Pakistan Journal of Medical Sciences最新文献

Objective: To assess the clinical effectiveness of postauricular injection of methylprednisolone in the treatment of individuals with sudden deafness (SD) and to identify influencing factors.

Methodology: In this retrospective study, we included clinical data of 106 eligible patients with SD who were hospitalized in the Department of Otorhinolaryngology of Nanjing Integrated Traditional Chinese and Western Medicine Hospital from October 2023 to October 2024. According to the different routes of administration of methylprednisolone, patients were divided into an observation (OBP) (n=54) and a control (CGP) (n=52) group. The CGP group received routine treatment of intravenous methylprednisolone combined with conventional medication and the OBP group received retroauricular injection of methylprednisolone in addition to the routine treatment.

Results: Patients in the OBP group reported a considerably better overall efficacy (87.0% vs. 67.3%) and tinnitus (74.1% vs. 60.7%) than the CGP group. The vertigo disappearance time (5.19±1.29 d vs 5.35±1.06 d) and ear fullness sensation halo disappearance time (5.73±1.21 d vs 6.16±1.27 d) in the OBP group were considerably shorter than in the CGP group (P<0.05). Levels of Homocysteine (HCY), High Shear Blood Viscosity (HBV), Low Shear Blood Viscosity (LBV), Plasma Viscosity (PV) and Hematocrit (HCT) in both groups decreased significantly after therapy and were substantially lower in the OBP group compared to the CGP group (p < 0.05).

Conclusion: Compared to conventional treatment, postauricular injection of methylprednisolone can enhance the treatment efficacy of SD and is associated with improvement in accompanying symptoms. Postauricular injection of methylprednisolone can more effectively reduce HCY, HBV, LBV, PV and HCT levels in SD patients.

Objective: The study aimed to assess the hemostatic complications in children with uncorrected CCHD, focusing on bleeding and thrombotic manifestations, thrombocytopenia, abnormal coagulation profiles, and deficiencies in clotting factors.

Methodology: This cross-sectional study was conducted from January to November 2022 at the largest tertiary care pediatric hospital in Lahore, Pakistan. Seventy-five children aged 1-14 years with diagnosed CCHD were enrolled. Detailed clinical evaluation and laboratory investigations, including Complete Blood Count, Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), International Normalized Ratio (INR) and clotting factors' assays were performed. Thrombophilia testing was done in patients with history of recent stroke. Data was analyzed using SPSS version 24.

Results: Among the 75 patients, the majority aged between 1-5 years (n=28, 37.3%) with male to female ratio of 1.5:1. The predominant diagnosis (n= 51,68%) was Tetralogy of Fallot (TOF). Hemostatic abnormalities included thrombocytopenia (48%), prolonged PT (56%), INR (43%), and APTT (36%). Bleeding manifestations were observed in 8% of the patients, while 5.3% had a history of stroke. Raised hematocrit was found to be significantly associated with deranged APTT. Coagulation factor deficiencies including factor V, combined factor VII and X and fibrinogen, were noted in 4% of the patients.

Conclusion: The study highlights significant coagulation challenges in children with uncorrected CCHD, like thrombocytopenia and coagulation factors' deficiencies. Enhanced understanding of these hemostatic abnormalities is crucial for better patient care in resource-constrained settings.

Objective: To assess the variation in levels of emotional intelligence of students in pre-clinical and clinical years of health sciences and to explore what factors were associated with differing levels of EI.

Methodology: This mixed-method study was done at the University of Lahore from March to August 2023. Quantitative data was collected using the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF) from 248 students, 62 participants were recruited from each discipline of health sciences students. Three focus group discussions and four one-on-one interviews were performed. Thematic analysis of the qualitative data was done based on Daniel's Goleman model of EI's theoretical framework.

Results: One-third (32.30%) of health sciences students had low EI levels. Physiotherapy clinical years had a higher mean EI score (141.13 ± 13.42 SD). In MBBS clinical years, EI decreased (p> 0.02), while for BDS, physiotherapy, and optometry, it remained non-significant (p> 0.05). However, proportion of students with moderate EI declined in MBBS (from 67.7% to 41.9%) and optometry (from 83.9% to 67.7%) but increased in physiotherapy (from 64.5% to 77.4%) and BDS (from 58.1% to 61.3%). Five key factors were identified influencing EI levels: self-awareness, social awareness, teacher role modelling, self-management, and communication skills.

Conclusion: Students' EI varied across and within disciplines, depending on self-awareness, the working environment, and the responses of their teachers and patients. Soft skills should be explicitly incorporated into the curriculum and reinforced through positive role modelling by teachers.

Objective: To investigate the application of pharmacy practice based on the evidence-based pharmacy (EBP) model in the anti-infective treatment of patients with severe pneumonia.

Methodology: This was a retrospective study. A total of 200 patients diagnosed with severe pneumonia caused by multidrug-resistant Gram-negative bacilli(MDR-GNB) and admitted to Baoding No.1 Central Hospital from April 2023 to March 2024 were randomly assigned to a control group(received conventional anti-infective treatment) and an experimental group(in addition to the conventional treatment, received pharmacy practice interventions based on the EBP model implemented by clinical pharmacists), with one hundred cases in each group.The two groups were compared in terms of antimicrobial drug use intensity, pre-antibiotic microbiological testing rates, clinical efficacy, adverse reaction rates, and irrational drug use.

Results: The antimicrobial drug use intensity in the experimental group was significantly lower than that in the control group (P< 0.05), while the pre-antibiotic microbiological testing rate was significantly higher (P< 0.05). The antimicrobial drug costs and anti-infective treatment duration in the experimental group were lower than those in the control group (P< 0.05, respectively). The bacterial eradication and overall response in the experimental group were significantly higher than those in the control group (P< 0.05, respectively). Furthermore, adverse reaction and irrational drug use rates were significantly lower in the experimental group compared to the control group (P< 0.05, respectively).

Conclusion: EBP model-based pharmacy practice may assist physicians in optimizing anti-infective treatment regimens for patients with severe pneumonia caused by MDR-GNB, improving treatment outcomes and medication safety while effectively enhancing patient prognosis.

Background & objective: Hydronephrosis is the dilatation of renal pelvis and calices with urine as due to obstruction of urine flow along the urinary tract. This study aimed to report the causes of hydronephrosis in the western region of Yemen.

Methodology: This retrospective study reviewed the electronic medical records of 418 patients diagnosed with hydronephrosis between June 2024 to December 2024 at Advanced AlRazi Diagnostic Center, Al-Hodeidah, Republic of Yemen.

Results: A total of 418 patients with 476 kidneys affected by hydronephrosis were included in this study. There were 265 (63.4%) male and 153 (36.6%) females, aged 1 to 80 years (mean age: 31.11±11.14). Hydronephrosis was most commonly among young adults (n=316, 66.4%). It was predominantly unilateral 361 (86.4), with right side more frequently affected than the left. The most common grade observed was Grade-II (69.7%), followed by Grade-III (17.9%). The leading cause of hydronephrosis was stones (74.4%), followed by reflux (9.5%) and pregnancy (8.8%). The stones causing hydronephrosis were most often located in the distal ureter (DU) (43.7%), followed by the middle ureter (MU) (18.5%), upper ureter (UU) (17%), vesicoureteral junction (10.5%), renal pelvis (2.3%) and urethra (0.8%). The non-parametric Kruskal-Wallis test revealed that the mean stone size increased with the grade of hydronephrosis from Grade-I to Grade-IV (p <0.001).

Conclusion: This study concluded that ureteric or renal stones (nephrolithiasis) were the predominant cause of hydronephrosis, followed by reflux, pregnancy and underactive bladder. Ureteric strictures and infections were rare causes. Nephrolithiasis were commonly found in the DU, MU and UU. Grade-II hydronephrosis was the most frequently reported, with strong correlation between stone size and hydronephrosis grade, as the mean stone size increased from Grade-I to Grade-IV.

Objective: This study aimed to compare the diagnostic value of magnetic resonance imaging (MRI) and multi-slice spiral computed tomography (MSCT) in patients with pancreatitis.

Methodology: Clinical data of 128 patients with suspected pancreatitis who underwent MRI and MSCT examinations in Jiading District Central Hospital from November 2022 to September 2024 were retrospectively analyzed. Of them, 64 patients were eventually diagnosed with pancreatitis and 64 received a different diagnosis. Pancreatitis detection rate, diagnostic sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of MRI and MSCT, as well as the performance of both methods in identifying focal or total pancreatic enlargement and peripancreatic exudate, were compared.

Results: The sensitivity (96.88%), accuracy (96.09%) and NPV (96.83%) of MRI in diagnosing pancreatitis were significantly better than those of MSCT (84.38%, 89.06%, 85.71%, respectively, P<0.05). Both methods had comparable specificity (MRI: 95.31%, MSCT: 93.75%) and PPV (MRI: 95.38%, MSCT: 93.10%) (P>0.05). The detection rate of MRI in identifying pancreatic enlargement (96.00%) and peripancreatic exudate (94.23%) was superior to that of MSCT (82.00% and 76.92%, respectively, P<0.05).

Conclusions: Both MRI and MSCT are high-value diagnostic tools for pancreatitis. However, MRI performs better in identifying pancreatic parenchymal changes and surrounding tissue involvement. Based on the results of this study, clinicians should prioritize MRI as an imaging evaluation method for pancreatitis when possible.

Background and objective: Prolonged stays in the Post-Anesthesia Care Unit (PACU) can negatively impact patient safety, hospital length of stay, and surgical workflow. While clinical reasons for delayed discharge are often studied, non-clinical factors such as bed unavailability and staff busyness are less frequently addressed. Our objective was to identify non-clinical factors contributing to delayed PACU discharge and implement quality improvement strategies to reduce PACU length of stay.

Methodology: A new departmental Key Performance Indicator (KPI) was introduced in July 2023 to monitor PACU length of stay, with "delayed discharge" defined as exceeding one-hour post-fitness for discharge. An audit was conducted using retrospective data from 69 patients in September 2023. Two Plan-Do-Study-Act (PDSA) cycles were conducted. Interventions included regular educational sessions, expanding the audit team, initiating monthly departmental quality improvement meetings, creating a new data collection form to assess staff busyness, and adding two beds to the High Dependency Unit (HDU).

Results: Baseline data showed that only 62% of patients were discharged within the target timeframe. After the first PDSA cycle, compliance improved to 74%. Following the second PDSA cycle, supported by multidisciplinary collaboration and infrastructure improvements, the department achieved its target (≥95%) by February 2024. Contributing non-clinical factors leading to delayed discharges included staff busyness (e.g., shift changes, porter delays) and lack of available beds.

Conclusion: Addressing non-clinical factors such as staffing logistics and bed availability significantly improved PACU discharge efficiency. Structured quality improvement initiatives and interdepartmental collaboration were key to achieving sustained improvements in patient flow and departmental performance.

Objective: To investigate the predictive value of thrombotic molecular markers, including TAT, PIC, TM, and t-PAIC, combined with the VTE score for venous thrombosis in patients with gastrointestinal malignancies.

Methodology: This was a retrospective study. Two hundred and fifteen patients diagnosed with gastrointestinal malignancies at the Affiliated Hospital of Hebei University between January 2024 and March 2025 were enrolled in this study. Based on whether venous thrombosis occurred during hospitalization after treatment, patients were divided into a thrombosis group(n= 34) and a non-thrombosis group(n= 181). The levels of thrombotic molecular markers, including TAT, PIC, TM, and t-PAIC, were measured, and the VTE score was recorded for both groups.

Results: The levels of TAT, PIC were significantly higher in the thrombosis group compared to the non-thrombosis group(P<0.05, respectively). ROC curve analysis showed that the area under the curve(AUC) for TAT, PIC, TM, t-PAIC, VTE score, and the integrated model were 0.774, 0.635, 0.539, 0.573, 0.577, and 0.793, respectively. The AUC of the integrated model was significantly higher than that of TAT, PIC, TM, t-PAIC, and the VTE score alone(P< 0.05, respectively). At the optimal cutoff value of 0.204, the integrated model achieved a sensitivity of 0.676 and a specificity of 0.851. Multivariate logistic regression analysis identified age, history of cardiovascular disease, and TAT as independent risk factors for VTE (P < 0.05, respectively). Each unit increase in TAT was associated with a 28.9% higher risk of venous thrombosis in patients with gastrointestinal malignancies.

Conclusion: The combination of thrombotic molecular markers and VTE score has significant clinical value in predicting venous thrombosis in patients with gastrointestinal malignancies. This approach facilitates the early identification of high-risk patients.

Background & objective: Repeat cardiac surgery is often complicated by re-entry injuries and other risks, especially in patients with a history of prior cardiac procedures. The associated reason of repeat surgeries include complications such as graft failure, valve dysfunction, or disease recurrence. The procedure is categorized as higher risk profiles compared to primary surgical intervention. This study aimed to assess the frequency of re-entry injuries and other early complications in patients undergoing repeat cardiac surgery at a newly established cardiac center.

Methodology: The study included patient's data who visited cardiac surgery department of Peshawar Institute of Cardiology between January 2021 to February 2025. This retrospective study included 28 patients who underwent repeat cardiac surgery. Data on demographics, pre-operative status, comorbidities, and surgical procedures were collected from the hospital's management information system (HMIS) and electronic medical records (EMR). The primary outcomes were re-entry injury frequency, postoperative complications, and 30-day mortality.

Results: The study included 64.3% female patients, with a mean age of 38.89 years. Common pre-operative conditions included hypertension (32.1%) and advanced heart failure, with 71.4% of patients classified as NYHA class III and IV. The most frequent procedures were redo mitral valve replacement (MVR) and pseudoaneurysm repair. Central cannulation was used in 78.57% of cases, with a mean bypass time of 140.23 minutes.

Conclusion: This study provides important insights into the characteristics, procedures, and outcomes of patients undergoing repeat cardiac surgery at a newly established cardiac centre with no re-entry injury. The findings indicate that the majority of patients were female, mostly presenting advanced heart failure and requiring complex, multi-valve procedures. Central cannulation was the predominant method for cardiopulmonary bypass.