Tag: nevin manimala

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

J Coll Physicians Surg Pak. 2023 Nov;33(11):1217-1222. doi: 10.29271/jcpsp.2023.11.1217.

ABSTRACT

OBJECTIVE: To investigate the anti-fibrotic effects of pirfenidone on Peyronie’s disease in an experimental rat model with intracavernosal injection of TGF-β and whether pirfenidone improves erectile function.

STUDY DESIGN: Experimental study. Place and Duration of the Study: Faculty of Medical Experimental Animals and Research Laboratory, Trakya University, from January to March 2021.

METHODOLOGY: In this study, 27 male Sprague Dawley rats were used, and three groups were randomly identified. The rats in Group 1 served as the control group. Group 2 was not treated, and Group 3 was treated with pirfenidone therapy. The rats in Group 3 were administered pirfenidone 30 mg/kg/day by oral gavage, every day for four weeks, three weeks after the start of the experiment. At the end of seven weeks, a haemodynamic study was performed with cavernosal nerve stimulation to evaluate the erectile function, the rats were sacrificed, and the penile tissues were evaluated immunohistochemically.

RESULTS: MeICP/MIBP values were found to be higher in treated rats compared to rats in the untreated group but no statistically significant difference was found in MeICP/MIBP values between the control, Peyronie model, and treatment groups (p=0.25). According to the histopathological examination, the rate of fibrosis with H&E staining was mild (100%) in the control group, severe (100%) in the Peyronie group, and severe (87.5% severe and 12.5% moderate) in the Peyronie + treatment group.

CONCLUSION: In the study, pirfenidone used in the treatment of Peyronie’s disease had a positive effect on erectile function, though not considered statistically significant. It has been shown that it has no histopathological effect on Peyronie’s plaques.

KEY WORDS: Anti-fibrotic agent, Erectile function, Experimental study, Peyronie’s disease, Pirfenidone.

PMID:37926870 | DOI:10.29271/jcpsp.2023.11.1217

Pharmacotherapy. 2023 Nov 5. doi: 10.1002/phar.2889. Online ahead of print.

ABSTRACT

PURPOSE: Acute kidney injury (AKI) commonly occurs in patients with lymphoma exposed to high-dose methotrexate (HDMTX), but our ability to reliably predict AKI is limited. This study sought to develop and validate a model for predicting AKI after HDMTX exposure.

METHODS: This multisite, retrospective study of consecutive adult lymphoma patients treated with HDMTX used the LASSO method to identify factors available at the outset of therapy that predicted incident AKI within 7 days following HDMTX. The model was then validated in an independent cohort.

RESULTS: The incidence of AKI within 7 days following HDMTX was 21.6% (95% Confidence Interval (CI) 18.4%-24.8%) in the derivation cohort (435 unique patients who received a total of 1,642 doses of HDMTX) and 15.6% (95% CI 5.3%-24.8%) in the validation cohort (55 unique patients who received a total of 247 doses of HDMTX). Factors significantly associated with AKI after HDMTX in the multivariable model included age ≥ 55 years, male sex, and lower HDMTX dose number. Other factors that were not found to be significantly associated with AKI on multivariable analysis, but were included in the final model, were body surface area, Charlson Comorbidity Index, and estimated glomerular filtration rate. The c-statistic of the model was 0.72 (95% CI 0.69-0.75) in the derivation cohort and 0.72 (95% CI 0.60-0.84) in the validation cohort.

CONCLUSION: This model utilizing identified sociodemographic and clinical factors is predictive of AKI following HDMTX administration in adult patients with lymphoma.

PMID:37926860 | DOI:10.1002/phar.2889

Acta Paediatr. 2023 Nov 5. doi: 10.1111/apa.17027. Online ahead of print.

ABSTRACT

AIM: To investigate how the aetiology of very preterm birth/very low birth weight is associated with mortality and later neurodevelopmental outcomes.

METHODS: Very preterm/very low-birth weight singletons were categorised based on the aetiology of preterm birth: spontaneous preterm birth (n = 47, 28.1%), preterm premature rupture of membranes (n = 56, 33.5%) or placental vascular pathology (n = 64, 38.3%). Mortality, cerebral palsy, severe cognitive impairment by 11 years of age (<2SD) and mean full-scale intelligence quotient at 11 years were studied in association with birth aetiology.

RESULTS: There was no difference in mortality or rate of cerebral palsy according to birth aetiologies. The rate of severe cognitive impairment was lower (4.9% vs. 15.3%) in the preterm premature rupture of the membrane group in comparison to the placental vascular pathology group (OR 0.2, 95% CI 0.03-0.9, adjusted for gestational age). At 11 years, there was no statistically significant difference in the mean full-scale intelligence quotient.

CONCLUSION: Placental vascular pathology, as the aetiology of very preterm birth/very low birth weight, is associated with a higher rate of severe cognitive impairments in comparison to preterm premature rupture of membranes, although there was no difference in the mean full-scale intelligence quotient at 11 years. The aetiology of very preterm birth/very low birth weight was not associated with mortality or the rate of cerebral palsy.

PMID:37926858 | DOI:10.1111/apa.17027