bluuebunny/crossref_metadata_2025 huggingface dataset:
Hirayama disease: the importance of flexion imaging
Authors: Kusel Kieran , Warne Richard , Lakshmanan Rahul , Mason Michael , Bynevelt Michael , Shah Snehal
Published: September 2021

Hirayama disease is a rare cervical myelopathy characterised by asymmetrical upper limb weakness and muscle atrophy in the forearm and hand. MRI of the cervical spine plays an essential role in diagnosis, however, the characteristic findings are often only seen when the patient is imaged with the neck in flexion.

We present a case of a 15-year-old male who presented with left forearm and hand weakness with muscle wasting. An MRI of the cervical spine with the neck in a neutral position demonstrated atrophy of the spinal cord with intrinsic signal abnormality between C5 and C7. Further imaging with the patient’s neck in flexion demonstrated the hallmark features of Hirayama disease. There was anterior displacement of the thecal sac and spinal cord, and an enlarged, crescent-shaped dorsal epidural space which enhanced following i.v. gadolinium administration. The atrophic segment of cord contacted the posterior vertebral bodies when the neck was in full flexion. This case highlights the importance of imaging patients suspected of having this entity with the neck in full flexion in order to make a diagnosis.
Radiological spectrum of invasive mucormycosis in COVID-19
Authors: Passi Nandini , Wadhwa Anshu C , Naik Swati
Published: September 2021

Mucormycosis, commonly known as the “black fungus” is recently emerging as a deadly complication in COVID patients in the Indian subcontinent. A growing number of cases are being reported from all over the country, with a majority of the patients either undergoing treatment or having recovered from COVID.

Here, we report three cases of multisystem mucormycosis in COVID positive patients showing, rhino-orbital, cerebral, pulmonary, and genitourinary involvement. The first is a case of a 41-year-old male patient who during his treatment developed left periorbital swelling with ecchymosis and headache. CT and CE-MRI of the paranasal sinuses and brain revealed features of pan fungal sinusitis and subsequent invasion into the left orbit. The second case is of a 52-year-old male patient who after complaining of a severe left-sided hemicranial headache was diagnosed with cavernous sinus thrombosis. The third is of a 57-year-old male patient who presented with left flank pain and dysuria. HRCT (High-resolution CT) chest revealed a thick-walled cavitary lesion, and NCCT KUB (Non-contrast CT of Kidneys, ureters, and bladder) revealed left-sided pyelonephritis. A cystoscopic and microbiological evaluation revealed fungal growth.

In all three patients, a biopsy from the involved area revealed broad aseptate filamentous fungal hyphae suggestive of mucormycosis, which was confirmed on culture.

These are all unusual cases and physicians should be aware of the possibility of secondary invasive fungal infections in patients with COVID-19 infection.
Role of imaging and endovascular radiology in endoscopically missed Dieulafoy’s lesion of stomach – A case report with review
Authors: Dadhania Divyesh , Valakkada Jineesh , Ayyappan Anoop , Kannath Santhosh
Published: September 2021

Dieulafoy’s lesion is an uncommon cause of life-threatening gastrointestinal bleed from a dilated and tortuous submucosal artery. With the advent of endoscopy-guided intervention, the mortality of the condition has reduced significantly from 80 to 8%. Imaging plays a vital role in diagnosing them in endoscopically negative cases. Endovascular management can also be offered for unidentified lesions or failed endoscopic treatment. We report a middle-aged male with acute hematemesis where endoscopy was unable to reveal the source of the bleed. Contrast CT detected the lesion, which was embolised by endovascular route. The clinical details, imaging appearance and treatment of this uncommon lesion is presented.
COVID-19 pneumonia detected by [18F]FDG PET/MRI: a case with negative antigen test and chest X-ray results
Authors: Tsujikawa Tetsuya , Anzai Masaki , Umeda Yukihiro , Tsuyoshi Hideaki , Kosaka Nobuyuki , Kimura Hirohiko , Okazawa Hidehiko
Published: September 2021

Since the outbreak of pneumonia caused by a novel coronavirus (SARS-CoV-2) named Coronavirus disease 2019 (COVID-19) in China, researchers have reported the fluorodeoxyglucose positron emission tomography/CT (FDG PET/CT) manifestations of COVID-19 infection. We present a 37-year-old female with early-stage cervical cancer and fever without a focus who had negative SARS-CoV-2 antigen test and chest X-ray results. FDG PET/MRI performed for preoperative evaluation incidentally detected pneumonia showing high FDG uptake and diffusion-weighted imaging signals in right lung base. She retested positive for SARS-CoV-2 and was diagnosed as having COVID-19 pneumonia. Whole-body PET/MRI can provide multi functional images and could be useful for evaluating the pathophysiology of COVID-19.
Application of MRI images based on Spatial Fuzzy Clustering Algorithm guided by Neuroendoscopy in the treatment of Tumors in the Saddle Region
Authors: Zhang Peng , Zhang Lingdang , Zhao Rui
Published: September 2021

Objective: The paper applies spatial fuzzy clustering algorithm to explore the role and value of neuroendoscopic assisted technology in the operation of tumors in the saddle region, and analyze the MRI image characteristics of tumors in the saddle region.

Methods: The clinical data of 63 patients from our hospital who underwent neuroendoscopic assisted microscopy to remove tumors in the saddle area from 2017 to 2019 (neuroendoscopy-assisted group) were collected. Seventy six patients who occupied the saddle area by microscopic resection only in the same period (Simple microscope group) clinical data. By comparing the patient’s tumor resection rate, postoperative complication rate and postoperative recurrence rate, the surgical effect was evaluated.

Results: The total resection rates of the tumors in the neuroendoscopy-assisted group and the microscope-only group were 95.24% (60/63) and 80.26% (61/76). The incidence of postoperative vasospasm was 3.17% (2/63) and 13.16% (10/76), the incidence of nerve injury was 0 (0/63) and 6.58% (5/76), the difference was statistically significant (P <0.05). There was no significant difference in the incidence of postoperative infection, cerebrospinal fluid leakage and postoperative recurrence rate between the two groups (P> 0.05).

Conclusion: Neuroendoscopy-assisted microscopy-based removal of the saddle area occupying space based on spatial fuzzy clustering algorithm can increase the total tumor resection rate and reduce the incidence of complications.

doi: https://doi.org/10.12669/pjms.37.6-WIT.4850

How to cite this:Zhang P, Zhang L, Zhao R. Application of MRI images based on Spatial Fuzzy Clustering Algorithm guided by Neuroendoscopy in the treatment of Tumors in the Saddle Region. Pak J Med Sci. 2021;37(6):1600-1604.  doi: https://doi.org/10.12669/pjms.37.6-WIT.4850

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Value of spiral CT multi-parameter combined preoperative evaluation of microvascular invasion in small liver cancer
Authors: Li Kun , Peng Yongjun , Tian Hongzhe , He Hailin
Published: September 2021

Objective: To explore the value of multi-slice spiral CT (MSCT) in predicting microvascular invasion in hepatocellular carcinoma (HCC).

Methods: The CT and clinical data of 102 patients with HCC were collected for retrospective analysis from January 2018 to December 2020 at Baoji Center Hospital, China. They were divided into two groups based on the pathological results with or without microvascular invasion. The independent sample t-test was used to compare the age, alpha-fetoprotein (AFP) value, tumor size, and tumor enhancement of the two groups. CT value; χ2 test was used to compare gender, hepatitis type, liver function classification, degree of classification, degree of tumor smoothness, envelope, peripheral enhancement, etc. between the two groups.

Results: There were 52 cases of non-microvascular invasion and 50 cases of microvascular invasion. The tumor size, grade, degree of margin, capsule, portal vein CT value, and peripheral enhancement were related to microvascular invasion.

Conclusion: Microvascular invasion of HCC can be predicted by MSCT manifestations before surgery.

doi: https://doi.org/10.12669/pjms.37.6-WIT.4851

How to cite this:Li K, Peng Y, Tian H, He H. Value of spiral CT multi-parameter combined preoperative evaluation of microvascular invasion in small liver cancer. Pak J Med Sci. 2021;37(6):1605-1609. doi: https://doi.org/10.12669/pjms.37.6-WIT.4851

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Application of ultrasound molecular imaging based on compressed sensing reconstruction algorithm to phase change drug-loaded PLGA nanoparticles targeting breast cancer MCF-7 Cells
Authors: You Yufeng , Cheng Wusong , Chen Hongbo
Published: September 2021

Objectives: To study the ability of aptamer-modified nano-gold rods and liquid carbon-targeted PLGA nanoparticles to target in vitro using compressed sensing reconstruction algorithm, and observe the phenomenon of mediating ultrasound / photoacoustic imaging.

Methods: PLGA nanoparticles were prepared by a double emulsification method, and the MUC1 aptamer was connected to the PLGA nanoparticles by the carbodiimide method to obtain an “aptamer-PLGA nanoparticle” targeted phase change contrast agent. Fluorescence microscopy was used to detect the in vitro targeting of breast cancer MCF-7 cells specifically identified by it, and three control groups were set up: the ordinary nanoparticle group, the aptamer interference group, and the HELA cell group. A photoacoustic instrument was used to observe the phenomenon of enhanced ultrasound / photoacoustic signal mediated in vitro.

Results: Many targeted nanoparticles were clustered around MCF-7 cells and bound firmly, but no specific binding was observed in the non-targeted nanoparticles group, the aptamer interference group and the HELA cell group. After the targeted nanoparticle was excited by the photoacoustic instrument, the ultrasonic signal and the photoacoustic signal were significantly enhanced compared with before the excitation.

Conclusion: The successfully prepared targeting nanoparticles have good targeting and specificity for breast cancer MCF-7 cells, and it has obvious effects on ultrasound / photoacoustic imaging, and has the potential to become a dual-mode ultrasound / photoacoustic targeted contrast agent. The various characteristics provide experimental basis for subsequent in vivo targeting experiments and are expected to become good target diagnostic molecular probes.

doi: https://doi.org/10.12669/pjms.37.6-WIT.4852

How to cite this:You Y, Cheng W, Chen H. Application of ultrasound molecular imaging based on compressed sensing reconstruction algorithm to phase change drug-loaded PLGA nanoparticles targeting breast cancer MCF-7 Cells. Pak J Med Sci. 2021;37(6):1610-1614.  doi: https://doi.org/10.12669/pjms.37.6-WIT.4852

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Application of CT images based on the optimal atlas segmentation algorithm in the clinical diagnosis of Mycoplasma Pneumoniae Pneumonia in Children
Authors: Fu Xilin , Yang Ningfei , Ji Jianwei
Published: September 2021

Objective: Use of optimal Atlas segmentation algorithm to study the imaging signs of mycoplasma pneumonia with multi-slice spiral CT (HRCT), and to explore the value of HRCT in the diagnosis and efficacy in evaluation of mycoplasma pneumonia in children.

Methods: The study retrospectively analyzed 72 patients diagnosed with mycoplasma pneumonia in our hospital from January 2017 to January 2019. The imaging data and clinical data of 72 patients were collected. The optimal Atlas segmentation algorithm was used to analyze the characteristics of CT examination, and the value of CT in the diagnosis of mycoplasma pneumonia and the evaluation of curative effect was summarized.

Results: Among all patients, 37 cases were unilateral lesions, 35 cases were bilateral lesions, 19 cases were in the left upper lobe, 24 cases were in the left lower lobe, 21 cases were in the right upper lobe, 13 cases were in the right middle lobe, 25 The lesion was located in the right lower lobe. The main CT findings of the lesions before treatment were large patchy, spot-shaped shadows, and strip-shaped or ground-glass shadows. After treatment, the main CT findings of the lesions were reduced lesion density and reduced lesion range.

Conclusion: CT can clearly show the pulmonary lesions of mycoplasma pneumonia, and its unique imaging signs can improve the clinical diagnosis accuracy. In addition, CT scans can evaluate the treatment effect according to the changes in the characteristics of the lesion, which has important value for the evaluation of the effect for clinical diagnosis and efficacy evaluation of mycoplasma pneumonia.

doi: https://doi.org/10.12669/pjms.37.6-WIT.4860

How to cite this:Fu X, Yang N, Ji J. Application of CT images based on the optimal atlas segmentation algorithm in the clinical diagnosis of Mycoplasma Pneumoniae Pneumonia in Children. Pak J Med Sci. 2021;37(6):1647-1651. doi: https://doi.org/10.12669/pjms.37.6-WIT.4860

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Efficacy of liver cancer microwave ablation through ultrasonic image guidance under deep migration feature algorithm
Authors: Ye Changkong , Zhang Wenyan , Pang Zijuan , Wang Wei
Published: September 2021

Objective: To explore the therapeutic effects of ultrasound-guided microwave ablation and radio frequency ablation for liver cancer patients.

Methods: Seventy-eight patients with microwave ablation were rolled into the experimental group and 56 patients with radio frequency ablation were in the control group. This study was conducted from March 1, 2019 to June 30, 2020 in our hospital. Based on Convolutional Neural Networks (CNN) and Migration feature (MF), a new ultrasound image diagnosis algorithm CNNMF was constructed, which was compared with AdaBoost and PCA-BP based on Principal component analysis (PCA) and back propagation (BP), and the accuracy (Acc), specificity (Spe), sensitivity (Sen), and F1 values of the three algorithms were calculated. Then, the CNNMF algorithm was applied to the ultrasonic image diagnosis of the two patients, and the postoperative ablation points, complications and ablation time were recorded.

Results: The Acc (96.31%), Spe (89.07%), Sen (91.26%), and F1 value (0.79%) of the CNNMF algorithm were obviously larger than the AdaBoost and the PCA-BP algorithms (P<0.05); in contrast with the control group. The number of ablation points in the experimental group was obviously larger, and the ablation time was obviously shorter (P<0.05); the experimental group had one case of liver abscess and two cases of wound pain after surgery, which were both obviously less than the control group (four cases; five cases) (P<0.05)

Conclusion: In contrast with traditional algorithms, the CNNMF algorithm has better diagnostic performance for liver cancer ultrasound images. In contrast with radio frequency ablation, microwave ablation has better ablation effects for liver cancer tumors, and can reduce the incidence of postoperative complications in patients, which is safe and feasible.

doi: https://doi.org/10.12669/pjms.37.6-WIT.4885

How to cite this:Riaz A, Sughra U, Jawaid SA, Masood J. Measurement of Service Quality Gaps in Dental Services using SERVQUAL in Public Hospitals of Rawalpindi. Pak J Med Sci. 2021;37(6):1693-1698. doi: https://doi.org/10.12669/pjms.37.6-WIT.4885

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Strengthening bonds of Friendship between Pakistan and China through scientific publishing
Authors: Jawaid Shaukat Ali
Published: September 2021

doi: https://doi.org/10.12669/pjms.37.6-WIT.5037

How to cite this:Jawaid SA. Strengthening bonds of Friendship between Pakistan and China through scientific publishing. Pak J Med Sci. 2021;37(6):1547-1549. doi: https://doi.org/10.12669/pjms.37.6-WIT.5037

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Frequency of Renal Dysfunction and its effects on outcomes after open heart surgery
Authors: Ali Taimur Asif , Tariq Khuzaima , Salim Areej , Fatimi Saulat
Published: September 2021

Objectives: In this study we determined the frequency of renal dysfunction and its outcomes in terms of morbidity and mortality in patients who underwent open heart surgery at the Aga Khan University Hospital, Karachi, Pakistan.

Methods: A total of 175 patients aged between 15-80 years having open heart Surgery(OHS) were included. Preoperative and postoperative serum creatinine (SCr) was noted and the glomerular filtration rate (GFR) calculated by Cockcroft-Gault equation. Their hospital course was charted and followed-up for 30-day.

Results: The mean age and mean BMI were 58.1±12.6 years and 26.4±4.3 kg/m2 respectively. Females were 18.3%, out of which 51.4% hypertensive, 46.9% diabetics, 45.1% had dyslipidemia, 2.9% had preoperative renal dysfunction and 40% had moderate ejection fraction. On follow up, 30.3% developed postoperative renal dysfunction within 30-days after OHS with mean SCr and GFR as 1.6±0.7 and 56.9±24.5, respectively. In RD group more patients showed positive outcomes i.e. prolonged inotropic requirement (75.5% vs. 18%, p-value <0.005), diuretic infusion usage (47.2% vs. 3.3%, p-value <0.005), dialysis/renal replacement therapy (17% vs. 0%, p-value <0.005), requirement for prolonged ventilation (35.8% vs. 6.6%, p-value <0.005), prolonged ICU and hospital stay (15.4% vs. 1.6%, p-value <0.005 and 41.5% vs. 17.2%, p-value <0.005), sepsis (20.8% vs. 1.6%, p-value <0.005) and death (9.4% vs. 2.5%, p-value 0.05).

Conclusion: Timely recognition of renal dysfunction, early renal replacement therapy, diuretics or dialysis and proper nutritional and inotropic support to maintain adequate hemostasis shows survival benefits.

doi: https://doi.org/10.12669/pjms.37.7.3865

How to cite this:Ali TA, Tariq K, Salim A, Fatimi S. Frequency of Renal Dysfunction and its effects on outcomes after open heart surgery. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.3865

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Is diagnosing patients with Organic Acidurias and Aminoacidopathies enough? Conundrums of a low middle-income country
Authors: Majid Hafsa , Jafri Lena , Khan Aysha Habib , Zulfiqarali Zeb , Afroze Bushra
Published: September 2021

Objective: This study was done to determine the factors responsible for non-treatment of inherited metabolic disorders (IMDs) requiring food for special medical purposes (FSMPs) in Pakistan.

Methods: A descriptive cross-sectional study was conducted by Departments of Pediatrics & Child Health and Pathology & Laboratory Medicine, Aga Khan University. Patients diagnosed with IMDs from January 2013 to December 2016 requiring FSMPs were surveyed after a year of initial diagnosis to collect the details of treatment advised, mortality status, and reasons of non-treatment, including not prescribed by physician, non-acceptance by family, non-availability or non-affordability.

Results: Over four years period, 311 patients were identified with IMDs; Median age of patients was 1.0 yrs (0.0.2-3.65) with 54% (n=168) being male. Of the total 38.2% (n=119) required FSMPs, 9% (n=28) patients were excluded due to unavailability of diagnostics information. Parents of 58 patients requiring FSMPs out of 119 participated in survey. The leading causes of non-treatment were, FSMPs not prescribed by physicians (n= 30, 51.7%) followed by non-affordability (n=23, 39.6%), families’ unacceptance in (n=9, 18%) patients, non-availability of FSMPs (n=2, 3.4%) and early death of patient (n=1, 1.7%).

Conclusion: The main factors responsible for non-treatment of FSMPs requiring IMDs were non-prescription by physician and non-affordability.

doi: https://doi.org/10.12669/pjms.37.7.3887

How to cite this:Majid H, Jafri L, Ali ZZ, Afroze B. Is diagnosing patients with Organic Acidurias and Aminoacidopathies enough? Conundrums of a low middle-income country. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.3887

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Development & Validation of Urdu Receptive Language Scale (URLS)
Authors: Butt Ghazal Awais , Mumtaz Nazia , Saqulain Ghulam
Published: September 2021

Objectives: To develop “Urdu Receptive Language Scale (URLS)” for Urdu speaking Pakistani children of age 0-6 years.

Methods: This exploratory study was done at mainstream schools and day care centers on children with normal language development between the ages of 0-6 years from 1st March 2016 to 31st August 2016, by using convenient sampling technique. Firstly, the items for the questionnaire were constructed from four sources: literature review, experts, parents and direct observation of 384 Children of same age. Secondly the constructed test items were sent to the field experts (SLP’s) for the purpose of improvement. Thirdly, after incorporation of suggestions, the improved items were securitized by Urdu experts and finalized. In the next step, these items were tested for Relevance, Ambiguity, Clarity and Simplicity from field experts. The developed scale was then analyzed for reliability and validity by SPSS Version-18.

Results: Study resulted in a 59 items Urdu Receptive Language Scale with each age range having different test items distribution. The mean of the relevance, clarity, simplicity, and ambiguity of test items was 3.89. The Item content validity index value was one for each of the 59 items. The content validity index for the entire scale was also one. The Cronbach’s alpha was 0.948, which indicates a high level of internal consistency.

Conclusion: The developed 59 Item Urdu Receptive Language Scale is reliable and valid tool for language assessment of Urdu speaking Pakistani children of 0-6 years age.

doi: https://doi.org/10.12669/pjms.37.7.3928

How to cite this:Butt GA, Mumtaz N, Saqulain G. Development & Validation of Urdu Receptive Language Scale (URLS). Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.3928

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The effect of short-term intensive insulin therapy in newly-diagnosed Type-2 diabetic patients
Authors: Karacaer Cengiz , Demirci Taner , Cengiz Hasret , Varim Ceyhun , Tamer Ali
Published: September 2021

Objectives: We aimed to determine the effect of short-term intensive insulin therapy (SIIT) on long-term glycemic control in newly-diagnosed Type-2 diabetes mellitus (nT2DM) patients.

Methods: In this retrospectively study conducted at Sakarya University Medical Faculty Training and Research Hospital Outpatient Clinic between 2016 and 2019, 65 nT2DM patients were enrolled soon after their SIIT was initiated and were followed for at least a year. Intensive insulin treatment was discontinued after three or 12 months in a total of 65 (23–73-year-old) patients who had been newly diagnosed with T2DM. Intensive insulin therapy was discontinued when glycemic control and the target Glycated Hemoglobin (HbA1c) level had been attained, after which oral anti-diabetic drug (OAD), long-term insulin, and diet therapies were pursued.

Results: There was a significant decrease in mean HbA1c from 11.25±1.96% to 6.67±1.07%. Fasting plasma glucose (FPG) was found to be an independent predictor of whether intensive insulin therapy could be discontinued after three months in a model that included FPG, HbA1c, and body mass index measured at baseline. Patients with FPG >13.8 mmol/L were 7.6 times more likely to require intensive insulin therapy beyond three months. There were significant decreases in HbA1c and low-density lipoprotein-cholesterol concentration, but no change in C-peptide between baseline and 3 months of therapy.

Conclusion: These results demonstrate that in nT2DM patients, intensive insulin therapy could be effective on long-term glycemic control and high FPG prior to three months of SIIT may predict poor long-term glycemic control.

doi: https://doi.org/10.12669/pjms.37.7.4013

How to cite this:Karacaer C, Demirci T, Cengiz H, Varim C, Tamer A. The effect of short-term intensive insulin therapy in newly-diagnosed Type-2 diabetic patients. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4013

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Comparison of preoperative and postoperative Lipid Profile changes in obese and morbidly obese patients after mini gastric bypass surgery
Authors: GUZEL Kerim , IKIZEK Mustafa
Published: September 2021

Background & Objective: Obesity has become a serious health problem that has become increasingly important in recent years. Since patients with high levels of obesity have dyslipidemia and an unbalanced lipid profile, they have a high risk of both diabetes mellitus and cardiovascular disease. This study aimed to evaluate the short (3 months) and long term (12 months) effects of mini-gastric bypass surgery from the current bariatric surgical techniques on the lipid profile.

Methods: Of the patients undergoing Mini-gastric bypass operation between January 2016 to December 2018 at the General Surgery Clinic of Private Samsun Büyük Anadolu Hospital, demographic data and changes in lipid concentrations at 3 and 12 months were analyzed. Patients were grouped according to age, sex, body mass index (BMI), cardiologic risk groups, bypass lengths, and obesity classes. Total cholesterol, triglyceride, LDL-cholesterol, and HDL cholesterol values of the patients were examined at the time of admission to the outpatient clinic before the operation, at the postoperative third month and at the post-operative twelfth-month. Patients who did not go for a checkup during the one-year follow-up and whose data could not be reached or missing were excluded from the study.

Results: There was no significant difference in terms of age, sex, and cardiovascular risk (p>0.05). Although the HDL-C level was initially low (p<0.001), it significantly increased 12 months after surgical treatment (p<0.001). While serum concentrations of LDL cholesterol, total cholesterol, and triglycerides were high preoperatively, they significantly decreased at 12 months postoperatively (p<0.001). When compared with values in the 3rd- and 12th-month, there was a significant decrease in the class-3 obesity group but not in the class-2 obesity group. When serum HDL cholesterol concentrations were compared with preoperative baseline and postoperative 12th-month those, no statistically-significant difference was found in serum concentrations in the 3rd month, although there was a significant increase in both class 2 and 3 obesity groups.

Conclusion: In patients undergoing mini-gastric bypass surgery, serum LDL cholesterol, total cholesterol, and triglyceride concentrations decreased in the 12th postoperative month, but serum HDL cholesterol concentrations increased.

doi: https://doi.org/10.12669/pjms.37.7.4123

How to cite this:Guzel K, Ikizek M. Comparison of preoperative and postoperative Lipid Profile changes in obese and morbidly obese patients after mini gastric bypass surgery. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4123

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The Impact of implementing multisource feedback on behaviors of young doctors
Authors: Ahmad Nasir , Sethi Ahsan , Khan Rehan Ahmed
Published: September 2021

Objectives: Multisource feedback (MSF) is a workplace-based assessment tool that offers 360-degree evaluation of the trainee doctor. Little is known about its receptiveness among stakeholders in Pakistan. This study explores house officers’ perceptions regarding MSF since its implementation in Eye Unit-II, Institute of Ophthalmology, King Edward Medical University/ Mayo Hospital, Lahore.

Methods: A qualitative case study was conducted from July 2019 to February 2020 in Eye Unit II. A purposive (maximum variation) sample of 12 house surgeons was taken. Two focus group discussions were conducted. Data were transcribed and analyzed thematically.

Results: The study identified the impact of MSF on house surgeons. Most participants reported positive experiences. The feedback they received increased their motivation, management skills and team working. A number of factors affecting the receptiveness of MSF were also identified which mainly included characteristics of raters and emotional response to MSF.

Conclusion: Multisource Feedback is a useful tool for feedback that impacts the young doctors in many ways. It contributes to increasing their sense of responsibility, management skills and self-directed learning. The improvement in individual abilities and teamwork also helped in improving patient care.

doi: https://doi.org/10.12669/pjms.37.7.4155

How to cite this:Ahmad CN, Sethi A, Khan RA. Impact of implementing multisource feedback on behaviors of young doctors. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4155

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Comparison of intra operative hemorrhage by blunt and sharp expansion of uterine incision at cesarean section
Authors: Faiza Faiza , Sadaf Farhadia , Ameena Behzar , Khan Nadia Rashid
Published: September 2021

Objectives: To compare the effect of blunt and sharp incision of uterus at cesarean section on intra-operative haemorrhage.

Methods: This trial was conducted at the Department of Obstetrics and Gynaecology, Pakistan Ordinance Factory Hospital, Wah Cantt from 14th January to 13th July 2012. Total 80 women planned for lower segment cesarean section through Pfannensteil incision were randomized to either blunt uterine incision (Group-A, n=40) or sharp uterine incision (Group-B, n=40). The fall in Haemoglobin and HCT was compared in two groups and analyzed with help of SPSS version 10.

Results: Both groups were similar in terms of demographic features like age, parity, gestational age and indication for cesarean section. The participants in Group-A reveled significantly less drop of mean Hb concentration as compared to Group-B (1.47±1.08 and 1.95±0.85 respectively, P value 0.031). Similarly, the fall in mean HCT was significantly less in Group-A in comparison to Group-B (3.21±1.3 and 4.21±2.17 respectively, P-value 0.015)

Conclusion: Blunt expansion of uterine incision during caesarean section is associated with less fall in Haemoglobin and HCT as compared to sharp expansion.

doi: https://doi.org/10.12669/pjms.37.7.4159

How to cite this:Faiza, Sadaf F, Ameena B, Khan NR. Comparison of intra operative hemorrhage by blunt and sharp expansion of uterine incision at cesarean section. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4159

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Single Median Raphe Scrotal incision Orchiopexy: A safe & feasible approach for fixation of Palpable Undescended testes
Authors: Jan Iftikhar Ahmad , Hassan Mokhtar , Shalaan Ikram , Alshehhi Muna Ahmed
Published: September 2021

Background: We wish to share our outcome of single median raphe scrotal incision orchiopexy (SMRSO) regarding safety & feasibility of technique by evaluating ease of access, conversion rate, duration of surgery, success rate, complications, and the need for redo-surgery.

Methods: We retrospectively analyzed data of 277 orchiopexies performed in our department on 224 patients operated on between June 2016 to June 2019. SMRSO was considered for palpable testes that can be brought to the upper limit of the scrotum under anesthesia. The conventional inguinoscrotal approach was used for high lying testes. A median raphe incision was made to access & mobilize the testis on either side, ligation of processus vaginalis performed, and the testes secured in the scrotal pouch. The approach was utilized for both unilateral and bilateral orchiopexies. Follow-up done at one week, one month & six months to evaluate the outcome.

Results: A total of 277 orchiopexies were performed in 224 patients. 237 (86%) orchiopexies were via the median raphe scrotal approach in 184 patients. Out of these, 53 cases had bilateral orchiopexies. 30 (11%) performed via a conventional inguinoscrotal approach and 10 (4%) by laparoscopic approach. The mean duration of surgery for SMRSO was 24 minutes for unilateral and 42 minutes for bilateral cases. Immediate postoperative complications included scrotal hematoma in three (1.6%) cases, Hematoma of the abdominal wall in one case, and scrotal edema in 4 (2%) patients. All complications were treated conservatively & resolved. No wound infection or testicular atrophy was reported. Long-term complications included testicular ascend in three cases [1.6%].

Conclusion: Single-incision Median Raphe Scrotal orchiopexy is an attractive alternative to the standard inguinoscrotal orchiopexy for palpable low lying undescended testes with a better cosmetic outcome.

doi: https://doi.org/10.12669/pjms.37.7.4261

How to cite this:Jan IA, Hassan M, Shalaan I, Alshehhi MA. Single Median Raphe Scrotal incision Orchiopexy: A safe & feasible approach for fixation of Palpable Undescended testes. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4261

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Perceived effectiveness of learning methods among preclinical medical students - role of personality and changes over time
Authors: Ali Arain Shoukat , Alhadid Daeya Ahmad , Rasheed Shahzad , Alrefaai Maram Mansour , Alsibai Tarek M. Ahyaf , Meo Sultan Ayoub
Published: September 2021

Background and Objectives: Active learning methods are vital in inculcating skills of critical thinking, lifelong learning and effective communication. Personality may influence learning method preferences and academic performance. The aim of this cross sectional study was to examine the relationship between students’ personality and their predilection for learning methods and academic performance.

Methods: Perceived effectiveness of learning methods was assessed over time. Second- and third-year medical students (n=112) completed a questionnaire consisting of Big Five Inventory to measure the personality dimensions, and evaluated lecture, problem-based learning (PBL) and team-based learning (TBL) for their helpfulness in learning. Grade point average (GPA), PBL and TBL grades were obtained. Correlation coefficients were calculated between personality traits and learning method effectiveness scores, and grades. Learning methods effectiveness was compared between second- and third-year students.

Results: Positive correlations were identified between conscientiousness and lecture (r = 0.30), agreeableness and lecture (r = 0.20), and agreeableness and TBL (r = 0.23). Likewise, positive correlations were seen between extraversion and PBL grade (r=0.20), and conscientiousness and GPA (r = 0.23). In third year, significant decline in perceived effectiveness of lecture was seen (81% vs 57%; p = 0.006), while increased perceived effectiveness for PBL (38% vs. 50%) was not statistically significant (p = 0.22).

Conclusions: The findings provide an evidence for modest correlations between personality and perceived effectiveness of learning methods. Remarkably, perceived effectiveness decreased for the lecture and increased for the PBL over time. The findings may help educators in better implementing active learning modalities. Besides, an earlier introduction may help students becoming acquainted with and getting the most out of PBL.

doi: https://doi.org/10.12669/pjms.37.7.4355

How to cite this:Arain SA, Alhadid DA, Rasheed S, Alrefaai MM, Alsibai TMA, Meo SA. Perceived effectiveness of learning methods among preclinical medical students - role of personality and changes over time. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4355

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Prevalence of Fibromyalgia in chronic kidney disease pre-dialysis patients: Experience from a Tertiary Care Renal unit in Pakistan
Authors: Khan Zara , Naqvi Rubina
Published: September 2021

Background and Objective: Fibromyalgia syndrome (FMS) is a well-established medical problem which gives rise pain at various sites, fatigue, sleep disturbances, poor memory and definitely affects quality of life. Its prevalence in chronic kidney disease (CKD) is scarcely reported, thus we aimed to assess this condition and report its prevalence in our population.

Methods: The current study was carried out in all adult CKD stage III and IV patients registered from January 2020 to July 2020 at outpatient department of a tertiary care renal institution in Karachi, Pakistan. This is a cross sectional study where prevalence of FMS was assessed by interviewing and examining patients according to established criteria for FMS. All data and laboratory parameters were recorded on a proforma and statistical analysis was done on SPSS version22.0.

Results: During the study period of six months, 161 patients with CKD stage III and IV were registered. Among these 81 male and 80 were females. Mean age was 47.12±9.27 (range 21-60) years. There were 22 (13.66%) patients found to have FMS. Mean Widespread Pain Index (WPI) score was 5.68±4.36 (range 1-16), while severity scale (SS) 2a was 3.17±1.78 (range 1-9) and SS2b 2.04±0.96 (range 1-5) was recorded.

Conclusion: From Pakistan prevalence of FMS has never been published. As this syndrome affects quality of life of patients, its recognition and proper management is immensely required.

doi: https://doi.org/10.12669/pjms.37.7.4474

How to cite this:Khan Z, Naqvi R. Prevalence of Fibromyalgia in chronic kidney disease pre-dialysis patients: Experience from a Tertiary Care Renal unit in Pakistan. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4474

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Neutrophils to lymphocytes ratio between benign and malignant thyroid nodule
Authors: Haider Nazia , Mahmood Zahid , Khalid Fizzah , Razzak Saad Abdul
Published: September 2021

Objectives: To determine the relationship of Neutrophils to lymphocytes ratio (NLR) values with the benign and malignant thyroid nodules.

Methods: In this cross-sectional clinical study conducted from September 1st 2020 to February 28th 2021, we included 216 patients who underwent thyroidectomy at Jinnah Postgraduate Medical Centre Karachi Pakistan. After thyroidectomy specimens were sent for pathologic examination. Patients were divided into two categories based on histopathologic results; Malignant nodule and benign nodules. Data of complete blood count was obtained from the pre-operative lab investigations and NLR was calculated.

Results: There were 42 (26%) men, and 116 (74%) women of 158 in the BTN group, 18 (31%) men, and 40 (69%) women of 58 in the MTN group. The mean age of 48±6 years in the BTN group as well as 47 ±8 years in the MTN group (p-value 0.32). The mean neutrophil count in the BTN group was 4.26±2.8 versus 4.41±2.2 (x 1000/mm3) the malignance thyroid group (p-value = 0.71). The mean lymphocyte count was 3.81±0.9 (x 1000/mm3) in the BTN group and 3.61±1.2 (x 1000/mm3) in the malignance group (p-value = 0.18). The mean NLR value for the benign thyroid nodular group was 1.19±2.2 and 1.22±1.8 in the malignant thyroid nodular group (p-value = 0.92).

Conclusion: According to the results of this study, we concluded that preoperative period biochemistry laboratory results such as neutrophils count, lymphocyte count, and NLR value don’t provide enough evidence to differentiate between benign and malignant thyroid carcinoma.

doi: https://doi.org/10.12669/pjms.37.7.4503

How to cite this:Haider N, Mahmood Z, Khalid F, Razzak SA. Neutrophils to lymphocytes ratio between benign and malignant thyroid nodule. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4503

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The Standard of Scientific Pedagogical Expertise: a Creative Dimension
Authors: Bychkov Anatoliy
Published: September 2021

Pedagogical expertise is considered as a system-forming scientific technology in education, which has a significant impact on the practice of teaching and the formation of a creative personality, actually becoming a method of scientific cognition in the context of improving the quality of education. It is advisable to design all programs of higher pedagogical education according to the deductive principle-from the general content component presented in the structure of technologies of pedagogical expertise of educational projects and programs, to private methodological practice-oriented recommendations proposed by experts as an indicative basis for teacher actions.

The role of an expert and his personal qualities are of particular importance in the composition of pedagogical expertise. Based on the professional analysis of the expert's activity, his personal portrait is formed. In pedagogical expertise, the ratio of the objective (various normative documents regulating the activities of an expert) and the subjective is crucial, when the quality of the examination depends on the competence, experience of an expert specialist, his wisdom, intuition and creative insight. The analytical review of the mistakes of pedagogical experts should be used as the basis of the methodology for training teachers and expert specialists in the field of education.
Relação entre gatekeeping materno e personalidade paterna em famílias com pré-escolares
Authors: Paraventi Larissa , Kolttermann João Paulo , Souza Carolina Duarte de , Vieira Mauro Luís
Published: September 2021

O Gatekeeping materno é um fator importante para avaliar a proximidade e qualidade da relação do pai com os filhos. Este consiste em crenças e comportamentos maternos que podem facilitar ou dificultar o envolvimento paterno com a criança. Dentre vários fatores que afetam esses comportamentos maternos encontra-se a personalidade do pai. Como poucos estudos investigaram a relação entre estas variáveis, esta pesquisa objetivou comparar as percepções de pais e mães do gatekeeping materno e investigar os efeitos da percepção paterna de sua personalidade nas percepções materna e paterna do gatekeeping da mãe em famílias com crianças de quatro a seis anos. Participaram 171 casais do Sul do Brasil que responderam ao Questionário de Gatekeeping Materno e Inventário dos Cinco Grandes Fatores de Personalidade. Os resultados apontaram níveis moderados de gatekeeping materno, e elevados níveis de conscienciosidade e amabilidade paterna. As análises comparativas indicaram que pais perceberam maiores níveis de confirmação da identidade materna em comparação às próprias mães, e as mães perceberam em maior nível que os pais que tarefas domésticas e cuidados com as crianças fazem parte do papel materno. A regressão linear múltipla indicou que quanto mais neuroticismo, maior foi a percepção paterna do controle materno pelas normas e responsabilidades domésticas; e quanto mais extroversão, menos as mães relataram realizar o controle pelas normas e responsabilidades domésticas. Reforça-se a relação entre características pessoais em interação com construções histórico-sociais de gênero que afetam crenças e comportamentos maternos sobre tarefas domésticas e cuidados infantis, influenciando o envolvimento paterno.