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

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 compare sugammadex with neostigmine / atropine combination for reversal of neuromuscular blocker agents in terms of postoperative gastrointestinal motility in patients who underwent laparoscopic cholecystectomy.

Study design: Experimental study. Place and Duration of the Study: University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Izmir, Turkiye, between December 2020 and June 2021.

Methodology: Seventy-two patients undergoing laparoscopic cholecystectomy were included. At the end of the surgery, patients were antagonised for neuromuscular blockers either by atropine / neostigmine or sugammadex by an anaesthesiologist who was not involved in the study. Total anaesthesia time, pneumoperitoneum time, surgery time, number of postoperative opioid dose requirements and total opioid dose administered, number of medication requirements for postoperative nausea and vomiting, postoperative hospital stay, and first gas and stool output time of all the cases were evaluated by the researcher who was unaware of the medicines used for antagonisation.

Results: There were no statistically significant differences between the two groups in terms of their effects on postoperative gastrointestinal motility (first gas and stool output time), duration of anaesthesia, duration of surgery, duration of pneumoperitoneum, the number of postoperative opioid dose requirements, the number of drug requirements for postoperative nausea / vomiting, and the postoperative hospitalisation duration of the cases.

Conclusion: Effects of reversal agents on postoperative gastrointestinal motility are still debated. Studies on this subject in the literature are both limited in number and have been conducted with different medicine combinations in a wide variety of patient populations. The authors thought that further prospective randomised studies are needed to interpret this effect more clearly.

Key words: Sugammadex, Neostigmine / atropine, Gastrointestinal motility, Laparoscopic cholecystectomy.

Bruxism is a centrally mediated neurological para-functional movement disorder encompassing clenching, and grinding of teeth, or thrusting and bracing of mandible, which may be performed without conscious awareness. Diagnosis of bruxism can be done with instrumental and non-instrumental tools. Non-instrumental tools include self-reporting, questionnaires, history, and clinical diagnostic criteria. Instrumental tools include the use of intra-oral bite appliances, electromyography, and polysomnography. Polysomnography is considered as the gold standard to diagnose bruxism requiring the presence of special equipment and / or access to a sleep laboratory. The purpose of this study was to evaluate the evidence available for the validity (ability to identify those who have the disease versus those who do not) of non-instrumental tools in the diagnosis of bruxism. The research question for this study was whether non-instrumental tools are sufficient for confirmatory diagnosis of bruxism. PICO was described as 'P'opulation = adults, 'I'ntervention = diagnostic tools, 'Comparison' = non-instrumental tools compared with instrumental tools, and 'O'utcome as results of the intervention. The study was conducted from May 2020 to November 2021. Out of 3,687 reviewed articles, eight articles were selected for final review and reviewed for quality appraisal. It was found that non-instrumental tools or questionnaires are not sufficient for confirmatory diagnosing of bruxism independently. Correlating instrumental recordings with non-instrumental tools such as clinical findings may be a good practice to diagnose bruxism definitely and precisely. Key Words: Diagnosis, Bruxism, History, Electromyography, Polysomnography.

Objective: To evaluate the value of preoperative 3D planning and intraoperative navigation in robot-assisted laparoscopic surgery for complex pheochromocytoma.

Study design: Observational study. Place and Duration of the Study: Department of Urology, The Affiliated Hospital of Hebei University, from July 2022 to July 2023.

Methodology: Sixty patients with complex pheochromocytoma were divided into the study group (n = 30) and the control group (n = 30) according to the treatment method. The study group was treated with robot-assisted laparoscopic surgery, with preoperative 3D printing-based planning, and intraoperative 3D navigation, and the control group underwent conventional retroperitoneal robot-assisted laparoscopic surgery. Surgical-related indicators and intraoperative and postoperative complication rates between the two groups were compared.

Results: The operation time, postoperative hospital stay, and drainage tube retention time in the study group were significantly shorter than in the control group (p <0.001), and the intraoperative blood loss in the study group was significantly less than in the control group (p <0.001). The study group exhibited a significantly lower incidence of intraoperative haemodynamic instability (HI), use of vasoactive drugs, and postoperative ICU transfer rate than the control group (p <0.05). The incidence of surgical complications in the study group was significantly lower than in the control group (p = 0.04). The non-recurrence rate in the study and control groups after 1-year follow-up was 96.7% and 90%, respectively (χ2 = 2.77, p = 0.10).

Conclusion: Robot-assisted surgery, performed through renal surface, has the advantages of less bleeding, shorter surgical time, faster recovery, fewer complications related to chromaffin cell inflammation and postoperative complications, and is safe and effective in treating complex pheochromocytoma.

Key words: 3D planning and navigation, Robot-assisted surgery, Complex pheochromocytoma.

Simulation has proven to be one of the most powerful forms of enactive experience in medical sciences, which enhances the efficacy of both direct and vicarious learning. At the undergraduate level, community health nurses are expected to be inclusively knowledgeable about population-based nursing practices with diverse communities; so, they prepare well to establish partnership skills with stakeholders and make collaborative decisions that promote awareness and understanding of the community's health needs. Problem prioritisation is an essential step of the planning cycle. It is one of the advanced concepts in community health nursing which needs in-depth knowledge and contemplation about the dynamics of the community. This paper highlights the students' perspectives regarding the impeccable effects of simulation pedagogy on students' learning in terms of improving their communication skills and alleviating the fear of dealing with community stakeholders before the actual problem-priority setting exercise for the clinical community project. Key Words: Community health nursing, Simulation-based learning, Problem prioritisation, Stakeholders.

Objective: To identify postgraduate (PG) prosthodontic trainees' and supervisors' introspective views regarding prosthodontic education and clinical training.

Study design: Cross-sectional survey. Place and Duration of the Study: The Aga Khan University Hospital, Karachi, from May to October 2021.

Methodology: Data regarding the trainee induction process, teaching and learning practices, research interests, frequency of assessment, and trainees' satisfaction levels with the adequacy of didactic and clinical training in their centres were collected from Prosthodontic PG trainees and supervisors in Pakistan using REDCap software and analysed using SPSS 23.0. Frequencies of the observed responses from both populations were reported, and associations among private and public training centres were studied with Chi-square (or Fisher's exact). Differences in satisfaction levels across theoretical and clinical training domains were assessed with Mann- Whitney U test.

Results: Out of 17 supervisors and 104 PG trainees, 30% reported having a supervisory board in their institute. Most participants had entry tests conducted in their centres. The interference of influential sources during trainee induction was reported by 88.2% of the supervisors, while 66.7% trainees expressed the need for such influence to acquire training. Simulation-based teaching was available to 43.2% of trainees, 83% expressed interest in publishing research and 85% in publishing cases. Trainees were overall satisfied with their didactic and clinical training, whereas their satisfaction level was found neutral with theory and clinical training in maxillofacial-prosthodontics and clinical training of occlusion and temporomandibular disorders.

Conclusion: The results emphasise the need for regulation and monitoring of the trainee induction process, quality of training, and frequent assessments in the prosthodontics postgraduate training programmes across Pakistan.

Key words: Prosthodontics, Programme evaluation, Graduate dental education, Postgraduate dental education, Postgraduate medical education.

Objective: To compare two different algological intervention technique outcomes with ultrasound-guided genicular pulse radiofrequency (PRF) and fluoroscopy-guided intra-articular pulse radiofrequency for knee osteoarthritis-related pain.

Study design: Observational study. Place and Duration of the Study: Izmir Bakircay University, Cigli Training and Research Hospital and Health Science University Tepecik, Training and Research Hospital, Izmir, Turkiye, between March 2022 and May 2023.

Methodology: Patients aged 60 years and above with stage 3 and 4 knee osteoarthritis, experiencing knee pain for more than six months, and non-responsive to conservative treatments were included. Patients with recent knee surgery or intra-articular injections and those ineligible for radiofrequency application were excluded. Ultrasound-guided genicular nerve PRF and fluoroscopy-guided intra-articular PRF were administered to the included patients. Pain and quality of life were evaluated using the visual analogue scale (VAS) and Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) scores before and after the procedures.

Results: The study included 64 patients. Both ultrasound-guided genicular PRF and fluoroscopy-guided intra-articular PRF resulted in significant reductions in VAS and WOMAC scores at 1 and 3 months after the procedures. There was no significant difference in efficacy between the two techniques.

Conclusion: Ultrasound-guided genicular PRF and fluoroscopy-guided intra-articular PRF are effective and safe options for managing knee osteoarthritis-related pain.

Key words: Osteoarthritis, Pulse radiofrequency, Ultrasound, Fluoroscopy, Pain.

Objective: To explore the potential adverse effects of prolonged inhalation of mosquito coil smoke on the testicular histomorphology and serum testosterone levels in rats.

Study design: An experimental study. Place and Duration of the Study: Department of Anatomy, Army Medical College, National University of Medical Sciences (NUMS), Rawalpindi, Pakistan, from January to December 2020.

Methodology: This study was carried out on 20 male Sprague-Dawley rats, divided into control Group A (n = 10) and experimental Group B (n = 10). Rats in Group B were exposed to mosquito coil smoke (allethrin-based) for 4 hours / day for 12 weeks. After 12 weeks of exposure, serum testosterone levels and testicular morphology (seminiferous tubule diameter, germinal epithelium height, and testicular capsule thickness) were compared between the groups.

Results: Rats exposed to mosquito coil smoke showed significantly reduced serum testosterone levels (p <0.001) along with testicular histological disruption in terms of significantly dilated seminiferous tubules (p <0.001), reduced germinal epithelial height (p <0.001), and thickened testicular capsule (p <0.001), as compared to the control group.

Conclusion: Prolonged inhalation of allethrin-based mosquito coil smoke reduced serum testosterone levels and caused testicular histological disruption in the exposed group of rats.

Key words: Allethrin, Germinal epithelium, Mosquito coil, Seminiferous tubules, Testicular capsule, Testosterone, Testis.

Objective: To determine the association of androgenetic alopecia (AGA) with metabolic syndrome (MetS) in either gender.

Study design: Descriptive study. Place and Duration of the Study: OPD complex, Pak Emirates Military Hospital, Rawalpindi, Pakistan, from February to August 2021.

Methodology: The study included a total of 90 patients who met the specified criteria for enrolment. Each group (case and control) contains 45 patients. Diagnosis of androgenetic 2 alopecia was done clinically and grading was based on the Norwood-Hamilton classification in males and Ludwig classification in females. Body mass index (BMI) was calculated and blood pressure was measured for all enrolled patients. Following an overnight fasting period, blood samples were collected from each patient to measure clinical parameters including triglycerides (TGs), fasting blood sugar (FBS), and high-density lipoprotein (HDL) levels.

Results: There were 85.6% males and 4.4% females with a mean age of 43.38 years. Out of which, 34.4% and 15.6% of patients fell in severity 1 and severity 2 Class. Patients were stratified on the basis of AGA with respect to TGs, FBS, HDL, and BMI. The p-value was significant when stratified on the basis of BMI, FBS, and HDL except TGs. Odd ratio of both groups on the basis of (MetS) 8.1. Odd ratio between androgenic alopecia and metabolic syndrome was of 2.4.

Conclusion: An association existed between androgenetic alopecia and metabolic syndrome indicating the potential benefit of early MetS screening for individuals with androgenic alopecia. This proactive approach could help prevent unforeseen complications through timely lifestyle adjustments.

Key words: Metabolic syndrome, Androgenic alopecia, Cholesterol, Triglycerides.

Objective: To evaluate the relationship between homocysteine levels and anti-mullerian hormone (AMH) levels, a biomarker of ovarian reserve, and the effect of high homocysteine levels on ovarian reserve in subfertile women.

Study design: Observational case-control study. Place and Duration of the Study: Samsun Training and Research Hospital, Samsun, Turkiye, from October to December 2023.

Methodology: Seventy-nine subfertile women and 35 healthy fertile women were included in this study. AMH, homocysteine, thyroid stimulating hormone (TSH), free T3 (fT3), free T4 (fT4), iron, and ferritin levels of subfertile and fertile women were compared. Logistic regression, receiver operating characteristic, and Kaplan-Meier analyses were performed for homocysteine levels.

Results: AMH, fT4, iron, and ferritin levels were lower in subfertile women than in fertile women (p <0.001). Homocysteine and TSH levels were higher in subfertile women than in fertile women (p <0.001). The sensitivity for homocysteine levels was 94.90% and the specificity was 94.30%. In the Kaplan-Meier analysis, homocysteine levels of 12.90 μmol/L and above were found to be risky in terms of fertility. Homocysteine levels, AMH, and ferritin levels were negatively correlated and TSH levels were positively correlated in subfertile women (p <0.001). However, these correlations were not observed in fertile women (p >0.05).

Conclusion: High homocysteine levels can be considered as a risk factor affecting ovarian reserve in subfertile women.

Key words: Anti-mullerian hormone, Female subfertility, Homocysteine, Hyperhomocysteinaemia, Ovarian reserve.