Journal of the Pakistan Medical Association最新文献

Objectives: To find radiographic association of the root pulp visibility and periodontal ligament visibility stages of lower second molar teeth with chronological age.

Methods: The prospective, analytical, cross-sectional study was conducted after approval from the ethics review committee of Ziauddin University, Karachi, and comprised digital orthopantomograms from 2020 to 2022. The orthopantomograms related to lower second molar teeth from the left side of the mandible of individuals of either gender aged 18-40 years. The orthopantomograms were subjected to stage classification to assess the radiographic root pulp visibility and periodontal ligament visibility of the lower second molar teeth. Data was analysed using SPSS 25.

Results: Of the 260 orthopantomograms, 140(53.8%) belonged to female subjects and 120(46.2%) to male. The overall median age of the subjects was 24 years (interquartile range: 7 years). There were 164(63.1%) subjects aged 18-25 years, 70(26.9%) aged 26-33 years, and 26(10%) aged 34-40 years. A positive correlation was noted between age and stages of radiographic root pulp visibility and periodontal ligament visibility (p<0.05). The individuals found at stages 0 and 1 for root pulp visibility were aged at least 18 years, and for stage 2, the corresponding value was 21 years. For periodontal ligament visibility, the minimum age for stage 0 was 18 years, while for stages 1 and 2, the corresponding values were 21 and 25 years.

Conclusions: Lower age was found to be associated more with stage 0 of root pulp visibility and periodontal ligament visibility.

Objective: To measure the readiness for self-directed learning among medical undergraduates of private and public medical colleges, and to evaluate their performance and strategies.

Methods: The cross-sectional study was conducted in Lahore, Pakistan from February to July 2023, and comprised medical undergraduate students of either gender from 1 private and 1 public academic institution. Data was collected using a prevalidated structured questionnaire having self-management, desire for learning, and self-control domains to explore self-directed learning readiness. Data was analysed using SPSS 26.

Results: Of the 330 subjects, 166(50.3%) were females and 164(49.7%) males, while 166(50.3%) were from the private institution and 164(49.7%) were from the public institution. There were 183(55.4%) students in the 3rd year, 89(27.0%) in the 4th year and 58(17.6%) in the final year of their coursework. Self-directed learning readiness was significantly higher in students from the private institution (p<0.05).

Conclusions: There was a significant correlation between self-directed learning readiness in private and public medical education institutions, with readiness being higher in the private sector.

Objective: To assess the histopathological effect of 50milliWatt red laser pointer on mice retinal tissue at variable exposure times.

Methods: The experimental study was conducted in the Postgraduate Laboratory of the Unit of Medical Physics, Department of Physiology, College of Medicine, Mustansiriyah University, Baghdad, Iraq, from November 2020 to April 2021, and comprised albino mice. Histopathological effects on the retinal tissues were evaluated microscopically using conventional haematoxylin and eosin stain just after being exposed to commercially available 50 milliWatt red laser pointers with 630nm wavelength at 1, 2 and 3 minutes, grouped as R1, R2 and R3, respectively. The laser beam was focussed on the right eye of the mice sedated with sodium pentobarbital, reserving the left eye for use as a control group. Data was analysed using SPSS 24.

Results: Of the 12 mice, 4(33.3%) were in each of the 3 groups. There was significantly destructive effect of red laser on retinal outer cellular layers in all the groups compared to the controls (p<0.05). The effect was significant between R1 and R2 (p=0.0001), and between R2 and R3 (p=0.02).

Conclusions: The handheld commercial red laser pointers could harmfully affect a wide range of mice retina and choroid.

Objective: To compare the convolution and inverse algorithm plans.

Methods: The cross-sectional study was conducted from January to May 2022 at the Icon Gamma Knife Centre, Al- Taj Hospital, Baghdad, Iraq, and comprised patients with malignant and benign brain tumours who underwent gamma knife therapy. Each patient's brain was imaged using computed tomography and magnetic resonance imaging. The neurosurgeon prescribed the dose depending on the tumour volume and type, while the medical physicist generated the two plans based on inverse and convolution algorithms. The prescribed dose was delivered to 50% of the isodose line of the tumour. Each plan was evaluated with respect to tumour conformity index, coverage, gradient index, number of shots, and time of treatment.

Results: Of the 30 patients, 17(56.7%) were males and 13(43.3%) were females. The overall mean age was 46.29±15.20 years (range: 10-71 years). The mean dose delivered was 15.86±3.86Gy, and the mean number of gamma radiation shots was 12.56±6.95. There was significant difference between the two algorithm plans for all dosimetric parameters, with the inverse plan providing higher coverage and selectivity than convolution plan, but taking longer time(p<0.05), while plan was inverse plan better than convolution plan in terms of gradient and conformity (p<0.05).

Conclusions: With more extended treatment, the inverse plan was found to have superior selectivity, coverage, gradient index and Paddick conformity index values compared to the convolution plan.

Objective: To compare the modulation complexity scores across treatment sites, and to examine their connection with monitor unit, segment number and global and local gamma passing percentage.

Methods: The cross-sectional study was conducted at the Baghdad Centre for Radiation Therapy and Nuclear Medicine, Baghdad Medical City, Baghdad, Iraq, from May 2021 to February 2022. Included were 34 patients, with the age range between 20 - 50 years, subjected to intensity-modulated radiation therapy for head and neck tumours in group A or pelvic tumours in group B. Treatment planning was done using Monaco 5.1, and radiotherapy was done using Synergy linear accelerator. Modulation complexity scores were calculated using MATLAB 2019a. Data was analysed using SPSS 24.

Results: Of the 34 patients, 22(64.7%) were in group A; 12(54.5%) males and 10(45.5%) females. There were 12(35.3%) patients in group B; 8(66.7%) females and 4(33.3%) males. The number of segments was greater in group B than group A. A modest positive linear association was seen in group A, demonstrating that an increase in segment numbers resulted in a rise in modulation complexity score (R2=0.0244). Group B tumours had inverse negative linear correlation (R2=0.0189). As the complexity of plans increased in group A, local gamma passing percentage decreased (R2=0.0452). Group B showed a slight negative connection with modulation complexity score (R2=0.0622).

Conclusions: The modulation complexity score may be used to provide a simple prediction for pre-treatment verification, and it may also serve as a simple quality assurance tool for intensity-modulated radiation therapy plans.

Objective: To evaluate compliance with enhanced recovery after surgery protocol of patients undergoing colorectal carcinoma surgery, and to compare its effect on outcomes.

Methods: The retrospective study was conducted at the Maroof International Hospital, Islamabad, Pakistan, and comprised data from July 15, 2016, to March 20, 2022, of patients of either gender undergoing elective or emergency colorectal carcinoma surgery. Data included age, gender, tumour site, type of surgery, surgical approach, compliance with each of the 25 components of the enhanced recovery after surgery protocol, length of hospital stay, surgery duration, 30-day readmission rate and perioperative mortality. Data was analysed using SPSS 23.

Results: Of the 96 patients with mean age 50.03±14.86 years (range: 20-79 years), 65(67.7%) were males, 70(72.91%) were aged at least 40 years, and 75(78.12%) underwent elective surgery. Most common tumour site was rectum and sigmoid 49(51%). Laparoscopic surgery was performed in 17(17.7%) patients. No compliance was seen with carbohydrate loading of patients or limiting use of opioids in standard anaesthesia protocol. No nutritional supplementation was started from postoperative day 1. Mean compliance with all the protocol components was 74.9%±37.652 for both elective and emergency cases. Mean duration of surgery was 192.50±75.33 minutes, while mean length of hospital stay was 5.52±1.57 days. Re-admission within 30 days was needed in 2(2.1%) cases. There was no perioperative mortality.

Conclusions: Better compliance with enhanced recovery after surgery protocol resulted in better perioperative outcomes.

Objective: To compare the effects of warm and cold dialysate solutions on the duration of post-dialysis fatigue in patients undergoing maintenance haemodialysis.

Methods: The quasi-experimental study was conducted at the Department of Nephrology, Pak Emirates Military Hospital, Rawalpindi, Pakistan, from May 9 to September 10, 2023, and comprised adult patients of either gender undergoing maintenance haemodialysis for a minimum of 3 months. The patient initially underwent haemodialysis with a dialysate temperature of 36°C for 2 weeks. During the subsequent washout period of one week when the dialysate temperature was not monitored, they underwent haemodialysis with a dialysate temperature of 37°C for another 2 weeks. Blood pressure was monitored every 30 minutes to record any hypotensive episodes. Patients were asked if they felt fatigued after the last haemodialysis session, and the duration was noted down. Data was analysed using SPSS 24.

Results: Of the 92 patients with mean age 49.1±16.1 years, 57(62%) were males. Post-dialysis fatigue was seen in 67(72.8%) and 75(81.5%) patients with dialysate temperatures at 36°C and 37°C, respectively (p<0.001). The duration of post-dialysis fatigue was also significantly longer at dialysate temperatures 37°C p<0.001). There was no significant difference in the proportion of hypotensive episodes in the two groups (p=0.445).

Conclusion: Dialysate temperature 36°C was found to be associated with less frequent and shorter duration of postdialysis fatigue compared to dialysate temperature 37°C.

Pulse transit time (PTT) is a non-invasive method for measuring arterial compliance and stiffness, which are excellent predictors of cardiovascular disease. This study aims to determine whether PTT can be used to precisely monitor vascular reactivity in response to changes in hand posture and whether the digital pulse wave index of time-to-maximum slope (TMS) is a suitable alternative to PTT. Fifteen healthy, 22-year-old males participated in the study. The PTT was monitored from electrocardiogram (ECG) to digital pulse wave (DPW), and the morphological variable TMS of the DPW wave was estimated in beat-tobeat intervals for the individuals while their arms were raised and dropped. The results demonstrated that the PTT increased significantly with elevating the hand, and the correlation probability of the second polynomial fitness equation neared infinite. In addition, the PTT significantly correlated (P < 0.007) with the TMS of the DPW throughout the hand motions. The data indicate that PTT can represent local vascular responses during changes in hand position. In this study, we developed a new DPW index and suggest a TMS index as a viable substitute for PTT.