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

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Objective: To investigate the mean tooth length and root canal configuration of human maxillary and mandibular premolars in the population of Hyderabad, Pakistan, using Cone Beam Computed Tomography (CBCT).

Study design: Observational study. Place and Duration of the Study: Department of Operative Dentistry and Endodontics, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh, Pakistan, from December 2022 to March 2023.

Methodology: Using retrospective analysis of CBCT scans, tooth length, the number of roots, and root canal configuration of 536 mandibular and maxillary premolars were assessed in the subpopulation of Pakistan. The data were analysed employing descriptive statistics, Chi-square tests, and One-Way ANOVA to determine the association between various factors and root canal morphology.

Results: Vertucci Type 1 (one canal) was the most common configuration in maxillary premolars, with frequencies ranging from 46.3 to 52.2%. The mean length of all 8 premolars ranged from 20.56 mm to 21.58 mm. C-shaped canal configurations were observed in a small percentage of maxillary and mandibular premolars, with C1 being the most common. No significant association was found between gender and canal configuration or tooth length, and in tooth lengths among different canal configurations.

Conclusion: Vertucci Type 1 was the most common configuration in maxillary premolars, followed by Vertucci Type 4. Single-rooted premolars were more prevalent, while two-root configurations were less common. C-shaped canal configurations were observed in a small percentage of premolars, with higher frequency in mandibular premolars.

Key words: Cone beam computed tomography, Dental anatomy, Endodontics, Premolars, Root canal morphology.

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Objective: To compare the effectiveness of early feeding and conventional feeding protocol after stoma reversal in adult surgical practices.

Study design: Randomised controlled trial. Place and Duration of the Study: Department of General Surgery, District Headquarters Hospital Mardan, Pakistan, from January 2020 to July 2022.

Methodology: A total of 72 patients enrolled in the surgical unit for stoma reversal were included in this study. After applying the exclusion criteria, 68 patients were randomised in two equal groups of 34 patients each. In Group A, patients were allowed oral liquid feed within 24 hours after surgery while in Group B oral liquid feed was allowed after 72 to 96 hours when the nasogastric tube was removed and bowel functions were returned. Efficacy, safety, and tolerability were evaluated from outcomes such as postoperative ileus, anastomosis leakage, infection of the wound, and length of hospital stay.

Results: The age range in this study was from 18 to 43 years with mean ± SD of 31.602 ± 6.75 years. There were 41 (60.29%) males while 27 (39.71%) females in this study and the male population was dominant in both groups. The results were significantly in favour of Group A, where 28 (82.35%) patients did not have postoperative ileus compared to 17 (50%) patients in Group B (p = 0.004). Wound healing was also significantly better in Group A compared to Group B, where 30 (88.23%) patients had no wound infection compared to 21 (61.76%), respectively (p = 0.001). There was no difference between both groups regarding anastomotic leakage. Length of hospital stay was significantly shorter in Group A (3.117 ± 0.87 days) compared to Group B (5.617 ± 1.43 days) (p = 0.001).

Conclusion: Early feeding after stoma reversal is effective, minimises the postoperative complications, and leads to shortening of hospital stay in adult surgical practices.

Key words: Anastomosis leakage, Early feeding, Length of hospital stay, Stoma reversal.

Objective: To determine clinically significant prostate cancer (csPCa) detection rate by combining the prostate-specific antigen density (PSAD) and prostate imaging-reporting and data system (PI-RADS) scores.

Study design: Descriptive study. Place and Duration of the Study: Department of Urology, University of Health Sciences, Ankara Oncology Training and Research Hospital, from January 2018 to April 2023.

Methodology: Patients who underwent prostate biopsies after multiparametric magnetic resonance imaging (mpMRI) were included in the study. PI-RADS 4 and 5 lesions were considered as MR positive. The cut-off values for PSAD were also determined to evaluate csPCa. csPCa detection rates were evaluated by grouping the patients based on the PSAD and mpMRI findings.

Results: PSAD cut-off value of 0.165 ng/mL/mL (sensitivity 80%, specificity 72%) was detected to predict csPCa (AUC = 0.81, 95% CI:0.756-0.866, p<0.001). csPCa detection rate was low (3%) in patients who have low PI-RADS scores (1-3) and a PSAD <0.165 ng/mL/mL. On the other hand, csPCa detection rate was high (50.5%) in patients who have a high PI-RADS score (4-5 lesions) and with a PSAD ≥0.165 ng/mL/mL.

Conclusion: csPCa detection rates are low in patients with PI-RADS 1-3 lesions and low PSAD values. Unnecessary biopsy may be avoided in these patients.

Key words: Gleason score, PI-RADS, Prostate cancer, Prostate-specific antigen, Prostate-specific antigen density.

Objective: To evaluate the efficacy of mustard gel versus chlorhexidine (CHX) gel in treating the most resistant Enterococcus faecalis (E. faecalis) bacteria as intra-canal medications.

Study design: Randomised controlled trial (in vitro study). Place and Duration of the Study: Department of Operative Dentistry, de'Montmorency College of Dentistry, in collaboration with Lahore General Hospital, between March and October 2021.

Methodology: Forty single-rooted teeth, extracted and randomly allocated, were divided into two groups. Group 1 underwent treatment with CHX gel, while Group 2 was treated with Mustard gel. Subsequently, after disinfection, each tooth was horizontally divided into three equal parts. The middle section was standardised and inoculated with a controlled strain of E. faecalis. Intra-canal medicaments were administered for seven days. Bacterial colonies were quantified as colony forming units (CFU/mL) and subjected to analysis using Statistical Package for Social Sciences (SPSS) version 25.

Results: The median bacterial count observed was 1,550 (range 775 - 2,500) for Group 1, contrasting with 400 (range 200 - 775) for Group 2, indicating a significant difference in bacterial count between the groups (p <0.001).

Conclusion: Mustard gel demonstrated significantly superior efficacy compared to chlorhexidine gel against E. faecalis in root canal procedures.

Key words: Chlorhexidine, Enterococcus faecalis, Mustard, Root canal medicament, Antimicrobial drug-resistance, Root canal irrigants.

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Objective: To determine the frequency and outcome of postoperative atrial fibrillation (POAF) in terms of in-hospital and 30-day mortality and morbidity after mitral valve replacement (MVR).

Study design: Observational study. Place and Duration of the Study: Department of Cardiac Surgery, Northwest General Hospital and Research Centre, Peshawar, Pakistan, from September 2017 to March 2023.

Methodology: A total of 186 patients between the ages of 20 and 70 years, who had severe mitral stenosis and normal sinus rhythm and underwent MVR surgery, were included in the study. The frequency of POAF within 7 days following surgery and outcomes in terms of in-hospital and 30-day mortality / morbidity were recorded.

Results: POAF occurred in 19.4% patients. Patients with POAF were predominantly male (p = 0.01), aged over 50 years (p = 0.002), diabetic (p = 0.02), hypertensive (p = 0.02), had impaired LV function (p <0.001), enlarged LA (p = 0.003), pulmonary hypertension (p = 0.009), previous PMBV (p <0.001), and previous infective endocarditis (p <0.001). In-hospital and 30-day mortality rates were 7% and 8.6%, respectively. POAF patients had prolonged ICU stays (p <0.001), hospital stays (p = 0.04), and higher mortality rates (p <0.001). Persistent AF (22%) contributed to 30-day morbidity in the form of embolic stroke, limb ischaemia, and congestive heart failure.

Conclusion: POAF commonly occurs following the MVR surgery and significantly impacts perioperative and 30-day morbidity and mortality.

Key words: Postoperative atrial fibrillation, Mitral stenosis, Mitral valve replacement.

Objective: To investigate the factors influencing the severity of acute ischaemic stroke (AIS) and short-term prognosis after endovascular treatment.

Study design: Observational study. Place and Duration of the Study: Department of Cerebrovascular Diseases, The First People's Hospital of Qujing City, Yunnan Province, China, from June 2020 to December 2022.

Methodology: An analysis was conducted on 160 AIS patients undergoing endovascular treatment, classified into atherosclerosis subtype (AS) and cardioembolic subtype (CE) based on the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification, each comprising 80 cases. The association among baseline and endovascular treatment parameters, clinical characteristics, postoperative complications, and short-term outcomes (risks of mortality and poor prognosis) was tested.

Results: Univariate analysis revealed significant positive correlations between increased fasting glucose, diastolic pressure, and the number of thrombectomy procedures with the frequency of cerebral haemorrhage in CE-type stroke. The time from femoral artery puncture to vessel opening was positively associated with the degree of brain oedema. In the AS subtype, univariate regression analysis demonstrated a significant association between heart rate, fasting glucose, cholesterol, time from femoral artery puncture to vessel opening, and degree of brain oedema with short-term prognosis. Fasting glucose and the number of thrombectomy procedures were significantly linked to short-term prognosis in CE-type AIS. A predictive model using line charts was developed for factors associated with postoperative complications and short-term prognosis, achieving predictive accuracies of 95.5% for the risk of death and 92.7% for poor prognosis (mRS >2), notably surpassing traditional prediction methods.

Conclusion: Clinical characteristics and endovascular treatment-related factors are important for the short-term prognosis of AIS patients. Development of predictive models can efficiently identify high-risk patients at an early stage.

Key words: Acute ischaemic stroke, Atherosclerosis, Cardioembolic, Severity, Prognosis.

Objective: To explore nursing educators' perceptions about using humour as a teaching strategy in the classroom setting.

Study design: Qualitative study. Place and Duration of the Study: Shifa College of Nursing, Shifa Tameer-e-Millat University, Islamabad, Pakistan, from September 2021 to January 2022.

Methodology: Twelve educators from the Bachelor of Science in Nursing (BScN) programme were purposefully selected for their rich and expressive insights. Institutional Review Board approval was obtained, and participants provided informed consent with the option to terminate interviews at any time. Data were collected and analysed simultaneously using content analysis, with rigour maintained per Lincoln and Guba's 1985 trustworthiness framework.

Results: The study revealed four key categories from educators' perspectives on using humour as a teaching strategy. First was the humour and learning, with innate vs. acquired competency and teaching phases. Second was the inside track, encompassing revitalisation, critical thinking, eco-friendliness, encouragement culture, self-esteem, and confidence. Third was provocation; with subcategories of language and student diversity. Fourth was the way forward addressed humour applicability and classification.

Conclusion: The study explored the importance of humour as a teaching strategy in the classroom, stressing the need to consider context, subject matter, and diverse student needs. It underscores a balanced approach that engages students and fosters inclusivity. The findings are individual differences. Future research should explore the long-term impact and how training can help teachers effectively using humour as a teaching tool.

Key words: Humour teaching strategy, Nursing, Nursing educator, Learning, Pedagogical tool.