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

Objective: To identify the factors associated with postoperative ileus (POI) following Caesarean section.

Study design: A descriptive study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, Zeynep Kamil Women's and Children's Diseases Training and Research Hospital, Istanbul, Turkiye, between April 2021 and February 2025.

Methodology: A total of 293 women who underwent Caesarean section were evaluated postoperatively. POI was defined as the absence of the first flatus within 24 hours after surgery. Demographic and obstetric characteristics, as well as factors associated with POI, were compared between patients with and without POI.

Results: POI developed in 33 patients (11.3%). Multivariate binary logistic regression showed an increased risk of POI with each 1-unit decrease in preoperative haemoglobin level (RR 1.357, 95% CI = 1.029-1.791, p = 0.031) and with intraoperative drain placement (RR 6.433, 95% CI = 2.326-17.792, p <0.001).

Conclusion: POI can delay postpartum recovery. Preoperative anaemia, history of POI, and intraoperative drain placement are significant risk factors for POI after Caesarean section.

Key words: Caesarean section, Ileus, Maternal health, Postoperative complications, Postpartum women.

Objective: To compare the efficacy of Letrozole and Elagolix in the medical management of endometriosis-associated pain Study Design: A quasi-experimental study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, Fatima Jinnah Medical University/Sir Ganga Ram Hospital, Lahore, Pakistan, from March to August 2025.

Methodology: Women presenting with endometriosis-related pain were allocated to treatment groups. Patients in Group A (n = 29) received oral Letrozole 2.5 mg, while patients in Group B (n = 30) received oral Elagolix 150 mg once daily for three months. VAS pain scores were recorded before and 3 months post-intervention, and compared between the Letrozole and Elagolix groups using an independent samples t-test and chi-square test.

Results: Baseline data were comparable between the study groups (all p > 0.05). At 3 months post-intervention, the Elagolix group showed a significantly lower VAS score for dyspareunia (3.6 ± 2.2 vs. 4.7 ± 0.9; p = 0.016) and a greater reduction in dysmenorrhoea scores (2.2 ± 0.9 vs. 1.4 ± 1.8; p = 0.048). A shift from severe to mild was evident with significant improvements in pelvic pain (p = 0.043) and dysmenorrhoea (p = 0.036). Stratified analysis revealed significantly greater reductions in dysmenorrhea scores among Elagolix users aged ≤29 years (p = 0.025), with BMI <25 kg/m2 (p = 0.013) and regular menstrual cycles (p = 0.027). Pelvic pain scores also improved significantly in participants with a monthly household income of ≥ 50,000 PKR (p = 0.037).

Conclusion: Elagolix demonstrated greater efficacy than Letrozole in reducing endometriosis-related pain after three months of treatment. This efficacy was more evident for dysmenorrhoea among specific patient subgroups, including those with younger age, lower BMI, or regular menstrual periods.

Key words: Elagolix, Endometriosis, Letrozole, VAS pain.

To determine the characteristics of non-small cell lung cancer (NSCLC) patients with fusion genes emerging after resistance to EGFR-TKIs. This study retrospectively collected 2800 cases of NSCLC with EGFR-sensitive mutations who underwent tissue-based next- generation sequencing (NGS) testing at least once. Patients with acquired fusion mutations, including ALK, ROS1, RET, etc., were included in the study, and clinical data, gene mutation status, treatment strategies, and follow-up were collected. Given the small sample size and exploratory design of this case series (n = 9), the findings were reported descriptively. There were six cases of ALK fusion, two cases of RET fusion, and one case of ROS1 fusion. EGFR abundance decreased in five patients, while EGFR was detected as negative in the other four patients. When fusion mutations emerged, the use of ALK/RET/ROS1-TKIs or EGFR-TKIs combined with fusion-TKIs demonstrated efficacy. The progression-free survival ranged from 5 months to ≥39 months. One patient with acquired fusion gene mutations developed small-cell lung cancer transformation after ALK-TKIs resistance. Key Words: Lung cancer, ALK fusion, RET fusion, ROS1 fusion, EGFR-TKIs-resistance, Targeted therapy.

Objective: To evaluate the role of the immature granulocyte (IG) value in the diagnosis of oesophagojejunostomy anastomosis leakage (EJAL).

Study design: A descriptive, analytical study. Place and Duration of the Study: Department of Gastroenterology Surgery, Ankara Etlik City Hospital, Ankara, Turkiye, from October 2022 to November 2024.

Methodology: The study included 59 patients who underwent total gastrectomy for gastric cancer between 2022 and 2024. Age, gender, T stage, N stage, tumour grade, preoperative albumin level, ASA score, combined organ resection, and postoperative values of CRP, white blood cell (WBC) count, and IG values on day 1, 3, and 5 were compared. Student's t-test, Mann-Whitney U test, and Pearson's chi-square test were used to compare the two groups with or without EJAL.

Results: EJAL was observed in 5 (8.5%) cases. There was a statistically significant difference between the groups in the CRP and IG values on postoperative day 5. Among these statistically significant results, the most meaningful was the IG value on postoperative day 5, with a cut-off value of 0.11 (sensitivity 100%, specificity 85.19%).

Conclusion: In cases undergoing total gastrectomy for gastric cancer, the IG value on postoperative day 5 can be used to diagnose EJAL and is more significant than CRP and WBC values.

Key words: Gastric cancer, Oesophagojejunostomy leak, Immature granulocyte.

Objective: To determine the frequency of anti-ganglioside autoantibodies and their clinical associations in patients clinically suspected of having Guillain-Barré Syndrome (GBS).

Study design: A cross-sectional descriptive study. Place and Duration of the Study: Department of Immunology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from July 2024 to July 2025.

Methodology: Anti-ganglioside (IgG/IgM) antibody-positive 28 patients with suspected GBS, tested using the EUROLINE Anti-Gangliosides Profile 2 (EUROIMMUN, Germany), were included. Band intensity was quantified automatically using EUROLineScan (EUROIMMUN, Germany). Clinical features, antecedent events, and electrophysiological findings (EMG/NCS) were documented. Normality was assessed using the Shapiro-Wilk test. The chi-square and Fisher's exact tests were applied; the independent-samples t-test was used for continuous variables. A p <0.05 was considered significant.

Results: Of the 28 patients, GBS variants were the predominant clinical entities (67.8%), with axonal subtypes accounting for 39.2% and demyelinating variants comprising 28.6% of the cases. The mean age of participants was 36.4 ± 16.6 years, and 75% were male. Gastrointestinal infections were the most common antecedent event (57.9%), followed by upper respiratory tract infections (26.3%). Progressive para/tetraparesis was significantly more frequent in axonal variants (p = 0.024), while cranial nerve palsies were notably associated with demyelinating forms (p = 0.005). Anti-GM1 antibodies were the most frequently detected (46.5%) and showed a statistically significant association with axonal subtypes (p = 0.019).

Conclusion: Axonal subtypes predominated, with anti-GM1 antibodies correlating with motor-predominant variants. Combining serology with clinical and electrophysiological data may strengthen diagnostic accuracy. Future studies should include larger cohorts and investigate preceding infections, such as Campylobacter jejuni.

Key words: Guillain-Barré syndrome, Anti-ganglioside autoantibody, Axonal GBS, Demyelinating GBS, Peripheral neuropathy.

Objective: To determine the frequency of impaired Oral Glucose Tolerance Test (OGTT) results in women with Polycystic Ovary Syndrome (PCOS) attending a tertiary-care gynaecology outpatient clinic.

Study design: A cross-sectional observational study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, MTI-Hayatabad Medical Complex, Peshawar, Pakistan, from June to December 2024.

Methodology: Consecutive women aged 18-45 years who met the Rotterdam criteria for PCOS were enrolled. Exclusion criteria included known diabetes mellitus, pregnancy, and use of medications affecting glucose metabolism, except for metformin. A standard 75-g OGTT was performed after an overnight fast (≥8 hours). Fasting and 2-hour plasma glucose levels were categorised using American Diabetes Association definitions. Demographic, clinical, and lifestyle variables were recorded. Associations between OGTT categories and categorical variables were tested using the chi-square test (α = 0.05).

Results: A total of 360 participants were analysed (mean age: 30.44 ± 6.14 years; mean BMI: 28.30 ± 5.27 kg/m2). Normal glucose tolerance occurred in 50.0% (n = 180) participants, impaired glucose tolerance in 37.5% (n = 135), and diabetes in 12.5% (n = 45). No statistically significant associations were observed between OGTT category and menstrual regularity, family history of diabetes, hypertension, dyslipidaemia, physical activity, dietary pattern, insulin resistance, medication use, or smoking status (all p >0.05).

Conclusion: Dysglycaemia is common in women with PCOS in outpatient care. Routine OGTT-based screening should be integrated into clinical assessment to enable early identification and management of metabolic risk.

Key words: Polycystic ovary syndrome, Oral glucose tolerance test, Impaired glucose tolerance, Diabetes mellitus, Screening.

Objective: To analyse the association of single-nucleotide polymorphisms in two variants of the GP130 (IL6ST) gene, rs754547662 Guanine/thymine (G/T) and rs747379809 Guanine/thymine (G/T), with unexplained infertility in women.

Study design: A case-control study. Place and Duration of the Study: Department of Physiology, University of Karachi, in collaboration with the Australian Concept of Infertility Medical Centre, from November 2020 to December 2022.

Methodology: A total of 135 females with unexplained infertility and 177 fertile women serving as controls were enrolled in the study. Genotyping was performed using Tetra-Amplification Refractory Mutation System Polymerase Chain Reaction (T-ARMS-PCR). Genomic DNA was amplified by T-ARMS-PCR, followed by agarose gel electrophoresis for the identification of the tested allele. The amplified and purified samples were sequenced via Sanger sequencing and subsequently submitted to GenBank. All statistical analyses were performed using SPSS 23. An independent t-test was used for group comparison; p <0.05 was considered statistically significant.

Results: In the rs747379809 and rs754547662 variants of the GP130 (IL6ST) gene, only the wild-type G allele was detected in all cases and controls. The major allele G and the GG (homozygous) genotype were found in all women. The minor allele T and the GT, TT (heterozygous) genotypes were not detected in any individual. Therefore, the findings reported no observed association between GP130 (IL6ST) gene polymorphisms rs747379809 (G/T) and rs754547662 (G/T) and unexplained infertility.

Conclusion: The findings indicate that unexplained infertility is not associated with the GP130 (IL6ST) gene polymorphisms in rs747379809 and rs754547662 variants. These results suggest that variations in this signalling pathway do not contribute significantly to the aetiology of unexplained infertility in the studied population. Further research involving larger cohorts and additional molecular markers may help clarify the complex genetic landscape underlying this condition.

Key words: Embryo Implantation, Genetic Polymorphism, Glycoprotein, GP130 (IL6ST), Infertility.

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This study aimed to determine the effectiveness of the Sofosbuvir and Daclatasvir (SOF/DCV) combination treatment in haemodialysis patients with chronic hepatitis C virus (HCV). This prospective interventional study was conducted from October 2023 to April 2024. Sixty patients of either gender, aged 18 to 60 years, with chronic HCV infection who had been on haemodialysis for >3 months were included. All patients received a fixed dose of SOF/DCV. Sustained virologic response (SVR) was assessed three months after completion of therapy. The mean age of the patients was 45 ± 14.32 years, with 31 (51.7%) females and 29 (48.3%) males. SVR was achieved in all cases, indicating a 100% efficacy of SOF/DCV. Furthermore, no side effects were reported. Thus, combination of SOF/DCV is effective and safe for the treatment of HCV infection in haemodialysis patients. Key Words: Chronic hepatitis C virus, Daclatasvir, Haemodialysis, Sofosbuvir.

Non-communicable diseases (NCDs) during pregnancy can have detrimental outcomes for the mother-child pair. An analytical cross-sectional study was conducted in Union Council 69, District Lahore, Pakistan, using a sample of 220 pregnant women to determine the prevalence of selected NCDs. Approximately one-quarter of the sample (23%) had a chronic disease, with pregnancy-induced hypertension being the most frequently occurring condition (19%). NCDs were significantly associated with postpartum complications in both mothers and neonates. The results provide essential baseline data to improve NCD care during this critical phase. Key Words: Non-communicable diseases, Maternal outcomes, Birth complications, Diabetes mellitus, Gestational diabetes.