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

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Objective: To evaluate the efficacy of radiomics features extracted from computed tomography (CT) images in predicting extracapsular invasion (ECI) of metastatic axillary lymph nodes in breast cancer patients.

Study design: Observational study. Place and Duration of the Study: Department of Radiology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Yenimahalle, Ankara, Turkiye, from January 2019 to 2024.

Methodology:  Female patients diagnosed with breast cancer and axillary lymph node involvement were retrospectively reviewed. High- dimensional radiomics features were extracted from CT images, including morphology, histogram, gray level co-occurrence matrix (GLCM), gray level run length matrix (GLRLM), neighbouring gray tone difference matrix (NGTDM), and gray level size zone matrix (GLSZM) features. Advanced statistical methods, including the Mann-Whitney U test, LASSO, and ANOVA, were employed to identify significant predictors of ECI. Logistic regression models were developed, and their performance was evaluated using ROC curve analysis.

Results:  The study identified 39 radiomics features significantly associated with ECI (p <0.05). Integrating multiple radiomics features, the combined model demonstrated adequate diagnostic performance. The model explained 57.8% of the variance in ECI status according to the Nagelkerke R-square statistic. Individual feature models' predictive power was lower than the combined model.

Conclusion:  Radiomics features derived from CT images provide a powerful non-invasive tool for predicting ECI in metastatic axillary lymph nodes due to breast cancer. The combined model's superior performance underscores the importance of a multifaceted approach in medical imaging analysis. These findings highlight the potential for radiomics to enhance prognostic assessments and guide personalised treatment strategies in breast cancer management.

Key words:  Radiomics, Breast cancer, Axillary lymph node involvement, Extracapsular invasion, Computed tomography, Predictive modelling.

Objective: To evaluate the adherence to practice guidelines for epidural insertion along with the medicines used for postoperative analgesia and the incidence of complications.

Study design: Clinical audit. Place and Duration of the Study: Doctors Hospital and Medical Centre, Lahore, Pakistan, from January 2021 to December 2023.

Methodology: Non-probability consecutive sampling technique was used to collect the data. After the approval to conduct this audit was obtained from the Ethical Committee of the hospital, data were collected from Surgical Epidural Registers of the anaesthesia department. All calculations were done manually and then put in Microsoft Word Document.

Results: A total of 308 surgical epidurals were inserted over the period of three years. Procedures constituted 125 (40.6%) orthopaedic procedures, 41 (13.31%) thoracic surgery procedures, 36 (11.7%) general surgery procedures, 25 (8.11%) hepatobiliary procedures, 14 (4.54%) urology procedures, and 12 (3.89%) gynaecological procedures. Level of insertion was as per the recommended guidelines in 200 (64.9%) patients out of 308. Bupivacaine was the most commonly used medicine, with 0.1% concentration generally preferred in the authors' setup. Among the adjuvants, fentanyl, dexmedetomidine, and tramadol were used. Overall complication rate was 40 (12.98%), with motor blockade being the most common, followed by nausea/vomiting, hypotension, dural tap, and blood tap.

Conclusion: This audit will help in rectifying the loopholes in the surgical epidural analgesia services provided by the authors' study centre, but also other epidural analgesia service providers to make changes in their practices for better outcomes in future.

Key words: Epidural analgesia, Dural tap, Blood tap, Motor blockade, Bupivacaine.

Objective: To determine the practical applications of musculoskeletal ultrasound (MSK US) in the precise diagnosis and optimal interventional management of painful musculoskeletal conditions within Physical Medicine and Rehabilitation (PMR) clinics in Pakistan.

Study design: An observational study. Place and Duration of the Study: Department of Physical Medicine and Rehabilitation, Combined Military Hospital, Mangla, Pakistan, from January 2023 to March 2024.

Methodology: A total of 402 patients presenting in the PMR pain clinic who underwent diagnostic MSK US examination and/or interventional procedure under ultrasound (US) guidance during year 2023-24, were enrolled. All US examinations and procedures were performed after getting written informed consent from the patients. The collected data were analysed to see the pattern of the most commonly presenting MSK diagnoses and the utility of US in the identification and treatment of diverse pain disorders.

Results: A total of 402 patients including 238 (59.2%) males and 164 (40.8%) females with a mean age of 51.2 years (ranging from 15-92 years) were examined using US. The main diagnoses were knee osteoarthritis (26.4%), rotator-cuff syndrome (18.9%), and adhesive capsulitis (12.9%). The US-guided interventions were categorised into three main groups including the joints (33.8%), soft tissues (50.5%), and peripheral nerves (15.7%). Among the patients presenting at the PMR pain clinic for MSK US, 75.1% culminated in interventions, whereas 24.9% were treated conservatively.

Conclusion: Musculoskeletal US is a time-efficient and reliable entity to diagnose and treat common pain disorders and help PMR clinicians to confirm the clinical diagnoses promptly and guide the needle while avoiding iatrogenic damage to the surrounding vital structures.

Key words: Musculoskeletal, Ultrasound, Interventional, Pain disorders, PMR clinic, Pakistan.

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Objective: To indirectly evaluate the hygiene hypothesis in the Pakistani population by assessing the difference in aeroallergen hypersensitivity frequency among patients from urban and rural households.

Study design: Cross-sectional, descriptive study. Place and Duration of the Study: Department of Immunology, The Armed Forces Institute of Pathology (AFIP) / NUMS, Rawalpindi, Pakistan, from January to December 2023.

Methodology: Patients advised skin prick test (SPT) by their treating clinicians and meeting the inclusion criteria were included. SPT was performed using six common inhalational allergens, with negative (normal saline) and positive (0.1% histamine hydrochloride) controls. Results were assessed after 15 minutes, and a wheal diameter >3 mm was considered positive. Aeroallergen sensitisation frequencies were compared between urban and rural populations using the Chi-square test. A p-value of <0.05 was considered statistically significant.

Results: Out of 312 patients, 106 (34%) tested positive for SPT, comprising 60 (57%) males and 46 (43%) females. Among these, 44 (41%) were polysensitised to two or more than two allergens. The most prevalent allergens were house dust mite mix (59%) and Cannabis (31%), while Aspergillus was the least common (8%). A statistically significant difference (p = 0.008) was observed in aeroallergen sensitisation prevalence between urban and rural dwellers, with urban patients showing higher sensitisation rates.

Conclusion: The findings support hygiene hypothesis, demonstrating a higher frequency of aeroallergen hypersensitivity in urban populations compared to rural counterparts. The role of environmental exposures in immune system modulation underscores the impact of urbanisation on allergic diseases in the Pakistani setting.

Key words: Aeroallergens, Allergy, Hygiene hypothesis, Sensitisation, Skin prick test, Urbanisation.

Objective: To investigate the causal effect of Type-II Diabetes (T2D) on osteoporosis (OP) risk using a two-example Mendelian randomisation (MR).

Study design: Descriptive study. Place and Duration of the Study: Third School of Clinical Medicine, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China, from February to July 2024.

Methodology: The data of the whole gene association study (GWAS) were gathered from two separate databases and the same East Asia descent, including 433,540 genetic variants in T2D and 212,453 genetic variants in osteoporosis. These genetic variants were used as instrumental variables, subsequently, these variables were analysed by several methods, including inverse variance weighted (IVW)-random effects, MR-Egger regression, and weighted median estimator (WM).

Results: The outcomes indicated that a potential causal association existed between T2D and OP in the primary MR analysis (IVW: Odds ratio (OR) = 1.0934, 95% confidence interval (95% CI): 0.8735-0.9643, p = 0.0007). Meanwhile, the secondary MR also revealed that T2D was causally associated with OP (MR-Egger: OR = 1.1142, 95% CI: 0.9511-0.9966, p = 0.0004, and WME: OR = 1.1422, 95% CI: 0.8611-0.9666, p = 0.0004). The accuracy and robustness of the above results were confirmed using sensitivity tests.

Conclusion: A causal relationship was found between T2D and OP, which also revealed that T2D increased the risk of OP.

Key words: Mendelian randomisation, Type-II diabetes, Osteoporosis, Causal inference.

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Objective: To observe medium to long-term outcomes of hepatic venoplasty in patients with Budd-Chiari syndrome (BCS).

Study design: An observational study. Place and Duration of the Study: Department of Gastroenterology and Radiology, Shaikh Zayed Hospital, Lahore, Pakistan, from February 2021 to December 2022.

Methodology: After obtaining ethical approval, adult patients presenting to the authors' Institute with BCS and candidates for venoplasty were recruited. After the procedure, they were followed up for twelve months.

Results: Twenty-five patients were recruited including 18 (72%) males and 7 (28%) females. Vascular occlusion was due to identified hypercoagulable state in 11 (44%) and idiopathic in 14 (56%). Eight (32%) patients had liver cirrhosis. Ascites was present in 24 (96%) patients prior to venoplasty. Twenty-one (84%) patients had varices. Stage of liver disease was child A in 5 (20%), B in 16 (64%), and C in 4 (16%). Vascular blockage involved all hepatic veins in nearly a quarter of patients. Vascular stenting post-venoplasty was done in 18 (72%). All patients received warfarin (target INR 2-2.5). Twelve months after venoplasty, 4 (16%) patients had undergone liver transplantation, 4 (16%) lost to follow up, and 6 (24%) had expired due to cirrhosis-related complications. In the remaining 11 (44%), hepatic veins were patent in 10 (40%) and blocked in 1 (4%). One (4%) patient had significant ascites, whereas significant-sized varices were noted in 2 (8%).

Conclusion: Venoplasty results in good long-term outcomes in patients with BCS if they have not developed advanced cirrhosis. In patients with cirrhosis, outcomes are suboptimal and liver transplantation remains the only curative option. This highlights the importance of early detection and specialist centre referral before cirrhosis develops.

Key words: Budd-Chiari Syndrome, Venoplasty, Cirrhosis.

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