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

Objective: To evaluate the effectiveness of video-assisted stoma-care teaching in improving patients' confidence and skills in stoma management.

Study design: Quasi-experimental study. Place and Duration of the Study: Section of Urology, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan, from December 2023 to May 2024.

Methodology: Nineteen patients underwent radical cystectomy with ileal conduit, of whom 15 met the eligibility criteria. On the third postoperative day, patients received verbal stoma-care instructions, followed by video-assisted teaching at their first clinic visit. A self-efficacy questionnaire was administered pre- and post-intervention. The Wilcoxon signed-rank test compared the scores, with p <0.05 deemed statistically significant.

Results: The median self-efficacy score improved significantly from 24/65 before the video intervention to 61/65 afterwards (p <0.05). Improvements were observed across stoma-care, application, and confidence domains. Pre-intervention, only one patient demonstrated high confidence, whereas post-intervention, all patients achieved high self-efficacy.

Conclusion: Video-assisted stoma-care teaching significantly improved patients' confidence and skills in managing their stoma after radical cystectomy. This method provides a valuable, repeatable tool to enhance patient outcomes and quality of life.

Key words: Radical cystectomy, Urinary diversion, Ileal conduit, Stoma management, Video-assisted teaching, Self-efficacy, Confidence, Patient confidence, Learning tool, Quality of life.

Objective: To evaluate trends in voluntary non-remunerated blood donors (VNRBD) versus replacement donors, and to investigate the prevalence of transfusion-transmitted infections (TTIs) among healthy blood donors in Malakand Division, Pakistan.

Study design: Retrospective study. Place and Duration of the Study: Department of Health, Regional Blood Centre, Central Hospital Saidu Sharif, Swat, Pakistan, from 2021 to 2024.

Methodology: This study analysed trends in VNRBD and replacement donors, along with the seroprevalence of TTIs (HCV, HBV, HIV, and Syphilis) using automated chemiluminescent microparticle immunoassay (CMIA). The Chi-square test in R-Studio was conducted to analyse trends in blood donor categories and TTIs over the four years.

Results: A total of 94,716 healthy blood donors were screened during the study period. Male donors dominated both categories, with 80,105 (84.57%) in replacement and 14,526 (15.34%) in voluntary donations. Female participation remained minimal, with only 27 (0.03%) in replacement and 58 (0.06%) in voluntary donations. Most donors were in the age range of 18-33 years, totalling 71,107 (75.1%). Statistically significant changes (p <0.001) in voluntary and replacement donation trends were confirmed by the Chi-square test. A total of 2,292 (2.42%) TTIs were detected, including 873 (0.92%) cases of HCV, 637 (0.67%) cases of HBV, 220 (0.23%) cases of HIV, and 562 (0.59%) cases of syphilis.

Conclusion: The study revealed a 2.42% TTIs prevalence among 94,716 donors, with male dominance (84.57%) and low female participation (0.03%). Syphilis and HIV cases increased in 2024 (p <0.001), highlighting the need for targeted blood donation campaigns and improved screening to reduce TTIs in Pakistan.

Key words: Voluntary non-remunerated blood donation, Replacement blood donation, Transfusion-transmitted infections, HCV, HBV, HIV, Syphilis.

Objective: To assess the duration of employment and examine the impact of emotional intelligence on the psychological well-being of men who have sex with men (MSM), trans women (TW), and female sex workers (FSW) working in HIV community-based organisations (CBOs) in Pakistan.

Study design: Explanatory sequential mixed-methods study. Place and Duration of the Study: CBOs in 16 districts and 50 sites across Pakistan, from November 2023 to April 2024.

Methodology: Individuals over 18 years of age, self-identifying as MSM, TW, or FSW, and working at a CBO were enrolled. Psychological well-being was measured using the Ryff's psychological well-being scale, and emotional intelligence was measured using the Wong and Law Emotional Intelligence scale (WLEIS). The multiple linear regression was used to identify predictors of psychological well-being. Ten in-depth qualitative interviews were also conducted among CBO workers.

Results: A total of 188 CBO workers were included in the quantitative survey; of these, 128 (68.1%) were MSM, 18 (9.6%) were FSW, and 42 (22.3%) were TW. The multiple regression analysis showed that residence away from family (β = 2.85; p = 0.038), history of suicidal ideation (β = -3.74; p = 0.022), and emotional intelligence (β = 3.25; p <0.001) were significant predictors of psychological well-being. The qualitative analysis showed a positive effect of CBO employment, contributing to professional growth and empowerment and acceptance of gender and sexuality.

Conclusion: Living away from family and having higher emotional intelligence were positive predictors of psychological well-being. A history of suicidal ideation was associated with poor psychological well-being. There is qualitative evidence that suggests that CBO employment improves psychological well-being.

Key words: Men who have sex with men, Trans women, Female sex workers, Psychological well-being, HIV, Community-based organisations.

Objective: To compare the efficacy of combined intralesional triamcinolone acetonide (IL TAC) and cryotherapy versus IL TAC alone in the treatment of keloid.

Study design: Randomised controlled trial. Place and Duration of the Study: Department of Dermatology, PNS Shifa, Karachi, Pakistan, from July 2024 to February 2025.

Methodology: Patients with keloids were randomly divided into two groups, with 38 patients in each group. Group A received a combination of IL TAC and cryotherapy, while Group B received IL TAC alone. Both treatments were administered three times at 4-weekly intervals. Keloids were assessed using photographic record, the Vancouver Scar Scale (VSS), and the Patients Scar Assessment Scale (PSAS). Treatment efficacy was defined as a >75% reduction in the VSS score from baseline at the end of the treatment. Repeated measure ANOVA was used to compare the VSS score and the PSAS score within the groups, whereas the independent t-test was applied to compare the scores between the two groups. The Chi-square test was used to compare efficacy between the two groups.

Results: Most patients were young males, and keloids were most commonly observed on the chest. IL TAC alone was effective in 23 patients (60.5%), while the combination of IL TAC and cryotherapy was effective in 31 patients (81.5%). The difference was statistically significant (p = 0.038). Patient satisfaction was also higher in the combination therapy group.

Conclusion: IL TAC combined with cryotherapy is more efficacious than IL TAC alone in the treatment of keloid, resulting in higher level of patient satisfaction.

Key words: Cryotherapy, Combination treatment, Efficacy, Intralesional triamcinolone acetonide, Intralesional steroid, Keloids.

Objective: To investigate the impact of enteral feeding during packed red blood cell transfusion (PRBCT) on splanchnic and cerebral regional oxygenation (sRSO2, cRSO2) in very-low-birthweight (VLBW) neonates.

Study design: Randomised controlled study. Place and Duration of the Study: Department of Neonatology, Faculty of Medicine, Akdeniz University, Antalya, Turkiye, from June 2021 to June 2024.

Methodology: Fifty-six VLBW neonates were categorised into No-feeding and Feeding groups. sRSO2, cRSO2, the ratio of sRSO2 to cRSO2 (SCOR), splanchnic and cerebral fractionated tissue oxygen extraction (sFTOE, cFTOE) were measured at predetermined intervals using near-infrared spectroscopy. Bonferroni-corrected linear mixed models were used to assess repeatedly measured variables across different time points.

Results: An overall increase in sRSO2 and cRSO2 was observed during the study. In contrast to a steady sRSO2 incline in the No-feeding group, the Feeding group exhibited a temporary reduction in sRSO2 and SCOR, followed by an increase in sFTOE during the first hour of PRBCT (∆Mean = -1.958, ∆Mean = -0.024, ∆Mean = 2.088, respectively). Despite the changing patterns in splanchnic oxygenation, the mean differences in sRSO2 and sFTOE between the two groups were -0.67 (95% CI: -2.74 - 1.40, p = 0.520) and 0.83 (95% CI: -1.46 -3.12, p = 0.473), indicating the impact of enteral feeding on sRSO2 was insignificant.

Conclusion: The findings demonstrated improved outcomes in both cerebral and splanchnic oxygenation during PRBCT in stable preterm infants, despite a temporary impairment in splanchnic tissue oxygen utilisation in the Feeding group. Enteral feeding alone did not pose a risk for transfusion-associated necrotising enterocolitis (TANEC). Large-scale studies are warranted to clarify the complex interplay between enteral feeding, transfusion, and tissue oxygenation.

Key words: Blood transfusion, Enteral feeding, Preterm infants, Very-low-birthweight infants, Splanchnic regional oxygenation, Cerebral regional oxygenation, Transfusion-associated necrotising enterocolitis.

Chronic laparoscopic port-site infection (PSI) is caused by non-tuberculous mycobacteria (NTM). This systematic review aimed to gather all existing information about the aetiology and management of chronic PSI. A systematic search of PubMed, Google Scholar, Cochrane, and PakMediNet databases was carried out. Ten studies were selected; eight from India and two from Pakistan. A total of 109 patients were reported to have chronic PSI. In all studies, reusable laparoscopic instruments were used, which were chemically sterilised. Clarithromycin, amikacin, ciprofloxacin, and levofloxacin were reported as the most sensitive medicines when used for a duration of three months. Additionally, 11% of cases were treated with standard first-line anti-tuberculous treatment (ATT). NTM was cultured successfully in 52% of patients. Histological examination of the excised tracts showed chronic granulomatous inflammation. The source of NTM was identified as the water used to rinse reusable instruments. Debridement or excision of infected tracts, followed by antimicrobial agents according to culture, was the most successful treatment. The use of disposable laparoscopic instruments and standard sterilisation measures can help prevent these infections. Key Words: Port-site infections, Non-tuberculous mycobacteria, Anti-tuberculous treatment.

A cross-sectional observational study was carried out at the Department of ENT-HNS, Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from April 2023 to May 2024, to determine the impact of hands-on cadaveric dissection courses on the improvement of surgical skills of Ear, Nose, and Throat trainees. Three courses were conducted with a gap of six months each. Participants were given a feedback form at the end of the workshop. Out of 312 participants, 298 (95.5%), 301 (96.4%), 278 (89.1%), and 283 (90.7%) agreed that it helped in learning anatomy, understanding the steps of surgeries, and increasing their confidence, respectively, and they would attend future courses. Eighty-three (26.6%) were not satisfied with the course fees. A total of 305 (97.8%) participants and almost all 55 HODs (96.5%) recommended that these workshops should be made an integral part of postgraduate training. Thus, it is recommended that hands-on cadaveric workshops should be made an integral part of postgraduate training programmes. Key Words: Workshop, Cadaver, Learning, Academic training, Anatomy.

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Objective: To evaluate the prognostic value and expression profile of F11R (junctional adhesion molecule-A, JAM-A) in colorectal cancer (CRC) and to elucidate its functional role, particularly in epithelial-mesenchymal transition (EMT) and Rap1 signalling.

Study design: Integrated bioinformatic and experimental study. Place and Duration of the Study: Department of Gastroenterology, Affiliated Hospital of Kunming University of Science and Technology, the First People's Hospital of Yunnan Province, Kunming, China, from 1st August 2021 to 30th June 2023.

Methodology: F11R-associated genes were analysed using The Cancer Genome Atlas (TCGA) and the Human Protein Atlas (HPA). Protein expression was assessed by immunohistochemistry, and cell-type localisation was determined by single-cell RNA-seq. Functional enrichment was performed to explore related pathways. CRC cell proliferation, migration, invasion, and apoptosis were examined with CCK-8, Transwell, scratch, and flow cytometry assays, while EMT-related proteins were evaluated by western blotting.

Results: F11R expression was significantly reduced in CRC compared with normal tissues. IHC revealed cytoplasmic and membranous localisation, and single-cell data showed enrichment in endothelial and epithelial cells. Enrichment analysis implicated F11R in T-cell receptor signalling, cadherin binding, and tight-junction pathways. Expression correlated with CD4⁺ Th1-like cells, effector and resting Tregs, and effector-memory T cells. Silencing F11R enhanced proliferation, migration, and invasion; reduced apoptosis; and promoted EMT, evidenced by decreased ZO-1 and E-cadherin, increased N-cadherin and vimentin, and Rap1 activation.

Conclusion: F11R regulates EMT and Rap1 signalling, thereby influencing CRC metastasis. Its reduced expression is associated with unfavourable outcomes and tumour progression. Cell type-specific enrichment in endothelial and epithelial cells, along with links to immune subsets, highlights F11R as a potential prognostic biomarker in CRC.

Key words: Colorectal cancer, F11R, Tumour progression, Prognostic potential, Immune infiltration.

Objective: To assess cardiovascular atherogenic risk in children with growth hormone deficiency (GHD) by comparing lipid profiles and plasma atherogenic indices (PAI) with those of healthy controls.

Study design: A comparative cross-sectional study. Place and Duration of the Study: Department of Chemical Pathology, the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from February to July 2024.

Methodology: Ninety children with short stature, aged 3-12 years were evaluated. They were categorised into the growth hormone-deficient group (GHD group) and the healthy control group (Control group) based on the insulin tolerance test, IGF-1, and IGFBP-3 levels. Fasting lipid profiles were assessed, including total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and non-HDL cholesterol. The PAI was calculated as log (TG/HDL). Data were analysed using SPSS version 23. The independent t-test and Mann-Whitney U test were used to compare continuous variables between the two groups, whilst the Chi-square test was applied for categorical variables. Statistical significance was set at p ≤0.05.

Results: Among the 90 participants, 48 exhibited GHD and 42 were healthy. Children with GHD showed markedly increased TC, TG, LDL, non-HDL cholesterol, and PAI values (p <0.001). Their HDL levels were also reduced compared with those of the healthy controls. A substantial proportion of GHD children (77.8%) were classified as high-risk based on PAI, whilst 100% of those with elevated non-HDL cholesterol were GHD. Atherogenic lipid parameters demonstrated a negative correlation with IGF-1 levels (p <0.001). IGF-1 concentrations correlated favourably with GH and HDL basal concentrations.

Conclusion: Children with GHD exhibited dyslipidaemia and elevated atherogenic risk markers, indicating a predisposition to premature atherosclerosis.

Key words: Cardiovascular disease, Growth hormone, Dyslipidaemia, Plasma atherogenic indices.