Journal of the Pakistan Medical Association最新文献

Objectives: To determine the level of health-related quality of life among patients treated for ischaemic heart disease in two public-sector tertiary care settings.

Methods: The analytical cross-sectional study was conducted from July to September 2021 at two tertiary care hospitals in Karachi after approval from the ethics review boards of the National Institute of Cardiovascular Diseases and the Dow University of Health Sciences, and comprised patients of either gender treated for ischaemic heart disease after being diagnosed within the preceding year who were coming for follow-up in the outpatient department. Data was collected using the short version of the World Health Organisation quality of life tool. Association of socio-demographic and clinical variables with health-related quality of life was explored. Data was analysed using SPSS 21.

Results: Of the 300 patients aged 25-85 years, 212(70.7%) were males and 88(29.3%) were females. The mean total quality of life score was 6.1+/-1.4, while mean general health was 52.6+/-10.5. The lowest score among quality of life subscales was for environmental 44.7+/-15.1, while the highest score was for psychological 60.1+/-10.7 domains. Quality of life was significantly associated with patients' age, education, comorbidities, marital status, monthly income, body mass index, activities of daily living and smoking status (p<0.05).

Conclusions: ischaemic heart disease patients had average health-related quality of life in all domains, but showed low quality of life in the environmental domain.

Stereotactic radiosurgery (SRS) is widely used for treating vestibular schwannoma (VS), offering high tumour control rates, especially in small to medium-sized tumours. However, a subset of patients experiences SRS failure, requiring subsequent salvage microsurgery (MS). The primary reason for salvage surgery is continued tumour growth, but other causes include symptom progression and cystic enlargement. Salvage surgery is more challenging due to increased tumour adhesion to critical structures, resulting in higher complication rates, particularly for facial nerve preservation. Studies suggest subtotal resection may offer better outcomes than gross total resection in terms of facial nerve function, though treatment remains complex and outcomes vary.

Paraneoplastic vasculitis is a rare entity usually seen in haematological malignancies. Its incidence is even more rare in solid tumours like breast, renal, colon and lung. F-18 FDG PET-CT is commonly used to differentiate between active vasculitis and atherosclerosis in patients with large to medium vessel vasculitis. We present a case of moderately differentiated adenocarcinoma colon presenting for the assessment of with paraneoplastic vasculitis.

Objective: To compare the effect of two ovulation induction drugs on anti-Mullerian hormone level in polycystic women.

Methods: The experimental cohort study was done at the infertility outpatient clinics of Al-Yarmouk Teaching Hospital, Baghdad, Iraq, from May 2020 to April 2021, and comprised infertile women aged 18-35 years with confirmed diagnosis of polycystic ovarian syndrome. Baseline blood level of anti-Mullerian hormone was tested in all patients. The patients were divided into two groups. Group A patients received clomid 50mg twice daily to a maximum of 200mg for 5 days starting from the third day of the menstrual cycle. Group B patients received letrozole 2.5mg twice daily for 5 days starting from the third day of the menstrual cycle. After ovulation induction on day 12- 14, a second sample of serum anti-Mullerian hormone was tested, and intergroup comparisons were done. Data were analysed by using the available statistical package of SPSS-28 (Statistical Packages for Social Sciences- version 28). Students-t-test , Paired-t-test , Pearson correlation , t-test or ANOVA test Statistical significance was considered for P value equal or less than 0.05.

Results: Of the 83 women, 41(49.4%) were in Group A with mean age 26.0±4.9 years, while Group B had 42(50.6%) subjects with mean age 27.0±5.1 years. Post-intervention, the level of anti-Mullerian hormone decreased significantly in both groups (p<0.05). The decrease in Group B was more than Group A, but the difference was not significant (p>0.05).

Conclusions: Ovulation induction drugs clomid and leterzole decreased the level of anti-Mullerian hormone significantly.

Objective: To evaluate relationship between oral health and body surface area among children.

Methods: The observational, cross-sectional study was conducted from January to February /2022 after approval from the ethics review committee of the College of Dentistry, University of Baghdad, Baghdad, Iraq, and comprised children of either gender aged 6-8 years who were randomly selected from primary schools in the city. Body surface area was calculated geometrically using different formulas, and the DuBois formula was used to make the intervals. The estimated body surface area values were broadly divided into four intervals: 0.8-0.9, >0.9-1.0, >1.0-1.1, >1.1. Dental caries was examined using the World Health Organisation criteria related to decayed, missed and filled teeth and surfaces for primary and permanent teeth. Dental plaque and gingival health status were measured using plaque and gingival indices. Data was analysed using SPSS 22.

Results: There were 240 subjects. There was no significant difference in terms of mean body surface area intervals of decayed, missed and filled teeth and surfaces for primary and permanent teeth (p>0.05). The mean values of gingival index showed significant differences across body surface area intervals (p<0.05). Mean plaque index values showed no significant differences (p>0.05).

Conclusions: No relationship between body surface area and caries experience of primary and permanent teeth was found. However, increasing the body surface area increased gingival inflammation.

Objective: To evaluate the impact of laser irradiation of human T-cell lymphocyte in culture to determine the photobiomodulatory effects of such irradiation on gene expression, and the release of growth factors and cytokines.

Methods: The experimental study was conducted from November 2021 to April 2022 at the Postgraduate Anatomy Laboratory, Mustansiriyah University, Baghdad, Iraq, and comprised human blood samples T-cell lymphocytes were extracted and irradiated, followed by the extraction of ribonucleic acid to assess the effect of laser on gene expression of cytokines, interlukine-2 and interferon-gamma. A 589nm yellow light low-level laser beam from a diode pumping solid state laser was used at doses 30J/cm2, 50J/cm2 and 70J/cm2 for an exposure time of 15 minutes. Reverse transcriptase-polymerase chain reaction was used to measure gene expression. Data was analysed using GraphPad Prism 9.

Results: Cellular gene expression of the mediators changed significantly in response to laser irradiation at a variety of dosage parameters, and these effects depended on the wavelength and radiation exposure (p<0.05).

Conclusions: The laser light may photobiomodulate the production of cytokines by human cells in vitro.

Objective: To assess the effect of using bolus on the efficiency of three-dimensional conformation radiation treatment of breast cancer post-mastectomy.

Methods: The prospective, clinical study was conducted at Al-Amal Center for Radiation Therapy and Nuclear Medicine, Iraq, from November 2020 to April 2021, and comprised patients with synchronous bilateral breast cancer with regional lymph nodes who underwent mastectomy. The three-diensional conformation radiation treatment technique was used to evaluate the dose received by the planning target volume and the organs at risk. The plans were generated using a treatment planning system, the plans were then fed into a linear accelerator. The plans had one isocenter for both breasts to avoid the errors that may cause the overlapping of the radiation fields with and without the use of bolus. Data was analysed using SPSS 24.

Results: There were 23 female patients with mean age 49.28±8.79 years (range: 35-62 years). There were 7(30.4%) females residing in rural areas, while 16(69.6%) lived in urban areas. The use of bolus increased the radiation dose coverage percentage of the planning target volume of the right (p=0.0002) and left (p=0.0164) breasts, while the right (p=0.3977) and left (p=0.7940) supraclavicular nodes were not significantly covered by the radiotherapy dose. The use of bolus showed a strong significant decrease of the mean dose that was received by the left lung (p=0.00001). Also, the use of bolus caused significant reduction in the amount of the mean scattered dose that reached the heart (p=0.00001) and larynx (p=0.00004).

Conclusions: The use of bolus provided a complete radiotherapy dose coverage for the right and left breasts, as well as an excellent protection for the left lung, heart and larynx.

Objective: To determine the association between a protein-rich diet and the expression of anoctamin 1 in Interstitial cells of Cajal within the muscle layer of the stomach wall in male mice.

Methods: The experimental study was conducted at the Anatomy Department of the College of Medicine, Al- Nahrain University, Iraq, from November 2020 to April 2021, and comprised male adult healthy male mice. They were divided randomly into two equal groups. Group A was fed a high protein diet, while control group B was fed a standard pellet diet. The tissue samples were harvested at day 30 post-surgery. The stomach samplings were placed in 10% neutral formalin for 24 hours to obtain paraffin sections for routine histological and immunohistochemical staining. The protein expression in stomach smooth muscle of each group was detected by immunohistochemical staining. Data was analysed using SPSS 24.

Results: Of the 20 mice, 10(50%) were in each of the two groups. Group A exhibited significant weight-gain compared to group B (p≤ 0.05). There was significant elevation in muscle wall thickness in group A, compared to group B (p≤0.05). Tunica muscularis of the stomach in group A significantly thickened compared to group B (p≤0.05). The expression of anoctamin 1 was significantly more intense in group A compared to group B (p≤0.01).

Conclusions: Unbalanced food had a significant impact on the stomach, affecting the thickness of the muscularis layer and the expression of anoctamin 1 in cajal cells in the muscularis externa.

Objective: To evaluate the potential protective effect of metformin against osteoarthritis development in rats.

Methods: The experimental study was conducted at the Iraqi Centre for Cancer Research and Medical Genetics, Mustansiriyah University, Baghdad, Iraq, from December 2021 to February 2022, and comprised male Sprague- Dawley mice who were divided into 5 equal groups: negative control group, osteoarthritis group subjected to monoiodoacetate induction, positive control group treated with celecoxib 30mg/kg, metformin 100mg/kg group, and metformin 200mg/kg group. Body mass index, inflammatory biomarkers, and serum C-terminal cross-linked telopeptide of type II collagen levels were noted for all the animals. Data was analysed using SPSS 24.

Results: Of the 35 mice, 7(20%) were in each of the 5 groups. Compared to the osteoarthritis group, metformintreated mice showed significantly reduced body mass index, inflammatory biomarker levels, and blood levels of Cterminal cross-linked telopeptide of type II collagen (p=0.05). Metformin 200mg/kg treatment had more beneficial effects than 100mg/kg dose on inflammatory biomarkers and serum C-terminal cross-linked telopeptide of type II collagen (p=0.05).

Conclusions: A beneficial protective effect against the onset of osteoarthritis was produced by metformin in a dosedependent way. Additionally, metformin could lessen cartilage damage as demonstrated by a decrease in the serum levels of C-terminal cross-linked telopeptide of type II collagen in the osteoarthritis group.