bluuebunny/crossref_metadata_2025 huggingface dataset:
A study of anxiety, depression and stress symptoms among Fayoum medical students during COVID-19 lockdown, Egypt
Authors: Soltan Mohamed R. , Soliman Shaimaa S. , Dawoud Mariam E.
Published: September 2021

Background

The widespread pandemic of COVID-19 virus carries not only physical hazards, but also major psychological effects especially among medical students. The aim was to investigate the psychological effects of COVID-19 on medical students and the factors affecting them. The study was carried out with an online questionnaire distributed through Google Forms for medical students at Faculty of Medicine, Egypt. The questionnaire included socio-demographic questions, validated psychometric tools for the assessment of depression, anxiety and stress (Depression Anxiety Stress Scales DASS-21) and the Impact of Event Stress Scale-Revised (IES-R) were applied.

Results

The total number of participants was 282 students. Percentage of participants with clinically significant depression was 75.2%, anxiety was 56.4% and stress was 52.9%. Those showed PTSD probability was 54.3%. The multivariate regression analysis revealed that IES remained significantly associated with gender and previous road accidents, depression and anxiety remained significantly associated with personal history of psychiatric illness, while stress remained significantly associated with gender and previous road accidents.

Conclusions

Medical students were highly depressed, anxious and stressed during period of COVID-19 pandemic. Being a female, having previous history of psychiatric illness and previous road accident were highly associated with increasing the psychological impact of COVID-19.
Practice-Changing Use of the 21-Gene Test for the Management of Patients With Early-Stage Breast Cancer in Latin America
Authors: Gomez Henry L. , Bargallo-Rocha Juan E. , Billinghurst Roberto J. , Núñez De Pierro Aníbal R. , Coló Federico A. , Gil Lisandro L. B. , Allemand Carola , McLean Ignacio L. , Lema-Medina Mauricio , Herazo-Maya Fernando , Terrier Francisco J. , Cwilich Raquel G. , Leon Mauricio , Falcon Silvia G. , Castaño Roberto E. , Oliveira Sergio C. , Jakubowski Debbie M. , Chao Calvin
Published: September 2021

PURPOSE

We present a physician survey of the impact of 21-gene Breast Recurrence Score test results on treatment decisions in clinical practice in Latin America.

METHODS

This prospective survey enrolled consecutive patients at 14 sites in Argentina, Colombia, Mexico, and Peru who had routine 21-gene testing. Physician surveys captured patient and tumor characteristics and treatment decisions before and after 21-gene test results. The survey spanned the period before and after Trial Assigning Individualized Options for Treatment (TAILORx) results reported (June 2018). Overall net percent change in adjuvant chemotherapy recommendations was estimated, and asymptotic 95% CIs with continuity correction were calculated. The proportion with a change between pretest treatment recommendation and actual treatment received was calculated overall and by Recurrence Score groups per TAILORx.

RESULTS

Between March 2015 and December 2019, the survey was completed for 647 patients; 20% were node-positive. The mean patient age was 54 years (24-85 years); 55% were postmenopausal; 17%, 63%, and 20% had grade 1, 2, and 3 tumors, respectively; and 30% had tumors > 2 cm. Recurrence Score (RS) results were as follows: 20% RS 0-10, 56% RS 11-25, and 24% RS 26-100. Overall, chemotherapy recommendations fell by a relative proportion of 39% (95% CI, 33.4 to 44.3) after 21-gene testing (33% decrease in node-negative and 55% decrease in node-positive). Among node-negative patients, the relative decrease in chemotherapy recommendations was 28% (95% CI, 18.9 to 39.5) before TAILORx and 36% (95% CI, 28.4 to 43.7) after.

CONCLUSION

To our knowledge, this large survey of 21-gene test practice patterns was the first conducted in Latin America and showed the relevance of 21-gene testing in low- and medium-resource countries to minimize chemotherapy overuse and underuse in breast cancer. The results showed substantial reductions in chemotherapy use overall—especially after TAILORx reported—indicating the practice-changing potential of that study.
Late Toxicity After Adjuvant Conventional Radiation Versus Image-Guided Intensity-Modulated Radiotherapy for Cervical Cancer (PARCER): A Randomized Controlled Trial
Authors: Chopra Supriya , Gupta Sudeep , Kannan Sadhana , Dora Tapas , Engineer Reena , Mangaj Akshay , Maheshwari Amita , Shylasree T. Surappa , Ghosh Jaya , Paul Siji N. , Phurailatpam Reena , Charnalia Mayuri , Alone Mitali , Swamidas Jamema , Mahantshetty Umesh , Deodhar Kedar , Kerkar Rajendra , Shrivastava Shyam K.
Published: September 2021

PURPOSE

Postoperative Adjuvant Radiation in Cervical Cancer (PARCER), a phase III randomized trial, compared late toxicity after image-guided intensity-modulated radiotherapy (IG-IMRT) with three-dimensional conformal radiation therapy (3D-CRT) in women with cervical cancer undergoing postoperative radiation.

METHODS

Patients were randomly assigned to receive either IG-IMRT or 3D-CRT after stratification for the type of hysterectomy and use of concurrent chemotherapy. The primary end point was 3-year grade ≥ 2 late GI toxicity assessed using Common Toxicity Criteria for Adverse Events v 3.0 and estimated using time-to-event, intention-to-treat analysis, with a study level type I error of 0.05 and a nominal α of .047 after accounting for one interim analysis. Secondary end points included acute toxicity, health-related quality of life, and pelvic relapse-free, disease-free, and overall survival.

RESULTS

Between 2011 and 2019, 300 patients were randomly assigned (IG-IMRT 151 and 3D-CRT 149). At a median follow-up of 46 (interquartile range, 20-72) months, the 3-year cumulative incidence of grade ≥ 2 late GI toxicity in the IG-IMRT and 3D-CRT arms were 21.1% versus 42.4% (hazard ratio [HR] 0.46; 95% CI, 0.29 to 0.73; P < .001). The cumulative incidence of grade ≥ 2 any late toxicity was 28.1% versus 48.9% (HR 0.50; 95% CI, 0.33 to 0.76; P < .001), respectively. Patients reported reduced diarrhea ( P = .04), improved appetite ( P = .008), and lesser bowel symptoms ( P = .002) with IG-IMRT. However, no difference was observed in the time by treatment interaction. The 3-year pelvic relapse-free survival and disease-free survival in the IG-IMRT versus the 3D-CRT arm were 81.8% versus 84% (HR 1.17; 95% CI, 0.68 to 1.99; P = .55) and 76.9% versus 81.2% (HR 1.03; 95% CI, 0.62 to 1.71; P = .89), respectively.

CONCLUSION

IG-IMRT results in reduced toxicity with no difference in disease outcomes.
Prevalence and Workplace Drivers of Burnout in Cancer Care Physicians in Ontario, Canada
Authors: Singh Simron , Farrelly Ashley , Chan Catherine , Nicholls Brett , Nazeri-Rad Narges , Bellicoso Daniela , Eisen Andrea , Falkson Conrad B. , Fox Colleen , Holloway Claire , Kennedy Erin , McLeod Robin , Rothenberger David , Trudeau Maureen , Shanafelt Tait , Bauman Glenn
Published: September 2021

PURPOSE:

Provider well-being has become the fourth pillar of the quadruple aim for providing quality care. Exacerbated by the global COVID-19 pandemic, provider well-being has become a critical issue for health care systems worldwide. We describe the prevalence and key system-level drivers of burnout in oncologists in Ontario, Canada.

METHODS:

This is a cross-sectional survey study conducted in November-December 2019 of practicing cancer care physicians (surgical, medical, radiation, gynecologic oncology, and hematology) in Ontario, Canada. Ontario is Canada's largest province (with a population of 14.5 million), and has a single-payer publicly funded cancer system. The primary outcome was burnout experience assessed through the Maslach Burnout Inventory.

RESULTS:

A total of 418 physicians completed the questionnaire (response rate was 44% among confirmed oncologists). Seventy-three percent (n = 264 of 362) of oncologists had symptoms of burnout (high emotional exhaustion and/or depersonalization scores). Significant drivers of burnout identified in multivariable regression modeling included working in a hectic or chaotic atmosphere (odds ratio [OR] = 15.5; 95% CI, 3.4 to 71.5; P < .001), feeling unappreciated on the job (OR = 7.9; 95% CI, 2.9 to 21.3; P < .001), reporting poor or marginal control over workload (OR = 7.9; 95% CI, 2.9 to 21.3; P < .001), and not being comfortable talking to peers about workplace stress (OR = 3.0; 95% CI, 1.1 to 7.9; P < .001). Older age (≥ 56 years) was associated with lower odds of burnout (OR = 0.16; 95% CI, 0.1 to 0.4; P < .001).

CONCLUSION:

Nearly three quarters of participants met predefined standardized criteria for burnout. This number is striking, given the known impact of burnout on provider mental health, patient safety, and quality of care, and suggests Oncologists in Ontario may be a vulnerable group that warrants attention. Health care changes being driven by the COVID-19 pandemic provide an opportunity to rebuild new systems that address drivers of burnout. Creating richer peer-to-peer and leadership engagement opportunities among early- to mid-career individuals may be a worthwhile organizational strategy.
A rare case of collision tumour of the ovary complicated by torsion
Authors: Jacob Dhanya , Pratap Thara , Abdul Jalal Muhammed Jasim , Mahadevan Pushpa , K Vishnu A
Published: September 2021

Collision tumour is the coexistence of two adjacent, but histologically distinct tumours without histologic admixture. Collision tumours are rare in the ovary. It is mostly a histopathological diagnosis often missed in preoperative imaging. The radiologist, gynaecologists and pathologists should be aware of such a combination of tumours to avoid misdiagnosis. We describe the finding of a rare collision tumour, mature cystic teratoma and ovarian fibroma complicated by torsion.
Application of Quantitative CT Imaging in Rehabilitation Nursing of Cerebral Apoplexy Patients
Authors: Yan Bing , Zhang Huanhuan , Liu Jie
Published: September 2021

Objectives: Electronic computed tomography (CT) is an important imaging method for the diagnosis of cerebral infarction. This paper explores the preventive effects of quantitative CT imaging and early rehabilitation nursing on patients with cerebral apoplexy and shoulder-hand syndrome.

Methods: Sixty cerebral apoplexy patients treated were included as control group and given routine care from September 2018 to May 2020. Sixty cerebral apoplexy patients were included as observation group, and early rehabilitation nursing intervention was given based on control group. The incidence of shoulder-hand syndrome and upper limb function were compared between the two groups, to explore the effectiveness of the CT examination in promoting the physical function restoration.

Results: The incidence of shoulder-hand syndrome in observation group after three months of intervention was lower than that in control group, and the severity was less than that in control group (P<0.05); The Ashworth score of muscle tension in observation group after three months of intervention was lower than that in control group, and the simplified FMA score of the upper limbs was higher than that in control group.

Conclusion: Early rehabilitation nursing intervention after CT examination can prevent the occurrence of cerebral apoplexy and shoulder-hand syndrome and improve upper limb function, which is worthy of promotion.

doi: https://doi.org/10.12669/pjms.37.6-WIT.4840

How to cite this:Yan B, Zhang H, Liu J. Application of Quantitative CT Imaging in Rehabilitation Nursing of Cerebral Apoplexy Patients. Pak J Med Sci. 2021;37(6):1574-1579. doi: https://doi.org/10.12669/pjms.37.6-WIT.4840

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.
Construction and application of color fundus image segmentation algorithm based on Multi-Scale local combined global enhancement
Authors: Hao Yanjie , Xie Hongbo , Qiu Rong
Published: September 2021

Objective: Aiming at the problem of low accuracy in extracting small blood vessels from existing retinal blood vessel images, a retinal blood vessel segmentation method based on a combination of a multi-scale linear detector and local and global enhancement is proposed.

Methods: The multi-scale line detector is studied, and it is divided into two parts: small scale and large scale. The small scale is used to detect the locally enhanced image and the large scale is used to detect the globally enhanced image. Fusion the response functions at different scales to get the final retinal vascular structure.

Results: Experiments on two databases STARE and DRIVE, show that the average vascular accuracy rates obtained by the algorithm reach 96.62% and 96.45%, and the average true positive rates reach 75.52% and 83.07%, respectively.

Conclusion: The segmentation accuracy is high, and better blood vessel segmentation results can be obtained.

doi: https://doi.org/10.12669/pjms.37.6-WIT.4848

How to cite this:Hao Y, Xie H, Qiu R. Construction and application of color fundus image segmentation algorithm based on Multi-Scale local combined global enhancement. Pak J Med Sci. 2021;37(6):1595-1599. doi: https://doi.org/10.12669/pjms.37.6-WIT.4848

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.
Exploring the NT-proBNP expression in Premature Infants with Patent Ductus Arteriosus (PDA) by Echocardiography
Authors: Shi Yunlong , Ji Jianwei , Wang Chunying
Published: September 2021

Objectives: To investigate the correlation between echocardiographic indicators and the expression level of N-terminal pro-brain natriuretic peptide (NT-proBNP) in premature infants (PIs) with patent ductus arteriosus (PDA) and the value of NT-proBNP in diagnosing symptomatic PDA (sPDA) in PIs whose gestational age (GA) was less than 32 weeks.

Methods: Ninty premature infants were selected as the research objects, including 52 in the non-PDA group and 38 in the PDA group (26 sPDA cases and 12 cases with asymptomatic PDA (asPDA)) from February 2019 to March 2020. The general information of these infants was recorded, including gender, delivery method, maternal infection, and serum NT-proBNP level on the 3rd day after birth. They were screened by echocardiographic indicators under an artificial intelligence convolutional neural network (AI-CNN). The Receiver Operating Characteristic (ROC) curves were illustrated to decide serum NT-proBNP expression levels, thereby determining specificity and sensitivity of sPDA and the correlation between serum sPDA NT-proBNP expression and echocardiographic indicators.

Results: The expression level of serum NT-proBNP in the sPDA group was greater than that in the asPDA group and the non-PDA group (P<0.001). The serum NT-proBNP expression level was positively correlated with the diameter of the ductus arteriosus in the sPDA group (r=0.462, P<0.001); it was also positively correlated with the ratio of left atrium/aorta (LA/AO) (r=0.573, P<0.001), but was not correlated with left ventricular ejection fraction (LVEF) (r=-0.015, P=0.747).

Conclusion: The combination of serum NT-proBNP expression and echocardiography had clinical values in early diagnosis of PDA.

doi: https://doi.org/10.12669/pjms.37.6-WIT.4853

How to cite this:Shi Y, Ji J, Wang C. Exploring the NT-proBNP expression in Premature Infants with Patent Ductus Arteriosus (PDA) by Echocardiography. Pak J Med Sci. 2021;37(6):1615-1619. doi: https://doi.org/10.12669/pjms.37.6-WIT.4853

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.
Improved support vector machine algorithm based on the influence of Gestational Diabetes Mellitus on the outcome of perinatal outcome by ultrasound imaging
Authors: Liu Hehua , Liu Jie
Published: September 2021

Objectives: In order to understand the incidence and epidemiological characteristics of gestational diabetes mellitus, the ultrasound imaging of support vector machine processing algorithm was used to clarify the outcome of maternal and neonatal gestational diabetes mellitus.

Methods: This study selected clinical data of 12,190 pregnant women who were hospitalized for delivery, and were divided into diabetic group (1268 cases) and control group (10922 cases) according to the diagnosis of gestational diabetes. The study was conducted from January 1, 2012 to December 31, 2019. Colour Doppler ultrasound was performed to record fatal umbilical artery and brain the middle arteries and uterine arteries which are effective indicators of measuring fatal intrauterine conditions. Chi-square test was used to compare the rates between groups, and multivariate logistic regression was used for labour outcomes.

Results: The incidence of diabetes during pregnancy is about 10.4% (1268/12190). Senior citizens and women suffering from obesity increase the risk of gestational diabetes, maternal hypertension disorders in pregnancy, premature rupture of membranes, oligohydramnios, fatal distress, multiple births, malpresentation risk increased significantly (P<0.05) than the control group. In gestational diabetes caesarean section rate was significantly higher (61.0% vs46.4%). Caesarean new born 5-minute Apgar score was significantly lower than the control group (P<0.05).

Conclusion: In maternal gestational diabetes in high risk pregnancies, complications of pregnancy significantly increase the importance of enhancing weight management and blood glucose monitoring to reduce complications.

doi: https://doi.org/10.12669/pjms.37.6-WIT.4855

How to cite this:Liu H, Liu J. Improved support vector machine algorithm based on the influence of Gestational Diabetes Mellitus on the outcome of perinatal outcome by ultrasound imaging. Pak J Med Sci. 2021;37(6):1625-1629. doi: https://doi.org/10.12669/pjms.37.6-WIT.4855

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.
Endoscopic Image-guided treatment of Upper Gastrointestinal foreign body and nursing care of complications
Authors: Liu Na
Published: September 2021

Objective: This study used phased array imaging algorithm to explore the epidemiological characteristics of endoscopic treatment of upper gastrointestinal foreign bodies to provide a basis for nursing intervention.

Methods: We collected data on the age, sex, cause, type of foreign body, success rate of removal, retention location, time and complications of patients with foreign bodies in the upper gastrointestinal tract who were treated in the emergency department of the Digestive Endoscopy Center in our hospital. The study was conducted from January 2018 to December 2020 and we also performed statistical analysis.

Results: The high incidence of foreign bodies in the upper digestive tract was in 45 years old to 74 years old patients. The foreign body types were mostly food balls and sharp foreign bodies, accounting for 37.0% and 44.2%, respectively. The cause was misuse and the most accounted for 52.1%, followed by oesophageal pathological stenosis which accounted for 45.5%. The oesophagus in the retention site accounted for up to 80.0%, and the success rate of foreign body extraction was 96.4%. The complications of patients with foreign body retention within twenty four our retention were mainly esophageal scratches and traumatic esophagitis, accounting for 48.5%. 39.6%.

Conclusion: There are high risks in the treatment of foreign bodies in the upper digestive tract. Targeted, prospective, and streamlined nursing interventions can provide patients with fast and professional medical care services and minimize patient pain.

doi: https://doi.org/10.12669/pjms.37.6-WIT.4858

How to cite this:Liu N. Endoscopic Image-guided treatment of Upper Gastrointestinal foreign body and nursing care of complications. Pak J Med Sci. 2021;37(6):1636-1640. doi: https://doi.org/10.12669/pjms.37.6-WIT.4858

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 vaginal delivery and Caesarean section on the anal Sphincter complex of Primipara based on optimized three-dimensional ultrasound image and nuclear regression Reconstruction Algorithm
Authors: He Naxin , Shi Liang
Published: September 2021

Objective: The study used the optimized nuclear regression reconstruction algorithm to explore the value of three-dimensional perineal ultrasound evaluation of the effect of caesarean delivery and caesarean section on the anal sphincter complex of primipara.

Methods: This study performed three-dimensional perineal ultrasound scanning of the anal sphincter complex of 157 primiparas 42 days after delivery. Among them, 77 were in caesarean delivery (spontaneous delivery group) and 80 were in caesarean section (caesarean delivery group) from September 2018 to December 2020 in our hospital. The thickness of the end plane, the middle plane, the distal plane and the distal plane of the external anal sphincter at 3, 6, 9, 12 o’clock direction, and measure the thickness of the central plane of the pubic rectum muscle at 4, 8 o’clock direction. At the same time, the study used tomography and volume contrast imaging to observe the morphology and integrity of the anal sphincter complex.

Results: The thickness of the distal anal sphincter at the 12 o’clock direction, the proximal anal sphincter at 6, 12 o’clock, and the central plane at 9 and 12 o’clock in the obstetric group were smaller than those in the caesarean section group (all P < 0.05). There were no significant differences in the thickness of the remaining anal internal and external anal sphincter and puborectalis muscles between the two groups in different directions (all P>0.05). In the obstetric group, a perineal sphincter defect was found via three-dimensional perineal ultrasound.

Conclusion: The delivery method has a certain influence on the shape of the anal sphincter complex. The thickness of the internal and external anal sphincter of the primiparous women in a certain direction is significantly smaller than that of caesarean section. Transperineally three-dimensional ultrasound can clearly show the morphological characteristics and integrity of the anal sphincter complex, and diagnose the defect of the anal sphincter complex.

doi: https://doi.org/10.12669/pjms.37.6-WIT.4859

How to cite this:He N, Shi L. The effect of vaginal delivery and Caesarean section on the anal Sphincter complex of Primipara based on optimized three-dimensional ultrasound image and nuclear regression Reconstruction Algorithm. Pak J Med Sci. 2021;37(6):1641-1646.  doi: https://doi.org/10.12669/pjms.37.6-WIT.4859

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 block matching method-based Echocardiography combined with serum NT-PROBNP level detection in the early prediction of PDA in premature infants
Authors: Wang Chunying , Shi Yunlong , Ji Jianwei
Published: September 2021

Objectives: The paper uses block matching method combined with echocardiography to explore the value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in predicting symptomatic patent ductus arteriosus (PDA) in preterm infants.

Methods: We selected premature infants born between February 2019 and March 2020, gestational age ≤32 weeks, and echocardiography within 48 hours to determine the presence of arterial ducts as the research object, monitor their clinical manifestations, and detect serum at three and five days after birth The level of NT-proBNP was checked with echocardiography, and the children were divided into PDA group and asymptomatic patent ductus arteriosus (aPDA) group according to the clinical manifestations and echocardiographic.

Results: The area under the ROC curve of PDA predicted by serum NT-proBNP level at 3 days after birth was 0.949, the cut-off value was 27035pg/mL, the sensitivity was 92.3%, and the specificity was 94.6%; serum NT-proBNP level at 5 days after birth predicted the ROC curve of PDA The lower area is 0.924, the critical value is 6411 pg/mL, the sensitivity is 92.3%, and the specificity is 92.9%.

Conclusion: NT-proBNP may be a quantitative indicator of arterial duct shunt; the detection of serum NT-proBNP levels at 3 and 5 days after birth is helpful for early prediction of PDA.

doi: https://doi.org/10.12669/pjms.37.6-WIT.4864

How to cite this:Wang C, Shi Y, Ji J. Application of block matching method-based Echocardiography combined with serum NT-PROBNP level detection in the early prediction of PDA in premature infants. Pak J Med Sci. 2021;37(6):1657-1661.  doi: https://doi.org/10.12669/pjms.37.6-WIT.4864

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.
Neurological safety of spinal surgery for nucleus pulposus removal under spinal endoscopic imaging guided by inter laminar spine
Authors: Chen Bin , Du Zengfeng
Published: September 2021

Original Article

Bin Chen1, Zengfeng Du2

ABSTRACTObjective: To explore the technical points, approach selection and short-term clinical efficacy of PELD through the intervertebral foramina or interlaminar approach in the treatment of highly shifted LDH. Methods: From September 2018 to June 2020, 19 patients with highly shifted LDH were treated with PELD in The First Hospital of Yulin. It included, 10 males and 9 females; aged 34 to 69 years, with an average of 48 years. Thirteen cases were shifted to the caudal side, and six cases were shifted to the head side. The responsible segments included L3/41 cases, L4/511 cases, and L5/S17 cases. All patients had symptoms of low back and leg pain. The Sowerby dysfunction index (ODI) was 63.5%±10.7% before surgery. The visual analogue scale of pain (VAS) was low back pain (5.2±2.1) and leg pain (7.1±2.4). 14 cases used transforaminal approach, and 5 cases used translaminar approach. Results: All cases completed the operation successfully, the operation time was 60~110min, with an average of 70 minutes. The follow-up time ranged from 6 to 42 months, with an average of 20.8 months. At the last follow-up, ODI was 10.8%±6.8%, VAS back pain score (2.1±1.1) and leg pain score (1.8±0.9). Compared with preoperative, ODI and VAS scores were significantly decreased (P<0.05). The results of Mac Nab method were 14 excellent, four good, and one fair. During the follow-up period, one patient’s leg pain symptoms recurred seven days after operation. No further hernia was found under intervertebral foramen. The symptoms disappeared after two weeks of symptomatic treatment such as swelling and analgesia, and he was discharged. No perioperative complications such as infection and nerve root injury occurred. Conclusion: When PELD is used to treat high-displacement LDH, the choice of transforaminal approach or interlaminar approach needs to be personalized according to the LDH segment and the direction of displacement.

KEYWORDS: Spinal Surgery, Spinal Endoscopic Imaging, Inter Laminar Spine, Nucleus Pulposus Removal.

doi: https://doi.org/10.12669/pjms.37.6-WIT.4880How to cite this:Chen B, Du Z. Neurological safety of spinal surgery for nucleus pulposus removal under spinal endoscopic imaging guided by inter laminar spine. Pak J Med Sci. 2021;37(6):1667-1671. doi: https://doi.org/10.12669/pjms.37.6-WIT.4880

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.
Medical Image and Physics Analysis of Human Physiology and Dysfunction
Authors: Wu Shaofei , Li Hailong
Published: September 2021

Note form the Guest Editors

doi: https://doi.org/10.12669/pjms.37.6-WIT.5005

How to cite this:Wu S, Li H. Medical Image and Physics Analysis of Human Physiology and Dysfunction. Pak J Med Sci. 2021;37(6):1550-1552.  doi: https://doi.org/10.12669/pjms.37.6-WIT.5005

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.
Hospital readmissions in Internal Medicine Specialty: Frequency, associated factors and outcomes
Authors: Fatima Samar , Shamim Sara , Riffat Simra , Tariq Muhammad
Published: September 2021

Objectives: Hospital readmission has become a focus of national attention as a potential indicator of healthcare quality and has a significant financial impact on healthcare system. Limited data is available regarding readmissions to Internal Medicine specialty from our sub-continent. It is, therefore, essential to determine the frequency and factors leading to readmissions, in order to avoid preventable readmissions and improve quality of healthcare provision.

Methods: This retrospective study reviewed adult discharges from Internal Medicine specialty between October 2018 and February 2019 at Aga Khan University Hospital. Out of 1,835 discharges, 491 were randomly selected after excluding expiries. The frequency, factors and outcomes of readmission were noted. The studied outcomes included length of stay and in-hospital mortality.

Results: Out of 491 patients, 15.3% were readmitted within 30-days of their discharge. Most of the readmitted patients were females (56%) and elderly with a mean age 67.1±14.9 years. Majority of the patient who got readmitted had multi-morbidities (68%) and were of functional Class-II (39%).The mean length of stay for index and readmission was between 4-7days. Eighty-percent readmissions were discharged as planned, 13% on request and seven-percent left against medical advice in their index admission. The most common causes of readmission were persistence of symptoms (43%) and nosocomial infection (29%). Avoidable causes included hospital-associated pneumonia, urinary tract infections and septic shock. Mortality in readmitted patients was 12%.

Conclusions: The causes of readmission is multi-factorial, including advanced age, multi-morbidities, persistence of symptoms and nosocomial infections. Early follow-ups should be advised to prevent avoidable readmissions.

doi: https://doi.org/10.12669/pjms.37.7.3575

How to cite this:Fatima S, Shamim S, Raffat S, Tariq M. Hospital readmissions in Internal Medicine Specialty: Frequency, associated factors and outcomes. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.3575

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.
Procalcitonin as a biomarker of bacterial infection in critically ill patients admitted with suspected Sepsis in Intensive Care Unit of a tertiary care hospital
Authors: Bibi Afshan , Basharat Nida , Aamir Muhammad , Haroon Zujaja Hina
Published: September 2021

Objective: To compare the diagnostic accuracy of procalcitonin (PCT), C- reactive protein (CRP), total leukocyte count (TLC) and lactate in critically ill patients admitted with suspicion of sepsis.

Methods: It was a cross sectional study conducted at the department of Chemical Pathology and Endocrinology AFIP, Rawalpindi, in collaboration with Medical and surgical intensive care units (ICU) of CMH Rawalpindi from January 2019 to December 2019. A total of 126 patients of both genders with age above 18 years and fulfilling the inclusion criteria of systemic inflammatory response syndrome (SIRS) were inducted in the study.

Results: Out of 126 patients 82 (65%) patients have positive blood culture results. Male predominance was noted in patients with positive blood culture. Out of 82 patients with positive blood culture results 69(84%) patients have positive PCT results as well whereas 13(15%) patients with positive blood culture results have negative PCT values. 57(69%) patients had Gram negative bacterial infection and 25(30%) patients had Gram positive bacterial infection. Significant difference was noted between the medians of PCT in blood culture positive and blood culture negative group (p value< 0.05) whereas no significant difference was found between medians of CRP, TLC and lactate between blood culture positive and blood culture negative patients (p value > 0.05). ROC curve analysis of PCT, CRP and TLC were done, keeping blood culture as reference standard, PCT showed largest area under the curve (AUC) and clearly outperformed TLC and CRP. PCT showed AUC of 0.781 as compared to CRP and TLC, which was 0.568 and 0.617 respectively. PCT showed sensitivity of 93.9%, specificity of 47.7%, positive predictive value (PPV) of 77% and negative predictive value (NPV) of 80.8%.

Conclusion: Higher NPV makes it a reliable marker for screening out sepsis in suspected cases.

doi: https://doi.org/10.12669/pjms.37.7.4183

How to cite this:Bibi A, Basharat N, Aamir M, Haroon ZH. Procalcitonin as a biomarker of bacterial infection in critically ill patients admitted with suspected Sepsis in Intensive Care Unit of a tertiary care hospital. Pak J Med Sci. 2021;37(7):---------.  doi: https://doi.org/10.12669/pjms.37.7.4183

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.
Correlation of Serum Vaspin, Omentin-1, and adiponectin with metabolic phenotypes in Type-2 diabetes mellitus patients
Authors: Baig Mukhtiar , Gazzaz Zohair J , Bakarman Marwan A , Alzahrani Sami H
Published: September 2021

Objectives: To investigate adipocytokines’ (vaspin, omentin-1, and adiponectin) correlation with metabolic phenotypes in type 2 diabetes mellitus (T2DM) patients. 

Methods: This case-control research was done at the Diabetic Clinic in Jeddah, Kingdom of Saudi Arabia (KSA), from November 2018 to March 2019. Seventy-five T2DM patients and 75 gender, age, and BMI-matched healthy subjects were recruited for this research. 

Results: In DM patients, the concentrations of serum vaspin and omentin-1 were substantially lower (p<0.001) than in the control group. A significant positive relationship between vaspin concentration and DBP (p<0.001), BMI (p<0.001), and waist circumference (p<0.001) was found in patients and control subjects, while FPG (p<0.016), serum insulin (p<0.001), HOMA-IR (p<0.001), TC (p<0.001), TG (p<0.001), and LDLc (p<0.001) were significantly interrelated among patients. Serum concentrations of omentin-1 and ADN were significantly negatively correlated with serum insulin, HOMA-IR, and TG among the DM group. Serum vaspin and ADN levels were significantly higher in the cases and control groups with BMI>25, and no gender-wise variance was observed in adipocytokines levels. Binary logistic regression analysis showed a significantly negative predictive relationship of vaspin and omentin-1 with DM.

Conclusion: The DM group displayed substantially lower serum vaspin and omentin-1 levels. However, there was no consistent relationship observed between these adipocytokines and metabolic phenotypes.

doi: https://doi.org/10.12669/pjms.37.7.4330

How to cite this:Baig M, Gazzaz ZJ, Bakarman MA, Alzahrani SH. Correlation of Serum Vaspin, Omentin-1, and adiponectin with metabolic phenotypes in Type-2 diabetes mellitus patients. Pak J Med Sci. 2021;37(7):---------.   doi: https://doi.org/10.12669/pjms.37.7.4330

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.
Analysis of choroidal thickness in patients with proliferative diabetic retinopathy by optical coherence tomography angiography
Authors: Ren Qian , Yu Hua , Sun Zhaohui , Li Li
Published: September 2021

Objectives: This study aimed to evaluate the changes in choroidal thickness at different parts in patients with stage IV-V diabetic retinopathy (DR) treated by Panretinal Photocoagulation (PRP) or its combination with anti-vascular endothelial growth factor (VEGF) therapy using optical coherence tomography angiography (OCTA).

Methods: Patients with proliferative DR (stage IV-V) diagnosed in Shijiazhuang People’s Hospital between January 2016 to January 2020 were selected and treated with conventional PRP or combined with anti-VEGF therapy. OCTA was performed before treatment and one three and six months after treatment to observe and compare subfoveal choroidal thickness (SFCT), perifoveal choroidal thickness at 500 um (M500) and 1500 um (M1500).

Results: A total of 76 patients (133 eyes) were included. Six months later, re-examination showed effective treatment in 122 eyes (91.72%) and ineffective treatment in 11 eyes. Before treatment and one week, three months and six months after treatment, the choroidal thickness was observed and compared by OCTA. SFCT, M500 and M1500 increased one week after treatment, were significantly thinner 3 months after treatment than those before treatment, and further decreased six months after treatment.

Conclusion: OCTA presents a good evaluation of perifoveal choroidal thickness in patients with proliferative DR. It provides a basis for treatment selection and efficacy determination of proliferative DR.

doi: https://doi.org/10.12669/pjms.37.7.4357

How to cite this:Ren Q, Yu H, Sun Z, Li L. Analysis of choroidal thickness in patients with proliferative diabetic retinopathy by optical coherence tomography angiography. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4357

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.
Clinical observation of mild hypothermia combined with intravenous thrombolysis in treating patients with acute cerebral infarction
Authors: Zhang Shaojie , Gao Lilin , Wo Xuewen , Wang Zhonggong
Published: September 2021

Objectives: To investigate the clinical effect of mild hypothermia combined with intravenous thrombolysis in the treatment of acute cerebral infarction.

Methods: Eighty-eight patients with acute cerebral infarction in Binzhou People’s Hospital between May 2018 and August 2019 were randomly selected and divided into a control group and an observation group according to the random number table method, with 44 patients in each group. The control group was given intravenous thrombolysis; the observation group was treated with mild hypothermia (30-350C) in addition to intravenous thrombolytic thrombolysis. The clinical efficacy, incidence of complications, oxidative stress indexes, inflammatory factor level, neurological function, and mental state of the two groups before and after treatment were compared.

Results: The clinical efficacy of the observation group was significantly better than that of the control group, and the difference was statistically significant (P<0.05). There was no significant difference in the levels of oxidative stress indexes and inflammatory factors between the two groups before treatment (P<0.05). After treatment, the levels of oxidative stress indexes and inflammatory factors of the two groups significantly improved, and the improvement of the observation group was better than that of the control group; the differences were statistically significant (P<0.05). There was no significant difference in the neurological function and mental state between the two groups before treatment (P<0.05). After treatment, the neurological function and mental state of the two groups significantly improved, and the improvement of the observation group was better than that of the control group; the differences were statistically significant (P<0.05). There was no significant difference in the incidence of complications and mortality between the two groups (P>0.05).

Conclusion: Thrombolytic therapy combined with mild hypothermia has a good efficacy in the treatment of acute cerebral infarction. The therapy can improve the neurological function of patients with acute cerebral infarction by significantly improving the oxidative stress index and relieving the inflammatory reaction. Its efficacy is better than single thrombolytic therapy.

doi: https://doi.org/10.12669/pjms.37.7.4499

How to cite this:Zhang S, Gao L, Wo X, Wang Z. Clinical observation of mild hypothermia combined with intravenous thrombolysis in treating patients with acute cerebral infarction. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4499

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.
Evaluation of outcomes of medication therapy management (MTM) services for patients with chronic obstructive pulmonary disease (COPD)
Authors: Liu Mingyue , Liu Jiayun , Geng Zhihui , Bai Shuang
Published: September 2021

Objectives: To evaluate the outcomes of clinical pharmacist-led medication therapy management (MTM) services for patients with chronic obstructive pulmonary disease (COPD).

Methods: Two hundred COPD patients admitted by the Department of Respiratory and Critical Care Medicine of Baoding No.1 Central Hospital during January 2019 and December 2020 were randomly assigned to a control group (n =100) and an experimental group (n =100). Patients in the control group received conventional treatment, while those in the experimental group were provided with MTM services based on the conventional treatment for comparative analysis of outcome measures, including use of antibacterials during hospital stay, length of stay (LoS), costs of hospitalization (CoH), cases of adverse drug reactions (ADRs), and medication adherence (MA) and COPD assessment test (CAT) score one and six months after discharge.

Results: Compared with the control group, the experimental group had reduced use of antibacterials during hospital stay, LoS, CoH, and ADR rate (P <0.05). After discharge, patients in both groups showed remarkable improvements in MA and CAT scores in comparison with their performances upon admission, and the experimental group exhibited better MA and higher CAT score than the control group, with the differences indicating statistical significance (P <0.05).

Conclusion: MTM designed for COPD patients can improve pharmacist-led service quality and clinical outcomes of COPD.

doi: https://doi.org/10.12669/pjms.37.7.4518

How to cite this:Liu M, Liu J, Geng Z, Bai S. Evaluation of outcomes of medication therapy management (MTM) services for patients with chronic obstructive pulmonary disease (COPD). Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4518

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.
Optimization of extraction conditions for polyphenols from the stem bark of Funtumia elastica (Funtum) utilizing response surface methodology
Authors: Fadjare Frempong Theophilus , Owusu Boadi Nathaniel , Badu Mercy
Published: September 2021

Background: The recovery of phenolic compounds is seen as an arduous task because phenolic compounds are available as free aglycones, as sugar or ester conjugates, or as polymers with several monomeric components. Furthermore, phenolic compounds do not disperse evenly and may be connected to cell walls, carbohydrates, or proteins. This study looks at the optimization of factors that affect the efficiency for the extraction of phenolic compounds from the stem-bark of Funtumia elastica.

Methods: Five independent variables (solvent concentration, time, the temperature, solid-liquid ratio, and pH) of the extraction process were selected. Single factor analysis as well as the response surface method was used to evaluate the impact of the selected factors on the total phenolic content. The effect of the extraction factors on the phenolic content was statistically significant (p <0.05). For the response surface method, a five/factor, five/level central composite design used, and a fitted second-order polynomial regression model equation was used to show how the extraction parameters affected the total phenolic recovery.

Results: The predicted value (R² of 0.5917) agreed with the adjusted value (R² of 0.7707). The residuals for response predictions were less than 5%. The optimal factors for the extraction were ethanol concentration of 75.99% v/v, extraction time of 193.86 minutes, temperature of 63.66°C, pH of 5.62, and solid-liquid ratio of 1:21.12 g/mL. Actual overall content of the phenolic compounds was validated at 82.83 ± 3.335 mg gallic acid equivalent (GAE) /g weight of extract, which agreed with the predicted response of 89.467 mg GAE/g of the dried extract under the optimal factors.

Conclusions: The rich phenolic content of stem-bark of Funtumia elastica points to its potential as a functional medicinal product to alleviate diseases caused by oxidative stress such as asthma, breathing disorders, inflammation, and cardiovascular diseases.