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

Objective: To evaluate the contribution of PAX2, ARID1A, and FOXA1 biomarkers to diagnosis in cases with atypical endometrial hyperplasia (AEH).

Study design: Descriptive Study. Place and Duration of the Study: Pathology Department of Umraniye Training and Research Hospital, from January 2018 to December 2020.

Methodology: Curettage materials of 100 patients diagnosed with AEH which stained PAX2, ARID1A, and FOXA1, were evaluated. The staining patterns in the atypical endometrial glandular areas were grouped as slight-no loss, moderate loss, and complete loss / severe loss for all three biomarkers. Complete or/severe loss in AEH was considered helpful in the diagnosis.

Results: Complete loss / severe loss rates in curettages were 84% for PAX2, 5% for ARID1A, and 15% for FOXA1, respectively. When used in combination, complete loss / severe loss rates were 85% in at least one of the three markers, 84% in PAX2 and/or ARID1A, 85% in PAX2 and/or FOXA1, and 17% in ARID1A and/or FOXA1.

Conclusion: Although all 3 biomarkers showed marked staining loss, PAX2 is the most sensitive biomarker for the diagnosis of AEH in curettage materials.

Key words: Endometrium, Atypical hyperplasia, PAX2, ARID1A, FOXA1.

Objective: To determine the combined effects of continuous positive airway pressure (C-PAP) and physical exercise rehabilitation on a cycle ergometer on postcoronary artery bypass surgery patients.

Study design: Randomised controlled trial. Place and Duration of the Study: Rawalpindi Institute of Cardiology, from December 2020 to May 2021.

Methodology: Patients, who underwent coronary artery bypass graft surgery, were divided into two equal groups of each 51. The control group received standard physiotherapy from the 1st postoperative day which included breathing exercises, passive mobilisation in the sitting position, and ambulation. The interventional group also had standard physiotherapy from 1st postoperative day; but also the 2nd to 4th postoperative day had additional dynamic exercises on cycle ergometry in combination with CPAP (continuous positive airway pressure).

Results: There was a significant improvement in functional capacity measured by 6-minute walk test in the interventional group (p<0.001). Length of hospital and ICU stay mean rank (68.88 and 58) were also significantly decreased in the interventional group (p<0.001). There was no improvement in maximum inspiratory pressure and maximum expiratory pressure. One-minute sit-to-stand test was increased on 4th postoperative day in the interventional group. There was no significant difference observed in arterial blood gases between these two groups.

Conclusion: Cycle ergometry combined with continuous positive airway pressure (C-PAP) applied earlier on patients undergoing coronary artery bypass grafting improves the functional capacity, decreases the ICU and hospital length of stay and also improves lower limb muscle strength. But no difference in respiratory muscle strength and arterial blood gases was observed between the control and interventional groups.

Key words: Aerobic exercise, Coronary artery bypass graft surgery, Continuous positive airway pressure.

ABSTRACT       Objective: To compare the clinical parameters of 4th and 5th COVID waves in Karachi, Pakistan.

Study design: Descriptive study. Place and Duration of the Study: PNS Shifa Hospital, Karachi, from July 2021 to February 2022.

Methodology: All patients with COVID-19 in PNS Shifa Hospital were included in the study. The patients were divided into two groups, those who had COVID-19 during the 4th wave, and others who had it during the 5th wave. The patients' demographic details, comorbidities, vaccination status, initial presentation, the severity of disease, clinical progress, and final disposal from the hospital were noted. A comparison of severity, length of hospital stays, and mortality was made between the groups.

Results: There were 747 patients admitted during the Delta variant-dominated 4th wave of COVID-19, and 490 patients during the 5th wave, dominated by the Omicron variant. A vast majority of fifth-wave patients had the mild disease (87.35% vs. 49.39%), with significantly lower critical patients (2.04% vs. 7.09%). Vaccination was effective against both the Delta and the Omicron variant of the SARS-CoV-2 virus. The mean length of stay in the hospital for patients was significantly lesser (p < 0.001) during the 5th wave as compared to the 4th wave (6.43 ± 3.37 vs. 9.56 ± 5.45 days). The mortality rate was 7.09% among patients admitted in the 4th wave and 2.04% in the 5th wave. This difference was statistically significant (p < 0.001).

Conclusion: The severity of disease, length of hospital stays, and mortality were higher in the Delta variant-dominated 4th wave of COVID-19 as compared to the Omicron variant-dominated 5th wave in Pakistan. The vaccination was effective against both the Delta and the Omicron variant of COVID 19, as the mortality rate among the vaccinated patients during the two waves was not significantly different.

Key words: COVID 19, Vaccination, Disease outcome, Mortality.

Objective: To determine Omentin-1 in hypothyroid patients with autoimmune thyroiditis compared to controls.

Study design: Observational study. Place and Duration of the Study: Department of Internal Medicine and Endocrinology, University of Health Sciences, Antalya Training and Research Hospital, Turkiye, between August 2017 and March 2020.

Methodology: The study included 63 newly diagnosed hypothyroid patients with autoimmune thyroiditis and 40 healthy volunteers. Body mass index, fasting blood glucose, homeostasis model assessment for insulin resistance, lipid profile, thyroid function tests, thyroid autoantibodies, and omentin-1 levels were determined before and after treatment with levothyroxine sodium in all participants.

Results: Omentin-1 was significantly higher in the control subjects [15.05 (12.12-18.06) ng/ml] than in the hypothyroid patients with autoimmune thyroiditis [3.04 (2.39-3.76) ng/ml, p<0.001]. There was no significant difference in omentin-1 level in patients who achieved euthyroidism by treatment (p=0.26). In correlation analysis, serum omentin-1 level was found to correlate negatively with thyroid-stimulating hormone (r=-0.27, p=0.006), anti-thyroid peroxidase (r=-0.32, p=0.001), and anti-thyroglobulin antibodies (r=-0.26, p=0.007), whereas it correlated positively with free triiodothyronine (r=0.22, p=0.021) and free thyroxine (r=0.24, p=0.012).

Conclusion: Lower omentin-1 levels in hypothyroid patients with autoimmune thyroiditis and its negative correlation with thyroid-stimulating hormone suggest that omentin-1 may play some role in hypothyroidism and autoimmune thyroiditis.

Key words: Hypothyroidism, Chronic autoimmune thyroiditis, Omentin-1.

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Parkinson's disease (PD) is the second most common neurological illness after Alzheimer's disease. According to research, medication alone can give palliative alleviation; however, freezing of gait (FOG) and balance can be treated with physical therapy. This meta-analysis aims to bridge gaps about exercise-based therapy's impact on balance and FOG in patients with PD. Google Scholar, CINHAL, Medline, PubMed, and PEDro were searched for 2016-2021 citations using the PIOD paradigm. Pooled effect size mean and SD were analysed using a fixed and random effects model. A total of 21 trials were included in this review, with SMD=0.60 and p=0.0007 utilising BBS. The pooled analysis revealed statistically significant impacts on exercise-based management in the experimental group. With SMD=0.87 and p<0.00001 using Mini-BESTest, the pooled analysis revealed that exercise-based management was also effective on balance in the experimental group. The fixed effect model of FOG in terms of SMD was used to draw the pooled effects of FOG in terms of SMD and FOG in terms of SMD (0.21; 95 percent CI -0.01 to 0.44; p=0.06). According to this research, several physiotherapy approaches such as exergaming, gamepad systems, virtual reality, gait exercises, and core training, help Parkinson's patients regain balance and FOG. Key Words: Parkinson's disease, Physical therapy techniques, Neurological rehabilitation, Balance, Freezing of gait, Motor symptoms.

Objective: To determine the ameliorative effects of prolotherapy on monosodium iodoacetate (MIA) induced and histomorphological changes in the articular cartilage of tibial condyles at rat knee joint.

Study design: An experimental study. Place and Duration of the Study: Department of Anatomy, Army Medical College Rawalpindi, NUMS, Rawalpindi, from August to November 2021.

Methodology: Thirty adult male Sprague Dawley rats were divided into three groups, each having 10 rats. Group A was control. Group B was injected with single dose of 1mg MIA intraarticularly in the right knee to induce osteoarthritic changes. Group C was injected with single dose of 1mg MIA intraarticularly, in right knee was followed by 0.1ml Prolotherapy (3ml of 25% dextrose, 2ml of 2% xylocaine, 1ml of injection neurobion, and 1ml of injection methecobal) as intra articular injection at week 2, 6 and 10 in right knee. Rats were sacrificed after one month of the last dose of Prolotherapy. Articular cartilage was collected for gross and histological examination and compared among the groups.

Results: Articular cartilage belonging to control group A was normal. While group B showed statistically significant deterioration in gross appearance (p = 0.001**), reduction in number of chondrocytes (p = 0.005*) and thickness of articular cartilage (p = 0.001**) in comparison to group A. In group C due to prolotherapy statistically significant improvement in gross appearance (p = 0.034*), increase in number of chondrocytes (p = 0.003*), and thickness of articular cartilage (p = 0.001**) was observed as compared to group B.

Conclusion: Prolotherapy significantly ameliorates histomorphology of tibial articular cartilage against MIA induced osteoarthritic changes in rat knee joint.

Key words: Articular cartilage, Knee joint, Monosodium iodoacetate, Osteoarthritis, Prolotherapy.

Objective: To determine the early surgical outcome of Mulliken's repair technique for bilateral cleft lip.

Study design: Descriptive cross-sectional study. Place and Duration of the study: Burns and Plastic Surgery Centre, Hayatabad Medical Complex, Peshawar, Pakistan, from January 2020 to December 2021.

Methodology: This study included 51 patients with bilateral cleft lip deformity. Patients were evaluated preoperatively to exclude any associated congenital anomalies or comorbidities. Then the patients were classified into mild, moderate, severe, and asymmetrical cases. Outcomes were determined immediately and one week postoperatively, as good (score 16-20), fair (score 11-15), and bad (0-10) on the basis of anthropometric measurements on outcome evaluation criteria (OEC).

Results: Preoperatively mild, moderate, and severe bilateral cleft lips were observed in 18 (35.3%), 6 (11.85%), and 15 (29.4%), respectively, while 10 (19.6%) were bilateral asymmetrical cleft lips. The postoperative outcome score ranged from 16 to 20 (mean 19.2+1.03) which falls in the good outcome range. Nasal symmetry was good in 64.7% (n=33) cases while 31.4% (n=16) patients had satisfactory scores.

Conclusion: Although Mulliken's repair is by far the most prevalent type of repair for bilateral cleft lip patients, the results can vary markedly. The early outcome evaluation criteria is an objective tool to measure the outcomes.

Key words: Cleft lip, Bilateral cleft lip, Mulliken, Mulliken's repair, Day care surgery, Outcome.

Objective:  To investigate whether plasma trimethylamine N-oxide (TMAO) levels might predict early neurological deterioration (END) in individuals with acute ischemic stroke.

Study design: Cohort study. Place and Duration of the Study: Jiulongpo District Hospital of Traditional Chinese Medicine, Chongqing City, China, from January 2020 to December 2021.

Methodology:  Patients presenting with ischemic stroke were classified into the END group and the non-END group. The National Institutes of Health Stroke Scale (NIHSS) total increasing by 2 points or more within 72 hours of admission was the definition of the END. Plasma TMAO levels were determined by high-performance liquid chromatographic and tandem mass spectrometry.

Results:  Twenty-six (25%) of the 104 patients, diagnosed with END exhibited higher TMAO levels after admission (median 1.438 vs. 0.449 nmol/mL, p=0.001). Elevated plasma TMAO levels were significant predictors of END in univariate logistic analysis. After controlling for age, gender, and cardiovascular risk factors in the multivariate conditional logistic regression model, the plasma TMAO levels in the END group remained significantly higher than those in the non-END group (OR=6.646, 95% CI 2.434-18.147, p<0.001). In receiver operator characteristic (ROC) analysis, the sensitivity and specificity of TMAO in distinguishing the END group and the non-END group at 0.564 nmol/mL cutoff value were 0.885 and 0.679, respectively.

Conclusion: According to this research, the development of END on admission in patients with acute ischemic stroke may be positively correlated with the elevation in plasma TMAO levels.

Key words:  Trimethylamine N-oxide level, Acute ischemic stroke, Early neurological deterioration, NIHSS score.

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