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

Objective: To identify the effect of the nasolabial angle (NL) on smile and facial profile attractiveness.

Study design: A cross-sectional study. Place and Duration of the Study: Department of Surgery, Section of Dentistry (Orthodontics), The Aga Khan University Hospital, Karachi, Pakistan, from 31 November 2021 to 28 March 2022.

Methodology: Profile photographs of one adult male and one female subject at rest and on smile were altered by the Photoshop software to NL angles of (85°, 90°, 95°, 100°, 105°, and 110°). These photographs were shown to a panel of raters comprising of three groups, laypersons (LP), general dentists (GD), and orthodontists (OD). The Kruskal-Wallis test was used to compare the NL angle scores among raters. Mann-Whitney U test was used for pairwise comparison between groups and gender-wise comparison of raters. Wilcoxon signed-rank test was used to analyse the effect of smile on the NL angle.

Results: Statistically significant differences (p ≤0.05) were seen between rest and smile scores in three groups of raters. LP gave the highest scores to 95° for males (p <0.001) and females (p = 0.011). GD found 90° for both males (p = 0.009) and females (p = 0.014) to be attractive, while OD gave the highest scores to 95° for both males (p <0.001) and females (p = 0.002).

Conclusion: There was a significant difference in preference of nasolabial angle between male and female raters. All groups of raters gave the highest scores to smiling photographs. The clinical significance is to ensure that, upon completion of orthodontic treatment, the nasolabial angle should be finished in a manner that enhances rather than detracts the attractiveness of the smile.

Key words: Nasolabial angle, Smile, Facial aesthetics, Profile photographs.

Objective: To determine the outcomes of autologous haematopoietic stem cell transplant (auto HSCT) in lymphoma patients in terms of overall survival (OS), disease-free survival (DFS), and treatment-related mortality and to identify the associated factors.

Study design: A descriptive study. Place and Duration of the Study: Department of Clinical Haematology, The Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan, from February 2006 to 2023.

Methodology: Clinical records of 59 patients who underwent auto HSCT were analysed. Median of OS and DFS was calculated by applying Kaplan-Meier test. Log-rank test was applied to check the association of OS and DFS with multiple variables. In multivariate analysis, Cox-regression was used to check the hazard ratio of significant variables.

Results: At day 100, the transplant-related mortality of the study was 6.7%, and disease relapse was experienced in 34%. The estimated OS was 82.7% at five years and 77.6% at 14 years with median OS of 117 months. The estimated DFS was 62% at five years and 58.6% at 14 years with median DFS of 97 months. Age was the only factor significantly associated with both OS and DFS. The subtype of lymphoma, indication to transplant, and septic shock were found significantly associated with OS only. While DFS was associated with, time to relapse after first complete remission (CR). However, at multivariate analysis only septic shock and time to relapse after the first CR remained significant Conclusion: For younger, chemosensitive patients who have experienced their first CR for a longer duration, auto HSCT is a compelling therapy option in the management of lymphoma.

Key words: Transplantation, Autologous, Diffuse large cell lymphoma, Hodgkin lymphoma.

Objective: To explore the understanding of medical students regarding the integration of AI in medical education.

Study design: Mixed methods, explanatory sequential study. Place and Duration of the Study: This study was conducted from March to May 2024 at the CMH Medical College, Lahore, Pakistan.

Methodology: A total of 152 undergraduate medical students were recruited. Quantitative surveys were used to measure AI-related attitudes and awareness of the students through a Likert scale, while in-depth insights into challenges and educational impact were obtained through open-ended questions. SPSS version 27 was used for the analysis of quantitative and Nvivo-11 for qualitative data.

Results: The study consisted of 152 participants. Most of them 139 (95.9%) had good knowledge about AI and expressed positive views. The majority believed that AI improves medical concepts, patient outcomes, and healthcare delivery, and helps in early disease detection. They agreed that AI will be effective in education 114 (75%) and will have a positive impact on learning experience 111 (73%) and future medical practice 94 (62%), so, it should be mandatory in medical education 90 (59%). Around half of the participants perceived potential job displacement and ethical dilemmas as a challenge due to AI in the future. Major themes emerging from qualitative data were AI-related challenges, topics of interest, and future expectations.

Conclusion: The study showed positive views and attitudes towards AI integration in medical education. Participants highlighted various benefits and perceived challenges including ethical concerns and resource limitations. As medical education advances, this subject needs to be studied more for its successful integration into medical education for better results.

Key words: Understanding, Awareness, Artificial intelligence, Medical education, Medical students.

Objective: To assess the association of serum folate and homocysteine parameters in diabetic patients with and without foot ulcers.

Study design: A comparative study. Place and Duration of the Study: Department of Physiology, Baqai Medical University, Karachi, Pakistan, from June 2023 to 2024.

Methodology: Participants were divided into three groups. Group I was healthy control, Group II had diabetic patients without foot ulcers, and Group III had diabetic patients with foot ulcers. Individuals with history of insulin-dependent diabetes and gestational diabetes mellitus (DM) were excluded. ELISA method was used to estimate serum folate and homocysteine. Pearson's Chi-square test / Fisher's exact test was used for the association and the Kruskal-Wallis test was used to compare the median of non-normally distributed parameters after checking the assumption of normality using the Shapiro-Wilk's test. Post-hoc analysis was done using the Dunnett's T3 test for significant parameters.

Results: The median of age, BMI, serum folate, FBS, HbA1c, and homocysteine levels were significantly different across all three groups (p <0.05). The Dunnett's T3 test for multiple comparisons showed insignificant differences for Folate, HbA1c, and FBS between diabetes and Diabetes with Foot ulcer samples (p >0.05). Spearman's rank correlation showed significant positive association between HbA1c and homocysteine (r = 0.65, p = 0.001).

Conclusion: HbA1c and blood homocysteine levels were correlated significantly among three groups. This indicates that HbA1c and serum homocysteine levels may influence foot ulcer pathogenesis in individuals with Type II DM.  Key Words: Diabetes mellitus, Insulin, Foot ulcer, Fasting blood sugar, Folate, Homocysteine.

Objective: To analyse the immunohistochemical staining of stem cell-related factors SOX9 and KLF4 in radical and partial nephrectomy specimens and to determine their relationship to grade, metastasis, stage, other prognostic parameters, and their predictive value.

Study design: Descriptive study. Place and Duration of the Study: Department of Pathology, Bolu Abant Izzet Baysal University, Faculty of Medicine, Bolu, Turkiye, from 2015 to 2022.

Methodology: The study included 92 cases diagnosed with clear cell renal cell carcinoma (ccRCC) from sections and blocks of partial and radical nephrectomies. Formalin-fixed and paraffin-embedded blocks were sliced. A Leica Bond Max staining device stained SOX9, E-cadherin, and KLF4 onto the slides. Nuclear staining for SOX9 and KLF4 and membranous staining for E-cadherin were evaluated. Since E-cadherin loss has an important role in the development of malignancy, the E-cadherin staining pattern was considered when evaluating the staining patterns of SOX9 and KLF4. The Mann-Whitney U and Kruskal-Wallis tests were applied to compare immunohistochemical data with prognostic factors such as gender, tumour size, grade, metastasis, and stage. The statistical analyses were conducted using the IBM SPSS version 20, with a p-value of less than 0.05 considered as statistically significant.

Results: Significant correlations were observed between SOX9, KLF4, and E-cadherin expression levels and high nuclear grade, with p-values of 0.005, <0.001, and 0.002, respectively. In addition, the overexpression of SOX9 was significantly linked to distant metastasis and stage, with p-values of 0.010 and 0.025, respectively.

Conclusion: SOX9, E-cadherin, and KLF4 expressions are linked to unfavourable prognostic factors in ccRCC. Thus, these immunohistochemical stains may serve as potential biomarkers in this cancer and aid in identifying prognosis and treatment response.

Key words: Clear cell renal carcinoma, SOX9 transcription factor, E-cadherin, Kruppel-like transcription factors, Prognosis.

Objective: To evaluate the perspectives and practices of Paediatricians and Obstetricians in Pakistan regarding termination of pregnancy (TOP).

Study design: A cross-sectional survey. Place and Duration of the Study: Department of Paediatrics, Pak Emirates Military Hospital, Rawalpindi, Pakistan, from January to March 2024.

Methodology: Convenience sampling was used to recruit 69 participants from the paediatrics and obstetrics departments in various healthcare settings in Pakistan. A structured questionnaire was developed by reviewing relevant literature and administered electronically using Google Forms. The participants were contacted through professional networks, associations, and email listservs. The questionnaire comprised four sections: Demographic information, knowledge evaluation, attitude assessment, and practice-related exploration. Descriptive statistics were used to calculate frequency and percentages.

Results: A significant number of participants, 51 (73.9%), had not attended any TOP-related talks or workshops. More than 90% of study participants believed that both spouses should provide consent for TOP, and 52 (75.4%) were in favour of TOP post-ensoulment due to severe foetal anomalies. However, 46 (66.7%) participants were against TOP and considered themselves pro-life.

Conclusion: The area needs more focus during teaching at both undergraduate as well as postgraduate levels as this study shares a very clear picture that residents and consultants lack knowledge of the basic definition of the concepts of TOP.

Key words: Induced abortion, Beginning of human life, Paediatrics, Obstetrics, Knowledge, Attitudes, Practice.

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Obsessive-compulsive disorder (OCD) is a highly disabling mental illness characterised by repetitive thoughts and behaviours that disrupt daily life and impair social functioning. The purpose of this meta-analysis was to assess the efficacy and safety of memantine augmentation in treating refractory OCD. This study searched several databases from inception to January 2024 and performed a random-effects meta- analysis with subgroup analyses to evaluate the effects of the dose and duration of the intervention. Seven randomised controlled trials involving 315 participants were included, although significant heterogeneity existed between the studies. Memantine augmentation was significantly superior to a placebo in treating OCD (SMD = -1.17, 95% CI = -2.14 to -0.20, p = 0.02). Subgroup analysis revealed that memantine significantly reduced compulsive behaviours (SMD = -0.99, 95% CI = -1.45 to -0.52, p <0.001). After eight weeks of treatment, the memantine group showed a significant improvement in the total Yale-Brown Obsessive- Compulsive Scale (Y-BOCS) score compared with the placebo group (SMD = -1.06, 95% CI = -1.77 to -0.36, p = 0.003). The memantine group showed a significant improvement in the total Y-BOCS score at a dose of 20 mg/day (SMD = -1.06, 95% CI = -1.77 to -0.36, p = 0.003). Memantine significantly increased the risk of mild rash (relative risk = 7.00, 95% CI = 1.31-37.47, p = 0.02). Memantine is safe and effective for OCD augmentation therapy at 20 mg/day and a continued intervention of at least eight weeks. Key Words: Memantine, Obsessive-compulsive disorder, Augmentation, Safety, Efficacy.

Studies of C-reactive protein (CRP) levels and suicidal behaviours have shown inconsistent results previously. This study investigated the relationship between CRP levels and suicidal ideation in a large population-based cohort in Korea to enhance the understanding of the biological aspects of suicide and inform more accurate risk assessment models in clinical applications. A multivariate regression model was used to estimate the CRP levels by suicidal ideation and calculate the odds ratio (OR) for suicidal ideation per increase in CRP. People with suicidal ideation had higher CRP levels than those without suicidal ideation (1.35 mg/dL vs. 1.17 mg/dL). In the age- and gender-adjusted model, the OR for suicidal ideation per 1-SD increase in log (CRP) was 1.14 (p = 0.029). However, the fully adjusted model did not reach statistical significance. The relationship between CRP levels and suicide might not be evident among Korean adults. Key Words: C-reactive protein, Inflammation, Socioeconomic factors, Suicidal ideation, Public health problem.

Objective: To determine the differences in terms of overall survival in platinum-sensitive ovarian cancer (PSOC) patients undergoing various chemotherapy protocols, and to demonstrate patient tolerance, toxicity, and efficacy data with the use of bevacizumab in different protocols.

Study design: An observational study. Place and Duration of the Study: Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey, from January 2018 to January 2022.

Methodology:  Patients aged 18 and above, who had received treatment for PSOC, were included in the study. Patients with platinum-resistant disease and those for whom bevacizumab usage was contraindicated were not enrolled in the study.

Results: For the 95 patients, the median age was 55 (34-78) years. Median follow-up are 39.7 (39.2-47.5) months. Median progression-free survival (PFS) of the patients are 10.8 (7.3-14.0) months for carboplatin-gemcitabine-bevacizumab (CGB), 10.9 (IQR 5.5-14.3) months in the carboplatin-liposomal doxorubicin-bevacizumab (CLdB) arms, and 6.1 (IQR 5.8-14.3) months in the carboplatin-paclitaxel-bevacizumab (CPB) group (p=0.79). The median overall survivals (OS) are 37.9 (IQR 33.3-46.9) months in the CGB arm, 41.0 (IQR 38.0-50.3) months CPB arm, and 41.3 (IQR 38.1-52.3) months in the CLdB arm (p=0.173).

Conclusion: There was no difference in terms of overall survival among all three chemotherapy protocols. However, due to the difference in toxicity, the treatment should be selected on a patient-specific basis. Additionally, the use of bevacizumab at a dose of 7.5 mg/kg was demonstrated to be equivalent to using 15 mg/kg in terms of overall survival. This lower dose is also important to avoid financial toxicity.

Key words: Bevacizumab, Ovarian cancer, Platinum-based chemotherapy, Tolerability, Adverse clinical events.