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

Objective: To compare the visual outcome in patients undergoing penetrating keratoplasty (PKP) with descemet membrane endothelial keratoplasty (DMEK).

Study design: A quasi-experimental study. Place and Duration of the Study: Department of Eye, The Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan, from January 2022 to June 2023.

Methodology: A prospective analysis of fourteen patients who underwent PKP in comparison with another group of fourteen patients who got the DMEK surgery was done. The evaluation of visual and refractive outcomes was done postoperatively. Fisher's exact test was used to compare visual acuity grouped into categories between two surgical procedures.

Results: Fourteen eyes from each group that were PKP and DMEK were included in the analysis. The best corrected visual acuity after 6 months was better in the DMEK group compared with the PKP group (p = 0.003) and these results were consistent after twelve months (p = 0.006) keeping the DMEK group superior in visual outcome over the PKP group.

Conclusion: PKP and DMEK play distinct roles in the treatment of corneal disorders, each with its own set of indications. However, DMEK resulted in a better visual outcome when compared to the PKP. Although quality of life improved in both groups, it was found to be better in the DMEK group compared to the PKP group.

Key words: Visual acuity, Descemet membrane endothelial keratoplasty, Penetrating keratoplasty, Corneal transplant.

Objective: To investigate the value of Lysine Demethylase 5B (KDM5B) in the prognosis and immunity of acute myeloid leukaemia (AML).

Study design: A case-control study. Place and Duration of the Study: Department of Haematology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China, from 2013 to 2024.

Methodology: Bioinformatic methods were used to compare the expression of KDM5B between 135 individuals with AML and 70 individuals without AML in the TCGA database. In order to confirm the findings, bone marrow specimens underwent real-time polymerase chain reaction analysis by the Mann-Whitney U test. A comprehensive assessment was conducted to explore the interplay among KDM5B expression levels, clinical profiles, and the overall survival prognosis in AML patients. Furthermore, the underlying mechanism of KDM5B in AML pathogenesis was delved into utilising GSEA. To assess the impact of KDM5B expression on the immune landscape within tumours, the ESTIMATE and CIBERSORT computational methodologies were employed to evaluate its role in tumour immune infiltration.

Results: KDM5B expression was notably increased in AML patients and linked to a poor prognosis. KDM5B expression was correlated with NPM1 mutation in bone marrow samples. Additionally, high KDM5B expression was a poor prognostic factor for overall survival. GSEA showed that high KDM5B expression was related to the immune system. Analysis of immune infiltration revealed a correlation between elevated KDM5B expression and decreased stromal and immune scores, accompanied by altered infiltration patterns of diverse immune cell types. Furthermore, immune checkpoint markers were correlated with low KDM5B expression.

Conclusion: KDM5B is highly expressed in AML and correlates with poor prognosis. KDM5B may be involved in AML by affecting the tumour micro-environment, thus being a potential biological target in AML.

Key words: KDM5B, Acute myeloid leukaemia, Immune infiltration, Prognostic factor.

The purpose of this study was to determine whether smoking behaviour, exhaled carbon monoxide (CO) levels, and addiction status differ between male and female smokers. The data of the applicants to the smoking cessation outpatient clinic were retrospectively examined to complete the study. Age, gender, carbon monoxide level, nicotine dependence level, and number of packs-year smoked were all taken from the records of patients who applied to the smoking cessation outpatient clinic. Males made up 53.7% of the 242 participants. Even though men smoked more cigarettes, there was no gender difference in the median number of packs smoked annually (p = 0.089). The median dependence score did not differ by gender (p = 0.259), even though men had higher ratings for dependence. Men were found to have higher CO ppm values, although gender-specific CO ppm medians were not different (p = 0.219). No gender-based variations in CO exposure were found. This shows that gender-based interventions are unnecessary to promote population health and raise smokers' knowledge of CO exposure. Key Words: Smokers, Carbon monoxide, Nicotine dependence.

Objective: To use Mendelian randomisation (MR) for determining the causal relationship between hypothyroidism and trigeminal neuralgia (TN).

Study design: Analytical study.                                                                                                             Place and Duration of the Study: Department of Neurosurgery, Yantai Yuhuangding Hospital, Yantai, Shangdong, China, from January to April 2024.

Methodology: Fifty hypothyroidism-related single nucleotide polymorphisms (SNPs) were retrieved as instrumental variables (IVs) from the genome-wide association studies (GWAS). MR analysis was conducted using summary statistics from GWAS in the European individuals. The inverse variance weighted (IVW) method was the main tool for finding causality. Other MR methods supported the IVW results and helped confirm the causality results. The additional methods strengthened the findings. Finally, multiple sensitivity studies were conducted to evaluate stability, heterogeneity, and horizontal pleiotropy.

Results: The IVW method showed a strong link between hypothyroidism and TN (p = 0.009). MR-Egger regression revealed that directional pleiotropy was unlikely to bias the results (p = 0.351). Evidence of a causal relationship between hypothyroidism and TN was also found using the weighted median (p = 0.008) and weighted mode (p = 0.016) approaches. Although the simple model showed a null causal effect, it showed a trend similar to that of several other methods.

Conclusion: The results of the MR study corroborate the possibility that hypothyroidism and the risk of TN are directly related.

Key words: Hypothyroidism, Trigeminal neuralgia, Mendelian randomisation, Single nucleotide polymorphisms, Genetics.

Objective: To investigate the optimal dosage of nalbuphine preemptive analgesia on pain after laparoscopic cholecystectomy.

Study design: A double-blind, randomised study. Place and Duration of the Study: Department of Anaesthesiology, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an Second Hospital, Jiangsu Province, China, from 2020 to 2023.

Methodology: This study enrolled 240 patients requiring elective laparoscopic cholecystectomy. Patients were randomly allocated into four groups receiving placebo (Group NS) or nalbuphine 0.1 mg/kg (Group N1) or 0.2 mg/kg (Group N2) or 0.3 mg/kg (Group N3) intravenously 15 minutes before surgery. The postoperative visual analogue scale (VAS) score, and the rescue analgesic requirement within 72 hours after surgery were evaluated. One-way analysis of variance and a non-parametric Kruskal-Wallis test were used to compare differences between the groups.

Results: The VAS scores at rest and on movement were significantly lower in the N2 and N3 groups compared to the placebo group at 4, 12, 24, and 48 hours after surgery (p <0.05). Moreover, the VAS scores of the N2 group were significantly lower than N1 and N3 groups. The first rescue analgesia time was significantly longer (p <0.05), and the rescue analgesic requirements were considerably reduced in the N2 group than in the placebo group (p <0.05).

Conclusion: Nalbuphine preemptive analgesia provided effective analgesia in patients undergoing laparoscopic cholecystectomy. The results showed that the optimal dose was 0.2 mg/kg for nalbuphine preemptive analgesia in laparoscopic cholecystectomy.

Key words: Nalbuphine, Preemptive analgesia, Laparoscopic cholecystectomy, Postoperative pain, Rescue analgesia, VAS score.

Currently, the methods used to detect M-protein such as SPEP (serum M-protein electrophoresis), IFE (immunofixation electrophoresis), and sFLC (serum free light chain) assay are hyposensitive, laborious, time-consuming, and expensive. In this study, the authors assessed the performance of MALDI-TOF-MS in the detection of M-protein in geriatrics. With IFE as the gold standard, the specificity, sensitivity, and consistency of MALDI-TOF-MS were 92.30, 89.68, and 90.06%, respectively. MALDI-TOF-MS achieved an agreement of 100.00, 100.00, 89.68, 88.89, and 87.50% in the detection of IgA, biclonal, negative, IgM, and IgG isotypes of M-protein, respectively. In addition, the results showed that the glycosylated haemoglobin level was increased in the MS-IFE+ group as compared to the MS+IFE- group. This study supports that the MALDI-TOF-MS is an alternative method for M-protein detection in aged subjects. The difference in glycosylated haemoglobin level may provide an explanation for the different detection results for M-protein between IFE and MALDI-TOF-MS. Key Words: M-protein, MALDI-TOF-MS, Immunofixation electrophoresis, Clinical laboratory findings, The aged.

Objective: To determine the impact of the modified frailty index (MFI) on patient-reported outcome measures (PROMs) using the knee injury and osteoarthritis outcome score (KOOS-12) following total knee arthroplasty (TKA).

Study design: Prospective-observational study. Place and Duration of the Study: Department of Surgery, Section of Orthopaedics, The Aga Khan University Hospital, Karachi, Pakistan, from August 2023 to July 2024.

Methodology: Sixty-six patients undergoing primary TKA were included, while those undergoing revision surgery were excluded. Each patient's frailty score was noted using the MFI. The primary outcome, KOOS-12 was collected preoperatively and at six weeks, three months, and six months postoperatively. Repeated measures ANOVA assessed the association of MFI and time on KOOS-12 scores.

Results: Patients with severe frailty levels showed significantly lower KOOS-12 scores at each time point, indicating low-grade improvement in outcomes in pain, function, and quality of life domains as compared to fit individuals. Severely frail patients had a mean KOOS-12 score of 26.3 ± 14.4 at admission, which improved to 65.5 ± 17.7 at six months, while non-frail patients showed higher baseline and follow-up scores. Repeated measures ANOVA results revealed significant effects of MFI level and time on KOOS-12 scores (p <0.001), with significant improvement across all domains over time.

Conclusion: High frailty is associated with overall lower KOOS-12 score as compared to individuals with no frailty after TKA. These findings emphasise the value of frailty assessment in predicting functional outcomes and guiding preoperative counselling and postoperative rehabilitation to optimise recovery for frail patients undergoing TKA.

Key words: Knee, Osteoarthritis, Arthroplasty, Frailty, Outcomes.

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Sevoflurane has been suggested to lower the incidence of acute kidney injury (AKI) after heart surgery compared to intravenous anaesthetics. However, recent studies indicated opposite results. Therefore, this meta-analysis was conducted on randomised controlled trials (RCTs) to determine if sevoflurane decreases the risk of AKI compared to propofol. Relevant RCTs were identified from PubMed, EMBASE databases, and reference lists of reviews and related articles till June 6, 2023. Review Manager was used for statistical analysis. In this study, 10 RCTs were included. Compared with propofol, sevoflurane increased the incidence of AKI (odds ratio [OR], 2.74; 95% confidence interval [CI], 1.62-4.65; p = 0.0002; I2 = 13%) and prolonged the length of intensive care unit (standard mean difference [SMD], 0.29; 95% CI, 0.06-0.53; p = 0.01; I2 = 0%) and hospital stays (mean difference [MD], 1.62; 95% CI, 0.59-2.64; p = 0.002; I2 = 0%). Based on current evidence, sevoflurane was linked to an increased risk of perioperative AKI compared to propofol. To verify the results, more high-quality RCTs are necessary. Key Words: Acute kidney injury, Sevoflurane anaesthesia, Propofol anaesthesia, Perioperative renal complications, Serum creatinine.

This review assessed the impacts of PCSK9 inhibitors on glucose metabolism in patients with dyslipidaemia. A comprehensive search was conducted using PubMed, Embase, Cochrane Library, and ClinicalTrials.gov to find randomised controlled studies investigating the indicators of glucose metabolism. All RCTs comparing PCSK9 inhibitors with other lipid-lowering drugs or placebo from January 2018 to December 2023 were included. In total, 12 randomised controlled trials were included, and the authors used a fixed-effects model to evaluate the potential impacts of PCSK9 inhibitors on glucose metabolism. Compared with the control group, FPG (MD = 0.08, 95% CI -0.07~0.24) and HbAlc (SMD = 0.02, 95% CI -0.09~0.12) slightly increased in patients treated with PCSK9 inhibitors, with no statistical significance. The PCSK9 inhibitor group also did not exhibit a statistically significant difference in risk between deteriorating pre-existing diabetes (RR = 0.92, 95% CI 0.84-1.01) and developing new-onset diabetes (RR = 0.95, 95% CI 0.86-1.05) from the control group. The results were not affected by the type of PCSK9 inhibitors or treatment duration. Key Words: PCSK9 inhibitors, Glucose metabolism, Diabetes mellitus.