Pakistan Journal of Medical Sciences最新文献

Objective: To analyze the impact of a visiting consultant pediatric neuro-oncologist on the outcome of pediatric patients with brain tumors in a health care system with no consultant pediatric neuro-oncologist.

Methodology: This retrospective study was conducted at the Punjab Institute of Neurosciences, Lahore, Pakistan, involving pediatric patients with brain tumors from January 2023 to January 2025. Patients were assessed by a visiting pediatric neuro-oncologist. These patients were followed for one year, and outcomes were observed.

Results: This study included 45 patients who were assessed by a visiting neuro-oncologist; 82.22% (37) underwent craniotomy and excision, and 8.89% (4) had a biopsy. In histopathology, the most common tumor was glioma, with 37.78% (17) of patients, and 24.44% (11) were referred for adjuvant therapy by the visiting neuro-oncologist. After a one-year follow-up, 13 patients were lost to follow-up (LTFU) during their treatment, with an overall LTFU rate of 28.89%. Of those with complete follow-up, 90.63% of patients were healthy without any new neurological deficits.

Conclusion: In countries with limited resources and few specialists, particularly pediatric neuro-oncologists, such a collaboration of shared care can impact the management and outcome of the patients without pouring more resources. However, LTFU remains a major challenge to assess complete disease courses and management outcomes in clinical practice.

Objective: To assess the effects of volatile and intravenous anaesthetic agents on long-term outcomes in patients with glioma, undergoing tumour resection.

Methodology: This systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Two databases were searched from inception until January 2025, namely PubMed/MEDLINE and EMBASE using MeSH terms for anaesthesia and glioma. Six retrospective cohort studies were selected for data extraction after thoroughly reviewing the database search results against pre-determined inclusion and exclusion criteria. The quality assessment was done as per National Heart, Lung and Blood institute checklist for observational studies.

Results: A total of six retrospective cohort studies conducted between 2017 and 2021 were reviewed. These included both sexes, predominantly aged over 18 years, except for one study that enrolled patients as young as 16. Five studies concluded that the type of anaesthesia had no effect on survival or recurrence. Only one associated propofol with increased progression free survival (PFS) and overall survival (OS). While rest of the studies showed no effect, Dong et al. suggested that sevoflurane may reduce OS in patients with Karnofsky Performance Status (KPS) <80. Overall, the type of general anaesthesia drugs did not affect five-year PFS rate.

Conclusion: We found no impact of anaesthetic agent on glioma outcomes in majority of studies, but the literature suggesting potential tumour-modulating effects of these drugs is significant enough to warrant further studies. Similar associations exist in other cancers. Well-designed RCTs are crucial to clarify if anaesthetic agents affect long-term survival and oncological outcomes in glioma patients.

Objective: This study aimed to assess the predictive value of pulse pressure (PP) for identifying the critical administration threshold (CAT) in hemodynamically stable patients with active bleeding following blunt trauma.

Methods: This retrospective study included hemodynamically stable blunt trauma patients treated from 2021 to 2022 in our hospital. Patients were grouped by CAT+ or CAT- status. Propensity score matching (PSM) was used to balance baseline characteristics. Logistic regression analyses evaluated the predictive value of PP, while receiver operating characteristic curve (ROC) analysis was performed to determine optimal thresholds in elderly patients (age >60 years).

Results: Of 456 patients, 65 (14.3%) were classified as CAT+. PP ≤40 mmHg was an independent predictor of CAT+ before PSM (OR = 5.931; 95% CI, 2.648-13.284; P < 0.001) and after PSM (adjusted OR = 4.579; 95% CI, 1.193-10.958; P = 0.016). In elderly patients, the optimal PP threshold for CAT+ was ≤41.5 mmHg, with an area under the curve (AUC) of 0.822 (95% CI, 0.724-0.921).

Conclusion: PP is a reliable predictor of critical hemorrhage in hemodynamically stable blunt trauma patients and elderly subgroups, supporting its use in trauma care.

Objective: The study aimed to investigate the mental health of nurses in Pakistan who are eligible to get employment in the UK but still struggling to do so because of WHO (World Health Organization) code of practice.

Methodology: This cross sectional study was conducted between October, 2024 to November, 2024. Data was collected from 72 participants via Warwick-Edinburgh Mental Well-being Questionnaire in addition to an open-ended question. Structured questionnaire was analyzed via descriptive analysis whereas, manifest content analysis was utilized for open-ended question.

Results: Majority (63.9%) of the participants were female nurses as compared to male nurses who were 36.1%. The analysis revealed that 48.6% of the participants were categorized to have very low mental well-being on Warwick-Edinburgh Mental Well-being Scale. The content analysis revealed the accounts of mental frustration, financial loss and other emotional concerns.

Conclusion: There is a dire need for WHO policy makers, national healthcare regulatory bodies, and educational system to address the concern of nurses belong to amber/red listed countries in order to promote their mental well-being.

Objective: To explore the long-term clinical value of the anterolateral thigh (ALT) perforator flap in the repair of limb soft tissue defects.

Methodology: This retrospective analysis included clinical records of 62 patients with limb soft tissue defects who received ALT perforator flap treatment at Guigang People's Hospital from January 2020 to October 2024. The defect area ranged from 8×6 cm to 28×15 cm. The arteries, veins and sensory nerves of the perforator flap were microanastomosed with the corresponding structures of the recipient area and the donor area was directly sutured in one stage. Patients were followed up eight months to five years after surgery.

Results: Postoperative follow-up ranged from 8~60 months (average 32.9 ± 13.4 months); 59 cases of skin flaps survived completely, with a success rate of 95.2%. Three patients had reported complications: one case had localized necrosis at the edge and two cases had full-thickness necrosis, which healed after debridement and skin grafting. The skin flap donor site was directly sutured without the occurrence of fascial compartment syndrome. The microcirculation of the surviving skin flap was good, the color coordinated with the surrounding tissues and the texture was flexible. Three patients underwent secondary volume reduction plastic surgery due to the large volume of the reconstruction area, which affected their function. The postoperative contour was satisfactory.

Conclusions: Long-term follow-up has confirmed that the ALT perforator flap can be used as a reconstruction treatment plan for soft tissue defects in limbs.

Objective: To develop a risk prediction model for gastrointestinal bleeding in coronary heart disease (CHD) patients who undergo dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI).

Methodology: The clinical data of 185 CHD patients who received DAPT after PCI and were admitted to the First People's Hospital of Linping District from November 2023 to March 2025 were retrospectively selected. Among them, 29 patients with gastrointestinal bleeding comprised the bleeding group, and 156 patients without gastrointestinal bleeding comprised the non-bleeding group. Logistic model analysis was used to identify independent risk factors for gastrointestinal bleeding during DAPT after PCI, and a prediction model was constructed. The receiver operating characteristic (ROC) curve of the prediction model for gastrointestinal bleeding, along with the area under the curve (AUC), was calculated to evaluate the predictive value of the model.

Results: Logistic model analysis identified age, chronic renal insufficiency, history of digestive tract disease and infarction, PCI procedure duration, creatinine clearance rate, and use of gastric mucosal protective agents as risk factors of gastrointestinal bleeding (P < 0.05). AUCs of the constructed prediction model for age, chronic renal insufficiency, history of digestive tract disease, history of myocardial infarction, PCI procedure duration, creatinine clearance rate, and gastric mucosal protective agent were 0.690 (95% confidence interval (CI) 0.594 - 0.778), 0.714 (0.616 - 0.807), 0.728 (0.633 - 802), 0.742 (0.654 - 0.828), 0.837 (0.763 - 0.901), 0.783 (0.691 - 0.870), and 0.754 (0.663 - 0.838), respectively.

Conclusion: The risk factors for gastrointestinal bleeding in CHD patients during DAPT after PCI include advanced age, chronic renal insufficiency, digestive tract disease history, myocardial infarction history, PCI procedure duration, creatinine clearance rate, and non-application of gastric mucosal protective agents. The ROC curve drawn based on the above factors can effectively predict gastrointestinal bleeding during DAPT. This model can be used to develop clinically targeted interventions aimed at preventing gastrointestinal bleeding and improving patients' prognosis.

Objective: To analyze the clinico-radiological characteristics and neurosurgical management of spinal space-occupying lesions (SOLs).

Methodology: A retrospective observational study involving patients with spinal cord SOLs who underwent surgical management at the Department of Neurosurgery, Unit-I, Punjab Institute of Neurosciences, between 2022 and 2024, was conducted after approval from the institute's review board. Patient profiles, clinical and radiological features, tumor location, and surgical outcomes were analyzed for comparative assessment.

Results: With a mean age of 36.78 ± 16.57 years, a clear male preponderance of 62.5% (35) was noted for spinal SOLs in a Pakistani cohort of 56 patients. Among all spinal SOLs, 46.4% (26) were intradural intramedullary (IDIM) lesions, 25% (14) were intradural extramedullary (IDEM), and 28.6% (16) were extradural (ED) lesions. The most common symptoms were lower back pain in 65.4% (17) in IDIM, 68.8% (11) in ED, and 64.3% (9) in IDEM lesions. Post-operatively, Karnofsky Performance Scale (KPS) score was improved in all patients. The most common histopathology was meningioma in 76.9% (20) of IDIM patients, astrocytoma in 71.4%(10) of IDEM patients, and hemangioma in 62.5% (10) of ED patients.

Conclusion: Patients with spinal lesions significantly improved clinically post-operatively, regardless of the anatomical location of the lesion. Surgical intervention remained the primary treatment for majority patients with spinal cord SOLs..