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

This study explored the effectiveness of an electrical impedance tomography (EIT)-based positive end-expiratory pressure (PEEP) titration strategy compared with traditional methods in patients with acute respiratory distress syndrome (ARDS). A systematic search of the literature was conducted through PubMed, Embase, and the Cochrane Library, resulting in the inclusion of 12 relevant studies. The results showed no significant differences between the EIT group and the traditional group with respect to PEEP levels, oxygenation index, lung compliance, ICU length of stay, or APACHE II scores. However, the mortality rate in the EIT group was significantly lower than that in the traditional group (OR = 0.59, p = 0.03), and their mean arterial pressure was also lower (SMD = -0.28, p = 0.03). Therefore, the EIT-guided PEEP titration protocol demonstrates superior mortality outcomes compared to traditional methods. Key Words: Electrical impedance tomography, Positive end-expiratory pressure, acute respiratory distress syndrome.

Elevated plasma triglyceride (TG) levels are recognised as a significant risk factor for cardiovascular disease. Pemafibrate, a novel selective peroxisome proliferator-activated receptor alpha (PPAR-α) agonist, offers potential therapeutic benefits. This systematic review and meta-analysis evaluated its efficacy and safety. Multiple databases from inception to February 2024 were searched for randomised controlled trials. Eleven studies involving 11,568 patients were included. Pemafibrate significantly reduced TG levels (WMD: -125.02 mg/dL; 95% CI: -182.04 to -68.00; p <0.001), addressing a key unmet need in dyslipidaemia management by specifically targeting hypertriglyceridaemia and non-high-density lipoprotein cholesterol (non-HDL-C, WMD: -11.41 mg/dL; 95% CI: -19.77 to -3.05; p <0.001), while increasing HDL-C (WMD: 7.05 mg/dL; 95% CI: 5.78 to 8.34; p = 0.370). The drug demonstrated a favourable safety profile. Pemafibrate is an effective and well-tolerated option for dyslipidaemia management, particularly in patients with hypertriglyceridaemia. Key Words: Pemafibrate, Dyslipidaemia, Triglyceride, Efficacy, Safety.

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Objective: To determine the resistance rates of anaerobic bacteria to metronidazole and amoxicillin/clavulanate and to assess the susceptibility of metronidazole-resistant isolates to meropenem.

Study design: A laboratory-based observational study. Place and Duration of the Study: Department of Microbiology, Chughtai Institute of Pathology, Lahore, Pakistan, from July 2023 to June 2025.

Methodology: Anaerobic bacteria isolated from various clinical specimens were identified, and antimicrobial susceptibility testing was performed using MIC Test Strip®. Minimum inhibitory concentrations were interpreted according to the Clinical Laboratory Standards Institute (CLSI M100, 33rd edition) guidelines. Isolates resistant to metronidazole were further tested for susceptibility to meropenem. Descriptive statistics were used to calculate the frequencies and percentages of anaerobic isolates and antimicrobial susceptibility patterns.

Results: A total of 251 anaerobes were recovered from 243 clinical samples, mainly from deep-seated pus and sterile body fluids. B. fragilis (n = 103) was the most common isolate, followed by Peptostreptococcus anaerobius and Prevotella bivia. More than half (53%) of the isolates were from polymicrobial infections. Resistance to amoxicillin-clavulanate and metronidazole was observed in 24.7% and 42.7% of isolates, respectively. Among metronidazole-resistant isolates, 91.7% remained susceptible to meropenem, with resistance detected in three B. fragilis isolates, suggesting emerging multidrug resistance.

Conclusion: There is a notable increase in resistance among anaerobic bacteria against metronidazole and amoxicillin/clavulanate. Although meropenem remains largely effective, the emergence of resistant isolates is concerning and underscores the need for stringent antimicrobial stewardship.

Key words: Anaerobic bacteria, Drug resistance, Metronidazole, Meropenem, Amoxicillin-clavulanate.

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The public release of ChatGPT in November 2022 and the rapid adoption of artificial intelligence (AI) tools have significantly influenced medical education and research worldwide, including in Pakistan. Despite widespread use among faculty and students, Pakistan currently lacks national guidelines on the ethical use of AI in medical education and research. Regulatory bodies such as the Higher Education Commission, Pakistan Medical and Dental Council, and College of Physicians and Surgeons of Pakistan have yet to provide policy direction. This absence of oversight raises concerns about academic integrity, responsible AI use, and equitable access. This viewpoint identified key gaps in governance and proposed practical, context-sensitive recommendations, including the national AI ethics guidelines, faculty training, curriculum integration, and the establishment of an AI research integrity consortium. Coordinated action by institutions, policymakers, and journal editors is essential to ensure ethical, effective, and locally relevant AI integration in medical academia. Without such measures, Pakistan risks academic misconduct and further marginalisation in global research. Key Words: Artificial intelligence, Ethics, Governance, Guidelines.

In the era of information bombardment, it is essential to adopt the ability to acquire new information and apply it in the respective context. Healthcare professionals continually face evolving challenges and advancements in their field. Traditional training methods often involve extensive theoretical content, which can be overwhelming and less practical. There is a growing need for concise, actionable guidance that can be easily implemented in daily practice to enhance skills and achieve professional goals. The Department of Educational Development, Aga Khan University Hospital, Karachi, Pakistan, developed the innovative five tips approach, comprising a series of brief, grounded, and helpful pointers on various topics in health professions education. The aim of developing these creative tips is to familiarise educators with diverse topics, thereby enhancing their knowledge and skills and supporting their professional development. Key Words: Educational material, Practical, Five tips, Brief.

Objective: To evaluate the effect of balance training, with taping and without taping, on mobility in patients with sub-acute or chronic stroke.

Study design: A randomised controlled trial. Place and Duration of the Study: Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from May to August 2023.

Methodology: Participants of both genders aged over 35 years, with hemiparesis of more than three months and less than one and a half years of stroke onset, who were able to walk more than 10 metres with or without a walking aid, had an MMSE score of 24 or higher, had spastic paralysis of the lower limb, and understood the goals of the study, were included in the study. Those who had a history of lower-extremity surgery, skin conditions, or extremely sensitive skin, reported pain during ankle joint dorsiflexion, or had a Modified Ashworth Scale score of>2 were excluded from the study. Participants were enrolled based on the inclusion and exclusion criteria. Participants were randomly assigned to the experimental group (balance training with taping) and the control group (balance training without taping) through simple randomisation using the lottery method. Before and after the treatment, the Six-Minute Walk Test (6MWT) was used to assess mobility. The intervention was administered for 30 minutes per session, three sessions per week, for four consecutive weeks.

Results: The mean age of the 36 participants was 52.19 ± 11.38 years. In the experimental group, the involved side was right in 9 participants and left in 9 participants. In contrast, in the control group, the damaged side was right in 10 participants and left in 8 participants. Balance training with taping showed significantly higher 6MWT score (150.39 ± 10.05m) in mobility recovery compared with balance training without taping (149.61 ± 11.65m). Within-group analysis showed a significant difference (p <0.05), with the 6MWT showing a significant change from baseline 133.06 ± 10.59 to 150.39 ± 10.05 in the experimental group, while the scores changed from 136.44 ± 11.22 to 140.61 ± 11.65 in the control group.

Conclusion: Balance training with taping is more effective for the improvement of mobility than balance training without taping in sub- acute to chronic stroke patients.

Key words: Taping, Mobility, Balance training, Rehabilitation, Stroke, Six-Minute Walk test.

Objective: To compare the safety and efficacy of two different anticoagulation strategies of aspirin and low-molecular-weight heparin (LMWH) for the prevention of postoperative venous thromboembolism (VTE) in elderly patients undergoing total hip replacement (THR).

Study design: A randomised controlled study. Place and Duration of the Study: Department of Anaesthesiology, the South Campus of Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, between January 2021 and June 2025.

Methodology: A total of 196 elderly patients were stratified into two cohorts: a combination therapy group (Group AL, n = 99) and a sequential therapy group (Group L, n = 97). Outcomes assessed included VTE incidence at 7 and 30 days postoperatively, intraoperative blood loss, intraoperative blood transfusion volume, and postoperative haemoglobin (Hb). Continuous variables between groups were compared using the t-test or the Mann-Whitney U test, and categorical variables were compared between groups using the chi-square test or Fisher's exact test.

Results: At 30 days post-surgery, VTE incidence was lower in the combination group (16.1%) than in the sequential group (29.8%; p <0.05).

Conclusion: Concurrent administration of aspirin and LMWH may more effectively mitigate surgery-induced hypercoagulability, thereby reducing VTE incidence in elderly patients without increasing the risk of perioperative bleeding.

Key words: Elderly, Total hip replacement, Aspirin, Low molecular weight heparin, Venous thromboembolism, Postoperative.

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