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

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Objective: To assess the factors that affect mothers' quality of life (QOL) and the association of various demographic variables with QOL of the respondents.

Study design: A cross-sectional survey. Place and Duration of the Study: Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan, from April to September 2023.

Methodology: Mothers of visually impaired children were selected through non-probability consecutive sampling. WHO QOL-BREF was used to analyse the QOL of the respondents. The Chi-square test of association was applied to determine the factors of QOL of the respondents.

Results: Out of 264, the majority of the visually impaired children were females (n = 144, 54.5%) and belonged to 5-8 years of age (n = 115, 43.6%). It was also noted that the majority of children had mild levels of visual impairment (n = 182, 69%). More than half of the mothers of visually impaired children were married to their cousins (n = 144, 54.5%) and belonged to rural areas (n = 140, 53%). Most of the mothers perceived that they had a good quality of life (n = 96, 36%) and were satisfied with their health status (n = 107, 40%). Mothers with poor QOL were slightly more in numbers compared to those with good QOL (n = 134. 51% vs. n = 130. 49%).

Conclusion: Mothers of visually impaired children exhibited poor QOL in all four domains. Major related factors associated with poor QOL of mothers were the age of the child, cause of disability, duration of disability, and duration of caregiving. While mother's related factors included marital status, outside family marriage, education, income level, number of children, and residence.

Key words: Mothers, Quality of life, Rawalpindi, Tertiary care hospitals, Visually impaired children.

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Objective: To establish the construct validity of the Assessment Implementation Measures (AIM) tool to accurately assess faculty perspectives on implemented assessment systems, facilitating the alignment with set standards.

Study design: Qualitative Study. Place and Duration of the Study: The study was carried out at RIPHAH International University and data were collected from participants (senior faculty members) involved in teaching and assessment of undergraduates from various medical and dental colleges in Pakistan. Google form questionnaire was distributed using email and WhatsApp. The data were analysed using IBM AMOS SPSS version 24.

Methodology: It was a 30-item tool. The sample size was calculated using 1:10 item-to-participant ratio. Hence data were collected from 313 participants. Confirmatory factor analysis was done to establish construct validity.

Results: The indices of confirmatory factor analysis of the tool showed a discrepancy. To remove this discrepancy, items with weak item-loading values were removed. In the end, the tool was reduced to 13 items belonging to three domains.

Conclusion: The final model was improved by excluding items from the original model. A re-validation study with a careful selection of experienced participants from various institutional backgrounds having baseline knowledge of medical education is suggested to improve the results.

Key words: AIM Tool, Confirmatory factor analysis, Medical education, Assessment.

Antimicrobial-resistant bacteria are particularly prevalent in Southeast Asia, mainly due to inadequate infection prevention and control (IPC) and the widespread and uncontrolled use of antibiotics. Pakistan is the third largest low-middle-income country (LMIC) user of antibiotics. Antibiotic consumption increased by 65%, from 800 million to 1.3 billion defined daily doses (DDD). Antimicrobial consumption is high and poorly regulated, and an estimated 300,000 people die because of bacterial antimicrobial resistance (AMR) annually. Due to the changing government priorities, antimicrobial stewardship programmes (ASP) implementation is not compulsory for hospitals to acquire national accreditation, which has led to de-prioritisation among hospital managers and clinical teams. Additionally, lack of support from hospital administration, limited nationwide health insurance coverage for bacterial cultures, and a lack of surgical centres and microbiology laboratories, information technology (IT) support to collect and analyse AS-related data, reduced availability of pharmacists, ID physicians, and IPC staff for ASP events are the primary contributing factors creating hindrance to the long-term viability of ASP. Briefly, strong hospital leadership support is the major factor for allocating the resources for ASP structures and activities and also for establishing the key performance indicators (KPIs), enforcing compliance with hospital-specific clinical practice guidelines, as well as addressing friction between ASP team members and prescribers. Key Words: Antimicrobial resistance, Antimicrobial stewardship programmes, Infection prevention and control.

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Objective: To compare the closed reduction approach with open reduction (transparotid approach) in the management of condylar fractures for parameters such as postoperative facial nerve injury, trismus, and malocclusion.

Study design: An analytical comparative study. Place and Duration of the Study: Department of Oral and Maxillofacial Surgery, The Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, from 10th January 2022 to 1st October 2023.

Methodology: Patients with condylar fractures were included and divided into two groups (30 each) and condylar fractures were managed under general anaesthesia. After obtaining informed consent, condylar fractures were managed with closed reduction (maxillomandibular fixation with Eyelets or Arch Bar) in one group. In the other group, open reduction and internal fixation (ORIF) via transparotid approach were performed. Postoperatively, facial nerve injury was recorded five days after the procedure. Postoperative trismus and malocclusion were recorded three months after the procedure.

Results: Better treatment outcomes in terms of postoperative malocclusion and trismus were recorded for open reduction and internal fixation i.e. transparotid approach as compared to closed reduction. Facial nerve injury was recorded for the initial period in transparotid approach but long-term results among both techniques were comparable.

Conclusion: Transparotid approach in comparison with closed reduction provides good results in the management of condylar fractures.

Key words: Condylar fractures, Open reduction, Closed reduction, Facial nerve injury, Transparotid approach.

Objective: To investigate the characteristics of Adult-onset Still's disease (AOSD) patients with macrophage activation syndrome (MAS) and explore the risk factors for the development of MAS.

Study design: A case-control study. Place and Duration of the Study: Department of Rheumatology and Immunology, the Second Hospital of Anhui Medical University, Anhui, China, from January 2008 to June 2024.

Methodology: AOSD patients with MAS (AOSD-MAS) and without MAS (AOSD-nonMAS) were compared. Clinical features and laboratory results from two groups were analysed using the independent samples t-test or Mann-Whitney U test. Fisher's exact test or Pearson's Chi-square test was used to compare the variables between the two groups. The multivariable logistic regression analysis was applied to identify AOSD with MAS-associated factors. The value of risk factors in predicting MAS occurrence was carried out by a receiver operating characteristic validation analysis.

Results: MAS patients showed higher prevalence of sore throat, splenomegaly and abnormal liver function, a lower prevalence of arthrodynia and higher levels of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, alanine aminotransferase, aspartate aminotransferase, lactic dehydrogenase, serum ferritin, D-Dimer levels, and a higher AOSD system score, along with a lower lymphocyte count (p <0.05). Multivariate logistic regression analysis identified NLR and AOSD system scores as predictors of MAS. An optimised threshold of 17.455 and 5.500 for NLR and AOSD system score yielded a sensitivity of 84.60% (38.50) and a specificity of 91.00%, (47.40).

Conclusion: Early detection of MAS in AOSD may be facilitated by monitoring these factors, particularly NLR and AOSD system scores.

Key words: Adult-onset still's disease, Macrophage activation syndrome, Risk factor.

Objective: To explore the prognostic significance of Sestrin-2 and Galectin-3 levels in atrial fibrillation complicated by left atrial remodelling, aiming to offer novel insights for prevention, treatment, and follow-up strategies.

Study design: Analytical study. Place and Duration of the Study: Department of Cardiology, Second People's Hospital of Anhui Province, Hefei, China, from January 2021 to December 2023.

Methodology: A total of 188 patients with atrial fibrillation were enrolled and divided into two groups based on the presence or absence of atrial remodelling. Serum levels of Sestrin-2 and Galectin-3, along with baseline clinical data, laboratory examinations, and Doppler echocardiography results, were compared between the groups.

Results: The atrial remodelling group showed significantly higher levels of age, AST, Sestrin-2, Galectin-3, and left atrial diameter compared to the non-atrial remodelling group (p <0.05). Multivariate logistic regression analysis indicated that both Sestrin-2 and Galectin-3 were independent risk factors associated with atrial remodelling in patients with atrial fibrillation (p <0.05). The combined assessment of Sestrin-2 and Galectin-3 yielded an area under the receiver operating characteristic (ROC) curve of 0.854, facilitating precise identification of the incidence of atrial fibrillation.

Conclusion: The study found that serum levels of Sestrin-2 and Galectin-3 were significantly elevated in the atrial remodelling group compared to the non-atrial remodelling group, suggesting their potential clinical utility in predicting atrial remodelling in patients with atrial fibrillation. These findings are significant for the prevention and treatment of this condition.

Key words: Atrial fibrillation, Sestrin-2, Galectin-3, Atrial remodelling.

Objective: To determine whether malignancy was discovered within one year of follow-up in patients with deep vein thrombosis (DVT) in the emergency department (ED).

Study design: Descriptive study. Place and Duration of the Study: Department of Emergency Medicine, School of Medicine, Duzce University, Duzce, Turkiye, from November 2019 to November 2022.

Methodology: All patients diagnosed with lower limb DVT on venous Doppler ultrasound were included in this study. Patients with a confirmed diagnosis or suspicion of malignancy were excluded. The study outcome was the discovery of malignancy within a year. DVT patients subsequently diagnosed with malignancy were grouped as secondary or idiopathic.

Results: A total of 224 DVT patients without malignancy were studied. The median age of patients diagnosed with DVT was 65.5 years (47-77), of which, 51.8% were females. Malignancy was detected in 5.4% (12/224) of the patients within one year. Malignancy discovery was significantly higher in the secondary DVT group (OR = 4.52, 95% CI = 1.31-11.55; p = 0.021). Ten of 12 patients (83.3%) diagnosed with malignancy were from the genitourinary or gastrointestinal systems.

Conclusion: In patients without known malignancy who were diagnosed with DVT in the ED, the rate of malignancy discovery in a one-year follow-up was 5.4%. EDs, where DVT is frequently diagnosed, are a hub of opportunities for early detection of malignancy. Arranging primary care follow-up of patients with DVT will contribute to better early diagnosis and survival rates, especially for genitourinary and gastrointestinal malignancies.

Key words: Deep vein thrombosis, Malignancy, Emergency department, Venous Doppler ultrasound.