Pakistan Journal of Medical Sciences最新文献

Objective: To determine the frequency of cases with atypical clinical history diagnosed as typhoid-related intestinal perforation (TIP) in a tertiary care hospital.

Methodology: A Cross sectional study was conducted in department of General Surgery, Jinnah Postgraduate Medical Centre, Karachi, from 20^th January 2021 to 20^th January 2024. Ninety-eight patients meeting the inclusion criteria of age 13-75 and diagnosis of typhoid related intestinal perforation, were enrolled through non-probability consecutive sampling. Data was collected after taking an informed verbal consent in self-designed proforma. SPSS version 25 was utilized for data analysis. A P-value of ≤ 0.05 was considered as significant.

Results: Median age was 23 (18, 35) years with 82.7 % male predominance. Out of ninety-eight cases, 96.94% (95) had at least one atypical clinical feature while 23.49% (23) had all three atypical features at presentation. About 75.5% (74) of the cases had atypical duration of illness (≤14 days or >21 days). 76.53% (70) had atypical fever pattern (other than continuous step ladder). 5.1% (5) were afebrile, also considered as atypical. 41.84% (41) had atypical bowel habits (normal). Most common time of presentation was week-one 38.8% (38), followed by week-three, week-two and beyond week-three. The most common fever pattern was intermittent 66.3%, followed by continuous, remittent and relapsing. Constipation was more common 58.16% (57) than diarrhea 41.84% (41).

Conclusion: Majority of patients with TIP had short duration of illness and intermittent pattern of fever, which were prone to be misdiagnosed due to their atypical presentation. Such cases must come into consideration for timely and adequate management of the disease.

Objective: Congenital anomalies (CA) have emerged as a leading cause of infant morbidity and mortality worldwide, particularly in low-resource countries such as Pakistan. This study investigated the distribution, types, and biodemographic attributes of CA in the Faisalabad Division of Punjab, Pakistan.

Methodology: A clinico-epidemiological study was conducted from September 2023 to April 2024. Individuals and families with CA were recruited through multiple approaches, including visits to Allied hospital, special education centers, Sundus Foundation and random door-to-door surveys. The anomalies were classified with the help of clinicians using the OMIM and ICD-10 databases. Descriptive statistics were employed for data analysis.

Results: A total of 867 independent individuals/families with CA were included. The CA were classified into 12 major and 107 minor categories. Among these major categories, neurological disorders were the most prevalent (40%), followed by sensorineural/ear defects (13%), neuromuscular disorders (9%), limb defects (7%), blood disorders (6%), orofacial defects (4%), musculoskeletal disorders (4%), congenital heart defects (4%), eye/visual impairments (4%), urogenital defects (3%), metabolic defects (3%) and others (2%). The parental consanguinity was observed in 62% cases. There was remarkably high representation of sporadic cases (66%) compared to familial (34%), respectively. Marked differentials were evident in the distribution of CA across the demographic, socio-economic and ethnic attributes of individuals.

Conclusions: Majority of the anomalies observed in this cohort are of severe nature suggesting the need for targeted public health interventions. There is a dire need for awareness programs regarding maternal exposures and parental consanguinity and prenatal screening and genetic counselling services.

Objective: To investigate the predictive effects of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), red blood cell distribution width (RDW), and mean platelet volume (MPV) on the severity of neonatal pulmonary infections.

Methodology: This is a retrospective design. Ninety childrens with pulmonary infection who received treatment in Mianzhu People's Hospital from March 2023 to September 2024 were randomly selected as the subjects, and were divided into mild, moderate, and severe groups according to the different degrees of pulmonary infection, while 50 healthy newborns were selected as controls. The levels of NLR, PLR, RDW, and MPV were measured, and correlation analyses were conducted.

Results: NLR, PLR and RDW levels were the highest in the severe group, and the MPV level was the lowest (P < 0.05). Serum NLR, PLR, and RDW levels all showed a significant positive correlation with the neonatal critical illness score (NCIS) and oxygenation index (OI) (P < 0.05) and a significant negative correlation with the respiratory index (RI) (P < 0.05); the serum MPV level showed a significant negative correlation with the NCIS and OI (P < 0.05) and a significant positive correlation with the RI (P < 0.05). The area under the curve was 0.710 for NLR, 0.713 for PLR, 0.714 for RDW, and 0.725 for MPV.

Conclusion: NLR, PLR, RDW, and MPV can evaluate the condition of neonatal pulmonary infection and provide a reference basis for clinicians to understand the severity of the condition and rational treatment of children, which has high clinical application value.

Background & objective: Posterior fossa tumors (PFTs) frequently cause hydrocephalus (HCP), requiring permanent cerebrospinal fluid (CSF) diversion post resection in both pediatric and adult patients. We aimed to compare the performance of various tools in predicting the risk of postoperative hydrocephalus and improving prediction for better neurosurgical decision-making.

Methodology: A comprehensive literature search was conducted across Google Scholar and PubMed database adhering to Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines using keywords such as posterior fossa tumors, hydrocephalus, CSF diversion, and predictive models. A total of ten original articles with a sample size of 1597 from 2021 to 2025 were selected for data extraction. Study quality evaluation was executed via PROBAST tool.

Results: The cumulative mean ages were 7.18±1.64 years for pediatric patients and 53.07±0.81 years for adults. Pediatric patients accounted for 67.31% (1075) patients while adults accounted for 19.41% (402) patients. Preoperative hydrocephalus was present in 52.4% (833) patients, out of which 22.9% (367) required CSF diversion post resection. Pooled post-operative shunt rates revealed higher shunt rate 53.9% (715) in patients with preoperative hydrocephalus than those without 13% (80). Logistic regression was used in 88.8% (8) of the identified models while AI based model demonstrated best performance (AUC = 0.938).

Conclusion: Of all the predictive models developed, till now, to predict the need for CSF diversion after PFT resection, artificial intelligence-based model shows superior accuracy for improving hydrocephalus risk prognostication. Apart from clinical, demographic, surgery-related and radiological predictors incorporated in conventional predictive models, the artificial-intelligence based model improves risk prediction by utilizing complex patterns in intraoperative and postoperative imaging of patients.

Background and objective: Pilocytic astrocytoma primarily affects children, commonly originates in the cerebellum, and generally has a favorable prognosis. The prognostic significance of patient age, tumor location, and extent of resection remains debated. This retrospective study aimed to evaluate clinicopathological and radiological features, identify prognostic factors, and assess progression-free survival at 1 and 5 years and overall survival at one, five and 10 years.

Methodology: This retrospective study was conducted at The Aga Khan University Hospital (2013-2022) on patients with histologically confirmed pilocytic astrocytoma. Patients with less than one year of follow-up were excluded. Data on demographics, clinical presentation, tumor characteristics, extent of resection, adjuvant therapy, and outcomes were collected. Survival outcomes were analyzed using Kaplan-Meier and Cox regression methods, with statistical significance set at p < 0.05.

Results: In the study of 101 patients, 53 (52.5%) were male and 48 (47.5%) were female. Of these, 59 were pediatric patients (<14 years), 35 were aged 15-39 years, and 7 were over 39, with a mean age of 16.9 years. The median pre-operative Lansky/KPS score was 80. The cerebellum was the most common site for tumors, and most tumors were solid-cystic (69.6%), while 14.5% were purely cystic. The mean preoperative tumor volume was 52.9 ml (SD 62.5). Hydrocephalus was present in 49.5% of patients, and leptomeningeal dissemination was seen in five patients. Gross total resection (GTR) was achieved in 37 (43.0%), near-total resection (NTR) in 7 (8.1%), subtotal resection (STR) in 38 (44.1%), and four patients (4.6%) had biopsy only. As an adjuvant treatment, 8 patients received both chemoradiation, four patients had received only chemotherapy, and 4 had received radiation only. Two patients died within 30 days after surgery, and 22 had recurrence/progression. The 1-year survival rate was 92%, 5-year survival was 87%, and 10-year survival was 83%. The 1-year progression-free survival (PFS) was 50%, and 5-year PFS was 10%. Kaplan-Meier analysis showed trends for better overall survival (OS) with GTR or NTR, cystic tumors with nodules, pediatric patients, absence of leptomeningeal dissemination, and microvascular proliferation, but these differences were not statistically significant.

Conclusion: This study of pilocytic astrocytoma over the past decade in a low-and-middle-income country highlights survival rates (1-year, 5-year, 10-year) reported for the first time in this population. Survival trends varied by age, leptomeningeal disease, extent of resection, and radiological tumor patterns. Cox regression identified radiological patterns, CNS infections, and endocrinological dysfunction as key predictors of overall survival.

Middle cranial fossa hemangiomas are challenging owing to the complex vascular anatomy of the region. Only few cases have been reported to date, in our setting. A 15-year-old male presented with the headache, right sided visual deterioration for 18 months. He had right pupil dilated, non-reactive, ptosis and ophthalmoplegia. Magnetic resonance imaging (MRI) revealed right middle fossa heterogeneous enhancing lesion. On angiography, internal carotid artery (ICA) showed cavernous segment blush. Digital subtraction angiography was suggestive of diminutive right ICA; no distal filling beyond its cavernous segment. Patient was re-operated, excision was done. Intraoperatively lesion was extra-axial and highly vascular. Histopathology was conclusive of OLIG2 and SSTR2 negative hemangioma. Post-operative recovery was uneventful. While probing the differentials of skull base lesions, especially near ICA, cavernous sinus hemangiomas must be considered. Although extremely rare but the vascular nature poses a threat to life, if not meticulously investigated and operated timely.

Objective: To evaluate the clinical value of bundled care protocols in enhancing postoperative recovery among lung cancer patients.

Methodology: This was a retrospective study. A total of 120 patients undergoing radical lung cancer surgery in the thoracic surgery department of Affiliated Hospital of Hebei University from November 2022 to November 2024 were enrolled randomly assigned to the study group and the control group using a random number table (n=60 each group). The control group received routine nursing care, while the study group was managed using a bundled care protocol. Indicators including pulmonary function parameters, immune status, postoperative complication rates, quality-of-life scores and satisfaction levels were compared between the two groups before and after the intervention.

Results: Post-intervention, the study group demonstrated significant improvements in FEV1, FVC, FEV1/FVC and PEF values compared to the control group(P=0.00). Immune indicators, including CD3⁺, CD4⁺ and CD4⁺/CD8⁺, in the study group were also markedly higher than those in the control group(P=0.00). The incidence of postoperative complications was 8% in the study group, markedly lower than the 23% observed in the control group (P=0.02). Post-intervention, KPS scores and SF-36 quality-of-life scores were significantly higher in the study group compared to the control group(P=0.00). Patient satisfaction in the study group reached 100%, compared to 90% in the control group, with a statistically significant difference(P=0.01).

Conclusion: Bundled care protocols demonstrate significant clinical benefits for lung cancer patients undergoing surgical treatment, including enhanced pulmonary function recovery, improved immune reconstitution, reduced postoperative complication rates and elevated quality of life and care satisfaction.

Objectives: Maternal weight gain during pregnancy affects fetal growth. This study aimed to determine the association between gestational weight gain (GWG) and fetal weight gain at different weeks of gestation. The study also intended to determine the relationships among maternal pre-pregnancy body mass index (BMI), GWG, and neonatal birth weight.

Method: This prospective observational cohort study examined 316 pregnant women at Security Forces Hospital, Makkah, from July 1st, 2023, to June 30th, 2024. All uncomplicated, singleton, booked cases with term deliveries were included. Maternal pre-pregnancy weight and BMI were determined and categorized as normal, overweight, or obese. Participants were followed up with from 18 ± 1 weeks until delivery. Gestational weight gain and estimated fetal weight by ultrasound were recorded and compared at weeks 18, 24, 28, 32, and 36.

Results: GWG showed no significant correlation with estimated fetal weight at 18 weeks (B=0.001, p=0.242) and 24 weeks (B=0.003, p=0.242). However, GWG at 28 weeks (B=0.044, p<0.001), 32 weeks (B=0.029, p=0.001), and 36 weeks (B=115.13, p<0.001) strongly predicted fetal weight at the corresponding weeks. Pre-pregnancy weight (r=0.10, p=0.073) and BMI (r=0.08, p=0.164) showed non-significant correlations with neonatal birth weight. However, total GWG (B=0.068, p<0.001) and pregnancy duration (B=20.81, p<0.001) significantly influenced birth weight. Despite variations in GWG, average birth weights were relatively similar across all BMI maternal groups, with the obese group having the highest birth weights, followed by the overweight and normal groups.

Conclusion: Maternal GWG directly affects fetal weight (especially during the third trimester) and birth weight.

Objective: To evaluate the value of a radiomics-based machine learning model in detecting Type-B aortic dissection (TBAD) on computed tomography (CT) images.

Methodology: This retrospective analysis included one hundred records of patients with clinically diagnosed TBAD and one hundred records of non-TBAD patients treated at the First Hospital of Jiaxing from January 2010 to January 2024. Radiomics features were extracted from CT non-contrast images, and the least absolute shrinkage and selection operator (LASSO) was used to construct dimensionality reduction and prediction models. The diagnostic performance of the model was evaluated through receiver operating characteristic (ROC) curves.

Results: Fifteen radiomics features were extracted from the training cohort. All eight machine learning-established radiomics models in the training cohort demonstrated good prediction accuracy, with area under the ROC curve (AUC) values exceeding 0.9 in the validation set. Among the three models compared, the AUC values of the nomogram were the highest in both the training and validation cohorts (0.991 [95% confidence interval (CI): 0.982-1.000] and 0.998 [95% CI: 0.993-1.000], respectively). The calibration curves of the nomogram in both cohorts were more closely aligned with the dashed line. The nomogram showed the highest clinical benefits in both training and validation cohorts.

Conclusions: The predictive model established based on radiomics analysis of CT images demonstrates good predictive ability in recognizing TBAD.