Pakistan Journal of Medical Sciences最新文献

Objective: To assess the inflammatory response and side effects of chemotherapy combined with Shenmai injection (SMI) in the treatment of patients with advanced colorectal cancer (CRC).

Methods: This retrospective cohort study included the clinical data of 152 patients with advanced CRC admitted to the First Affiliated Hospital of Huzhou University from April 2020 to April 2023. The patients were divided into control group (patients received chemotherapy treatment, n=75) and observation group (patients received chemotherapy combined with SMI, n=77) based on the treatment received. Tumor control rate, levels of immune function indicators before and after treatment, levels of inflammatory factor indicators, and incidence of toxic side effects in two groups were analyzed.

Results: Tumor control rate in the observation group (89.61%) was higher than that in the control group (77.33%) (P<0.05). After the treatment, the levels of CD3⁺, CD4⁺, CD4⁺/CD8⁺in both groups were significantly higher than before the treatment, and significantly higher in the observation group compared to the control group (P<0.05). After the treatment, serum levels of interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-α), and interleukin-8 (IL-8) in both groups decreased compared to pretreatment levels, and was significantly lower in the observation group (P<0.05). The incidence of adverse reactions in the observation group was significantly lower than that in the control group (P<0.05).

Conclusions: Compared with chemotherapy alone, chemotherapy combined with SMI better alleviates inflammatory response in patients with advanced CRC, enhance immune function, and improve tumor control rate, with a lower incidence of toxic side effects.

Objective: To investigate the clinical value of psychological nursing and nutritional intervention in radiopharmaceutical therapy of patients with thyroid carcinoma.

Methods: This was retrospective study. One hundred and twenty patients with thyroid carcinoma were included at Baoding No.1 Central Hospital from May 10, 2021 to July 10, 2023 to as subjects and randomly divided into the control group and the experimental group (n=60 each group). Patients in the control group were given conventional nursing, while those in the experimental group received psychological nursing and nutritional intervention. The differences in quality of life, compliance, satisfaction and cognitive level between the two groups before and after intervention were compared.

Results: After intervention, the scores of emotional functions, role function, cognitive function, physical function and social function of the experimental group were significantly higher than those of the control group, with statistically significant differences (P= 0.00); The compliance of the experimental group was 100%, which was significantly higher than 90% of the control group, with a statistically significant difference (P= 0.01). Moreover, the scores of SAS and SDS in the experimental group were significantly lower than those in the control group after intervention, with a statistically significant difference (P= 0.00).

Conclusion: Psychological nursing and nutritional intervention may result in a variety of benefits for patients with thyroid carcinoma receiving radiopharmaceutical therapy, such as effectively ameliorating the quality of life of patients, improving the cognitive level of patients with the disease and treatment compliance, reducing anxiety and depression, and enhancing patient satisfaction with nursing.

Objective: To compare the effects of the Muscle Energy Technique (MET) and the Bowen Technique on hamstring muscle tightness in chronic low back pain (CLBP) patients.

Method: A randomized clinical trial (RCT) designed study in which 62 participants were recruited through the purposive sampling technique were divided into two groups by the lottery method. Subjects who had pain for more than six months in the back and hamstring tightness were included. The duration of the study was four months from February to May 2023 conducted at Madinah Teaching Hospital Faisalabad. Subjects in Group-A were given the Bowen technique, whereas subjects in Group-B were given the MET. Numeric pain rating scale (NPRS), Oswestry disability index (ODI), and active knee extension (AKE) tests were used for measurements of outcomes.

Results: Intra-group comparison by using Friedman test revealed that both Group-A & B subject's pain were reduced (P<0.000), their tightness in back thigh muscles were significantly reduced (P<0.000) and functional activities of subjects were also improved (P<0.000). Mann Whitney test was used to determine the between group comparison. P-value ≤ 0.05 was considered as significant. Inter Group-Analysis revealed that there was no statistically significant difference between effects of Bowen technique & MET on pain, hamstring tightness and disability as both techniques improved pain, flexibility & disability.

Conclusion: This study revealed that both groups treated by MET and Bowen Technique had significantly reduced pain, improved flexibility of back thigh muscle and reduced functional disability.

Objective: To determine the frequency, associated risk factors, and outcome of meningitis in neonates presenting with sepsis at Aga khan Tertiary Care Hospital, Karachi.

Methods: A descriptive cross-sectional study was conducted at pediatrics department of Aga Khan Tertiary University Hospital, Karachi, Pakistan from July 31, 2020, till January 30, 2021. Neonates of either gender admitted with neonatal sepsis were enrolled using non-probability consecutive sampling technique. Meningitis was diagnosed as per the findings of cerebrospinal fluid (CSF) along with the outcome in terms of death and early neurological complications such as subdural effusions and hydrocephalus.

Results: Of 209 neonates with sepsis, meningitis was observed in 59 (28.2%) neonates. A significantly lower mean weight (p-value 0.024) while significantly higher mean duration of stay (p-value <0.001) was observed in patient with meningitis. Moreover, a significantly higher proportion of meningitis was observed in neonates who had fever (p-value 0.048), vomiting (p-value 0.009), abdominal distension (p-value <0.001), and blood culture positivity (p-value <0.001). Blood culture positive Methicillin-sensitive Staphylococcus aureus (MSSA) was considerably higher among neonates with meningitis. Of 59 neonates with meningitis, mortality was observed in 2 (3.4%) neonates. Positive CSF culture was observed in 6 (2.9%) while hydrocephalus was observed in 7 (11.9%) and effusion in 6 (10.2%) neonates.

Conclusion: Neonatal meningitis is common in neonates presenting with sepsis, but mortality rate is low. Positive cultures, particularly with MSSA, further underscore the bacterial etiology in neonatal meningitis.

Objective: To identify the risk factors for cardiovascular disease in women with pre-eclampsia and intrauterine growth retardation.

Methods: This cross sectional study was conducted in Department of Gynecology and Obstetrics, Liaquat University Hospital, Hyderabad, from April 2022 to October 2022. Patients with history of intrauterine growth retardation or preeclampsia after 20 weeks of gestation, age more than 18 years were included in this study. Patients were assessed for cardiovascular risk factors during pregnancy.

Results: The average age and gestational age were almost equal in preeclampsia and IUGR patients, (p≤0.050). The primparous were higher in preeclampsia than IUGR, n=286 (73.5%) and n=80 (52.3%), respectively, (p=0.000). The average birth weight of IUGR was lower than preeclampsia patients, 925.19±6.35 gram and 1324.76±10.19 gram, respectively, (p=0.000). The average systolic and diastolic blood pressure of IUGR patients was less than preeclampsia patients, (p=0.000). But, the chronic hypertension was higher in preeclampsia patients n=99 (25.4%) as compare to IUGR n=13 (8.5%) patients, (p=0.000). The average cholesterol level in IUGR was 5.52±0.58(mmol/L) versus preeclampsia 5.34±1.01(mmol/L), (p=0.043). The average triglycerides was almost equal in both the groups, (p=0.924). The mean Lp(a) in preeclampsia patients was 177.15±20.15(mg/L) versus 202.94±24.83 (mg/L), (p=0.000).

Conclusion: Findings of this study help conclude that women with known history of IUGR or preeclampsia must be screened for possible cardiovascular risk factors and treated for these risk factors in order to avoid future mortality and morbidity associated with cardiovascular diseases.

Objective: Cancer patients treated with chemotherapy often face variety of side effects, with nausea and vomiting being the most frequent. Ginger (Zingiber officinale), contains natural compounds that can speed up the metabolism and increase intestinal motility. It is traditionally used to treat gastrointestinal disorders. The objective of this study was to evaluate the role of ginger in management of nausea among patients receiving chemotherapy.

Methods: This crossover interventional study was conducted to evaluate the role of ginger in management of nausea among patients receiving chemotherapy. Study was carried out at chemotherapy daycare of Shifa International Hospital Islamabad, with a sample size of 90 patients, using non-probability convenient sampling. Patients undergoing chemotherapy were given the dose of ginger (550 mg twice a day) for five consecutive days. On the next chemo cycle the same patients were given the placebo capsules of same color and weight for two times a day for five days. Patients and attendants were contacted for five days and being asked about post-chemotherapy nausea. Nausea and vomiting were measured by Rhodes scale.

Results: Results showed that Rhodes score of patients taking Ginger capsules was significantly lower than those taking placebo (p-value < 0.05) in all the five days.

Conclusion: Ginger significantly managed the nausea among patients receiving chemotherapy. Its natural antiemetic properties provide a convenient and safe way to reduce the post-chemotherapy nausea and vomiting.

Objective: To investigate the clinical efficacy of 3D-printed fusion cage implantation in treating cervical spondylotic myelopathy.

Methods: A retrospective analysis was performed on 52 patients with single-segment cervical spondylotic myelopathy who received anterior cervical discectomy and fusion in Affiliated Hospital of Beihua University from July 2019 to July 2022. They were divided into the 3D group and the control group. Afterward, the perioperative indicators were compared between the two groups. Meanwhile, the Japanese Orthopaedic Association (JOA) scores, Visual analogue scale (VAS) and neck disability index (NDI) were recorded pre-operation and one-year post-operation. Evaluate the fusion rate of two group of intervertebral fusion cages.

Results: The JOA score and NDI of the two groups of patients were significantly improved compared to pre-operation(P<0.05), and the JOA score, JOA score improvement rate, and NDI of the 3D group were better than the control group (P<0.05), the VAS scores were significantly improved compared to pre-operation(P<0.05), but there was no statistically significant difference between the groups (p >0.05). The intervertebral height, angle, and cervical Cobb angle of the two groups of patients were significantly improved compared to pre-operation (P<0.05), and the improvement of intervertebral height, angle, and cervical Cobb angle in the 3D group was better than the control group(P<0.05).

Conclusion: The clinical efficacy of 3D printed intervertebral fusion cage placement in the treatment of cervical spondylotic myelopathy may be reliable, and it would be better than traditional intervertebral fusion cages in maintaining the height, angle, cervical Cobb angle, and fusion rate of the intervertebral space.

Objective: To compare the epidemic trends of different types of influenza viruses and the clinical characteristics of patients, so as to provide reference for influenza prevention and control.

Methods: This was descriptive research. The human monitoring data collected from the Influenza Research Database (IRD) from 2006 to 2016 were used to descriptively analyze the distribution of influenza viruses in terms of time, geography, gender and age. The positive samples were divided into three groups based on the type of pathogen (H1N1 influenza A viruses, H3N2 influenza A viruses, and influenza B viruses). Compared and analyzed the distribution and clinical characteristics among groups.

Results: There were statistically significant differences in the positive rates among different countries (p< 0.001). The proportion of positive samples gradually decreased with age. The proportion of oseltamivir resistance was significantly higher in H1N1-positive patients compared with that in H3N2-positive patients (p< 0.001). Significant differences were observed in the vaccination status among H1N1, H3N2 and influenza B viruses (p< 0.001). Cough was common in all cases with H1N1, H3N2 and influenza B infections, while cough, fever and running nose occurred more frequently in influenza B-positive cases than those of H1N1-positive and H3N2-positive cases (p< 0.001).

Conclusion: People aged 0-18 years are the major susceptible population to influenza, and H1N1 influenza viruses are the main pathogens of infection in this population, with major clinical manifestations of fever, cough and headache. The findings in this study highlight the necessity to strengthen the protection for this age group in clinical practice.

Objective: To evaluate the efficacy and safety of the through-and-through wire (TTW) technique for antegrade ureteral Double-J stent placement after failure of either antegrade or retrograde ureteral stent placement.

Method: This retrospective study analyzed the medical records of consecutive patients who underwent Double-J stent placement with the TTW technique at Asan Medical Center and Gil Medical Center between January 2016 and February 2023. Patient histories, reasons for employing the TTW technique, TTW pathways, and complications were reviewed. Eight patients were included in the study. The reasons for using the TTW technique were failure to advance a larger-diameter catheter, balloon catheter, or Double-J stent passing over the guidewire beyond the stricture (6/8, 75.0%); failure to negotiate the stricture with a guidewire (1/8, 12.5%); and guidewire passing through a ureteropelvic junction defect (1/8, 12.5%).

Results: TTW was applied either between a percutaneous nephrostomy (PCN) and the urethral orifice (n=4), between a PCN and an ileostomy pouch (n=3), or between a left and right PCN (n = 1). Urologic assistance was required for retrograde ureteral cannulation in one male patient (12.5%). Subsequently, balloon dilation and/or Double-J stent placement were performed in all eight patients, resulting in 100% technical success. No major or minor complications occurred.

Conclusions: The TTW technique was safe and effective in the undertaking of PCN and antegrade Double-J stent placement in patients for whom either antegrade or retrograde access had failed.

Objective: Exploring the clinical efficacy and safety of targeted therapy, immunotherapy combined with chemotherapy in the treatment of advanced gastric cancer.

Methods: A retrospective analysis was performed on the medical records of 134 patients with advanced gastric cancer who visited Renmin Hospital, Hubei University of Medicine from January 2019 to December 2022. According to therapeutic regimens, enrolled patients were divided into the control group and the study group. Patients in the control group received chemotherapy intervention, while those in the study group were provided with a combined intervention of apatinib, PD-1 inhibitor and chemotherapy. We analyze the tumor control effect and incidence of adverse reactions in two groups of patients.

Results: The disease control rate (DCR) of patients in the study group and the control group was 72.06% and 42.42%, with an overall response rate (ORR) of 8.82% and 4.55%, The differences are statistically significant(P<0.05). By the end of follow-up, the median progression-free survival (mPFS) and the median overall survival (mOS) of the control group patients were 3.0±0.266 and 5.0±0.224 months respectively; while the mPFS and mOS of the study group were 5.0±0.261 and 7.0±0.172 months respectively, the differences are statistically significant (P<0.05). However, there was no significant difference in adverse reactions between the two groups (P>0.05).

Conclusion: The therapeutic regimen of apatinib, a PD-1 inhibitor combined with chemotherapy exhibits relatively high clinical efficacy and safety for the treatment of patients with advanced gastric cancer. It can be considered as an interventional option for this type of patient.