Pakistan Journal of Medical Sciences最新文献

Objective: In this study, it was aimed to screen fatty liver in individuals with metabolic disorders, and to investigate the use of some anthropometric calculations and body composition indices in demonstrating fatty liver disease.

Methods: The cross-sectional study included 224 participants with metabolic diseases. Anthropometric measurements of the participants were measured. Waist/Height ratio, Rohrer Index, Broca-Katsura Index, Relative Fat Mass (RFM), Body Roundness Index (BRI), A Body Shape Index (ABSI) were calculated. The presence of qualitative steatosis was evaluated abdominal ultrasonography. As a result of all analyzes, p <0.05 was accepted as significant.

Results: The mean age of the 224 participants included in the study was 55.1±10.6 (min=23, max=83) years. 84 (37.5%) of the participants were female and 140 (62.5%) were male. Steatosis was detected on ultrasonography in 142 (63.4%) of the participants. Waist/Height ratio, Rohrer index, Broca-Katsura index, RFM, BRI, BMI and waist circumference were found to be significantly higher in participants with steatosis (p<0.05). According to the ROC analysis, BRI cut-off value of 4.6 were found to be significant in detecting steatosis.

Conclusions: As a result of our study, we found that various body composition indices, especially BRI, were associated with fatty liver. Especially in female, it was seen that screening of fatty liver with cut-off values of body composition indices, and confirmation by ultrasonography, if necessary, may enable early diagnosis. In male, it was seen that body composition indices and fatty liver could not be determined directly, only BMI and waist circumference were indicative.

Objective: The study aimed to examine the factor structure and psychometric properties of ethical leadership questionnaire (ELQ) by using a healthcare professional sample in Saudi Arabia.

Methods: A cross-sectional study was conducted, and a total of 387 healthcare professionals completed the 15-items ELQ questionnaire between 18 October, 2023 and 17 January, 2024. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and a reliability test were performed on the obtained data.

Results: It was found that the ELQ involved four factors including honesty (four items), integrity (four items), sets example (three items), and concern for values (four items). The study was able to explain 74.14% of the total variance. The model comparative fit index (CFI) was 0.952, the goodness-of-fit index (GFI) was 0.915, the standardized root mean squared residual (SRMR) was 0.0536, and the root mean square error of approximation (RMSEA) was 0.076. The reliability value was obtained by using Cronbach's alpha, and the results of each subscale were higher than 0.80, which means they were deemed adequate and reliable. The results from these fit indices indicated that the four-factor model with EC offered the utmost fit.

Conclusion: The ELQ is a reliable and valid instrument that can be used on this population to determine employees' perceptions of their leaders' ethical behavior.

Background & objective: The specific influence of the pre-pregnancy body mass index (PPBMI) on women with gestational diabetes mellitus (GDM) is unclear. Our objective was to investigate how PPBMI categories affect pregnancy and neonatal outcomes in women with GDM.

Methods: A retrospective cohort study was conducted using data from patients attending the Fujian Maternity and Child Health Hospital (Fuzhou, China) from 2021 to 2023. The participant records were stratified into four groups according to their BMI values: underweight, normal-weight, overweight, and obese. The pregnancy and neonatal outcomes for these BMI categories were analyzed using multivariable logistic regression.

Results: The study included data from 2,909 pregnant women diagnosed with GDM. Underweight women with GDM showed significantly lower risks of pregnancy-induced hypertension (PIH) (adjusted OR, 0.26) and cesarean sections (adjusted OR, 0.55) but higher risks of low body weight (LBW) infants (adjusted OR, 3.40). Overweight and obese women experienced higher risks of PIH (adjusted OR, 2.96), cesarean sections (adjusted OR, 1.62), and macrosomia (adjusted OR, 1.43).

Conclusion: PPBMIs significantly impact pregnancy outcomes in women with GDM. Both underweight and overweight/obese categories are associated with adverse outcomes, highlighting the need for pre-pregnancy counseling and interventions to achieve and maintain a healthy BMI.

Infective endocarditis used to frequently cause mortality in subjects having PDA before the advent of antibiotics and surgical ligation. It has been documented that clinically silent PDAs may cause infective complications of heart valves. We present case of an 18-years-old male who presented with palpitations and fever to our emergency department. The fever was sudden in onset, associated with rigors, high-grade and with a continuous pattern for 12 days. The patient was previously managed as a case of dengue fever based on serology. Eight days after the onset of fever, the patient developed left-sided chest pain. Past medical record showed documentation of a patent ductus arteriosus. A two-dimensional echocardiography showed circumferential pericardial effusion and a small-sized PDA; the left ventricular function was normal. Nevertheless, the definitive cause of the pericardial effusion was not known. The patient became haemodynamically unstable during the hospital stay and it was planned to ligate the PDA with cardiac surgical consultation. A left thoracotomy approach was chosen for the PDA ligation that unveiled rupture of the main pulmonary artery, so the pulmonary artery repair alongside the PDA ligation was planned with median sternotomy approach and cardiopulmonary bypass immediately. The patient had a 14-days course of antibiotics during the ICU stay. In conclusion, infective endocarditis remains a rare yet life-threatening complication of PDA irrespective of the size; a timely PDA-ligation could prevent the life-threatening sequels.

Background & objective: Obstructive sleep apnea (OSA) has been increasingly recognized as a comorbidity in many psychiatric disorders, including bipolar disorder (BD). This study aimed to synthesize existing evidence to determine the frequency of OSA in patients diagnosed with BD and identify potential predictors of its occurrence.

Methods: PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar databases were searched for English-language papers published up from 1^st January 1960 to 31^st October 2023 that reported incidences of OSA in patients with BP and provided sufficient data for quantitative analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane Handbook (version 5.1.0) guidelines were followed. Meta-regression analyses were done to identify predictors that correlate with the prevalence of obstructive sleep apnea.

Results: The systematic review identified a total of 14 eligible studies. The pooled prevalence of OSA in individuals with BD was determined to be [24.55%] (95% confidence interval (CI): [17.25 to 32.63%, I²=99.57%]). Meta-regression analyses showed that male gender was associated with a higher prevalence of OSA, while body mass index (BMI) and mean age showed no significance in predicting OSA prevalence.

Conclusion: Our results demonstrated higher incidence of OSA in patients with BD. Male BD patients had higher rate of OSA.

Objective: To design a deep learning-based model for early screening of diabetic retinopathy, predict the condition, and provide interpretable justifications.

Methods: The experiment's model structure is designed based on the Vision Transformer architecture which was initiated in March 2023 and the first version was produced in July 2023 at Affiliated Hospital of Hangzhou Normal University. We use the publicly available EyePACS dataset as input to train the model. Using the trained model, we predict whether a given patient's fundus images indicate diabetic retinopathy and provide the relevant affected areas as the basis for the judgement.

Results: The model was validated using two subsets of the IDRiD dataset. Our model not only achieved good results in terms of detection accuracy, reaching around 0.88, but also performed comparably to similar models annotated for affected areas in predicting the affected regions.

Conclusion: Utilizing image-level annotations, we implemented a method for detecting diabetic retinopathy through deep learning and provided interpretable justifications to assist clinicians in diagnosis.

Objective: To identify the disease-causing variant in a family with tuberous sclerosis complex (TSC).

Methods: This study including a Han-Chinese pedigree recruited from the Third Xiangya Hospital, Central South University, Changsha, Hunan, China was conducted between February, 2019 and January, 2023. Detailed clinical examinations were performed on the proband and other family members of a Han-Chinese family with TSC. Whole exome sequencing of the proband and Sanger sequencing of all family members were performed, followed by variant pathogenicity prediction and conservation analysis. SWISS-MODEL and PyMOL software were used for protein modelling and creating the three-dimensional structure model illustration of the critical GTPase-activating protein (GAP) domain. The variant was classified following the American College of Medical Genetics and Genomics (ACMG) standards and guidelines.

Results: The female proband exhibited typical features of TSC, including hypomelanotic macules, angiofibromas, shagreen patches, seizures, brain lesions, cognitive impairment, renal abnormalities, and cardiovascular abnormalities. A recurrent c.5126C>T variant in the TSC complex subunit 2 gene (TSC2) was identified as the genetic cause of TSC in this family, classified as "pathogenic" according to ACMG standards and guidelines. The c.5126C>T variant leads to an amino acid change from proline to leucine at position 1709 (p.P1709L) in the functional GAP domain of tuberin protein, which may impair tumor growth inhibition of the hamartin-tuberin complex.

Conclusion: This study reported a Han-Chinese TSC patient with a recurrent variant TSC2 c.5126C>T (p.P1709L). These findings broaden the phenotypic spectrum of TSC caused by this variant and may contribute to improving TSC genetic diagnoses as well as understanding of its mechanisms.

Objective: This study was conducted to investigate the social media practices and attitudes towards e-professionalism among undergraduate medical students in a medical college of Pakistan.

Methods: This cross-sectional study was conducted on 220 undergraduate medical students from 2^nd to final-year MBBS, at CMH Lahore Medical College from March to August 2022. After ethical approval, a printed questionnaire was distributed among students, selected by stratified random sampling technique. Data on demographics, social media usage, and attitudes toward e-professionalism was collected using the pre-validated SMePROF scale. Chi-squared, Fisher's exact test, and the Mann-Whitney U test were used to analyze the results.

Results: Responses from 220 students were analyzed. Most students were active social media users, spending 5.5±4.38 hours daily on Instagram (82.3%) and Facebook (80%). Male students were less likely to accept friend requests from the patients than females (p=0.009). While overall responsible online behavior was observed, attitudes towards e-professionalism varied. Pre-Clinical students were more likely to post pictures from the workplace than Clinical students (p=0.009). Females majorly supported social media bans (p=0.018), while males were more interested in keeping up with trends (p=0.022). Pre-clinical students favored more freedom in using social media for patient interaction (p=0.034).

Conclusion: This study highlights the widespread social media usage among medical students and its impact on e-professionalism. Gender and academic seniority influence social media practices and e-professionalism. These findings emphasize the importance of targeted education and policies to promote more responsible use of social media and e-professionalism in the health sector.

Objective: To probe the influence of early rehabilitation nursing on postoperative rehabilitation of patients with hallux valgus on the basis of information-motivation-behavior skills (IMB) model.

Methods: Convenience sampling was adopted, and 80 patients with hallux valgus admitted to the Sixth People's Hospital Affiliated to Shanghai Jiaotong University from July 2020 to July 2022 were randomly separated into control group (CG) and observation group (OG) with 40 patients in each group according to the time of admission. Patients in the CG received routine nursing and rehabilitation guidance and follow-up. Patients in the OG were given rehabilitation guidance and follow-up based on IMB model. The American Orthopaedic Foot and Ankle Association Scoring System (AOFAS) scores, Self-efficacy for Rehabilitation Out-come Scale (SER) scores, The Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores, quality of Life scores, incidence of complications as well as nursing satisfaction in both groups were compared.

Results: After receiving usual nursing and rehabilitation guidance in each group, AOFAS scores, SER scores, quality of life scores and nursing satisfaction in the OG were elevated compared to the CG (P<0.05), SAS and SDS scores, and the incidence of complications in the OG were lessened compared to the CG (P<0.05).

Conclusion: To sum up, Early rehabilitation nursing based on IMB model could promote the postoperative recovery of limb function after hallux valgus, reduce bad emotions, decrease the occurrence of complications, promote self-efficacy, and promote the quality of life of patients, which is valuable for promotion.

Objectives: Dyslipidemias are major risk factors for cardiovascular disease, and other comorbidities. The focus on food and nutrition to prevent and treat cardiovascular risk factors including dyslipidemia is a paradigm shift. This is the first meta-analysis to assess the association of dates fruit and dyslipidemia in Type-2 diabetes. The study aimed to assess the same among patients with Type-2 diabetes.

Methods: Six databases were searched for relevant articles from inception to March 2024. We included randomized trials, studies with other methods, and those conducted among healthy people were excluded. A structured checklist including the author's name, country, year of publication, study type, duration of the study, lipid profile at baseline and after-dates fruit consumption, age, and gender of participants, type of dates, and the amount consumed.

Results: Out of the 448 studies retrieved, fourteen cohorts from four studies (298 participants with Type-2 diabetes) were included. Dates fruit reduced cholesterol, odd ratio, -0.87, 95% CI, -1.39--0.35, P-value, 0.001, and I² for heterogeneity=90%. No significant changes were observed on low-density lipoprotein (odd ratio, -0.31, 95% CI, -0.65-0.03, and P-value, 0.08), triglycerides (odd ratio, -0.77, 95% CI, -2.17--0.63, P-value 0.28), and high-density lipoproteins (odd ratio, 0.03, 95% CI, -0.13-0.19, P-value, 0.69). The I² for heterogeneity were=99%, 95%, and 65% respectively.

Conclusion: Dates fruit could reduce total cholesterol, with a non-significant reduction in low-density lipoproteins. No significant effect was evident regarding triglycerides and high-density lipoproteins. Further larger studies with a high selection of controls and dates are needed.