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

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Pancreatic surgery, associated with technical difficulties and high complication rates, remains a challenge for surgeons. The laparoscopic approach has been shown to have benefits over the open approach; however laparoscopic distal pancreatectomy (LDP) still has its challenges. Robotic distal pancreatectomy (RDP) offers a technical edge over the laparoscopic approach in terms of superior imaging and ergonomics. Whether the technical advantages translate into improved outcomes is to be established. The aim of this study was to produce an overview of systematic reviews, summarising the evidence to date comparing RDP and LDP in terms of intraoperative, postoperative, and oncological outcomes and assessing the quality of the included reviews. Three electronic databases, PubMed, Embase, and Scopus, were searched to identify systematic reviews with meta-analyses comparing RDP with LDP. The AMSTAR-2 format was used to assess the quality of the studies. Fourteen systematic reviews were identified for inclusion. RDP had a significantly higher rate of spleen preservation, significantly shorter hospital stay, and a significantly lower rate of conversion to open surgery, whilst having higher total costs compared to LDP. The overall quality of the reviews was variable. The evidence suggests that RDP has potential advantages over LDP in terms of higher spleen preservation rate, shorter hospital stays, and lower conversion rate to open surgery, whilst maintaining comparability with most other outcomes. Based on the variable quality evidence, RDP is a safe alternative to LDP. Key Words: Pancreatectomy, Laparoscopic distal pancreatectomy, Robotic surgery, Outcome.

Objective: To compare the clinical efficacy of erector spinae plane block (ESPB) administered at the medial versus lateral aspect of the fifth thoracic transverse process (TP) apex and to investigate the potential influence of the intermuscular partitioning fascia (IMPF) on medicine diffusion.

Study design: Randomised controlled trial. Place and Duration of the Study: Department of Anaesthesiology, Affiliated Cancer Hospital of Xinjiang Medical University, Xinjiang, China, from August 2023 to April 2024.

Methodology: Twenty patients undergoing thoracic surgery were randomly allocated to the medial TP apex group (M Group, n = 10) or lateral TP apex group (L Group, n = 10). ESPB was performed at the T5 level, and sensory blockade regions were evaluated 30 minutes post-injection.

Results: All patients in the M Group (10/10) exhibited sensory blockade covering the posterior midline to 2 cm laterally (L group: 0/10, p <0.001). The M Group also demonstrated a significantly higher blockade rate at the T11-T12 region (7/10 vs. 1/10, p = 0.020). Anatomical analysis indicated that the IMPF at the TP apex segregated medial and lateral medicine diffusion pathways.

Conclusion: ESPB administered at the medial TP apex provides a broader blockade range, potentially mediated by the IMPF restricting multidirectional medicine diffusion. This fascial barrier may influence clinical efficacy by directing medicine spread.

Key words: Erector spinae plane block, Transverse process, Ultrasound-guided, Fascial barrier, Sensory blockade.

Objective: To determine the effect of intralesional vitamin D3 injection in the treatment of cutaneous warts.

Study design: Quasi-experimental study. Place and Duration of the Study: Department of Dermatology, P.N.S. Shifa Hospital, Karachi, Pakistan, from May to November 2023.

Methodology: A total of 30 patients with cutaneous warts of various sizes and durations were selected. Vitamin D3 (0.2 ml, 15 mg/ml) was injected to the base of the warts after anaesthetising with lignocaine (0.2 ml, 20 mg/ml). The injections were repeated two weeks apart for a maximum of 4 sessions or until complete clearance, whichever was earlier. A maximum of two warts were treated per session, and patients were followed up for six months after the last injection.

Results: The patients' average age was 32.20 ± 11.9 years, and their average illness duration was 14.3 ± 6.5 months. Out of the 30 patients, 10 (33.4%) were females and 20 (66.6%) were males. Twenty cases (66.6%) showed complete clearance, seven cases (23.3%) showed a moderate response, and three (10%) showed a mild response. The only side effects observed in 17 (56.6%) cases were mild swelling and irritation at the injection site, both of which went away on their own within a few days.

Conclusion: Intralesional vitamin D3 is an effective and affordable treatment option for cutaneous warts.

Key words: Cutaneous warts, Common warts, Efficacy, Intralesional treatment, Vitamin D3.

The aim of this study was to describe the frequency, locations, and neurological symptoms in Behcet's patients to contribute to the understanding of the complexity of Neuro-Behcet's disease (NBD). A total of 187 patients diagnosed with Behcet's disease (BD) over five years were retrospectively examined. The gender of those with neurological involvement, areas of involvement seen on imaging, neurological symptoms, demographics, and treatments used were documented. Among the patients, 163 had no neurological involvement, and 24 were diagnosed with NBD. The frequency of neurological involvement was 12.8%. Among the neurological symptoms, headache was the most common (41%). No statistically significant relationship was found between neurological involvement and age, the year of BD diagnosis, gender, or HLA-B51 positivity. A statistically significant relationship was observed between vascular and neurological involvement (p <0.05). In areas where BD is common, young male patients presenting with headache and accompanying neurological symptoms should also be evaluated for NBD. Key Words: Behcet's disease, Neuro-Behcet's disease, Neurological involvement.

Objective: To evaluate the prognostic potential of a new parameter, the Samatya ratio, calculated by dividing tumour volume by the albumin-derived neutrophil-to-lymphocyte ratio (Alb-dNLR), in rectal cancer patients.

Study design: Descriptive study. Place and Duration of the Study: Department of General Surgery, Istanbul Education and Research Hospital, Istanbul, Turkiye, from January 2019 to October 2023.

Methodology: The analysis was conducted involving 86 patients diagnosed with rectal cancer who underwent surgery. Patients with ileus, tumour perforation or other confounding factors were excluded. Tumour volumes were calculated using MRI-based automated segmentation, while Alb-dNLR was obtained from preoperative laboratory data. The Samatya ratio was computed and analysed using ROC curve analysis, and its diagnostic performance was assessed for tumour perforation and carbohydrate antigen 19-9 (CA 19-9) marker elevation. Statistical significance was set at p <0.05.

Results: The mean Samatya ratio was 1177.64 ± 161. It was significantly associated with elevated CA 19-9 levels (p = 0.031) and tumour perforation (p = 0.003). At a cut-off value of >1069.34, the Samatya ratio demonstrated 72.7% sensitivity and 69.3% specificity for CA 19-9 levels (p <0.05), and at a cut-off value of >771.25, it demonstrated 84.6% sensitivity and 56.1% specificity for tumour perforation (p <0.05).

Conclusion: The results suggest that the Samatya ratio is a promising prognostic marker for rectal cancer, particularly in predicting tumour perforation and CA 19-9 levels. Its preoperative calculation may enhance prognostic assessment and guide clinical decision-making in oncology practice.

Key words: Rectal cancer, Alb-dNLR, Tumour volume, CA 19-9, Tumour perforation.

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In translational research, utilisation of laboratory animal models contributes significantly to the understanding of human diseases, diagnostics, and therapeutics. Due to their genetic, anatomical, and physiological similarities to humans, their use allows for in vivo studies to assess the safety, efficacy, and side effects of potential treatments before human trials. However, the relevance is often challenged by significant physiological and genetic differences between species. Additionally, ethical concerns regarding the use of animals' research and variability and reproducibility issues also arise due to differences in strains, breeding practices, and housing conditions, complicating the consistency and reliability of experimental outcomes. To address these challenges, researchers are exploring alternative approaches such as in vitro models, organoids, and computational simulations, which offer promising and ethical substitutes for animal models. Despite these developments, animal models remain indispensable for certain investigations due to their ability to replicate complex biological processes and disease mechanisms. Collaborative efforts to standardise protocols and promote data sharing are essential to improve the reproducibility and translational value of animal research. Key Words: Animal models, Translational research, Challenges in translational research, Alternative to animal models.

Objective: To determine the outcome of haematopoietic stem transplant (HSCT) in beta-thalassaemia major (BTM) patients.

Study design: Descriptive Study. Place and Duration of the Study: Department of Clinical Haematology, Armed Forces Bone Marrow Transplant Centre (AFBMTC), Rawalpindi, Pakistan, from April 2018 to December 2023.

Methodology: All cases of BTM undergoing HLA-matched allogeneic HSCT after myeloablative conditioning were included. Cases undergoing second HSCT and HSCT with treosulfan-based conditioning were excluded. Age, gender, complications, mortality, and associated factors were evaluated.

Results: This study analysed the data of 118 cases of BTM including 71 (60.2%) males undergoing HSCT after myeloablative conditioning during the study period. The mean age at the time of HSCT was 85.7 ± 33.6 months. Eighty-one (68.6%) cases were in Pesaro Class III. Neutropenic fever was the most common complication documented in 117 (99.2%) cases. Mortality at day-100 was 14 (11.9%). Overall treatment-related mortality (TRM) was 23 (19.4%). In univariate analysis, factors having a statistically significant association with TRM were graft failure (p = 0.001), Pesaro class (p = 0.03), severity of acute graft versus host disease (aGVHD) (p = 0.02), and veno-occlusive disease (VOD) (p = 0.02). The median follow-up time was 26.87 ± 16.60 months with overall survival (OS) and disease free survival (DFS) rates of 80.5% and 78.0%, respectively.

Conclusion: The OS of around 80% is promising which can be further improved with better transfusion services, regular iron chelation, and HSCT at a younger age.

Key words: Haematopoietic stem cell transplant, Beta-thalassaemia major, Pakistan.

Objective: To evaluate if the systemic immune inflammation index (SII) predicts extraglandular involvement and disease activity in primary Sjogren's Syndrome (pSS).

Study design: Cross-sectional, observational study. Place and Duration of the Study: Department of Rheumatology, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkiye, from July 2022 to January 2023.

Methodology: This study included 102 healthy controls (HCs) and 128 pSS patients, matched for gender and age. SII, monocyte/ lymphocyte ratio (MLR), plateletcrit (PCT), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) were calculated. The EULAR Sjogren's syndrome patient-reported index (ESSPRI) and the EULAR Sjogren's Syndrome disease activity index (ESSDAI) were used to measure disease activity. Logistic regression identified predictors of disease activity and extraglandular involvement. SII's diagnostic performance was evaluated via receiver operating characteristic curve analysis.

Results: Primary Sjogren's syndrome had higher NLR, MLR, SII, PLR, and PCT than HCs (all p <0.001). According to the ESSDAI, the SII was higher in moderate-to-severe disease activity (p <0.001). SII, with a moderate positive correlation between ESSDAI and ESSPRI, showed diagnostic performance when disease activity was assessed by both ESSDAI and ESSPRI (area under the curve: 0.930, 0.983, respectively, p <0.001). SII was associated with moderate-to-severe disease activity as well as pulmonary and neurological involvement. PLR was associated with skin involvement. The cut-off value of SII for predicting moderate-to-severe disease activity was 660.2 x 103 cells/µL.

Conclusion: Haematological indices such as MLR, NLR, PLR, and PCT, especially SII, which are economical and practical, can be effective clinical assessment tools to monitor extraglandular involvement and disease activity.

Key words: Systemic immune-inflammation index, Primary Sjogren's syndrome, Blood cell count, Pulmonary, Neurological involvement.