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

Objective: To compare the effectiveness of a flipped classroom model and a large group interactive session (LGIS) method to teach the basis of screening to fourth-year MBBS students.

Study design: Quasi-experimental study. Place and Duration of the Study: Department of Community Medicine, Wah Medical College, National University of Medical Sciences, Wah Cantt, Pakistan, from December 2024 to February 2025.

Methodology: The sample was selected from fourth-year medical students using a purposive sampling technique and divided into two groups. Group A and B were taught the topic ''Basis of Screening'' by two subject experts, following the LGIS and flipped classroom methods, respectively. Students were assessed through a class test comprising of one-best-answer type multiple choice questions (MCQs). Data were analysed using SPSS version 23. Mean test scores and standard deviation were calculated for both groups, and an independent t-test was applied to find the difference between the groups. The Chi-square test was applied to determine the difference between achieving more than 75% marks and teaching strategies. A p-value of <0.05 was considered statistically significant.

Results: A total of 95 students who attended the teaching sessions and appeared in the assessment were included in the study. The number of students who passed the exams was 69 (72.6%), and only 26 (27%) students attained ≥75% marks. A significant difference was noted among students' scores when their results were categorised as more and less than 75% marks. Out of the 26 students, 19 attended flipped classroom sessions.

Conclusion: The flipped classroom model is a very effective strategy for teaching the basis of screening to medical students, as compared to the LGIS, to improve their performance in examinations.

Key words: Curriculum, Education, Students, Teaching, Flipped classroom.

Objective: To compare the positivity rates of pathogens detected in diabetic and non-diabetic pneumonia cases, to assess the role of multiplex respiratory polymerase chain reaction (PCR) testing in diagnosis, and to compare inflammatory parameters between the two groups.

Study design: Observational study. Place and Duration of the Study: Department of Pulmonology, Hisar Intercontinental Hospital, Istanbul, Turkiye, from September 2021 to June 2023.

Methodology: The study included 151 adults diagnosed with community-acquired pneumonia (CAP). Group 1 comprised patients with diabetes (n = 42), and Group 2 consisted of patients without diabetes (n = 109). Patients' demographic and clinical data were collected and statistically compared using the Mann-Whitney U test, the median test, and the Chi-square Independence test.

Results: The positivity rate of the multiplex respiratory PCR test was significantly greater in Group 1 compared with Group 2 (p = 0.005). In Group 1, the most frequently identified nasopharyngeal pathogen was SARS-CoV-2. In Group 2, Streptococcus pneumoniae was the predominant pathogen. Procalcitonin (PCT), C-reactive protein (CRP), and neutrophil levels, as well as the CRP-to-lymphocyte ratio (CLR), were markedly higher in Group 1 compared with Group 2 (p = 0.016, p = 0.002, p = 0.016, and p = 0.016, respectively).

Conclusion: A significantly higher PCR test positivity rate was found in diabetic patients compared with non-diabetic. Differences in the distribution of specific pathogens between the groups were observed. In addition, this study confirmed that diabetic pneumonia cases exhibit elevated levels of inflammatory biomarkers.

Key words: Pneumonia, Diabetes, Multiplex respiratory polymerase chain reaction test.

This meta-analysis with trial sequential analysis (TSA) evaluated the efficacy of venlafaxine in migraine prevention through database searches from inception to 1st November 2024. A total of eight studies involving 582 patients were included. Results demonstrated venlafaxine's superior overall efficacy (OR = 18.71, p = 0.0008) and significant reductions in multiple outcomes, including Visual Analogue Scale Score (MD = -0.83, p = 0.03), migraine days (MD = -1.59, p = 0.02), Dizziness Handicap Inventory (DHI)-total (MD = -5.16, p = 0.01), DHI-physical (MD = -1.73, p = 0.02), DHI-emotional (MD = -2.04, p = 0.02), vertigo severity scores (MD = -1.18, p = 0.0007), and analgesic use (MD = -3.32, p <0.001). No differences were observed in withdrawals due to adverse reactions and any other reasons, including DHI-functional change, duration, frequency change in the Venlafaxine group VLF versus the Other medicines group. TSA revealed insufficient evidence for dizziness improvement (DHI-total: required information size [RIS] = 614 versus currently available size = 242), requiring 372 additional patients to confirm stability and mitigate false positives. While venlafaxine showed advantages over most comparators in efficacy and safety measures, these findings require further validation through larger-scale studies. Key Words: Migraine, Venlafaxine, Meta-analysis, Trial sequential analysis, Efficacy.

Objective: To compare the neurological and functional outcomes of early versus delayed surgical decompression in patients with cauda equina syndrome (CES).

Study design: Descriptive study. Place and Duration of the Study: Department of Neurosurgery, Medical Teaching Institution, Mardan Medical Complex, Mardan, Pakistan, from June 2020 to May 2025.

Methodology: Adult patients diagnosed with CES who underwent surgical decompression were included. Patients were categorised into the early decompression (ED) group (≤48 hours from symptom onset) and the delayed decompression (DD) group (>48 hours from symptom onset). Neurological function was evaluated using the Modified Frankel Scale (MFS) at presentation and at 12-month follow-up. The primary outcome was bladder function recovery, and secondary outcomes included neurological improvement (≥1-grade improvement on the MFS) and the resolution of saddle paraesthesia. The Fisher's exact test was used for statistical analysis.

Results: Thirty-six patients were included (mean age: 34 years; 66.7% male). CES with urinary retention (CES-R) was spotted in 77.8% of the cases. The most frequently involved levels were L5-S1 (55.6%) and L4-L5 (44.4%). Early surgery was performed in 15 patients (41.7%), while 21 (58.3%) underwent delayed surgical decompression. At one-year follow-up, persistent bladder dysfunction was distinctly lower in the ED group (13.3%) compared to the DD group (47.6%; p = 0.040). Saddle paraesthesia was more common in the DD group, without any statistical significance. Overall, 88.9% of patients displayed improvement of ≥1 Frankel grade, and most regained independent ambulation.

Conclusion: Early surgical decompression within 48 hours of symptom onset is linked with significantly better bladder and neurological outcomes in CES. Systemic delays in diagnosis and referral highlight the urgent need for national CES protocols and efficient referral pathways in resource-limited settings.

This study assessed the role of peripheral blood counts in donor deferral and its utility as a quality control measure in blood banking. It was conducted retrospectively at the Department of Haematology, Combined Military Hospital, Lahore, Pakistan, from April 2023 to September 2023. The study included data from 5,515 donors aged 18-50 years, with weight >50 kg, pulse 60-100/minute, and normal blood pressure per AABB criteria. Donors with HBV or HCV positivity were excluded from donation. CBC analysis showed that 704 donors (12.7%) were deferred due to abnormal CBC results, with anaemia (46.3%)-primarily hypochromic-microcytic anaemia-being the leading cause. Thrombocytopenia and neutropenia were other significant parameters, followed by elevated mixed cell and total leucocyte counts. Most deferred donors did not return, emphasising the need for strategies to improve donor haematologic health and retention. Key Words: Blood banking, Peripheral blood parameters, Donor deferral.

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Objective: To compare six machine learning models for predicting early neurological deterioration (END) after intravenous rt-PA thrombolysis in acute ischaemic stroke, and to develop an interpretable clinical tool.

Study design: Observational study. Place and Duration of the Study: Department of Neurology, Benxi Central Hospital, Benxi, China, from January 2021 to December 2023.

Methodology: All consecutive adults receiving standard-dose rt-PA within 4.5 hours of onset were screened. END was defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) score of ≥4 or death within 24 hours. Thirty-two baseline variables were collected; those showing p <0.10 on univariate analysis (NIHSS, age, fibrinogen, and hypertension) entered model construction. An 80:20 stratified split produced training and validation cohorts. Decision tree, random forest, XGBoost, support vector classifier, multilayer perceptron, and logistic regression were tuned by grid search with fivefold cross-validation. Discrimination (area under the ROC curve and AUC), accuracy, sensitivity, specificity, and F1 score were calculated on the hold-out set. The best model underwent SHapley Additive exPlanation (SHAP) analysis to visualise feature important and protective or harmful thresholds. Internal robustness was confirmed with 1,000 bootstrap resamples.

Results: Among 209 eligible patients (END = 16, 7.7%), the XGBoost model achieved the highest discrimination (AUC 0.966), perfect sensitivity (1.000), accuracy (0.905), and specificity (0.897). The decision tree produced the top F1 score (0.750) but lower AUC (0.957). SHAP plots identified admission NIHSS, hypertension, age ≥72 years, and fibrinogen >3.2 g/L as the principal drivers of risk, together accounting for 85 % of model weight.

Conclusion: A concise, four-variable XGBoost model reliably stratifies END risk after rt-PA, offering a transparent decision aid for clinicians to allocate intensified monitoring or adjunctive therapy.

Key words: Machine learning, Stroke, Intravenous thrombolysis, rt‑PA, Early neurological deterioration.

Objective: To determine the frequency of subclinical hypothyroidism (SCH) and autoimmune thyroid disease (ATD), assess dominant follicular formation and conception rates after thyroxine replacement, and evaluate the association between SCH and ATD with conception among subfertile females.

Study design: Quasi-experimental study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, Pakistan, from August 2022 to August 2023.

Methodology: The study was carried out on 67 women with primary or secondary subfertility diagnosed with SCH, with or without thyroid autoimmunity. History, examination, subfertility worksup, thyroid function tests, and anti-TPO antibody testing were performed and recorded on a predesigned proforma. The participants were administered 50 microgram thyroxine (LT4) supplementation and later given three cycles of ovulation induction with clomiphene citrate. The dominant follicular formation and conception rates were noted. Descriptive statistics were calculated as frequencies, percentages, means, and standard deviations. Univariate logistic regression was applied to predict pregnancy using thyroid function tests and anti-TPO results. The p-value of ≤0.05 was considered significant.

Results: The frequency of subfertility was 25.8%, SCH 9.9%, and TAI 1.9%. The mean age was 28.88 ± 3.6 years, and most participants had secondary subfertility (48, 71.6%). As a result of LT4 supplementation, a dominant ovarian follicle formed in 24 (35.8%) participants, and conception was achieved in 12 (17.9%) participants. No significant association was found between thyroid function tests, ATD, and conception.

Conclusion: SCH is not uncommon in subfertile females of reproductive age. However, a significant relationship could not be established between SCH and subfertility in the studied patients, and conception rates were low after thyroxine supplementation.

Key words: Subclinical hypothyroidism, Female subfertility, Thyroid autoimmunity, LT4 supplementation.

Objective: To evaluate the neck muscle stiffness in patients with cervicogenic dizziness (CGD) using shear wave elastography (SWE).

Study design: A case-control study. Place and Duration of the Study: Department of Otorhinolaryngology, Van Yuzuncu Yil University, Van, Turkiye, from 2023 to 2025.

Methodology: The study included 33 patients with CGD and 33 matched healthy controls. Cervical muscle stiffness was measured by SWE in the sternocleidomastoid (SCM), trapezius (TRAP), splenius capitis (SPLC), and semispinalis capitis/cervicis (SCC) muscles. Neck pain, dizziness, neck disability, and dizziness handicap levels were also determined. Student's t-test and Mann-Whitney U test were used to compare muscle stiffness between the groups.

Results: CGD patients and the Control group were similar in terms of age, gender, and body mass index (BMI [kg/m2]; p >0.05). CGD patients had significantly higher stiffness values in SCM (p = 0.029) and TRAP (p = 0.025) muscles compared to the Control group. However, there was no significant difference in the stiffness scores of SPLC (p = 0.199) and SCC (p = 0.681) muscles between the groups. In CGD patients, a significant positive correlation between SPLC muscle stiffness and neck disability was observed. However, there was no significant correlation between cervical muscle stiffness and neck pain, dizziness, neck disability, or dizziness handicap.

Conclusion: SWE findings showed that CGD patients had higher SCM and TRAP stiffness than healthy controls. These findings may be useful for understanding CGD and for improving diagnosis, differential diagnosis, and treatment. However, this is a preliminary study on the subject, and further studies are warranted.

Key words: Cervical, Cervicogenic, Dizziness, Elastography, Neck pain, Neck muscles, Ultrasonography.

This study aimed to evaluate the efficacy of 0.2% topical hyaluronic acid in the management of symptomatic oral lichen planus (OLP). This prospective interventional study was conducted at the Department of Dermatology, Services Institute of Medical Sciences / Services Hospital, Lahore, Pakistan. Fourteen patients with symptomatic OLP lesions applied hyaluronic acid in orabase gel for 28 days. Patients were followed up weekly, and the final assessment was performed at the end of four weeks. The baseline mean modified oral mucositis index (MOMI) score decreased from 2.06 ± 0.41 to 0.27 ± 0.34 for cheek lesions and from 1.50 ± 00 to 0.25 ± 0.25 for lip lesions. The mean change in MOMI score for cheek was 1.79 ± 0.40 and for lips was 1.25 ± 0.25. These findings suggest that topical hyaluronic acid 0.2% is effective in the treatment of symptomatic OLP and can be easily and safely used as an adjuvant treatment alongside other topical and systemic treatments. Key Words: Oral lichen planus, Topical hyaluronic acid, Modified oral mucositis index, Oral ulcers.