Medical College Research Articles

B cell deficiency in thymoma tissues of Good’s syndrome patients

ObjectivesGood’s syndrome (GS) is a rare secondary immunodeficiency which is characterized by hypogammaglobulinemia and thymoma. This study aims to investigate the expression and distribution of B cells in thymoma tissue, given that B cells had been found to be reduced or absent in peripheral blood or bone marrow.MethodsThis study retrospectively analyzed thymoma tissues from 5 GS patients at the First Affiliated Hospital of Wenzhou Medical University and Zhejiang Provincial People’s Hospital. Tissues from 20 patients with simple thymoma were used as controls. Immunohistochemistry analyses were performed to detect the markers CD19, CD20, PAX5 and CD138 to evaluate the expression of B cells or plasma cells.ResultsCompared to the control group, 4 GS patients exhibited a complete absence of B cells in their thymoma tissue, while 1 GS patient exhibited a notable reduction in B cells. The expression levels of CD19, CD20 and PAX5 in the thymoma tissues of GS patients were dramatically lower than those in the control group (0 vs. 85%, 20 vs. 85%, 20 vs. 85%, respectively; P < 0.05). However, no significant difference was observed in the expression frequency of CD138 between the thymoma tissues of the two groups (0 vs. 30%, P > 0.05).ConclusionThis is the first report of B cell deficiency in 5 thymoma tissues of GS patients.

Intraoperative changes in electrophysiological monitoring can be used to predict clinical outcomes in patients with spinal cavernous malformation.

The study aimed to evaluate the sensitivity and specificity of these monitoring parameters in predicting postoperative neurological dysfunction. In this study, a total of 85 patients with spinal cavernous malformations (SCMs) treated at Xuanwu Hospital, Capital Medical University, from November 2012 to August 2017 were included. During the surgical procedures, all patients underwent monitoring of motor evoked potentials (MEP) and somatosensory evoked potentials (SEP). The criteria for warning included a reduction of ≥80% in MEP amplitude and ≥50% in SEP amplitude. Among 85 patients, 40 (47.1%) had SCMs located in the thoracic segment, 35 (41.2%) in the cervical segment, 6 (7.1%) in the cervical thoracic segment, and 4 (4.7%) in the lumbar segment. MEP recordings were obtained from 81 patients, and the preoperative McCormick score was 1.53 ± 0.69. The sensitivity of multimodal monitoring combined with the criteria of 80% reduction in MEP amplitude and SEP was 83.9%, with a specificity of 69%, a positive predictive value of 69%, and a negative predictive value of 90.4%. This study emphasizes the crucial role of electrophysiological monitoring, particularly MEP and SEP, during the surgical resection of SCMs. The findings demonstrate that this approach is effective in predicting and preventing postoperative neurological dysfunction, thereby improving patient outcomes.

Comparison of chronotype and learning motivation in medical university students

BackgroundPeople differ in their preferred time for intellectual activities. Morningness-eveningness preferences describe the preferred time for performing daily activities and are determined by chronotype. Chronotype reflects circadian preference in humans and is divided into morning, intermediate, and evening types. Learning motivation is a key predictor of student success and may influence learning and study, academic performance, intention to continue medical research, and well-being. Helping students develop learning motivation may improve their educational achievement and health. There are opposing studies regarding chronotype and academic achievement. We hypothesized that chronotype affects the learning motivation of medical school students.MethodsWe used the reduced Morningness-Eveningness Questionnaire (rMEQ), and the Motivated Strategies for Learning Questionnaire (MSLQ) for Russian, Polish, Japanese, and Australian students in the first and second years of medical university. A total of 540 medical students answered the questionnaires. The MSLQ contains six subscales: intrinsic goal orientation, extrinsic goal orientation, self-efficacy for learning and performance, control of learning beliefs, task value, and test anxiety.ResultsThe rMEQ was used to classify the students into three types, which were morning (26.7%), intermediate (60.5%), or evening chronotypes (12.7%) based on their scores. The learning motivation scores for the intrinsic and extrinsic goal orientations, task value, and self-efficacy were lower in evening chronotypes.ConclusionsOur findings suggest that the evening chronotype had a lower learning motivation than the morning chronotype. Evening-oriented students may need a more flexible schedule, and a shift of the most important courses in the university to the afternoon may help them to attain higher motivation for learning medicine.

Clinical study on conversion therapy of hepatocellular carcinoma - summary and comparison of clinical data from a single center of consecutive four years

AimThe purpose of this study was to interpret real-world clinical data to analyze the surgical safety and survival outcomes of patients with initial unresectable hepatocellular carcinoma (uHCC) after conversion therapy.MethodsA retrospective analysis was performed on 2984 hepatocellular carcinoma (HCC) patients hospitalized in Shandong Cancer Hospital Affiliated to Shandong First Medical University from June 1st, 2019 to June 1st, 2023. Clinicopathological features, response to systemic and/or loco-regional treatments, surgical resection rate after conversion therapy, surgical safety, and postoperative recurrence were analyzed.ResultsA total of 38 patients were successfully converted to obtain surgical resection. 35 patients underwent radical resection. A high objective response rate (ORR) (52.6% under RECIST v1.1 and 78.9% under mRECIST criteria) was observed in patients under conversion therapy, and the disease control rate (DCR) was 100%. Pathologic complete response (pCR) was 42.9%. Treatment-related adverse events (TRAEs) of any grade were observed in 37 patients (97.4%). Safety of conversion or direct surgery continues to improve. The median follow-up time was 19.3 months. The 1-year Disease-free survival (DFS) rate of patients with direct surgery and patients with conversion surgery were 91.4% and 86.8%, respectively.ConclusionsWith conversion therapy, a small percentage (1.81%) of uHCC patients are likely to be converted to radical resection. Local combined systemic therapy is a relatively safe and effective conversion therapy, and the safety of surgery is gradually improved after successful conversion. Preliminary follow-up data showed satisfactory survival benefits for patients undergoing conversion surgery.Trial registrationThis was a retrospective study and it did not interfere with treatment decisions.

Early Mortality in Cardiac Surgery - Is Lactate Significant?

Serum lactate is a consequence of tissue hypoperfusion and has been used routinely for patient management following cardiac surgery. This study aims to determine the association of lactate with early mortality and postoperative morbidity. This is a prospective cohort study carried out in the Department of Cardiovascular and Thoracic Surgery, King George's Medical University (India), from January 2020 to December 2022. A total of 270 patients were included in this study. Serum lactate levels were measured preoperatively, intraoperatively on-pump, coming off-pump, and at six, 12, 24, and 48 hours postoperatively. Early mortality was noted in 17 cases (6.3%). While both lactate and lactate clearance correlated with duration of mechanical ventilation, vasopressor duration, and intensive care unit and hospital stay, correlation with early mortality was noted only with lactate at 24 hours. Logistic regression analysis demonstrated that lactate levels at preoperative period (adjusted odds ratio [OR] 4.76 [1.67-13.59], P=0.004) and at 24 hours after bypass (OR 1.21 [1.00-1.47], P=0.046) and vasopressor duration (OR 1.11 [1.04-1.19], P=0.002) are independent predictors of mortality. Receiver operating characteristic curve analysis showed that arterial lactate on-pump, off-pump, and at six, 12, and 24 hours after surgery had significant area under the curve for predicting mortality. Arterial lactate and lactate clearance show good correlation with duration of mechanical ventilation, vasopressor support, and intensive care unit and hospital stay and can serve as a good indicator to guide therapeutic decisions in postoperative period. However, it fails to be a sensitive predictor of mortality.

Development of an intraductal papillary mucinous neoplasm malignancy prediction scoring system.

Despite the presence of various guidelines, diagnosing malignant intraductal papillary mucinous neoplasm (IPMN) continues to pose challenges. Furthermore, although endoscopic ultrasonography (EUS) offers high-resolution images, it has not yet recognized as the primary tool for malignancy diagnosis. The study objective was to develop a simplified and user-friendly scoring system to improve the diagnostic accuracy of malignant IPMNs. Additionally, the utility of EUS and its effect on diagnostic accuracy were assessed. We retrospectively collected the clinical data on 160 cases of resected IPMN at Tokyo Medical and Dental University Hospital from January 2008 to December 2022. We examined clinical features, computed tomography (CT) and magnetic resonance imaging (MRI) findings, and EUS results if available. We then calculated the odds ratio of malignancy for these factors and developed an IPMN malignancy prediction (IMAP) scoring system. There were 89 (55.6%) cases of benign IPMNs and 71 (44.4%) of malignant IPMNs. Eight clinical and imaging findings, including age, diabetes mellitus status, jaundice, CA19-9 level, enhancing mural nodules ≥5mm, thickened wall, and main duct dilatation, were significantly associated with malignancy. The IMAP score was calculated by assigning 0 to 2 points to these factors based on the odds ratio. The area under the receiver operating characteristic curve for the IMAP score was 0.78 [95% confidence interval (CI): 0.71-0.85] based on CT/MRI alone and improved to 0.81 (95% CI: 0.74-0.87) when EUS was added. When the total exceeds 5 points, the positive predictive value becomes 100% (95% CI: 95.9-100). In conclusion, the IMAP scoring system has demonstrated promise as a clinically useful tool, offering both simplicity and sufficient accuracy. It holds potential as an important decision criterion for determining the treatment approach for IPMN. Additionally, EUS contributes to enhancing the diagnostic accuracy of the IMAP scoring system, thereby enabling more precise decision-making.

Disclosure of true medical information: the case of Bangladesh

BackgroundTruth-telling in health care is about providing patients with accurate information about their diagnoses and prognoses to enable them to make decisions that can benefit their overall health. Physicians worldwide, especially in the United Kingdom (U.K.) and the United States (U.S.), openly share such medical information. Bangladesh, however, is a Muslim-majority society with different social norms than Western societies. Therefore, we examined whether Muslim culture supports truth disclosure for patients, particularly how and to what extent medical information about life-threatening diseases is provided to patients in Bangladesh.MethodsThis was a phenomenological qualitative study. We conducted thirty in-depth interviews with clinicians, nurses, patients and their relatives at Shaheed Suhrawardy Medical College Hospital in Dhaka, Bangladesh. We also used observations to explore interactions between patients, families and healthcare professionals regarding their involvement in medical decisions and truth disclosure issues. NVivo software was used to identify common themes, and a thematic analysis method was utilised to analyse the datasets.ResultsThis study identified three recurring themes relevant to the ethics and practice of truth disclosure: best interest rather than autonomy, the ambivalent value of deception and who understands what. The participants revealed that physicians often withhold fatal medical prognoses from terminally ill patients to ensure the best healthcare outcomes. The results indicate that deception towards patients is commonly accepted as a means of reducing burden and providing comfort. The participants opined that true medical information should be withheld from some patients, assuming that such disclosures may create a severe burden on them. Whether or to what extent medical information is disclosed primarily depends on a family’s wishes and preferences.ConclusionsWhile truth disclosure to patients is considered an ethical norm in many cultures, such as in the U.K. and the U.S., the practice of concealing or partially revealing severe medical prognoses to patients is an actual medical practice in Bangladeshi society. This study emphasises the importance of recognising a patient’s active involvement and respecting the cultural values that shape family involvement in medical decision-making. These findings may have significant policy and practical implications for promoting patient autonomy within Bangladeshi family dynamics and religious-based cultural values.

Public–Private Partnership Model in Delivering Quality Health Care and Medical Education - An Enduring Success Story for the Past Seven Decades

Public–private partnerships (PPPs) are integral to the National Health Mission (NHM). Kasturba Medical College (KMC), Mangalore, was the first private institution in India to embrace the PPP model way back in 1953. The then Government of Madras permitted KMC Mangalore to partner with the 2 district hospitals – the Government Wenlock and the Lady Goschen Hospitals. For almost seven decades, KMC Mangalore has been using the clinical facilities at District Wenlock and Lady Goschen hospitals to provide quality health care and also train the Undergraduate and Postgraduate students of KMC. The Manipal experiment is a shining example of public–private collaboration to provide quality accessible health care to everyone, which is in line with the Sustainable Development Goal (SDG) 3 and its targets.

Association between axial length and uveitis.

Multiple studies have examined the association between myopia and various ocular diseases, but there is no clinical report of the relationship between myopia and uveitis. This study aimed to elucidate the relationship between myopia and uveitis by comparing axial lengths (AL) of uveitis patients with control individuals. This study included 1052 eyes (663 patients; 288 males, 375 females; median age 56.0years) with uveitis referred to Tokyo Medical University Hospital. Controls were 738 eyes with cataract but no other ocular diseases. AL was measured by IOLMaster or conventional A-mode ultrasound system. Uveitis eyes were grouped into various types of non-infectious uveitis, infectious uveitis, and unidentified uveitis. Median AL of each uveitis group was compared with control group using Mann-Whitney U-test, and also compared with adjustment for age and sex using multiple regression analysis. Binary logistic analysis was performed to examine whether AL plays a role in the risk of developing uveitis. Of 1052 eyes, 808 eyes (76.8%) were diagnosed with non-infectious uveitis [sarcoidosis (176 eyes, 16.7%), Vogt-Koyanagi-Harada disease (122 eyes, 11.6%), Behçet's disease (130 eyes, 12.4%), and others (380 eyes, 36.1%)], 146 eyes (13.9%) with infectious uveitis, and 98 eyes (9.3%) with unidentified uveitis. Median AL in all uveitis eyes was significantly shorter than in control eyes (23.73 vs 24.31mm, p < 0.001 unadjusted), and AL remained significantly shorter in uveitis than in control after age- and sex-adjustment (p < 0.001). Median AL was significantly shorter in non-infectious uveitis (23.72mm) and in infectious uveitis (23.99mm) compared to controls (p < 0.001 and < 0.05, respectively), and was significantly shorter in non-infectious uveitis than in infectious uveitis (p < 0.05). Each millimeter decrease in AL was associated with 1.266-fold increase in unadjusted risk [odds ratio (OR), 1.266; 95% confidence interval (CI), 1.196-1.341; p < 0.001) and 1.446-fold in age- and sex-adjusted risk (OR, 1.446; 95% CI, 1.349-1.549; p < 0.001) of developing uveitis. Median AL of uveitis eyes with infectious or non-infectious etiologies was significantly shorter than that in control eyes, suggesting an increased risk of developing uveitis in eyes with shorter AL. This feature should be considered when exploring new pathogenetic mechanisms of uveitis. What is known Shorter axial length may be associated with the pathogenesis of central serous chorioretinopathy and increased risk of early age-related macular degeneration. What is new Here we assessed the relationship between myopia and uveitis by comparing axial lengths of uveitis patients. Median axial length in all uveitis eyes was significantly shorter than in control eyes, and axial length remained significantly shorter in uveitis than in control after age- and sex-adjustment. Each millimeter decrease in axial length was associated with 1.266-fold increase in unadjusted risk and 1.446-fold in age- and sex-adjusted risk of developing uveitis.

Reliability and validity test of the Chinese version of the spiritual care-giving scale in nursing undergraduates and its application

Objective: To evaluate the reliability and validity of the Chinese Version of the Spiritual Care-giving Scale (C-SCGS) in nursing undergraduates and its application. Methods: This was a retrospective study. A questionnaire survey was conducted among 262 senior nursing undergraduates from Chengde Medical University, China from May to June, 2023 through convenience sampling method. The C-SCGS and the general demographic data table were employed to investigate the subjects. Results: The C-SCGS retained 34 items, and four common factors were extracted by exploratory factor analysis, with a cumulative contribution rate of 65.15%. The I-CVI value of the scale was 0.88-1.0, and the S-CVI/Ave value was 0.94. The Cronbach’s α coefficient of the total scale was 0.957, that of each dimension ranged from 0.850 to 0.944, with a split-half coefficient of 0.887. Conclusion: The C-SCGS may be used to evaluate the spiritual cognition of Chinese nursing undergraduates by virtue of its good reliability and validity. doi: https://doi.org/10.12669/pjms.40.10.9021 How to cite this: Huang Y, Lv D, Wang T, Zhang H, Zhang L. Reliability and validity test of the Chinese version of the spiritual care-giving scale in nursing undergraduates and its application. Pak J Med Sci. 2024;40(10):2313-2318. doi: https://doi.org/10.12669/pjms.40.10.9021 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.

Ferulic Acid in the Treatment of Papulopustular Rosacea: A Randomized Controlled Study.

Rosacea is a chronic inflammatory skin disease characterized by flushing, erythema, papules, and pustules on the central face. It affects patient appearance and is noted for its chronicity, recurrence, and resistance to treatment. Effective rosacea treatment requires repairing the skin barrier, reducing inflammation, and promoting vasoconstriction. This study aims to evaluate the efficacy of topical ferulic acid in treating papulopustular rosacea and its impact on skin barrier function. Sixty patients with mild to moderate papulopustular rosacea were selected from the Department of Dermatology at the Affiliated Hospital of Shandong Second Medical University between January 2023 and December 2023. Patients were randomly assigned to either a control group or an observation group, with 30 patients in each group. The observation group applied ferulic acid solution to the affected areas, while the control group used normal saline, both twice daily for 6 weeks. Both groups also received 0.1 g doxycycline hydrochloride tablets orally once daily. Skin lesions and skin barrier function were assessed using VISIA imaging and self-rating scales before and during treatment, and adverse reactions were recorded. After 6 weeks, both skin lesion assessments and self-assessment scores improved significantly from baseline, with greater improvement in the observation group compared to the control group (p < 0.05). Indicators of skin barrier function and VISIA imaging results demonstrated the efficacy of ferulic acid in treating rosacea. The total effective rate was significantly higher in the observation group (80.00%) compared to the control group (63.33%) (p < 0.05). In the observation group, nine patients (30.00%) experienced a greasy sensation initially, one patient (3.33%) reported tingling and itching, and no serious adverse reactions were observed. Ferulic acid is effective as an adjuvant treatment for papulopustular rosacea, significantly improving skin lesions and repairing skin barrier function with minimal adverse reactions.

Outcome of Targeted Driving Pressure Mechanical Ventilation in ARDS patients

Background: Lung protective strategy in acute respiratory distress syndrome (ARDS) patients is based on low tidal volume (VT), lower end-inspiratory (plateau) pressure and higher positive end-expiratory pressure (PEEP). But to predict body weight adjusted tidal volume, heterogeneous pathology of the lung in ARDS with different respiratory system compliance (CRS) is not considered. In driving pressure (ΔP=VT / CRS) tidal volume (VT) is normalized to functional lung size. It is unclear whether mechanical ventilation targeting driving pressure (ΔP) is more effective than low tidal volume ventilation (LTVV) in patients with ARDS. Materials and Methods: An open labelled randomized controlled trial was conducted at Intensive Care Unit of Dhaka Medical College Hospital, a tertiary care referral hospital over 12 months from March 2021 to February 2022. Ninety two patients with ARDS, defined by the Berlin criteria, requiring mechanical ventilation were randomized to 1:1 ratio after enrollment in the study using simple random sampling, one group receiving targeted driving pressure (ΔP) that is &lt;/=14cm of H2O ventilation another group receiving low tidal volume ventilation (LTVV) that is 4-6ml/kg PBW. Results: The study found no significant differences between the two groups in terms of clinical variables and laboratory parameters (p &gt; 0.05), except for the duration of mechanical ventilation (MV), which was significantly shorter in the Targeted ΔP group (p&lt;0.05). Aspiration pneumonia was the most common cause of ARDS, occurring in 34.8% of the Targeted ΔP group and 39.1% of the LTVV group. The Targeted ΔP group demonstrated a significant increase in mean respiratory system compliance compared to the LTVV group (p&lt;0.001), and a significantly shorter length of ICU stay (p &lt;0.001). Additionally, the PaO2/FiO2 ratio was significantly higher in the Targeted ΔP group on Days 3, 5, and 7 (p&lt;0.05). Mean exhaled tidal volume was also significantly higher in the Targeted ΔP group on these days (p&lt;0.05). In the Targeted ΔP group, mean driving pressure significantly decreased on Days 3, 5, and 7 (p &lt;0.001), along with a significant reduction in mean plateau pressure (PPlt) (p &lt;0.001). Mean positive end-expiratory pressure (PEEP) significantly decreased on Days 3, 5, and 7 (p &lt;0.001). Respiratory rate significantly decreased on Day 7 (p &lt;0.05). Mean set tidal volume (VT) significantly increased on Days 3, 5, and 7 (p &lt;0.001). Moreover, the 28-day mortality incidence was significantly lower in the Targeted ΔP group compared to the LTVV group (8.7% vs. 26.1%, p &lt;0.05). Conclusion: Targeted Driving pressure (ΔP) guided ventilation offers significant clinical benefits over LTVV in managing ARDS patients in terms of increased respiratory system compliance (CRS), shorter lengths of hospital and ICU stays, and lower in-hospital mortality. Bangladesh Crit Care J September 2024; 12 (2): 81-88

Determinants affecting the medical students adoption of mobile learning: extended UTAUT

BackgroundThis research investigates the fundamental factors which may stymie or simplify the adoption of m-learning by medical college educators in Sudan. We made use of the Extended Unified Theory of Acceptance and Use Technology (UTAUT) with COVID-19 fear (CF) and social isolation (SIS) as exogenous components.ObjectiveThis research aims to find out factors impacting medical students’ behavioural intention to use mobile learning.MethodsData was gathered from 499 undergraduate learners from different universities in Sudan. Partial Least Square (PLS) and structural equation modeling (SEM) were used to examine the data.The resultsShowed that expected performance, effort expectancy (EE), social influence (SI), facilitation condition (FC), COVID-19 fear, and social isolation (SIS) are predictors of behavioural intentions (BI). In addition, our findings show that COVID-19 fear and social isolation increase student adoption of mobile learning during the COVID-19 epidemics in developing countries.ConclusionsThe study unveiled that the suggested framework, derived from UTAUT, effectively discerns the factors impacting students’ intentions in mobile learning during pandemics. Sudanese medical students’ can strategize and execute effective classroom environments based on these findings.

Evaluation of Bedside Lung Ultrasonography in Diagnosis of Acute Pulmonary Oedema

Background: Pulmonary oedema is one of the major causes of mortality and morbidity. Acute heart failure is the major cause of pulmonary oedema. NT-pro B-type natriuretic peptide has been found to be effective in distinguishing acute pulmonary oedema from other causes of dyspnea in the emergency care setting. But it is costly and time consuming. Bedside lung ultrasonography (LUS) is being considered as noninvasive, radiation-free and easy to perform tool to diagnosis pulmonary oedema. Objective: To determine the role of bedside LUS in diagnosis of patients with acute pulmonary oedema. Methods: This observational cross-sectional study was carried out in ICU, Department of Anaesthesia, Analgesia, Palliative &amp; Intensive Care Medicine, Dhaka Medical College Hospital, Dhaka from August 2018 to October 2019. Ethical approval was sought before conduction of the study. One hundred critically-ill patients with pulmonary oedema, detected by clinical examination &amp; chest X-ray, due to heart failure were included in the study. Routine labs including NT-pro B-type natriuretic peptide level were sent. Bedside LUS was done with a portable ultrasound machine. Data was collected by using a semi-structured data sheet. Observation and Results: The median age was 42 years (IQR 18-66). Among them, 67.71% were male. 90.0% of patients diagnosed as acute pulmonary oedema by NT-pro B-type natriuretic peptide levels findings and 88.5% of patients were diagnosed as acute pulmonary oedema by bedside lung ultrasonography. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of lung ultrasonography findings alone statistically significant as 94.2%, 66.7%, 96.4% &amp; 54.5% and 91.66% respectively in detection of pulmonary oedema. Conclusions: Bed side lung ultrasonography can be an effective adjunct tool for rapid and high diagnostic accuracy for diagnosis of acute pulmonary oedema along with NT pro BNP level in ICU. Bangladesh Crit Care J September 2024; 12 (2): 113-117

Evaluation of the Safety and Effectiveness of Ultrasound-guided Internal Jugular Vein Catheterization in Critically Ill Patients

Background:Central venous catheterization is a frequently performed procedure in intensive care units (ICU) for diagnostic and therapeutic purpose. As an invasive procedure it carries some risk and should be performed with few attempts. Traditionally this procedure is performed blindly by considering body surface landmark, but this procedure can be done with the help of ultrasound machine as an alternative of landmark procedure. Objectives: Evaluation of the safety and effectiveness of USG-guided internal jugular vein(IJV) catheterization in critically ill patients. Methods: This prospective observational study was conducted in the ICU of Dhaka Medical College Hospital, from May 2017 to October 2018. Patients scheduled for central venous catheterization via the IJV were included based on selection criteria and randomly allocated into two groups of 50 patients each using card sampling. Group A received ultrasound-guided catheterization, while the landmark technique was used in Group B. Results: The analysis revealed that in the ultrasound group 49 out of 50 (98.0%) patients were successfully catheterized while the landmark method was successful in 45 out of 50 (90.0%) patients. Successful catheterization by first attempt was possible in 29 patients of group A, where as it was 5 in group B. The average number of attempts for successful catheterization in Group A was 1.7 (SD=0.2) and in the landmark group it was 2.8 (SD=0.1). On the average, 4.9 minutes (SD=1.3) were needed for catheterization in ultrasound group. The time was significantly increased in the landmark group 11.4 (SD=5.8). Total number of complication was 2 in Group A and it was 8 in Group B. After considered all the above parameter, by using four points safety and effectiveness rating scale, safety and effectiveness mean score was 10.3 for Group A and 8.2 for Group B. Conclusion: Two-dimensional ultrasound offers improved safety and quality when compared with an anatomical landmark technique for IJV catheterization. Bangladesh Crit Care J September 2024; 12 (2): 96-104

Dysregulated renal tubular handling of filtered glucose in patients with type 2 diabetes mellitus: a descriptive study

Objective: To determine the frequency of suspected dysregulated renal tubular handling of filtered glucose, and its association with blood glucose levels in type 2 diabetes mellitus. Method: The analytical, cross-sectional study was conducted from November 2022 to June 2023 at the Department of Medicine along with the Department of Pathology and Biochemistry, Pakistan Railway Hospital, Islamic International Medical College, Rawalpindi, Pakistan, and comprised diabetics aged 19-80 years. Blood and urinary glucose were assessed at the point of contact. Blood glucose 80-180mg/dl was considered glucose in range and &gt;180mg/dl glucose above range. Hyper-function of sodium glucose transport receptors was suspected if urinary glucose was &lt;++ and the function of these receptors was considered normal if urinary sugar was ++ or more. Association of suspected receptors and their association with blood glucose levels was determined. Data was analysed using SPSS 26. Results: Of the 159 diabetics, 91(57%) were females and 68(43%) were males. The overall mean age was 57±11 years (range: 46-68 years). Of the total, 43(27%) patients had glucose in range and 116(73%) had glucose above range. Of the diabetics with glucose above range, 54(47%) patients had hyper-functioning sodium glucose transport receptors, and 62(53%) had normal functioning sodium glucose transport receptors. Of the patients with glucose in range, 11(26%) had hyper-functioning sodium glucose transport receptors, and 32(74%) had normal functioning sodium glucose transport receptors. There was a significant association between sodium glucose transport receptors’ function and blood glucose levels (p&lt;0.001). Conclusion: Dysfunction of sodium glucose transport receptors affected the secretion of glucose in the urine, resulting in impaired glucose regulation in type 2 diabetes mellitus cases. Key Words: Blood glucose, Diabetes, Glycosuria, Sodium-glucose transporter 2.

Clinical Study of Eclampsia Patients in Early Age Group of Women Admitted into DMCh between July 2023 to December 2023

Background: Eclampsia, characterized by the onset of seizures in women with preeclampsia, is a significant cause of maternal and neonatal mortality, especially in low-resource settings like Bangladesh. Young women, particularly those in their teenage years, are especially vulnerable to this life-threatening condition due to socio-economic and health factors. Objective: This study aims to assess the clinical outcomes of eclampsia patients aged 15 to 20 years admitted to Dhaka Medical College Hospital (DMCh) between July 2023 and December 2023. Method: A cross-sectional study was conducted at DMCh, focusing on young women diagnosed with eclampsia. Patients admitted with symptoms of preeclampsia or eclampsia after 20 weeks of gestation were included. Detailed clinical evaluations and sociodemographic data were collected, including obstetric history and predisposing factors. Diagnostic tests were performed, and management protocols were followed, including the administration of magnesium sulfate. Maternal and neonatal outcomes were monitored, including mode of delivery and complications. Results: The majority of eclampsia patients (39.13%) were aged 17-18 years, followed by 35% aged 15-16 years, with a significant proportion being primigravida (55%). Most cases occurred between 36-38 weeks of gestation (35%). Antepartum eclampsia accounted for 90% of cases, and 80% of deliveries were via cesarean section. Maternal outcomes revealed a 77% improvement rate, while neonatal outcomes showed an 80% survival rate, despite a 15% stillbirth rate. Conclusion: The findings indicate that eclampsia predominantly affects young, primigravida women in late gestation, with significant implications for maternal and neonatal health. The high incidence of cesarean deliveries and notable stillbirth rates highlight the need for improved prenatal care and postnatal monitoring in this vulnerable population. Addressing these gaps could help reduce the burden of eclampsia in young women in Bangladesh.

Outcomes of acetaminophen infusion on visual analogue scale with varying pain intensity during labour, A randomized controlled trial

Objective: Acetaminophen (Paracetamol) is the most widely used analgesic. We aimed to determine its efficacy in labour with varying pain intensity, to make labour less painful for women. Methods: This randomized controlled trial was conducted on primigravida’s in their active phase of first stage of labour at Pharmacology department of Army Medical College, National University of Medical Sciences in collaboration with Gynecology department of Pak Emirates Military hospital, Rawalpindi. It was a registered trial with trial number of IRCT20220308054220N1. Duration of study was from May 2022 to October 2022. Patients were divided into two groups, Group-I received two doses of I/V 100 ml normal saline whereas Group-II received I/V two doses of 1000 mg acetaminophen in 100 ml normal saline. Calculated sample size was 130, 65 in each group. Visual analogue scale was used as a tool for data measurement. Data was analysed using split plot anova test. Results: Mean VAS in acetaminophen infusion group was found to be less than placebo for 1st dose, but this effect was apparent only one hour after 2nd dose intervention. The difference in means between groups was statistically significant only for 1st dose with p-value of 0.003 (for second dose p-value 0.21). In acetaminophen infusion group, for both doses mean VAS decreased as an immediate effect of drug, but then it increased with time. The difference in VAS between intervals had p-value of &lt;0.001 for 1st dose and 0.005 for 2nd dose. Conclusion: Acetaminophen is an effective non opioid labour analgesic in active phase of first stage of labour. doi: https://doi.org/10.12669/pjms.40.10.8425 How to cite this: Najeeb W, Komal N, Noor M, Khan MA, Chaudry A. Outcomes of acetaminophen infusion on visual analogue scale with varying pain intensity during labour, A randomized controlled trial. Pak J Med Sci. 2024;40(10):2163-2169. doi: https://doi.org/10.12669/pjms.40.10.8425 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.

Hepatocellular Changes on Paracetamol Induced Liver Damage in Long Evans Male Rats upon Green Tea Administration

Background: The liver is a vital organ that serves a number of purposes in our body. It may be harmed by pollutants, substances with toxic effects, and long-term, unchecked drug use. Green tea is a well-liked beverage that has gained popularity recently and may have hepatoprotective properties. Objective: To observe the effect of green tea (Camellia sinensis) on paracetamol induced liver damage in Long Evans male rats. Methods: From July 1st, 2018, to June 30th, 2019, this study was conducted in the Department of Physiology at Sir Salimullah Medical College (SSMC), Dhaka. For the purpose of the study, thirty (30) male Long Evans rats, weighing between 150 and 200 grams and 90 to 120 days old, appeared to be in good health. They were split into two groups after 14 days of acclimatization: Group A, which served as the control group, and Group B, which served as the experimental group (green tea pretreatment and paracetamol treated). Group A1 (baseline control group) and group A2 (paracetamol treated control group) comprised the subdivided control group. There were ten rats in each of these groups. For 28 days, the rats were all fed a baseline diet. The baseline control group was given normal saline (20 ml/kg/day) orally every day for 28 days in addition to their basal diet. For the final three days of the study—the 26th and 28th—the paracetamol-treated control group was given oral paracetamol at a dose of 1.5 g/kg/day. During the final three days of the study period (the 26th and 28th days), the experimental group was given oral paracetamol (1.5g/kg/day) and an ethanolic extract of green tea (500 mg/kg/day) for a total of 28 days. On day 29, every rat was sacrificed. Following the sacrifice, liver samples were taken. Hepatic contents of malondialdehyde (MDA) were measured by using standard laboratory method. Histopathology of liver was also done by using standard laboratory procedure in the department of pathology, SSMC. Version 22 of the Statistical Package of Social Science (SPSS) for Windows was used to do the statistical analysis. The data were displayed as mean±SD. To compare the results, one-way ANOVA, post hoc Bonferroni, and Chi-square tests were used, where appropriate. A p value of less than 0.05 was regarded as significant. Result: When compared to the baseline control group, the mean malondialdehyde concentration in the liver was significantly (p) greater in the green tea pretreatment, paracetamol treated, and control groups who received paracetamol treatment. Once more, the groups treated with green tea and paracetamol had mean malondialdehyde concentrations in their livers that were significantly (p) lower than those of the paracetamol group. Additionally, 0% of the rats in the baseline control group, 100% of the rats in the paracetamol-treated group, and 30% of the rats in the green tea-pretreated and paracetamol-treated group had abnormal histological findings of the liver. Conclusion: This study revealed that green tea has hepatoprotective effect against paracetamol induced liver damage in Long Evans male rats. Bangladesh Crit Care J September 2024; 12 (2): 145-152

Long-term efficacy and safety of ab externo canaloplasty in the Polish Caucasian population with open-angle glaucoma: A 3-year retrospective study.

This study aimed to assess the effectiveness and safety of ab externo canaloplasty over a 3-year follow-up period in Polish Caucasian patients with glaucoma. This retrospective study of a cases series was conducted at the Department of Ophthalmology Medical University of Bialystok, Poland. Primary outcome measures were intraocular pressure and medication burden. Secondary outcome measures were best corrected visual acuity, retinal nerve fiber layer thickness, visual field test results, endothelial cell density, intraoperative and postoperative complications, and additional glaucoma surgery. The study group consisted of 160 eyes diagnosed with early to-moderate primary open-angle glaucoma and treated with ab externo canaloplasty from 2014 to 2020. The criteria for qualified and complete success were intraocular pressure < 18 mmHg or ≥ 20% reduction in intraocular pressure from baseline with or without antiglaucoma medications, respectively. After surgery, the mean intraocular pressure decreased from 19.23 ± 4.33 to 14.52 ± 3.79 mmHg, which constituted a 36.7 ± 7.8% reduction compared to the baseline value. The number of medications decreased by two at the end of the study period (from 2.69 ± 1.05 to 0.32 ± 0.75). Complete and qualified success were achieved in 58.7% and 68.7% of the patients, respectively, at the end of follow-up. An incomplete cannulation of Schlemm's canal was the most common intraoperative complication, occurring in 32 eyes (20%). The most frequent postoperative complications were hyphema, Descemet's membrane detachment, and a transient increase in intraocular pressure. Additional surgical procedure was required in seven cases (4.4%). In 16 patients (10%), medical treatment was re-administered. Overall, our findings suggest that ab externo canaloplasty is a good option for Polish Caucasian patients with primary open-angle glaucoma. It reduces intraocular pressure and has a low postoperative complication rate. Additional glaucoma surgery or re-administration of medications is required if the target intraocular pressure is unsatisfactory.