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

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 Objective: To investigate the frequency of sarcopenia in patients with chronic obstructive pulmonary disease (COPD) and in the Control group, and to compare the 6-minute walk test (6MWT), handgrip strength (HGS) measured by a dynamometer, pulmonary function test (PFT) parameters, and bioimpedance analysis (BIA) parameters among the COPD GOLD A, B, and E subgroups.

Study design: Cohort study. Place and Duration of the Study: Department of Pulmonary Disease, Faculty of Medicine, Tokat Gaziosmanpasa University, Totak, Turkiye, from February to August 2022.

Methodology: Sarcopenia rates were compared between the COPD group and the Control group. Patients diagnosed with COPD according to the GOLD 2022 criteria by pulmonologists were included in the COPD group. Volunteers without any neuromuscular and pulmonary disease were included in the Control group.

Results: The study included 43 patients with COPD and 40 volunteers without respiratory disease. The incidence rate of sarcopenia was found to be 39.5% in the COPD group. Group E patients had the highest rate of sarcopenia (70%). It was found that the COPD group had lower HGS, as measured by dynamometer, and age and gender-corrected HGS measurements compared with the Control group (p = 0.019 and p = 0.005, respectively).

Conclusion: Sarcopenia was found to be higher in the COPD group compared to the Control group. The highest rate was observed in Group E. Sarcopenia should definitely be taken into consideration in the follow-up of COPD patients, and treatment of sarcopenia (nutritional supplement, exercise, and pulmonary rehabilitation etc.) should be evaluated in those patients.

Key words: Chronic obstructive pulmonary disease, Sarcopenia, Inflammation, Muscle mass.

Objective: To determine the frequency of atypical presentation of hepatitis A virus (HAV) infection in children.

Study design: A cross-sectional study. Place and Duration of the Study: Department of Paediatric Gastroenterology, Hepatology and Nutrition, The Children's Hospital and the Institute of Child Health, Multan, Pakistan, from November 2023 to April 2024.

Methodology: Children of either gender, aged 1-18 years, who visited the outpatients or emergency department, and were diagnosed with HAV infection were included in the study. HAV infection was diagnosed based on clinical and laboratory findings. Atypical manifestations of HAV were also documented. The Chi-square test for categorical data and the Independent sample t-test or Mann-Whitney U test for the comparison of quantitative variables were applied, considering p <0.05 as statistically significant.

Results: In a total of 246 children, 144 (58.5%) were boys. The mean age was 6.52 ± 4.25 years. Atypical presentation of HAV infection was recorded in 60 (24.4%) children. The most frequent atypical presentations were ascites, pleural effusion, thrombocytopenia, and cholestasis, noted in 21 (35.0%), 16 (26.7%), 13 (21.7%), and 9 (15.0%) children, respectively. A relatively younger age was found to have a significant association with atypical presentation of HAV (p = 0.014). When compared to children with typical HAV manifestations, children with atypical manifestations had significantly less serum bilirubin (p <0.001), higher INR (p <0.001), and lower haemoglobin (p = 0.004).

Conclusion: Atypical manifestations of HAV are common among children, with ascites, pleural effusion, thrombocytopenia, and cholestasis being the most frequent occurrences. A relatively younger age was significantly associated with atypical HAV manifestations. Distinct laboratory parameters were observed among children with atypical manifestations of HAV.

Key words: Ascites, Cholestasis, Hepatitis A virus, Pleural effusion, Thrombocytopenia.

Objective: To evaluate the safety and effectiveness of treatment for inguinal hernia and to compare the short- and long-term outcomes of open mesh repair (OMR) and laparoscopic total extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques in primary unilateral inguinal hernia.

Study design: Retrospective study. Place and Duration of the Study: Department of General Surgery, University of Health Sciences, Training and Research Hospital, from January 2018 to September 2023.

Methodology: The authors analysed patients aged 18 years and older who were diagnosed with primary unilateral inguinal hernia and underwent surgery. Patients were divided into three groups according to the surgical techniques used: OMR, TEP, or TAPP. Demographic data, intraoperative and postoperative outcomes, postoperative visual analogue scale (VAS) scores, chronic groin pain scores, and recurrence rates were compared across the groups. The Chi-square test and the Kruskal-Wallis test were used to compare the groups, followed by Dunn's multiple comparison test.

Results: This study involved 1466 patients. Of these, 943 underwent OMR, 322 underwent TEP, and 201 underwent TAPP. The mean follow-up period was 18.80 ± 7.86 months. The OMR group required a shorter operative time than other groups, whereas intraoperative complications did not differ significantly among the groups. The length of hospital stays and time to return to work were significantly longer in the OMR group. Postoperative complications did not differ among the groups. The VAS scores were higher in the OMR group on postoperative day 1 and at 1 year. Similarly, chronic pain scores for the first year were higher in the OMR group. Meanwhile, recurrence was significantly less frequent following the OMR technique.

Conclusion: Laparoscopic techniques such as TEP and TAPP are as safe and effective as OMR for the treatment of primary unilateral inguinal hernia, with similar intraoperative and postoperative complication rates. They also offer additional advantages, including earlier discharge, quicker return to work, and improved results in terms of early postoperative pain and long-term chronic pain when compared with the OMR technique.

Key words: Inguinal hernia, Open mesh repair, Total extraperitoneal, Transabdominal preperitoneal, Recurrence, Chronic pain.

Objective: To assess the accuracy and clinical applicability of YOLO-based segmentation models for detecting Schistosoma eggs in urinary bladder histopathology slide images, focusing on both bounding box and mask segmentation tasks.

Study design: A descriptive, cross-sectional study. Place and Duration of the Study: Artificial Intelligence Technology Centre, National Centre for Physics, Islamabad, Pakistan, from September to November 2024.

Methodology: A high-quality dataset was compiled using histopathological slides obtained from real patient samples available on the open-source platform PathPresenter. All images were meticulously annotated by expert histopathologists. The dataset included 681 images containing 2,751 schistosomes, divided into 476 training images (1,932 schistosomes), 136 validation images (539 schistosomes), and 69 testing images (280 schistosomes). Data pre-processing techniques were applied to optimise the quality of training and evaluation datasets. Multiple YOLO-based segmentation models, such as YOLOv5, YOLOv8, YOLOv9, and YOLOv11 variants (n/s/m/l/x/c/e), were trained and evaluated for both bounding box and mask detection. Model performance was evaluated using precision, recall, F1 score, mean Average Precision at 50% Intersection over Union (IoU; mAP50), and mAP across 50 to 95% IoU (mAP50-95) for both bounding box and mask segmentation tasks.

Results: Among the models, YOLOv8l demonstrated the highest diagnostic accuracy, achieving an F1 score of 95.09 and a mAP50 of 96.8 for bounding box detection. For mask detection, it attained an F1 score of 94.19 and an mAP50 of 96.2. YOLOv5m and YOLOv5x also performed well, balancing accuracy with computational efficiency. Smaller models exhibited limitations in sensitivity and precision.

Conclusion: YOLO-based segmentation models exhibit strong potential for automated detection of schistosomiasis in urinary bladder histopathology images. However, future large-scale validation studies on bigger datasets are required for further confirmation.

Key words: Deep learning, Mask segmentation, Medical image analysis, Schistosomiasis, YOLO segmentation.

Objective: To compare the efficacy and safety of oral and subcutaneous (SC) routes of methotrexate (MTX) administration in patients with severe psoriasis in terms of the time taken to attain a Physician Global Assessment (PGA) score of 0 or 1.

Study design: Single-blinded randomised controlled trial. Place and Duration of the Study: Department of Pharmacology and Therapeutics, Army Medical College, in collaboration with Departments of Dermatology and Pathology, Pak Emirates Military Hospital, Rawalpindi, Pakistan, from January 2024 to January 2025.

Methodology: Patients of either gender aged between 18 and 65 years, diagnosed with severe psoriasis (PGA score of 4), were included. Patients were randomised by the lottery method into two equal groups, with 30 patients in each group. Group 1 (G-1) received oral MTX (10 to 25mg) once a week for 4 weeks, and Group 2 (G-2) received SC MTX (10 to 25mg) once a week for 4 weeks. Efficacy and safety were compared between the two groups at 0 and 4 weeks. The Chi-square and t-test were used for comparison among the groups.

Results: A total of 60 patients with a median (IQR) age of 42.0 (27.0) years; 51 (85%) were males and 9 (15%) were females. The pre-treatment PGA score was 4, while after treatment, 14 (23.3%) patients had a score of 0, 23 (38.3%) had a score of 1, 17 (28.3%) had a score of 2, and 06 (10%) had a score of 3. Both groups showed effective improvement after the treatment, with statistically significant findings (p <0.001). The SC route in the G-2 showed a greater reduction in the PGA score compared to the oral route in the G-1. Corres- pondingly, the SC route of medicine is comparatively safer than the oral route by reporting less episodes of diarrhoea (76.7% vs. 3.3%) and vomiting (26.7% vs. 6.7%).

Conclusion: The SC route of MTX administration is safer and more effective than the oral route in patients with severe psoriasis.

Key words: Efficacy and safety of methotrexate, Methotrexate, Oral route, Psoriasis, Subcutaneous route.

Objective: To compare the face and content validity of two robotic surgery simulators-the DaVinci Skills Simulator (dVSS) and the CMR Versius Simulator-among surgeons with varying levels of experience, to guide simulation-based training programmes.

Study design: Descriptive analytical study. Place and Duration of the Study: Department of General Surgery, Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan, from March 2024 to February 2025.

Methodology: A cross-over study was conducted involving 26 surgical faculty members. Participants performed standardised tasks on both simulators and completed a 5-point Likert-scale questionnaire assessing face and content validity. Statistical analyses were performed using the Wilcoxon signed-rank test for non-normal data and Cronbach's α for reliability.

Results: Twenty-six faculty members included 16 males and 10 females, with 80.8% novices and 11.5% experts. The dVSS showed significantly higher face [21 (19-22) vs. 17 (16-19); p <0.001] and content validity [22 (19-24) vs. 19 (16-24); p = 0.001] compared to CMR. The assessment demonstrated good reliability (α = 0.835). Most participants (65.4%) had no prior dVSS or CMR exposure, with 80.8% being novices.

Conclusion: While the dVSS remained superior in realism and skill assessment, the CMR simulator demonstrated acceptable validity for training, particularly for novices. Future studies should incorporate longitudinal performance metrics and larger expert cohorts to further evaluate the CMR's role in robotic surgical education.

Key words: Robotic surgery simulation, DaVinci, CMR Versius, Face validity, Content validity, Surgical training.

Objective: To evaluate the levels of interleukin-12 (IL-12), a critical cytokine for NK cells, and hemogram parameters in infertile women with unknown causes.

Study design:  Descriptive study. Place and Duration of the Study: Department of Gynaecology and Obstetrics, Medical Faculty of Pamukkale University, Denizli, Turkiye, between January and December 2022.

Methodology: The study included 43 female patients aged 22-49 years with unexplained infertility who met the inclusion and exclusion criteria, along with 40 healthy control females from the Department of Gynaecology and Obstetrics. The sandwich ELISA method, which depends on antigen-antibody reactivity, was utilised to quantify serum IL-12 levels, and data were analysed using the Mann-Whitney U test. Complete blood cell parameters were also investigated.

Results:  There was no significant difference in serum IL-12 levels between the Control and Unexplained infertile (UI) groups (median: 16.51, IQR: 14.58 - 21.43 vs. median: 15.92, IQR: 14.4 - 25.47; p = 0.623, respectively). Sedimentation and CRP levels did not show significant differences between the groups (p = 0.327 and 0.320, respectively). There was also no statistically significant difference in total leucocyte count (p = 0.114). The UI Group had a substantially higher neutrophil percentage (median: 62.45, IQR: 56.93 - 68.28 vs. median: 58.75, IQR: 52.08 - 64.48); p = 0.017) and absolute neutrophil count (5164.4 ± 1483.29/µl vs. 4408.55 ± 1153.3/ µl; p = 0.012) compared to the Control group.

Conclusion:  While IL-12 levels did not significantly differ among ladies with unexplained infertility, there was a notable increase in the percentage and number of neutrophils.

Key words: Infertility, Interleukin-12 (IL-12), Cytokine, Neutrophil.

Objective: To compare the effectiveness of a flipped classroom model and a large group interactive session (LGIS) method to teach the basis of screening to fourth-year MBBS students.

Study design: Quasi-experimental study. Place and Duration of the Study: Department of Community Medicine, Wah Medical College, National University of Medical Sciences, Wah Cantt, Pakistan, from December 2024 to February 2025.

Methodology: The sample was selected from fourth-year medical students using a purposive sampling technique and divided into two groups. Group A and B were taught the topic ''Basis of Screening'' by two subject experts, following the LGIS and flipped classroom methods, respectively. Students were assessed through a class test comprising of one-best-answer type multiple choice questions (MCQs). Data were analysed using SPSS version 23. Mean test scores and standard deviation were calculated for both groups, and an independent t-test was applied to find the difference between the groups. The Chi-square test was applied to determine the difference between achieving more than 75% marks and teaching strategies. A p-value of <0.05 was considered statistically significant.

Results: A total of 95 students who attended the teaching sessions and appeared in the assessment were included in the study. The number of students who passed the exams was 69 (72.6%), and only 26 (27%) students attained ≥75% marks. A significant difference was noted among students' scores when their results were categorised as more and less than 75% marks. Out of the 26 students, 19 attended flipped classroom sessions.

Conclusion: The flipped classroom model is a very effective strategy for teaching the basis of screening to medical students, as compared to the LGIS, to improve their performance in examinations.

Key words: Curriculum, Education, Students, Teaching, Flipped classroom.