Journal of the Pakistan Medical Association最新文献

Objective: To compare postoperative pain scores at rest and on movement in patients undergoing open inguinal hernia repair between those receiving illioinguinal/illiohypogastric nerve block with ropivacaine or wound infiltration with ropivacaine.

Methods: The randomised clinical trial was conducted at the Department of Anaesthesiology, Aga Khan University Hospital a tertiary care centre from March to August 2019 and comprised patients of either gender scheduled for elective unilateral open inguinal hernia repair under general anaesthesia. They were randomised into illioinguinal/illiohypogastric nerve block group A, and wound infiltration group B. In group A, 20 ml of 0.25% ropivacaine was infiltrated in the vicinity of the nerves under ultrasound guidance, while group B received wound infiltration with ropivacaine 10ml 0.25% at the end of surgery. Postoperative static and dynamic pain was assessed at 0, 2, 6, 12 and 24 hours using visual analogue scale. Total usage of opioids in 24 hours postoperatively in both groups, patient satisfaction and complications were recorded. Data was analysed using SPSS 19.

Results: Of the 60 patients, 30(50%) were in each of the 2 groups. There were 29(96.7%) males and 1(3.3%) female in group A with mean age 45.63±17.43 years, and 28(93.3%) males and 2(6.7%) females in group B with mean age 49.33±15.39. The mean pain score at rest was not significantly different between the groups (p>0.05). On movement, the mean pain score between the groups was different only at 6 hours (p=0.02). There were no significant intergroup difference in total usage of opioids in 24 hours postoperatively and patient satisfaction (p>0.05).

Conclusions: Illioinguinal/illiohypogastric nerve block and wound infiltration with ropivacaine were found to be equally effective methods in controlling postoperative pain.

Clinicaltrials.gov id: NCT04462510.

The term somnometabolic syndrome has been used to describe a condition where obstructive sleep apnoea coexists with one or more components of metabolic syndrome. We propose a wider definition, stating that somnometabolic syndrome refers to the multifaceted, bidirectional relationship between sleep and metabolic health, including vascular health. This also includes the association of sleep with psychological and neurocognitive function.

Objective: To enhance the understanding and usefulness of decellularised plant tissues as scaffolds for bone tissue engineering, and to review the recent advances in plant-based scaffolds for bone regeneration.

Methods: The systematic review was conducted from February to June 2022, and comprised literature search on PubMed and Science Direct databases for articles published in the English language between 2013 and June, 2022. The search was conducted using key words 'plant-based scaffolds and osteogenesis' and 'decellularised plant and scaffolds and bone tissue engineering' and 'plant root-based scaffold and bone formation'. Full-text articles and short communication covering both in vitro and in vivo studies focussing on plant-based scaffolds for osteogenesis were included. Additional references that satisfied the inclusion criteria were found on Google Scholar and included in the review. Quality evaluation of the studies included was done independently by two researchers, and the risk of bias was calculated and categorised as low, medium and high risk.

Results: Of the 564 articles, 10(1.77 %) were included; 6(60%) purely in vitro studies, and 4(40%) studies having both in vitro and in vivo components. Decellularized plant tissue alone was used as three-dimensional scaffold materials in 5(50%) studies, but in 4(40%) studies, plant-based composite scaffolds were used. The risk of bias was medium in 7(70%) studies.

Conclusions: Plant-based scaffolds promote osteogenesis, but more in vivo research on plant-based studies is needed to label it as suitable scaffolds for bone tissue engineering.

Objective: To compare the cycloplegic refraction in children with different iris colour categories and age groups.

Methods: The cross -sectional study was conducted from December 2 022 to June 2023 at the Eye Clinic of Sehat Medical Complex, Hanjarwal, Lahore, and Khizar Eye Centre, Lahore, Pakistan, and comprised hyperopic children aged 5-12 years of either gender. Data regarding age, gender, iris colour, auto -refraction and retinoscopy before and after cycloplegic refraction was collected using a structured proforma. Data was analysed using SPSS 21.

Results: Of the 139 subjects, 73(52.5%) were males and 60(47.5%) were females. There were 79(56.8%) subjects aged 5-8 ye ars and 60(43.2%) aged 9 -12 years. The iris colour dis tribution was 23(16.5%) light, 80(57.6%) med ium and 36(25 . 9%) da r k, w ith a mean visual acuity of 0.7 ±0.6. There wa s a signi ficant differe nce in non - cyclopleg ic and cycloplegic refraction for different iris colours and age groups (p<0.05).

Conclusions: Children with light iris colour accommodated more and needed a low concentration of cyclopentolate compared to those with m edi u m and dark ir is col ours. More accomm odation was noted among child ren ag ed 9-12 years.

Objective: To evaluate the effect of nurses-led health education intervention on quality of life among polycystic ovary syndrome females.

Methods: The quasi-experimental study was conducted from May to August 2022 at the Obstetrics and Gynaecology outpatient department of Dow University Hospital, Karachi, and comprised married females aged 18-45 years, who were diagnosed with polycystic ovary syndrome based on the Rotterdam criteria. Nurses-led health education intervention session was conducted for all the patients. Data was collected using the self-administered polycystic ovaries syndrome quality of life scale. Data was analysed using SPSS 26.

Results: Of the 50 females, 26(52%) were aged 26-35 years. There was a significance difference between baseline and postintervention scores across all domains of quality of life (p<0.05). Also, baseline body mass index of the participants was 30.4±4.711 which went down post-intervention to 29.4±4.800 (p<0.001).

Conclusion: Nurses-led health education intervention improved the quality of life and body mass index of polycystic ovary syndrome patients.

Objectives: To determine microbiological pathogens and in-hospital mortality in patients admitted with communityacquired sepsis to the intensive care unit in a tertiary-care setting in a low- and middle-income country.

Methods: The retrospective, observational study was conducted at the medical intensive care unit of a large tertiary care hospital in Karachi, and comprised data from January 1 to December 31, 2019 of patients with community-acquired sepsis who were assessed using the Sepsis-3 criteria. Data was compared between survivors and non-survivors, and independent factors associated with in-hospital mortality were identified. Data was analysed using SPSS 23.

Results: Of the 135 patients with mean age 49.8±18.0 years, 91(67.4%) were males and 44(32.6%) were females. The most common primary site of infection was the respiratory tract 63(46.7%). Multi-drug-resistant organisms were isolated in 39 (28.9%) patients. In-hospital mortality was noted in 52(38.5%) cases, while there were 83(61.5%) survivors. Serum levels of lactate and bicarbonate as well as urine output, fungal pathogens, septic shock and sequential organ failure assessment score were significantly associated with mortality (p<0.05).

Conclusions: Clinical and microbiological spectrum of community-acquired sepsis in a low- and middle-income country was found to be different from other regions of the world. Clinicians should keep these differences in mind while managing these critically ill patients.