Journal of the Pakistan Medical Association最新文献

Objective: To determine the effects of vagal nerve stimulation on cognition and epilepsy-associated psychosocial problems in patients with intractable epilepsy, and to assess their relation to seizure decline.

Methods: The longitudinal study was conducted at Saad Al-Witry Neurosciences Hospital, Baghdad, Iraq, from December 2015 to December 2020, and comprised refractory epilepsy cases with implanted vagal nerve stimulation devices. They were subjected to pre- and post-implantation epilepsy protocol assessment with added neuropsychological evaluation using the Mini-Mental State Examination system. Each case was followed up for 2 years post-implantation. Descriptive data regarding patient records of age, seizure nature, mental functioning level, and vagal nerve stimulation insertion was noted. Data was analysed using SPSS 21.

Results: Of the 150 patients, 75(50%) each were males and females, with 70(46.7%) aged <10 years at the time of surgery. Overall, 80(53.3%) patients had partial seizures with secondary generalisation, 70(46.7%) had refractory seizure attacks for <5 years, 78(52%) had attack frequency of 2-5 per day. All 150(100%) patients had had vagal nerve stimulation for >2 years. Post-intervention, 80(53.3%) patients had <2 attacks per day. Mini-Mental State Examination score was >25 in 35(23.3%) patients which post-intervention rose to 64(42.7%).

Conclusions: There was evidence of improvement with respect to patient characteristics predictive of vagal nerve stimulation-related cognition and neuropsychological responsiveness in refractory epilepsy.

Objective: To detect the gene of entamoeba histolytica by polymerase chain reaction and investigate the expression of immunogene entamoeba histolytica calreticulin in stool samples of infected patients.

Methods: The case control study was conducted at Central Teaching Hospital of Paediatrics and Al Mahmoudia General Hospital, Iraq, from December 30, 2020, to September 1, 2021, and comprised diarrhoeal faecal samples collected from 86 children with age ranging from ˂1 year to 13 years who were suspected of having been infected with entamoeba histolytica. Microscopically positive samples were then subjected to conventional and real-time polymerase chain reaction for the detection of entamoeba histolytica HM1:IMSS strain using Phage shock protein (Psp) gene sequences and detection of entamoeba histolytica calreticulin expression.

Results: Of the 86 patients, 71(82.6%) were found to be infected with entamoeba histolytica; 39(54.93%) boys and 32(45.07%) girls. The remaining 15(17.4%) patients were taken as non-amoebic controls; 8(53.3%) boys and 7(46.7%) girls. There were 36(50.70%) cases and 8(53.33%) controls aged 1-4 years. Among the Entamoeba histolytica gene was detected in 44(62%) of the cases using conventional polymerase chain reaction, and immunogene entamoeba histolytica calreticulin was expressed in 36(50.7%) using real-time polymerase chain reaction. Data was analysed using SPSS 24.

Conclusions: Polymerase chain reaction was found to be a useful tool for diagnosing entamoeba histolytica infection in children.

Objective: To assess the role of inflammatory markers ferritin and C- reactive protein as indicators of preeclampsia severity.

Methods: The case-control study was conducted at Al-Yarmouk Teaching Hospital, Baghdad, Iraq, from November 2021 to May 2022, and comprised pregnant women from the obstetrics ward and outpatient clinics aged 16-40 years having a viable singleton pregnancy and gestational age >32 weeks. They were divided into severe preeclampsia group A, non-severe preeclampsia group B and control group C. Serum ferritin and C-reactive protein levels were measured for all the subjects, and compared. Data was analysed using SPSS 26.

Results: Of the 87 pregnant women, 27(31%) were in group A with mean age 29.76±7.53 years and mean gestational age 35.63±1.92 weeks, 29(33.33%) were in group B with mean age 26.83±6.30 years and mean gestational age 36.24±1.72 weeks, and 31(35.63%) were in group C with mean age 26.00±5.73 years and mean gestational age 36.52±1.61 weeks. Ferritin levels in patient groups were significantly higher than in the control group (p<0.05), but it was not significantly different between the patient groups (p>0.05). C-reactive protein levels in the patient groups were significantly higher than in the control group (p<0.05), and they were also significantly higher in group A than in group B (p<0.05). At a cut-off value >101.8 ferritin had sensitivity 92.59% but specificity 20.69%, whereas C- reactive protein at a cut-off value >17.1 had sensitivity 66.67% but specificity 75.86%.

Conclusions: Serum C- reactive protein level was significantly associated with severity of preeclampsia with an acceptable grade of discriminative ability between severe preeclampsia and non-severe preeclampsia patients.

Objective: To compare the anxiety, depression and health-related quality of life of dermatology patients with healthy individuals in a tertiary care setting.

Methods: The case-control study was conducted at the Pak-Emirates Military Hospital, Rawalpindi, Pakistan, from April to September 2022, and comprised adult outpatients and inpatients with diagnosed skin diseases. They were designated as group A, while healthy adults who did not suffer from any dermatological condition formed control group B. Data was collected using a questionnaire which in addition to demographic characteristics, comprised the Dermatology Life Quality Index and the Hospital Anxiety and Depression Scale. Data was analysed using SPSS 21.

Results: Of the 200 subjects with mean age 30.21±12.09 years, 100(50%) were in group A; 75(75%) males and 25(25%) females with mean age 32.56±13.49 years. The remaining 100(50%) subjects were in group B; 75(75%) males and 25(25%) females with mean age 27.86±10.02. In group A, 71(71%) were outpatients and 29(29%) were inpatients. Quality of life and depression scores were significantly different between inpatients in group A and group B (p<0.05). The difference was significant between outpatients in group A and group B in all categories (p<0.05).

Conclusions: Dermatological diseases had a significant impact on the daily life and psychological health of patients.

Objective: To evaluate the diagnostic accuracy of lower urinary tract symptoms in uncomplicated urinary tract infection in women.

Methods: The cross-sectional study was conducted from September 2020 to December 2021 after approval from the ethics review board of Jinnah Postgraduate Medical Centre, Karachi, and comprised data of women aged at least 16 years from 8 institutions across Pakistan. Data included menstruation status, symptoms, urinalysis and organisms found in urine samples. The association of urinalysis variables with symptoms among culture-positive patients was measured to assess the certainty of positive diagnosis. Data was analysed using SPSS 23.

Results: Of the 457 women with mean age 37.87±13.9 years, 182(39.8%) had a positive urine culture. Dysuria was the most significant symptom 120(65.9%), followed by daytime frequency 114(62.6%) amongst culture-positive patients. On urinalysis, 139(76.3%) had white blood cells, and 66(36.2%) had haematuria. Dysuria along with the presence of leucocyte esterase had the highest diagnostic utility (p=0.002). Urgency along with haematuria was strongly predictive of urinary tract infection (p=0.058).

Conclusion: The diagnosis of uncomplicated urinary tract infection in women could be reliably made based on a combination of symptoms along with urine analysis without urine culture.

Objective: To assess the structure as well as availability of essential equipment and medicine at emergency departments in Baghdad hospitals.

Method: The descriptive, cross-sectional study was conducted from March to June 2021 after approval from the ethics review committee pf the College of Medicine, Mustansiriyah University, Baghdad, Iraq, and comprised emergency departments of general and teaching hospitals in the city. Evaluations were done using the World Health Organisation checklist and the guidelines of the Australasian College for Emergency Medicine related to Emergency Department Design.

Results: Of the 26 secondary care hospitals in Baghdad, 13(50%) were evaluated. Triage was not available in 8(62%) hospitals, resuscitation room in 10(77%) and waiting room in all the 13(100%). An obvious shortage of medicines and vaccines was noted in 11(85%) hospitals. Coronary care unit and intensive care unit were not close to the emergency department in 7(54%) hospitals, and liaison psychiatry and social work links were not available in all 13(100%) hospitals.

Conclusions: There is a need to improve service delivery at emergency departments functioning at hospitals in Baghdad.

Objective: To assess growth parameters in adolescents and children with type 1 diabetes mellitus, and the factors influencing their growth.

Methods: The case-control study was conducted from February to December 2020 at the Endocrine Outpatient Clinic of the Central Child Teaching Hospital of Paediatrics, Baghdad, Iraq, and comprised patients aged 2-16 years who had type 1 diabetes for at least a year. The patients formed group A, while healthy controls matched for age and gender from different schools and kindergartens formed group B. Weight, height and body mass index of all the subjects in both groups were measured and worked out, and the values were compared. Data was analysed using SPSS 25.

Results: Of the 192 subjects, 96(50%) were in each of the 2 groups; 50(52.1%) girls and 46(47.9%) boys in group A, and 58(60.4%) girls and 38(39.6%) boys in group B. The overall mean age was 9.66±3.26 years. Group A children had significantly lower mean height, weight and body mass index Z scores compared to group B (p=0.001). The height Z score of group A children was significantly inversely associated with age, duration of disease, and glycated haemoglobin level (p=0.001), while the weight Z score was significantly inversely correlated with age and glycated haemoglobin (p=0.001). The body mass index Z score of group A was significantly inversely associated with age and glycated haemoglobin level (p<0.05).

Conclusions: Children with type 1 diabetes mellitus had significantly lower mean height, weight and body mass index Z scores compared to their counterparts in the control group. Pubertal age group, poor glycaemic control, longer disease duration, and using conventional insulin regimen were the factors affecting growth parameters.

This study aimed to assess the impact of irradiation on red blood cells (RBCs), white blood cells (WBCs), and platelets (PLTs) using modest doses of X-ray radiation (40 kV and 80 kV). The blood samples were exposed to X-ray irradiation at 40 and 80 kV. A haematology analyzer system with automated capability was used to quantify cellular components, specifically WBCs, RBCs, and PLTs, both before and after exposure to radiation. The study found that irradiation reduced WBC and PLT numbers. When exposed to 40 kV and 80 kV voltages, the WBC and PLT improved statistically significantly (p = 0.001). Nonetheless, the statistical analysis revealed no statistically significant difference (p > 0.05) in red blood cell count between 40 and 80 kV doses. It can be concluded that the haematopoietic system exhibits a high degree of sensitivity to radiation exposure.

Objective: To assess the frequency of early discontinuation of Implanon as a method of contraception.

Methods: The cohort prospective study was conducted at the Obstetrics and Gynaecology Department, Al-Yarmouk Teaching Hospital, Baghdad, Iraq from January 2017 to January 2021, after approval from the ethics review committee of the College of Medicine, Al-Mustansiriyha University, Bghadad, Iraq, and comprised women of childbearing age seeking long-acting contraception. The participants received Implanon, an etonorgestril implant, under local anaesthesia, and were followed up for 12 months for possible side effects. Data was analysed using SPSS 26.

Results: There were 115 women with mean age 29.8±6 years (range: 15-44 years) and mean body mass index 27±4.9 kg/m2. Early discontinuation of the plant was done by 32(27.8%) subjects, and the overall incidence of early Implanon removal per 1,000 women per month was 14.47 (95% confidence interval: 10.24-20.47). Lower body mass index, dizziness and insertion-site side effects were the potential determinants of early discontinuation (p<0.05).

Conclusions: More than a quarter of the sample opted for early Implanon discontinuation. Low body mass index, dizziness and insertion-site side effects were potential determinants of early removal.