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

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Objective: To identify the risk factors for in-hospital mortality in postoperative patients with acute type-A aortic dissection (ATAAD), and combine a simplified-fit index which is feasible and helpful in a clinical practice.

Study design: Observational study. Place and Duration of the Study: The Second Hospital of Shandong University, Jinan, China, from May 2020 to July 2021.

Methodology: Hospitalised patients diagnosed with ATAAD were enrolled. The primary observational end-point of the study was mortality at discharge. Logistic analyses were used for the identification of risk factors. Fit index was calculated according to the results of logistic analysis. Receiver operating characteristic curves were used for the evaluation of diagnostic performance of single factors or fit index.

Results: Two hundred and ninety-five consecutive patients were enrolled, with mortality at discharge of 7.8%. A multivariate analysis revealed that haemoglobin (OR 0.958, p = 0.023), creatinine (OR 1.006, p = 0.045), Troponin I (OR 1.047, p = 0.001), and left ventricular ejection fraction (EF, OR 0.000, p <0.001) were independent factors associated with adverse outcome. Then, the four factors were fitted using the logistic analysis (fit index). The area under the receiver operating characteristic curve (AUROC) of fit index was 0.852.

Conclusion: Lower postoperative haemoglobin and EF, higher postoperative creatinine and Troponin I after ATAAD operation represent a higher patient mortality at discharge. Fit index originated in the above indicator may be feasible and helpful for the identification of patients with adverse prognosis.

Key words: Acute type-A aortic dissection, Risk factors, Hospital mortality.

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Physical inactivity is known to be as performing less than 150 minutes of moderate- to vigorous-intensity physical activity per week. It poses a substantial risk for not only non-communicable, chronic diseases such as stroke, diabetes etc. but also contributes to the global mortality. Evidence suggests that the usual urban green environment is sturdily related to several health paybacks to the elderly population, which includes not only decreased cardiovascular mortality, Type 2 Diabetes risk, but overall improved physical, emotional, and mental health. It also invokes physical activity for community involvement, natural green curative sensory effect, spiritual boost, and leisure recreation to the elderly. Additionally, parks serve to perform activities like exercise, gardening, brisk walk or simply meditation in the natural environment. Unfortunately, in Pakistan, the urban green spaces like parks are scarce. Most people do not have access to well-designed parks. People over the age of 50 and above seem to be most affected by this deficiency. There is a need for specially designed parks that can address the challenges faced by elderly people while exercising. This study summarises the available evidence for designing special open area space in parks for the elderly population across Pakistan and highlights the need for further work to alleviate the global sickness of physical sedentariness among the elderly. Key Words: Older adults, Parks, Physical activity, Physical inactivity.

Objective: To identify key enhancer RNAs (eRNA) in esophageal cancer through a comprehensive analysis and explore its importance in esophageal cancer.

Study design: An observational study. Place and Duration of the Study: Department of Thoracic Surgery, Hubei Cancer Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China, from September to October 2022.

Methodology: RNA-sequencing data, survival data, and clinical data for a total of 33 tumours were gathered from TCGA (The Cancer Genome Atlas) datasets. The survival-associated eRNAs were detected by means of Spearman's correlation and Kaplan-Meier survival analyses. Enhancer RNAs linked to survival rate and their target genes in esophageal cancer were screened, and a clinical correlation analysis of key eRNAs was carried out. A functional enrichment analysis was performed and the selected key eRNAs were confirmed in pan-cancer.

Results: The key eRNA was identified as SLC44A3-AS1, and patients with higher expression of SLC44A3-AS1 had worse prognosis than those with low expression. SLC44A3-AS1 expression was significantly associated with many clinical traits, namely tumour status, grade, pathological tumour, node, metastasis (TNM) stage, tumour type, etc. According to KEGG (Kyoto Encyclopedia of Genes and Genomes) pathway enrichment results, SLC44A3 may affect the prognosis of esophageal cancer patients through the herpes simplex virus 1 (HSV1) infection pathway. According to pan-cancer validation results, SLC44A3-AS1 was related to the survival of eight tumours. Correlations were observed between SLC44A3-AS1 and SLC44A3 in 32 types of tumours.

Conclusion: SLC44A3-AS1 plays a key role in esophageal cancer related to prognosis, which may be a new therapeutic target for clinical exploration.

Key words: SLC44A3-AS1, Enhancer RNA, Esophageal cancer, Prognosis.

Objective: To assess the level of acceptability of oral pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and transwomen (TW) in Pakistan.

Study design: Cross-sectional study. Place and Duration of the Study: Online study portal from September to November 2021.

Methodology: The study participants were recruited through snowball sampling. Consenting individuals who were >13 years and were identified as MSM or TW were included in the study. Data were analysed using SPSS version 25. Frequencies, percentages and correlation coefficients were computed.

Results: A total of 347 participants were recruited. The mean age of all participants was 29.8 ± 6.7 years. Fifty-eight (19.7%) of the participants had chemsex with amphetamine-type stimulants (ATS) at least once in preceding six months of the study, and 58 (19.7%) had a sexually transmitted infection (STI) in preceding six months whereas 10 (3.4%) participants had used drugs via injection. Two hundred and thirty-eight (72%) of the participants were aware of PrEP, 30 (11.7%) had used PrEP in the past, and 3.88% were currently using PrEP. The willingness to use PrEP, free of cost, was shown by 300 participants (86.45%) and by 180 (54.5%), if available at a low cost.

Conclusion: There was a high prevalence of risk factors posing them at considerable risk of human immunodeficiency virus (HIV). The majority was aware of PrEP for HIV prevention. The willingness to use PrEP was high when PrEP was offered free of cost but dropped down when participants were asked to pay for PrEP. Based on this finding, PrEP should be available free of cost at the community preferred outlets.

Key words: Gay, Men who have sex with men, HIV, Pre-exposure prophylaxis Pakistan, Transwomen, Chemsex, People living with HIV.

Tumour boards are meetings where physicians from various disciplines treating cancer patients meet to recommend evidence-based or the best possible treatment plan. These meetings have evolved with time and now, in every part of the world; site-specific multi-disciplinary tumour boards are established. These meetings are considered pivotal for improving patient outcomes. The advances in molecular and genetic knowledge and technique and their integration in treatment options have paved the way for multiple therapeutic options. However, the adoption of personalised treatment choices is associated with a huge financial burden, especially in low and middle-income countries (LMICs). A molecular tumour board can help to identify and suggest the most appropriate plan of management. Key Words: Molecular, Genetics, Personalised, Challenges.

This prospective randomised controlled trial aimed to compare the clinical efficacy of Delta spinal endoscopy with bilateral laminotomy for degenerative lumbar spinal stenosis (DLSS). Eighty patients with DLSS were randomly assigned to two groups: 40 treatments by Delta spinal endoscopy named (A) and 40 treatments by bilateral laminotomy named (A). Patients were followed up for one year. The incision length, intraoperative bleeding, and hospitalisation time were lower in group A than in B (p <0.01); however, the operation time in group B was lower than in A (p <0.05). The VAS and ODI in both groups improved significantly after surgery, compared with the results before the surgery. The VAS and ODI in group A after surgery were lower than in B, but only for one week after the surgery, (p <0.05). The excellent rate of modified MacNab criteria was not statistically significant between groups A and B (p >0.05). Overall, Delta spinal endoscopy can effectively manage DLSS with faster patient recovery. Key Words: Delta spinal endoscopy, Spinal stenosis, Minimally invasive, Bilateral laminotomy.

Objective: To evaluate the effect of complete pathological response (pCR) on prognosis in patients with axillary lymph node-positive triple-negative breast cancer (TNBC) and the efficiency of adjuvant capecitabine.

Study design: Analytical study. Place and Duration of the Study: University of Health Sciences, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, between March 2015 and December 2021.

Methodology: The study included 92 patients with TNBC with enlarged axillary lymph nodes and treated with neoadjuvant chemotherapy. The patients were classified as those with and without postoperative pCR and compared in terms of survival. Subsequently, the patients who did not achieve pCR were classified as receiving and not receiving adjuvant capecitabine and were compared for DFS (disease-free survival) and OS (overall survival). Parameters that showed statistical significance were re-evaluated with Cox regression analysis.

Results: The 5-year DFS rate was 84.3% in those who achieved pCR, while it was 55.1% in those who did not (p=0.026). The 5-year OS rate was 82.8% in the pCR arm, while it was 51.0% in the non-pCR arm (p=0.070). The 5-year DFS rate was 66.3% in adjuvant capecitabine-receiving patients, while it was 40.8% in the non-capecitabine arm (HR=0.40, p=0.031). The 5-year OS rate was 68.9% in adjuvant capecitabine-receiving patients, while it was 29.6% in the non-capecitabine arm (HR= 0.40, p=0.062).  Conclusion: Obtaining pCR following NAC in a locally advanced TNBC is an independent prognostic marker for DFS and OS. In the presence of residual disease, improvement in DFS and OS with adjuvant capecitabine was demonstrated by the real-life data.

Key words: Triple-negative breast cancer, Neoadjuvant chemotherapy, Capecitabine, Survival.

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