Nevin Manimala

Exp Dermatol. 2023 Nov 5. doi: 10.1111/exd.14973. Online ahead of print.

ABSTRACT

Psoriasis vulgaris is a chronic, autoimmune skin disease involving a complex interplay of epidermal keratinocytes, dermal fibroblast and infiltrating immune cells. Differential expressions of miRNAs are observed in psoriasis and the deregulated miRNAs are sometimes associated with disease severity. This study aims to identify miRNAs altered in the serum of psoriasis patients that are associated with the Psoriasis Area and Severity Index (PASI). In order to assess miRNA levels in the serum of psoriasis patients, we selected 24 differentially expressed miRNAs in the psoriatic skin are possibly derived from the skin and immune cells, as well as five miRNAs that are enriched in other tissues. We identified 16 miRNAs that exhibited significantly (p < 0.05) altered levels in the serum of psoriasis patients compared to healthy individuals. Among these, 13 miRNAs showed similar expression pattern in the serum of psoriasis patients as also observed in the psoriatic skin tissues. Ten miRNAs showed an accuracy of greater than 75% in classifying the psoriasis patients from healthy individuals. Further analysis of differential miRNA levels between the low PASI group and the high PASI group identified three miRNAs (miR-147b, miR-3614-5p, and miR-125a-5p) with significantly altered levels between the low severity and the high severity psoriasis patients. Our systematic investigation of skin and immune cell-derived miRNAs in the serum of psoriasis patients revealed alteration in miRNA levels to be associated with disease severity, which may help in monitoring the disease progression and therapeutic response.

PMID:37926911 | DOI:10.1111/exd.14973

J Matern Fetal Neonatal Med. 2023 Dec;36(2):2278020. doi: 10.1080/14767058.2023.2278020. Epub 2023 Nov 5.

ABSTRACT

OBJECTIVES: Ongoing controversies persist regarding risk factors associated with the failure of transition from epidural labor analgesia to cesarean section anesthesia, including the duration of labor analgesia, gestational age, and body mass index (BMI). This study aims to provide an updated analysis of the incidence of conversion from epidural analgesia to general anesthesia, while evaluating and analyzing potential risk factors contributing to the failure of this transition to cesarean section anesthesia.

METHODS: We conducted an extensive literature search utilizing databases such as PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WANGFANG, and the Chinese Biomedical Literature Database (CBM) up to September 30, 2022. The meta-analysis was performed using STATA 15.1 software. The quality of the included studies was assessed using the 11-item quality assessment scale recommended by the Agency for Healthcare Research and Quality (AHRQ).

RESULTS: A total of 9,926 studies were initially retrieved, and after rigorous selection, 19 studies were included in the meta-analysis. The overall incidence of conversion from epidural analgesia to general anesthesia was found to be 6% (95% confidence interval [CI]: 5-8%). Our findings indicate that, when compared to patients in the successful conversion group, those in the failure group tended to be younger (weighted mean difference [WMD] = -1.571, 95% CI: -1.116 to -0.975) and taller (WMD = 0.893, 95% CI: 0.018-1.767). Additionally, the failure group exhibited a higher incidence of incomplete block in epidural anesthesia, received a higher dosage of additional epidural administration, experienced a greater rate of emergency cesarean sections, and received anesthesia more frequently from non-obstetric anesthesiologists. However, no statistically significant differences were observed in gestational age, depth of the catheter insertion into the skin, epidural catheter specifics, duration of epidural analgesia, infusion rate of epidural analgesia, primiparity status, cervical dilatation during epidural placement, BMI, or weight.

CONCLUSION: Our study found that the incidence of conversion from epidural analgesia to cesarean section under general anesthesia was 6%. Notably, the failure group exhibited a higher rate of incomplete block in epidural anesthesia, a greater incidence of emergency cesarean sections, a more frequent provision of anesthesia by non-obstetric anesthesiologists, a higher dosage of epidural administration, and greater height when compared to the success group. Conversely, women in the failure group were younger in age compared to their counterparts in the success group.

PMID:37926901 | DOI:10.1080/14767058.2023.2278020

J Coll Physicians Surg Pak. 2023 Nov;33(11):1315-1320. doi: 10.29271/jcpsp.2023.11.1315.

ABSTRACT

OBJECTIVE: To compare the clinical and radiographic outcomes between patients treated with single plate osteosynthesis, double plate osteosynthesis, and antegrade locked intramedullary nailing (IMN) in treatment of humerus diaphyseal fractures.

STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of Orthopaedics and Traumatology, Adiyaman University Training and Research Hospital, Adiyaman, Turkey, between 2014 and 2020.

METHODOLOGY: A total of 99 patients with humerus diaphyseal fractures were retrospectively evaluated. Forty-six had been treated with single plating, 24 were treated with double plating, and 29 with IMN. The outcomes were evaluated in terms of the union time, union rate, complications, and Disabilities of the Arm, Shoulder, and Hand (DASH) functional scores.

RESULTS: The average union time was 17 weeks and nonunion rate was 6% of patients. There was no significant difference between the groups in terms of DASH functional score and nonunion (p >0.05). The surgical time and bleeding amount were significantly shorter in the IMN group compared to the other groups (p <0.05). A statistically significantly short union time was observed in both plating groups compared to IMN (p <0.05), but it was not different between single and dual plating (p >0.05).

CONCLUSION: Regardless of the implant used, good reduction and stable fixation, respect for the soft tissue and use of the implant in accordance with the surgical technique are sufficient to achieve union in the surgical treatment of humeral shaft fractures.

KEY WORDS: Humeral shaft fracture, Surgical treatment options, Comparison, Outcomes.

PMID:37926888 | DOI:10.29271/jcpsp.2023.11.1315

J Coll Physicians Surg Pak. 2023 Nov;33(11):1310-1314. doi: 10.29271/jcpsp.2023.11.1310.

ABSTRACT

OBJECTIVE: To investigate whether adding docetaxel chemotherapy to androgen deprivation therapy is effective regarding progression-free and overall survival in patients with de novo metastatic castration-sensitive prostate cancer patients with Gleason Grade Group 5 (Gleason scores 9 and 10).

STUDY DESIGN: Observational study. Place and Duration of the Study: Department of Medical Oncology at Manisa Celal Bayar University, Izmir Ege University, Bitlis Tatvan Public Hospital, Izmir Bozyaka Education and Research Hospital, and Izmir Kent Hospital, from March 2015 to May 2020.

METHODOLOGY: Patients with de novo metastatic castration-sensitive and histopathologically confirmed GGG 5 prostate cancer were evaluated retrospectively. The patients were divided into two groups. The first group included patients who were given androgen deprivation therapy alone (ADT-only group), and the second group consisted of patients who were given ADT plus docetaxel (chemohormonal group). The two groups were compared in terms of overall survival and progression-free survival till cut-off limit.

RESULTS: A total of 194 patients with metastatic castration-sensitive and GGG 5 prostate cancer were analysed retrospectively. The chemohormonal group comprised of 72 patients, and the ADT-only group included 122 patients. Median progression-free survival was 15.7 months in the chemohormonal group and 14.8 months in the ADT-only group (p = 0.97). The median overall survival was 37.5 months in the chemohormonal group and 37.8 months in the ADT-only group (p = 0.93).

CONCLUSION: The addition of docetaxel chemotherapy in patients with metastatic castration-sensitive and GGG 5 prostate cancer did not result in a statistically significant difference in terms of overall survival and progression-free survival. Docetaxel may be ineffective in this group of patients.

KEY WORDS: Prostate cancer, Castration-sensitive, Gleason grade group 5, Docetaxel, Androgen deprivation therapy (ADT), Overall survival.

PMID:37926887 | DOI:10.29271/jcpsp.2023.11.1310

J Coll Physicians Surg Pak. 2023 Nov;33(11):1283-1287. doi: 10.29271/jcpsp.2023.11.1283.

ABSTRACT

OBJECTIVE: To assess the clinical outcome of arthroscopic stabilisation for recurrent anterior glenohumeral joint dislocations.

STUDY DESIGN: Case series. Place and Duration of the Study: Ghurki Trust Teaching Hospital, Lahore, from May 2018 to December 2022.

METHODOLOGY: Fifty-two patients who underwent arthroscopic repair of Bankart lesion were studied. Those who had concomitant fractures, neurological injury or underwent any surgery on the same shoulder were excluded. The outcome was assessed in terms of improvement in pain, constant and Rowe scores, postoperatively.

RESULTS: The mean delay in the procedure after the first dislocation was 65.15+38.23 months, and the mean follow-up period was 26.61+7.55 months. On final follow-up, improvement in pain was statistically significant (p<0.05): (VAS: 2.17+1.77 to 0.69+0.64 at rest and from 4.5+2.24 to 1.58+1.85 at motion). On subjective assessment, 50% of the sample was very satisfied, and an objective assessment showed statistically significant (p<0.05) improvement in Constant score from 65.4 to 78.6. Rowe score not only showed a significant improvement (from 31.6 to 80.3 with p<0.05), but 69.2% of the follow-up scores lied in the good and excellent results range as well. Recurrence was noted in 8 cases (15.3%).

CONCLUSION: Significant clinical improvement was seen after arthroscopic stabilisation in anterior shoulder instability. However, further research is required regarding the recurrence rate and restriction in the range of motion.

KEY WORDS: Glenohumeral joint, Dislocation, Stabilisation, Shoulder arthroscopy.

PMID:37926882 | DOI:10.29271/jcpsp.2023.11.1283

J Coll Physicians Surg Pak. 2023 Nov;33(11):1259-1263. doi: 10.29271/jcpsp.2023.11.1259.

ABSTRACT

OBJECTIVE: To compare and correlate safety climate standards and safety practices among different subspecialities of pathology.

STUDY DESIGN: Cross-sectional study. Place and Duration of the Study: The study was conducted at Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from February to November 2022.

METHODOLOGY: Responses of 199 participants were recorded according to the validated Nordic Safety Climate Questionnaire (NOSACQ-50) and Lab Safety Survey form. The safety climate presented as seven dimensions according to the validated questionnaire was compared among different workgroups, based on subspeciality and job designation, using one-way ANOVA and independent sample t-test, respectively. Pearson’s correlation was used to assess the relationship between the safety climate and safety practices.

RESULTS: Among the safety climate dimensions, safety communication, trust in co-workers’ safety competence (M=3.02) and workers trust in efficacy of safety systems (M=3.00) were the most positively perceived aspects followed by management’s safety priority (M=2.98). Comparison of subspecialities showed significant differences in management safety empowerment, management safety justice, workers’ safety commitment, safety communication, and trust in efficiency of safety systems (p<0.001 for all 5 factors). Chemical pathology workers and technical staff were workgroups with lower safety climate scores. A statistically significant positive correlation (r=0.97) was observed between the safety procedures and safety climate at an organisational level.

CONCLUSION: The results demonstrated the existence of a good safety climate within the participating laboratories of the institute. It successfully identified areas that need further safety improvements. The study will help increase awareness about occupational safety and safety culture among healthcare workers in general and clinical laboratory setups in particular.

KEY WORDS: Laboratory safety climate, Occupational health, Safe laboratory practices.

PMID:37926878 | DOI:10.29271/jcpsp.2023.11.1259

J Coll Physicians Surg Pak. 2023 Nov;33(11):1254-1258. doi: 10.29271/jcpsp.2023.11.1254.

ABSTRACT

OBJECTIVE: To compare superoxide dismutase 1 (SOD 1) and malondialdehyde (MDA) levels along with biochemical parameters in patients of non-alcoholic fatty liver disease (NAFLD) with and without Type 2 diabetes mellitus.

STUDY DESIGN: Cross-sectional comparative study. Place and Duration of the Study: Centre for Research in Experimental and Applied Medicine, AMC, in collaboration with the Department of Radiology, Combined Military Hospital, Rawalpindi, from February to November 2022.

METHODOLOGY: Two hundred and ten patients were selected by non-probability purposive sampling and divided into 3 groups. Healthy individuals were labelled as Group Ι, Group II included patients of NAFLD without diabetes mellitus, and Group III had patients of NAFLD with diabetes mellitus. Fasting blood glucose levels and lipid profile were measured. ELISA (enzyme-linked immunoassay) was done for the assessment of SOD 1 and MDA levels. The data was analysed by version 22.0 of SPSS and expressed in mean ± SD and percentage. One-way ANOVA was done for all groups and grade comparison was followed by the post-hoc Tukey test.

RESULTS: When compared to control groups, the mean SOD 1 level in diseased groups was significantly lower (p<0.001). There was a statistically significant difference between each group (p<0.001). Mean levels of MDA were significantly increased in diseased groups as compared to controls with a statistically significant difference between all groups except between Group II and III.

CONCLUSION: In patients having NAFLD with and without diabetes mellitus, SOD 1 levels were considerably lower compared to controls whereas MDA levels were significantly higher. This decrease in SOD 1 and raise in MDA levels was indicative of increased oxidative stress in patients and can be viewed as a biomarker for oxidative stress.

KEY WORDS: NAFLD, ELISA, Oxidative stress, SOD 1, MDA, Lipid peroxidation.

PMID:37926877 | DOI:10.29271/jcpsp.2023.11.1254

J Coll Physicians Surg Pak. 2023 Nov;33(11):1240-1243. doi: 10.29271/jcpsp.2023.11.1240.

ABSTRACT

OBJECTIVE: To differentiate between complicated and uncomplicated acute appendicitis using the modified systemic inflammation score (mSIS) preoperatively.

STUDY DESIGN: Observational study. Place and Duration of the Study: The Emergency Surgery Service of General Surgery Clinic of Ankara Bilkent City Hospital, Turkey, between 2021 and 2022.

METHODOLOGY: The study included 2,584 patients older than 18 years who underwent surgery with the diagnosis of acute appendicitis. Patients with malignant diseases and those younger than 18 were excluded. The patients’ demographic characteristics, laboratory data, surgical notes, and pathology results were electronically obtained and analysed. According to the surgical findings and pathology records, gangrenous, perforated, and phlegmonous cases and those with any abscess focus were included in the complicated group and the remaining cases were included in the uncomplicated group. mSIS was evaluated as 0 if albumin was ≥4.0 g/dL and LMR (the lymphocyte-to-monocyte ratio) was ≥3.4, 1 if albumin <4.0 g/dL or LMR <3.4, and 2 if albumin <4.0 g/dL and LMR <3.4.

RESULTS: mSIS was 0 in 868 (33.6%) cases and 1-2 in 1,716 (66.4%) cases. When the patients with mSIS values of 0 and 1-2 were compared, there was a statistically significant difference (p=0.03). mSIS 1-2 was found to have 85% sensitivity and 42% specificity in predicting complicated appendicitis. In addition, the probability of complicated appendicitis was 1.48 times higher among the patients with an mSIS of 1-2.

CONCLUSION: Complicated appendicitis cases can be predicted preoperatively by simply calculating mSIS using the routine laboratory parameters.

KEY WORDS: Complicated acute appendicitis, mSIS, Appendectomy.

PMID:37926874 | DOI:10.29271/jcpsp.2023.11.1240

J Coll Physicians Surg Pak. 2023 Nov;33(11):1235-1239. doi: 10.29271/jcpsp.2023.11.1235.

ABSTRACT

OBJECTIVE: To investigate the relationship between preoperative pain scores and the mesoappendix volume and the presence of complications in patients with acute appendicitis.

STUDY DESIGN: Cross-sectional observational study. Place and Duration of the Study: Department of General Surgery at Kutahya Health Sciences University, Kutahya, Turkey, from January to December 2021.

METHODOLOGY: Pain degrees in patients with acute appendicitis were measured by Numerical Rating Scale (NRS) and Wong-Baker Scale (WBS). Mesoappendix volume was calculated using the formula: mesoappendix length x width x height. Appendicitis type (as complicated or uncomplicated) was grouped.

RESULTS: There was a positive and statistically significant correlation (17%) between the NRS and mesoappendix volume (p=0.065). In addition, there was a positive and statistically significant correlation (17%) between the WBS and mesoappendix volume (p=0.057). Additionally, there was a statistically significant relationship between the NRS, WBS, and complicated appendicitis (p=0.022, p=0.022, respectively).

CONCLUSION: The mesoappendix volume might contribute to preoperative pain process in acute appendicitis patients. Specifically, there is a statistically significant correlation between complicated appendicitis and preoperative pain scores.

KEY WORDS: Appendicitis, Pain, Mesentery, Complicated appendicitis.

PMID:37926873 | DOI:10.29271/jcpsp.2023.11.1235

J Coll Physicians Surg Pak. 2023 Nov;33(11):1223-1228. doi: 10.29271/jcpsp.2023.11.1223.

ABSTRACT

OBJECTIVE: To determine the oxygen reserve index (ORI) as a supporting parameter to the arterial partial oxygen pressure (PaO2) in blood gases in hypoxia and hyperoxia monitoring with different fresh gas flows (FGF) in patients undergoing abdominal surgery.

STUDY DESIGN: Randomised controlled trial. Place and Duration of the Study: Department of Anaesthesiology and Reanimation, Samsun Education and Research Hospital, Turkey, from January to September 2020.

METHODOLOGY: The study population of ninety patients was divided into three groups. After the high-flow period, the inspired oxygen fraction (FiO2) and flow-guided ventilation (FGF) were set to be 4 L/m and 40% in Group H (high-flow), 1 L/m and 50% in Group L (low-flow), and 0.5 L/m and 68% in Group M (minimal-flow), respectively.

RESULTS: There was a very high statistically positive correlation between PaO2 and ORI in H, L, and M groups. When using a cut-off value of 0.005 for ORI for the detection of PaO2 >100 mmHg, the area under the curve (AUC) was 0.97 (p<0.001) with a sensitivity of 94.4% and specificity of 95.3%. The AUC was detected to be 0.95 in receiver operating characteristic (ROC) analysis when the hyperoxia cut-off value of ORI was used to determine PaO2 >150 mmHg in the estimation of hyperoxia.

CONCLUSION: ORI can be used to complement SpO2 in low-flow anaesthesia in patients undergoing abdominal surgeries, provide guidance for PaO2, give information about tissue oxygen delivery, and contribute to the individualisation of oxygen therapy, and will therefore be included in the standard monitoring in the future.

KEY WORDS: Anaesthesia, Index, Inhalation, Oxygen, Pressure, Surgery.

PMID:37926871 | DOI:10.29271/jcpsp.2023.11.1223