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

The study aimed to determine the occurrence of parafunctional habits in adults with and without temporomandibular disorder (TMD). It was a cross-sectional descriptive study conducted at Fauji Foundation Hospital and Fatima Tuz Zahra Medical Centre, Rawalpindi, Pakistan, from March 2023 to January 2024. A Fonseca Anamnestic Index (FAI) was utilised as a screening tool for grading TMD. Four hundred participants were divided into four groups according to all four grades of TMD by using a non-probability quota sampling and were inquired about the occurrence of parafunctional habits. Two hundred and eighty-five (71.3%) were female, and 115 (28.8%) were male participants. The findings depicted that headache (81.6%, n = 326) was the most frequently reported TMD symptom, while leaning the jaw on hands (59.5%, n = 238) was identified as the most common parafunctional habit. The results indicated the high occurrence of concomitant or parafunctional habits in moderate and severe grades of TMD. This study may help inform preventive measures for parafunctional habits, particularly among individuals exhibiting moderate to severe symptoms of TMDs. Key Words: Craniomandibular disorder, Nail biting, Manual therapy, Mandibular disease, Musculoskeletal diseases, Temporomandibular joint dysfunction syndrome, Secondary headache disorder.

Objective: To evaluate the expression of Human Epidermal Growth Factor Receptor (HER) family members (HER1, HER2, HER3, and HER4), along with Ki-67 and E-cadherin in oral squamous cell carcinoma (OSCC), and to determine their prognostic and therapeutic relevance in relation to clinicopathological parameters.

Study design: A cross-sectional observational study. Place and Duration of the Study: Department of Oral and Maxillofacial Surgery, Diagnostic and Research Laboratory, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan, from September 2023 to September 2025.

Methodology: Formalin-fixed, paraffin-embedded OSCC tissue samples (n = 138) were stained with haematoxylin and eosin and classified according to the WHO/Broder's grading system and the AJCC TNM staging system. Immunohistochemistry was performed to evaluate the expression of HER1-HER4, Ki-67, and E-cadherin. Statistical analysis was performed using SPSS version 26, utilising descriptive statistics and chi-square tests, with p <0.05 considered statistically significant.

Results: The study included 138 OSCC cases, comprising 73.2% males and 26.8% females, with a mean age of 44.7 ± 11.8 years. Buccal mucosa was the most prevalent site (60.99%). HER1 and HER3 were expressed in 79.0% of cases, while HER2 expression was minimal (2.9%). HER3 and HER4 demonstrated significant association with the TNM stage (p <0.05 and p = 0.044, respectively). Ki-67 was highly expressed (88.4%) and significantly correlated with the TNM stage (p = 0.045). E-cadherin showed a significant association with histological grade (p = 0.001).

Conclusion: HER1 and Ki-67 emerged as strong predictors of tumour aggressiveness, while HER3 and HER4 were linked with advanced disease characteristics. Therapy against these markers could be promising in OSCC.

Key words: Oral squamous cell carcinoma, Biomarkers, Prognosis, EGFR family, Therapy.

Objective: To compare virtual microscopy (VM) and optical microscopy (OM) as teaching methodologies for pathology in medical education.

Study design: A randomised controlled trial. Place and Duration of the Study: Department of Pathology, Quaid-e-Azam Medical College, Bahawalpur, Pakistan, from August to October 2024.

Methodology: Fourth-year medical students were randomly assigned to either the VM group or the OM group, each receiving identical 2-hour instructional sessions on breast pathology. Pre- and post-intervention assessments comprised seven validated histopathological identification questions, with a 12-item Likert-scale feedback questionnaire. Data were collected via Google Forms. Statistical analysis was performed using IBM-SPSS version 26.0, with an independent or paired samples t-test applied to compare baseline and post-test scores and feedback ratings between the groups, as appropriate. A p-value of <0.05 was considered statistically significant.

Results: Of the 350 invited students, 286 (81.7%) completed the pre-test. The median age of students was 22 years (range 20-24 years), with 51.4% male. The internal consistency of the baseline assessment was acceptable (Cronbach's alpha 0.622). After intervention, 277 (96.9%) students completed the post-test. Both groups showed significant score improvement; however, the VM group achieved higher post-test scores than the OM group (5.40 ± 1.34 vs. 4.70 ± 1.92; p = 0.001). Post-intervention feedback scores were relatively higher in the VM group, although differences were not statistically significant (p >0.05).

Conclusion: This study provides compelling evidence that VM is more effective than traditional OM for achieving student learning outcomes (SLOs) in the undergraduate pathology education.

Key words: Medical education, Microscopy, Pathology, Students, Undergraduate.

Objective: To compare the short-term clinical efficacy and safety of unilateral biportal endoscopic discectomy (UBED) and microendoscope discectomy (MED) in the treatment of lumbar disc herniation (LDH).

Study design: A descriptive study. Place and Duration of the Study: Department of Orthopaedics, the Second Hospital of Shijiazhuang, Hebei, China, from January 2020 to December 2022.

Methodology: A total of 160 patients with LDH were divided into two groups: the UBED group (n = 80) and the MED group (n = 80), according to the operation carried out. Data were collected on operation time, hospital stay, blood loss, changes in C-reactive protein (CRP), intraoperative x-ray times, complications, modified MacNab criteria, Oswestry Disability Index (ODI), and Visual Analogue Scale (VAS) scores for low back and leg pain to compare the treatment efficacy and safety between the two groups. An independent samples t-test was used to analyse continuous variables, and the chi-square test was used to assess the categorical variables.

Results: There was no significant difference in blood loss (p = 0.168), intraoperative x-ray times (p = 0.084), or complication rates between the two groups (p = 0.844). Similarly, there was no significant difference in the VAS and ODI scores at 3, 6, and 12 months postoperatively (all p >0.05). The VAS scores for low back pain in the MED group were higher than that in the UBED on the first postoperative day (p <0.001). In terms of the modified MacNab criteria, there was no significant difference in clinical outcomes between the groups after surgery (p = 0.312). The operation time for the MED group was shorter than that for the UBED group (p <0.001). The length of hospital stay in the MED group was longer (p <0.001). Additionally, changes in CRP levels before and after operation in the UBED group were more significant than that in the MED group (p <0.001).

Conclusion: The clinical efficacy and safety of the two processes were similar for the treatment of LDH. The operation time of the MED group was shorter than that of the UBED group; however, the length of the hospital stay was longer. UBED could relieve the symptoms of low back pain earlier, but it was more invasive than MED.

Key words: Minimally invasive method, Lumbar disc herniation, Unilateral biportal endoscopic discectomy, Microendoscopic discectomy.

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Sudden cardiac death (SCD) is a public health problem that affects people worldwide regardless of age and social groups. SCD is an unexpected, sudden death caused by cardiac reasons, which often occurs within one hour of the onset of symptoms. With the rapid development of the economy, population, and hospital infrastructure in China, SCD among doctors has become a major social and contemporary health problem, posing challenges to medical education and hospital management. This study aimed to explore the influence of the COVID-19 epidemic on SCD among doctors in China. Key Words: COVID-19 epidemic, Chinese doctors, Sudden cardiac death.

Objective: To evaluate the effectiveness of silicone oil retention sutures versus inferior peripheral iridectomy (PI) in avoiding silicone oil migration in vitrectomised unicameral aphakic eyes.

Study design: A quasi-experimental study. Place and Duration of the Study: College of Ophthalmology and Allied Vision Sciences, King Edward Medical University/Mayo Hospital, Lahore, Pakistan, from March 2023 to August 2023.

Methodology: Patients aged over 20 years, of either gender, who underwent pars plana vitrectomy resulting in single-segment vitrectomised aphakic eyes, were randomly segregated into two study groups. In Group A, patients underwent pars plana vitrectomy with the placement of 10-0 Prolene sutures applied through the anterior chamber of the eye (retention sutures), followed by silicone oil endotamponade. In Group B, patients underwent pars plana vitrectomy with inferior PI, followed by silicone oil endotamponade. All the patients were followed up for four weeks, after which a comparative analysis was performed using SPSS version 28. The chi-square test was applied to compare the two surgical techniques.

Results: A total of 102 patients were enrolled in this study. Patients enrolled in Group A had a mean age of 49.55 ± 7.44 years. Those enrolled in Group B had a mean age of 45.96 ± 8.36 years. In Group A, there were 39 (76.5%) males and 12 (23.5%) females. In Group B, there were 33 (64.7%) males and 18 (35.3%) females. In Group A, prolapse of polydimethylsiloxane (PDMS)/silicone oil into the ocular anterior chamber was observed in six (11.8%) eyes. In Group B, migration of PDMS/silicone oil into the anterior chamber was observed in 16 (31.4%) eyes. A statistically significant difference in PDMS/silicone oil prolapse into the anterior chamber of the eyes was observed between the two study groups (p <0.05), proving that the retention suture group was superior to the PI group.

Conclusion: The silicone oil retention suturing technique is associated with a lower frequency of PDMS/ silicone oil migration into the anterior chamber compared to the current gold standard, inferior PI, after pars plana vitrectomy in unicameral aphakic eyes.

Key words: Silicone oil retention sutures, Inferior peripheral iridectomy, Anterior chamber, Vitrectomised, Unicameral, Aphakic eyes, Endotamponade, Polydimethylsiloxane.

Objective: To determine the prevalence of jugular bulb (JB) variations in a Pakistani population, including high-riding jugular bulbs (HRJB) and JB dehiscence.

Study design: A cross-sectional study. Place and Duration of the Study: Department of Radiology, the Aga Khan University Hospital, Karachi, Pakistan, from May 2024 to April 2025.

Methodology: This study analysed HRCT images of 199 patients to evaluate the height of JB within the temporal bone on both the left and right sides. Patients who underwent a temporal bone HRCT scan, regardless of age or gender, were included in the study. Experienced radiologists reviewed the images to identify and classify the JB levels in the tympanic cavity according to the Manjila classification. The patients were categorised into five age groups. Demographic data and clinical indications were summarised using descriptive statistics. The chi-square analysis was used to determine the association between categorical variables, including JB type, age category, and gender.

Results: Type 2 was the most common on both sides combined, followed by Types 1, 4, and 3, respectively. A significant association was observed between JB type and age category (p = 0.002). However, JB type and gender were not significantly associated (p = 0.857). A significant association was also observed between the presence of an HRJB and age category (p = 0.005).

Conclusion: The frequency of HRJB and the significance of individual variations in JB anatomy underscore the need for comprehensive preoperative evaluation and advanced imaging techniques.

Key words: Jugular bulb, Temporal bone, Computed tomography, High-riding jugular bulb, Jugular bulb dehiscence, Anatomical variation, Otologic surgery, Skull base surgery, Prevalence, Pakistan.

Objective: To introduce a novel acetabular biplanar calibration (ABC) method to improve the accuracy of hip arthroscopic portal establishment.

Study design: An observational study. Place and Duration of the Study: Department of Orthopaedic Surgery, Chongqing Orthopaedic Hospital of Traditional Chinese Medicine, Chongqing, China, from January to December 2024.

Methodology: This study included patients with femoroacetabular impingement syndrome or acetabular labral tear. Pelvic morphology was measured from preoperative radiographs. The ABC method involved placing metallic markers on the coronal (Landmark A) and sagittal (Landmark B) planes around the operative hip and measuring the distances from the anterior superior iliac spine (ASIS) to the two markers. The establishment of anterolateral (AL), mid-anterior (MA), and distal anterolateral accessory (DALA) portals was based on the above landmarks and confirmed by fluoroscopy. The accuracy rates of these portal placements were calculated as percentages, respectively.

Results: A total of nine patients were included. The puncture target on the coronal plane was 3.06 ± 0.39 cm distal and 2.97 ± 0.42 cm medial to the ASIS. The puncture target on the sagittal plane was 2.88 ± 0.38 cm distal and 8.13 ± 1.25 cm lateral to the ASIS. The accuracy rates of establishing the AL, MA, and DALA portals using the ABC method were 77.8% (7/9), 88.9% (8/9), and 77.8% (7/9), respectively.

Conclusion: The ABC method appears to be a promising avenue for improving the accuracy of hip arthroscopic portal-establishment, with reduced reliance on femoral positioning. It can also be used for frequent arthroscopic instrument navigation. Future research with larger samples, multicentre studies, and the integration of advanced imaging technologies is needed to validate its reliability and effectiveness fully.

Key words: Hip arthroplasty, Landmark, Portal establishment.

Objective: To assess the use of subdermal sterile water injections (SWIs) as a cost-effective and reliable analgesia option for labouring women in setups with high patient flow, limited staff availability, and favourable delivery outcomes.

Study design: Randomised clinical trial. Place and Duration of the Study: Department of Maternal and Child Health, Pakistan Institute of Medical Sciences Hospital, Islamabad, Pakistan, from August 2024 to January 2025.

Methodology: A total of 212 labouring women in the active stage of labour were randomly assigned using the lottery method to either the Trial group, which received subdermal SWIs, or the Control group, which received the standard labour ward protocol. Pain levels were assessed using the Numerical Pain Scale (NPS), with a pain-score of <7 considered indicative of effective pain control. The primary outcome was the pain control before and after the intervention, while the secondary outcome was the mode of delivery. The Mann-Whitney U test and the chi-square test were used to compare variables between groups. The Wilcoxon signed-rank test was used to compare pain scores before and after the intervention within the trial group.

Results: The study indicated that 94% of women in the Trial group reported effective pain relief (NPS 4-6) at 10, 30, and 60 minutes after the use of SWIs compared to the Control group, which was considered clinically significant. Additionally, 92% of women in each group had a normal vaginal delivery (p >0.05), making no difference in delivery outcomes in both groups.

Conclusion: This study shows that the use of subdermal SWIs is an effective method for labour pain relief and represents a cost-effective analgesic option for labour pain management in low-resource settings.

Key words: Sterile water, Subdermal, Labour pain, Analgesia, Epidural, Vaginal delivery.