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

Objective: To examine the sociodemographic and clinical characteristics of patients with first-episode psychosis (FEP) and to explore their associations with symptom severity, length of hospital stay, and PANSS symptom clusters.

Study design: A cross-sectional study. Place and Duration of the Study: Department of Psychiatry, Khyber Medical College, Peshawar, Pakistan, from January 2021 to December 2024.

Methodology: A total of 104 inpatients with FEP were recruited. Sociodemographic and clinical data were collected, and symptom severity was assessed using the Positive and Negative Syndrome Scale (PANSS). Chi-square test, Fisher's exact test, ANOVA, and logistic regression identified associations and predictors of symptom severity and hospitalisation.

Results: Of 104 patients, 77.9% were male (mean age 23.4 years). Females were more likely to be married (p = 0.002), while substance misuse occurred only among males (28.7%, p = 0.001). Patients aged ≤18 years had significantly higher PANSS total scores (p = 0.013). Multiple regression revealed that younger age, lower socioeconomic status (SES), fewer years of education and unawareness or cultural barriers to referral predicted higher total PANSS severity (all p < 0.05). Longer duration of untreated psychosis (DUP) and tribal residence predicted elevated positive symptoms, whereas low education and tribal origin predicted thought disturbance. PANSS severity correlated strongly with longer hospital stay (p < 0.001). Age and gender were not significant predictors, and no major gender differences were observed across subscales.

Conclusion: Younger age, limited education, low SES, and sociocultural barriers were associated with more severe FEP. Enhancing community awareness and early referral pathways may improve outcomes in low-resource settings.

Key words: Acute psychosis, First-episode psychosis, Acute and transient psychotic disorder, PANSS.

Objective: To compare the performance of the modified DECAF and NEWS-2 scores in predicting in-hospital mortality among patients admitted with acute exacerbations of chronic obstructive pulmonary disease (AECOPD).

Study design: A cross-sectional analytical study. Place and Duration of the Study: Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan, from November 2023 to May 2024.

Methodology: Seventy-nine patients with AECOPD were enrolled using a consecutive sampling technique. The modified DECAF and NEWS-2 scores were calculated at admission. Diagnostic accuracy was evaluated using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Receiver operating characteristic (ROC) analysis was performed to determine discriminatory power.

Results: The modified DECAF showed 100% sensitivity, 19.05% specificity, 77.33% PPV, and 100% NPV. NEWS-2 demonstrated 100% sensitivity, 22.22% specificity, 77.42% PPV, and 100% NPV. AUCs were 0.465 for the DECAF and 0.549 for the NEWS-2, indicating weak discriminative ability in this cohort.

Conclusion: The Modified DECAF and NEWS-2 scores showed high sensitivity but low specificity and weak discriminatory power in predicting in-hospital mortality among patients with AECOPD. These findings suggested limited prognostic accuracy in this population and highlighted the need for larger multicentre studies for validation.

Key words: Acute exacerbation, Chronic obstructive pulmonary disease, DECAF score, NEWS-2 score, In-hospital mortality, Predictive accuracy.

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This network meta-analysis (NMA) evaluated the efficacy and safety of radiotherapy combined with various therapeutic strategies in locally advanced head and neck squamous cell carcinoma (LA-HNSCC). Fourteen randomised controlled trials (RCTs) with over 5,900 patients and a minimum two-year follow-up were included. Primary outcomes were overall survival (OS), progression-free survival (PFS), and grade ≥3 toxicities. Bayesian models were used for data synthesis and sensitivity analysis. Pembrolizumab plus radiotherapy (A_V) showed a trend toward improved OS [OR = 1.7, 95% CrI (credible intervals): 0.55-5.6] and PFS (OR = 1.6, 95% CrI: 0.4-6.2) without statistical significance. Toxicity analysis indicated manageable risks for A_V (OR = 0.13, 95% CrI: 0.0095-1.6), while radiotherapy with cisplatin and immunotherapy (A_I_V) showed higher toxicity (OR = 3.3, 95% CrI: 0.45-24). This study highlights the need to optimise radiotherapy strategies, refine combination therapies, and identify predictive biomarkers, providing key insights for personalised treatment approaches in LA-HNSCC. Key Words: Locally advanced head and neck squamous cell carcinoma, Network meta-analysis, Radiotherapy, Pembrolizumab, Overall survival, Progression-free survival, Cisplatin, Toxicity, Immunotherapy, Bayesian analysis.

Objective: To examine the association between the atherogenic index of plasma (AIP) and glycated haemoglobin A1c (HbA1c), serum uric acid (SUA), and homocysteine (Hcy) in individuals with type II diabetes mellitus (T2DM) and acute stroke.

Study design: A descriptive study. Place and Duration of the Study: Department of Endocrinology, First Central Hospital of Baoding, Hebei, China, from January 2023 to January 2024.

Methodology: Ninety patients were categorised based on NIHSS score: mild (n = 30), intermediate (n = 30), and severe (n = 30). Forty healthy participants were selected as the comparison cohort. Variations in lipid profiles, blood glucose, SUA, and Hcy concentrations were compared. Logistic regression analysis was conducted to determine the risk factors for T2DM and acute stroke. Spearman's rank correlation assessment was used to evaluate the relationship between AIP and HbA1c, SUA, and Hcy.

Results: The comparison cohort demonstrated a lower frequency of hypertension compared to the mild (χ2 = 4.667; p = 0.031), moderate (χ2 = 8.750; p = 0.003), and severe cohorts (χ2 = 12.153; p <0.001). Moreover, the comparison cohort exhibited markedly lower concentrations of TG, TC, LDL-C, FPG, HbA1c, SUA, Hcy, and AIP, whereas maximum concentrations were observed in the severe cohort (all p <0.05). HDL-C concentrations were significantly decreased in the severe cohort, whereas maximum HDL-C concentrations were noted in the comparison cohort (p = 0.002). Logistic regression determined that HDL-C functioned as an independent protective factor against T2DM and acute stroke (p <0.05), whereas HbA1c, SUA, Hcy, and AIP were distinct risk elements of these diseases (p <0.05). Spearman's rank correlation assessment revealed positive correlations between AIP and HbA1c, SUA, and Hcy.

Conclusion: HbA1c, SUA, Hcy and AIP are potential risk factors for acute stroke in patients with T2DM. AIP is positively correlated with HbA1c, SUA, and Hcy.

Key words: Type II diabetes mellitus, Acute stroke, Atherogenic index of plasma, Glycated haemoglobin A1c, Serum uric acid, Homocysteine.

Brain injuries are an increasing healthcare problem in Pakistan. Despite the growing burden of head injuries, few specialised brain injury rehabilitation services are available in the country. This results in poor functional and cognitive outcomes for patients. This article examines the need for dedicated brain injury rehabilitation units in Pakistan and how these might enhance patient care through multidisciplinary team working and individualised rehabilitation plans. It also identifies gaps in the healthcare system, workforce, and public awareness regarding brain injury rehabilitation. This study provides recommendations to implement best-practice guidelines from across the globe to improve lifetime care and support head-injured individuals and their families in a resource-limited environment. Key Words: Traumatic brain injury, Rehabilitation, Pakistan.

Objective: To identify risk factors for deep vein thrombosis (DVT) following total knee arthroplasty (TKA) and to develop a predictive nomogram model.

Study design: An observational study. Place and Duration of the Study: Department of Orthopaedics, Nanjing Pukou People's Hospital, Liangjiang Hospital, Southeast University, Nanjing, China, from March 2018 to March 2022.

Methodology: Among the 1,015 eligible TKA patients, 457 developed postoperative DVT (DVT group), and 558 served as controls (non-DVT group). Risk factors were identified through univariate analysis and multivariate logistic regression.

Results: The DVT group showed significantly higher proportions of patients aged age ≥65 years, BMI ≥28 kg/m2, female gender, history of diabetes, cemented prosthesis, operation duration ≥90 minutes, bed rest duration ≥72 hours, no mechanical thromboprophylaxis, D-dimer levels >0.545 mg/L, and von Willebrand factor (vWF) level >178.55 ng/mL (all p <0.05) vs. the non-DVT group. Independent risk factors for DVT included age ≥65 years, BMI ≥28 kg/m2, female gender, history of diabetes, cemented prosthesis, operation duration ≥90 minutes, bed rest duration ≥72 hours, no mechanical thromboprophylaxis, D-dimer >0.545 mg/L, and vWF >178.55 ng/mL. A predictive nomogram incorporated these variables using regression coefficients (e.g., age × 1.128 ... vWF × 6.225; intercept = 4.545).

Conclusion: Key modifiable and non-modifiable factors influence the risk of DVT following TKA. The predictive validated nomogram demonstrates clinical utility for individualised risk stratification and prevention strategies.

Key words: Total knee arthroplasty, Deep vein thrombosis, Risk factors, Predictive model.

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Objective: To investigate the immune mechanisms underlying susceptibility to COVID-19 and the development of sequelae.

Study design: A cross-sectional observational study. Place and Duration of the Study: Clinical Laboratory, Jilin Province People's Hospital, Jilin, China, from 14th to 30th December 2022.

Methodology: Seventy-one individuals were investigated, including 56 individuals who had recovered from COVID-19 infection and 15 uninfected individuals. Immunophenotypic analysis of B, T, and NK lymphocytes in peripheral blood samples was performed using full-spectrum flow cytometry. The differences in immune cell populations defined by the traditional gating strategy and the unsupervised algorithm between groups were analysed. Categorical data were compared between groups using the chi-square test. Quantitative data were compared using the t-test or Mann-Whitney U test.

Results: Compared to uninfected individuals, recovered individuals, especially those with sequelae, had significantly higher counts of lymphocytes, T cells, NKT cells, CD8+T cells, CD4+CD28+T cells, CD4+CD38+T cells, CD8+CD28+T cells, CD8+CD38+T cells, CD69+T cells, and Tregs. An increase in these lymphocytes may contribute to immune homeostasis. Meanwhile, the CD38+NKT cell count was significantly decreased in the recovered individuals. Moreover, an upregulation of T-cells, NKT cells, CD4+T cells, CD8+T cells, CD4+CD28+T cells, CD4+CD38+T cells, CD8+CD28+T cells, CD8+CD38+T cells, CD69+T cells, Treg cells, and CD38+NKT cells was observed in patients with sequelae.

Conclusion: This study showed that the lymphocyte subgroups' counts were associated with COVID-19 infection and post-infection sequelae. These findings may contribute to understanding the mechanism of COVID-19 infection and recovery.

Key words: COVID-19, Full-spectrum flow cytometry, Traditional gating strategy, Unsupervised algorithm, Blood immune cells, Suscep- tibility, Sequelae.

Objective: To compare kinesiophobia levels between parents of haemophilic patients and parents of healthy children, and to investigate the factors associated with kinesiophobia in parents of haemophilic patients.

Study design: A cross-sectional descriptive study. Place and Duration of the Study: Department of Physical Medicine and Rehabilitation, Bursa City Hospital, Bursa, Turkiye, between December 2023 and June 2024.

Methodology: Thirty mothers of children with haemophilia (MCwH) and thirty mothers of healthy children (MHC) were evaluated using the Visual Analogue Scale for pain, the Short Form-36 for quality of life, the Beck Depression Inventory (BDI) for depression level, and the Tampa Scale for Kinesiophobia (TSK). TSK scores between the two groups were compared using the Mann-Whitney U test. The correlations between TSK scores and the study variables were examined using Spearman's rank correlation coefficient.

Results: No significant differences were found between the MCwH and MHC groups in terms of age, BMI, and educational status (p >0.05). The median TSK scores were 44.0 (33.3-46.0) in the MCwH group and 40.5 (36.0-44.0) in the MHC control group. There was no significant difference in TSK scores between the groups (p >0.05).

Conclusion: The risk of bleeding in people with haemophilia, the pain secondary to bleeding, and the risk of sustaining an injury contribute to increased levels of kinesiophobia, not only in individuals with haemophilia but also in their parents. Physicians should focus on parents' kinesiophobia when evaluating patients with haemophilia and inform parents about its importance and available treatment strategies.

Key words: Fear of movement, Haemophilia, Kinesiophobia, Emotion regulation.