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

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Objective: To explore the value of contrast-enhanced CT radiomics in predicting occult lymph node metastasis (OLNM) in patients with clinical N0 (cN0) stage non-small cell lung cancer (NSCLC) prior to surgery.

Study design: Descriptive study. Place and Duration of the Study: Department of Radiology, Guangzhou First People's Hospital, Guangzhou, Guangdong, China, from January 2023 to November 2024.

Methodology: A total of 290 NSCLC patients from two hospitals were divided into training and validation sets. Radiomics features were extracted from the tumour volume of interest, and optimal features were selected in the training set to develop a radiomic signature. Univariate and multivariate logistic regression analyses identified clinical characteristics associated with OLNM, leading to the creation of a clinical model. A combined model was developed by integrating the radiomics signature with clinical features. Model performance was assessed using the area under the ROC curve (AUC), with validation conducted in the independent validation set.  Results: Three radiomics features and two clinical characteristics associated with OLNM were identified (p <0.05). The AUCs of the clinical model, radiomic signature, and combined model in the training and validation sets were 0.746, 0.809, 0.838, 0.708, 0.802, and 0.823, respectively, with the combined model showing the highest AUC in both sets.

Conclusion: The combined model, integrating preoperative CT radiomics features and clinical characteristics, effectively predicts OLNM in cN0 stage NSCLC patients, aiding personalised clinical decision-making and improving prognosis.

Key words: Non-small cell lung cancer, Occult lymph node metastasis, Radiomics.

Objective: To outline immune-cell infiltration and identify diagnostic genes for atherosclerosis (AS) to better understand the potential molecular processes involved in AS development.

Study design:  Descriptive study. Place and Duration of the Study: Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China, from 10th June to 8th October 2024.

Methodology: Relevant datasets were collected from the Gene Expression Omnibus database. Gene set enrichment analysis was conducted on differentially expressed genes (DEGs). Subsequently, three machine-learning algorithms were used to identify the core genes. Receiver operating characteristic (ROC) curves were used to analyse the clinical diagnostic value of the core genes.

Results: A Total of 3,307 DEGs, which were found primarily enriched in inflammation-related pathways. Further analysis of the core genes using three machine-learning algorithms revealed four intersecting genes, IBSP, PI16, MYOC, and IGLL5, which are all inflammation-related genes; they also showed good clinical diagnostic abilities, which were verified using ROC curves (area under the curve: 0.959, 0.946, 0.931, and 0.880, respectively).

Conclusion: IBSP, PI16, MYOC, and IGLL5 participate in AS pathogenesis by regulating inflammatory reactions. These are novel diagnostic markers and are expected to become potential targets for AS-targeted therapies.

Key words: Atherosclerosis, Inflammatory reaction, Machine-learning algorithms, Bioinformatic.

Objective: To assess the frequency of disease subsets and the spectrum of organ involvement, particularly focusing on interstitial lung disease (ILD) patterns among patients with systemic sclerosis (SSc).

Study design: Observational study. Place and Duration of the Study: Institute of Rheumatic Diseases, Central Park Teaching Hospital, and its affiliated Arthritis Care Centre, Lahore, Pakistan, from July 2022 to December 2023.

Methodology: Data were extracted from electronic records and gathered using a questionnaire. Patients were classified into limited cutaneous systemic sclerosis (lcSSc) and diffuse cutaneous systemic sclerosis (dcSSc) subsets based on clinical criteria. Gender, age, duration of disease, clinical features, and ILD patterns were compared between the groups.

Results: The mean age of the 68 (88.3%) female patients was 37.9 ± 11.2 years. Younger patients presented with diffuse scleroderma (36 ± 11.3 years) compared to those with limited scleroderma (40.2 ± 10.7 years). The most common clinical feature was Raynaud's phenomenon (90.9%), followed by digital ulcers (41.6%). ILD was present in 68.8%, with non-specific interstitial pneumonia (NSIP) identified in 31.2%, usual interstitial pneumonia (UIP) in 19.5%, and fibrosing NSIP in 3.9%.

Conclusion: Systemic sclerosis predominantly affects younger females, with a higher diffuse cutaneous subtype. Raynaud's phenomenon is the most common manifestation. ILD is a significant complication, with NSIP being the most common pattern observed.

Key words: Systemic sclerosis, Rheumatic diseases, Limited cutaneous systematic sclerosis, Diffuse cutaneous systematic sclerosis.

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Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a potentially life-threatening systemic autoimmune disease. This study aims to compare the effectiveness and safety of biologics and immunosuppressive agents in the maintenance treatment of AAV. A comprehensive search was conducted in Medline, PubMed, Embase, and the Cochrane Library databases to identify the relevant randomised controlled trials (RCTs). Nine RCTs involving 1,157 patients were included. For primary efficacy, rituximab had a lower relapse rate than azathioprine (AZA) and mycophenolate mofetil (MMF) (odds ratio (OR): 0.47, 95% confidence interval (CI): 0.26-0.84 and OR: 0.23, 95% CI: 0.08-0.68, respectively). Based on the result of the surface under the cumulative ranking curve (SUCRA), rituximab had the highest probability of reducing relapse (SUCRA = 86.6%), followed by cyclophosphamide (CYC), belimumab + AZA, methotrexate (MTX), AZA, and MMF. Regarding major relapse, rituximab also showed the highest probability (SUCRA = 93.6%). Concerning safety, there were no significant differences in the incidence of SAEs and serious infection among the different medicines. According to the SUCRA, MMF had the lowest probability of SAEs and serious infection. In conclusion, rituximab may be a treatment method for effectively reducing relapses in AAV patients during maintenance therapy among the medicines investigated. MMF has shown the lowest incidence of SAEs and serious infection. Key Words: Immunosuppressant, Rituximab, Meta-analysis.

Objective: To explore the impact of midazolam premedication on the difficulty of mask ventilation induced by remifentanil during general anaesthesia induction.

Study design: A prospective, randomised, double-blind study. Place and Duration of the Study: This study was conducted at Karaman Training and Research Hospital, Karaman, Turkiye, from May 2022 to January 2024.

Methodology: This study included 120 patients aged 18-60 years with ASA score I-II scheduled to undergo general anaesthesia for elective surgery. The patients were randomly divided into two groups: Group M and Group C. Patients in Group M received midazolam premedication before induction, while patients in Group C received saline. After the general anaesthesia induction, the level of mask ventilation difficulty for the patients was evaluated using the Warters scale as a primary outcome of the study, in which an independent Sample t-test was used for comparison.

Results: The groups showed a significant difference in Warters scale results distribution (p <0.001). The mean Warters scores were 1.58 (2.03) in Group M and 3.40 (2.26) in Group C.

Conclusion: The study concluded that using midazolam premedication can help prevent difficulties with mask ventilation that may arise with the use of remifentanil during anaesthesia induction. The results also showed that midazolam premedication can facilitate mask ventilation for patients with risk factors for difficult mask ventilation.

Key words: Anaesthesia, General, Airway management, Midazolam, Opioids, Premedication, Remifentanil.

Objective: To compare measuring methods of haemodialysis adequacy; realtime urea reduction ratio (RT-URR) and realtime Kt/V (RT- Kt/V) with calculated urea reduction ratio (C-URR) and calculated Kt/V (C-Kt/V), respectively, in end-stage kidney disease (ESKD) patients.

Study design: Cross-sectional prospective study. Place and Duration of the Study: Department of Nephrology, Mayo Hospital, King Edward Medical University, Lahore, Pakistan, from July to December 2023.

Methodology: Patients on maintenance haemodialysis for more than 3 months via a well-functioning arteriovenous fistula were included, while patients with acute kidney injury and dialysis-related complications were excluded. Pre- and post-dialysis blood samples for urea measurement were sent to the laboratory. RT-URR and RT-Kt/V were measured by the NIKKISO-DBB-EXAES machine using the ultraviolet absorbance method on spent dialysate. By putting pre- and post-dialysis, urea values C-URR and C-Kt/V (Daugirdas formula) were calculated. RT-URR, C-URR, RT-Kt/V and C-Kt/V were analysed for correlation using the Bland-Altman graph.

Results: Fifty patients were included, with a mean age of 45.18 ± 12.25 years. The majority (n = 29, 58%) were male. Major cause of ESKD was hypertension (n = 27, 54%), followed by diabetes mellitus (n = 16, 32%). The mean duration of dialysis was 54.16 ± 31.74 months, and the majority of patients, 29 (58%), were on thrice weekly dialysis. A positive statistically significant correlation was found between C-URR and C-Kt/V with RT-URR and RT-Kt/V, respectively (p <0.001). A significant negative correlation was found for body surface area (BSA) with C-URR (p <0.001) and RT-URR (p = 0.013). Also, a significant negative correlation of BSA with C-Kt/V (p <0.001) and RT-Kt/V (p = 0.008) was found.

Conclusion: RT-URR and RT-Kt/V, being strongly correlated with C-URR and C-Kt/V, can precisely tell about adequacy of haemodialysis.

Key words: Renal dialysis, Haemodialysis, Home, Urea, Ultraviolet rays, Haemodialysis solutions.

Objective: To collect and analyse cancer data of all malignancies from the Hyderabad Cancer Registry (HCR) for the estimation of cancer incidence (2020-2023) in various age groups and genders to identify common malignancies and any risk factors to facilitate cancer control initiative and prioritisation by the government and private sector.

Study design: Observational study. Place and Duration of the Study: Hyderabad Cancer Registry (HCR) Secretariat, Liaquat University of Health Sciences (LUMHS), Jamshoro, in collaboration with Karachi Cancer Registry, Health Research Institute, NICH, JPMC, Karachi, Pakistan, from January 2020 to December 2023.

Methodology: Cancer data of HCR collected from across Sindh province were analysed using SPSS. Parameters included age, gender, first contact date, primary site, and ICD coding. Data were cleaned, merged, and analysed. As per the standard guidelines, patients aged 0-14 years were classified as children, 15-19 years as adolescents, and aged 20 years and above as adults. Age-standardised incidence rates (ASIR) were also determined.

Results: During these four years, i.e., from January 2020 to December 2023, a total of 7,169 malignant cases were received. This included 3,310 (46.2%) males and 3,859 (53.8%) females, respectively. Out of a total of 7,169 cases, 6,967 (97.18%) tumours were seen in adults (≥20 years), 104 (1.45%) in adolescents, and 98 (1.37%) in children. In male adults, the oral, prostate, and urinary bladder, while in females, the breast, oral, and ovary constituted the three most common sites. The overall ASIR in males was 188.96 for adults, 2.25 for adolescents, and 2.41 for children. The overall ASIR in females was 236.68 for adults, 2.17 for adolescents, and 1.62 for children.

Conclusion: Both genders combined, breast cancer was the most common malignancy in Sindh. Oral cancer (OC) topped the list in males as the most common cancer, while it was 2nd most common in females after breast. OC, though largely a preventable cancer, has shown an upward trend mostly due to highly prevalent chewing habits, while breast cancer, largely a non- preventable one, not only shows an upward trend but more and more cases are occurring in young and pre-menopausal women. In adolescents and children, the orbital, oral, brain, colorectal, and bone malignancies were predominant.

Key words: Hyderabad, Sindh, Cancer registry, Oral cancer, Breast cancer.

Objective: To investigate the predictive factors influencing lymphatic metastasis in gastroenteropancreatic neuroendocrine neoplasm (GEP-NENs).

Study design: Observational study. Place and Duration of the Study: Department of General Surgery, Ankara City Hospital, Ankara, Turkiye, between the years 2019 and 2022.

Methodology: Patients who underwent surgery and were diagnosed with GEP-NEN based on final pathology between the study years were enrolled. Demographic information of the patients including age, gender, tumour location, and pathological characteristics (tumour size, grade, Ki-67 index, mitotic rate, total number of lymph nodes examined, pathological lymph nodes), inflammatory markers (White blood cell, lymphocyte, neutrophil, and monocyte counts, albumin levels, modified systemic inflammation score [mSIS], delta neutrophil index [DNI], neutrophil-lymphocyte ratio [NLR], and lymphocyte-monocyte ratio [LMR]) were retrieved from the patient database.

Results: One hundred and thirty-two patients were included. The median age was 51 (34-64) years, with 56.8% being male. GEP- NENs were most commonly found in the pancreas (43.2%) and appendix (22.7%). The median tumour size was 1.7 cm (0.7-3.5 cm), the mitotic rate was 1(1-2), and the Ki-67 Index was 2 (1-5). Grade I and II accounted for 91.6 % of cases. In multivariate analysis, independent predictive factors for pathological lymph node involvement were identified as small bowel tumour location (p = 0.002), tumour Grade III (p = 0.008), and tumour size ≥2 cm (p = 0.017).

Conclusion: This study identified tumour size, grade, and site of origin as independent risk factors for LN metastasis.

Key words: Neuroendocrine neoplasm, Lymph node metastasis, Gastrointestinal system.