Journal of the College of Physicians and Surgeons--Pakistan : JCPSP最新文献

This observational study evaluated the clinical utility of ultrasound-guided midline catheters (MCs) for the delivery of cardiovascular medications in the cardiovascular intensive care unit (CICU). Conducted at a tertiary hospital in China between 2020 and 2022, 387 critically ill CICU patients (median age 78 years) requiring multi-drug infusions were analysed. MCs demonstrated a median dwell time of 9 days (IQR: 6-13 days), successfully administering 13 cardiovascular medications, including vasopressors and antiarrhythmics. Complication rates were remarkably low (1.3%), with two lumen occlusions, two haemorrhages, and one phlebitis. No central line-associated bloodstream infections (CLABSIs) or symptomatic thromboses occurred. Compared to central venous catheters (CVCs), MCs reduced insertion complexity and infection risk while maintaining efficacy for prolonged therapy. The findings support MCs as a safe alternative to traditional CVCs in CICU settings, particularly for elderly patients with complex comorbidities. Nurses performed most insertions (78%), highlighting procedural accessibility. This study underscores the value of ultrasound-guided MCs in optimising vascular access strategies for critical cardiovascular care. Key Words: Midline catheter, Central venous catheter, Peripherally inserted central catheter, Cardiovascular intensive care unit.

Objective: To investigate the clinical characteristics of patients with saddle pulmonary embolism (SPE) among those with intermediate- to high-risk acute pulmonary embolism (APE).

Study design: A comparative study. Place and Duration of the Study: Department of Interventional Vascular Surgery, the First Hospital of Putian City, Putian, China, from May 2017 to October 2024.

Methodology: Combined anticoagulation and interventional therapy was administered to all enrolled intermediate- to high-risk APE patients (with right ventricular dysfunction and/or elevated cardiac biomarkers, or haemodynamic instability) per the study protocol. Based on whether SPE was identified on computed tomography pulmonary angiography, patients were divided into the SPE group and the non-SPE group. Clinical characteristics, cardiac biomarkers, imaging features, and clinical outcomes were compared between the two groups.

Results: When comparing the groups, no significant differences were observed in N-terminal pro-B-type natriuretic peptide, right ventricular diameter/left ventricular diameter, and peripheral pulmonary artery obstruction index before and after treatment (p >0.05). However, the SPE group had higher levels of cardiac troponin I than the non-SPE group before and after treatment (p <0.05). There was no significant difference in in-hospital mortality between the two groups (p = 0.653). In the SPE group, the saddle embolism resolved completely in 94.74% of patients after treatment.

Conclusion: Patients with SPE may experience more severe myocardial injury. The short-term resolution of the saddle embolism after treatment appears not to be a critical factor affecting treatment response.

Key words: Intermediate- to high-risk, Acute pulmonary embolism, Computed tomography pulmonary angiography, Saddle pulmonary embolism, Clinical characteristics.

Objective: To determine gender using cranial measurements from CT scans and to evaluate their predictive accuracy for gender classification.

Study design: A cross-sectional study. Place and Duration of the Study: Department of Forensic Medicine and Toxicology, Ziauddin University, Karachi, Pakistan, from July to December 2025.

Methodology: A total of 280 CT scans of adult male and female were used for fourteen cranial measurements, including foramen magnum length (sagittal diameter; FML) and foramen magnum breadth (transverse diameter; FMB), right and left frontal sinus height (RTFSH, LTFSH), right and left frontal sinus breadth (RTFSB, LTFSB), right and left frontal sinus depth (RTFSD, LTFSD), frontal bone inclination angle (FI), maximum cranial length (MCL) and maximum cranial breadth (MCB), interorbital breadth (IOB), lateral wall interorbital breadth (LWIOB), and bizygomatic breadth (BZB). Right and left frontal sinus index (RTFSI, LTFSI) and cephalic index (CI) were calculated. SPSS version 27 was used to calculate mean ± SD, compare means (independent samples t-test or Mann-Whitney U test), and estimate gender prediction accuracies using binary logistic regression (BLR), decision tree (DT), and ROC curve analyses.

Results: MCL, MCB, RTFSB, LTFSB, RTFSD, LTFSD, FI, FML, FMB, LWIOB, BZB, and LTFSI showed significant gender differences. MCL, MCB, FML, LWIOB, BZB, and FI were the significant gender predictors in the BLR model. ROC curve analysis with male gender as the state variable showed an AUC >0.5 for 13 measurements, except for FI. BZB was the most important classifier in DT analysis, followed by MCL. Assuming male gender as the positive class, the BLR model showed higher specificity (0.814 > 0.714) but lower sensitivity (0.764 <0.835) than the DT model.

Conclusion: All the cranial measurements showed significant gender differentiation except IOB, RTFSH, and LTFSH. BLR and DT models both can be employed for gender prediction.

Key words: Craniometry, Gender determination, CT images, Binary logistic regression, Receiver operating characteristic curve analysis, Decision tree.

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 Objective: To compare the efficacy and mean pain scores of trypsin-chymotrypsin and naproxen sodium for post-endodontic treatment pain.

Study design: A randomised controlled trial. Place and Duration of the Study: Department of Operative Dentistry and Endodontics, Dr Ishrat-ul-Ibad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan, from August 2024 to January 2025.

Methodology: A total of 100 patients were randomly allocated to receive oral formulations of the trypsin-chymotrypsin group (n = 50) or the naproxen sodium group (n = 50). The numeric rating scale (NRS) was utilised to assess pain score at 1, 6, 12, and 24-hour intervals. The Mann-Whitney U test was used for pre- and post-operative comparisons, and age and gender were stratified using the independent-sample t-test and chi-square test.

Results: There was no notable difference between the two groups in baseline characteristics or pre-operative pain (p >0.05). Pain scores were comparable at 1-hour intervals (p = 0.695); however, at 6 hours, the trypsin-chymotrypsin group showed a significant reduction in pain compared with the naproxen sodium group (p = 0.049). At 12- and 24-hour intervals, both groups showed zero pain scores (p = 0.999).

Conclusion: The efficacy of trypsin-chymotrypsin was comparable to that of naproxen sodium in reducing post-endodontic pain in teeth with symptomatic irreversible pulpitis.

Key words: Postoperative pain, Non-steroidal anti-inflammatory agents, Trypsin-chymotrypsin, Root canal therapy, Pain, Numeric rating scale.

Objective: To determine the prevalence of vancomycin-resistant enterococci (VRE) among clinical isolates and to detect the presence of the vanA and vanB genes through polymerase chain reaction (PCR).

Study design: A descriptive cross-sectional study. Place and Duration of the Study: Department of Microbiology, Pak Emirates Military Hospital, Rawalpindi, Pakistan, from February to July 2025.

Methodology: A total of 107 Enterococcus isolates from various clinical specimens were identified according to standard guidelines. Antimicrobial susceptibility testing was performed according to the CLSI recommendations, including the vancomycin agar dilution method. Minimum inhibitory concentration (MIC) was determined using the Vitek 2 system. Isolates identified as VRE were further analysed for the presence of vanA and vanB genes.

Results: Among the 107 isolates, 84 (78.5%) were Enterococcus faecium, 21 (19.6%) were Enterococcus faecalis, and 2 (1.9%) were classified as other Enterococcus species. Seventeen isolates were identified as VRE; hence, the observed prevalence of VRE in clinical isolates was (15.9%), all of which exhibited resistance to teicoplanin. Additionally, two VRE isolates (1.9%) were resistant to linezolid. Out of 17 VRE isolates, the vanA gene was detected in 8 (7.5%) isolates, while the vanB gene was not detected in any isolate.

Conclusion: The presence of VRE and the vanA gene among clinical isolates in a tertiary care setting underscores the need for stringent surveillance and effective infection control practices.

Key words: Enterococcus faecium, Enterococcus faecalis, polymerase chain reaction, VanA gene, VanB gene.

Objective: To evaluate the outcomes of radical excision of infected Pfannenstiel (gynaecological and obstetric) surgical wounds.

Study design: A descriptive case study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, Lady Reading Hospital, Peshawar, Pakistan, from December 2023 to June 2024.

Methodology: A total of 80 female patients with culture-confirmed infected lower abdominal surgical wounds following obstetric or gynaecological procedures, who had failed debridement (three or more), were included in the study. Patients' primary outcomes were assessed in terms of whether the wound healed after a single radical excision and the number of days spent in the hospital after the procedure. The mean difference between the duration of stay before and after radical excision was determined by using the Paired T-test. Secondary outcomes were complications at long-term follow-up at one and three months.

Results: The mean age was 38.70 ± 16.66 years. The prior surgical procedures included elective gynaecological (46.7%) and emergency C-section (30%). The primary outcome of wound healing was observed in 86.7% (26 patients) within 2 weeks, with 13% healed by the end of the third week. Prior hospital stay was 10.793 ± 8.36 days. The mean difference between the duration of stay before and after radical excision was statistically significant, with a mean difference of 8.1 days (p <0.001, 95% CI: -5.55 to -11.97). The mean difference in scar size between the preoperative and postoperative measurements was 10.367 cm, representing a statistically significant decrease (p <0.001, 95% CI: -9.124 cm to -11.609 cm). Complications were observed in four patients, with three having partial wound dehiscence and one patient leading to delayed wound healing (>21days).

Conclusion: Radical wound excision offers a one-step streamlined procedure, enabling swift resumption of regular activities and minimising hospitalisation duration. Additionally, it alleviates the strain on both patients and healthcare systems.

Key words: Radical excision, Surgical site infection, Wound debridement.

Objective: To evaluate the predictive performance of combining serum D-Dimer levels with Injury Severity Score (ISS) for forecasting in-hospital mortality and unfavourable outcomes among trauma patients.

Study design: An analytical study. Place and Duration of the Study: Department of Emergency, Foshan Hospital of Traditional Chinese Medicine, Foshan, China, from January 2021 to April 2025.

Methodology: Trauma patients were divided into a survival group (n = 250) and a death group (n = 35) based on in-hospital survival status. Whole-body CT examinations were performed upon admission, and general clinical data, serum D-Dimer levels, and ISS scores were compared between the two groups. ROC curves were generated to evaluate predictive performance. Logistic regression identified independent prognostic factors, which were then used to build a nomogram model using R software.

Results: A total of 285 trauma patients were included, with a mortality rate of 12.3%. Logistic regression analysis revealed that D-Dimer (p <0.001), ISS score (p = 0.02), GCS (p = 0.06), and days of hospitalisation (p <0.001) were independent risk factors for in-hospital mortality. The AUC was 0.766 for D-dimer, 0.740 for the ISS score, and 0.811 for the combined model. The combined model demonstrated significantly better predictive performance than either individual predictor (p <0.05). The nomogram was constructed based on the results of the multivariate regression analysis and demonstrated good predictive performance.

Conclusion: D-Dimer levels and ISS scores were higher in trauma patients who died during hospitalisation.

Key words: Trauma, D-Dimer, Injury severity score.

Objective: To explore the potential biological significance and diagnostic value of ferroptosis-related differentially expressed genes (DEGs) in liver fibrosis (LF).

Study design: Bioinformatic analysis of a publicly available microarray dataset. Place and Duration of the Study: Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hangzhou First People's Hospital, West Lake University School of Medicine, Hangzhou, China, from June 2 to July 2, 2024.

Methodology: Gene expression data from GSE139602 and ferroptosis-related genes from the GeneCards database were analysed to identify ferroptosis-related DEGs in LF. Functional enrichment, gene set enrichment, immune infiltration, protein-protein interaction, and ROC analyses were performed to identify key genes and their potential roles in LF.

Results: Forty-one DEGs were associated with ferroptosis, and LF were identified. Among these, CEBPA, MYC, SCD, and SREBF1 were highlighted as important genes with significant diagnostic ability, confirmed through the receiver operating characteristic curve. Notably, CEBPA and SCD were implicated in fibrosis progression via their roles in lipid metabolism and oxidative stress modulation, which are essential components of ferroptosis.

Conclusion: The bioinformatics analysis identified four key ferroptosis-related genes-CEBPA, MYC, SCD, and SREBF1-as diagnostic biomarkers for LF. This study found the ferroptosis-related pathways as potential therapeutic targets for LF.

Key words: Biomedicine, Liver fibrosis, Ferroptosis, Differentially expressed genes.

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