Tag: pubmed

J Coll Physicians Surg Pak. 2025 Sep;35(9):1159-1164. doi: 10.29271/jcpsp.2025.09.1159.

ABSTRACT

OBJECTIVE: To evaluate the predictive power of the ARISCAT (assess respiratory risk in surgical patients in Catalonia) score for postoperative pulmonary complications (PPCs) following major urological procedures.

STUDY DESIGN: A descriptive study. Place and Duration of the Study: Department of Anaesthesiology and Critical Care, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkiye, from January to December 2023.

METHODOLOGY: A total of 140 ASA I-IV patients aged 18-85 years who had elective major urological surgery were included. Records were kept including patient demographics, surgical technique, comorbidities, length of postoperative hospital stay, ASA scores, preoperative pulmonary risk scores (ARISCAT), and any PPCs occurring during hospitalisation. Appropriate statistical analyses were performed using Chi-square or Fisher’s exact tests for categorical variables, Mann-Whitney U and Student’s t-tests for numerical variables, and ROC analysis to evaluate the predictive power of the ARISCAT score for PPC incidence.

RESULTS: Of the 140 patients who had major urological surgery, 24 (17.1%) experienced postoperative pulmonary problems. The findings showed that the development of PPC was significantly correlated with the ASA and the ARISCAT scores, the amount of intraoperative fluids administered, the length of the operation, and a body mass index of 25 or above.

CONCLUSION: The ARISCAT risk score system was shown to be a simple, repeatable, economical, and effective method for forecasting the occurrence of PPC in major urological procedures. In terms of forecasting the growth of PPC, it was found that the ARISCAT score outperforms the ASA score. It was believed that implementing effective preventative measures, morbidity and mortality rates could be decreased when high-risk individuals were identified.

KEY WORDS: ASA score, ARISCAT score, Postoperative pulmonary complications, Major urological surgery.

PMID:40948164 | DOI:10.29271/jcpsp.2025.09.1159

J Coll Physicians Surg Pak. 2025 Sep;35(9):1153-1158. doi: 10.29271/jcpsp.2025.09.1153.

ABSTRACT

OBJECTIVE: To evaluate the efficacy of a novel CAD/CAM-guided crown preparation technique compared with conventional manual methods in fixed prosthodontics.

STUDY DESIGN: A randomised controlled trial (RCT). Place and Duration of the Study: Department of Endodontic Dentistry, Hefei Stomatological Clinic College, Anhui Medical University, Hefei Stomatological Hospital, Hefei, China, from February 2023 to 2024.

METHODOLOGY: Sixty patients requiring single-unit ceramic crowns for mandibular premolars were randomly divided into either the CAD/CAM-guided group (n = 30) or the manual adjustment group (n = 30). The CAD/CAM group utilised intraoral scanning, digital design, and 3D-printed adjustment guided crowns to achieve precise tooth preparations, while the control group relied on the manual undercut adjustments. Operational efficiency, preparation accuracy, prosthetic fit, survival rate, and patient satisfaction were evaluated. Data were statistically analysed using the independent t-test and Chi-square (χ2) test at a significance level of p <0.05.

RESULTS: The CAD/CAM group exhibited significantly shorter preparation times than the control group. No statistically significant differences were found in preparation accuracy, prosthetic fit, clinical success rates, or patient satisfaction between the two groups.

CONCLUSION: CAD/CAM technology effectively reduces the clinical operating time for tooth preparation. While maintaining clinically acceptable outcomes, it has promising application scenarios.

KEY WORDS: CAD/CAM-guided crown preparation, Fixed prosthodontics, Preparation adjustment, Traditional manual adjustment.

PMID:40948163 | DOI:10.29271/jcpsp.2025.09.1153

J Coll Physicians Surg Pak. 2025 Sep;35(9):1141-1146. doi: 10.29271/jcpsp.2025.09.1141.

ABSTRACT

OBJECTIVE: To assess the impact of varying levels of controlled hypotension on cerebral oxygenation and examine their association with postoperative delirium and cognitive dysfunction among individuals undergoing rhinoplasty or septoplasty.

STUDY DESIGN: A randomised double-blind study. Place and Duration of the Study: Department of Anaesthesiology and Reanimation, Faculty of Medicine, Hitit University, Corum, Turkiye, between May and August 2024.

METHODOLOGY: Seventy ASA (American Society of Anesthesiologists) I-II patients (aged 18-65 years) undergoing elective rhinoplasty or septoplasty were randomly assigned to two equal groups. Group A (n = 35) received anaesthesia with a target mean arterial pressure (MAP) of 50-57 mmHg, and Group B (n = 35) with 58-65 mmHg. Assessment of cognitive function and delirium was conducted using the Mini-Mental Test (MMT) and the Delirium Rating Scale-Revised-98 (DRS-R-98). Continuous variables were analysed using the independent samples t-test, Mann-Whitney U test, or Friedman test, depending on data distribution. Categorical variables were compared using the Chi-square test. A p <0.05 was considered statistically significant.

RESULTS: Delirium was significantly more frequent in Group A than in Group B within the recovery unit (31.4% vs. 5.7%, p <0.05). DRS-R-98 scores were also notably higher in Group A than in Group B during both recovery and at the 24-hour mark (p <0.05). There were no statistically significant differences identified between the groups in MMT scores at 24 hours (p = 0.100), 7 days (p = 0.457), or 3 months (p = 0.114). Prolonged operative duration emerged as an independent risk factor for delirium in the recovery phase (p <0.05).

CONCLUSION: Controlled hypotension with MAP levels reduced to 50 mmHg appears to be safe with respect to medium- and long-term cognitive outcomes. However, the increased rate of early postoperative delirium in this group highlights the importance of close neurological monitoring during the immediate recovery period.

KEY WORDS: Controlled hypotension, Cerebral oxygenation, Delirium, Cognitive dysfunction, Rhinoplasty, Septoplasty.

PMID:40948161 | DOI:10.29271/jcpsp.2025.09.1141

J Coll Physicians Surg Pak. 2025 Sep;35(9):1135-1140. doi: 10.29271/jcpsp.2025.09.1135.

ABSTRACT

OBJECTIVE: To investigate the causal relationship between socioeconomic status (SES) and corneal diseases.

STUDY DESIGN: Two-sample Mendelian randomisation (MR) analysis. Place and Duration of the Study: Department of Pharmacy, Eye Hospital, Wenzhou Medical University, Wenzhou, China, between May and September 2024.

METHODOLOGY: The genome-wide significant single-nucleotide polymorphisms (SNPs) (p <5 × 10-8) associated with educational attainment, household income, and occupational status were selected as instrumental variables (IVs). Linkage disequilibrium (LD) clumping (r2 <0.001) was applied to ensure independence, and SNPs with F-statistics <10 were excluded. Corneal disease outcomes were analysed using inverse variance weighting (IVW) as the primary method. Sensitivity analyses, including Cochran’s Q-test for heterogeneity, the MR-Egger for interception, and MR-PRESSO for pleiotropy, were performed to assess robustness.

RESULTS: A significant negative association was observed between educational attainment and corneal ulcer risk in the univariate MR analysis (IVW OR, 0.77; 95% CI: 0.66-0.92; p = 0.003). In the multivariate MR (MVMR) analysis adjusting for household income and educational attainment, occupational status showed a significant association with corneal ulcer risk (IVW OR, 0.91; 95% CI: 0.82-0.99; p = 0.041). No significant associations were observed with other subtypes of corneal diseases.

CONCLUSION: These findings indicate that genetic evidence that lower socioeconomic status, particularly lower educational attainment and occupational status, is associated with an increased risk of corneal ulcer. Targeted public health strategies to improve socioeconomic conditions in disadvantaged populations may help reduce the burden of corneal diseases.

KEY WORDS: Socio-economic status, Corneal diseases, Mendelian randomisation, Corneal ulcers.

PMID:40948160 | DOI:10.29271/jcpsp.2025.09.1135

J Coll Physicians Surg Pak. 2025 Sep;35(9):1128-1134. doi: 10.29271/jcpsp.2025.09.1128.

ABSTRACT

OBJECTIVE: To investigate the association between postoperative CA-125 levels and overall survival (OS) in patients with ovarian cancer, assessing its potential role as a prognostic biomarker.

STUDY DESIGN: Observational study. Place and Duration of the Study: Department of Medical Oncology, Faculty of Medicine, Celal Bayar University, Manisa, Turkiye, from February 2012 to November 2024.

METHODOLOGY: The medical records of 211 women diagnosed with ovarian cancer were retrospectively reviewed. Descriptive statistical analyses were conducted to investigate the relationship between CA-125 levels and OS. Patients were categorised into high and low perioperative CA-125 groups based on predefined cut-off values: 305 U/mL preoperatively and 30.4 U/mL postoperatively. The predictive performance of preoperative and postoperative CA-125 levels for ovarian cancer recurrence was assessed using receiver operating characteristic (ROC) analysis. The Kaplan-Meier survival curves were employed to estimate OS, and the Cox regression analysis was performed for univariate and multivariate assessments.

RESULTS: Significant differences in OS were observed between the patients with low versus high postoperative CA-125 levels: 1-year OS (93.3% vs. 81.8%), 3-year OS (87.8% vs. 48.1%), 5-year OS (73.3% vs. 35.4%), and 10-year OS (52.0% vs. 19.7%) (p <0.001). Furthermore, postoperative CA-125 levels were independent predictors of both OS (univariate: p <0.001; multivariate: p = 0.009) and progression-free survival (PFS) (univariate: p = 0.005; multivariate: p = 0.011).

CONCLUSION: Perioperative CA-125 levels hold significant prognostic value in ovarian cancer management, offering a valuable biomarker for predicting survival outcomes and disease progression.

KEY WORDS: Postoperative CA-125, Tumour marker, Ovarian cancer, Overall survival, Prognostic marker.

PMID:40948159 | DOI:10.29271/jcpsp.2025.09.1128

J Coll Physicians Surg Pak. 2025 Sep;35(9):1122-1127. doi: 10.29271/jcpsp.2025.09.1122.

ABSTRACT

OBJECTIVE: To compare the efficacy of gabapentin combined with pregabalin in postherpetic neuralgia (PHN) attenuation, focusing on patient-reported outcomes and inflammatory cytokine reduction.

STUDY DESIGN: Single-blinded randomised controlled trial. Place and Duration of the Study: Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, China, from June to December 2022.

METHODOLOGY: A total of 134 consecutive patients diagnosed with PHN were randomly allocated into two groups: gabapentin alone (GB group, n = 67) or a combination of gabapentin and pregabalin (GBP group, n = 67) administered orally for 8 weeks. The outcome measures, including the visual analogue scale (VAS) score, clinical efficacy rate, and serum inflammatory factors, were analysed using the t-test, paired t-test, or χ2 test.

RESULTS: At 8 weeks post-treatment, the VAS score of the GBP group was statistically lower than that of the GB group (t = 22.441, p <0.001). The clinical efficacy rate of the GBP group was statistically higher than that of the GB group (74.6% vs. 56.7%, p = 0.029). The GBP group had significantly lower serum levels of interleukin (IL)-6, IL-1β, and tumour necrosis factor-α (TNF-α) compared to the GB group (p <0.05). No significant differences were observed in adverse effects between the two groups (46.3% vs. 54.8%, χ2 = 0.478, p = 0.489).

CONCLUSION: The combination therapy with gabapentin and low-dose pregabalin could help reduce pain and inflammatory factors.

KEY WORDS: Postherpetic neuralgia, Gabapentin, Pregabalin, Anti-inflammatory, Single-masked, Randomised controlled trial.

PMID:40948158 | DOI:10.29271/jcpsp.2025.09.1122

J Coll Physicians Surg Pak. 2025 Sep;35(9):1083-1087. doi: 10.29271/jcpsp.2025.09.1083.

ABSTRACT

OBJECTIVE: To investigate the incidence of postoperative atrial fibrillation (POAF) in patients following isolated coronary artery bypass grafting (CABG), evaluate its impact on mortality and morbidity, and analyse demographic and comorbid variables associated with its onset.

STUDY DESIGN: Observational cohort study. Place and Duration of the Study: Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkiye, from June 2020 to December 2022.

METHODOLOGY: Patients who underwent isolated CABG were included in the study. Those diagnosed with valvular heart disease on echocardiography were excluded, as were those with a history of atrial fibrillation (AF).

RESULTS: Statistical analysis was conducted on data from 489 patients. Among the demographic factors examined, only age (p = 0.021) exhibited a significant correlation with the development of POAF. Chronic renal disease (p = 0.044) and reduced glomerular filtration rate (GFR) levels (p = 0.020) were significantly associated with POAF. Regarding perioperative factors, cardiopulmonary bypass (CPB) duration (p = 0.104) was not significantly related to POAF, whereas prolonged cross-clamp time was (p = 0.009). POAF was associated with postoperative complications, including acute kidney damage (p = 0.002), extended intubation (p = 0.003), infection (p <0.001), the need for intra-aortic balloon pump (IABP) or inotropic support (p = 0.004), and mortality (p = 0.001).

CONCLUSION: POAF is a common complication after isolated CABG and is significantly associated with advanced age, reduced GFR, chronic kidney disease, and prolonged cross-clamp time. Its occurrence is associated with increased postoperative morbidity and mortality. These findings emphasise the importance of perioperative risk factors in predicting adverse outcomes.

KEY WORDS: Atrial fibrillation, Coronary artery bypass, Acute kidney injury, Mortality, Morbidity, Intra-aortic balloon pumping.

PMID:40948152 | DOI:10.29271/jcpsp.2025.09.1083

Hypertension. 2025 Sep 15. doi: 10.1161/HYPERTENSIONAHA.125.25022. Online ahead of print.

ABSTRACT

BACKGROUND: The sFlt-1 (soluble fms-like tyrosine kinase 1) and PlGF (placental growth factor) ratio holds significant value in the early identification of preeclampsia and risk stratification. However, its application within the Chinese population remains under-researched. This study evaluates the predictive performance of the sFlt-1/PlGF ratio in hospitalized Chinese patients with hypertensive disorders of pregnancy.

METHODS: This prospective single-center cohort study (December 2023-June 2024) enrolled East Asian women aged ≥18 years with singleton pregnancies (23 weeks to 36 weeks and 6 days of gestation) and signs or symptoms of hypertensive disorders of pregnancy. A serum sFlt-1/PlGF level of 38 was selected as the critical value to differentiate risk levels. Maternal outcomes and fetal parameters were assessed within 2 weeks post-enrollment and statistically analyzed.

RESULTS: The study included 132 hospitalized patients with hypertensive disorders of pregnancy, among whom 44 (33.3%) had an sFlt-1/PlGF ratio ≥38. The interval to delivery detected in the high-ratio group was significantly shorter (0.8 weeks compared with 4 weeks; P<0.001), and the risk of delivery within 2 weeks after detection was significantly increased (adjusted hazard ratio, 5.36 [95% CI, 3.42-8.39]; P<0.001). The sFlt-1/PlGF ≥38 had an area under the curve of 0.88 for predicting delivery within 2 weeks. This indicator also demonstrated good negative predictive performance in excluding maternal-fetal adverse outcomes (negative predictive values: severe preeclampsia, 0.93; severe small for gestational age, 0.93).

CONCLUSIONS: The sFlt-1/PlGF ratio demonstrates strong predictive value for short-term delivery in hospitalized hypertensive disorders of pregnancy patients in China. Its high negative predictive value is particularly useful in excluding the risk of maternal-fetal adverse outcomes.

REGISTRATION: URL: https://www.medicalresearch.org.cn; Unique identifier: MR-44-23-049132.

PMID:40948128 | DOI:10.1161/HYPERTENSIONAHA.125.25022

Community Dent Health. 2025 Sep 15:265539X251379611. doi: 10.1177/0265539X251379611. Online ahead of print.

ABSTRACT

BACKGROUND: Children with special needs face restrictions in dental hygiene due to disabilities. Dental education and preventive measures can significantly improve oral health among children with special needs. This study aims to assess the oral health status of children with Cerebral Palsy, Autism and Down Syndrome and to evaluate the effectiveness of the interventional programs on oral health status in Karnataka, India.

METHODS: A quantitative, interventional study with a repeated measures design was conducted among 135 children diagnosed with Cerebral Palsy, Autism, and Down Syndrome. Data were gathered using a Demographic Proforma, the WHO Oral Health Status Questionnaire and WHO Oral Health Assessment Form (2013). The intervention included weekly sessions over 3 months, featuring supervised tooth brushing training, individualised dental counselling for caregivers, interactive educational modules, and distribution of a Pictorial Information Manual in local languages. Data were analysed using SPSS Version 29.0, with a significance level set at p < 0.05.

RESULTS: The study consisting 135 children, oral health status scores as evidenced by statistically significant changes (p < 0.001) indicating improvement in dental health. The Oral health of children shows substantial changes, which were statistically significant (p < 0.001), confirming the positive impact of the intervention.

CONCLUSIONS: The study interventions were enriching for caregivers with sufficient information and skill on dental care. The development of the Pictorial Information Manual is a unique manual enriched with of attractive pictures and relevant information on oral health, which was made copyrighted and distributed to caregivers.

PMID:40948109 | DOI:10.1177/0265539X251379611

Int J Gynaecol Obstet. 2025 Sep 15. doi: 10.1002/ijgo.70536. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the effect of a goal attainment program using the LINE OA application, Teen Mom Care (GAP-LINE OA: TMC), on self-care behaviors and hematocrit levels among pregnant adolescents with anemia.

METHODS: A quasi-experimental, two-group pretest-posttest design was used. The study included 54 pregnant adolescents receiving antenatal care at six hospitals in southern Thailand from April to June 2024. Participants were divided into a control group (n = 27), receiving standard care, and an experimental group (n = 27), receiving standard care combined with GAP-LINE OA: TMC. Data were collected twice: at baseline (before 28 weeks of gestation with hematocrit < 33%) and at four weeks post-intervention. Instruments included GAP-LINE OA: TMC, a demographic questionnaire, and a self-care behavior questionnaire for pregnant adolescents with anemia. Data were analyzed using descriptive statistics, chi-square, t-test, Wilcoxon signed-rank test, and Mann-Whitney U test.

RESULTS: In the experimental group, self-care behavior scores and hematocrit levels significantly improved after the intervention compared with baseline (P < 0.001). Inter-group analysis showed significantly greater increases in self-care behavior scores and hematocrit levels in the experimental group compared with the control group (P = 0.044).

CONCLUSION: The GAP-LINE OA: TMC program effectively enhances self-care behaviors and improves hematocrit levels in pregnant adolescents with anemia. The GAP-LINE OA: TMC program can enhance antenatal care by providing targeted support, goal-setting interventions, and improved communication for pregnant adolescents with anemia via the LINE OA platform.

PMID:40948108 | DOI:10.1002/ijgo.70536