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Objective: To investigate whether intra-operative hypotension could be predicted with pulse wave velocity (PWV) if measured preoperatively.
Study design: Descriptive analytical study. Place and Duration of the Study: The University Hospital in Turkiye between September 2021 and September 2022.
Methodology: All patients aged 30 years and older, whose physical status was graded as I or II according to the American Society of Anaesthesiologists (ASA) classification, were scheduled for elective lower extremity surgery under spinal anaesthesia (SA). Patients previously diagnosed with hypertension (HT) and/or using antihypertensive medication constituted the HT group, and patients with a preoperative systolic blood pressure (SBP) with a value of <140 mmHg constituted the control group. Arterial stiffness measurements of the patient and control groups were performed using the Oscillo metric device [Mobil-O-Graph]. The SBP and diastolic blood pressure (DBP) values were measured. A 20% or more decrease in systolic blood pressure (SBP) compared to the baseline SBP indicated spinal anaesthesia-related hypotension (SARH).
Results: The PWV was higher in the HT group than the control group (p <0.001). The rates of patients that developed hypotension at the 3rd, 5th, 10th, 20th, and 30th minutes of SA were also higher in the HT group than in the control group (p <0.05). The PWV value was significantly higher in patients with SARH than those without SARH at the 3rd, 5th, 10th, 20th, and 30th minutes after SA (p = 0.001, p = 0.001, p = 0.002, p = 0.001, and p = 0.001, respectively).
Conclusion: Preoperative PWV may be an effective biomarker in predicting spinal anaesthesia-related hypotension in hypertensive patients.
Key words: Hypotension, Hypertension, Adult, Haemodynamic, Spinal anaesthesia.
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Objective: To assess the burnout and resilience scores among medical and dental students and to identify the factors that affect burnout and resilience of the students.
Study design: Descriptive cross-sectional study. Place and Duration of the Study: Bahria University Health Sciences, Karachi, Pakistan, from March to September 2023.
Methodology: A calculated sample of 392 students participated in this cross-sectional study. In which students self-administered the Burnout Assessment Test (BAT-23) and Brief Resilience Scale (BRS) questionnaire. Descriptive statistics were determined using frequency and percentages and multiple regression analysis.
Results: The mean age of the students was 21.6 ± 1.6 years predominantly females from a medical college, studying in clinical years, and residing in hostels or rented flats. The total burnout was 38%, out of which academic burnout was 80%. Among the four burnout categories, most of the students experienced exhaustion (87.5%) followed by cognitive impairment. The brief resilience score was high which assessed the coping mechanism, and 74.5% of the students had normal resilience. Medical students in clinical years living with a family, spending few hours on social media, having financial difficulties, and having lower resilience are all associated with a slightly higher burnout score.
Conclusion: The students displayed elevated brief resilience scores, signifying proficient coping strategies despite high academic burnout frequency. Exhaustion was the most widespread in the burnout categories, and factors linked to a slightly increased burnout score encompassed being a medical student in clinical years, living with family, dedicating more time to social media, encountering financial challenges, and possessing lower resilience.
Key words: Burnout, Resilience, Medical students, Exhaustion.
Objective: To determine the relationship between mean platelet volume (MPV), leucocyte count, and HbA1c levels in patients with type 2 diabetes mellitus (DM).
Study design: Observational study. Place and Duration of the Study: Bahcesehir Family Healthcare Centre (FHC), Adana, Turkiye, from January 2023 to 2024.
Methodology: This study included 101 controls and 106 patients with Type 2 diabetes mellitus (DM). Age, gender, body mass index (BMI), duration of diabetes, smoking, type of diabetic medication, and presence of chronic diseases were all assessed in relation to the patients. Analysis of leucocyte count, MPV, and HbA1c was conducted retrospectively. IBM SPSS version 25.0 was utilised for the statistical analysis, with p <0.05 being considered as the significance threshold.
Results: The DM group exhibited significantly higher levels of HbA1c (7.8 ± 1.5%), MPV (9.2 ± 1.3 fL), and leucocyte count (7.1 ± 1.8 x10^3/µL) in comparison to the control group (p <0.001). There was a positive and statistically significant association found between the leucocyte count, MPV, and HbA1c. In the control group, there was no significant link onserved.
Conclusion: In patients with Type 2 DM, a favourable connection between HbA1c, MPV, and leucocyte count was observed. These results point to a higher risk of thrombosis and inflammation in DM patients. Patients with HbA1c values above 7 showed increased leucocyte counts and MPV, which indicated that these patients were at a higher risk of vascular problems. Leucocyte counts and MPV may serve as useful biomarkers to gauge the likelihood of vascular problems in DM.
Key words: Type 2 diabetes mellitus, HbA1c, Mean platelet volume, Leucocyte count, Inflammation, Vascular complications.
Objective: To investigate the efficacy and safety of the mesoporous silica-based nano-drug co-delivery system with gemcitabine (GEM) in the treatment of pancreatic cancer.
Study design: Experimental study. Place and Duration of the Study: Wenzhou Central Hospital, Zhejiang Province, China, between July 2022 and November 2023.
Methodology: Ce6@MSN-Fe3O4/GEM@DPM nanoparticles were prepared and structurally characterised, then their drug loading and entrapment efficiency were calculated, and in vitro drug release and cytotoxicity assays were performed. In addition to that, mesoporous silica nanorods were prepared and structurally characterised for cellular uptake, cytotoxicity, and reactive oxygen species detection.
Results: The mesoporous silica nanoparticles were spherical in shape and possessed a unique core-shell structure. The prepared nanoparticles had good entrapment efficiency and drug loading, and exibited pharmacotoxic and phototoxic effects on cells. The mesoporous silica nanorods were taken up by pancreatic cancer cells and exbitied cytotoxicity.
Conclusion: Mesoporous silica-based nano-drug co-delivery system, which carries GEM, is an effective targeted drug delivery system to provide new research ideas for the treatment of pancreatic cancer.
Key words: Pancreatic cancer, Gemcitabine, Magnetic nanocomposites, Photodynamic therapy, Targeted drug delivery.
Objective: To determine the clinical and embryo laboratory factors that affect the clinical pregnancy rate of infertile patients with endometriosis (EMs), and establish a model for predicting clinical pregnancy.
Study design: An observational study. Place and Duration of the Study: Reproductive Medicine Centre, Jiangxi Provincial Maternal and Child Health Hospital, China, from January 2016 to December 2023.
Methodology: Inclusion criteria were EMs patients diagnosed and treated through laparoscopic surgery, aged 22 - 37 years, who did not undergo surgery within 3 months before oocyte retrieval, and received fresh embryo transfer; and the causes of infertility included male factors, tubal infertility, intrauterine adhesions, and others. The exclusion criteria were EMs patients with combined uterine adenomyosis, chromosomal abnormalities, abnormal uterine structure, endocrine diseases, cardiovascular diseases and autoimmune diseases. The research variables included clinical and embryonic factors that affect clinical pregnancy rates, such as age, duration of infertility, type of infertility, and sex hormone levels. The outcome variable was the clinical pregnancy rate.
Results: The clinical pregnancy rate was 61.84%. This predictive model was built on the basis of the number of high-quality cleavage embryos, number of embryos transferred, progesterone on HCG day, infertility duration, female age, number of oocytes retrieved, and body mass index showing good calibration and discriminatory abilities, with the area under the curve of receiver operating characteristic curve of 0.641 (95% CI = 0.599 - 0.684) for training set and 0.583 (95% CI = 0.515 - 0.650) for testing set. The Hosmer-Lemeshow test showed no significant difference (p >0.05) between the predicted and the true clinical pregnancy probabilities. The clinical decision curve analysis showed that both the training and testing sets achieved maximum net benefit within a threshold probability range of 0.4 - 0.8, indicating good clinical efficacy within this threshold probability range.
Conclusion: The model for predicting clinical pregnancy in patients with EMs after fresh IVF/ICSI-ET had high accuracy, and can provide useful guidance for clinical doctors and individual adjuvant treatment of patients.
Key words: Endometriosis, Predictive model, Clinical pregnancy, Nomogram, In vitro fertilisation.
To uncover the clinical characteristics and investigate the underlying causes of psychiatric manifestations in patients with systemic lupus erythematosus (SLE), including its subset, neuropsychiatric systemic lupus erythematosus (NPSLE). Through comprehensive database searches in PubMed, Embase, Medline, and Cochrane, from their inception to August 2023, the study focused on adult SLE and NPSLE cases. From the selected studies, data were synthesised via a random-effects meta-analysis, encompassing a total of 2,997 subjects across six studies. The findings highlighted differences in medical indicators such as discoid rash, hypertension, mean disease duration, and various autoantibodies between SLE and NPSLE patients, indicating a nuanced approach to treatment is necessary, particularly with NPSLE requiring extended treatment periods. The analysis suggests that the causality behind these manifestations is multifactorial, encompassing mental state, autoantibody profiles, and environmental factors, thus providing valuable insights into the clinical management and understanding of SLE and NPSLE. This study emphasises the complexity of SLE, particularly in its neuropsychiatric manifestations, and underscores the importance of targeted treatment strategies. Key Words: Systemic lupus erythematosus, Neuropsychiatric systemic lupus erythematosus, Neuropsychiatric event, Meta-analysis.
Objective: To evaluate the risk factors for early onset of coronary artery disease (CAD) and assess the preoperative presentation, perioperative course, survival, and short-term complications after coronary artery bypass graft (CABG) in patients aged 45 years or younger undergoing CABG.
Study design: Observational study. Place and Duration of the Study: Department of Cardiothoracic Surgery, The Aga Khan University Hospital, Karachi, Pakistan, from December 2020 to January 2021.
Methodology: All patients aged 45 years or younger who were undergoing CABG were included in the study. Patients with incomplete medical records were excluded. Study variables included preoperative demographic information, intraoperative variables including the number and type of conduits used, and postoperative morbidity and mortality. Descriptive analysis was reported for all variables.
Results: The study population cohort included 134 patients, of whom 120 (89.6%) were male, with a mean age of 38.6 ± 5.1 years (range: 30-45 years). The indication for surgery was 3-vessel CAD in 56 (41.7%) patients. A total of 421 grafts were constructed, with a mean of 3.14 grafts per patient. One patient died in the hospital with an overall operative mortality of 1.5%. The most common risk factors were found to be family history, the presence of diabetes mellitus, hypertension, and smoking.
Conclusion: The risk factors and outcomes in younger patients (less than 45 years) undergoing CABG are not markedly different from those in older patients and are comparable to the existing literature.
Key words: Coronary artery disease, Coronary artery bypass graft, Young adults, Risk factors, Three vessel disease.
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