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

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Objective: To evaluate the efficacy and safety of dual antiplatelet therapy (DATP) in subjects with Child-pugh class A cirrhosis complicated with acute coronary syndrome (ACS) after coronary Drug-eluting stent (DES) implantation.

Study design: Observational study. Place and Duration of the Study: Department of Cardiology, Beijing You 'an Hospital, Capital Medical University, China, from January to August 2021.

Methodology: Cirrhotic patients with ACS after DES were divided into an early cirrhosis group (n=90) and a non-cirrhosis group (n=66). They underwent monthly follow-ups for 12 months, and DATP was administered with acetylsalicylic acid and clopidogrel in standard doses. The endpoints included efficacy endpoints (Major Adverse Cardiovascular and Cerebrovascular Events, MACCE) and safety endpoints (bleeding events). Endpoint events were calculated. Cox regression model and Kaplan-Meier survival curve were used to analyse the correlation between the two groups.

Results: The overall frequency of five indicators was higher in the early cirrhosis group, including increased heart rate (HR), abnormal renal function, abnormal liver function, thrombocytopenia, and coronary multivessel disease (84.5% vs. 51.6%, all p<0.05). Kaplan-Meier survival analysis showed no significant difference between early cirrhosis and non-cirrhosis groups (p=0.688 for MACCE, p=0.960 for bleeding events). Multivariate Cox regression analysis also showed no statistical difference between the early cirrhosis group and the non-cirrhosis group (p=0.642 for MACCE, p=0.720 for bleeding events).

Conclusion: In patients of ACS with early cirrhosis, 12 months of DAPT may be effectively and safely reduced MACCE after implantation of DES.

Key words: Acute coronary syndrome, Liver cirrhosis, Dual antiplatelet therapy, Major adverse cardiovascular and cerebrovascular events.

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Objective: To determine the sensitivity of combining the model for end-stage liver disease (MELD) scoring with new inflammatory indexes in determining the priority for liver transplantation and demonstrating its potential usability in solid tumour visceral crisis.

Study design: Descriptive study. Place and Duration of the Study: Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkiye, from June 2017 to June 2022.

Methodology:  Patients hospitalised in the medical oncology clinic for hepatic dysfunction were included. The MELD scores of these patients were calculated, and the predictive contribution of the systemic immune-inflammatory index (SII) to prognosis and mortality was evaluated.

Results: A total of 295 patients (158 (53.6%) men and 137 (46.4%) women) were included. When compared for primary tumour types, colorectal cancers were the most common with 55 (18.6%) cases, followed by breast cancers at 52 (17.6%), pancreatic carcinoma at 50 (16.9%), and stomach cancers at 40 (13.6%) cases. In the survival analyses of all three MELD scores (MELD-Original, MELD-Na, and MELD 3.0) between <20 groups and ≥20 groups, the median Overall Survival (OS) for MELD-Original was 1.44 vs. 0.88 months (p<0.001), for MELD- Na it was 1.64 vs. 0.85 months (p<0.001), and for MELD 3.0 it was 2.16 vs. 1.28 months (p=0.039). In the ROC analysis, the SII parameter cut-off was ≥626.28 for the estimation of mortality, SII sensitivity was 78.7%, and specificity was 100% (p=0.013).

Conclusion: Combined use of MELD and SII scores in patients with solid tumours with hepatic visceral crises will be practical, cost-effective, and easy to access, eliminate gender-based disparities, and contribute to clinical follow-ups with objective data.

Key words: Malignant neoplasm, MELD score, MELD-Na, MELD 3.0, SII.

Objective: To compare and correlate corneal keratometry (K), central corneal thickness (CCT), and anterior chamber depth (ACD) using a partial coherence interferometry device and a Scheimpflug camera system device in patients planned for cataract surgery.

Study design: Comparative cross-sectional study. Place and Duration of the Study: Armed Forces Institute of Ophthalmology, from December 2021 to June 2022.

Methodology: Patients planned for cataract surgery underwent measurement of central corneal thickness (CCT), anterior chamber depth (ACD), and keratometric values (K) by Wavelight OB 820 biometer and Allergo Oculyzer II, preoperatively. Correlation and inter-device agreement were assessed between two devices.

Results: There were 115 patients with a mean age of 64.23 ± 9.26 years. All anterior segment parameters showed excellent agreement and high degree of correlation between the two optical devices. Correlation coefficient (r) for central corneal thickness was r = 0.958 (p<0.001) while correlation coefficient for anterior chamber depth was r = 0.965 (p<0.001), r = 0.966 (p<0.001) for flat K, and r = .0969 (p<0.001) for steep keratometry, respectively.

Conclusion: Ophthalmic parameters assessed by both devices were comparable and are recommended to be used in the clinical practice of keratorefractive and cataract surgeries interchangeably.

Key words: ACD, CCT, Keratometry, Cataract, OB 820 biometer, Oculyzer II.

Objective: To investigate the correlation between general self-efficacy and online learning readiness among Pakistani undergraduate dental students.

Study design: Cross-sectional study. Place and Duration of the Study: Riphah International University, Islamabad, between September 2020 and March 2021.

Methodology: Using cluster sampling, three dental colleges of Islamabad and Rawalpindi were selected. Electronic questionnaires were sent to 750 students. The questionnaire was comprised of two instruments, General Self-Efficacy Scale (GSES), and Online Learning Readiness Scale (OLRS). GSES had 10-items with response measurement on four-point Likert scale, while the OLRS had 18 items in five different domains measured by five-point Likert scale. Data were analysed using SPSS-23. Correlation between dependent variables was calculated using linear regression analysis.

Results: The response rate was 59.3% with a predominant response from female students (82.2%) compared with male students (17.8%). The majority of responses were recorded from third year students (27.9%). The year four students' scores for GSE, computer and internet self-efficacy, and self-directed learning differed significantly from other students. The overall mean GSE score was 29.37+4.57. Regression indicated a low degree of correlation between GSE and the five domains of OLRS with r2 values ranging from 0.12 to 0.32.

Conclusion: A weak to moderate correlation was found between self-efficacy and the five dimensions of online learning readiness among Pakistani undergraduate dental students as depicted by the r-values.

Key words: Cross-sectional studies, Dental education, Dental students, Dentistry, Efficacy, Online learning, Questionnaire.

The success of autologous tooth transplantation depends on the activity of the periodontal ligament of the donor tooth. Its activity decreases with a longer exposure time. In order to reduce the exposure time of the donor tooth and quickly prepare the alveolar fossa highly matching with the donor tooth root, the clinical data of cone-beam CT (CBCT) was imported into Mimics 21.0 software in this study to obtain three-dimensional (3D) images of the jaw tissue structure. The images were used to extract the target area and select the target tooth. By analysing the information of the recipient region and the donor region, 3-Matic 13.0 software was used to implant the donor virtual into the target region, and restrictive personalised guidance was designed. Subsequently, the surgical guide template was printed by 3D printing technology, and the alveolar fossa was rapidly prepared in vitro. After the operation, the donor tooth was matched with the complete alveolar cavity using 3-Matic13.0 software. The depth deviation of the prepared alveolar cavity was measured within 2.0 mm, and the width deviation was about 1.0 mm. The maximum width deviation is 2.88 mm due to the tilt of the roots. With a high matching degree to the donor tooth root, it needs further and larger clinical studies. Key Words: CBCT, Tooth autotransplantation, 3D printing technology, Computer-aided imaging, Periodontal ligament.

The aim of this study was to investigate a serodiagnostic model as a substitute for liver stiffness measurement (LSM) for diagnosing compensated liver cirrhosis (LC). This retrospective study included 150 patients with compensated hepatitis B-related LC and 153 with chronic Hepatitis B virus (HBV) infection. It was conducted from May 2017 to June 2022 at Qinghai University Affiliated Hospital, China. The values of LSM, aspartate transaminase-to-platelet ratio index (APRI), gamma-glutamyl transpeptidase-to-platelet ratio (GPR), and fibrosis-4 (FIB-4) were evaluated in all admitted patients. The diagnostic value of APRI, GPR, FIB-4, and LSM was assessed using the receiver operating characteristic (ROC) curve. FIB-4 score (AUC=0.842; specificity=77.8%; sensitivity=80.7%; cut-off=2.824) was the best substitute for LSM from the three serum scoring models. The Cox regression model indicated that a FIB-4 score ≥2.824 was an independent predictor of prognosis for compensated hepatitis B-related LC (HR=1.15, 95%CI: 1.07-1.23, p<0.001). This study's findings suggested that FIB-4 could be the best substitute for LSM and may help to assess LC prognosis. Key Words: APRI, GPR, FIB-4, LSM, Diagnosis, Liver cirrhosis.

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Objective: To determine the predictive value of Ki67 on pathological complete response (pCR) of breast and axilla regions in breast cancer (BC) patients receiving neoadjuvant therapy (NAT).

Study design: Descriptive study. Place and Duration of the Study: Departments of Medical Oncology, Sirnak State Hospital, Aydin State Hospital, Manisa Celal Bayar University, and Dokuz Eylul University, from November 2010 to July 2022.

Methodology: PCR and various histopathological parameters were evaluated for BC patients receiving NAT. The Youden Index method was used to find the cut-off value for the Ki67 variable according to the receiver operating characteristic (ROC) curve. This value was obtained as 77.5. Breast and axillary responses were individually evaluated to assess response to NAT. Univariate and multivariate logistic regression analysis were used to predict both breast and axillary pCR.

Results: A total number of 280 females receiving NAT for BC were included in the study. Multivariate analysis for breast pCR to NAT showed that Ki67 index (>77.5 vs <77.5, p=0.047) was statistically significant marker. While Ki67 index was significant for breast pCR in both univariate and multivariate analyses, the same was not observed on axillary response (p=0.387).

Conclusion: High Ki67 level was significantly associated with breast pCR in BC patients receiving NAT, but a similar effect was not observed on axillary pCR. These findings suggest that breast and axilla tissues have a biological differences in treatment responses.

Key words: Axillary response, Breast cancer, Ki67 Labeling Index, Neoadjuvant therapy, pathological complete response.