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

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Objective: To determine the outcome of awake surgery with combined spinal epidural in geriatric colon cancer patients with advanced comorbidity.

Study design: Quasi-experimental study. Place and Duration of the Study: Department of Anaesthesiology and Reanimation, Ankara Bilkent City Hospital, Ankara, Turkiye, from April 2022 to 2023.

Methodology: Twenty-four American Society of Anaesthesiologists (ASA) I-II patients, aged 25-65 years and scheduled for colon cancer surgery were included in this research. All patients were observed preoperatively, at the operation room and at the postoperative surgery service. Spinal anaesthesia was planned for Group I and general anaesthesia for Group II. Ketofol (1:1) was administered to the combined spinal-epidural group, with a Ramsay sedation score of 3 after the spinal block. Epidural analgesia was planned for all patients. Patients' age, gender, weight, comorbidities, ASA risk scores, intraoperative haemodynamic parameters, bleeding amounts, colloid, crystalloid, and blood products were collected.

Results: There was no significant difference between the demographic characteristics of both anaesthesia groups (p >0.05). The amount of bleeding was statistically lower in Group I than in the general anaesthesia group (p = 0.004). Oral intake, drain withdrawal, mobilisation, discharge times, and costs were similar in all groups (p >0.05).

Conclusion: The regional anaesthesia applications facilitate compliance with routine mobilisation, discharge procedures and prevent complications in abdominal surgery and its positive perioperative effects in patients with poor respiratory parameters, poor general condition, and high comorbidity in advanced age.

Key words: Regional anaesthesia, Spinal-epidural, Mobilisation, Pain, Colon cancer.

Objective: To evaluate disparities in gene expression profiles between Ovarian Clear Cell Carcinoma (OCCC) and High-Grade Serous Ovarian Carcinoma (HGSOC).

Study design: A descriptive study. Place and Duration of the Study: The Second People's Hospital of Jingdezhen, Jiangxi, China, between 31st December 2017 and December 2023.

Methodology: Basic and clinical diagnostic information, along with genetic test reports, were compiled from all patients within the included groups. Differential gene expression between the two cohorts was scrutinised to elucidate its clinical significance.

Results: Comparative analysis revealed nine differentially expressed genes in OCCC relative to HGSOC, with six exhibiting significant disparities (p <0.05). These genes are implicated in pivotal cellular processes including the cell cycle, apoptosis, DNA damage repair, and the PI3K pathway. Notably, aberrant expression patterns, such as overexpression of MET and downregulation of PTEN and SMARCA4, correlated with adverse prognosis and survival outcomes in selected patients.

Conclusion: Distinctive gene expression profiles between OCCC and HGSOC underscore disparate tumorigenic mechanisms, thereby laying a foundation for the tailored therapeutic interventions. Further elucidation of the identified differentially expressed genes is warranted to delineate their role in OCCC pathogenesis and prognostic significance.

Key words: Ovarian clear cell carcinoma, High-grade serous ovarian cancer, Gene expression profiles, Homologous recombination repair.

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Objective: To comprehensively analyse the current state of metabolomics in clinical laboratories across Pakistan.

Study design: Cross-sectional survey. Place and Duration of the Study: Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan, from June to November 2022.

Methodology: This survey assessed metabolomics availability, computational methods, and resources in Pakistani clinical laboratories. The survey questionnaire was distributed within the chemical pathology community via Google Forms, and responses were garnered from 44 chemical pathologists across 17 laboratories in 10 cities.

Results: Among respondents, 11 had formal metabolomics training, with three having less than 1 year, five more than 1 year, and 33 lacking any experience. Primary clinical applications included inherited metabolic disorders, bio-informatics, microbiology, therapeutic drug monitoring, toxicology, and nutritional and environmental science. Thirty-three labs reported no omics-related technology; LC-MS and GC-MS were present in eight labs and capillary spectroscopy, direct infusion mass spectroscopy, and Fourier transform infrared-spectroscopy were predominantly used for metabolite identification. Challenges identified in implementing metabolomics included lack of awareness, limited expertise, low volume, restricted applicability, high instrument costs, and insufficient funding.

Conclusion: Metabolomics in Pakistan faces limitations, but the chemical pathology community expresses strong interest, emphasising the need for intensified efforts in education and training in this emerging field.

Key words: Metabolomics, Chemical pathology, Pakistan, Clinical laboratories, Genetics, Survey.

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Objective: To determine the value of hypointense pericholedocal ring sign in magnetic resonance imaging (MRI) T2W sequence images in the diagnosis of pancreatic ductal adenocarcinoma (PDA).

Study design: Retrospective observational study. Place and Duration of the Study: Department of Radiology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkiye, from January 2016 and March 2022.

Methodology: Retrospective analysis of MRI scans was performed on 70 patients with postoperative histopathological confirmation of a diagnosis of periampullary cancer. The patients' demographic information, the results of their histopathological examinations, and the findings of their MRIs were recorded. The results of the MRI were statistically analysed and compared between the PDA and the non-PDA groups.

Results: The study included 43 (61.4%) male and 27 (38.5%) female patients, with a mean age of 62.2 ± 8.4 years. The means of Wirsung diameter and tumour diameter were significantly higher in PDA group (p = 0.034, p = 0.010, respectively). A progressive contrast enhancement pattern of 95.3% was observed in PDA group, while 40.7% rapid contrast enhancement pattern was observed in the non-PDA group. Hypointense pericholedochal ring sign, observed in T2W sequences, was detected in 74.2% (n = 32) of the PDA group and 11.1% (n = 3) of the non-PDA group, and the findings were statistically significant (p <0.001).

Conclusion: Hypointense pericholedochal ring sign in axial T2W sequences in periampullary tumours is a complementary MRI finding in the distinction between the PDA and the non-PDA groups.

Key words: Magnetic resonance imaging, Pancreatic ductal adenocarcinoma, Periampullary tumours, Pericholedochal ring sign.

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Objective: To determine the presence of microplastics in the stomach, and the relationship between pathological changes in stomach tissue and microplastics.

Study design: An analytical study. Place and Duration of the Study: Department of Internal Medicine, Sorgun State Hospital, Yozgat, Turkiye, from December 2022 to November 2023.

Methodology: Fasting gastric fluid sampling and endoscopic sampling including mucosal and submucosal layers from the antrum were performed. The pH values of the gastric fluids were recorded. Samples were analysed gradually by adding iron solution, hydrogen peroxide, and sodium chloride (NaCl) in a beaker at 75 degrees for 30 minutes. Biopsy materials obtained from antrum were examined histopathologically and reported according to the Sydney classification. The relationship between gastric biopsy results and the presence of microplastic was evaluated using Chi-square test. The significance level was taken as p <0.005.

Results: The study included 61 individuals. The presence of microplastics was detected in 17 (27.86%) gastric fluid samples obtained from the individuals. A significant correlation was found between increased activity and inflammation in antrum biopsy and the presence of microplastic (χ2 = 8.55 p = 0.014; χ2 = 25.75, p = 0.001). The relationship between atrophy, metaplasia, and Helicobacter pylori in gastric tissue and the presence of microplastic was statistically insignificant (p >0.05).

Conclusion: Microplastics were detected in gastric fasting fluid. These materials can cause histopathologic changes and inflammation in the gastric antrum.

Key words: H. pylori, Intestinal metaplasia, Inflammation, Microplastic, Plastic, Sydney classification.

Objective: To compare the efficacy of dexmedetomidine versus ketofol for moderate sedation in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP).

Study design: Randomised controlled trial. Place and Duration of the Study: Department of Anaesthesia, SICU and Pain Management, Sindh Institute of Urology and Transplantation, Karachi, Paksitan, from December 2021 to June 2022.

Methodology: Sixty-two patients aged 20-60 years of any gender scheduled for elective ERCP were included. Patients were randomly divided into Dexmedetomidine group (2ml ampule of 100ug/ml diluted in 18ml of normal saline) and Ketofol group (2ml ketamine and 10ml of propofol 1% diluted in 8ml of normal saline) for sedation. The mean difference in time to achieve Ramsay Sedation Scale (RSS) score of 4 and Modified Aldrete's Score (MAS) of 9 were noted as outcomes in each group. In addition, complications during the procedure and recovery were also noted.

Results: The mean age was 39.15 ± 9.82 years. There were 33 (53.2%) males and 29 (46.8%) females. The mean time to achieve RSS 4 was significantly lower in patients who were treated with Dexmedetomidine as compared to Ketofol, i.e., 11.84 ± 1.77 minutes vs. 13.10 ± 1.64 minutes respectively (p-value 0.005, 95% CI -2.12 to -0.39). Similarly, the mean time to achieve MAS score 9 was significantly lower in patients who were treated with Dexmedetomidine as compared to Ketofol, i.e., 11.19 ± 1.72 minutes vs. 12.23 ± 1.84 minutes, respectively (p-value 0.026, 95% CI -1.94 to -0.13).

Conclusion: Dexmedetomidine proved to be more effective than Ketofol for sedation in ERCP, achieving faster sedation and quicker recovery.

Key words: Dexmedetomidine, Ketofol, Sedation, Endoscopic Retrograde Cholangiopancreatography.