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

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DeepSeek, a rising artificial intelligence (AI) company in Hangzhou, China, introduced DeepSeek-R1, an advanced reasoning model that rivals top large language models such as GPT-4 and Gemini, while operating at significantly lower costs. Its innovative architecture, which includes multi-head latent attention and a mixture of experts, enhances efficiency, reduces computational demands, and improves the processing of long text. DeepSeek's open-source approach has accelerated AI adoption, particularly in clinical medicine, where it supports intelligent diagnosis, surgical planning, and personalised treatment. With multimodal integration capabilities, it processes imaging, pathology, and real-time patient data to optimise decision-making. Notably, DeepSeek can significantly enhance medical education through interactive simulations and virtual training. However, challenges such as interpretability, data privacy, and cultural adaptability remain unresolved. Despite these hurdles, the advancements introduced by DeepSeek in AI-driven healthcare hold promise for enhancing clinical decision support, medical imaging, and patient-doctor communication, thereby positioning it as a transformative force in the field of medical AI. Key Words: DeepSeek, Artificial intelligence, Clinical decision support, Healthcare technology.

Objective: To determine the early success rate in cases of great saphenous vein insufficiency treated with radiofrequency ablation (RFA) and combined transsheath ultrasonography-guided foam sclerotherapy (RFA+ST).

Study design: Descriptive study. Place and Duration of the Study: Department of Cardiovascular Surgery, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkiye, from July 2022 to October 2024.

Methodology: Patients who underwent only RFA and combined RFA+ST between July 2022 and October 2024 were retrospectively scanned. Demographic data and complications were recorded. Differences between the demographic and collected data of the two groups were examined using the Mann-Whitney U test, Pearson's Chi-square or Fisher's exact test.

Results: In total, 235 patients were included in the study: 120 in the RFA group (Group A) and 115 in the RFA+ST group (Group B). The median age (IQR) of Groups A and B was 48 (24) and 50 (26) years, respectively. The gender distribution was 86 females (65.6%) and 45 males (34.4%) in Group A, 75 females (67%) and 37 males (33%) in Group B. The median GSV diameter was 6.7 (1.5) mm and 7 (1.7) mm, respectively. Recanalisation occurred in 8 (6.1%) patients in Group A and 1 (0.9%) patient in Group B (p = 0.041). Other complications in Groups A and B included tenderness [7 (5.3%) vs. 12 (10.7%)], phlebitis or cellulitis [4 (3.1%) vs. 2 (1.8%)], ecchymosis [1 (0.8%) vs. 2 (1.8%)], hyperpigmentation [5 (3.8%) vs. 2 (1.8%)], and phlebothrombosis [7 (5.3%) vs. 24 (21.4%); p <0.001], respectively.

Conclusion: In Group B combined with foam sclerotherapy, recanalisation rate was found to be significantly lower, and phlebothrombosis was higher in the early period. Closure reactions may develop more strongly with phlebothrombosis; however, appropriate case selection and procedure should be performed very carefully due to possible adverse conditions such as deep vein thrombosis.

Key words: Venous insufficiency, Radiofrequency ablation, Endovenous laser, Foam sclerotherapy.

Objective: To compare the effects of intravenous (IV) ibuprofen and acetaminophen on pain perception and opioid consumption following laparoscopic cholecystectomy.

Study design: Randomised-controlled study. Place and Duration of the Study: Department of Anaesthesiology and Reanimation, Giresun University Training and Research Hospital, Giresun, Turkiye, from February to April 2024.

Methodology: The patients undergoing laparoscopic cholecystectomy were randomised into two groups: Group I (n = 35; administered 800 mg of ibuprofen) and Group A (n = 36; administered 1000 mg of acetaminophen). Demographic data, including gender, age, American Society of Anaesthesiologists (ASA) classification, body mass index (BMI), duration of anaesthesia and surgery, incidence of postoperative nausea and vomiting (PONV), length of hospital stay (LOS), visual analogue scale (VAS) scores, and opioid consumption, were recorded. To compare the two independent groups, the Student's t-test was used for parametric data, whereas the Mann-Whitney U-test was employed for non-parametric variables. A p-value <0.05 was considered statistically significant.

Results: Demographic data such as age, gender, BMI, and ASA scores were similar in both groups. The pain scores at recovery, 12, and 24 hours were lower in Group I (p <0.05). However, the VAS scores were similar at 2 and 6 (p >0.05). While the peak VAS scores were similar between the groups, the VAS scores at discharge were found to be significantly lower in Group I (p= 0.271, 0.001 respectively). In terms of total tramadol consumption, 24-hour consumption was lower in Group I (100 [0-300] and 0 [0-300] mg, respectively; p = 0.001).

Conclusion: The present study suggests that the IV administration of ibuprofen results in lower pain scores and reduced opioid consumption compared with the administration of acetaminophen postoperatively in patients undergoing laparoscopic cholecystectomy.

Key words: Intravenous ibuprofen, Acetaminophen, Laparoscopic cholecystectomy, Postoperative pain control, Analgesia, Anti-inflammatory agents.

Objective: To evaluate survival outcomes and identify sociodemographic and clinicopathological factors associated with survival among women diagnosed with ovarian cancer (OC) in Karachi, Pakistan.

Study design: Retrospective cohort study. Place and Duration of the Study: The Aga Khan University Hospital, Karachi, Pakistan, between 2010 and 2020.

Methodology: A total of 966 women aged 18-91 years with OC were identified from the University Hospital cancer registry. Data on vital status and last contact dates were updated. Sociodemographic characteristics, tumour features, stage, CA125 levels, and treatment modalities were analysed. Survival was assessed as the primary endpoint using Kaplan-Meier survival analysis and Cox proportional hazards models, with hazard ratios (HR) and 95% confidence intervals (CI) reported.

Results: Patients who did not undergo cytoreductive surgery exhibited the highest mortality risk (HR: 3.94; CI: 2.69-5.76), followed by those who underwent suboptimal cytoreduction surgery (HR: 2.01; CI: 1.29-3.13) compared to those who underwent optimal cytoreduction surgery. Chemotherapy significantly reduced mortality risk (HR: 0.56; CI: 0.39-0.82). Recurrence was a critical determinant of poor survival, with the highest risk observed in patients who were never disease-free (HR: 10.81; CI: 6.12-19.07) or experienced recurrence (HR: 7.44; CI: 4.31-12.86).

Conclusion: Optimal cytoreduction surgery and chemotherapy are essential in improving survival outcomes for OC patients. Recurrence remains a significant determinant of poor prognosis. Enhancing early detection, optimising treatment strategies, and strengthening healthcare infrastructure are critical for improving survival outcomes among OC patients in Karachi.

Key words: Ovarian cancer, Survival outcomes, Cytoreductive surgery, Chemotherapy, Recurrence.

Objective: To assess the performance of a deep learning method for detecting the segmentation of periapical lesions on dental panoramic radiographs.

Study design: Observational study. Place and Duration of the Study: Faculty of Dentistry, Van Yuzuncu Yil University, Van, Turkiye, from March to September 2024.

Methodology: The deep learning model, YOLOv5, based on the YOLO algorithm for periapical lesion segmentation, was further developed using 1,500 anonymised panoramic radiographs. The radiographs were obtained from the Radiology Archive at the aforementioned University. For apical lesion segmentation, YOLOv5 with the PyTorch model was utilised. The dataset was divided into training (n = 1,200 radiographs / 2,628 labels), validation (150 radiographs / 325 labels), and test (n = 150 radiographs / 368 labels) sets. The model's effectiveness was measured using the confusion matrix. Sensitivity (recall), precision, and F1 scores provided quantitative assessments of the model's predictive capabilities.

Results: The sensitivity, precision, and F1 score performance values of the YOLOv5 deep learning algorithm were 0.682, 0.784, and 0.729, respectively.

Conclusion: Periapical lesions on panoramic radiography can be reliably identified using deep learning algorithms. Dental healthcare is being revolutionised by artificial intelligence and deep learning methods, which are advantageous to both the system and practitioners. While the current YOLO-based system yields encouraging findings, additional data should be gathered in future research to improve detection outcomes.

Key words: Panoramic radiography, Periapical pathology, Deep learning, Artificial intelligence, Lesion segmentation, YOLOv5.

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Objective: To conduct carrier screening for spinal muscular atrophy (SMA) among individuals of childbearing age in the Hubei region, identify the carrier frequency, and provide a relevant basis and reference for prenatal diagnosis.

Study design: An observational study. Place and Duration of the Study: Department of Medical Genetics Centre, Maternal and Child Health Hospital of Hubei Province, Hubei, China, from August 2019 to August 2022.

Methodology: Real-time quantitative PCR was performed on 4,816 reproductive individuals from the Hubei region to detect the copy numbers of E7 and E8 in the SMN1 gene. The screening of SMA carriers and their spouses and prenatal diagnostic analysis of high-risk foetuses were also performed. Statistical analyses were conducted using SPSS version 20.0. Categorical data were compared using Chi-square tests, with statistical significance set at p <0.05.

Results: A total of 105 SMA carriers were identified, with a carrier rate of 2.18%. Among them, 100 carriers had heterozygous deletions of SMN1 exons 7 and 8, and five carriers had heterozygous deletions of SMN1 exon 7. The carrier rate was 2.33% in males and 2.15% in females. Four couples were found to be carriers (both with heterozygous deletions of SMN1 exons 7 and 8). Prenatal diagnosis of their foetuses showed that two were carriers, one foetus was affected with SMA (homozygous deletion of SMN1 exons 7 and 8), and one had no abnormalities. The result for the foetus with homozygous deletion was verified by multiplex ligation-dependent probe amplification (MLPA).

Conclusion: Screening SMA carriers and population genetic counselling can reduce SMA foetus births, with great significance for eugenics.

Key words: Spinal muscular atrophy (SMA), Carrier screening, Prenatal genetic diagnosis, Real-time quantitative PCR, SMN1 gene, Eugenics.

Objective: To compare the Michigan Neuropathy Screening Instrument (MNSI) score and plantar sensory nerve conduction study (NCS) in diabetic patients with neuropathy.

Study design: Comparative study. Place and Duration of the Study: Department of Neurology, Liaquat National Hospital, Karachi, from March to August 2024.

Methodology: Using a non-probability purposive sampling technique, patients aged between 16 and 65 years with diabetic polyneuropathy and age-method healthy controls were included in the study. Neuropathy was graded based on MNSI score. Sural and plantar NCS were performed using the standard and modified Ponsford techniques, respectively. All evaluations were performed using a Nihon Kohden electromyography system to ensure reliable results. Data were collected using a well-designed questionnaire administered by neurology trainees and later analysed by SPSS version 27.

Results: A total of 78 participants, comprising 53 diabetic patients (33 MNSI-positive, 20 MNSI-negative) and 25 age-matched healthy controls, were analysed. MNSI-positive patients had significantly higher HbA1c and fasting blood sugar (FBS) levels compared to MNSI-negative patients with p = 0.005 and p = 0.001, respectively. The sural nerve conduction abnormalities were found in 39.7% participants, while 51.3% participants showed plantar nerve conduction abnormalities. There was a notable association between higher MNSI score and abnormal plantar NCS (p = 0.001), with significantly reduced amplitudes and conduction velocities in MNSI-positive patients, highlighting their sensitivity in detecting diabetic polyneuropathy. Additionally, lower amplitudes in the MNSI-negative group indicated their potential for identifying subclinical diabetic peripheral neuropathy (DPN).

Conclusion: The comparison of MNSI score with plantar sensory nerve conduction studies demonstrates that integrating both methods enhance the detection of early diabetic neuropathy.

Key words: Diabetic peripheral neuropathy, Plantar nerve conduction studies, sural nerve conduction studies, Michigan Neuropathy Screening Instrument, Glycated haemoglobin.