Nevin Manimala

Pak J Med Sci. 2021 Jul-Aug;37(4):1104-1110. doi: 10.12669/pjms.37.4.4328.

ABSTRACT

OBJECTIVES: We designed this prospective observational study to clarify the associations between dialysate IL-6, a marker of ongoing peritoneal inflammation, Tie2, an important factor in angiogenesis in the peritoneum, and a high peritoneal solute transport rate (PSTR) in patients undergoing peritoneal dialysis (PD) and to investigate their outcome predictive roles.

METHODS: A total of 60 stable continuous ambulatory peritoneal dialysis (CAPD) patients from a single center in China were analyzed in this prospective study. We measured dialysate levels of IL-6 and Tie-2 using ELISAs. Our primary study endpoint was all-cause mortality with 10 years’ follow-up.

RESULTS: For the evaluation of PSTR, we used the Dialysis/Plasma creatinine (D/Pcr) ratio. We subdivided the patients into two groups for statistical evaluation: low and low average D/Pcr (<0.64; L/A), and high and high average D/Pcr (≥0.65; H/A) transporters. The mean levels of dialysates IL-6 (21.71 ± 8.88 pg/mL) and Tie-2 (1.23 ± 0.43 ng/mL) were significantly higher in the H/A (high and high average, group than those in the L/A group (13.94 ± 5.43 pg/mL, p<0.001 and 0.95 ± 0.43 ng/mL, p=0.019; respectively). Moreover, IL-6 and Tie-2 were positively correlated with D/Pcr (r=0.366, p=0.004 and r=0.402, p=0.001; respectively). Both dialysates IL-6 and Tie-2 were independent determinants of a high peritoneal solute transport rate. After follow-up for 42.65±18.08 months, 30 patients (50.0%) had died. An increased D/Pcr increased the risk of all-cause mortality in patients with CAPD (p=0.018), but the dialysates IL-6 and Tie2 were not independent predictors of all-cause mortality (p>0.05).

CONCLUSION: Our results suggest that patients undergoing CAPD have a high peritoneal solute transport status with local peritoneal inflammation and angiogenesis. Increased D/Pcr is a relative risk factor for mortality and technique failure in patients undergoing CAPD.

PMID:34290791 | PMC:PMC8281163 | DOI:10.12669/pjms.37.4.4328

Pak J Med Sci. 2021 Jul-Aug;37(4):1099-1103. doi: 10.12669/pjms.37.4.3892.

ABSTRACT

OBJECTIVES: To assess the effect of pelvic organ prolapse (POP) and/or stress urinary incontinence (SUI) on various domains of female sexual functions in patients before and after reconstructive surgery for these pelvic floor disorders.

METHODS: We conducted a quasi-experimental study of 126 women aged 25-65 years, presenting with POP / SUI, from January 1^st 2019 to December 31^st 2019 at Aga Khan University Hospital. POP surgery was performed only in patients with symptomatic POP ≥ stage 2 according to POP-Q (quantification). Sexual functions were assessed using Female Sexual Function Index (FSFI) questionnaire, among sexually active women at baseline and 18 months after surgery.

RESULTS: Mean age of the participants was 51.6, with a mean parity of four. Out of 126 patients, 31 patients underwent vaginal hysterectomy, pelvic floor repair and mid-urethral sling (MUS), 55 had vaginal hysterectomy with pelvic floor repair, 12 women had only pelvic floor repair and 10 patients had uterine suspension surgery for prolapse, while 18 patients underwent MUS operation alone for SUI. There was a statistically significant difference in female sexual functions after surgery for POP and/or SUI (p<0.01). This improvement was observed in both total and individual scores of each domain of FSFI with an overall improvement in sexual function from a mean of 18.5 pre-surgery to 20.8 post-surgery.

CONCLUSIONS: This study reveals that women sexual functions are affected by POP and SUI and improve remarkably after reconstructive surgeries for these pelvic floor disorders.

PMID:34290790 | PMC:PMC8281190 | DOI:10.12669/pjms.37.4.3892

Pak J Med Sci. 2021 Jul-Aug;37(4):1080-1085. doi: 10.12669/pjms.37.4.4000.

ABSTRACT

OBJECTIVES: Evaluation of TBL from students’ perspective has been done extensively, but limited studies have analyzed the effect of TBL on students’ academic performance. Objectives of the present study were to assess students’ perceptions about team-based learning versus traditional lectures and then to compare with students’ grades in both TBL and lecture-based assessments.

METHODS: Cross-sectional descriptive study which included 147 dentistry students was conducted between March and June, 2020 at Qassim University, Saudi Arabia. A self-composed 10 item closed ended instrument was administered through electronic mail. One block from each academic year was selected randomly and organizers were requested to provide grades of students in both TBL and lecture-based exams. Grades from A to F were determined as achievement indicator and were compared statistically using Kruskal Wallis, Tuckey Posthoc and Chi-square tests.

RESULTS: A total of 120 students (81.6%) responded to the survey, and mean perception score was (3.29±0.94). Perceptions of students, regarding TBL as a learning strategy were comparatively superior as compared to the lectures. Students scored significantly higher grades in TBL exams (p<0.05) as compared to lecture-based assessments. Gender-wise analysis indicated that female students secured significantly higher grades in the TBL.

CONCLUSION: We conclude that dentistry students perceived TBL as superior teaching and learning strategy compared to traditional lectures. Their perception was verified by their significant higher academic achievements in the assessments for the coursework taught by utilizing team-based learning strategy.

PMID:34290787 | PMC:PMC8281172 | DOI:10.12669/pjms.37.4.4000

Pak J Med Sci. 2021 Jul-Aug;37(4):1075-1079. doi: 10.12669/pjms.37.4.3476.

ABSTRACT

OBJECTIVES: The current study aimed to determine the Spontaneous Bacterial Peritonitis (SBP) risk due to increased use of Proton Pump Inhibitors (PPIs) among cirrhotic patients with ascites.

METHODS: This retrospective case-control study was conducted at Chandka Medical College & Hospital, Larkana from March 2013 to February 2014, involving 215 cirrhotic patients with ascites. Paracentesis was performed to distinguish cirrhotic patients with SBP and Polymorphonuclear Neutrophil (PMN) count ≥ 250 neutrophils/mm³ (cases) and non-SBP with PMN count < 250 neutrophils/mm³ (controls). The demographic details, history of PPIs use before admission and duration of Chronic Liver Disease (CLD) were inquired and statistical analysis was carried through SPSS Version 23.0.

RESULTS: Increased pre-hospital PPI intake was observed among cirrhotic patients with SBP (69.8%) as compared to those without SBP (48.8%; p = 0.014). The mean duration of PPI use was 19.16 ± 4.772 days, and it was more significant among older cirrhotic patients (p < 0.05). Increased duration of CLD was observed among PPI users, i.e. 20.47 ± 6.305 months vs. 18.95 ± 5.527 months among non-PPI users (p < 0.05).

CONCLUSIONS: Our results show that cirrhotic patients with ascites consuming PPIs are more likely to develop SBP as compared to non-PPI users.

PMID:34290786 | PMC:PMC8281193 | DOI:10.12669/pjms.37.4.3476

Pak J Med Sci. 2021 Jul-Aug;37(4):1063-1068. doi: 10.12669/pjms.37.4.3820.

ABSTRACT

OBJECTIVE: To evaluate the effect of sintilimab combined with chemotherapy on tumor markers and immune function in advanced non-small cell lung cancer.

METHODS: The study was conducted at Xi’an Medical University, China. The 120 patients with advanced NSCLC who were treated in our hospital from January 2016 to January 2020 were randomly divided into two groups, with 60 cases in each group. Patients in the control group received conventional GP chemotherapy, while those in the experimental group received intravenous injection of sindilimab on the basis of conventional GP chemotherapy. The changes of serum tumor markers CYFRA211, CEA, CA125 and T lymphocyte subsets CD3+, CD4+, CD8+, CD4+/CD8+ in the two groups prior to and after treatment were compared and analyzed. At the same time, the clinical efficacy at six months was compared between the two groups.

RESULTS: The serum tumor markers CYFRA211, CEA and CA125 in the two groups after treatment were lower than those before treatment, and the difference was statistically significant (P=0.00). Specifically, the above-mentioned markers in the experimental group decreased more significantly than those in the control group, and the difference was statistically significant (CYFRA211, CA125, p=0.00; CEA, p=0.01; the levels of CD3+ and CD4+ in the experimental group were higher than those in the control group after treatment, with statistical significance (CD3+, p=0.00; CD4+, p=0.01)). No significant change can be seen in CD8+ (p=0.14), and the level of CD4+/CD8+ in the experimental group was higher than that in the control group, with a significant difference (p=0.02). The complete remission rate (CR) was 22% in the experimental group and 8% in the control group (P=0.04), which was statistically significant. The progress rate (PD) of the experimental group was significantly lower than that of the control group, with statistical significance (p=0.02). The overall response rate (RR) of the experimental group was more advantageous than that of the control group, with a statistically significant difference (p=0.01).

CONCLUSION: Compared with chemotherapy alone, significant therapeutic effects can be obtained in the treatment of advanced non-small cell lung cancer with sintilimab combined with chemotherapy. With this combination regimen, the level of serum tumor markers can be significantly reduced, the cellular immune function of patients can be improved, with the overall response rate of treatment increased, and the risk of progressive disease of patients reduced.

PMID:34290784 | PMC:PMC8281194 | DOI:10.12669/pjms.37.4.3820

Pak J Med Sci. 2021 Jul-Aug;37(4):1054-1057. doi: 10.12669/pjms.37.4.3993.

ABSTRACT

OBJECTIVE: To investigate the efficacy of hyperbaric oxygen (HBO) combined with escitalopram in patients with depression and its effect on cognitive function.

METHODS: From 2016 to 2018, seventy patients with depression aged 18-65 years treated in Affiliated Hospital of Hebei University were selected. Seventy patients with depression meeting the diagnostic criteria of ICD-10 were selected and randomly divided into control group and observation group using a random number table, with 35 patients in each group. The control group was treated with escitalopram, while the observation group was additionally treated with HBO on this basis. The patients were assessed using the Hamilton Depression Scale (HAMD) and Montreal Cognitive Assessment Scale (MoCA) before treatment and two, four and six weeks after treatment.

RESULTS: Two weeks after treatment, HAMD score showed a statistically significant difference between the two groups (P < 0.05). No statistically significant differences were found in HAMD score between the two groups four and six weeks after treatment (P > 0.05). Four and six weeks after treatment, MoCA score presented statistically significant differences between the two groups (P < 0.05).

CONCLUSION: Escitalopram combined with HBO in the treatment of depression presents rapid efficacy and a certain effect in improving cognitive function.

PMID:34290782 | PMC:PMC8281171 | DOI:10.12669/pjms.37.4.3993

Pak J Med Sci. 2021 Jul-Aug;37(4):1036-1041. doi: 10.12669/pjms.37.4.4066.

ABSTRACT

OBJECTIVES: To evaluate the clinical effect of apatinib combined with chemotherapy in the treatment of advanced non-small cell lung cancer (NSCLC).

METHODS: Eighty patients with advanced NSCLC treated in Hebei General Hospital from January 2017 to July 2020 were randomly divided into two groups: the experimental group and the control group, each with 40 cases. Patients in the control group were treated with conventional paclitaxel combined with cisplatin chemotherapy, while patients in the experimental group were treated with apatinib mesylate tablets based on the treatment of the control group. After treatment, tumor efficacy evaluation was conducted on all patients every two cycles, and the therapeutic effect, adverse drug reactions, improvement of quality-of-life scores prior to and after treatment, and changes of indicators such as tumor markers carcinoembryonic antigen (CEA) and carbohydrate antigen 153(CA153) were compared and analyzed between the two groups.

RESULTS: The total effective rate of the experimental group was 67.5%, which was significantly better than the 45% of the control group (p=0.04); The incidence of adverse drug reactions in the experimental group was 25%, while that in the control group was 37.5%, with no significant difference (p=0.23); Moreover, the improvement rate of quality of life scores in the experimental group was significantly higher than that in the control group (p=0.03), and the levels of CEA and CA153 in the experimental group were significantly lower after treatment than those in the control group, with a statistically significant difference (p=0.01).

CONCLUSION: Apatinib combined with conventional chemotherapy is effective in the treatment of advanced non-small cell lung cancer, the quality of life can be significantly improved, tumor markers can be significantly reduced, and adverse reactions will not be significantly increased.

PMID:34290779 | PMC:PMC8281184 | DOI:10.12669/pjms.37.4.4066

Pak J Med Sci. 2021 Jul-Aug;37(4):983-987. doi: 10.12669/pjms.37.4.3841.

ABSTRACT

OBJECTIVE: To investigate the changes in levels of C-reactive protein (CRP) and hematological parameters among smokeless tobacco (SLT) users.

METHODS: A comparative cross-sectional study was conducted at the community level in the coastal districts of Sindh province namely Badin, Thatta, and Sujawal from January 2017 to December 2019. The CRP and hematological parameters were evaluated by well-established methods among SLT and non-SLT users.

RESULTS: There was a statistically significant difference between SLT users (mean CRP = 0.77) versus non-users (mean CRP = 0.18), p = <0.001. Among hematological parameters, white blood cells (SLT users median = 7.85 versus non-SLT users median = 8.50, p = 0.004), monocytes (SLT users median = 6.00 versus non-SLT users median = 6.00, p = 0.001) and erythrocyte sedimentation rate (SLT users median = 15.00 versus non-SLT users median = 10.00, p = 0.006) showed statistically significant difference.

CONCLUSIONS: Significantly elevated CRP was observed in SLT users similarly hematological parameters also showed changes. WBCs, monocytes and ESR were significantly deranged among SLT users. Further studies looking into long term effects of these changes would be helpful.

PMID:34290770 | PMC:PMC8281176 | DOI:10.12669/pjms.37.4.3841

Pak J Med Sci. 2021 Jul-Aug;37(4):972-978. doi: 10.12669/pjms.37.4.3661.

ABSTRACT

OBJECTIVES: Examine the effect of fasting during Ramadan on kidney functions in patients with chronic kidney disease.

METHODS: The study was conducted on 130 patients with stage III-IV chronic kidney disease (CKD), who were admitted to the Ordu University nephrology polyclinic during the month before Ramadan and one month after Ramadan in 2019. Blood samples were taken in the morning after 12 hours of fasting.

RESULTS: There was a statistically significant difference between BUN in the fasting group before and after the month of Ramadan. The median BUN before Ramadan was 26.65 mg/dl, the median after Ramadan was 24.05 mg/dl (p=0.004).There was a statistically significant difference between the nonfasting groups before and after Ramadan with respect to creatinine level. Median creatinine before Ramadan was 1.69 mg/dl,and the median after Ramadan was 1.86 mg/dl (p <0.001).There was a statistically significant difference between the fasting groups before and after Ramadan with respect to creatinine levels. Fasting group ,the median before Ramadan was 1.5 mg/dl, and the median after Ramadan was 1.42 mg/dl (p = 0.038).The impact of independent variable of fasting, using linear regression was found to be statistically significant (p_post-<0.001). The eGFR was 14.826 points higher in those who fasted after Ramadan than in those who did not.

CONCLUSION: Fasting during the month of Ramadan does not deteriorate kidney functions and even leads to a moderate improvement in kidney functions. Taking these results into consideration, fasting may be advised for patients with stage III-IV CKD who want to fast and remain in stable condition.

PMID:34290768 | PMC:PMC8281173 | DOI:10.12669/pjms.37.4.3661

Pak J Med Sci. 2021 Jul-Aug;37(4):952-958. doi: 10.12669/pjms.37.4.3987.

ABSTRACT

OBJECTIVES: To evaluate the clinical significance of individualized nutritional formulas on inflammatory factors, immune status and gastrointestinal tolerance in patients with severe head injury.

METHODS: A total of 80 patients with severe head injury who were hospitalized in Baoding No.1 Central Hospital from March 2017 to March 2020 were randomly divided into two groups with 40 cases in each group. Patients in both groups were given enteral nutrition (EN), the control group was given conventional enteral nutrition formula through nasointestinal tube, and the experimental group was given individualized nutrition formula. All patients were tested for tumor necrosis factor(TNF-α), C-reactive protein(CRP), interleukin 6(IL-6), IgA, IgM, IgG, serum intestinal fatty acid binding protein(I-FABP) and D-lactic acid concentration before and after enteral nutrition treatment. The incidence of adverse reactions such as abdominal distension, diarrhea, constipation, and gastric retention within seven days after treatment of two groups were compared and analyzed.

RESULTS: There was no significant difference in inflammatory factors such as TNF-a, CRP, IL-6, immunoglobulin levels, I-FABP and D-lactic acid concentration between the two groups before treatment (p>0.05). After treatment, the above indicators of the two groups of patients were better than before treatment, the difference was statistically significant (p<0.05), and the experimental group was significantly better than the control group (p<0.05). The experimental group had a gastrointestinal adverse reaction rate of 10%, and the control group had 27.5%, the difference was statistically significant (p=0.04).

CONCLUSIONS: Individualized nutritional formula has more significant advantages than conventional nutritional formula for patients with severe head injury, which can reduce inflammatory response, increase the patient’s immune level, improve the intestinal mucosal barrier function, have good gastrointestinal tolerance, and have a low incidence of adverse reactions.

PMID:34290765 | PMC:PMC8281155 | DOI:10.12669/pjms.37.4.3987