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

Objective: To ascertain whether the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are reliable diagnostic tools for acute appendicitis.

Study design: An analytical study. Place and Duration of the Study: Department of General and Laparoscopic Surgery, Sheikh Khalifa Bin Zayed Al Nahyan Hospital, Muzaffarabad, Pakistan, from January to June 2022.

Methodology: This study was conducted using consecutive sampling of patients aged ≥16 years. Admission haemogram was used to calculate the NLR and PLR. These ratios were compared with peroperative findings regarding the stage of inflammation in the appendix. Sensitivity, specificity, and accuracy rates were compared and evaluated using a non-parametric (empirical) method for receiver operating characteristic curve analysis.

Results: The median age of patients was 26 years, with a male-to-female ratio of 1:1.03. NLR had a sensitivity of 76.9%, a specificity of 93.3%, a negative predictive value (NPV) of 94.2%, and an accuracy of 70.2% in separating complicated from uncomplicated appendicitis. Moreover, it had a sensitivity of 73%, a specificity of 100%, an NPV of 98%, and an accuracy of 73.03% in separating non-inflamed appendix from uncomplicated appendicitis. PLR did not show any significant differentiation between non-inflamed appendix and uncomplicated appendicitis (p = 0.8), and its accuracy for differentiating complicated from uncomplicated appendicitis was also low, that is, 48.2%.

Conclusion: NLR is a helpful diagnostic tool that can predict uncomplicated and complicated appendicitis and differentiate between them. However, relying solely on NLR for diagnosing appendicitis is not advisable. PLR does not have similar predictability. More research needs to be done to find additional biomarkers for NLR and PLR to improve their predictability as a diagnostic tool.

Key words: Appendicitis, Biomarker, Negative appendectomy, Neutrophil-to-lymphocyte ratio, Perforation, Platelet-to-lymphocyte ratio, Sensitivity, Specificity.

Objective: To determine the console time and safety of robotic-assisted cholecystectomy using the Versius system.

Study design: An observational study. Place and Duration of the Study: Department of Surgery, National Hospital and Medical Centre, Lahore, Pakistan, from May 2022 to March 2024.

Methodology: Cases of robotic-assisted cholecystectomy were reviewed. Prospective data was collected. Informed consent regarding surgery and the use of clinical data was obtained. Confidentiality of patient information was maintained. Perioperative variables and postoperative follow-up were recorded, and 90-day morbidity, readmission, and mortality were noted.

Results: A total of 156 cases of robotic-assisted cholecystectomy were performed. Most of the patients were female (n = 115, 73.71%). The overall mean console time was 63.04 ± 33.14 minutes. There were no readmissions, mortality, or 90-day morbidity. Only one patient (0.61%) had a bleeding complication, requiring laparoscopic exploration.

Conclusion: In appropriately selected cases, robotic-assisted cholecystectomy surgery is safe, and its short-term outcomes are comparable to laparoscopic surgery. Console time is influenced by patient gender and gallbladder characteristics.

Key words: Robotic-assisted, Cholecystectomy, Pakistan, Initial experience, Versius system.

Objective: To assess the effect of a single-shot posterior quadratus lumborum block (QLB) on double-J stent-related (DJS-related) lower urinary tract symptoms (LUTS) and postoperative opioid consumption following ureteroscopic lithotripsy (URSL).

Study design: A randomised controlled trial. Place and Duration of the Study: Department of Urology, Mugla Sitki Kocman University, Training and Research Hospital, Mugla, Turkiye, from January to October 2024.

Methodology: A total of 154 patients undergoing unilateral URSL with double-J stent (DJS) placement under spinal anaesthesia were randomly assigned to two groups. The QLB group (n = 77) received a posterior QLB, whereas the Control group (n = 77) received standard care without regional blocking. Postoperative pain was assessed using the Numerical Rating Scale (NRS) at 1, 6, 12, 24, and 48 hours, as well as on day 7. LUTS were assessed with the Ureteral Stent Symptom Questionnaire (USSQ) on day 7 (USSQ-1, during stent indwelling) and five days after stent removal (USSQ-2). Cumulative tramadol consumption within the first 48 hours was also recorded.

Results: Compared with the Control group, the QLB group showed lower USSQ-1 scores (68.05 ± 19.08 vs. 90.22 ± 23.60; p <0.001), improved USSQ-2 scores (43.64 ± 6.04 vs. 52.58 ± 15.13; p <0.001), and reduced tramadol consumption (75.32 ± 101.51 mg vs. 229.87 ± 146.06 mg; p <0.001). Pain scores were consistently lower at all time points except the first hour. No major adverse events were observed.

Conclusion: A single posterior QLB appears to reduce DJS-related LUTS, postoperative pain, and opioid use after URSL. Its inclusion in multimodal analgesia protocols may contribute to improved perioperative care in urological surgery.

Key words: Double-J stent, Lower urinary tract symptoms, Postoperative pain, Quadratus lumborum block, Regional anaesthesia, Ureteroscopic lithotripsy.

A systematic review was conducted to compare rivaroxaban with enoxaparin in the prevention of venous thromboembolism (VTE) and wound complications after total knee arthroplasty. Comprehensive searches of electronic databases were conducted, encompassing Medline/PubMed, Embase, and the International Clinical Trials Registry Platform (ICTRP), covering all the available literature up to January 2022. Adhering to the Cochrane methodology for systematic reviews, two independent researchers meticulously screened the retrieved studies, extracted pertinent data, and assessed the quality of the evidence. The review included six studies with 6,627 patients, sourced from Medline/PubMed, Embase, and clinical trial registries. Meta-analysis showed that rivaroxaban significantly reduced symptomatic VTE and deep vein thrombosis (DVT), with relative risks (RR) of 0.55 (p = 0.009) and 0.44 (p = 0.007), respectively. However, there was no significant difference in symptomatic pulmonary embolism (PE), wound complications, major bleeding, or mortality (all p >0.05). Rivaroxaban demonstrated superior efficacy for VTE and DVT prevention without increasing major risks. Key Words: Enoxaparin, Meta-analysis, Rivaroxaban, Wound complications.

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Objective: To determine the threshold β-hCG values ​​that can predict the live birth (LB) rates in in vitro fertilisation-embryo transfer (IVF-ET) cycles, and to compare these serum β-hCG values ​​separately in fresh and frozen embryo transfers.

Study design: Case-control study. Place and Duration of the Study: Department of Gynaecology and Obstetrics, University of Health Sciences Gulhane Training and Research Hospital, Ankara, Turkiye, between January 2017 and January 2023.

Methodology: Serum β-hCG values ​​of patients who underwent single embryo transfer on Day 5 were measured on Days 12 and 14 after transfer. The patients were divided into two groups: pregnancies that resulted in live birth (LB (+)) and pregnancies that did not result in live birth (LB (-)). The two groups were compared in terms of serum β-hCG values ​​and β-hCG increase rates on the 12th and 14th days after transfer.

Results: The median β-hCG value measured on day 12 in fresh transfers resulting in LB was found to be 277 IU/L. However, this value was found to be 332 IU/L in frozen transfers. When all transfers were considered without discrimination, it was concluded that the β-hCG test could predict LB with a sensitivity of 75% and a specificity of 72% at a value of 197 IU/L.

Conclusion: A cut-off value of 197 IU/L was found to be a strong parameter to predict LB in all transfers, regardless of whether the transfer was fresh or frozen. It will guide clinicians in predicting pregnancy outcomes and counselling patients.

Key words: β-hCG, Live birth, Fresh transfer, Frozen transfer, In vitro fertilisation.

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Objective: To identify risk factors and to develop a predictive model for urinary incontinence (UI) after laparoscopic radical prostatectomy (LRP).

Study design: Observational study. Place and Duration of the Study: Department of Urology, Qinghai University Affiliated Hospital, Xining, China, from June 2019 to June 2024.

Methodology: The study analysed 210 prostate cancer patients who underwent LRP at a single tertiary centre. Propensity score matching method was utilised to compare patients with urinary incontinence (UI group, n = 34) to those with urinary continence (Control group, n = 176). Predictors included age, body mass index (BMI), membranous urethral length (MUL), prostate volume, and bladder neck preservation (BNP) status. Multivariable logistic regression was applied to identify independent risk factors, followed by nomogram development and bootstrap validation (1,000 iterations).

Results: Significant intergroup differences were observed in MUL [(12.21 ± 2.57) mm vs. (14.97 ± 2.80) mm, p <0.001], prostate volume [(47.41 ± 4.97) ml vs. (37.28 ± 5.27) ml, p <0.001], and BNP status (23.53% vs. 73.86%, p <0.001). Multivariate analysis identified advanced age (OR = 1.714, 95% CI 1.322-2.221), prostate volume ≥50ml (OR = 1.105, 95% CI 1.038-1.177), MUL ≤12mm (OR = 0.430, 95% CI 0.278-0.664), and non-preservation of bladder neck (OR = 6.637, 95% CI 1.496-29.452) as independent UI risk factors. The nomogram demonstrated excellent discrimination, with C-indices of 0.988 (95% CI: 0.977-0.999) in the training set and 0.923 (95% CI: 0.885-0.961) in the validation set. For the combined cohort, the overall area under the curve (AUC) was 0.974 (p <0.001).

Conclusion: This model integrates anatomical and surgical factors to predict post-LRP UI risk, demonstrating potential for preoperative risk stratification. However, external validation is required before clinical implementation.

Key words: Urinary incontinence, Prostatectomy, Prostate cancer, Nomogram, Risk factors.

Objective: To compare the Objective Structured Clinical Examination (OSCE) performance and learner satisfaction among undergraduate medical students trained in depression assessment during the Mental State Examination (MSE), using simulated patients (SPs) versus real patients (RPs).

Study design: A quasi-experimental study. Place and Duration of the Study: Department of Psychiatry, Civil Hospital, Karachi, Pakistan, from June to November 2023.

Methodology: Fourth-year medical students on psychiatry clinical postings were divided into two groups: Control group and Intervention group. A demonstration session on assessing depression, led by the facilitator, was followed by a practice session. The Control group practised on real patients, while the Intervention group practised on simulated patients. Students' satisfaction with learning experience was recorded using a validated, self-rated scale, Escala de Satisfacao com as Experiencias Clinicas Simuladas (ESECS). Clinical skills were assessed during the OSCE at the end of the clinical posting using a rating scale. Data were analysed using SPSS, Chi-square test, independent sample t-test, and Pearson correlation for descriptive statistics.

Results: A total of 80 students participated in this study. The two groups demonstrated comparable performance on the OSCE station (p = 0.43) and almost similar levels of learner satisfaction (p = 0.06), indicating no statistically significant differences.

Conclusion: Both real and simulated patients contributed equally to the acquisition of clinical skills for assessing depression by medical students. The selection of teaching resources, therefore, depends on patient availability and specific clinical needs of the students.

Key words: Simulated Patients, Mental state examination, Depression, Medical students, Objective structured clinical examination, Learner satisfaction.