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

Objective: To identify potential pivotal genes associated with Crohn's disease (CD) that may serve as potential diagnostic biomarkers.

Study design: A bioinformatics analysis. Place and Duration of the Study: Department of Gastrointestinal Dysfunction Centre, Anhui No.2 Provincial People's Hospital, Hefei, China, from June 2023 to June 2024.

Methodology: Multiple gene expression datasets from the NCBI Gene Expression Omnibus (GEO) were used to identify potential diagnostic biomarkers. Weighted gene co-expression network analysis (WGCNA) was conducted; CD-related genes were selected through WGCNA, gene-gene interaction network analysis, and Least Absolute Shrinkage and Selection Operator (LASSO) regression. Logistic regression and six supervised learning techniques-including support vector machine, random forest, K-nearest neighbour, neural network, decision tree, and extreme gradient boosting (XGB)-were used to assess and compare the diagnostic performance of various models.

Results: Hub gene screening, immune infiltration analysis, and gene set enrichment analysis were used to explore the association between the potential genes and CD. A nomogram based on the logistic regression model was developed, and the clinical utility of the hub genes was evaluated through decision curve analysis (DCA). Additionally, six machine learning models were developed, with the XGB model demonstrating the highest performance. The area under the curve (AUC) for the XGB model was 99.4% for the training set, 77.7% for the validation set, and 83.5% for external validation data, indicating its superior diagnostic potential.

Conclusion: This study identified five genes that are closely associated with CD. Based on these genes, a CD diagnostic model was established, with the XGB model showing the most promising results among the six tested models.

Key words: Crohn's disease, Genes, Prediction model, Machine learning.

Objective: To examine the association of sarcopenia with elevated all-cause mortality risk.

Study design: Descriptive study. Place and Duration of the Study: Department of Endocrinology, the First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Hubei, China, from December 2024 to April 2025.

Methodology: Data were obtained from 11,176 eligible adults who participated in the National Health and Nutrition Examination Survey (NHANES) conducted from 1999 to 2006. The sarcopenia index (SI) was computed as the ratio of appendicular skeletal muscle mass (ASM, kg), measured using dual-energy x-ray absorptiometry, to body mass index (BMI, kg/m2). The cohort was stratified into quartiles based on the SI (Q1-Q4). Mortality follow-up lasted until December 31, 2019. A multivariable Cox proportional hazards model was used to evaluate the association between the SI and all-cause mortality. Non-linear relationships were assessed using restricted cubic splines, and subgroup analyses were performed to assess effect modification.

Results: After accounting for demographic, socio-economic, lifestyle, and clinical factors, there was an inverse, non-linear relationship between SI and all-cause mortality. Specifically, the mortality risk in the Q4 group (highest SI quartile) was 24% lower than in the Q1 group (lowest SI quartile; p <0.05). In participants with metabolic abnormalities, such as overweight/obese, hypertension, or impaired glucose metabolism, higher SI was significantly linked to reduced mortality. Moreover, using the Kaplan-Meier analysis, the Q4 group featured the best prognosis, while the Q1 group had the lowest survival rate.

Conclusion: Sarcopenia, assessed by the SI, has a significant correlation with all-cause mortality. Moreover, a strong association between them was observed in populations with metabolic abnormalities.

Key words: Sarcopenia, Sarcopenia index, Mortality, Metabolic abnormalities, Nutrition surveys, Cohort study.

Objective: To determine the diagnostic accuracy of elevated preoperative C-reactive protein (CRP) level in predicting a difficult laparo- scopic appendectomy (LA).

Study design: A descriptive study. Place and Duration of the Study: Department of General Surgery, Dr Ruth, K. M. Pfau Civil Hospital, Dow University of Health Sciences, Karachi, Pakistan, from June to November 2021.

Methodology: Patients operated for LA underwent baseline investigations and preliminary anaesthesia fitness. Intraoperative findings, including difficult dissection due to dense adhesions, were recorded by a primary surgeon on postoperative notes. Serum CRP level, specificity, sensitivity, diagnostic accuracy, positive predictive value (PPV), and negative predictive value (NPV) were measured. ROC curve was plotted, and the area under the curve (AUC) was utilised. An independent-sample t-test was used to compare mean CRP in patients who underwent laparoscopy-corrected-to-open appendectomy with those who underwent LA. The Chi-square test was used to compare the differences in the proportion of conversion to open surgery from LA and between CRP levels (<220 vs. ≥220 mg/L).

Results: The mean age of the 181 patients was 39.21 ± 10.90 years. There were 87 (48.07%) males and 94 (51.93%) females. The cut-off CRP levels were 220 mg/L for predicting conversion to open appendectomy from LA. The percentages of PPV, NPV, accuracy, sensitivity, and specificity of CRP ≥220 mg/L were 86.96%, 93.26%, 93.02%, 87.37%, and 90.01%, respectively. The area under the receiver operating characteristic curve (AUROC) for the said study model was 0.941, with 95% confidence interval of 0.91 to 0.97.

Conclusion: Elevated preoperative CRP level is a significant predictor of difficult LA. The CRP level aids in selecting patients for early discharge and reducing unnecessary investigations.

Key words: Appendicitis, Laparoscopic appendectomy, C-reactive protein level.

Objective: To determine the frequency and severity of joint hypermobility (JH) in rhinoplasty patients and to assess rhinoplasty satisfaction in rhinoplasty cases with JH.

Study design: Comparative cross-sectional study. Place and Duration of the Study: Department of Plastic and Aesthetic Surgery, Yuzuncu Yil University Hospital, Van, Turkiye, between February and May 2024.

Methodology: A total of 108 participants (54 rhinoplasty patients and 54 matched healthy controls) were examined in this study. Patients and healthy controls were compared in terms of the frequency and severity of JH. The Beighton scoring system was used to assess hypermobility. Rhinoplasty patients with JH (Beighton score ≥4) and without JH (Beighton score <4) were compared in terms of rhinoplasty outcomes. The rhinoplasty outcome evaluation (ROE) questionnaire was used as an outcome measure.

Results: Rhinoplasty patients and healthy controls were statistically similar in terms of frequency (p = 1.0) and severity (p = 0.754) of JH. No significant correlation was found between hypermobility scores and rhinoplasty results in rhinoplasty patients (n = 54; r = 0.015; p = 0.916; Spearman's correlation test). Rhinoplasty patients with and without JH were similar in terms of rhinoplasty results (15.30 ± 6.82 vs. 16.16 ± 4.92; p = 0.645). No significant correlation was found between JH scores and rhinoplasty results (p = 0.916).

Conclusion: JH does not appear to be associated with rhinoplasty and should not be a concern in rhinoplasty. It is not necessary to consider JH to ensure rhinoplasty satisfaction.

Key words: Rhinoplasty, Satisfaction, Joint hypermobility, Beighton score.

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Objective: To investigate the impact of plasma homocysteine (Hcy) levels on the cardiac valve calcification (CVC) in patients undergoing maintenance haemodialysis (MHD).

Study design: A retrospective observational analysis. Place and Duration of the Study: Department of Nephrology, Hangzhou First People's Hospital, Hangzhou, China, from May 2022 to August 2023.

Methodology: Patients undergoing MHD were classified into two groups based on the echocardiographic results: CVC group and Non-CVC group. The former had CVC, and the latter was without calcified valves. The differences in baseline data between the two groups were compared, and logistic regression analysis was employed to investigate the impact of plasma Hcy on the CVC.

Results: Of the total 98 patients undergoing MHD, 64 (65.3%) had CVC, and 79 (80.6%) had hyperhomocysteinaemia. The proportion of hyperhomocysteinaemia was greater in the CVC group than in the Non-CVC group (90.6% vs. 61.8%, p = 0.001). Multivariate logistic regression indicated that, after adjusting for age, duration of dialysis, serum calcium levels, diabetes, and other variables, elevated plasma Hcy levels were independently linked to an increased risk of CVC, irrespective of whether Hcy was considered as a continuous variable (OR = 1.121, 95% CI 1.051-1.195; p <0.001) or a binary variable (OR = 5.191, 95% CI 1.379-19.54; p = 0.015).

Conclusion: Elevated plasma Hcy levels are independently linked to a greater risk of CVC in patients undergoing MHD.

Key words: Homocysteine, Cardiac valve calcification, Haemodialysis.

This paper aimed to identify the facilitators, barriers, and recommendations for overcoming challenges to HIV self-testing (HIVST) uptake among men who have sex with men (MSM) and transgender (TG) people in Asia. Using a systematic search strategy, databases including PubMed, OCLC, EBSCOhost, Google Scholar, SABINET Online, Union Catalogue of Theses and Dissertations, WorldCat Dissertations, and ERIC were searched. The Confidence in the Evidence from Reviews of Qualitative Research (CERQual) approach was used to analyse the findings. The results suggest that HIVST is perceived as a more confidential and easier method compared to traditional HIV testing among MSM and TG individuals. HIVST can increase the reach of HIV testing services for MSM and TG individuals in Asia. Community-based organisations and community workers can facilitate HIVST among MSM and TG in Asia. However, the cost of test kits is a significant barrier to HIVST uptake. Additionally, counselling services make traditional HIV testing preferable than HIVST method among these populations. Overall, there is a lack of policy for supporting HIVST for MSM and TG in many Asian countries. There are concerns among users and stakeholders that HIVST may lead to mental distress, promoting recommendations to link mental health services in a way that protects users' privacy. Key Words: HIV self-testing, Uptake, Health system, Multi-stakeholder, Men who have sex with men.

Helicobacter pylori is a class I carcinogen, strongly associated with gastric cancer, gastric ulcers, and gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Helicobacter pylori (H. pylori) infection necessitates effective eradication strategies. This study evaluated Saccharomyces boulardii (S. boulardii) as an adjunctive therapy to standard bismuth-containing quadruple therapy for H. pylori eradication. Comprehensive searches across PubMed, Embase, Cochrane Library, CNKI, WanFang Data, CBM, and Web of Science identified relevant randomised controlled trials (RCTs). Analysis of 11 RCTs (n = 2,295 patients) demonstrated significantly higher eradication rates (78.6% to 89.2%) with adjunctive S. boulardii (n = 2,295; ITT analysis: RR = 1.12; 95% CI: 1.06-1.18; Z = 4.27, p <0.01) versus standard therapy alone. Crucially, the probiotic combination also substantially reduced treatment-related adverse events (n = 2,183; RR = 0.46; 95% CI: 0.28-0.74; Z = 3.16; p = 0.002), with pronounced reductions in diarrhoea (n = 2,091; RR = 0.46; 95% CI: 0.22-0.93; Z = 2.15; p = 0.03) and rash occurrence (n = 1,271; RR = 0.33; 95% CI: 0.14-0.77; Z = 2.55; p = 0.01). These findings support S. boulardii supplementation as an effective strategy that enhances standard bismuth quadruple therapy efficacy while mitigating gastrointestinal and dermatological complications in H. pylori management. Therefore, the combination of S. boulardii and bismuth-containing quadruple therapy was effective in the treatment of H. pylori infection and has shown significant efficacy and safety as an effective and safe treatment. Key Words: Saccharomyces boulardii, Helicobacter pylori, Bismuth, Quadruple therapy.