Journal of the Pakistan Medical Association最新文献

Objectives: To determine the correlation of the Glasgow Coma Scale score and different Neuroimaging Radiological Interpretation System categories in patients with traumatic brain injury.

Methods: The prospective observational study was conducted at the Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, from July to December 2023, and comprised patients aged at least 18 years with documented traumatic brain injury. The patient underwent assessment in the emergency department. The mechanism of injury, and Glasgow Coma Scale score at the time of hospital arrival were noted. A non-contrast head computed tomography scan was done to acquire images of sufficient quality for Neuroimaging Radiological Interpretation System classification. Data was analysed using SPSS 23.

Results: Of the 388 patients with mean age 33.44±18.51 years, 319(82.2%) were males and 69(17.8%) were females. Road traffic accidents accounted for 283(72.9%) cases. Glasgow Coma Scale-based severity classification revealed mild traumatic brain injury in 185(47.7%), moderate in 100(25.8%) and severe in 103(26.5%) patients. Neuroimaging Radiological Interpretation System category distribution showed category 2 being the most frequent 165(42.5%), while category 0 was least common 5(1.3%). There was a strong negative correlation between Glasgow Coma Scale scores and Neuroimaging Radiological Interpretation System categories (p=0.001), with the coefficient of determination indicating that 27.4% of Glasgow Coma Scale score variance was explained by Neuroimaging Radiological Interpretation System classification.

Conclusions: There was a negative correlation between Neuroimaging Radiological Interpretation System category and Glasgow Coma Scale score in patients with traumatic brain injury.

Objective: To analyse the symptoms of Bardet-Biedl Syndrome, and to check the association of BBS10 (Bardet-Biedl syndrome 10 gene), BBS6 (Bardet-Biedl syndrome 6 gene) and BBS12 (Bardet-Biedl syndrome 12 gene) with the pathogenesis of Bardet-Biedl Syndrome.

Methods: The case-control study was conducted in Karachi in 2019-20, and comprised Bardet-Biedl Syndrome patients and healthy controls from the same family. Blood was drawn from all the subjects for deoxyribonucleic acid extraction. Genotyping was performed by conventional and tetra primer amplification refractory mutation system polymerase chain reaction (T-ARMS-PCR) to identify the possible genetic variations. To validate the results, samples were randomly selected and sent for sequencing. Data was analysed using SPSS 20, while sequencing data was analysed using the Molecular Evolutionary Genetics Analysis X software.

Results: Of the 20 subjects with mean age 15.8+/-5.09 years (range: 9-25 years), 8(40%) were cases and 12(60%) were controls. The male-to-female ratio was 1:1. Pedigree analysis revealed that the pattern of inheritance was autosomal recessive. All the 8(100%) cases were obese compared to the controls. Truncal obesity, polydactyly, learning impairment and dysmorphic features, renal pain, olfactory dysfunction, respiratory tract infection and dysphasia were observed in all the 8(100%) cases. The globally reported genetic variants of BBS10 (rs1057516628 and rs1489342987) and BBS12 (rs121918327 and rs587777802) did not indicate any association with the clinical phenotype in the family concerned. The genetic variations of BBS6 (rs1547, rs1545 and rs1351192494), BBS12 (rs309370, rs2292493) and a BBS10 variant (rs35676114) had significant association with the disease.

Conclusions: The genetic variations showed confounding effects of BBS10, BBS6 and BBS12 genes which might indicate the epistatic effects of other variants present on different loci.

Oral Rehydration Solution (ORS) is a life-saving therapy widely used for the management of dehydration, especially in diarrhoeal illnesses. However, in patients with acute kidney injury (AKI) or chronic kidney disease (CKD), including those with hypertension, oliguria, or fluid overload, standard ORS formulations may cause harm. These patients often present with impaired sodium and potassium handling, low urine output, and increased risk of volume overload or hyperkalaemia. This review summarises the limitations of conventional ORS in this population and provides evidence-based, stage-wise recommendations for renal-safe ORS formulations that consider fluid status, serum potassium levels, GFR, and comorbid conditions like hypertension.

Objectives: To find correlation of mentolabial sulcus depth and mentolabial sulcus angle with skeletal and dental characteristics.

Methods: The observational, cross-sectional study was conducted at the Department of Orthodontics, Bahria University Health Sciences, Karachi, from October 7, 2023, July 31, 2024, and comprised patients of either gender aged 18-25 years with having complete permanent dentition except third molars. Different skeletal, dental and soft tissue variables were measured from cephalometric radiograph. including mentolabial sulcus depth and mentolabial sulcus angle. Overjet, overbite, curve of Spee, incisor, canine and molar relationship were measured from the dental cast. The patients were divided into three groups on basis of mentolabial sulcus depth and mentolabial sulcus angle. Mentolabial sulcus depth was divided into Shallow, Average and Deep depth subgroups, while mentolabial sulcus angle was divided into Shallow, Average and Deep angle subgroups. Data was analysed using SPSS 23.

Results: Of the 148 patients, 104(70.3%) were females and 44(29.7%) were males. The overall mean age was 20.75±2.47 years. The mean mentolabial sulcus depth was 5.86±2.10mm and mean mentolabial sulcus angle was 106.22±25.11°. The mean mentolabial sulcus depth was deeper in males than females (p<0.05). Overjet, class II canine and molar relationship, retruded mandible and bimax proclination were associated with deep mentolabial sulcus depth (p<0.05). When Shallow Angle was compared with Average and Deep angles, all vertical values were found increased in the Shallow Angle group (p<0.05).

Conclusion: Male gender, class II malocclusion, increased overbite, bimax proclination and low facial height were associated with deep mentolabial sulcus, whereas increased facial height was associated with shallow mentolabial sulcus depth.

Objective: To assess the efficacy of diagnostic ultrasound-guided corticosteroid injections in subacromial/subdeltoid bursa in the management of shoulder pain.

Methods: The systematic review and meta-analysis was conducted from November 2023 to February 2024 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, and comprised search on Cochrane Central Register of Controlled Trials, Excerpta Medica dataBASE, Scopus and PubMed databases for randomised controlled and/or clinical trials involving adult patients with shoulder pain/subacromial impingement/bursitis, comparing ultrasound-guided corticosteroid injections versus blind injections, and published in the English language between January 2003 and August 2023. Quality assessment was performed using the Physiotherapy Evidence Database scale, and meta-analysis was performed using MedCalc software.

Results: Of the 72 full-text articles assessed, 11(15.3%) were analysed. There was a definite short-term effectiveness of ultrasound-guided corticosteroid injections in reducing pain, as assessed by visual analogue scale scores (p <0.001 at 6 weeks; p<0.05 at 12 week and 33 week) and improved range of motion in flexion, abduction, internal and external rotation (p<0.001-0.05). While meta-analysis confirms significant pooled effects for pain scores and range of motion outcomes at 6 weeks, long-term efficacy remained inconclusive due to heterogeneity across studies and limited long-term follow-up research on the subject.

Conclusion: Evidence supported short-term efficacy of ultrasound-guided corticosteroid injections for shoulder pain management, but robust trials with extended followup periods and larger cohorts are needed to establish their long-term effectiveness.

Peritoneal dialysis-associated peritonitis caused by Listeria monocytogenes (LM) is a rare occurrence among peritoneal dialysis patients. It can be induced by an contaminated diet and lacks characteristic clinical manifestations. We present a case of recurrent peritonitis caused by LM. The patient an aged male, had a history of four years of peritoneal dialysis with diabetic kidney disease, high blood pressure, heart failure, chronic hepatitis B, and syphilis. The patient ingested food contaminated with monocyte listeria and had repeated symptoms of peritoneal cloudy, diarrhoea, abdominal pain, chills and fever. The efficacy of Cefazolin sodium combined with Ceftazidime is poor. Finally, its successful treatment included a combination of Vancomycin, Amikacin, and Piperacillin Tazobactam.

Hyperthyroidism, a prevalent metabolic disorder, poses diagnostic challenges due to variability in clinical presentations and access to laboratory tests. Given the clinical importance of hyperthyroidism and the challenges associated with timely and accessible laboratory testing for thyroid hormones, the evaluation of diagnostic tools, such as the Wayne index, is crucial. The current cross-sectional study, conducted from January to December 2022, evaluated the diagnostic performance of the Wayne index in detecting hyperthyroidism in 65 thyroid enlargement patients at the Sultan Agung Islamic Hospital, Indonesia. The Wayne index was assessed against thyroid stimulating hormone, free thyroxine, and total triiodothyronine. Sensitivity, specificity, predictive values, likelihood ratios, and area under the curve were calculated. Results showed sensitivity ranging from 86.1% to 92.6% and specificity from 66.7% to 79.3% for the Wayne Index across thyroid function tests, with an area under the curve ranging from 0.80 to 0.83. These findings suggested that the Wayne Index could serve as a reliable diagnostic tool for hyperthyroidism in clinical practice.