Journal of the Pakistan Medical Association最新文献

Objective: To evaluate people's knowledge and perceptions regarding tuberculosis.

Method: The cross-sectional study was conducted at 10 community pharmacies in Mosul, Iraq, from December 2021 to March 2022, and comprised individuals of either gender aged >18 years. Data was collected using a 17-item questionnaire, with 12 questions related to knowledge and 5 related to perception regarding tuberculosis. Data was analysed using SPSS 25.

Results: Of the 200 participants with mean age 38.79+/-13.72 years, 113(56.5%) were females and 101(50.5%) had education up to university level. Overall, 85(42.5) subjects could differentiate between tuberculosis and pulmonary tuberculosis, and 176(88%) knew TB was curable. Besides, 135(67.5%) subjects said they would not visit patients with tuberculosis.

Conclusions: The national tuberculosis control programme in Iraq seemed to have improved public awareness regarding tuberculosis.

Objective: To determine whether tocilizumab improved outcomes of patients hospitalised with severe coronavirus disease-2019 cytokine storm syndrome.

Methods: The case-control study was conducted at Al-Yarmouk Teaching Hospital, Baghdad, and Al Shatra General Hospital, Thi Qar, Iraq, from September 2020 to March 2021, and comprised patients with severe acquired respiratory syndrome-corona virus-2 pneumonia who were not candidates for mechanical ventilation and received a single-dose intravenous infusion of tocilizumab 8mg/kg in group A. The outcomes were compared with patients in group B who received only standard care. Data was analysed using SPSS 26.

Results: Of the 60 patients, 30(50%) were in group A; 22(73.3%) males and 8(26.7%) females with mean age 56.63±10.92 years. There were 30(50%) patients in control group B; 24(80%) males and 6(20%) females with mean age 54.8±6.18 (p>0.05). Group A showed significant changes compared to group B in the levels of interleukin-6, serum ferritin, D-dimer, procalcitonin, lymphocytes count and oxygen saturation (p<0.05). Mortality rate was not significantly different between the groups (p>0.05).

Conclusions: Majority of the acute phase inflammatory markers were reduced significantly by treatment with tocilizumab.

Objective: To find the relationship between vitamin D deficiency and the activity of systemic lupus erythematosus in Iraqi patients.

Methods: The case-control study was conducted at Baghdad Teaching Hospital, Baghdad, Iraq, from July to October 2018, and comprised systemic lupus erythematosus patients regardless of age and gender visiting the Rheumatology outpatient clinic. Serum levels of complement protein 3, complement protein 4, anti-doublestranded deoxyribonucleic acid and 25-hydroxy vitamin D were estimated. Based on disease activity scores, patients were divided into moderate activity group SLE-M and severe activity group SLE-S. Healthy subjects matched for age and gender were also enrolled as the control group. Data was analysed using Graph Pad Prism 5.0.

Results: Of the 150 subjects, 62(41.3%) were in SLE-S group, 38(25.3%) in SLE-M and 59(33.3%) in the control group. Among the patients, 97(97%) were females and 3(3%) were males, with a female-to-male ratio of 32:1. The patients' age range was <10-≥50 years, while the control group consisted of 2 (4%) males and 48 (96%) females with an age range of <10-≥50. The mean levels of serum complement protein 3, complement protein 4 and vitamin D levels were significantly lower in the patient groups compared to the controls (p<0.05).

Conclusions: Systemic lupus erythematosus patients suffered from either vitamin D deficiency or insufficiency, and low vitamin D levels were found related to disease activity.

Objectives: To determine the correlation between inflammatory indices and the Tumour-Node-Metastasis stage of oesophageal carcinoma.

Methods: The prospective study was conducted from January 2021 to January 2023 at the Department of Upper Gastrointestinal Surgery, Dr Ruth K.M. Pfau Civil Hospital, Karachi, and comprised patients of either gender aged 18- 60 years with biopsy-proven oesophageal cancer. Blood samples were drawn and on the basis of plasma obtained, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, C-reactive protein-to-albumin ratio, lymphocyte-tomonocyte ratio and platelet-to red cell distribution width ratio were calculated. Modified Glasgow Prognostic Score was calculated on the basis of C-reactive protein and albumin levels. Values were compared with tumour length, depth of invasion, lymph node status, vascular involvement, metastasis, pathological subtype and grade of differentiation. Data was analysed using SPSS 24.

Results: Of the 220 patients aged 46.1±14.2 years, 120(54%) were females and 100(46%) were males. C-reactive protein-to-albumin ratio demonstrated the highest predictive power for advanced disease stage (p=0.003). Elevated neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio (p=0.010 and p=0.044) were positively correlated with node stage, while elevated platelet-to-lymphocyte ratio was associated with advanced clinical stage (p=0.046). C-reactive protein-to-albumin ratio exhibited positive association with higher tumour stage (p=0.033), node stage (p<0.001) and clinical stage IV (p<0.001). Modified Glasgow Prognostic Score was significantly associated with advanced clinical stage (p<0.001).

Conclusion: Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, C-reactive protein-to-albumin ratio, and Modified Glasgow Prognostic Score could be used effectively as a predictor of advanced oesophageal cancer.

The current narrative review was planned to evaluate the quality of life of Pakistani cancer patients. Using relevant questionnaires and comparing global data over the last 2 decades, the review planned to explore artificial intelligence's role in cancer care, and to develop strategies for better outcomes. The review yielded poor results and exposed huge and neglected gaps in the overall approach towards the management of cancer patients based on different tumour types and categories. A few experimental interventions demonstrated promising results and echoed the need for further clinical and non-clinical experimentation for negating poor quality of life outcomes. Unsurprisingly, not a single study in the literature analysed, revealed a positive quality of life. A multi-pronged approach, therefore, must be brainstormed and safely implemented through experimentation of artificial intelligence and active coordination among healthcare bodies, finance/economic boards and welfare organisations that are active in countries like Pakistan to uplift the neglected quality of life domain among cancer patients, especially breast and oral cancers that have the highest incidences worldwide.

Objective: To determine the incidence of respiratory viral infections in bone marrow transplant patients.

Methods: The prospective, descriptive, cross-sectional study was conducted at a tertiary care hospital in Rawalpindi, Pakistan, from September 2019 to August 2020, and comprised respiratory specimens from recipients of haematopoietic stem cell transplant. The specimens were collected in viral transport medium, and were then taken to the Department of Virology. Multiplex polymerase chain reaction was performed on the specimens to ascertain the incidence and prevalence of respiratory viruses. Data was analysed using SPSS 24.

Results: Of the 85 subjects, 53(62.35%) were males and 32(37.65%) were females. The overall median age was 20.0 years (interquartile range: 11.0-32.0 years). Respiratory viral infections were detected in 31(36.4%) specimens. Among them, human rhinovirus was detected in 12(38.7%) cases, respiratory syncytial virus in 5(16.1%), influenza A/H3 in 4(13%), human parainfluenza virus-1 in 3(9.7%), adenovirus in 2(6.4%), human parainfluenza virus-3 in 1(3.2%), human parainfluenza virus-4 in 1(3.2%) and human metapneumovirus in 1(3.2%) case. There were 2(6.4%) cases of co-infection.

Conclusions: More than one-third recipients of haematopoietic stem cell transplant were found to have respiratory viral infections, highlighting the importance of employing multiplex respiratory polymerase chain reaction in early diagnosis and treatment of such infections.

Cardiovascular mortality is a major health burden worldwide and the number of patients with cardiac diseases is increasing. Dilated cardiomyopathy (DCM) is the most frequent cause for patient visits in cardiac care units and emergency departments. It is commonly misdiagnosed as ischaemic cardiac disease. Middle- and low-income countries rely on pharmacological management as the only treatment option. Most of the patients cannot afford heart transplants or advanced treatment strategies. Most health professionals also do not prescribe cardiac rehabilitation for DCM patients in their routine clinical practice. There is evidence that supervised cardiac rehabilitation is safe and beneficial for DCM patients. In addition to medications, cardiopulmonary exercise testing (CPET) and supervised cardiac rehabilitation, can provide more benefits to the affected population of cardiomyopathies. CPET and cardiac rehabilitation are still novel concepts in countries like Pakistan. The present review aims to provide clinicians with an overview of an evidence-based and innovative perspective. This perspective emphasizes the utilization of the additional benefits of cardiac rehabilitation in the holistic management of DCM patients and the prevention of chronic heart failure.

Objective: To study the effect of physical plasma jet in treating open wounds in diabetic and non-diabetic dogs.

Methods: The experimental study was conducted at the College of Veterinary Medicine, University of Baghdad, Iraq, from 20 January, 2020 to 1st May 2020, according to (no. 1364/ P.G), and comprised adult male diabetic and nondiabetic dogs. They were divided into non-diabetic group N and diabetic group D. Each group was further divided into treatment subgroup T and control subgroup C. Each dog was subjected to 4 wounds 3×3cm in size. Homemade helium non-equilibrium atmospheric pressure plasma jet therapy was used for healing purposes. Clinical parameters were evaluated by observation, while histological images were scored based on the semi-quantitative evaluation of histological sections on days 3-, 7- and 21-days post-wound. Data was analysed using SPSS Version 26 with One-way ANOVA for statistical analysis between groups and sub-groups.

Results: Of the 24 dogs, 12(50%) were in each of the two groups, which were further divided into subgroups having 6(50%) dogs each. The therapy accelerated the process of wound healing in the NT and DT subgroups compared to NC and DC. Clinical observations revealed early and complete closure of plasma-treated wounds in NT and DT subgroups started at day 30 post-wounding, while in the NC subgroup it started at day 35, and in the DC subgroup, wounds failed to close even after 35 days post-wounding. Histological analysis suggested that a plasma jet supported epithelisation, angiogenesis, formation of new hair follicles and collagen fibres, while it also controlled inflammation. In addition, in NT and DT subgroups, it increased the proliferation of fibroblasts and deposition of collagen, and there is a very, highly significant difference between groups (P<0.001), and a significant difference between days (P<0.05).

Conclusions: Home-made helium non-equilibrium atmospheric pressure plasma jet therapy improved the quality and pace of wound healing.