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

Objective: To evaluate the predictive value of the modified frailty index-5 (mFI-5) for postoperative complications in patients undergoing radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC).

Study design: A retrospective study. Place and Duration of the Study: Department of Urology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkiye, from January 2020 to July 2024.

Methodology: A retrospective analysis was conducted on 184 individuals who underwent RC for muscle-invasive bladder cancer. Demographic data, medical history, histopathological results, perioperative parameters, complications, and mFI-5 score were recorded. Patients were categorised as having either high (mFI-5 scores ≥2) or low (mFI-5 scores <2) preoperative mFI-5 scores. The chi-square test was used to compare complications rate between the groups.

Results: The study included 184 patients (91.3% male and 8.7% female), and the mean age was 65.23 ± 9.25 (24-86) years. Eighty-one (44%) out of 184 patients were in the high-risk group (mFI-5 ≥2), while 103 patients (56%) were in the low-risk group (mFI-5 <2). The rate of major complications (Clavien-Dindo ≥3) was found to be relatively higher in the high-risk group (n = 125, 30.86% vs. n = 18, 17.47%; p = 0.033). Although the overall complication rate did not differ between groups, gastrointestinal complications were found to be significantly higher (p = 0.005) in the high-risk group, with a longer duration of hospital stay.

Conclusion: A higher mFI-5 score is associated with a higher rate of major complications after radical cystectomy. The mFI-5 score may be a useful tool for determining treatment options in patients with MIBC.

Key words: Bladder cancer, Radical cystectomy, Modified frailty index-5, Complications, Outcome assessment.

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Objective: To identify the motivational factors and barriers influencing undergraduate (UG) research in a dental college in Pakistan from students' perspectives using semi-structured interviews.

Study design: A qualitative phenomenological study. Place and Duration of the Study: Nishtar Institute of Dentistry, Multan, Pakistan, from October 2022 to October 2023.

Methodology: A validated, modified, and pilot-tested Vodopivec questionnaire was distributed among 67 consenting final-year BDS students as a pre-test to assess their knowledge of research. The pre-test results were calculated manually. Based on these results, a study sample of 20 students was selected: 10 students with the top scores and 10 students with the bottom scores. Semi-structured interviews were conducted with these students until data saturation was achieved. Thematic analysis was performed using NVivo software.

Results: Twelve themes were identified by students, including both research barriers and promoting factors. Each theme comprised several subthemes. The major themes included the poor status of UG research, lack of institutional vision, and insufficient funding. Subthemes included no research-related coursework, favouritism by teachers, and inadequate laboratory infrastructure with untrained research faculty. The incorporation of research projects into the community dentistry subject was suggested in the final year BDS programme.

Conclusion: There is a suboptimal status of UG research in public-sector dental colleges in Pakistan, with few motivational factors and numerous barriers.

Key words: Undergraduate research, Motivational factors, Barriers, Curriculum, Dentistry.

Objective: To compare the effects of intermittent classical blood cardioplegia and single-dose modified Del Nido cardioplegia on postoperative serum lactate levels and extubation time in patients undergoing coronary artery bypass grafts (CABG).

Study design: An observational study. Place and Duration of the Study: Department of Cardiovascular Surgery, Faculty of Medicine, Kastamonu University, Kastamonu, Turkiye, from 2020 to September 2023.

Methodology: Forty patients who underwent CABG between 2020 and 2023 were randomly divided into two groups. Group 1 formed 20 patients who received intermittent classical blood cardioplegia, and Group 2 formed 20 patients who received single-dose modified Del Nido cardioplegia. Demographic data, bypassed vessels, cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time, postoperative drainage, inotrope required and extubation time, glomerular filtration rate (GFR), and serum lactate levels were recorded 2 hours after surgery. The Shapiro-Wilk test was utilised to evaluate the normality of data distribution. The Mann-Whitney U test was employed for variables that did not follow a normal distribution, whereas normally distributed variables were analysed using the independent samples t-test. Additionally, the chi-square test was applied to compare categorical variables across groups.

Results: No statistically significant differences were detected between the groups with respect to demographic data, ACC time, CPB time, bypassed vessels, postoperative drainage, inotrope requirement, or GFR. Postoperatively, lactate levels were statistically lower in Group 2 than in Group 1, and extubation time was statistically shorter in Group 2 than in Group 1 (p <0.001).

Conclusion: Modified Del Nido cardioplegia reduces postoperative lactate levels and extubation time. Therefore, modified Del Nido cardioplegia provides better patient stability and myocardial protection than the classical blood cardioplegia after CABG.

Key words: Atherosclerosis, Coronary artery bypass grafting, Mortality.

This meta-analysis aimed to compare the efficacy and safety of Diode laser haemorrhoidoplasty (DLH) with conventional haemorrhoidectomy (CH) techniques, namely Milligan-Morgan haemorrhoidectomy (MMH) and Ferguson haemorrhoidectomy (FH), for the treatment of symptomatic haemorrhoids. A search of PubMed, Embase, Cochrane, Web of Science, and Scopus identified 13 eligible studies. Primary outcomes included intraoperative blood loss, postoperative bleeding, pain (measured by VAS), complications (e.g., urinary retention and anal stenosis), recovery time, and recurrence rate. Statistical analysis used both random-effects and fixed-effects models, with results reported as 95% confidence intervals (CIs), and heterogeneity was assessed using the I2 statistic. The results showed that DLH offered significant benefits over MMH and FH, including reduced intraoperative blood loss (MD = -20.19 mL, 95% CI: -28.32 -12.07; p <0.001), lower postoperative bleeding (OR = 0.32, 95% CI: 0.11 - 0.93; p = 0.04), and less postoperative pain, both immediately and one week later. Key Words: Diode laser haemorrhoidoplasty, Milligan-Morgan haemorrhoidectomy, Ferguson haemorrhoidectomy, Haemorrhoids, Meta-analysis.

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This meta-analysis aimed to evaluate the efficacy and safety of perioperative transcutaneous electrical acupoint stimulation (TEAS) in improving sleep quality after general anaesthesia. A comprehensive search of relevant randomised controlled trials was conducted using PubMed, Embase, Web of Science, CNKI, Wanfang, VIP, and SinoMed by June 2024, encompassing a total of 12 studies involving 1,076 patients. The results of the meta-analysis demonstrated that TEAS significantly improved postoperative sleep quality in patients. Improvements were observed in the Pittsburgh Sleep Quality Index [MD = -1.51, 95% CI (-2.01, -1.01), p <0.001], the Athens Insomnia Scale [MD = -2.15, 95% CI (-2.81, -1.44), p <0.001], and the Insomnia Severity Index [MD = -3.04, 95% CI (-3.48, 2.59), p <0.001]. It was also associated with a higher postoperative recovery quality score [MD = 13.16, 95% CI (4.48, 21.85), p = 0.003 <0.05]. A positive correlation was identified between postoperative nausea and vomiting [RR = 0.49, 95% CІ (0.36, 0.67), p <0.001] and dizziness [RR = 0.49, 95% CІ (0.28, 0.84), p <0.001]. The existing evidence demonstrates that TEAS can effectively enhance patients' sleep quality following general anaesthesia, promote postoperative recovery, and minimise the occurrence of postoperative adverse responses. Key Words: General anaesthesia, Meta-analysis, Postoperative sleep disorder, Transcutaneous electrical acupoint stimulation.

Objective: To evaluate the survival benefits and procedural morbidity associated with iterative cytoreductive interventions in recurrent epithelial ovarian cancer (EOC), comparing outcomes across secondary, tertiary, and quaternary surgical procedures.

Study design: A descriptive analytical study. Place and Duration of the Study: Department of Oncology, Azerbaijan Medical University, Narimanov, Azerbaijan, from 2014 to 2024.

Methodology: A total of 349 patients undergoing secondary cytoreduction, including subsequent tertiary (n = 155) and quaternary (n = 55) interventions, were analysed. Multivariate analysis assessed prognostic variables, such as residual disease burden, platinum sensitivity, disease-free interval (DFI), recurrence patterns, and histopathological characteristics. Survival analysis employed Kaplan-Meier estimates with Cox proportional hazards modelling.

Results: Complete macroscopic resection (R0) significantly improved survival across all surgeries, including secondary (36.6 vs. 15.3 months, HR 0.42, 95% CI 0.31-0.58; p <0.001), tertiary (22.2 vs. 6.4 months, HR 0.38, 95% CI 0.24-0.61; p <0.001), and quaternary (29.1 vs. 10.5 months, HR 0.29, 95% CI 0.17-0.51; p <0.001). A DFI of more than 12 months, platinum sensitivity, and isolated recurrence were identified as favourable prognostic factors. Platinum-sensitive patients with a DFI greater than 12 months demonstrated superior median overall survival (OS) in the following categories: secondary: 50.2 vs. 15.5 months (p <0.001), tertiary: 47.1 vs. 8.5 months (p <0.001), and quaternary: 50.6 vs. 9.2 months (p <0.001). Morbidity increased with successive interventions but remained clinically manageable. Intraoperative complication rates were as follows: secondary 9.1%, tertiary 15.5%, and quaternary 9%; postoperative complication rates were as follows: secondary 4.9%, tertiary 15.5%, and quaternary 9%.

Conclusion: Maximal-effort cytoreduction achieving R0 status significantly improves survival across multiple EOC recurrences when combined with platinum-based chemotherapy. DFI >12 months, isolated recurrence patterns, and platinum sensitivity emerge as critical selection criteria.

Key words: Tertiary cytoreduction, Ovarian cancer recurrence, Surgical oncology, Survival outcomes, Peritoneal carcinomatosis.

Objective: To compare serum homocysteine, zinc, and copper levels between chronic obstructive pulmonary disease (COPD) patients and healthy controls, and to assess their associations with systemic inflammation.

Study design: A comparative cross-sectional study. Place and Duration of the Study: Department of Pulmonary Diseases, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkiye, from February to April 2025.

Methodology: This study evaluated homocysteine, folic acid, vitamin B12, zinc, and copper levels in 30 COPD patients and 30 healthy controls (HCs). Pearson's chi-square test was used to compare categorical variables between groups. The Student's t-test was employed for comparisons between two groups. Pearson's correlation analysis was conducted to assess the relationship between continuous variables.

Results: Statistically significant differences were found in leucocyte, platelet, red cell distribution width (RDW), immature granulocyte, and immature granulocyte percentage levels in COPD patients (p <0.001, p = 0.024, p = 0.002, p = 0.035, and p = 0.022, respectively). CRP levels were significantly elevated in the COPD group (p = 0.006). No statistically significant differences were found in homocysteine, folic acid, vitamin B12, zinc, and copper levels between the COPD and Control groups (p >0.05). All measured values in both groups were within the normal reference ranges. However, zinc levels positively correlated with RDW (r = 0.417; p = 0.030), and a negative correlation was observed between copper levels and RDW (r = -0.543; p = 0.009) in the COPD group.

Conclusion: Homocysteine, zinc, copper, vitamin B12, and folic acid levels did not differ between COPD patients and HCs, all within normal ranges. Secondary analyses showed significant haematogram and CRP alterations, indicating systemic inflammation. These markers cannot be used as inflammatory parameters in COPD.

Key words: COPD, Homocysteine, Zinc, Copper, Vitamin B12, Folic acid.

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