Journal of the Pakistan Medical Association最新文献

Objectives: To assess psychological insulin resistance, and to identify associated factors among type 2 diabetes patients.

Methods: The cross-sectional study was conducted at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, between August 2023 and January 2024, and comprised type 2 diabetes patients. Apart from routine demographic and clinical data, Insulin Treatment Appraisal Scale scores were collected to evaluate the participants' attitudes towards insulin therapy. Data were analysed using SPSS 25.

Results: Of the 397 patients with mean age 47.22±15.04 years, 201(50.6) were females and 196(49.4) were males. The mean Insulin Treatment Appraisal Scale score was 34.58±7.75, indicating a moderately resistant attitude towards insulin therapy. Concerns about insulin use were prevalent, with 136(34.3%) participants agreeing that insulin initiation signified a failure in managing diabetes through diet and tablets, and 148(37.3%) having a fear of needles. The Insulin Treatment Appraisal Scale score had significant associations with marital status, monthly income, education level and certain comorbidities (p<0.05).

Conclusions: The level of psychological insulin resistance was found to be considerable among type 2 diabetes patients, emphasising the need for targetted patient education.

Objectives: To evaluate immunohistochemical expression of erythroblast transformation-specific-related gene in prostate carcinoma and benign prostate hyperplasia, and its association with Gleason grade groups.

Methods: The retrospective, comparative, cross-sectional study was conducted from January to December 2022 at the Department of Histopathology, Pakistan Navy Ship Shifa Hospital, Karachi, and comprised prostate samples from January 2019 to January 2020. All tissue specimens were subjected to immunohistochemical staining with erythroblast transformation-specific-related gene. The expression of immunohistochemical and its association was determined in benign prostate hyperplasia and prostate carcinoma groups. Data was analysed using SPSS 23.

Results: Of the 60 cases with mean age 72±7.4 years (range: 58-88 years), 33(55%) had prostate carcinoma and 27(45%) had benign prostate hyperplasia Of the prostatic carcinoma cases, 20(60.6%) showed positive nuclear staining, while 13(39.4%) showed no nuclear staining. Weak positive staining was observed in 3(9.1%), and moderate in 3(9.1%) cases. Strongly positive ERG expression was found in 14(42.4%) patients. The erythroblast transformation-specific-related gene was equally expressed in low and high Gleason grade groups of prostate carcinoma (p>0.05). All 27(100%) cases of benign prostate hyperplasia showed negative immunohistochemical expression for erythroblast transformation-specific-related gene.

Conclusions: The erythroblast transformation-specific-related gene expression was found to be associated with prostate carcinoma compared to benign prostate hyperplasia cases, and could be used as a diagnostic tool for distinguishing between the two.

Objective: To develop functional balance training tasks for stroke rehabilitation to enhance recover y outcomes for stroke patients.

Methods: A cross-sectional study employing a two-phase structured Delphi technique was conducted in Rawalpindi and Islamabad, Pakistan, from August to December 2023, following approval from the ethics review committee of Riphah College of Rehabilitation and Allied Health Sciences, Islamabad. In the first phase, a list of functional balance tasks was generated through literature review and semi-structured interviews with experts. In the second phase, iterative three-round Delphi survey was conducted with a larger panel. Descriptive statistics were used at the end of each round to finalise the list of functional tasks based on pre -set consensus criteria. Data was analysed using SPSS 25.

Results: Of the 10 experts in Phase 1, there were 8(80%) females and 9(90%) had postgraduate qualification in Neuromuscular Physical Therapy, while the mean professional experience was 6.1±5.17 years. The corresponding values for the 30 experts in Phase 2 were 34(80%), 29(96%) and 5.48±5.08. In Phase 1, 100 functional balance tasks were generated. In Round 1 of Phase 2, 76 tasks met the consensus criteria of ≥60% agreement. In Round 2 of the phase, 52 tasks reached consensus criteria of ≥75% agreement, while in Round 3 of the phase, 50 tasks achieved consensus of ≥80% agreement.

Conclusion: An evidence-based list of functional balance tasks for stroke rehabilitation was deemed suitable by local experts for stroke patients in Pakistan.

Person-centered care can be measured and monitored by using validated tools such as the Person-centered care Index (PCI). Simpler and shorter versions of such indices may help in enhancing their appeal, and expanding their usage across health care settings. We propose a visual, simplified tabular, and brief textual version of the PCI. These alternatives can complement the original tool, and serve as user-friendly teaching tools.

Artificial intelligence can potentially ensure high-quality health care delivery in many ways. An observational study was conducted at a tertiary care university hospital to assess the perception of preparedness and professional impact of artificial intelligence among medical and nursing students and healthcare professionals. The "Shinners Artificial Intelligence Perception tool" was used. Responses from 345 respondents were included. The number of respondents between the ages of 18-30 years was 305 (88.4%), while 202 (58.6%) of them were female. The mean score for "professional impact of AI" was highest amongst medical students (3.98 ± 0.58) and lowest amongst medical doctors (3.52±0.66). The mean score for "preparedness of AI" was highest amongst nursing professionals (3.28±1.13), while it was lowest amongst nursing students (2.29±0.98). Future interventions to train healthcare workers for utilisation of AI should take these differences into account.

Objectives: To assess the effect of the timing of antibiotic prophylaxis on the incidence of surgical site infections in patients undergoing caesarean section in a public-sector tertiary care setting.

Methods: The prospective study was conducted at Gynaecology Unit 2 of the Dr Ruth KM Pfau Civil Hospital, Karachi, from November 2023 to April 2024, and comprised adult inpatients aged 18-45 years who had elective or emergency caesarean section. The patients were divided into four groups based on the timing of antibiotic administration; group A <30 minutes, group B 30-60 minutes, group C 60-120 minutes, and group D >120 minutes. All the patients received a single dose of prophylactic antibiotic in the shape pf 2g injection of ceftriaxone. Following hospital discharge, the patients were monitored for wound infection for 30 days. Data was analysed using SPSS 21.

Results: Of the 323 patients with mean age 33.88±6.61 years, 81(25.07%) were in group A with mean age 34.58±6.22 years, 81(25.07%) were in group B with mean age 33.50±6.81 years, 81(25.07%) were in group C with mean age 33.09±6.85 years, and 80(24.76%) were in group D with mean age 35.32±6.33 years. Overall, 36(11.1%) patients developed wound infection; 4(11.1%), 5(13.9%), 12(33.3%) and 15(41.7%) in group A, B, C and D, respectively (p=0.010).

Conclusion: The timing of prophylactic antibiotic administration was found to have significantly affected the occurrence of surgical site infections.