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

Objective: To determine the clinical microbial synergy in skin and soft tissue infections (SSTIs) based on bacterial groups and explore the likelihood ratios of clinical parameters.

Study design: Descriptive cross-sectional study. Place and Duration of the Study: The study was conducted at the Department of Microbiology, University of Karachi in collaboration with Jinnah Postgraduate Medical Centre, and Jinnah Sindh Medical University, Karachi, Pakistan, from June 2023 to May 2024.

Methodology: A total of 304 pus samples from clinically diagnosed cases of SSTIs were included in the study and were processed for microbiological work-up. Isolates were cultured on blood and MacCokney's agar media. Staphylococcal species were identified via the Rapid-ID staph plus system. Continuous data was represented as mean and standard deviation and categorical data were expressed as frequencies (percentages) and were further analysed by using the Chi-square test and multinomial regression model.

Results: The study revealed substantial associations between bacterial types and factors such as clinical unit, ethnicity, skin-barrier disruptions, infection site, and wound classification (p-value <0.05) in SSTIs. Metabolic and endocrine disorders increased the odds ratio of gram-negative rod infections (OR = 3.25). Accidents and trauma were associated with higher odds ratio of gram-positive cocci infections (OR = 3.288). Bacterial types varied across wound classes, with gram-positive cocci more common in classes I, II, and III (OR = 3.29, 2.00).

Conclusion: This study identifies key predictors of bacterial aetiology in skin SSTIs, revealing increased associations between gram-negative rods and metabolic and endocrine disorders, gram-positive cocci and trauma-related SSTIs, and gram-negative rods in surgical site infections.

Key words: Bacterial infections, Infection control, Soft tissue infections, Surgical site infections.

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Objective: To investigate the effects of bulk-fill, resin-based composite types (high or low viscosity) on the internal adaptation of Class V restorations.

Study design: Experimental study. Place and Duration of the Study: Hefei Stomatological Hospital, Hefei, China, from October 2022 to December 2023.

Methodology: A total of 140 extracted human premolars were collected. Class V cavities were prepared on the buccal surface of each tooth, which was randomly divided into seven groups (n = 20). Cavities were restored by two low-viscosity and three high-viscosity bulk-fill resin-based composites or two conventional resin-based composites. All the samples were artificially aged. The percentage of debonding formation (D%) was calculated at baseline and 6 months later using optical coherence tomography (OCT). The OCT data were statistically analysed using one-way ANOVA, and the effects of composite type and artificial ageing were analysed via two-way ANOVA.

Results: For Class V restorations, two low-viscosity bulk-fill resin-based composites generated significantly lower D% (p <0.05). Two-way ANOVA revealed that both composite type and artificial ageing significantly influenced internal adaptation (p <0.05).

Conclusion: The low-viscosity bulk-fill resin composites demonstrated better internal adaptation both before and after artificial ageing.

Key words: Bulk-fill resin composite, Debonding formation, Artificial ageing, Optical coherence tomography, Class V.

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Objective: To assess the factors that affect mothers' quality of life (QOL) and the association of various demographic variables with QOL of the respondents.

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

Methodology: Mothers of visually impaired children were selected through non-probability consecutive sampling. WHO QOL-BREF was used to analyse the QOL of the respondents. The Chi-square test of association was applied to determine the factors of QOL of the respondents.

Results: Out of 264, the majority of the visually impaired children were females (n = 144, 54.5%) and belonged to 5-8 years of age (n = 115, 43.6%). It was also noted that the majority of children had mild levels of visual impairment (n = 182, 69%). More than half of the mothers of visually impaired children were married to their cousins (n = 144, 54.5%) and belonged to rural areas (n = 140, 53%). Most of the mothers perceived that they had a good quality of life (n = 96, 36%) and were satisfied with their health status (n = 107, 40%). Mothers with poor QOL were slightly more in numbers compared to those with good QOL (n = 134. 51% vs. n = 130. 49%).

Conclusion: Mothers of visually impaired children exhibited poor QOL in all four domains. Major related factors associated with poor QOL of mothers were the age of the child, cause of disability, duration of disability, and duration of caregiving. While mother's related factors included marital status, outside family marriage, education, income level, number of children, and residence.

Key words: Mothers, Quality of life, Rawalpindi, Tertiary care hospitals, Visually impaired children.

Objective: To establish the construct validity of the Assessment Implementation Measures (AIM) tool to accurately assess faculty perspectives on implemented assessment systems, facilitating the alignment with set standards.

Study design: Qualitative Study. Place and Duration of the Study: The study was carried out at RIPHAH International University and data were collected from participants (senior faculty members) involved in teaching and assessment of undergraduates from various medical and dental colleges in Pakistan. Google form questionnaire was distributed using email and WhatsApp. The data were analysed using IBM AMOS SPSS version 24.

Methodology: It was a 30-item tool. The sample size was calculated using 1:10 item-to-participant ratio. Hence data were collected from 313 participants. Confirmatory factor analysis was done to establish construct validity.

Results: The indices of confirmatory factor analysis of the tool showed a discrepancy. To remove this discrepancy, items with weak item-loading values were removed. In the end, the tool was reduced to 13 items belonging to three domains.

Conclusion: The final model was improved by excluding items from the original model. A re-validation study with a careful selection of experienced participants from various institutional backgrounds having baseline knowledge of medical education is suggested to improve the results.

Key words: AIM Tool, Confirmatory factor analysis, Medical education, Assessment.

Antimicrobial-resistant bacteria are particularly prevalent in Southeast Asia, mainly due to inadequate infection prevention and control (IPC) and the widespread and uncontrolled use of antibiotics. Pakistan is the third largest low-middle-income country (LMIC) user of antibiotics. Antibiotic consumption increased by 65%, from 800 million to 1.3 billion defined daily doses (DDD). Antimicrobial consumption is high and poorly regulated, and an estimated 300,000 people die because of bacterial antimicrobial resistance (AMR) annually. Due to the changing government priorities, antimicrobial stewardship programmes (ASP) implementation is not compulsory for hospitals to acquire national accreditation, which has led to de-prioritisation among hospital managers and clinical teams. Additionally, lack of support from hospital administration, limited nationwide health insurance coverage for bacterial cultures, and a lack of surgical centres and microbiology laboratories, information technology (IT) support to collect and analyse AS-related data, reduced availability of pharmacists, ID physicians, and IPC staff for ASP events are the primary contributing factors creating hindrance to the long-term viability of ASP. Briefly, strong hospital leadership support is the major factor for allocating the resources for ASP structures and activities and also for establishing the key performance indicators (KPIs), enforcing compliance with hospital-specific clinical practice guidelines, as well as addressing friction between ASP team members and prescribers. Key Words: Antimicrobial resistance, Antimicrobial stewardship programmes, Infection prevention and control.

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Objective: To compare the closed reduction approach with open reduction (transparotid approach) in the management of condylar fractures for parameters such as postoperative facial nerve injury, trismus, and malocclusion.

Study design: An analytical comparative study. Place and Duration of the Study: Department of Oral and Maxillofacial Surgery, The Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, from 10th January 2022 to 1st October 2023.

Methodology: Patients with condylar fractures were included and divided into two groups (30 each) and condylar fractures were managed under general anaesthesia. After obtaining informed consent, condylar fractures were managed with closed reduction (maxillomandibular fixation with Eyelets or Arch Bar) in one group. In the other group, open reduction and internal fixation (ORIF) via transparotid approach were performed. Postoperatively, facial nerve injury was recorded five days after the procedure. Postoperative trismus and malocclusion were recorded three months after the procedure.

Results: Better treatment outcomes in terms of postoperative malocclusion and trismus were recorded for open reduction and internal fixation i.e. transparotid approach as compared to closed reduction. Facial nerve injury was recorded for the initial period in transparotid approach but long-term results among both techniques were comparable.

Conclusion: Transparotid approach in comparison with closed reduction provides good results in the management of condylar fractures.

Key words: Condylar fractures, Open reduction, Closed reduction, Facial nerve injury, Transparotid approach.

Objective: To investigate the characteristics of Adult-onset Still's disease (AOSD) patients with macrophage activation syndrome (MAS) and explore the risk factors for the development of MAS.

Study design: A case-control study. Place and Duration of the Study: Department of Rheumatology and Immunology, the Second Hospital of Anhui Medical University, Anhui, China, from January 2008 to June 2024.

Methodology: AOSD patients with MAS (AOSD-MAS) and without MAS (AOSD-nonMAS) were compared. Clinical features and laboratory results from two groups were analysed using the independent samples t-test or Mann-Whitney U test. Fisher's exact test or Pearson's Chi-square test was used to compare the variables between the two groups. The multivariable logistic regression analysis was applied to identify AOSD with MAS-associated factors. The value of risk factors in predicting MAS occurrence was carried out by a receiver operating characteristic validation analysis.

Results: MAS patients showed higher prevalence of sore throat, splenomegaly and abnormal liver function, a lower prevalence of arthrodynia and higher levels of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, alanine aminotransferase, aspartate aminotransferase, lactic dehydrogenase, serum ferritin, D-Dimer levels, and a higher AOSD system score, along with a lower lymphocyte count (p <0.05). Multivariate logistic regression analysis identified NLR and AOSD system scores as predictors of MAS. An optimised threshold of 17.455 and 5.500 for NLR and AOSD system score yielded a sensitivity of 84.60% (38.50) and a specificity of 91.00%, (47.40).

Conclusion: Early detection of MAS in AOSD may be facilitated by monitoring these factors, particularly NLR and AOSD system scores.

Key words: Adult-onset still's disease, Macrophage activation syndrome, Risk factor.