Pakistan Journal of Medical Sciences最新文献

Background & objective: Patient safety checklists are established tools for reducing preventable errors in clinical practice. The use of World Health Organization (WHO) safety checklist outside the operating room environment remains inconsistent. This audit was conducted to assess compliance with the Royal College of Radiologists (RCR) standards.

Methodology: A prospective audit by the anesthesia team was carried out in the Radiology Department of Shaukat Khanum Memorial Cancer Hospital and Research Center, Peshawar. All patients receiving sedation for CT, MRI, or PET scans in February 2023 were included (n=30). Data sources included patient records, resuscitation equipment logs, drug inventory checks, staff training records, and direct observations. Standards were benchmarked against Royal College of Radiologists (RCR) recommendations. Audit findings were presented to the Quality Council, and a modified WHO safety checklist specific to radiology was developed and implemented. A re-audit was latter conducted in March-April 2024 which included 55 patients.

Results: Baseline data demonstrated compliance with all RCR standards except for the use of a safety checklist, which was absent in all 30 cases. In response, a concise modified WHO checklist was introduced, incorporating high-risk patient identification and independent double-checking of medications. The re-audit showed 100% compliance across all RCR indicators, including checklist use, in 55 patients.

Conclusion: The adaptation of the modified WHO safety checklist for radiology enhanced compliance with international safety standards and closed previously identified gaps. Regular clinical audits and the incorporation of tailored checklists can strengthen patient safety in non-operating room anesthesia.

Background & objectives: Alzheimer's disease (AD) is characterized by gradual cognitive decline. Here, we deciphered the molecular mechanisms using transcriptomic data derived from the dorsolateral prefrontal cortex (DLPFC) of patients with severe AD using next-generation knowledge discovery (NGKD) techniques.

Methodology: RNA sequencing data from the Gene Expression Omnibus (GEO) database (GSE53697) derived from the DLPFC of individuals with severe AD and healthy controls, obtained originally from frozen brain tissues of individuals classified based on the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) criteria, and differentially expressed genes (DEGs) were identified by GEO2R analysis. The WEB-based GEne SeT AnaLysis Toolkit (WebGestalt) was used for overrepresentation analysis (ORA) using the Kyoto Encyclopedia of Genes and Genomes (KEGG) Pathway Database and Gene Set Enrichment Analysis (GSEA) using the KEGG, Reactome, and Wiki pathway databases. Ingenuity Pathway Analysis (IPA) software was used to decode the key canonical pathways and gene networks implicated in severe AD.

Results: We identified 24,207 DEGs using P ≤0.05, and this list was further filtered with a fold change cut-off ±1.5 to derive 3103 genes. WebGestalt analysis showed that retrograde endocannabinoid signaling, motor proteins, oxidative phosphorylation, and ribosome biogenesis were downregulated, whereas pathways related to immune system activation, such as antigen processing and presentation and cytokine signaling, were enriched in patients with severe AD. IPA analysis showed significant downregulation of ribosomal RNA (rRNA) processing and enrichment of neuroinflammatory signaling pathways. Crucially, dysregulation of energy metabolism, protein synthesis, axonal transport, and immunological responses have been identified in the DLPFC of patients with severe AD.

Conclusion: Using NGKD methods, we identified an array of molecular pathways implicated in neuroinflammation, dysregulation of energy metabolism, and mitochondrial damage in severe AD and their association with disease progression. Our findings add to the existing knowledge on the pathophysiology of severe AD and help in the development of more effective strategies for diagnosis, therapy, and prevention.

Objective: To retrospectively evaluate the relationships between glycated hemoglobin (HbA1c) levels and diabetes and other diseases in primary care.

Methodology: This study was conducted retrospectively using the available recorded data of individuals registered with the Bursa Uludag University Family Health Center, and who underwent HbA1c measurement during the five years between January 2020 to December 2024. 3520 Visits (N) constituted the study population. Simple random sampling was at least 385 patients with a 5% error rate and a 95% confidence level. 537 (n) Patients who met the inclusion criteria were included in the study sample. The study's sample power was determined to be 99% and the effect size was determined to be quite high at 0.49.

Results: Of the 537 individuals who participated in the study, 117 (21.8%) were female and 420 (78.2%) were male. The average age of the individuals was determined to be 39.29±14.63. Based on the main findings of the study, allergic disease (β=4.62), gender (β=4.45), anemia (β=3.92), and non-pregnancy status (β=3.22) were found to be multiple associations. Patients with these characteristics are at an estimated risk of having an HbA1c level above 6.5 (R²=0.51).

Conclusion: In our study, the male gender, older age, genetic and chronic diseases, allergies, anemia and diabetes were significantly different across HbA1c groups. Allergic diseases, gender, anemia and pregnancy were found to have associations affecting HbA1c levels. Our results regarding HbA1c levels in family medicine are crucial for diagnosis, treatment, follow-up and referral to other clinics.

Objectives: This study aimed to determine the prevalence and radiographic characteristics of supernumerary teeth (ST) in a Saudi population using cone beam computed tomography (CBCT). The research also explored the clinical and orthodontic implications of ST on tooth eruption and treatment planning.

Methodology: A retrospective cross-sectional study was conducted at the Department of Diagnostic Sciences, College of Dentistry, Qassim University. A total of 992 CBCT scans obtained between January 2020 to January 2024 were reviewed. Demographic and radiographic variables-such as morphology, orientation, eruption status and relationship with adjacent teeth-were recorded in Microsoft Excel. Two calibrated oral radiologists independently evaluated the scans. Statistical analysis, including descriptive statistics and chi-square tests, was performed using SPSS version 27.0.

Results: Supernumerary teeth were detected in 28 patients, indicating an overall prevalence of 2.82%. The prevalence among males (5.61%) was significantly higher than in females (1.10%). Most individuals presented with a single ST (67.86%). The common morphologies were conical (46.15%) and supplemental (38.46%). A majority were impacted (76.92%) and exhibited an inverted orientation (33.33%). In 20.51% of cases, ST obstructed the eruption of adjacent permanent teeth.

Conclusions: Supernumerary teeth in this population showed a strong male predilection and were predominantly conical, impacted and inverted. CBCT was instrumental in their detailed assessment.

Objective: To explore the individual and community-level factors influencing the professional identity formation (PIF) of health professions educators and educationists and examine how these factors influence educator identity within professional communities.

Methodology: This qualitative systematic review followed the SPIDER and PICO frameworks to identify relevant empirical literature published between 2005 to 2024. Four databases (PubMed, ERIC, CINAHL, and PsycINFO) were searched. Studies were included if they employed qualitative or mixed methods with significant qualitative components and focused on health professions educators. Data were synthesized using thematic synthesis following Thomas and Harden's three-stage approach. Quality appraisal was conducted using the CASP checklist, and inclusion required a minimum score of 12 out of 18 across six evaluative criteria.

Results: Sixteen studies were included, representing diverse geographic and disciplinary contexts. Thematic synthesis revealed four core domains influencing PIF: (1) transitions into educator roles, (2) individual-level drivers such as motivation and reflective agency, (3) community and institutional enablers including mentorship and recognition, and (4) psychological processes such as impostor phenomenon and identity affirmation. These factors interact dynamically within socio-cultural contexts to shape educator identity.

Conclusion: Professional identity formation in health professions educators is a multidimensional, non-linear process shaped by personal motivation, institutional culture, and emotional validation. Faculty development programs must explicitly address identity support alongside pedagogical training to foster sustainable educator roles and academic engagement. Institutional policies should recognize and reward educational contributions to strengthen teaching legitimacy in clinical academic settings.

Background and objective: Lateral wall thickness is an important anatomical entity in sinus lift procedures, but its relationship with crestal bone dimension has received limited attention. This study assessed the association between the thickness of the lateral wall of the maxillary sinus and horizontal crestal bone changes in cases undergoing lateral window sinus lift with simultaneous implant placement and without bone grafts.

Methodology: This retrospective study included 35 patients undergoing lateral sinus lift procedures without bone graft and immediate implant placement. Cone-beam computed tomography (CBCT) measurements, including residual bone height (RBH), bone density, and lateral wall thickness, were performed immediate-preoperatively and at six months postoperatively. Change in crestal bone width was compared between patients with lateral wall thickness >1 mm vs. <1 mm.

Results: The change in crestal bone width ranged from 0.24 to 4.35 mm at six months. Fourteen cases had lateral wall thickness of >1 mm while 21 cases had <1 mm. The change in crestal bone width was significantly higher at 2.45±0.97 mm in patients with lateral wall thickness <1 mm as compared to 1.54±0.98 mm in patients with lateral wall thickness >1 mm. Pearson's correlation analysis showed statistically significant medium negative relationship between lateral wall thickness and crestal bone width (r=-0.47; p=0.004). A similar relationship was noted with residual ridge height.

Conclusion: Lateral wall thickness and RBH may be factors inversely associated with changes in crestal bone width. Incorporating these anatomical determinants into surgical planning may help minimize crestal bone change, and enhance long-term peri-implant stability.

Objective: The study aims to evaluate the effectiveness of labetalol versus hydralazine in managing severe hypertension during pregnancy.

Methodology: A quasi-experimental study was conducted in the unit of the Department of Gynecology, Services Hospital Lahore, from July 30, 2021, to November 30, 2022. Recruitment of 320 pregnant women diagnosed with severe hypertension were allocated into two treatment groups. Group-A (n=160) received IV labetalol in incremental doses up to 80 mg at 20 minutes interval with maximum cumulative dose of 300 mg, and Group-B (n=160) was administered IV hydralazine in 5mg dose over five minutes, repeated at 20 minutes interval with maximum of five doses. Blood pressure and pulse were monitored every 10 minutes, with follow-up lasting for one hour. Efficacy was defined as achieving target BP ≤140/100 mmHg. Data was analyzed using SPSS version 23.

Results: The target BP was achieved in 248 (77.50%) women, with 134 (83.8%) in the labetalol Group-And 114 (71.2%) in the hydralazine group (p=0.007). Hydralazine achieved BP control faster (50.25 ± 20.43 min vs. 75.34 ± 35.67 min, p=0.001), with fewer doses required (1.85 ± 0.92 vs. 3.68 ± 1.45, p=0.0001).

Conclusion: Labetalol showed better overall efficacy, while hydralazine provided faster BP control with higher adverse effects. Labetalol is recommended for sustained BP management, and hydralazine for rapid BP reduction.

Objective: To investigate the expression characteristics of Ki-67, estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2) in breast cancer (BC) patients and to evaluate their associations with lymph node metastasis and clinical disease stage.

Methodology: The clinicopathological data of 122 patients with BC admitted to Affiliated Nantong Hospital 3^rd of Nantong University from April 2020 to November 2023 were analyzed retrospectively. The immunohistochemical expression of Ki67, ER, PR (labeling indices, %) and HER-2 (IHC score, 0-3+) was compared between groups stratified by lymph node metastasis status and clinical disease stage, and correlations were assessed using Spearman rank analysis.

Results: Patients with lymph node metastasis had a significantly higher Ki67 labeling index and significantly lower ER and PR labeling indices than those without lymph node metastasis (all P<0.05), whereas HER-2 IHC scores did not differ significantly between the two groups (P>0.05). Across clinical stages, the Ki67 labeling index increased progressively from Stage I to Stage IV, whereas ER and PR labeling indices decreased correspondingly, with all pairwise comparisons between adjacent stages remaining statistically significant (P<0.05). Spearman analysis showed that the Ki67 labeling index was positively correlated with lymph node metastasis and clinical disease stage, whereas ER and PR labeling indices were negatively correlated with both parameters (P<0.05). In contrast, HER-2 IHC score showed no significant correlation with lymph node status or clinical stage (P>0.05).

Conclusions: BC patients exhibit characteristic alterations in Ki67, ER, and PR immunohistochemical expression, and the degree of Ki67 increase together with ER and PR decrease is closely associated with lymph node metastasis and clinical disease stage. These findings suggest that combined assessment of these biomarkers may be useful for risk stratification and staging in breast cancer.

Objective: This study aimed to evaluate the impact of the gamified learning tool "Anatomy Cluedo" on cognitive learning gain and engagement in cranial nerve anatomy among medical students.

Methodology: The quantitative research study was carried out in the Department of Anatomy, Shalamar Medical and Dental College, Lahore. In this study 40 students were divided into two groups: the experimental group engaged with "Anatomy Cluedo," while the control group participated in problem-based learning (PBL). Pre-test and post-test assessments, along with engagement metrics measured by the Flow Short Scale (FSS), were analyzed.

Results: The results showed significantly higher cognitive gains in the experimental Group-A (p < 0.001), and strong positive correlations between engagement metrics and learning outcomes (r = 0.78, p < 0.01). Key game elements, such as mechanics, feedback and storytelling, were identified as critical contributors to cognitive learning gains.

Conclusion: This study underscores the potential of gamified tools in enhancing engagement and knowledge retention, providing a foundation for further integration of gamification into medical education curricula.

Objective: To explore the effect of mindfulness-based complementary alternative therapy on physical and mental stress, self-efficacy, and coping styles of patients undergoing breast cancer surgery.

Methodology: This was a retrospective study. This study included 80 breast cancer patients who underwent surgical treatment in Hefei Cancer Hospital Breast Cancer Center, Chinese Academy of Sciences from May 2023 to December 2024. They were equally allocated to two cohorts (n= 40 per group) using randomization. The control cohort received standard postoperative care, while the experimental cohort was provided with mindfulness-based complementary interventions(MBIs) integrated into conventional nursing protocols. The intervention period was eight weeks. SAS, SDS, VAS, GSES and MCMQ were used to evaluate the effects of the two groups before and after intervention, and the total satisfaction(NSNS) of the two groups was evaluated.

Results: Compared to the control group, the intervention group demonstrated significantly lower levels of anxiety(SAS), depression(SDS), and pain perception(VAS) (all P< 0.05). Post-intervention analyses revealed a notable increase in self-efficacy(GSES) within the intervention cohort relative to controls(P< 0.05). Additionally, the intervention group exhibited enhanced coping strategies, with higher scores in "confrontation," "avoidance," and "compromise" domains compared to the control group(P< 0.05). Regarding satisfaction outcomes, the intervention group achieved an overall satisfaction rate of 97.50%, surpassing the control group's 85.00%(P< 0.05).

Conclusion: Eight weeks of mindfulness-based complementary alternative therapy for patients undergoing breast cancer surgery can effectively relieve postoperative stress responses, enhance their self-efficacy, and optimize coping strategies, which should be promoted in clinical practice.