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

Objective: To establish a predictive model for pathological complete response (pCR) in operable primary breast cancer after neoadjuvant chemotherapy (NAC).

Study design: Observational study. Place and Duration of the Study: Breast Centre, Shunyi District Health Care Hospital for Women and Children of Beijing, Beijing, China, from January 2010 to June 2023.

Methodology: Four hundred and fourteen operable invasive breast cancer patients who received NAC were included in this study. After a random assignment at a ratio of 7:3, 289 patients in the training set were analysed for model building, and the remaining 125 patients in the test set were used for validation. The definition of pCR was the absence of residual invasive disease in either the breasts or the axillary lymph nodes (ypT0 / is ypN0). After multivariate logistic regression analysis, a nomogram was drawn. In the validation phase, the receiver operating characteristic (ROC) curve and AUC were used for evaluation of discrimination, while the calibration plot and Hosmer-Lemeshow test for calibration. Additionally, a decision curve was drawn.

Results: A model containing 8 variables, including BMI, tumour size, histological grade, HR, HER2, axilla status, chemotherapy cycles, and regimens was built. After validation, the model had moderate discriminatory power [AUC, 0.831; 95% CI (0.733, 0.928)]. Calibration curve and Hosmer-Lemeshow goodness of fit (GOF) test (p = 0.1645) demonstrated that the model fitted well. Meanwhile, the decision curve analysis revealed that the model was beneficial to patients.

Conclusion: Model containing BMI, tumour size, histological grade, HR, HER2, axilla status, chemotherapy cycles, and regimens showed moderate discrimination and calibration abilities in predicting pCR.

Key words: Breast neoplasms, Neoadjuvant therapy, Surgery, Pathology, Nomogram.

Objective: To determine the frequency and types of dermatological conditions including sexually-transmitted infections (STIs) within the lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities.

Study design: A cross-sectional survey. Place and Duration of the Study: Department of Dermatology, Services Hospital, Lahore, Pakistan, from 19 April to 20 May 2023.

Methodology: The survey was conducted on members of the LGBTQ community registered with Fountain House, Lahore, aged 18 years and above. Data on demographics, sexual orientation, hormone use, gender-affirming procedures, chronic hepatitis, and STIs and dermatological findings were collected using a structured questionnaire.

Results: Among the 143 LGBTQ individuals who participated, the average age was 53.29 ± 10.85 years. Most participants (84.6%) were transwomen while 15.4% were transmen. Regarding sexual orientation, 67.1% selected themselves as gay, 16.1% as bisexual, 1.4% as lesbian, 0.7% as hetero-sexual, and 14.7% chose not to disclose. Dermatological findings were observed in 94 (64%), among which androgenic alopecia (18.18%), generalised xerosis / atopic eczema (11.19%), melisma (4.20%) and infections such as scabies (11.19%), and 52 (36%) did not have any skin disease. For gender affirmation, 2.1% underwent hormonal therapies and 7.69% adopted surgical procedures.

Conclusion: The LGBTQ community suffers from many dermatological problems such as androgenic alopecia, atopic eczema, melasma and infections that need to be addressed. Hence training of doctors to cater for the dermatological concerns of this community is important.

Key words: LGBTQ, Transgender skin diseases, Gender affirming procedures, Gender dermatology.

Objective: To investigate the variations and clinical implications of serum Gal-3 and IL-6 values in individuals with heart failure (HF) complicated with renal impairment.

Study design: Analytical study. Place and Duration of the Study: Department of Nephrology, The Affiliated Hospital of Hebei University, Baoding, Hebei, China, from May 2022 to 2023.

Methodology: A total of 80 HF individuals who were treated in the Department of Nephrology, The Affiliated Hospital of Hebei University, Baoding, Hebei, China, from May 2022 to 2023, were classified into the normal renal function band (n = 40) and the renal impairment band (n = 40) according to glomerular filtration rate (eGFR). The serum galactose-3 (Gal-3) and interleukin-6 (IL-6) values and their correlation with renal impairment were compared between the two bands, along with an analysis of the sensitivity and specificity of Gal-3 and IL-6 using receiver operating characteristic (ROC) curves.

Results: There were higher Gal-3 and IL-6 values in the renal impairment band, in contrast to the normal renal function band (p <0.05). Spearman's correlation analysis indicated a significant association between Gal-3 and IL-6 values in HF individuals and renal impairment (p <0.05). The AUC values of Gal-3 and IL-6 in predicting renal impairment in HF individuals were <0.914 and <0.717, respectively; the specificity of Gal-3 and IL-6 in predicting renal impairment was 70.00% and 62.50%, respectively, the sensitivity was 97.50% and 80.00%, respectively.

Conclusion: HF individuals complicated with renal impairment have increased serum Gal-3 and IL-6 values, both of which are significantly associated with renal impairment.

Key words: Heart failure, Renal impairment, Galactose lectin-3, Interleukin-6 protein.

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Objective: To determine the mobilisation failure rate and identify its associated factors in this part of the world in order to identify patients at risk of mobilisation failure and to promptly explore alternative treatment.

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 January 2014 to July 2023.

Methodology: Clinical records of 115 patients due for autologous haematopoietic stem cell transplantation (auto HSCT) and undergoing mobilisation regimen were analysed. Poor mobilisers were defined as patients who failed to achieve minimum PBSC collection of CD34 >2 x 106/kg of recipient body-weight or required an additional dose of Plerixafor after Cyclophosphamide GCSF mobilisation to achieve the target dose.

Results: Among the mobilisation regimes, 85 (74%) were mobilised with Cyclophosphamide followed by GCSF (Cyclo-G), 28 (24%) with GCSF and Plerixafor (G-Plerixafor), and only 2 (2%) with GCSF alone. After the first mobilisation regimen, 84% of patients achieved PBSC collection of CD34 count of >2 x 10^6/kg. The entire mobilisation failure rate was 16%. Successful stem cell collection was significantly correlated with age, lymphoma group and its transplant indication, previous chemotherapy lines, exposure to the type of myelotoxic medicines, steady-state CD34 count, and use of Plerixafor. However, at multivariate analysis, only use of Plerixafor was found associated with successful mobilisation.

Conclusion: Plerixafor significantly improved mobilisation regimens' yield and cost-effectiveness by greatly increasing mobilisation success rates, particularly in heavily pre-treated lymphoma patients.

Key words: Haematopoietic stem cell mobilisation, Plerixafor, Lymphoma, Multiple myeloma, Plasma cell dyscrasias.

Objective: To explore the differences in the occurrence of postoperative hypertrophic anal papillae (HAP) using different surgical techniques (Ferguson haemorrhoidectomy or Milligan-Morgan haemorrhoidectomy), and whether the haemorrhoidectomy technique is an independent risk factor of postoperative HAP.

Study design: A descriptive study. Place and Duration of the Study: The First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China, from October 2018 to 2023.

Methodology: Data were collected retrospectively from the electronic inpatient and outpatient records of patients with haemorrhoidectomy who were grouped according to the specific haemorrhoidectomy technique, and the difference in the incidence rate of postoperative HAP between the two groups was compared by χ2 test. In addition, the correlation between other observation indicators and postoperative HAP was tested. Relevant indicators were included in binary logistic regression analysis to determine whether the haemorrhoidectomy technique was an independent risk factor for postoperative HAP.

Results: This study collected 815 cases with 494 Milligan-Morgan surgery and 321 Ferguson surgery. Twenty-six (8.1%) cases with Ferguson surgery and 13.16% cases with Miligan-Morgan surgery (n = 65) had postoperative HAP. The difference between the two groups is statistically significant (p = 0.025). After multivariate regression analysis, it was found that the haemorrhoidectomy technique was an independent risk factor of postoperative HAP (p = 0.004).

Conclusion: The frequency of postoperative HAP varies significantly between Milligan-Morgan haemorrhoidectomy and Ferguson haemorrhoidectomy, and the haemorrhoidectomy technique can independently affect the occurrence of postoperative HAP. In order to get a lower occurrence of postoperative HAP, it was recommended for front-line colorectal doctors to consider the Ferguson haemorrhoidectomy.

Key words: Ferguson haemorrhoidectomy, Milligan-Morgan haemorrhoidectomy, Mixed haemorrhoids, Hypertrophic anal papillae, Independent risk factor.

Objective: To assess the efficacy of growth hormone (GH) co-treatment during controlled ovarian stimulation for in-vitro fertilisation (IVF).

Study design: Descriptive analytical. Place and Duration of the Study: Department of Gynaecology, Etlik Zubeyde Hanim Training and Research Hospital, Ankara, Turkiye, from January 2010 to 2023.

Methodology: A total of 191 women with diminished ovarian reserve (DOR) who underwent IVF cycles were included in the study. Eighty- nine patients with DOR who received GH during the study period were designated as the study group (Group A), and the 102 patients with DOR who did not receive GH were chosen as the control group (Group B). Chi-square and Mann-Whitney U tests were used to compare groups' variables.

Results: The Group B's basal estradiol and FSH levels were higher than those of Group A. No significant correlation was found in regards to number of 2PNs (pro-nuclear), and the count of collected oocytes. The clinical pregnancy rate of the groups was comparable [(n = 13 (27.7%) vs. n = 19 (35.2%), p = 0.417)].

Conclusion: This study has shown that the clinical pregnancy rate did not increase significantly in the GH group.

Key words: Controlled ovarian hyperstimulation, Growth hormone, In-vitro fertilisation, Clinical pregnancy rate.

Objective: To evaluate the clinical safety and efficacy of the self-expanding transcatheter aortic valve system in Chinese patients with severe aortic stenosis (AS) during follow-up.

Study design: Observational study. Place and Duration of the Study: Department of Cardiology, Yulin First People's Hospital, The Sixth Affiliated Hospital of Guangxi Medical University, Yulin, Guangxi, China, from April 2020 to September 2022.

Methodology: A retrospective analysis was conducted on 101 patients with severe symptomatic AS who underwent transcatheter aortic valve replacement (TAVR) using a self-expanding transcatheter aortic valve system. Inclusion criteria were patients with severe symptomatic AS at high surgical risk or with contraindications for traditional surgery. Exclusion criteria included active infections and untreated severe coronary artery stenosis. The primary endpoint of this study was the mortality rate or complications within one year after TAVR.

Results: The average age of the cohort was 69.5 ± 7.9 years, with 39.6% (n = 40) being female. The average risk score according to the Society of Thoracic Surgeons was 3.5 ± 2.7%. At one-year follow-up, the all-cause or cardiovascular disease mortality rate was 7.9% (n = 8). Importantly, no reports of major stroke or coronary artery obstruction occurred during the one-year follow-up, and the prognosis of patients with bicuspid aortic valve and tricuspid valve stenosis was comparable.

Conclusion: The studied transcatheter valve replacement system is a safe and effective treatment option for Chinese patients with severe aortic valve stenosis. Future multicentre and larger-scale randomised controlled trials are needed to verify that the self-expanding system can provide long-term benefits.

Key words: Aortic valve stenosis, Transcatheter aortic valve replacement, Self-expanding transcatheter aortic valve system.

Objective: To determine the frequency of diabetic retinopathy and its association with HbA1c in children and adolescents having Type-I Diabetes Mellitus (T1DM).

Study design: Analytical, cross-sectional study. Place and Duration of the Study: Department of Paediatric Endocrinology and Diabetes, National Institute of Child Health, Karachi, Pakistan, from October 2023 to March 2024.

Methodology: Children aged between 5-18 years having known T1DM were analysed. Children who had record of HbA1c for the last one year (4 HbA1c readings, three months apart) were enrolled. HbA1c was categorised as good (<7%), fine (7-10%), and poor (>10%). Patients were referred to ophthalmologists with more than five years of disease screening experience for diabetic retinopathy.

Results: In 137 patients, 79 (57.7%) were females. The mean age and age at the time of diagnosis were 13.42 ± 2.48 years and 7.42 ± 3.60 years. The mean of last one-year HbA1c (4 separate readings, three months apart) was 10.44 ± 2.50%. The glycaemic control was found to be good, fine, and poor based on the mean of the last one-year in 6 (4.4%), 63 (46.0%), and 68 (49.6%) patients, respectively. Diabetic retinopathy was diagnosed among 30 (21.9%) patients. The comparison of mean HbA1c levels between various diabetic retinopathy classifications showed the statistically significant relationship of higher HbA1c levels with diabetic retinopathy (p = 0.011).

Conclusion: The frequency of diabetic retinopathy was high (21.9%) among children and adolescents with T1DM. Higher HbA1c levels were significantly associated with diabetic retinopathy, highlighting the critical role of glycaemic management in preventing retinal complications.

Key words: Children, Adolescents, Diabetic retinopathy, HbA1c, Type-I diabetes mellitus.

This cross-sectional study investigated the relationship between oxidative balance (OB) scores and suicidal ideation among the Korean adults. Data from 17,753 adults with information on suicidal ideation and OB scores were analysed using four years of the nationwide survey. A stepwise multivariate logistic regression model was used to catch the factors associated with suicidal ideation, including depressive mood and OB scores. Approximately 5% of the participants had suicidal ideation. Low OB scores were significantly and independently associated with suicidal ideation, and this association was not influenced by depressive mood. In conclusion, oxidative imbalance was related to suicidal ideation, independent of depressive mood. Key Words: Depression, Oxidative stress, Population surveillance, Suicidal ideation.