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

Objective: To compare distal transradial access (dTRA) via the anatomical snuffbox as an alternative to conventional transradial access (TRA) for coronary angiography and angioplasty in terms of clinical outcomes and feasibility.

Study design: An observational study. Place and Duration of the Study: Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan, from August 2022 to January 2023.

Methodology: This study analysed medical records involving 100 participants, through a convenience sampling, who underwent angio- graphy, with or without angioplasty, during the years 2022-2023. The participants were divided into two groups: Fifty patients were randomly selected for the conventional TRA group (Group T) and 50 for the dTRA group (Group D). Both groups were compared based on procedure type and the target vessel for angioplasty to minimise bias. Stratification analysis was performed using the independent t-test or Mann-Whitney U test (two-tailed) for quantitative data, and the Chi-square or Fisher's exact test for qualitative data to compare the groups based on their clinical and demographic profiles, procedural characteristics, and follow-up data, including post-procedural complications.

Results: The mean age of participants was comparable between Group D (58.6 ± 9.26 years) and Group T (57.8 ± 9.80 years). Procedural parameters, including median procedure time (Group D: 25 minutes; Group T: 25 minutes) and median fluoroscopy time (Group D: 6.40 minutes; Group T: 4.90 minutes), showed no significant differences (p >0.05). Group D had a higher proportion of procedures for acute coronary syndrome (ACS) (56.0% vs. 34.0%; p = 0.044); however, no differences were observed for other indications. Haematoma incidence (Group D 2.0% vs. Group T 12%; p = 0.004) and haemostasis time (Group D vs. Group T) were significantly lower in Group D.

Conclusion: dTRA demonstrated comparable procedural efficiency to conventional TRA while offering significant advantages in safety and post-procedural outcomes. The faster haemostasis and reduced incidence of complications, particularly haematoma formation, suggest that dTRA may provide a safer vascular access alternative, minimising patient discomfort and enhancing recovery.  Key Words: Transradial access, Distal radial artery access, Snuffbox, Coronary angiography, Coronary angioplasty.

Objective: To present the management of retained foreign bodies in the genitourinary system resulting from warfare, bomb blasts, and firearm-related injuries.

Study design: Descriptive case series. Place and Duration of the Study: Department of Urology, Institute of Kidney Diseases, Hayatabad Medical Complex, Peshawar, Pakistan, from June 2017 to December 2023.

Methodology: Patients with retained foreign bodies in the genitourinary tract, resulting from previous exposure to bomb blasts, mines, and firearm-related injuries, were included in this study. All patients underwent surgical management. Descriptive statistics were determined for location, duration of retention, type of foreign body, outcome, length of hospital stay, and postoperative complications.

Results: All 14 patients included in the study were male, with a mean age of 30.85 ± 13.38 years. The average indwelling time of these foreign bodies was 33.50 ± 16.34 months, ranging from 10 to 61 months. These foreign bodies were retained in the kidney (n = 5), urinary bladder (n = 4), and testes and ureter (n = 2; each); penis was involved in one case. The extracted foreign bodies were metal pellets (n = 12) and bullets (n = 2). The successful removal of pellets and bullets from kidneys and bladder was achieved endoscopically in nine cases. The mean length of hospital stays for open and endourological procedures was 4.0 ± 1.41 days and 3.5 ± 2.13 days, respectively (p = 0.630). Postoperative complications were reported in one case only, which required a blood transfusion; it was labelled as Clavien-Dindo Grade II.

Conclusion: Retained foreign bodies in the genitourinary tract in warfare injuries are uncommon and can be managed effectively with endourological as well as open surgery.

Key words: Retained foreign bodies, Genitourinary tract, Bomb blasts, Warfare.

Objective: To evaluate the effectiveness of the cross-spreader graft technique (CSGT) in an I-shaped crooked nose surgery.

Study design: Retrospective observational study. Place and Duration of the Study: Department of Otorhinolaryngology, University of Health Sciences Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkiye, from 2022 to 2024.

Methodology: Patients with I-shaped crooked noses operated using the CSGT were included. Their demographic and clinical data were recorded. The Standardised Cosmesis and Health Nasal Outcomes Survey (SCHNOS) was used to evaluate patient satisfaction after surgery. The Wilcoxon test was used to compare pre- and postoperative data.

Results: A total of 42 patients (16 males and 26 females, median (IQR) aged 26.0 (8.5) years) who underwent I-shaped crooked nose correction procedure were analysed. Compared to preoperative scores, postoperative scores showed a highly significant decrease in all SCHNOS divisions, including function, appearance, and overall satisfaction (p <0.001).

Conclusion: This study showed that the CSGT is an effective procedure for the correction of I-shaped crooked noses.

Key words: Rhinoplasty, Cross-spreader graft, Operative therapy, Treatment outcomes, Patient satisfaction.

Objective: To compare the efficacy and safety of oblique subcostal transversus abdominis plane (OSTAP) block and external oblique intercostal plane (EOIP) block for postoperative pain management in patients undergoing laparoscopic cholecystectomy (LC).

Study design: A randomised controlled trial. Place and Duration of the Study: Department of General Surgery, Samsun University Training and Research Hospital, Samsun, Turkiye, between January and September 2024.

Methodology: Eighty adult patients undergoing elective LC were randomly divided into two groups: OSTAP block (n = 40) and EOIP block (n = 40). Blocks were performed at the end of surgery. The primary outcome was cumulative opioid consumption. The secondary outcomes included pain intensity measured by Numerical Rating Scale (NRS), time to first analgesic request, quality of recovery (QoR-15 score), and incidence of postoperative nausea and vomiting. Statistical analysis included the t-test, Mann-Whitney U test, and Chi-square test, with Bonferroni correction applied for repeated NRS measurements.

Results: Demographic characteristics and perioperative variables were comparable between the groups. The mean 24-hour tramadol consumption was similar in both groups (175 ± 98.79 mg vs. 184 ± 106.62 mg; p = 0.696). The pain scores were not significantly different at all measured time points (p >0.05). In addition, time to first analgesic request (p = 0.954) and QoR-15 scores (p = 0.269) were comparable. No major block-related complications were observed.

Conclusion: Effective postoperative analgesia was achieved in both groups with similar opioid consumption and pain scores. However, the EOIP block may be considered as a technically easier and safer alternative for regional analgesia in LC. Further research is needed to determine the long-term benefits and optimum clinical applications of these blocks in laparoscopic surgery.

Key words: Laparoscopic cholecystectomy, Oblique subcostal TAP block, External oblique intercostal plane block, Regional anaesthesia, Postoperative pain management.

Artificial intelligence (AI) tools have been integrated into medical research and writing at a rapid pace since ChatGPT was launched in November 2022. This development has created unprecedented opportunities for efficiency and accessibility in research and writing. This viewpoint examines the potential benefits and risks associated with the adoption of AI tools, particularly among medical students and early-career and healthcare researchers. The authors discuss that the uncritical use of AI can potentially lead to superficial learning and compromise the development of essential critical thinking skills. Effective use of AI tools requires background knowledge, as illustrated by examples in research question generation, literature review, data interpretation in clinical trials, and manuscript preparation. The authors emphasise the value of traditional skills, such as critical analysis, in-depth reading, and independent literature search in medical professions and suggest strategies for the ethical and effective integration of AI tools in research workflows, with a focus on building a strong foundation of knowledge before relying on these tools. This study offers some recommendations for educators and senior researchers in guiding the next generation of medical professionals. There is a need for collaboration and dialogue among all key stakeholders to ensure that AI tools enhance, rather than diminish, the quality and integrity of medical research and education. Key Words: Artificial intelligence, Medical writing, Medical research.

The present systematic review aimed to evaluate the utilisation of artificial intelligence (AI) across several aspects of periodontal diagnosis and treatment planning by studying and analysing recent literature on the assessment of periodontitis through various radiographic analysis models using AI. The databases including PubMed, Cochrane, ScienceDirect, and Google Scholar were searched from 1st June to August 2024. From the shortlisted studies, 15 original research articles were included in the review and were assessed for risk of bias using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool by the Cochrane Collaboration as a quality evaluation tool. All the models showed comparable sensitivity compared to that of examiners. AI can serve as a time-saving aid for clinicians; however, further studies are required using well-defined and accepted gold standard, applied in clinical setting with datasets of intraoral periapical series. Key Words: Artificial intelligence, Periodontitis, Diagnosis.

Objective: To assess the impact of bariatric surgery on postoperative eating behaviour and dietary compliance.

Study design: A descriptive study. Place and Duration of the Study: Department of Bariatric Surgery, International Metabolic and Bariatric Centre, Afridi Medical Complex, Peshawar, Pakistan, from January to June 2024.

Methodology: The study included patients who underwent bariatric procedures, such as sleeve gastrectomy or gastric bypass. Data were collected after the surgical procedure, and patients were categorised according to anthropometric measurements, including height, weight, and body mass index (BMI). The Adult Eating Behaviour Questionnaire (AEBQ) and Postoperative Dietary Compliance Survey (PDCS) were used. SPSS software was incorporated for data analysis, and the Kruskal-Wallis test was applied to find a significant association.

Results: A total of 168 participants were included in the study, with a mean overall eating behaviour score of 116.21 ± 9.5. A total of 163 (97.02%) participants showed symptoms of moderate eating disorder, while 3 (1.7%) of respondents had severe disturbance, and 2 (1.2%) of individuals rated their eating behaviours as mild. Emotional undereating (EU) had the highest mean score of 17.72 ± 2.75. The findings revealed no statistically significant association between eating behaviour and patients' demographics and anthropometrics, including age (years), gender, weight [kg], type of surgery, postoperative duration, and pre- or post-operative BMI (Kg/m2; p >0.05).

Conclusion: Bariatric surgery was associated with a moderate disturbance in eating behaviours, and the emotional aspect of eating comprised a significant role. There was no discernible relationship between eating habits and variables such as age, weight, or surgery type. This highlighted the importance of providing patients with continuing behavioural and psychological assistance following bariatric surgeries.

Key words: Bariatric surgery, Body mass index, Compliance, Dietary changes post-surgery, Food avoidance, Gastrectomy, Postoperative dietary habits.

Objective: To investigate the diagnostic value of serum programmed cell death protein 4 (PDCD4) and heat shock protein 70 (HSP70) levels in detecting lymph node metastasis (LNM) in patients with early-stage cervical cancer (International Federation of Gynaecology and Obstetrics [FIGO] stages I to IIA).

Study design: A comparative study. Place and Duration of the Study: Department of Gynaecology, Urumqi Maternal and Child Health Hospital, Xinjiang, China, from January 2021 to December 2023.

Methodology: One hundred and thirty-two early-stage cervical cancer patients were divided into two subgroups: the LNM subgroup (25 cases) and the Non-LNM subgroup (107 cases). Additionally, 60 healthy women were included as the Control group. Serum PDCD4 and HSP70 levels were measured using enzyme-linked immunosorbent assay (ELISA). Multivariate logistic regression analysis was conducted to identify risk factors for LNM.

Results: Serum PDCD4 levels were significantly lower in the Cervical cancer group compared to the Control group (1.31 ng/mL vs. 3.27 ng/Ml; p <0.001), and HSP70 levels were significantly higher (85.20 ± 14.88 ng/mL vs. 39.22 ± 10.03 ng/Ml; p <0.001). The incidence of LNM among the 132 early-stage cervical cancer cases was 18.94% (25/132). The LNM subgroup exhibited lower serum PDCD4 levels (1.31 ng/mL, IQR 0.59-2.14) and higher HSP70 levels (85.20 ± 14.88 ng/mL) compared to the Non-LNM subgroup (PDCD4: 3.27 ng/mL, IQR 1.78-5.37; HSP70: 39.22 ± 10.03 ng/mL; both p <0.05). The multivariate logistic regression analysis identified advanced stromal infiltration depth (≥1/2 cervical muscle wall, OR 4.288, 95% CI: 1.155-15.922) and elevated serum HSP70 levels (OR 1.093, 95% CI 1.031-1.158) as independent risk factors for LNM, while elevated serum PDCD4 levels were found to be an independent protective factor (OR 0.245, 95% CI: 0.091-0.656). The combined detection of serum PDCD4 and HSP70 demonstrated a sensitivity of 88.00%, specificity of 84.11%, and a Youden index of 0.721 (AUC 0.926, 95% CI: 0.867-0.964).

Conclusion: Reduced serum PDCD4 levels and elevated HSP70 levels were significantly correlated with LNM in early-stage cervical cancer. The combination of serum PDCD4 and HSP70 levels demonstrated high diagnostic efficacy for LNM in early- stage cervical cancer.

Key words: Early-stage cervical cancer, Programmed cell death protein 4, Heat shock protein 70, Lymph node metastasis, Diagnostic efficiency.

Objective: To determine factors influencing progression-free survival (PFS) in patients with advanced non-small cell lung cancer (NSCLC) treated with anlotinib and to create a predictive model using a nomogram.

Study design: A descriptive study. Place and Duration of the Study: Clinical Research Centre, Hefei Cancer Hospital, Chinese Academy of Sciences, Hebei, China, from July 2020 to 2024.

Methodology: Data of patients with advanced NSCLC receiving anlotinib treatment were retrieved from medical records. Potential predictors of PFS were first identified using univariate Cox proportional hazards regression analysis, and subsequently, multivariate Cox regression analysis was performed to identify key factors influencing PFS. A nomogram was constructed for PFS prediction.

Results: The study included 145 patients. Six factors were identified as significant predictors: combined use of proton pump inhibitors (PPI), nutritional risk score, monocyte percentage, pathological grading, combined use of immune checkpoint inhibitors (ICI), and body temperature. The combined use of PPI and Pathological Grading Ⅳ was found to be an independent risk factor for PFS, whereas the combined use of ICI, a nutritional risk score of 0, a monocyte percentage below 10.04%, and a body temperature under 36.2°C was identified as an independent protective factor. The areas under the ROC curve (AUC) at 1, 3, 6, and 12 months were 0.765 (95% CI: 0.672-0.859), 0.816 (95% CI: 0.759-0.873), 0.784 (95% CI: 0.718-0.849), and 0.773 (95% CI: 0.673-0.874), respectively. The model demonstrated a C-index of 0.71 (95% CI: 0.65-0.76), and the calibration curves indicated a high degree of alignment between the predicted and actual outcomes. A nomogram was successfully created to predict PFS.

Conclusion: Six significant factors affecting PFS in patients with advanced NSCLC treated with anlotinib were identified. A reliable nomogram was successfully constructed for the prediction of PFS, offering a tool to support personalised treatment planning.

Key words: Anlotinib, Non-small cell lung cancer, Predictors, Cox regression, Nomogram.

Objective: To find out the association of food taboos and pica with dietary patterns in pregnant women.

Study design: A cross-sectional survey. Place and Duration of the Study: Al-Shifa School of Public Health, Al-Shifa Eye Trust Hospital, Rawalpindi, Pakistan, from April to September 2023.

Methodology: Pregnant women were selected through a non-probability consecutive sampling. The Chi-square test was applied to determine the association between dietary practices and pica, food taboos, and socio-demographic characteristics of pregnant women.

Results: Out of 139 pregnant women, the majority were between the age of 20 and 30 years (n = 89, 64%). It was noted that 58% of respondents (n = 81) did not know about food taboos. Fifty-six women (40%) reported avoiding some food items during pregnancy for multiple reasons. Nearly 49% women (n = 68) were unaware of pica, and 45% women (n = 63) were reported taking non-food items during pregnancy. Overall, it was noted that women with poor dietary practices were higher (n = 72, 58%) as compared to those with good dietary practices. Dietary practices were significantly associated with the educational, income, and residential status of women and their husbands (p <0.05). Sources of nutritional information, food avoided during pregnancy, and the types of foods avoided during pregnancy were also significantly associated with dietary practices among pregnant women (p <0.05).

Conclusion: Poor dietary practices were slightly more common than good practices in pregnant women. Food taboos significantly affect dietary habits, while pica is not significantly associated with dietary intake.

Key words: Dietary practices, Food taboos, Pica, Pregnant women, Public hospitals.