Journal of the Pakistan Medical Association最新文献

Diabetes is rapidly increasing globally, especially in lowand middle-income countries, with Pakistan ranking third in prevalence, having 33 million people. The lack of adherence to the first-line treatment, metformin, mainly due to gastrointestinal side effects, is a significant concern. A novel approach for managing type 2 diabetes in Pakistan is to combine linagliptin and empagliflozin. Linagliptin is well-tolerated and suitable for those who cannot tolerate metformin, while empagliflozin reduces cardiovascular risks and nephropathy, showing promising results in controlling diabetes with minimal side effects. The synergy between linagliptin and empagliflozin could greatly improve diabetes management and patient wellbeing. It is recommended that healthcare providers in Pakistan use social media and seminars to educate the public on this new treatment option to tackle the diabetes crisis effectively.

Human teeth serves as a potential reservoir for postembryonic mesenchymal dental stem cells. Researchers have identified and isolated seven types of dental stem cells from pulp and periodontal ligament tissues. These cells have a wide range of clinical applications across the fields of medicine and dentistry due to their increased proliferative nature. Biobanking is a concept for storing human biological tissues to preserve and isolate stem cells. Until now, haematopoietic tissues have been the area of focus for biobanking facilities. Extracted human teeth may serve as a valuable resource for the isolation and preservation of dental stem cells for future therapeutic benefits. The current narrative review was planned to focus on the workflow of the teeth biobanking process, its isolation, cryopreservation, and potential therapeutic uses in medical and dental specialtiesxx.

Objective: To assess the efficacy of renal score grading in guiding therapy decisions, predicting perioperative outcomes, and characterising tumours following partial nephrectomy.

Methods: The retrospective, single-centre study was conducted at the University College Hospital Galway, Ireland, and comprised data from January 11, 2012, to June 17, 2016, of all patients aged >18 years who underwent partial nephrectomy as part of treatment for kidney cancer. Data was analysed using SPSS 20.

Results: Of the 76 patients, 52(68.4%) were males and 24(31.6%) were females. The median age of patients was 58 years (IQR: 16). Tumours were predominantly on the right side 44(57.9%) and lower pole 36(47.4%), with a median tumour size of 2.35 cm (IQR: 1.0 cm), and renal score had a median of 5.00 (IQR: 2). Of the total, 70(92.1%) patients underwent open surgery, with complications in 6(7.9%), which were associated significantly with higher body mass index, American Society of Anaesthesiologists classification score, warm ischaemia time and tumour size (p<0.05). Recurrence correlated with tumour size and positive margins (p<0.05). Survival analysis showed a median diseasefree survival (DFS) of 30 months (IQR: 6 months). However, due to the absence of events, the median overall survival (OS) and survival estimates could not be fully calculated. The longest follow-up time was 36 months, with no recorded mortality in the cohort.

Conclusions: For individuals with comparatively small localised renal tumours, the selection of partial nephrectomy was found to be a suitable alternative, showcasing exceptional results regarding the complication profile, recurrencefree survival and overall survival.

Objectives: To assess different tear film parameters in female patients with thyroid eye disease and diabetes using a single portable device.

Methods: The observational study was conducted at the College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia, from January 12 to April 28, 2022, and comprised women patients with thyroid eye disease in group A, women patients with diabetes in group B, and healthy controls in group C. The sample size was determined with a confidence level of 80% and a significance of 0.05. The participants were subjected first to the Ocular Surface Disease Index, followed by non-invasive tear breakup time, tear meniscus height, and lipid layer pattern tests using EasyTear View+. Data was analysed using SPSS 22.

Results: Of the 120 women, 40(33.33%) with mean age 40.4±11.7 years were in group A, 40(33.33%) with mean age 39.8±12.2 years in group B, and 40(33.33%) controls with mean age 37.2±9.5 years were in group C. Significant differences were found in the median values of Ocular Surface Disease Index, non-invasive tear breakup time, tear meniscus height and lipid layer pattern in group C compared to groups A and B p<0.00. The non-invasive tear breakup time score was strongly correlated in group B with the tear meniscus height score (r=0.559, p<0.001. The lipid layer pattern analysis indicated that grade A was predominant in groups A (35%) and B (45%), while grade D was typical in group C (40%).

Conclusions: Women with thyroid eye disease and diabetes had significantly thin lipid layers and lower tear meniscus height and non-invasive tear breakup time than healthy subjects.

Objective: To assess patients' satisfaction with tele-dermatology versus face-to-face visits, and to identify their attitude toward the new modality.

Methods: The cross-sectional study was conducted from January to December 2021 at the Department of Dermatology, Aga Khan University Hospital, Karachi, and comprised patients of either gender. Those who opted to personally visit the outpatient department were placed in group A, while those opting for tele-dermatology were placed in group B. A selfdesigned questionnaire was used to evaluate the experiences in both the groups. Scoring was done using a Likert scale. The responses were recorded as dichotomised, and a cut-off score of 14 was identified as an expression of satisfaction. Data was analysed using SPSS 20.

Results: Of the 202 patients, 100(49.5%) were in group A; 65(65%) females and 35(35%) males, with 44(44%) aged 20-30 years. There were 102(50.5%) patients in group B, with 71(69.6%) females and 31(30.4%) males, and 42(41.2%) aged 20-30 years (p>0.05). Satisfaction was expressed by 94(46.2%) patients in group B compared to 108(53.8%) in group A. More females 48(57.1%) were satisfied than males 36(42.8%) in group A, while more males 50(69.4%) expressed satisfaction in group B females 22(30.5%).

Conclusions: Tele-dermatology was found to be a valuable method to deliver healthcare which could be adopted in future practices.

"Hot quadrate lobe sign" refers to visualization of caudate lobe of liver due to excess accumulation of radiotracer secondary to superior vena cava obstruction. Collateral channels are formed between thoracic and mediastinal vessels; internal mammary through the paraumbilical vessels which drain blood to the left portal vein and into the caudate lobe of liver. It was first described on Tc99-m sulfur colloid scan. We present a case with superior vena cava obstruction presenting as hot quadrate lobe sign on F18-FDG PET-CT.

Primary Sjogren's syndrome (pSS) typically presents with Sicca symptoms xerostomia and xeropthalmia. This study highlights atypical presentations of Primary Sjogren's syndrome posing diagnostic and therapeutic challenges. Four female patients (median age 30 years, IQR = 15.5) with atypical pSS features, confirmed by positive Anti-Ro antibodies and negative lupus or rheumatoid arthritis tests, were treated between February and August 2023. PSS presented as erythema nodosum, soft tissue swelling with medium-vessel vasculitis, palpable purpura, and severe thrombocytopenia in these cases prior to Sicca symptoms. Initial treatment included steroids and hydroxychloroquine. Azathioprine, Methotrexate, and Cyclophosphamide were added as steroid-sparing agents. Three patients achieved remission. One patient with co-existing pulmonary tuberculosis (TB) died. Atypical features can occur in SS, requiring vigilance for diagnosis and individualised treatment. Our series demonstrates the diverse atypical clinical features of Sjogren's syndrome, encompassing radiologic, histopathologic, laboratory abnormalities, and treatment guidelines, expanding the known spectrum of disease presentation and management.