Jcpsp-Journal of the College of Physicians and Surgeons Pakistan最新文献

Objective: To evaluate the existence of any relationship between the bolus/basal (B/b) insulin ratio and HbA1c and lipid profile in patients with Type 1 Diabetes mellitus (T1DM) on a basal-bolus treatment regimen.

Study design: Retrospective observational study. Place and Duration of the Study: University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey, from January 2015 to March 2020.

Methodology: This retrospective-observational study included 181 adult patients with T1DM. They were divided into two groups with <1.5 and ≥1.5 B/b insulin ratios, and the parameters were compared.

Results: The subjects comprised 94 females and 87 males with a mean age of 30.1 ± 9.2 years. Microvascular complications and dyslipidaemia were found in 30.9% and 68.5% of the patients, respectively. B/b insulin ratio of ≥1.5 was observed in 65.1% of the patients. The HbA1c level was <58 mmol/mol in 11.6% of the patients. A positive correlation was found between the B/b insulin ratio and HbA1c level. Fasting Plasma Glucose (FPG) and HbA1c levels were higher in those with ≥1.5 B/b insulin ratio. The rate of patients who reached the optimal HbA1c level was 3.57-fold lower in those with ≥1.5 B/b ratio.

Conclusion: A higher B/b insulin ratio was associated with higher HbA1c levels in patients with T1DM treated with intensive insulin therapy. Prospective studies are needed to define a causal relationship between the B/b insulin ratio, glycaemic parameters, and lipid profile.

Key words: Bolus/basal insulin ratio, Type 1 Diabetes mellitus, HbA1c, Low-density lipoprotein, Lipid profile.

Objective: To determine the differences in terms of overall survival in platinum-sensitive ovarian cancer (PSOC) patients undergoing various chemotherapy protocols, and to demonstrate patient tolerance, toxicity, and efficacy data with the use of bevacizumab in different protocols.

Study design: An observational study. Place and Duration of the Study: Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey, from January 2018 to January 2022.

Methodology:  Patients aged 18 and above, who had received treatment for PSOC, were included in the study. Patients with platinum-resistant disease and those for whom bevacizumab usage was contraindicated were not enrolled in the study.

Results: For the 95 patients, the median age was 55 (34-78) years. Median follow-up are 39.7 (39.2-47.5) months. Median progression-free survival (PFS) of the patients are 10.8 (7.3-14.0) months for carboplatin-gemcitabine-bevacizumab (CGB), 10.9 (IQR 5.5-14.3) months in the carboplatin-liposomal doxorubicin-bevacizumab (CLdB) arms, and 6.1 (IQR 5.8-14.3) months in the carboplatin-paclitaxel-bevacizumab (CPB) group (p=0.79). The median overall survivals (OS) are 37.9 (IQR 33.3-46.9) months in the CGB arm, 41.0 (IQR 38.0-50.3) months CPB arm, and 41.3 (IQR 38.1-52.3) months in the CLdB arm (p=0.173).

Conclusion: There was no difference in terms of overall survival among all three chemotherapy protocols. However, due to the difference in toxicity, the treatment should be selected on a patient-specific basis. Additionally, the use of bevacizumab at a dose of 7.5 mg/kg was demonstrated to be equivalent to using 15 mg/kg in terms of overall survival. This lower dose is also important to avoid financial toxicity.

Key words: Bevacizumab, Ovarian cancer, Platinum-based chemotherapy, Tolerability, Adverse clinical events.

Objectives: To compare the total oxidant status (TOS), total antioxidant capacity (TAC), and oxidative stress index (OSI) in the aqueous humour of cataract patients with and without type 2 diabetes mellitus (T2DM).

Study design: Cross-sectional analytical study. Place and Duration of the Study: Department of Physiology, Army Medical College, National University of Medical Sciences, Rawalpindi, Pakistan in collaboration with Armed Forces Institute of Ophthalmology, from 1st June 2022 to 31st January 2023.

Methodology: A total of 120 individuals were recruited and divided into 2 equal groups. Sample of aqueous humour was collected, and the total oxidant status, and total antioxidant status were measured by spectrophotometry. Blood samples were collected to measure the fasting glucose and glycosylated haemoglobin levels. Results were analysed by SPSS version 24 and p-value ≤0.05 was considered significant.

Results: Total oxidative stress and OSI were (55.57±5.46) vs. (33.75±4.28) = p (0.001), (32.79±9.23) vs. (13.28±3.02) = p (0.001) found significantly increased in aqueous humour of diabetic patients while TAC was reduced (1.86±0.41) vs. (2.62 ± 0.45) = p (0.001) compared to the non-diabetics. Fasting blood glucose (109.18±12.32 vs. 91.61±5.71 mg/dl, p=0.001) and glycosylated haemoglobin levels (6.46±0.85 vs.5.43±0.85, p=0.001) were also found significantly high in the diabetic group compared to the non-diabetics.

Conclusion: Increased levels of glucose and glycosylated haemoglobin increase oxidative stress in the blood of T2DM patients. This raises the total oxidative stress in the aqueous homor while lowering the TAC. This disturbed oxidant-antioxidant status in the aqueous humour of diabetic patients plays an important role in the development of cataract in T2DM patients compared to non-diabetics.

Key words: Cataract, Aqueous humour, Oxidative stress, Type 2 diabetes mellitus.

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Objective: To compare changes in corneal biomechanical properties after laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) in low and moderate myopia by Ocular Response Analyzer.

Study design: Quasi-experimental study. Place and Duration of the Study: Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi, Pakistan, between September 2020 and April 2022.

Methodology: Myopic correction was done in forty-six eyes of twenty-three patients by PRK, and forty-seven eyes of twenty-four patients by LASIK. Corneal hysteresis (CH) and corneal resistance factor (CRF) were measured using Ocular Response Analyzer (ORA), pre-operatively, and then 1, 3, and 6 months, postoperatively. The relationship between the amount of myopia treated and biomechanical properties was also studied.

Results: CRF and CH were decreased significantly after LASIK and PRK. A significantly larger decrease in CRF was observed after LASIK as compared to PRK at 6 months (Mann-Whitney U test: CRF, p = 0.02); however, decrease in CH was not statistically significant between LASIK and PRK at 6 months period (Mann-Whitney U test: CH, p = 0.388). A significant correlation was observed between the changes in biomechanical properties and extent of myopic correction after LASIK and PRK.

Conclusion: Biomechanical strength of the cornea was significantly reduced by PRK and LASIK, which was also dependent on the spherical equivalent (SEQ) of myopic correction. A significantly larger change in CRF was observed after LASIK as compared to post PRK.

Key words: Myopia, Laser in situ keratomileusis, Photorefractive keratectomy, Cornea, Biomechanics.

Objective: To determine the yield of cervical mediastinoscopy in determining causes of mediastinal lymph node enlargement.

Study design: Observational study. Place and Duration of the Study: CMH Rawalpindi, Lahore and Multan, from January 2010 to December 2021.

Methodology: Patients who underwent lymph node biopsy through cervical mediastinoscopy approach were included. Record of the patients including age, gender, clinical presentation, and findings on CT scan chest were noted along with the record of preoperative complications and duration of surgery. Histopathology report was also recorded.

Results: Out of 398 patients, 259 (65%) were males and 139 (35%) were females. Out of 338 patients who were operated for diagnostic purpose, 157 (46%) had tuberculosis and 34 (10.1%) had sarcoidosis. Fifty-two (15.3%) were diagnosed to have malignancy including non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC), and metastatic carcinoma of unspecified origin. Amongst staging group (n=60), 33 (55%) patients had negative mediastinal disease. Complication rate was 3.8%, including hoarseness of voice in three patients while 2 patients had wound infection requiring intervention.

Conclusion: Cervical mediastinoscopy is a safe and efficacious means of diagnosis in indeterminate mediastinal lymphadenopathy and staging of lung malignancy.

Key words: Mediastinoscopy, Lymph nodes, Tuberculosis, Lung cancer, Staging.

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Objective: To compare Rapid Antigen Test (RAT) with Reverse Transcription Polymerase Chain Reaction (RT-PCR) in highly suspected COVID-19 patients and to determine its diagnostic parameters.

Study design: Hospital-based, descriptive/observational study. Place and Duration of the Study: Department of Medicine/COVID Complex, Medical Teaching Institution/Lady Reading Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan, from October 2021 to April 2022.

Methodology: A total of 300 highly suspected cases of COVID-19 of either gender admitted in the COVID Complex of the hospital, were included. Data from the patients, including RAT and RT-PCR for COVID-19, were collected retrospectively. RT-PCR was used as the reference test and compared with RAT. Diagnostic statistics of RAT, with their respective 95% confidence intervals were calculated for RAT in diagnosing COVID-19, with significance at p ≤0.05.

Results: Among the 300 patients, 137 (45.7%) were males and 163 (54.3%) were females. The mean age was 56.80 ± 13.72 years. On screening, 138 (46%) patients tested positive and 162 (54%) were negative by RAT; whereas 213 (71%) tested positive and 87 (29%) were negative on RT-PCR. The sensitivity and specificity of RAT were 54.5% (95% CI: 47.52%-61.28%) and 74.7% (95% CI: 64.25%-83.42%), respectively. Positive predicted value was 84.1% (95% CI: 78.26%-88.53%) and negative predictive value was 40.1% (95% CI: 35.63%-44.79%). The positive likelihood ratio was 2.15 (95% CI: 1.47-3.15). The negative likelihood-ratio was 0.61(95% CI: 0.50-0.74). The overall accuracy was 60.33% (95% CI: 54.55%-65.91%).

Conclusion: There was a low sensitivity and specificity of the RAT for COVID-19, with an overall accuracy of 60.33%, compared with RT-PCR.

Key words: COVID-19, Rapid Antigen Test, Sensitivity, Specificity, RT-PCR.

Objective: To investigate the importance and diagnostic yield of genetic and radiological evaluations in children with hypotonia.

Study design: Comparative observational study. Place and Duration of the Study: Department of Pediatrics Neurology, Namik Kemal University, Tekirdag, Turkey, between 2019 and 2022.

Methodology: Patients' medical histories, laboratory results, radiological examinations, and genetic tests, if any, were obtained retrospectively from the patients' clinic files. Children with hypotonia detected since the infantile period and who were on regular follow-up were included in the study. Patients who lost the follow-up were excluded.

Results: Out of one hundred and seventy patients, 61.8% (n=105) were boys and 38.2% (n=65) were girls. The admission age of the patients ranged from 1 to 121 months; the mean age at presentation was 13.52±17.35 months. Hypotonia was central in 85.3% (n=145), peripheral in 12.4% (n=21), and mixed in 2.3% (n=4). Cerebral palsy was the predominant, non-genetic clinical cause of hypotonia (n=66, 39%). Brain magnetic resonance imaging (MRI) was normal in 48.2% (n=82). The most common MRI abnormality was periventricular leukomalacia in 15.9% (n=27). Sixty-five (38.2%) patients were diagnosed genetically. More than half of the patients with a genetic diagnosis were diagnosed by whole exome sequencing (WES).

Conclusion: Brain MRI is the first choice for the patients with central hypotonia. Patients who cannot be diagnosed with clinical findings and brain MRI should undergo WES. This is helpful for the long-term prognosis and management.

Key words: Hypotonia, Whole exome sequencing, Magnetic resonance, Spinal muscular atrophy, Cerebral palsy.