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

Objective: To determine referral patterns for psychiatric consultations among COVID-19 patients encompassing both the in-patient and Emergency Department of a multidisciplinary hospital in Karachi, Pakistan.

Study design: A retrospective chart review. Place and Duration of the Study: The Aga Khan University Hospital, Karachi, Pakistan, from March 2020 to December 2021.

Methodology: The research team collected pertinent information from medical records using a standardised proforma, which encompassed data from physicians' notes, nurses' notes, assessment forms, and discharge summaries. The data were analysed using descriptive and inferential statistics.

Results: This study examined 233 psychiatric referrals, with 67% male patients (n = 156) and 57.1% (n = 133) aged above 60 years. The primary psychiatric diagnosis was delirium (47.1%, n = 105), followed by adjustment disorders (10.8%, n = 27) and mood disorders (11.7%, n = 25). The main symptoms leading to consultation were agitation/confusion (45%, n = 106) and psychotropic adjustment (18%, n = 41). Clinical outcomes, including mortality, were associated with agitation/confusion (p = 0.001), delirium (p = 0.001), older age (p = 0.003), and longer length of stay (p = 0.001). Patients aged 61 years and above exhibited frequent agitation/confusion (p = 0.002) and delirium (p = 0.001). Longer stays correlated with agitation/confusion (p = 0.022), and a one-month hospital stay showed an association with delirium (p = 0.050).

Conclusion: This study highlights the crucial role of consultation-liaison psychiatric services in addressing the psychological issues in COVID-19 patients. The significance of delirium and its high mortality risk underscores the need for focused research and integration of mental health care into pandemic responses for comprehensive patient care.

Key words: Referrals, Psychiatric consultations, Hospitalised patients, COVID-19, Pakistan, Consultation-liaison services.

Objective: To determine the importance of the Glasgow Coma scale (GCS), ASA physical status classification system, and P-POSSUM score in predicting mortality among patients undergoing emergency laparotomies.

Study design: An analytical study. Place and Duration of the Study: Department of General Surgery, Sheikh Khalifa Bin Zayed Al-Nahyan Hospital Muzaffarabad, Pakistan, from October 2020 to January 2022.

Methodology: All emergency laparotomies performed during the above-mentioned period were included consecutively, excluding trauma laparotomies, re-do laparotomies after elective surgery, appendectomies, cholecystectomies, pancreatectomies, organ transplantation surgeries, and laparotomies due to gynaecological or vascular causes such as ruptured abdominal aortic aneurysm. The GCS scores were broken down into mild (14-15), moderate (9-13), and severe (3-8) categories. The ASA scoring was classified into five classes, i.e., Classes I to V. The P-POSSUM scores were assessed for each of the following five groups: (≤10, 11-20, 21-30, 31-40, and ≥41).

Results: Out of 50 patients (mean age: 47 ± 19 years), there were 39 (78%) males and 11 (22%) females. The median values for GCS and P-POSSUM scores were 15 and 11.1, respectively. According to the ASA, most patients (21, 42%) fit into Class II. Twelve (24%) patients died, while 38 (76%) survived. The mortality rate increased with an increasing P-POSSUM score, a lowering GCS score, and a higher class of ASA (all p <0.001). The ROC curve analysis showed that P-POSSUM had the best performance at 0.987, followed by ASA (0.951) and GCS (0.411).

Conclusion: The ASA Physical Status Classification System and P-POSSUM scoring were significantly predictive of mortality after an emergency laparotomy.

Key words: ASA Physical Status Classification System, Emergency laparotomy, Glasgow coma scale, Mortality, Outcome, P-POSSUM.

Fraudulent medical practices remain prevalent globally, fueled by digital platforms spreading false claims. This study analysed 3,327 published studies and 400 grey literature sources, selecting 38 studies and 19 excerpts for detailed examination. It identified 126 distinct quackery techniques and products used throughout history. Traditional methods are considered legitimate in Asian and African regions and dismissed as quackery in the West. In Western countries, quacks often use electricity, mechanical instruments, and gadgets for treatment. Historically, faith-based treatments are practised globally. However, these were limited to Asia and Africa. The rise of the internet has enabled quacks to exploit digital platforms to deceive and attract victims. These findings highlight the persistence of quackery and underscore the need for targeted strategies to combat these deceptive practices globally. Key Words: Charlatan, Illegal treatment, Medical fraud, Quackery.

Objective: To evaluate the association of serum albumin levels with short-term mortality in ICU patients, including ICU and 28-day mortality.

Study design: Observational study. Place and Duration of the Study: Intensive Care Unit, Izmir Tepecik Training and Research Hospital, Izmir, Turkiye, from January to July 2023.

Methodology: The study included 60 patients aged above 18 years who had stayed in the ICU for at least two days. Exclusion criteria were massive transfusion within the last 48 hours, septic shock with fluid resuscitation, liver failure at admission, end-stage renal disease, proteinuria, and BMI <18.5. The primary outcome included ICU mortality and 28-day mortality. Normality was assessed using the Shapiro-Wilk's test. A comparison between the quantitative data of the two studied groups was made with the independent samples t-test for normal distribution and for skewed data using the Mann-Whitney U test. A p-value of <0.05 was considered statistically significant.

Results: There was a significant association of both APACHE-II scores with ICU and 28-day mortality besides age and serum albumin level. In the binary logistic regression analysis, a statistically significant correlation was found between the albumin level at 48-hour and 28-day mortality (p <0.001).

Conclusion: Serum albumin levels at 48 hours post-admission were independent predictors of 28-day mortality.

Key words: Albumin, Critical care, Mortality.

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Objective: To evaluate Chicago Sky Blue (CSB) stain, Calcofluor white (CW) stain, and Potassium Hydroxide (KOH) mount for rapid diagnosis of dermatomycosis, using fungal culture as the gold standard.

Study design: Cross-sectional analytical study. Place and Duration of the Study: This study was conducted in the Department of Microbiology, Armed Forces Institute of Pathology / National University of Medical Sciences, Rawalpindi, Pakistan, from July 2023 to February 2024.

Methodology: Clinical specimens were collected from patients suspected of having dermatomycosis, including skin scrapings, hair, and nails. Each sample was divided into two parts. The first part underwent three microscopic techniques, namely 10% KOH mount, CSB stain, and CW stain. The presence and absence of hyphae were noted by each of the techniques. Second part was inoculated onto Sabouraud Dextrose agar (SDA) with and without antibiotics, along with Dermatophyte test medium (DTM). Culture plates were incubated at 30o C for four weeks. True-positive, true-negative, and diagnostic accuracy of the microscopy methods were calculated against fungal culture.

Results: Out of 121 patients, the majority were females constituting 65.3% (n = 79) while males were 34.7% (n = 42). The average age of participants was 32.98 ± 16 years. Diagnostic accuracy was 82.6% for CSB, 87.6% for CW stain, and 76.8% for 10% KOH mount.

Conclusion: CW stain proved to be superior to 10% KOH mount and CSB stain for rapid dermatomycosis diagnosis, with enhanced sensitivity and diagnostic accuracy. Both CW and CSB stains are recommended for laboratory use to improve reporting accuracy as compared to the conventional 10% KOH mount technique.

Key words: Calcofluor white, Chicago sky blue, Dermatomycosis, Fungal culture, Fungal hyphae.

Objective: To compare the inflammatory markers between therapeutic and emergency cerclage and assess the predictive role of inflammatory markers for the latency period.

Study design: Descriptive study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, Bursa Yuksek Ihtisas Training and Research Hospital, Turkiye, from January 2016 to September 2022.

Methodology: The therapeutic cerclage group (n = 64) included patients with a history of cervical insufficiency, normal prenatal screening test results, and who underwent cerclage based on history indications. The emergency cerclage group (n = 14) included patients with painless cervical dilation in the second trimester or a history of preterm and a short cervix on ultrasonography. Exclusion criteria composed of multiple pregnancies, active uterine contractions, vaginal bleeding, chorioamnionitis, membrane rupture, foetal anomalies, history of conization or abdominal cerclage, and having inflammatory diseases. Sociodemographic features, perinatal outcomes, and inflammatory markers such as neutrophil-to-lymphocyte ratio, C-reactive protein, and systemic immune-inflammation index were compared. Systemic immune-inflammation index was calculated by formulating the multiplication value of the neutrophil and platelet count divided by the lymphocyte count.

Results: The latency period was shorter (5.5 (0-29) vs. 20 (1-31) weeks, p <0.001) in the emergency cerclage group. Neutrophil-to- lymphocyte ratio and systemic immune-inflammation index, which are representatives of increased inflammatory state, were significantly higher in the emergency cerclage group (p = 0.007 for both). Systemic immune-inflammation index was correlated with cerclage to delivery interval for all patients (r = -0.307, p = 0.006). Also, it predicted neonatal mortality with a cut-off value of 1078.08, 90% sensitivity and 70.59% specificity (AUC = 0.776, p <0.001) and low Apgar scores with 57.1% sensitivity and 74% specificity (AUC = 0.641, p = 0.038).

Conclusion: Systemic immune-inflammation index, correlated with cerclage to delivery interval, could be a marker for predicting neonatal mortality and morbidity in cerclage patients.

Key words: Cervical cerclage, Inflammatory markers, Perinatal outcomes, Systemic immune-inflammation index.

Objective: To investigate the causal influence of gut microbiota on small cell lung cancer (SCLC) progression using Mendelian randomisation (MR), providing insights into the gut-lung axis in lung cancer pathology.

Study design: Analytical study. Place and Duration of the Study: Department of Radiotherapy, Binhai County People's Hospital, Yancheng, Jiangsu, China, and Department of Paediatrics, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China, from January to May 2024.

Methodology: The study used 18,340 single nucleotide polymorphisms (SNPs) as instrumental variables to analyse 418 gut microbiota varieties. The inverse variance weighted (IVW) and MR Egger's methods were applied to explore causal relationships. Sensitivity analyses, including leave-one-out tests and Cochrane's Q tests, ensured robust results. A uni-directional Mendelian randomisation (MR) analysis was conducted using summary statistics from genome-wide association studies (GWAS) provided by the MiBio-Gen and Finn-Gen consortia.

Results: MR identified several bacterial taxonomic groups significantly associated with SCLC risk. Protective factors included Bacteroidetes (p = 0.0154), Eubacterium ruminantium group (p = 0.0241), Barnesiella (p = 0.0015), Clostridia (p = 0.0242), Christensenellaceae (p = 0.0314), Ruminococcaceae UCG-003 (p = 0.0381), and an unknown genus in the Ruminococcaceae family (p = 0.0458). Conversely, the risk factors linked to increased SCLC risk included Firmicutes (p = 0.0456), Pasteurellaceae (p = 0.0177), Eubacterium oxidoreducens group (p = 0.0188), Pasteurellales (p = 0.0177), and Alcaligenaceae (p = 0.0423).

Conclusion: The study suggests a protective role of specific gut microbiota against SCLC and identifies others that may increase the risk. The absence of heterogeneity and pleiotropy supports the causal associations, underscoring the significance of the gut-lung axis in SCLC and the utility of MR in cancer epidemiology.

Key words: Small cell lung cancer, Gut microbiota, Mendelian randomisation, Causal inference, Cancer epidemiology.

The Valsalva manoeuvre is widely recognised for its effectiveness in reverting supra-ventricular tachycardia (SVT) in patients with good coordination. However, this is not applicable in sedated ventilated patients and there is a dearth of literature regarding the application of Valsalva in unconscious patients on mechanical ventilation. The authors, for the first time, present a novel non-pharmacological method to treat SVT in critically ill patients on mechanical ventilation, employing the high positive end-expiratory pressure (PEEP) technique. This method successfully reverted SVT in two patients. While the exact mechanism remains unconfirmed, it is believed to be similar to that of the Valsalva manoeuvre. Further research is needed to validate this technique and determine the optimal ventilator settings, including the PEEP threshold, for such cases. Key Words: Valsalva manoeuvre, Supraventricular tachycardia, Positive end-expiratory pressure, Mechanical ventilation.

Objective: To assess the disease response and patient survival outcomes for cancer patients treated with helical tomotherapy.

Study design: Descriptive study. Place and Duration of the Study: The Tomotherapy Unit of Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from October 2020 to August 2023.

Methodology: A retrospective analysis was conducted on the data of patients who underwent definitive radiation at Tomotherapy Centre. The evaluation of disease response utilised CT scans performed three months after completing radiotherapy, following RECIST criteria. Survival and disease-free status were determined through telephonic interviews with the patients.

Results: A total of 654 patients received treatment on Tomotherapy, of which, 143 underwent definitive Radiotherapy. The average age was 51 ± 16.8 years, with 85 (59.4%) males. The predominant area subjected to definitive radiation was the head and neck, accounting for 65 cases (45.5%), trailed by the gastrointestinal tract and pelvis with 52 (36.4%) and 26 (18.2%) cases, respectively. Response assessment revealed a complete response in 73 (52.14%) patients, partial response in 47 (33.5%), stable disease in 11 (7.85%), and progressive disease in 9 (6.4%). Currently, 108 (77%) patients are alive. Twenty-eight (20%) patients experienced local or distant disease development. Among them, 6 (4.3%) patients had local recurrence, and 22 (15.7%) developed metastatic disease.

Conclusion: Helical tomotherapy offers promising disease control and survival outcomes, making it a viable treatment modality for cancer patients in a lower middle-income country. These findings highlight the importance of careful patient selection and optimising resource utilisation for curative treatments to enhance cancer care in Pakistan.

Key words: Radiotherapy, Tomotherapy, Radiotherapy technique, Multidisciplinary treatment, Peer-review practice.