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

Postpartum haemorrhage (PPH) is a serious complication of pregnancy. In this study, patients with PPH were treated with blood component transfusion, and the effectiveness of blood component transfusion and its influence on coagulation function were analysed. This retrospective randomised controlled study evaluated the clinical data of patients with PPH who were admitted to the Department of Blood Transfusion at the First Affiliated Hospital of Xiamen University, from January 2021 to December 2021. In 2021, 84 patients received treatment at this hospital. Patients transfused with a 1:1 ratio of red blood cells (RBC) to cryoprecipitate showed a significant improvement in coagulation levels compared to pretreatment. The combination of RBC, plasma, and cryoprecipitate in a reasonable proportion effectively improves coagulation function in haemorrhage puerperae, showing a good clinical treatment effect. It is worth promoting. Key Words: Postpartum, Blood component transfusion, Coagulation, Resuscitation rate.

Objective: To evaluate major bleeding risk factors in percutaneous nephrolithotomy (PCNL) for upper urinary tract calculi and validate a prediction model.

Study design: Analytical study. Place and Duration of the Study: The First Affiliated Hospital of Wannan Medical College, Wuhu, China, from January 2019 to August 2023.

Methodology: Major bleeding was defined as a decrease in haemoglobin of ≥20 g/L compared to preoperative levels. A retrospective analysis of 468 PCNL patients identified risk factors for major bleeding using univariate, LASSO, and logistic regression analyses. Nomogram models were developed using R software, with ROC and calibration plots assessing the model's accuracy. The bootstrap method provided internal validation, and DCA evaluated clinical utility.

Results: Independent risk factors included diabetes (OR = 4.17), staghorn calculi (OR = 3.41), operative duration (OR = 1.01), and staged surgery (OR = 2.75). The model showed high discriminative ability (C-statistic: 0.783) and alignment with observed outcomes. Internal validation confirmed robustness (C-statistic: 0.728).

Conclusion: The predictive model for major bleeding during and after PCNL, focusing on diabetes, staghorn calculi, operative duration, and staged surgery, is highly accurate, aiding in the PCNL risk assessment.

Key words: Upper urinary tract calculi, Percutaneous nephrolithotomy, Major bleeding, Risk factors, Prediction model.

Objective: To assess the quality of life (QoL), perceived stigma, and extent of anxiety and/or depression among parents of female children with congenital adrenal hyperplasia (CAH).

Study design: Observational cross-sectional study. Place and Duration of the Study: Department of Paediatric Surgery and Endocrinology Clinics of National Institute of Child Health (NICH), Karachi, Pakistan, from June to December 2022.

Methodology: Parents of the female children diagnosed with CAH were enrolled. A validated parent self-report questionnaire, parent- focused items of the experiences and reactions questionnaire used for assessing disorders of sex development (DSD)-related experienced or anticipated stigma and the patient health questionnaire-4 (PHQ-4) were used to gather the information. The scores were calculated for each item and compared among mothers and fathers. Independent samples student t-test was used to find any significant differences between the mean scores. A value of p <0.05 was considered statistically significant.

Results: Out of the 98 parents, there were 74 (75.5%) mothers and 24 (24.5%) fathers. The score recorded in all three tools showed multiple challenges that had a negative impact on parents. In QoL assessment for experiences and reactions, scores between mothers and fathers were similar. In the PHQ-4 tool, the scores were significantly related to the female gender of the parents as anxiety and depression were more reported in mothers (p = 0.046). In parents of children >7 years of age, the differences in scores were statistically significant for the domains such as talking to others, and stigma.

Conclusion: The parental QoL was affected resulting in limited social interactions with the feeling of being stigmatised. Many reported significant anxiety and/or depression.

Key words: Parental anxiety, Congenital adrenal hyperplasia, Disorders of sex development, Gender assignment, Gender.

This systematic review was conducted to assess the curative effect of Thymosin alpha 1 in the acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients. Six electronic databases including EMBASE, PubMed, Cochrane Library, China National Knowledge Infrastructure Database, Chinese Biomedical Database, and Wanfang Database were searched for eligible papers focusing on the thymosin alpha 1 treatment in AECOPD patients. The effectiveness outcomes included T cell subset, pulmonary function, arterial blood gases, and the length of hospital stay. Stata and Review Manager Software were used for data analysis. Thirty-nine randomised controlled trials with a total of 3,329 patients were included. Compared with the control treatment, Thymosin alpha 1 therapy significantly improved forced expiratory volume in 1 second [MD = 0.29, 95% (0.26, 0.32), p <0.001] and the ratio of forced expiratory volume in the first second to forced vital capacity [MD = 6.24, 95% (3.83, 8.65), p <0.001], increased the arterial partial pressure of oxygen [MD = 7.24, 95% (3.42, 11.07), p = 0.0002], lowered the arterial partial pressure of carbon dioxide [MD = -5.85, 95% (-9.38, -2.33), p = 0.001], shortened the length of hospital stay [MD = -5.39, 95% (-7.82, -2.97), p <0.001], raised the level of CD4+ T lymphocytes count [MD = 7.54, 95%(6.66, 8.41), p <0.001] and the ratio of CD4+/CD8+ [MD = 0.40, 95% (0.34, 0.46), p <0.001], and decreased level of CD8+ T lymphocytes count [MD = -2.74, 95% (-3.86, -1.63), p <0.001]. Thymosin alpha 1 could significantly boost the immune function, and improve pulmonary function and arterial blood gas of AECOPD patients than routine treatment only. More high-quality randomised controlled trials are needed to further confirm Thymosin alpha 1 efficacy. Key Words: Thymosin alpha 1, Efficacy, Acute exacerbation of chronic obstructive pulmonary disease, Meta-analysis.

Objective: To determine the values of electrical conductivity (EC) of cadaveric skeletal muscles of male rats and their relationship with different postmortem intervals (PMI).

Study design: Experimental study. Place and Duration of the Study: Department of Forensic Medicine and Toxicology, King Edward Medical University (KEMU), Lahore, in collaboration with the University of Veterinary and Animal Sciences (UVAS) Lahore, from October 2021 to September 2022.

Methodology: The non-probability consecutive sampling technique was used for the sample collection of 98 Sprague-Dawley rats and all were male. All lower-hind limb skeletal muscles of rats with known death intervals were used. Parameters (EC) were measured by using conductivity meter DDS-11A, through the method described by Ekanem and Achinewhu. Healthy adult rats within a specific weight range (250-300 g) and with a known time of death, euthanised using a standardised method such as CO2 asphyxiation were included, and the rats with pre-existing diseases or injuries affecting muscle tissue, those showing advanced decomposition or bacterial contamination, or with an unknown or inconsistent PMI were excluded.

Results: The results showed that there was a significant correlation between the duration of PMI and EC, and the data fitted well in the quadratic regression equation as y = -1203.67 + 2.50 EC + 0.001x2 (R2 = 0.924).

Conclusion: This study suggests that measuring the EC of skeletal muscle extracts offers a reliable method for estimating late PMIs, showing a strong correlation with PMI duration and providing a valuable forensic tool.

Key words: Postmortem interval, Electrical conductivity, Skeletal muscles, Postmortem changes, Muscle conductivity.

Objective: To compare the effect of varying durations of noise exposure on the histomorphological and endocrine profile of the thyroid gland in male and female adult rats.

Study design: An experimental study. Place and Duration of the Study: Department of Anatomy, Army Medical College, Rawalpindi / NUMS, from January to December 2020.

Methodology: Thirty Sprague-Dawley rats (15 males and 15 females) were divided into three groups each having 10 rats with equal male- to-female ratio. Group A was the control group. Group B and Group C were exposed to 100 dB noise for 4 hours daily and 100 dB noise for 6 hours daily for 4 months, respectively. Thyroid histomorphological parameters such as follicular epithelial cells' height, follicular diameter, and thyroid stimulating hormone (TSH) levels were evaluated at the end of the study.

Results: Both male and female rats exposed to noise stress exhibited reduced follicular diameter (p <0.001) and increased epithelial cells' height (p <0.001) as compared to the control group. The experimental groups showed significantly higher TSH levels compared to the control group (p <0.001) among female rats, while no significant difference was observed among male rats (p 0.47). No significant differences in histological and serum parameters were noted between the experimental groups (Group B and C).

Conclusion: Chronic noise exposure induces hyperactivity of thyroid follicles in both male and female adult rats as evidenced by the thyroid histology, whereas only female rats showed raised TSH levels, suggesting a potential disruption in the hypothalamic-pituitary-thyroid axis.

Key words: Thyroid gland, Chronic noise stress, Follicular epithelial cells, Thyroid stimulating hormone, Thyroid follicles.

Objective: To map the practice of paediatric perioperative pain assessment and management among consultant anaesthetists working in teaching institutions in the two provinces of Pakistan.

Study design: A cross-sectional survey. Place and Duration of the Study: Department of Anaesthesiology, Teaching institutions of Sindh and Khyber Pakhtunkhwa (KPK), Pakistan, from January to October 2022.

Methodology: A questionnaire was designed to determine the participants' practices about perioperative pain assessment and management. It consisted of 26 questions that included participants' demographic data and questions about their paediatric practice.

Results: A total of 152 responses were received (response rate 76%). Most participants (n = 84, 55.3%) had a two-year diploma in anaesthesiology, while 38.2% had a four-year diploma. Additionally, 66.4% worked at public sector hospitals and 28.3% at private hospitals. Only 66% of respondents used paediatric pain scales for pain assessment in the recovery rooms. Most participants, 72.2%, had no Paediatric Pain Management Guidelines available at their institution. Only 5% had access to 5 analgaesic medications, while 32% had access to only 2 medications for intraoperative pain management.

Conclusion: The practice of anaesthesiologists in these two provinces of Pakistan is highly varied since there is a lack of national guidelines.

Key words: Paediatric anaesthesia, Acute pain, Pain management, Pain measurement, Paediatric pain assessment, Anaesthesia and analgaesia, Survey and questionnaires.

Objective: To evaluate the efficacy of a new perfusion method in DeBakey Type I aortic dissection surgery, with the goal of enhancing thorough organ protection and optimising patient outcomes.

Study design: Descriptive study. Place and Duration of the Study: Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of the University of South China, from January 2020 to December 2021.

Methodology: Thirty-two patients undergoing total aortic arch replacement with descending aortic stenting were included in the study. The new perfusion method involved a combination of bilateral selective cerebral perfusion, descending aortic balloon occlusion, and antegrade lower body perfusion. Lower limb ischaemic complications and mortality rate were the main outcome measures. Surgical procedures and patient data were collected and analysed.

Results: No cases of paraplegia, intestinal necrosis, or lower-limb ischaemia were observed. The new perfusion method effectively protected lower-body organs, with a short duration of lower-body ischaemia during surgery. The overall mortality rate was 3.13%, and postoperative complications were minimal, resulting in satisfactory survival rates.

Conclusion: The combination of perfusion techniques, including bilateral selective cerebral perfusion, descending aortic balloon occlusion, and anterograde lower body perfusion, proved effective in improving the outcomes for DeBakey Type I aortic dissection surgery. Further research is needed to confirm the long-term benefits of this approach.

Key words: DeBakey type I aortic dissection, Descending aortic balloon blockade, Lower body anterograde perfusion, Bilateral selective cerebral perfusion.

Objective: To determine the relation between C5aR2 and clinicopathological parameters of breast cancer.                   Study Design: Observational study.                                                                                                                                               Place and Duration of the Study: Department of Histopathology, PNS Shifa Hospital, Karachi, from January to June 2023.   Methodology: One hundred and twenty-eight women, aged 24-90 years with histologically proven diagnosis of breast cancer, were included in the study. Immunohistochemistry (IHC) was performed to evaluate the C5aR2 expression by its percentage and intensity. The C5aR2 staining was observed in membranes and/or cytoplasm. The immunoreactive score (IRS) was obtained and its association was analysed with clinicopathological parameters of breast cancer. SPSS version 27 was used to analyse the data.                      Results: The C5aR2 expression was higher in tumour cells (90.6%) compared to stromal cells (53.1%), predominantly exhibiting cytoplasmic localisation. Higher C5aR2 expression was observed in older age groups, higher-grade tumours, and ER/PR/HER2 and HER2 positive tumours. Moreover, tumours with poor treatment response also showed increased C5aR2 expression compared to those with good treatment response. Although no significant association was identified between C5aR2 expression and Ki67, increased C5aR2 expression has been found in tumours with high cell proliferation rates.

Conclusion: In this study, an association between tumour and stromal cell C5aR2 expression and age, grade, receptor status, proliferation rate, and post-treatment response was identified.

Key words: Breast cancer, C5aR2, Cancer associated fibroblasts, Immunohistochemistry, Ki67.

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