Pakistan Journal of Medical Sciences最新文献

Objective: To study the clinical profile and management outcomes of non-tubal ectopic pregnancy at a tertiary care hospital in the United Arab Emirates (UAE).

Methods: Case files of non-tubal ectopic pregnancy (NTEP) patients from October 2017 to October 2020 presented to Alqasmi Women and Children's Hospital, Sharjah, were included in the study. The data was extracted from available medical records.

Results: A total of 30 confirmed cases of NTEP were identified with the following break-up: caesarean scar ectopic pregnancy (n=14; 46.7%), cornual pregnancy (n=11; 36.7%), cervical pregnancy (n=3; 10%) and ovarian pregnancy n=2; 6.7%). Abdominal pain was the most common presenting symptom, present in 23 (76.7% patients) followed by vaginal bleeding in 17 (56.7%) patients. Ten women were managed medically, ten required surgical treatment, and eight were managed with combined medical and surgical treatments; Two patients were managed expectantly. Patients in each treatment strategy did well and there were no deaths. One patient in the medical treatment group developed complications after one month and underwent subtotal hysterectomy.

Conclusion: Patients with NTEP were presented with varying symptoms and signs depending upon the location of NTEP. The different currently available management options for NTEP seem to be effective and safe when carefully selected based on the clinical merits of each case.

Background & objective: Acute appendicitis is one of the commonest causes of acute abdominal pain presenting to emergency department (ED) and Computerized Tomography scan (CT) is considered gold standard for its diagnosis. Internationally Low Dose Computerized Tomography scan (LDCT) in emergency department is recommended as a beneficial tool to diagnose acute appendicitis with less exposure to radiation and reduction in the rate of negative laparotomy. Local trials are needed to determine the diagnostic accuracy of LDCT as the first line imaging test for acute appendicitis. Our objective was to determine the diagnostic accuracy of LDCT as the first line imaging test for acute appendicitis.

Methods: An observational study was conducted over a sample of 147 patients presented with suspected acute appendicitis to the emergency department of Ziauddin University Hospital, Karachi from November 2018 till May 2019. Non-probability consecutive technique used. Aged ≥ 16 years presented in emergency department with the history (symptoms) and physical examination (Signs) suspecting acute appendicitis were included. Patients with contraindications to CT scan e.g. pregnant women. Patients with signs of Acute Peritonitis requiring immediate surgery. CT scan refused by the patient or patient's attendant were excluded. Histopathology was the gold standard in diagnosing acute appendicitis. The data was analyzed using open epi sample size calculator.

Results: One hundred forty six patients had positive findings on LDCT for acute appendicitis (99.3%) whereas only one patient had negative findings (0.7%). The sensitivity and specificity of LDCT for the detection of acute appendicitis were estimated as 96.45% and 16.67% by taking histopathology as gold standard. Negative predictive value (NPV) and positive predictive value (PPV) were estimated as 16.67% and 96.45% respectively. The overall accuracy of LDCT was 93.88%.

Conclusion: Our study showed that for diagnosing acute appendicitis, LDCT is harmless, fast and economical imaging modality and has diagnostic accuracy with decrease in radiation dose.

Objective: To determine the frequency of cerebral aneurysm in patients with subarachnoid haemorrhage on CT cerebral angiography.

Methods: This prospective cross-sectional study was conducted at Department of Radiology, JPMC, Karachi from 5^th June 2022 to 30^th January 2023. Total 176 patients with subarachnoid haemorrhage irrespective of gender were selected. CT angiography of cerebral vessels was performed. Cerebral aneurysm was noted as per operational definition and recorded.

Results: Age range was from 18 to 60 years. Mean age was 39.516±6.77 years, Mean BMI 29.630±3.08 Kg/m2. and mean duration of symptoms was 7.721±2.40 days. Male patients were 80.1% and females were 19.9%. Cerebral aneurysm was observed in 91.4% female and 78.7% male patients. Aneurysmal percentage was slightly higher in younger (18-40 years) age group (84.2% vs 80.4%) as compared to older (40-60) age group but statistically not significant. Although total percentage of female was quite less 19.9% (n=35 vs n=141 male), in this lesser female percentage, aneurysmal detection was higher as compared to male gender (91.4% vs 78.7%). Distribution of aneurysms according to vessel involved was; 28.7% along anterior communicating artery, 28.3% related to middle cerebral artery and, 22.9% were along posterior communicating vessel. Rest was distributed among other vessels including tip of basilar artery.

Conclusion: In Our study aneurysms was seen 81.3% in patients of subarachnoid hemorrhage having CT angiography at our center in Karachi Pakistan.

Objective: In thalassemia major, repeated blood transfusions result in iron overload causing organ damage. The objective of this study was assessment of liver enzymes in patients with Thalassemia major and to observe their association with ferritin.

Method: A cross-sectional study was performed, at Islamabad Medical and Dental College and its affiliated Akbar Niazi Teaching Hospital from November 2021 till August 2022. Serum ferritin, AST, ALT, and total bilirubin levels were determined, in 135 patients of beta thalassemia major receiving transfusions. Data analysis was performed using SPSS Version 20. For categorical variables, calculation of frequencies and percentages was performed. Mean (± standard deviation) was determined for quantitative variables. ANOVA with post hoc Tukey's test was used for determining association between liver enzymes and serum ferritin. A p-value of <0.05 was considered significant. The correlation between ferritin and LFTs was determined by Pearson's correlation coefficient.

Results: Patients had an age range of 7-30 years, and males constituted 51% of sample. Mean level of ferritin was 6062.61 + 3641.79 ng/ml, with an insignificant difference between the genders (p =0.366). The levels of AST, ALT and bilirubin were perceived to show a significant increase in patients with ferritin levels >5000ng/ml, when compared with patients having ferritin levels < 2,500 ng/ml. A significant positive correlation of increasing serum ferritin levels was observed with ALT (r= 0.682), to a lesser extent with AST (r = 0.532), and only a weak correlation with serum bilirubin (r = 0.350).

Conclusion: Liver damage was caused by increased iron deposition. LFTs should be performed regularly to detect and reduce liver damage by increasing chelation therapy, thereby reducing morbidity and mortality due to thalassemia.

We report a case of incomplete intestinal obstruction in a 29-year-old adult male with Down syndrome in The First Affiliated Hospital, Hebei Medical University from January 2023 to July 2023 the patient had been experiencing intermittent abdominal distension and reduced bowel movements and gas for a period of two years. Physical examination revealed tenderness in the left lower abdomen. Abdominal CT and gastrointestinal imaging showed intestinal and colonic distension, while colonoscopy did not show any abnormalities. During laparoscopic exploration, adhesions were observed between the greater omentum and the left lower abdominal wall, resulting in dilation of the proximal colon. After the adhesions were released, intestinal contents were able to pass through the distal segment, relieving the obstruction. The patient had no history of trauma or surgery. This case highlights a potential association between Down syndrome and congenital abdominal adhesions that can lead to intestinal obstruction. Due to the communication difficulties in patients with Down syndrome, there is a potential for misdiagnosis, emphasizing the importance of awareness. Laparoscopic examination not only aids in the diagnosis but also offers therapeutic benefits in such cases.

Objectives: Obesity is a chronic, multifaceted, leading health problem causing numerous non-communicable diseases with a huge burden on the global healthcare system and economies. Worldwide, multiple interventions have been familiarized for weight reduction strategies, however, in recent years, mobile health applications (mHealth apps) for reshaping weight reduction have been introduced. Therefore, this study aimed to investigate the role of mobile health applications in reducing weight among users in Riyadh, Saudi Arabia.

Methods: This questionnaire-based cross-sectional study was conducted in the Department of Family and Community Medicine, and Medical Education, College of Medicine, King Saud University, Riyadh from May 2019 to December 2022. A total of 502 participants, 332 (66.1%) females and 170 (33.9%) males aged 18-50 years, using smartphones, residing in Riyadh, Saudi Arabia were recruited. The questionnaire was distributed via social media platforms including WhatsApp, and emails and information were recorded.

Results: Among 502 participants, 221 (44.02%) were using mobile health applications and 281 (55.98%) did not use mobile health applications. The results revealed that the participants who have been using mHealth apps for the last six months had significantly decreased body weight compared to those who did not use the mHealth apps (p=0.001).

Conclusions: The study participants using mobile health applications (mHealth apps) had significantly reduced their body weight and felt healthier. The mHealth apps provide health-related information regularly to individuals to track their weight, monitor diet, and physical activity, and information about their overall health.

Objective: To investigate the clinical efficacy of roxithromycin combined with azithromycin sequential therapy in the treatment of mycoplasma pneumoniae pneumonia in children.

Methods: A retrospective study was conducted on 100 patients with mycoplasma pneumoniae pneumonia admitted to The First Affiliated Hospital of Yangtze University from January 2020 to December 2022. All patients were divided into the observation group (roxithromycin combined with azithromycin sequential therapy) and the control group (azithromycin sequential therapy), with 50 cases in each group. The clinical efficacy, improvement time of clinical symptoms/signs, inflammation indexes, oxidative stress indexes and immune function levels of the two groups were compared. Moreover, the improvement of lung function indexes and the adverse reactions were observed.

Results: The overall response rate of the observation group was 96.00%, which was higher than the control group (84.00%) (p<0.05). The time of clinical symptoms/signs in the observation group were significantly lower than those in the control group(p<0.05). After treatment, significant improvements were seen in the levels of CRP, TNF-ɑ, IL-6, GSH-Px, SOD, MDA, CD3⁺, CD4⁺, CD4⁺/CD8⁺, IgM, IgG , IgA, FEV₁, FEV₁%, FVC and FEV₁/FVC of the two groups compared with those before treatment (p<0.05), and the improvement in the observation group was more obvious than that in the control group(p<0.05). The overall incidence of adverse reactions in the observation group was 6.00%, which was slightly lower than that in the control group (8.00%) (c²=0.154, P=0.695).

Conclusion: Roxithromycin combined with azithromycin sequential therapy is a safe regimen for the treatment of mycoplasma pneumoniae pneumonia in children.

Objective: To identify risk factors for complications in patients undergoing gastrointestinal endoscopy under acupuncture anesthesia and to construct a nomogram predictive model.

Methods: This retrospective study included 292 patients who underwent gastrointestinal endoscopy under acupuncture anesthesia at the Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from June 2020 to May 2023. Logistic regression analysis was used to identify risk factors for complications in patients undergoing gastrointestinal endoscopy under acupuncture anesthesia. A nomogram prediction model was constructed using the RMS package of R4.1.2 software based on the independent risk factors identified. The predictive performance of the model was assessed using consistency index (C-index), calibration curve, and receiver operating characteristic (ROC) curve.

Results: Seventy-five patients (25.68%) had complications. Body mass index (BMI), history of cardiovascular diseases, fasting time, history of respiratory diseases, and Sedation-Agitation Scale (SAS) score were identified as risk factors for complications. Based on this risk, a nomogram predictive model was constructed. The C-index of the nomogram model was 0.927. Calibration curve showed a good consistency between actual observations and nomogram predictions. The ROC curve area under curve (AUC) was 0.927 (95% CI: 0.895-0.959), indicating a certain predictive value for the occurrence of complications. When the optimal cut-off value was selected, the sensitivity and specificity of the model were 77.0% and 92.0%, respectively, indicating that the predictive model was effective.

Conclusions: BMI, history of cardiovascular disease, fasting time, history of respiratory disease, and SAS score are independent risk factors for complications in patients undergoing gastrointestinal endoscopy under acupuncture anesthesia. The constructed nomogram predictive model has a good performance in predicting the occurrence of complications in patients undergoing gastrointestinal endoscopy with under acupuncture anesthesia.

Objective: To compare the effectiveness of different tirofiban administration time windows in patients with no-reflow myocardial infarction (MI) during percutaneous coronary intervention (PCI).

Methods: This single centre retrospective observational study included patients with no-reflow MI, undergoing PCI at the Hanyang Hospital affiliated to Wuhan University of Science and Technology from March 2020 to May 2023. All patients were administered tirofiban. Patients who received tirofiban with postinterventional thrombolysis in myocardial infarction (TIMI) flow ≥ 1 were grouped as Group-I, and patients who were directly given tirofiban through the guiding catheter without forward blood flow were grouped as Group-II. TIMI blood flow classification, levels of cardiac troponin T (cTnT) and creatine kinase isoenzyme MB (CK-MB), incidence of complications and major adverse cardiovascular events (MACE) in the two groups before and after the treatment were statistically analyzed.

Results: A total of 156 patients were included in this study, including 79 patients in Group-I and 77 patients in Group-II. There was no significant difference in the baseline data between the two groups (P>0.05). After treatment, TIMI blood flow classification of the two groups improved and was significantly better in Group-I compared to Group-II (P<0.05). After treatment, levels of Serum cTnT and CK-MB in the two groups decreased, and were significantly lower in Group-I than in Group-II (P<0.05). There was no significant difference in the incidence of complications between Group-I (3.80%) and Group-II (6.49%) (P>0.05). The incidence of MACE in Group-I (3.80%) was lower than that in Group-II (12.99%) (P<0.05).

Conclusions: Compared with the direct application of tirofiban, tirofiban given when TIMI Grade≥ 1 for patients with no-reflow MI during PCI can more effectively regulate the blood flow status of target vessels, reduce myocardial injury, and reduce the risk of MACE.

Objective: To explore the efficacy of argon-helium cryoablation (AHC) combined with chemotherapy in the treatment of advanced non-small cell lung cancer (NSCLC).

Methods: A retrospective study was carried out between February 2020 to June 2022 of 85 patients with advanced NSCLC admitted to Tianjin Cancer Hospital Airport Hospital. Patients were categorized into two groups based on whether they had received AHC: patients received chemotherapy treatment alone (chemotherapy group, n=41); patients received chemotherapy combined with AHC (combined group, n=44). Tumor control rate, serum tumor marker levels, quality of life, and median survival time between the two groups were compared.

Results: Tumor control rate in the combined group (86.36%) was significantly higher than that in the chemotherapy group (68.29%) (P<0.05). After treatment, the levels of serum cytokeratin 19 fragment (CYFRA21-1), carcinoembryonic antigen (CEA) and glycoprotein antigen 125 (CA125) in the two groups were significantly lower than those before the treatment, and significantly lower in the combined group compared to the chemotherapy group (P<0.05). After the treatment, the quality of life of patients in both groups was significantly higher than before the treatment. Quality of life in the combined group was significantly higher than in the chemotherapy group (P<0.05). One year after treatment, the median survival time of the combined group (10.5 months; 95% CI: 9.775-11.225) was significantly higher than that of the chemotherapy group (9.4 months; 95% CI: 8.55-10.323) (P=0.045).

Conclusions: Compared with chemotherapy alone, conventional chemotherapy combined with AHC in the treatment of advanced NSCLC can significantly reduce the levels of serum tumor markers and improve overall treatment efficacy, quality of life and 1-year overall survival rate.