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

Objective: To evaluate the efficacy and safety of minimally invasive surgery in elderly patients with cholecystolithiasis and choledocholithiasis and its effects on liver function and stress response.

Study design: Comparative observational study. Place and Duration of the Study: Department of Hepatobiliary Surgery, Anyang City People's Hospital, Xinxiang Medical College, Anyang, China, from August 2021 to 2023.

Methodology: Eighty-six elderly patients with cholecystolithiasis and choledocholithiasis were divided into two distinct groups. The control group (n = 43) underwent endoscopic retrograde cholangiopancreatography (ERCP) in conjunction with laparoscopic cholecystectomy (LC). The observation group (n = 43) received LC along with laparoscopic common bile duct exploration (LCBDE). Comparative analysis of perioperative outcomes, complication rates, the frequency of residual stones, and liver function markers, including total bilirubin (TBil), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) was made. Furthermore, inflammatory markers such as tumour necrosis factor-alpha (TNF-α), C-reactive protein (CRP), and Interleukin-6 (IL-6), as well as stress markers including cortisol and epinephrine were also evaluated. Also, the quality of life both before and after surgery was assessed.

Results: The observation group had better perioperative outcomes with a lower complication rate (4.65% vs. 20.93% in controls, p <0.05). Both groups showed significant post-surgical improvements in liver function markers (TBil, AST, ALT, p <0.05), with no significant inter-group differences. Postoperative inflammatory (TNF-α, CRP, IL-6) and stress markers (cortisol, epinephrine) increased significantly (p <0.05), with trends favouring lower levels in the observation group. Quality of life scores significantly improved in both groups one month post-surgery (p <0.05).

Conclusion: LC combined with LCBDE is as effective as ERCP combined with LC for removing stones and improving liver function and quality of life in elderly patients with cholecystolithiasis and choledocholithiasis. However, the LC combined with the laparoscopic common bile duct exploration approach has fewer complications, reduces inflammation and stress responses, and supports better overall recovery, making it the preferred option for this patient population.

Key words: Gallstone, Choledocholithiasis, Old age, Minimally invasive surgery, Liver function, Stress response.

This paper explores climate change as a catalyst for mass migration, emphasising the resulting mental health consequences for displaced populations. The tendency of social ties upon migration is substantial, as these provide both resources and stress, while the severance of such ties tends to worsen mental illness. Insufficient access to mental health services for migrants has been attributed to a lack of resources, legal barriers, and negative attitudes of the community. Furthermore, migration related to climate change may provoke competition over scarce resources which will worsen the mental health situation. Although some psychosocial support arrangements have been shown to work, people are still unable to obtain such treatment, especially in resource-poor countries. Such findings demonstrate why it is essential that any response to climate migration policy incorporate mental health as a component of most, if not all, climate policy measures. In this regard, it calls for the promotion of comprehensive and flexible mental healthcare systems, increased a funding for programmes targeting refugees, and redesigning a priority setting oriented in addressing the chronic mental health problems among refugee populations. Key Words: Syndemic, Climate change, Migration, Mental health, Global health.

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Objective: To compare rapid Resa-Imipenem NP test with conventional disc-diffusion method for carbapenem susceptibility testing in Acinetobacter baumannii.

Study design: Cross-sectional analytical study. Place and Duration of the Study: Department of Microbiology, The Armed Forces Institute of Pathology / National University of Medical Sciences, Rawalpindi, Pakistan, from December 2022 to November 2023.

Methodology: A rapid resazurin-based test to assess imipenem susceptibility was performed on the growth of Acinetobacter baumannii in 202 clinical samples from different clinical settings, and the results were compared with the conventional disc-diffusion testing method. Bacterial suspensions of the isolates were added to imipenem and resazurin (a viability colourant) containing Mueller-Hinton broth on a 96-well polystyrene microtitre plate and incubated for 2.5 hours. A colour change from blue to pink indicated resistance. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. Cohen's kappa assessed agreement between tests.

Results: Out of 202 isolates, 157 were imipenem resistant and 45 were imipenem sensitive. The sensitivity, specificity, PPV, and NPV were 99.4%, 100%, 100%, and 97.8%, respectively. Diagnostic accuracy was 99.5% with one very major error (VME, 0.5%). Cohen's Kappa showed excellent agreement between the two tests (<0.001).

Conclusion: The rapid Resa-Imipenem NP test is simple, reliable, and significantly faster, providing accurate results within 2.5 hours compared to 18-24 hours by conventional disc-diffusion.

Key words: Acinetobacter baumannii, Imipenem, Rapid resazurin test, Microbial sensitivity tests, Disk diffusion method, Carba-penems.

Objective: To compare the outcomes of hand-assisted laparoscopic (HALS) and hand-assisted retroperitoneoscopic (HARS) donor nephrectomy procedures.

Study design: Descriptive study. Place and Duration of the Study: Pakistan Kidney and Liver Institute and Research Centre (PKLI & RC), Lahore, Pakistan, from May 2018 to December 2022.

Methodology: Data from 358 donors were analysed for pre- and postoperative outcomes of HALS and HARS donor nephrectomies, considering techniques based on clinical judgement and donor characteristics, covering demographics, pre- and postoperative complications under multidisciplinary oversight.

Results: In a group of 358 donors, the median age was 36 years, with an interquartile range (IQR) of 29-44 years, and the median (IQR) body mass index (BMI) was 25.82 (22.57-28.53). Most donors were female (58.7%) and had blood type O (47.8%). A majority had no prior surgeries (86.0%). HALS donor nephrectomies were performed in 36.3% and HARS donor nephrectomies in 63.7%, with left kidneys predominantly procured (98.3%). The median warm ischaemia time (WIT) was 88.00 seconds (IQR: 17.25). No complications were reported in 95.5% of cases. Pain scores at 12 hours (p <0.001), 24 hours (p <0.001), 48 hours (p <0.001), and 10 days (p = 0.028), along with the length of hospital stay (LOS) (p <0.001), displayed significant differences in their distributions across procedures. HARS donor nephrectomies showed better pain management, while both techniques had similar outcomes for early bowel movement within 48 hours.

Conclusion: The study results emphasise tailored surgical approaches and meticulous postoperative care in live kidney donation surgeries. HARS technique offers advantages in postoperative pain management, contributing to optimising donor outcomes and surgical techniques.

Key words: Live kidney donation, Hand-assisted laparoscopic surgery, Hand-assisted retroperitoneal surgery, Laparoscopic donor nephrectomy, Surgical outcomes, Perioperative complications.

Objective: To evaluate and compare the efficacy and potential side effects of transabdominal preperitoneal repair (TAPP) and total extraperitoneal repair (TEP) for inguinal hernia with mesothelial cysts of uterine round ligament (IHMCURL) repair.

Study design: Observational study. Place and Duration of the Study: Department of General Surgery, The Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, Guangdong, China, from January 2018 to December 2023.

Methodology: Data on patient demographics, cyst characteristics, surgical duration, blood loss, postoperative pain scores, hospital stay, and occurrence of seroma were retrieved from medical charts and analysed for differences between patients who had received TAPP versus TEP.

Results: The study population comprised 32 female patients diagnosed with inguinal hernia complicated by round ligament cysts who received surgical management, between 2018 and 2023. Of these, 17 (53.1%) patients underwent TEP repair, with the remaining 15 (46.9%) cases managed via the TAPP approach. Demographically, the patient cohorts were quite similar across both groups. Postoperative pain levels (VAS scores at 12 hours after surgery) were significantly lower in the TEP group (5.06 ± 1.676 vs. 6.20 ± 1.014, p <0.05). Hospitalisation time (1.59 ± 1.004 days vs. 2.47 ± 1.302 days, p <0.05) and the number of postoperative seromas (0 vs. 4, p <0.05) were also significantly lower in the TEP group. The mean operative time and intraoperative blood loss were comparable between the groups.

Conclusion: As a surgical procedure for treating IHMCURL, TEP is superior to TAPP in terms of postoperative pain, length of hospital stay, and the incidence of postoperative seroma. Perhaps it can be considered as the preferred surgical procedure.

Key words: Total extraperitoneal repair, Transabdominal preperitoneal repair, Female inguinal hernia, Mesothelial cyst of uterine round ligament.

Objective: To investigate the therapeutic effect of the immune modulator Bacillus Calmette-Guerin polysaccharide and nucleic acid injection (BCG-PSN) on postherpetic neuralgia (PHN), and measure immune-related markers to elucidate the immune mechanism of BCG-PSN in treating patients with PHN with neuropathic pain.

Study design: Single-masked randomised controlled trial. Place and Duration of the Study: Department of Dermatology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China, from January 2022 to December 2023.

Methodology: Ninety-eight patients with PHN were randomly assigned to receive oral administration of gabapentin (control group, n = 49), or a combination of gabapentin and locally injected BCG-PSN (BCG-PSN group, n = 49) for eight weeks. Two-sample and paired t-tests were used to measure the visual analogue scale (VAS) and quality of life (QOL) scores. Immune-related markers were measured in peripheral blood samples using flow cytometric staining. The χ2 test was used to compare the incidence of adverse reactions.

Results: The VAS and QOL scores in the BCG-PSN group were significantly better than those of the control group (p <0.001 and p = 0.002). The CD3+, CD4+, CD19+, and CD56+ cells and the CD4+/CD8+ ratio of the BCG-PSN group were statistically lower than those of the control group (p <0.05). No significant differences were observed in the incidence of adverse reactions between the two groups (p = 0.804).

Conclusion: The results indicated that BCG-PSN could effectively alleviate pain and improve immune function in patients with PHN.

Key words: BCG-PSN, Postherpetic neuralgia, Immune modulation, Neuropathic pain, Gabapentin.

Objective: To establish cascade family screening of newly diagnosed hereditary angioedema (HAE) patients.

Study design: Cross-sectional, observational study. Place and Duration of the Study: Department of Immunology, The Armed Forces Institute of Pathology / CMH / NUMS, Rawalpindi, Pakistan, from September 2021 to June 2024.

Methodology: Eighty-nine parents, siblings, and children of 10 diagnosed patients of HAE were screened. Thirty-two family members were screened by using C1 esterase and complement C4 levels, whereas 57 patients were not available or willing for blood samples, and a questionnaire designed for HAE was recorded from patients / index cases. Baseline characteristics of HAE-Index and HAE-Screened patients were analysed using inferential statistics (independent t-test, Chi-square / Fisher's exact, and Mann-Whitney U test), selected based on data distribution (assessed by the Shapiro-Wilk's test).

Results: A total of 10 cases were followed for screening in families. Upon cascade screening of 89 individuals, 16 confirmed and 24 probable cases of HAE among family members (symptomatic and asymptomatic) were identified. Out of these 40 positive patients, 26 were male and 14 were female. Three patients among these screened individuals died secondary to laryngeal oedema. Out of ten index cases, two did not have any family history of hereditary angioedema, hence suspected for de novo mutation in the SERPING-1 gene.

Conclusion: Cascade screening helps in facilitating early diagnosis of asymptomatic or mildly symptomatic family members of HAE patients. This will provide better guidance for avoiding potential triggers, appropriate prophylaxis, and better management of HAE patients. Young patients of HAE need genetic counselling for a 50% risk of HAE in offspring and are recommended for prenatal diagnosis.

Key words: C1 esterase, C4, Hereditary angioedema, Laryngeal oedema, Screening.

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The objective of this study was to determine the outcomes of Kangaroo Mother Care (KMC) in preterm and low birth weight newborn babies. This prospective observational study was conducted at the Department of Paeds Medicine, People's University of Medical and Health Sciences for Women, Nawabshah, Pakistan, from March to December 2022. A total of 106 neonates were included. KMC was initiated right after stabilising the baby. Outcome measures were length of hospital stay, mortality, and morbidities (hypothermia, hyperthermia, hypoglycaemia, and sepsis). The average weight at birth was 2041.53 ± 145.41 grams. The mean gestational age at birth was 37.42 ± 29.02 weeks. The mean KMC duration was 13.91 ± 1.37 hours. The mean hospital stay was 10.20 ± 2.3 days. Mortality was 4.7%. Hypothermia was found in 7 (6.6%) patients, hyperthermia was found in 12 (11.3%) patients, sepsis was found in 6 (5.7%) patients, and hypoglycaemia was found in 7 (6.6%) patients. The KMC method played an important role in reducing the duration of hospital stay and decreasing the mortality rate in infants with low birth weight. Key Words: Kangaroo mother care, Preterm birth, Low birth weight, Newborns.