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

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The aim of this study is to see the role of the chest X-ray severity index (Brixia score) as a predictor of requiring invasive positive pressure ventilation in COVID-19-positive patients. This descriptive cross-sectional prospective study were carried out in the Department of Pulmonology and Radiology, Mayo Hospital, Lahore. The data were collected from 1st May to 30th July 2020 from 60 consecutive COVID-19 positive patients. Analysis was conducted using each patient's age, gender, clinical presentation, and the report of CXR containing the most elevated score. The mean age of the study participants was 59.43±11.27, and 81.7% of patients had positive Brixia scores (≥8). Brixia score had high sensitivity (93.886) and specificity (90.91%) to predict the need for IPPV using chest X-rays. It showed excellent predictive power, having a high numerical AUC (0.870) and a statistically significant p-value (<0.0001). High Brixia score conferred a high risk of the need for invasive positive pressure ventilation due to COVID-19. Key Words: Chest X-ray, Brixia score, COVID-19, Invasive positive pressure ventilation.

Objective: To analyse mitochondrial hypervariable segment I (HVS-I) variations in Pakistani type 2 diabetic subjects.

Study design: Case-control study. Place and Duration of the Study: National Institute of Diabetes and Endocrinology, Dow University of Health Sciences, Karachi, Pakistan, between January 2019 to January 2021.

Methodology: DNA from whole blood was isolated, and mitochondrial HVS-I region (16024-16370) of 92 individuals, including 47 controls and 45 diabetics, was amplified, sequenced, and analysed.

Results: Ninety-two variable sites in the sequenced region were identified and individuals were classified into 56 different haplotypes according to phylotree 17.0 classifications, where major haplotype M5 was nearly 2-fold higher in diabetes. Fischer's exact test revealed variant 16189T>C significantly associated with diabetes (Odds ratio = 12.9, 95% CI = 0.6917 - 2400248) as compared to controls. The authors further analysed 1000 Genomes Project data of Pakistani Control subjects (i.e. PJL, n=96) and found that besides 16189T>C (Odds ratio = 5.875, 95% CI = 1.093 - 31.57, p <0.0339), 16264C>T (Odds ratio = 16, 95% CI = 0.8026 - 314.7, p <0.0310) also showed significant association with diabetic subjects. Comparing diabetic subject data with global control population data of the 1000 Genomes Project, significant associations of eight variants in the studied region were found.

Conclusion: Based on the results of this case-control study, it can be concluded that specific variations in the mitochondrial hypervariable segment I (HVS-I) region are significantly associated with type 2 diabetes in the Pakistani population. The major haplotype M5 was found to be higher in diabetic subjects and variants 16189T>C and 16264C>T were significantly associated with diabetes. These findings suggest that mitochondrial DNA variations may play a role in the development of type 2 diabetes in the Pakistani population.

Key words: Diabetes Mellitus, HVS-1 region, Diabetic subjects, Mitochondrial genomics, Pakistani population.

Objective: To explore aspects that define successful mentor-mentee relationships in medical education from a mentor and mentees' perspective.

Study design: Qualitative study. Place and Duration of the Study: Bahria University Health Sciences, Karachi campus, from May to October 2022.

Methodology: Data were collected using observations of mentoring sessions by recording videos, video-elicitation interviews for mentors and focus group discussions for mentees. Mentor Evaluation Tool (MET) questions were used during focus group discussions to gain detailed feedback from mentees on mentors and additional questions were added regarding the mentoring sessions' organisation and environment. During video-elicited interviews with mentors, an interpersonal process recall strategy was used to explore factors that define a mentor-mentee relationship. Video recordings of the mentoring sessions were used as an elicitation tool to guide the interviews. Giorgi's method was used for data analysis. Transcripts of observations by video recordings, video elicitation interviews, and focus group discussions were analysed first separately and then compared and integrated.

Results: According to mentors, the true essence of mentoring is mutual respect and confidentiality. Mentees suggested multiple mentors for professional development in different attributes.

Conclusion: The mentors' commitment to their mentees and the mentees' respect and trust is the foundation of a successful mentor-mentee relationship.

Key words: Mentor, Mentee, Relationship, Mentoring and Medical Education.

Objective: To compare the efficacy of electrocoagulation and direct pressure application in controlling haemorrhage from the liver bed during laparoscopic cholecystectomy.

Study design: Randomized controlled trial. Place and Duration of the Study: Department of General Surgery, Sir Ganga Ram Hospital, Lahore, Pakistan, from July 2021 to December 2021.

Methodology: A total of 218 patients of either gender, aged 18 to 60 years and with bleeding from the liver bed during laparoscopic cholecystectomy were randomly allocated to two groups of haemorrhage control techniques. In group A, electrocoagulation was used and in group B, direct pressure was applied to the bleeding area for 5 minutes. Efficacy in controlling bleeding was compared in both groups.

Results: The mean age of all study participants was 44.6 + 13.5 years. The majority of the patients were females (89%). The mean body mass index (BMI) of all participants was 25.3 ± 3.09 kg/m2. Intraoperative bleeding was secured in 86.2% of patients in Group A vs. 81.7% of patients in Group B. However, the difference was not statistically significant (p=0.356). In 27 (12.4%) cases, bleeding could not be controlled by both of these techniques. In these cases, endosuturing was applied in 19 (70.4%) cases, spongostan in 6 (22.2%) cases, and endo-clips in 2 (7.4%) cases. Intraoperative drain and conversion to open procedure was required in 1 patient each, both belonging to the direct pressure application group.

Conclusion: The efficacy of electrocoagulation in securing haemorrhage from the liver bed is better than the direct pressure application technique.

Key words: Laparoscopic cholecystectomy, Haemorrhage, Electrocoagulation, Surgical hemostasis, Liver bed.

The study aimed to identify the relationship between Avoidant/Restrictive Food Intake Disorder (ARFID), Anorexia and Bulimia nervosa with stress, depression, and anxiety, among undergraduate students at Aga Khan University (AKU) in Pakistan. The data collection was done online using Eating Attitude Test-26 (EAT-26), Nine Item ARFID Screen (NIAS), and Depression Anxiety Stress Scale (DASS-21). A total of 79 responses were received. Among them, 83.5% (n=66) were females and 16.5% (n=13) were males. On the NIAS screen, 16.5% participants tested positive and 15.2% indicated high risk of eating disorders on EAT-26. There were 26% participants who were underweight while 20% were overweight. Anxiety was significantly associated with all eating disorders while depression and stress were significantly associated with positive EAT-26 results too. Females and early- year students were at higher risk. We recommend regular monitoring for eating changes which may improve psychological and physical wellbeing of medical and nursing students. Key Words: Eating disorders, Stress, Dysfunctional eating behaviours, Students, Pakistan.

Objective: To determine the complementary feeding patterns and their association with malnutrition.

Study design: Prospective observational study. Place and Duration of the Study: Outpatient clinics of Aga Khan University Hospital, Pakistan, from June to November 2019.

Methodology: A total of 207 children from age six to twenty-four months, who presented in the outdoor clinics of the study place, were enrolled. Data were recorded in a predesigned data sheet adopted from the infant and young child feeding module. Chi-square test was applied post-stratification and a p-value of <0.05 was taken as significant.

Results: Among a total of 207 children, 115 (55.6%) were males and 92 (44.4%) were females, with a mean age of 14.15 ± 5.6 months. Complementary feeding was started at an appropriate age in 124 (60%) children. Normal weight was seen in 133 (64.3%) children, while 73 (35.3%) were underweight. Stunting was presented in 44 (21.3%) children, whereas 163 (78.7%) children were of normal length. The most common reason for early initiation of complementary feeding was difficulty in continuing to breastfeed (n=50, 24.2%); the most common reason behind late complementary feeding was bottle feeding (n=45, 21.7%).

Conclusion: Only sixty percent of mothers living in an urban setting started complementary feeding at an appropriate age. Various myths are counteracting complementary feeding practices.

Key words: Complementary feeding, Infant's nutrition, Stunting, Wasting, Z-score.