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

Objective: To evaluate the effectiveness and safety of duodenum suspension in the laparoscopic treatment of congenital duodenal obstruction (CDO).

Study design: A descriptive study. Place and Duration of the Study: Department of Paediatric Surgery, Ganzhou Maternal and Child Healthcare Hospital, Ganzhou, China, from January 2015 to December 2024.

Methodology: Patients who underwent surgery for duodenal obstruction were categorised into three groups: open repair (OP), laparoscopic repair (LA), and laparoscopy with duodenal suspension (Sus-LA). Patients with severe malformations or age >1 month were excluded. Demographics, comorbidities, intraoperative and postoperative data, and outcome parameters were evaluated. Descriptive statistics were employed to summarise the distribution of continuous variables, with normally distributed data presented as mean ± standard deviation and skewed data as median (interquartile range). ANOVA, Welch's t-test, Bonferroni post hoc comparison, and Fisher's exact test were used for pairwise comparisons.

Results: Thirty-eight patients were included, with no significant differences in gender, age, weight, gestational weeks, obstruction aetiologies, and comorbidities among the groups (p >0.05). Operating time was shorter in the Sus-LA group [120.0, (48) minutes] compared to the LA group [(176.5, (75) minutes, p = 0.001)], but did not differ from the OP group [85.0, (31) minutes; p = 0.055]. Time to feed initiation was shorter in the Sus-LA group [4.0, (3) days] than the OP group [7.5, (4) days; p = 0.033], with no difference between the OP and LA groups [p >0.99]. The length of hospital stay differed significantly among the groups [23.0 (8), 24.0 (15), and 18.0 (8) days, respectively, (p = 0.036)]. Complications occurred in 13 (34.2%) patients, with lower frequencies in the Sus-LA group (7.7%) than the OP group (55.6%; p = 0.024).

Conclusion: Duodenal suspension in the laparoscopic treatment of neonatal duodenal obstruction is a manoeuvre that facilitates the surgical procedure and is associated with reduced surgical difficulty, shorter operative time, and decreased postoperative complications.

Key words: Neonate, Duodenal obstruction, Duodenum suspension, Laparoscopy, Complications.

Due to advancements in diagnostic techniques and global trends in HIV, histoplasmosis-a fungal infection caused by Histoplasma (H.) capsulatum-is increasingly spreading in non-endemic areas. Although it is not considered endemic in Pakistan, research indicates that the majority of the population has not exposed to H. capsulatum. Nevertheless, cutaneous histoplasmosis, although rare, is an important clinical manifestation among people living with human immunodeficiency virus (PLHIV) and is frequently linked to widespread illness. H. capsulatum grows best in places where bats serve as primary reservoirs, such as humid places, ancient buildings, and contaminated soil. In immunocompetent individuals, infection frequently presents as a self-limiting pneumonia or is asymptomatic. However, in immunocompromised hosts-especially infected with HIV-the infection spreads via the haematogenous route, affecting the skin and other organs. Key Words: Cutaneous histoplasmosis, H. capsulatum, Immunocompromised.

Objective: To determine the dose-dependent effects of the ethanolic leaf extract of Psidium (P.) guajava on diabetes and lipid profile in rabbits with alloxan-induced diabetes.

Study design: An analytical and experimental study. Place and Duration of the Study: Department of Pharmacology, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan, from March 2021 to 2023.

Methodology: A total of 48 male rabbits were selected (aged 4-6 months) and randomly divided into six groups (n = 8): normal control, diabetic control, glibenclamide-treated (0.45 mg/kg/day), and P. guajava leaf extract-treated groups receiving 100, 150, and 200 mg/kg/day. Diabetes was induced by intraperitoneal injection of alloxan monohydrate (100 mg/kg). Blood glucose and lipid levels were measured at baseline and after the 28-day treatment period. Data were analysed using SPSS version 23.0. A paired t-test was used to compare the blood glucose levels and lipid profiles between the groups.

Results: A significant hypoglycaemic effect (p = 0.002) was observed at the 200 mg/kg dose, although the absolute reduction was modest. Dose-dependent improvements were observed in the lipid profile, including significant reductions in LDL (-2.87 mg/dL, p <0.001), triglycerides (-1.75 mg/dL, p = 0.013), and total cholesterol (-3.25 mg/dL, p = 0.009), alongside an increase in HDL (+0.87 mg/dL, p = 0.006) at the 200 mg/kg dose. Histopathological examination revealed that doses of 150-200 mg/kg protected against diabetes-induced renal and hepatic damage.

Conclusion:  The P. guajava leaf extract exhibited significant antihyperlipidaemic and modest antihyperglycaemic properties at higher doses (150-200 mg/kg) and exhibited protective effects on the kidney and liver.

Key words: Psidium guajava, Antidiabetic, Antihyperlipidaemic, Alloxan, Diabetes, Rabbits.

Suicide among medical students is a serious issue. To understand the pattern and risk factors associated with medical students' deaths by suicide, a Google search was conducted for news reports in the last 10 years (2013-2023) using the keywords: medical students, suicide, death by suicide, medical student suicide, and Pakistan. Over this decade, 12 medical student suicides were reported, of which two were excluded. Among the remaining 10 suicide cases, eight were males, and two were females (male-to-female ratio was 4:1). Most of the victims (n = 7, 70%) were in their clinical years of study. The most frequently used method of suicide was hanging (n = 3, 30%), followed by firearms (n = 2, 20%), jumping in front of trains (n = 2, 20%), and drug overdose (n = 1,10%). Academic failure was reported as the most common precipitating factor. Suicide among medical students is an urgent issue that requires a multi-layered preventive strategy, including improved mental health support to medical students. Key Words: Medical students, Pakistan, Suicide, Mental health.

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This study aimed to investigate the potential educational applications of teacher-made mind maps for students. This quasi-experimental study employed a single-group pre-test, post-test design and was conducted from September 2022 to April 2024. Fifty-five medical students studying symptomatology, who were willing to participate, were recruited. The effectiveness of teacher-made mind maps was assessed based on changes in two test scores, and students' perceptions were evaluated using questionnaires. The difference between pre-test and post-test scores in two tests was statistically significant (p <0.001), and the majority of students provided favourable feedback. Teacher-made mind maps were effective in improving students' academic performance, were well received by students, and are recommended for use in student teaching. Key Words: Mind map, Perception, Motivation, Academic performance, Medical education.

Objective: To compare the impact of root canal treatment (RCT) versus tooth extraction using the Urdu version of Oral Health-Related Quality of Life (OHRQoL) in a sample of Pakistani dental patients, with special emphasis on gender differences.

Study design: A cross-sectional study. Place and Duration of the Study: Department of Dentistry, Islamic International Dental Hospital, Foundation University Dental Hospital, Polyclinic Hospital, and Armed Forces Institute of Dentistry, Islamabad, Pakistan, from March to June 2023.

Methodology: A cross-sectional study of 100 adult patients (mean age = 38.53 ± 13.75; 65% male, 35% female) was conducted. All patients had undergone RCT or tooth extraction within the previous three months. The Urdu-translated Oral Health Impact Profile-14 (OHIP-14) was used to assess OHRQoL.1 Employing exploratory factor analysis with varimax rotation, a seven-factor solution (KMO = 0.819; Bartlett's test χ2 = 478.89, p <0.001) explained 64.2% of the variance. Overall, the OHIP-14 Cronbach's alpha was 0.83. Group OHIP-14 scores were compared using the Mann-Whitney U test.

Results: The final sample had 49 RCT patients and 51 extraction patients. Female patients reported higher functional limitation scores than male patients (p <0.05), while extraction patients reported higher psychological discomfort scores than RCT patients (p <0.05). Factor analysis revealed the seven-factor structure that explained 64.2% of the variance, indicating that the OHIP-14 was robust. OHIP-14 scores were higher (indicating lower OHRQoL) in extraction patients compared to RCT patients (p <0.05).  Conclusion: Females reported more functional limitations and psychological distress following tooth extraction. The seven-factor Urdu OHIP-14 showed strong reliability. These findings emphasise gender-sensitive treatment and the psychological benefits of tooth preservation.

Key words: Root canal therapy, Tooth extraction, Oral health, Quality of life.

Objective: To determine the diagnostic accuracy of serum pro-adrenomedullin (proADM) as a biomarker of bacterial sepsis in neonates.

Study design: A cross-sectional study. Place and Duration of the Study: Departments of Chemical Pathology, Microbiology, Paediatric Emergency, and NICU, King Edward Medical University / Mayo Hospital, Lahore, Pakistan, from June to December 2023.

Methodology: After parental consent, a total of 71 patients who met the inclusion and exclusion criteria were enrolled in the study. proADM levels and blood cultures were measured from blood samples. The enzyme-linked immunosorbent assay (ELISA) was used to quantify proADM. Quantitative variables were presented as mean ± SD, while qualitative variables were presented as frequencies and percentages. An ROC curve was plotted to find the optimal proADM cut-off value. Calculations were performed to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of proADM.  The diagnostic accuracy of pro-ADM was calculated using a 2x2 contingency table.  Results: The median age (IQR) of the patients with and without sepsis was 7 (18) and 4 (11) days, respectively. There were 16 (55%) males and 13 (45%) females in the group with sepsis, whereas 24 (57%) were males and 18 (43%) were females in the group without sepsis. Using a cut-off value of 14.1 nmol/L, the sensitivity, specificity, PPV, and NPV values of proADM were 79.31%, 80.9%, 74%, and 85%, respectively. Diagnostic accuracy of serum proADM was 80%.

Conclusion: Serum proADM has an excellent diagnostic accuracy for identifying neonatal bacterial sepsis.

Key words: Proadrenomedullin, Diagnostic accuracy, Neonatal sepsis, Biomarker, ROC curve.

Objective: To assess the effectiveness of leucocyte- and platelet-rich fibrin (L-PRF) as a potential substitute for split-thickness skin grafting (STSG) in treating large wounds in resource-limited settings.

Study design: A cross-sectional observational study. Place and Duration of the Study: Department of Dermatology, Combined Military Hospital, Khuzdar, Pakistan, from August 2023 to January 2025.

Methodology: Eighty-two patients with wounds from various causes, most commonly electrical injuries (20.7%), were treated with L-PRF prepared using Choukroun's protocol. L-PRF gel was applied in weekly sessions (mean: 3.99 ± 0.85). Outcome measures included photographic evidence, improvement categories and patient satisfaction scores.

Results:   The mean age was 32.2 ± 15.7 years, with 85.4% male patients. Wound dimensions ranged from 1-16 cm in length, 1-14 cm in width, and 0.4-2.0 cm in depth. Healing time ranged from 3 to 6 weeks. Every wound achieved 76-100% healing, an exceptional and uniform therapeutic response. A significant positive relationship was identified between wound depth and the duration of healing (p <0.001), indicating that deeper wounds required more extended healing periods. Remarkably, no adverse events were reported, underscoring the safety of L-PRF therapy. Furthermore, patient satisfaction was exceptionally high, with all participants expressing complete contentment with the treatment outcomes.    Conclusion: L-PRF is a safe, cost-effective, and clinically effective alternative to STSG for large wound healing in resource-limited settings. The predictable outcomes and excellent patient acceptance warrant further large-scale studies to confirm its role in standard wound care protocols.

Key words: Leucocyte- and platelet-rich fibrin, Platelet-rich plasma, Wound healing, Split-thickness skin grafts.

Objective: To investigate the impact of preoperative sleep quality on postoperative delirium in adults aged 45-64 years and those aged over 65 years undergoing general anaesthesia.

Study design: An observational study. Place and Duration of the Study: Department of Anaesthesiology and Reanimation, University of Health Sciences, Konya City Hospital, Konya, Turkiye, from August to December 2023.

Methodology: Patients aged 45-64 years and those aged ≥65 years who underwent surgeries lasting more than 2 hours under general anaesthesia were assigned to age groups solely according to their chronological age and were observed during routine clinical care. Preoperatively, the STOP-Bang questionnaire, Pittsburgh Sleep Quality Index (PSQI), and Mini-Mental State Examination (MMSE) were administered. Intraoperative and postoperative parameters were recorded. Postoperatively, the PSQI and QoR-15 were reassessed, and delirium screening was performed daily for 72 hours using the 3D-CAM and ICU-CAM tools. Patients discharged early were followed up by phone. Continuous variables were compared using the independent t-test or Mann-Whitney U test, depending on data distribution, and categorical variables were analysed using the chi-square or Fisher's exact test. A p-value of <0.05 was considered statistically significant.

Results: In the ward setting, a comparison between the two groups revealed no statistically significant variation in the frequency of postoperative delirium among the 150 patients (p = 0.248) or ICU (p = 0.471). However, the patients aged over 65 years, with poor preoperative sleep quality (PSQI >5), showed a significant correlation with ICU delirium (p = 0.03).

Conclusion: Poor preoperative sleep quality in elderly patients is associated with increased risk of postoperative delirium. These findings warrant further study.

Key words: Delirium, General anaesthesia, Sleep quality, Age, Pittsburgh Sleep Quality Index, Postoperative outcomes.