to January 2024 and 100 healthy individuals(control group) undergoing routine physical examinations during the same period. Prognosis was assessed using the Eastern Cooperative Oncology Group (ECOG) performance status scale. Serum levels of LDH, β₂-MG and FLCs were compared among the three groups and the relationships between these biomarkers and the clinical characteristics of MM were analyzed.

Results: Compared with the control group, the MM group exhibited significantly higher levels of LDH, β₂-MG and FLCs(P< 0.05, respectively). In patients with MM, elevated serum levels of these biomarkers were significantly associated with advanced age(> 60 years), high ECOG scores(> 3) and advanced Durie-Salmon(DS) stage(stage III). Notably, significantly higher levels were observed in female patients, those with severe anemia and those with the immunoglobulin G IgG subtype of MM (P < 0.05, respectively). Patients in the PP group had significantly higher levels of LDH, β₂-MG and FLCs compared with the FP group(P< 0.05, respectively).

Conclusion: Elevated serum levels of LDH, β₂-MG and FLC are risk factors for poor prognosis in patients with MM. Combined assessment of these three biomarkers may improve clinical evaluation and prognostic stratification.