Tag: pubmed

Ann N Y Acad Sci. 2023 Oct 7. doi: 10.1111/nyas.15067. Online ahead of print.

ABSTRACT

Objective analytical identification methods are still a minority in the praxis of paleobiological sciences. Subjective interpretation of fossils and their modifications remains a nonreplicable expert endeavor. Identification of African bovids is a crucial element in the reconstruction of paleo-landscapes, ungulate paleoecology, and, eventually, hominin adaptation and ecosystemic reconstruction. Recent analytical efforts drawing on Fourier functional analysis and discrimination methods applied to occlusal surfaces of teeth have provided a highly accurate framework to correctly classify African bovid tribes and taxa. Artificial intelligence tools, like computer vision, have also shown their potential to be objectively more accurate in the identification of taphonomic agency than human experts. For this reason, here we implement some of the most successful computer vision methods, using transfer learning and ensemble analysis, to classify bidimensional images of African bovid teeth and show that 92% of the large testing set of images of African bovid tribes analyzed could be correctly classified. This brings an objective tool to paleoecological interpretation, where bovid identification and paleoecological interpretation can be more confidently carried out.

PMID:37804072 | DOI:10.1111/nyas.15067

J Coll Physicians Surg Pak. 2023 Oct;33(10):1204-1206. doi: 10.29271/jcpsp.2023.10.1204.

ABSTRACT

COVID-19 ARDS (acute respiratory distress syndrome), caused by SARS-CoV-2, involves a decrease in the end expiratory lung volume (EELV), compliance, and hypoxemia. The authors retrospectively analysed the relationship between the EELV, Plateau pressure (Pplat), and compliance of the respiratory system in a group of 21 mechanically ventilated COVID ARDS patients with moderate to severe hypoxia who were subjected to a recruitment manoeuvre. Further, these parameters were studied after dividing them into two groups as Group 1 of clinically non-recruitable and Group 2 of clinically recruitable patients. There was relationship between EELV, compliance, and Pplat among those patients who were clinically recruited versus those who were not in a homogeneous group of COVID ARDS patients. In Group 1, the statistical value of EELV and compliance were r = 0.395, p>0.05, EELV and Pplat were r = 0.021, p>0.05, and compliance and Pplat were r = -0.848, p<0.001. In Group 2, the statistical values of EELV and compliance were (r = 0.605, p<0.001), EELV and Pplat were r = -0.391, p<0.05, compliance and Pplat were r = -0.848, p<0.001. The additional information gained after understanding this relationship can help to optimise ventilator settings. Key Words: COVID, ARDS, End expiratory lung volume, Plateau pressure, Compliance, Recruitment, Ventilation.

PMID:37804032 | DOI:10.29271/jcpsp.2023.10.1204

J Coll Physicians Surg Pak. 2023 Oct;33(10):1194-1197. doi: 10.29271/jcpsp.2023.10.1194.

ABSTRACT

OBJECTIVE: To evaluate the efficacy of mandibular advancement device as a treatment of mild to moderate obstructive sleep apnoea and to evaluate the change in upper airway space volume by using cone beam CT (CBCT).

STUDY DESIGN: In vivo observational study. Place and Duration of the Study: Department of Prosthodontics, Crown and Bridge, Sri Aurobindo College of Dentistry, Indore (M.P), India, from March 2017 to January 2021.

METHODOLOGY: Patients with mild to moderate obstructive sleep apnoea patients using Berlin questionnaire were selected. Pre- and posttreatment-CBCT analysis was done to compare the changes in superior and inferior upper airway space before and after using mandibular advancement device. The pre and postoperative CBCT were also compared using a paired t-test for the quantitative variables. After two months, the patients were asked to complete a self-administered questionnaire to assess their sleep improvement, initial symptoms regression, and effectiveness of the mandibular advancement device.

RESULTS: On comparative evaluation of the pre- and post-CBCT, the mean score before the mandibular advancement device placement was found to be 7.77+2.79 cc, whereas the mean score after the mandibular advancement device placement was found to be 9.75+3.34 cc (p<0.001). Significant volumetric change was seen in upper airway space after receiving treatment for the two months. The patient noticed a substantial improvement in their sleep as well as a reduction in the original symptoms.

CONCLUSION: This study showed statistically significant volumetric change in the upper airway space and reduction in their symptoms after treatment with the mandibular advancement device (MAD).

KEY WORDS: Obstructive sleep apnoea syndrome (OSA), Continuous positive airway pressure (CPAP), Cone beam computed tomography, Mandibular advancement device (MAD), Upper airway volume.

PMID:37804029 | DOI:10.29271/jcpsp.2023.10.1194

J Coll Physicians Surg Pak. 2023 Oct;33(10):1171-1175. doi: 10.29271/jcpsp.2023.10.1171.

ABSTRACT

OBJECTIVE: To evaluate the student’s perspective about educational and training efficacy of workplace based learning (WBL) during surgical clerkship in Orthopaedics amongst 4th and 5th year medical students.

STUDY DESIGN: Cross-sectional study. Place and Duration of the Study: Department of General Surgery, Shifa Tameer-e-Millat University, Islamabad, from September 2020 to December 2021.

METHODOLOGY: The inclusion criteria was fourth and final year MBBS students who had completed their orthopaedic surgery mini-clerkship. The exclusion criteria was medical students who did not attend the orthopaedics clerkship in the study period. The research instrument was a questionnaire based on the principles of experiential based learning. The participants were sent an online questionnaire as well as a consent form through e-mail. The responses were recorded and analysed for descriptive statistics.

RESULTS: From the target group, 140 responses were received, 94 students (67%) expressed that workplace environment was conducive to learning and 98 (70%) agreed that their diagnostic and management skills further developed following exposure to the orthopaedic workplace. A short duration of 2 weeks served as a hindrance with 53 (38%) of students expressing that they were not able to effectively inculcate all concepts within that limited time-frame. Moreover, 52 (37.5%) students described limited patient’s clerking time.

CONCLUSION: Though majority of students were satisfied with teaching and learning strategies, design and implementation of the curriculum at the orthopaedics department; yet, there were significant limitations requiring further evaluation and cooperation by both students and faculty in order to establish ecosystem focusing on experiential learning.

KEY WORDS: Orthopaedics, Workplace based learning (WBL), Student, Clerkship, Learning environment.

PMID:37804025 | DOI:10.29271/jcpsp.2023.10.1171

J Coll Physicians Surg Pak. 2023 Oct;33(10):1153-1158. doi: 10.29271/jcpsp.2023.10.1153.

ABSTRACT

OBJECTIVE: To determine the clinical impact of preventive nursing on children with hypospadias and the intervention effect on postoperative complications.

STUDY DESIGN: Comparative study. Place and Duration of the Study: Department of Urology Surgery, Beijing Children’s Hospital Affiliated to Capital Medical University Baoding Hospital, Hebei, China, from August 2019 to July 2021.

METHODOLOGY: Children with hypospadias who received elective surgery were randomly divided into two groups of forty cases each. The control group received traditional specialised nursing care during the perioperative period, the study group administered preventive care on the control basis. The postoperative rehabilitation, VAS, anxiety and depression score, postoperative complications, and nursing satisfaction were compared between the two groups.

RESULTS: The time of first bowel movement, extubation, and hospitalisation in the study group were significantly shorter than in the control group, with statistically significant value (p<0.001). After intervention, the SAS and SDS in the study group were significantly lower than those in the control group, and the difference was statistically significant (p<0.05). The incidence of complications in the study group was 7.50%, lower than the 25% of control group (p = 0.034). The postoperative VAS scores of the study group were significantly lower than those of control group at 6 and 24 hours (p<0.05). Besides, nursing satisfaction in the study group was 97.50%, higher than the 82.50% of the control group (p = 0.025).

CONCLUSION: Preventive nursing had a reliable nursing effect on children undergoing hypospadias surgery, which can reduce postoperative complications, alleviate postoperative pain, improve postoperative anxiety and depression, enhance nursing experience, and promote postoperative recovery.

KEY WORDS: Preventive care, Hypospadias in male children, Urethroplasty, Complication, Clinical effect.

PMID:37804022 | DOI:10.29271/jcpsp.2023.10.1153

J Coll Physicians Surg Pak. 2023 Oct;33(10):1141-1147. doi: 10.29271/jcpsp.2023.10.1141.

ABSTRACT

OBJECTIVE: To make a comparative evaluation of induction chemotherapy (ICT) or adjuvant chemotherapy (ACT) added to standard concurrent chemoradiotherapy in patients diagnosed with locally advanced nasopharyngeal cancer (LANPC) (Stage 3-4a patients, except T3N0).

STUDY DESIGN: Observational study. Place and Duration of the Study: Department of Medical Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey, from April 2009 to June 2021.

METHODOLOGY: Clinicopathological features of adult patients diagnosed with LANPC were recorded from the hospital’s patient registry database. Patients without the medical records were excluded. An assessment of the effectiveness of induction or ACT added to standard definitive chemoradiotherapy (CRT) was performed, and the application cycles were evaluated.

RESULTS: Seventy-four patients (71.6% male, mean age 50.8±11.7) with LANPC were included in the study. There is no statistical difference in progression-free survival (PFS) between patients who applied ICT (before CRT) and ACT (after CRT) (p = 0.61). Female patients and patients aged ≤50 years had better PFS as independent factors (HR=3.82, 95% CI 1.14-12.74, p = 0.029; HR: 1.06 95% CI 1.02-1.10, p = 0.002, respectively). Also, patients aged 50 years and younger and female patients had a statistically longer overall survival (OS) (p = 0.045, and p = 0.012, respectively). While there was statistically no significant difference in PFS according to the number of cycles for EBER-positive patients received adjuvant Cisplatin-5FU (CF); 3 cycles compared to 2 showed a statistically higher OS (p = 0.06, and p = 0.022, respectively). Conclusion: LANPC patients were found to have a positive survival if they were young and females. There was a positive impact on survival of intensified adjuvant CF in EBER-positive nonkeratinising, undifferentiated LANPC patients.

KEY WORDS: Locally advanced nasopharyngeal cancer, EBER, Induction chemotherapy, Adjuvant chemotherapy.

PMID:37804020 | DOI:10.29271/jcpsp.2023.10.1141

J Coll Physicians Surg Pak. 2023 Oct;33(10):1136-1140. doi: 10.29271/jcpsp.2023.10.1136.

ABSTRACT

OBJECTIVE: To determine the performance of lactate clearance to predict prognosis in patients with upper gastrointestinal bleeding (UGIB).

STUDY DESIGN: Observational study. Place and Duration of the Study: Department of Emergency Medicine, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey, from January 2018 to 2022.

METHODOLOGY: This study was conducted with 141 patients with UGIB. Lactate clearance was calculated based on the lactate levels at the time of admission and 6th hour. The primary outcome was survival. The secondary outcomes were the need for intensive care unit, endoscopic intervention, blood transfusion, and length of hospital stay.

RESULTS: The median age of the patients was 71 years and 65.2% were males. In the non-survivor group; systolic blood pressure, diastolic blood pressure, base deficit, delta lactate, and lactate clearance were significantly lower; however, heart rate, baseline lactate and final lactate were significantly higher. The median lactate clearance of survivors and non-survivors were 23.61 and -0.51, respectively (p = 0.002). A unit decrease in lactate clearance increased mortality 1.011-fold. The performance of lactate clearance in predicting mortality was followed as; sensitivity 76.4, specificity 51.4 (AUC = 0.673, p = 0.002), and the cut-off value was 21.51. Lactate clearance was not statistically significant in determining the need for intensive care (p = 0.110), endoscopic intervention (p = 0.152) and blood transfusion (p = 0.266) in UGIB.

CONCLUSION: Lactate clearance was an independent predictor of in-hospital mortality in UGIB. It is thought that the study will guide clinicians in the differentiation of critically-ill patients and an effective treatment planning.

KEY WORDS: Upper gastrointestinal haemorrhage, Lactate, Lactate clearance, Mortality, endoscopy, Blood transfusion, Intensive care.

PMID:37804019 | DOI:10.29271/jcpsp.2023.10.1136

J Coll Physicians Surg Pak. 2023 Oct;33(10):1130-1135. doi: 10.29271/jcpsp.2023.10.1130.

ABSTRACT

OBJECTIVE: To determine the clinical efficacy of ultrasonic irrigation combined with epoxy resin-based sealer in single visit root canal treatment of chronic pulpitis.

STUDY DESIGN: Randomised controlled trial. Place and Duration of the Study: Department of Stomatology, Hefei BOE Hospital, Hefei, China, from March 2019 to December 2021.

METHODOLOGY: Ninety patients with chronic pulpitis, comprising 104 affected teeth, were enrolled. Using a random number table, they were divided into Group A (n = 30, 35 teeth), Group B (n = 30, 35 teeth), and the control group (n = 30, 34 teeth). All underwent single visit root canal treatment. Group A received ultrasonic irrigation followed by sealing with epoxy resin-based paste; Group B had conventional syringe irrigation followed by the same sealing; the control group had syringe irrigation and closure with zinc oxide-eugenol paste. Pain during treatment, posttreatment clinical outcomes, and differences in inflammatory markers (IL-4, IL-6, hs-CRP), and quality of life (QOL) scores pre- and posttreatment over two months were observed.

RESULTS: After the treatment, improvement rates for Groups A, B, and the control group were 91.4%, 65.7%, and 61.7%, respectively. Pain occurrence rates were 6.7%, 30.0%, and 36.7%, respectively. Group A outperformed both Group B and the control group in improvement and pain incidence with statistical significance (p<0.016). Posttreatment, Group A had lower IL-4, IL-6, hs-CRP levels than Groups B and the control group (p<0.05), and had higher scores for sleep, mood, and appetite (p<0.05).

CONCLUSION: Ultrasonic irrigation combined with epoxy resin-based paste yields better results for chronic pulpitis treatment, reducing postoperative pain, mitigating inflammation levels, and enhancing quality of life.

KEY WORDS: Chronic pulpitis, Ultrasonic irrigation, Epoxy resin paste, Root canal treatment, Therapeutic effect.

PMID:37804018 | DOI:10.29271/jcpsp.2023.10.1130

J Coll Physicians Surg Pak. 2023 Oct;33(10):1124-1129. doi: 10.29271/jcpsp.2023.10.1124.

ABSTRACT

OBJECTIVE: To find the frequency of hearing loss in newly diagnosed patients with fibromyalgia (FM), and the factors affecting it.

STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of Physical Medicine and Rehabilitation and Department of Otorhinolaryngology Head and Neck Surgery, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Turkey, from March 2021 to November 2022.

METHODOLOGY: Patients with FM and gender/age matched controls were compared with pure-tone audiometric (PTA), and transient evoked otoacoustic emissions (TEOE) tests after standardised otorhinolaryngologic assessment The subjects were questioned for NSAID uptake and scored with ASAS-NSAID score.

RESULTS: There were 33 patients with FM and 32 healthy volunteers. Subjective tinnitus, dizziness, and hearing loss rate in the FM group were 12%, 18%, and 15%, respectively. PTA air and bone conduction studies yielded significant differences between the control and FM group (p<0.05). The statistical difference was pronounced in higher frequencies. TEOE tests showed the FM group had significantly lower scores when compared to the control group at 3000 Hz and 4000 Hz (p<0.05). The median ASAS-NSAID scores were 0 for the control group and 7.78 for the FM group (p <0.001).

CONCLUSION: Patients with FM had high rate of audiometric hearing loss of the sensorineural type. The abnormalities were more prominent in the high frequencies but also present in the low frequencies.

KEY WORDS: Fibromyalgia syndrome, Hearing loss, Audiometry, Ototoxicity, Central sensitisation.

PMID:37804017 | DOI:10.29271/jcpsp.2023.10.1124

J Coll Physicians Surg Pak. 2023 Oct;33(10):1100-1105. doi: 10.29271/jcpsp.2023.10.1100.

ABSTRACT

OBJECTIVE: To investigate the predictive value of the carotid plaque contrast-enhanced ultrasound (CEUS) score and blood homocysteine (HCY) in senile metabolic syndrome (MetS) complicated by cerebral infarction.

STUDY DESIGN: Observational study. Place and Duration of the Study: Department of Ultrasound Imaging, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, China, from July 2020 to December 2021.

METHODOLOGY: A total of 118 senile MetS patients complicated by cerebral infarction were selected as Group A, and 103 senile MetS patients without cerebral infarction were selected as Group B. Both groups were compared in terms of cardiovascular risk factors and ultrasonic examination of carotid plaques. The independent risk factors for cerebral infarction among senile MetS patients were analysed using logistic regression. An ROC curve was used to assess the predictive value of statistically significant risk factors in senile MetS complicated by cerebral infarction.

RESULTS: Significant differences were observed in smoking, abdominal circumference, blood pressure, HCY, fasting blood glucose, high-density and low-density lipoprotein cholesterol, triacylglycerol, carotid plaque thickness, CEUS score, lumen stenosis, and ulcer plaque between the two groups. Logistic regression analysis showed that the plaque CEUS score and HCY were independent risk factors for senile MetS complicated by cerebral infarction. The areas under the ROC curve for the CEUS score and HCY were 0.795 and 0.812, respectively, and was 0.858 for the combined diagnosis of both. When the CEUS score was ≥2 and HCY was ≥16.45 mmol/l, the sensitivity and specificity of predicted senile MetS complicated by cerebral infarction were 83.1% and 74.8%, respectively.

CONCLUSION: The carotid plaque CEUS score and blood HCY exhibit a substantial predictive capacity for cerebral infarction in elderly MetS patients. The combined diagnostic efficacy of the two is superior.

KEY WORDS: Contrast-enhanced ultrasound, Homocysteine, Elderly, Metabolic syndrome, Cerebral infarction, Carotid plaque.

PMID:37804013 | DOI:10.29271/jcpsp.2023.10.1100