Pakistan Journal of Medical Sciences最新文献

{"title":"Outcomes of Complex Iatrogenic Biliary Tract Injuries: Retrospective Single-Center Experience from Pakistan.","authors":"Nadir Farid, Muhammad Yasir Khan, Ihsan Ul Haq, Sohail Rashid","doi":"10.12669/pjms.42.3.14851","DOIUrl":"https://doi.org/10.12669/pjms.42.3.14851","url":null,"abstract":"<p><strong>Background & objective: </strong>Iatrogenic bile duct injury (IBDI) is a well-established complication of cholecystectomy. Effective management of this complex surgical complication necessitates early referral to high-volume hepatobiliary centers. The sequelae of this injury can lead to biliary peritonitis, recurrent cholangitis, biliary stricture, liver cirrhosis, sepsis, and even mortality. The aim of this study was to thoroughly examine the clinical presentation, injury grading, surgical approaches, and outcomes of patients with IBDI.</p><p><strong>Methodology: </strong>Data of all IBDI patients were collected, and 79 patients were included who underwent surgery between 1st January 2019 to 31st January 2025 at Hepato pancreato biliary department Pakistan Kidney and Liver Institute and Research Centre. Our primary outcomes included the success rate of different surgical procedures, postoperative morbidity and mortality, need for hepatic resection or liver transplantation, and length of hospital stay. Categorical data such as age, gender, risk factors, and diagnosis were presented as frequencies and percentages. Crude odds ratios (ORs) with 95% confidence intervals were determined for the risk of death.</p><p><strong>Results: </strong>A total of 79 patients met the selection criteria, including 18 (22.8%) males and 61 (77.2%) females. The median age of the patients was 43 years (IQR, 34-53 years). The majority of IBDI cases, 48 (60.8%), were treated with hepaticojejunostomy, followed by 16 (20.3%) with redo hepaticojejunostomy, and one patient underwent liver transplantation for secondary biliary cirrhosis. Right hepatectomy with biliary reconstruction was performed in 45.4% of cases with isolated RHA injury. The overall success rate was 96.2%, irrespective of the type of surgery performed. The median follow-up duration for the 77 patients was 20 months (IQR, 11-31 months). Two (2.5%) patients were lost to follow-up after the initial visit, and hospital mortality was observed in 2 (2.5%) patients. There was no statistically significant difference in postoperative complications across the different risk factors or surgical types. Postoperative morbidity occurred in 23 patients (29.1%), and these complications were more pronounced in E5 injuries associated with vascular involvement.</p><p><strong>Conclusion: </strong>IBDI represents a complex surgical complication that demands expertise, and inadequate reconstruction by the index surgeon should not be attempted. Early referral to high-volume hepatobiliary centers is recommended. Complex biliary and vascular injury is an independent risk factor for hepatectomy and significantly prolongs postoperative recovery but does not substantially compromise the long-term outcomes when adequately treated.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 3","pages":"570-577"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13080078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for surgical site infections after hysterectomy: A systematic review and meta-analysis.","authors":"Yaqing Yue, Tiantian Zhao","doi":"10.12669/pjms.42.3.13718","DOIUrl":"https://doi.org/10.12669/pjms.42.3.13718","url":null,"abstract":"<p><strong>Background & objective: </strong>Surgical site infections (SSIs) are a common complication following hysterectomy that is associated with higher morbidity, prolonged hospitalization, and a healthcare burden. Identifying key risk factors for SSIs will allow the development of effective prevention measures. Our objective weas to review and analyze potential risk factors associated with SSIs after hysterectomy, focusing on modifiable and non-modifiable contributors.</p><p><strong>Methodology: </strong>PubMed, EMBASE, Scopus, and CENTRAL databases were searched based on the PRISMA guidelines. The last electronic search was carried out on 30^th January 2025 to include studies to date. Sixteen studies with 165,589 participants were included. Random-effects meta-analysis was done to calculate odds ratios (OR) and 95% confidence intervals (CI). Heterogeneity was assessed using the I² statistic. <i>P</i> < 0.05 was considered significant. The protocol was registered in PROSPERO (CRD42025629931).</p><p><strong>Results: </strong>A total of 16 studies were included in this review. Key risk factors for SSIs included obesity [Body Mass Index (BMI) >30 kg/m²; OR = 3.34, 95% CI: 2.45-4.56], diabetes mellitus (OR = 1.82, 95% CI: 1.41-2.35), smoking (OR = 1.76, 95% CI: 1.37-2.26), and prolonged operative time (>2 hours; OR = 1.59, 95% CI: 1.19-2.11). Procedural factors such as open surgical approaches (OR = 2.88, 95% CI: 2.24-3.72) significantly increased SSIs risk. Additional contributing factors included prolonged hospital stays (>1 day; OR = 2.47, 95% CI: 1.78-3.43) and bowel resection (OR = 3.07, 95% CI: 1.71-5.49).</p><p><strong>Conclusion: </strong>Obesity, diabetes, smoking, and prolonged operative time are risk factors for SSIs that may be considered as modifiable for intervention. Evaluating these risk factors in patients undergoing hysterectomy may significantly reduce the burden of SSIs, improve outcomes, and lower healthcare costs.<b>Registration No.</b> (PROSPERO: # CRD42025629931).</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 3","pages":"784-795"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13080080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining physiotherapy students' level of knowledge about non-steroidal anti-inflammatory drugs.","authors":"Esin Ergonul, Tahir Keskin, Mesut Ergan, Ferdi Baskurt, Zeliha Baskurt, Mehtap Savran","doi":"10.12669/pjms.42.3.14070","DOIUrl":"https://doi.org/10.12669/pjms.42.3.14070","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the level and scope of knowledge regarding nonsteroidal anti-inflammatory drugs (NSAIDs) among physiotherapy students.</p><p><strong>Methodology: </strong>This cross-sectional study was conducted between March and June 2025 and included 175 undergraduate students enrolled in the Department of Physiotherapy and Rehabilitation at a university who had previously completed a pharmacology course. Participants were assessed using a questionnaire that evaluated their knowledge of NSAID indications, contraindications, and adverse effects. In addition, students' awareness of pharmacology education, current legal regulations, and potential interactions between NSAIDs and physiotherapy modalities was examined.</p><p><strong>Results: </strong>The majority of students expressed willingness to engage in non-medical prescribing. Participants demonstrated a moderate level of knowledge regarding NSAID indications and contraindications, while the level of knowledge about NSAID-related adverse effects was found to be low. In contrast, students showed a high level of knowledge concerning physiotherapy modalities and drug-physiotherapy interactions.</p><p><strong>Conclusions: </strong>Although physiotherapy students showed adequate awareness of drug-physiotherapy interactions, their overall knowledge of NSAIDs-particularly regarding adverse effects and clinical safety-was insufficient. Despite their willingness to engage in non-medical prescribing of NSAIDs, these findings highlight the need to strengthen undergraduate physiotherapy curricula with greater emphasis on NSAID-related education.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 3","pages":"610-616"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13080034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of task-oriented training based on sodium hyaluronate therapy on kinesiophobia in patients after anterior cruciate ligament reconstruction.","authors":"Yinghui Wang, Weihua Song, Hui Li, Chunhong Zhao","doi":"10.12669/pjms.42.3.12621","DOIUrl":"https://doi.org/10.12669/pjms.42.3.12621","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effect of task-oriented training (TOT) based on sodium hyaluronate therapy on kinesiophobia in patients after anterior cruciate ligament reconstruction (ACLR).</p><p><strong>Methodology: </strong>A total of 110 patients who underwent ACLR between January 2022 and January 2024 at Luohe Orthopedic Hospital, Luohe, China, were randomly divided into a control group (n=55) and an observation group (n=55) using a random number table. The study was a prospective, randomized controlled trial conducted from January 2022 to January 2024. All patients received sodium hyaluronate therapy. The control group received routine nursing care, while the observation group underwent TOT. The primary outcome measures included kinesiophobia scores (at rest and during activity), knee function scores (HSS scores) and pain scores (NRS scores) at one, three and six months postoperatively. Kinesiophobia scores (at rest and during activity) and knee function scores (HSS scores) at one, three and six months postoperatively were compared between the two groups. SPSS 22.0 with repeated measures ANOVA.</p><p><strong>Results: </strong>The observation group had significantly lower kinesiophobia scores and pain scores (at rest and during activity) than the control group (P<0.05). Additionally, the HSS scores in the observation group were significantly higher than those in the control group at all follow-up time points (P<0.05).</p><p><strong>Conclusion: </strong>TOT combined with sodium hyaluronate therapy can reduce the incidence of kinesiophobia and functional impairment after ACLR, promote knee function recovery and improve patients' quality of life.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 3","pages":"604-609"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13080046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of the integrated management model of medical care on non-attendance, satisfaction, and complications in adult patients undergoing day surgery for inguinal hernia.","authors":"Qian Sun, Shuhui Zhao, Xiaoshuang Liu, Jingchao Yang, Litao Liu","doi":"10.12669/pjms.42.3.13309","DOIUrl":"https://doi.org/10.12669/pjms.42.3.13309","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the efficacy of the integrated management model of medical care on the non-attendance rate, satisfaction rate, and incidence of complications in adult patients undergoing day surgery for inguinal hernia.</p><p><strong>Methodology: </strong>This was a retrospective study. A total of one hundred patients with inguinal hernia who underwent day surgery in Affiliated Hospital of Hebei University from January 2023 to May 2025 were selected as the subjects and were divided into an Intervention group(n=50) and a control group (n=50) according to intervention methods. Conventional management was implemented in the control group, while the integrated management model of medical care was adopted in the intervention group in addition to conventional management. The surgical non-attendance rate, incidence of adverse reactions, satisfaction, incidence of complications, and quality of life(QoL) were compared between the two groups.</p><p><strong>Results: </strong>The surgical non-attendance rate and incidence of adverse events in the observation group were significantly lower than those in the control group(P<0.05). Meanwhile, patient satisfaction in the observation group was higher than the control group(χ²=4.762, p=0.029). Additionally, the observation group incidence of complications was lower than the control group(p<0.05). Furthermore, KPS and SF-36 QoL scores in the observation group were significantly improved as compared to those in the control group(p<0.05).</p><p><strong>Conclusion: </strong>The integrated management model of medical care in adult patients undergoing day surgery for inguinal hernia exhibits satisfactory results and may significantly reduce the surgical non-attendance rate and incidence of adverse events and complications.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 3","pages":"743-747"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13080033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application and advantages of induced sputum cytology with gradient concentrations of hypertonic saline in the diagnosis of chronic cough.","authors":"Wei Luo, Hanxiao Xin, Pengyun Zhao, Ji Qi","doi":"10.12669/pjms.42.3.13191","DOIUrl":"https://doi.org/10.12669/pjms.42.3.13191","url":null,"abstract":"<p><strong>Objective: </strong>To explore the application and advantages of induced sputum cytology with gradient concentrations of hypertonic saline in the diagnosis of chronic cough (CC).</p><p><strong>Methodology: </strong>This was a prospective study. A total of 180 patients with CC admitted to Baoding No.1 Central Hospital between January 2022 to November 2024 were selected, and 115 individuals undergoing physical examinations during the same period were selected as the control group. Induced sputum cytology with gradient concentrations of hypertonic saline was conducted for all subjects. Analyzed the success rate of sputum induction and compared the results of sputum cytology examination of patients with different etiologies and the diagnosis rate of each test item for different etiologies.</p><p><strong>Results: </strong>The success rate of sputum induction was 92.78%(167/180), and the incidence of adverse reactions during the induction was 9.44%(17/180) in the patients with CC. These adverse reactions were resolved spontaneously after the induction was terminated. In patients with successful sputum induction, etiology was definitely diagnosed in 93.41%(156/176) patients, including cough variant asthma (CVA) in 38/156 patients (24.36%), eosinophilic bronchitis (EB) in 14/156 patients (8.97%), upper airway cough syndrome (UACS) in 25/156 patients (16.03%), gastroesophageal reflux cough (GERC) in 16/156 patients (10.26%), and atopic cough (AC) in 63/156 patients (40.38%). The etiology was unknown in 11/167 patients (6.59%).</p><p><strong>Conclusion: </strong>The success rate of sputum induction is high and the etiology is comprehensively diagnosed in patients with CC when induced sputum cytology with gradient concentrations of hypertonic saline is used.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 3","pages":"578-582"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13080091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in MELD-Na & Fibroscan Scores in Patients with Chronic Hepatitis-B on Entecavir: A Cohort Analysis.","authors":"Bader Faiyaz Zuberi, Faiza Sadaqat Ali, Tazeen Rasheed, Nimrah Bader","doi":"10.12669/pjms.42.3.12534","DOIUrl":"https://doi.org/10.12669/pjms.42.3.12534","url":null,"abstract":"<p><strong>Objective: </strong>To determine on-treatment changes in MELD-Na & Fibroscan scores after a period of six months in patients with chronic Hepatitis-B who are treated with Entecavir (ETV).</p><p><strong>Methodology: </strong>This observational cohort was conducted at Department of Medicine/Gastroenterology, Dow Medical College affiliated with Dow University of Health Sciences, Karachi, Pakistan during the period of August 2019 to December 2024. Patients of either gender aged between 18 - 80 years attending hepatitis clinic and who are on treatment for Hepatitis-B with Entecavir were inducted after informed consent. MELD-Na & Fibroscan scores were recorded at induction and after six months of treatment with ETV.</p><p><strong>Results: </strong>A total of 288 patients were enrolled including 153 (53.1%) were males with mean age of 37.6 ±11.6 years and 135 (46.9%) were females with mean age of 43.5 ±9.6 years. The difference in age between genders was significant (<i>p</i> < .001). Comparison of parameters at induction of study and after six months of treatment with Entecavir using Paired Sample T-Test, we found significant improvement in all parameters except serum albumin which showed significant reduction in levels after six months. MELD-Na Score improved from 9.38 to 8.94 (<i>p</i> <.001). CTP Score & Fibroscan improved from 5.7 to 5.66 (<i>p</i> <.001) & 8.95 to 8.61 (<i>p</i> <.001) respectively. Albumen values reduced from 4.08 to 3.98 (<i>p</i> <.001).</p><p><strong>Conclusion: </strong>Significant improvement in MELD-Na & Fibroscan scores were observed in patients on treatment with ETV.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 3","pages":"599-603"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13080092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary Prophylaxis of Hepatic encephalopathy in Liver cirrhosis: Rifixamine plus Probiotics vs. Rifixamine alone.","authors":"Khurram Shahzad, Shahid Sarwar, Samina Saeed, Amina Umer","doi":"10.12669/pjms.42.3.13066","DOIUrl":"https://doi.org/10.12669/pjms.42.3.13066","url":null,"abstract":"<p><strong>Objective: </strong>To determine the efficacy of adding probiotics with rifaximin for the secondary prevention of hepatic encephalopathy in patients with liver cirrhosis.</p><p><strong>Methodology: </strong>In this qausi experimental study, conducted in Department of Medicine, Jinnah Hospital Lahore from December 2024 to May 2025, 120 patients with liver cirrhosis and history of at least one episode of hepatic encephalopathy were enrolled. Participants were allocated into two groups: Group-A received rifaximin 550 mg twice daily along with Saccharomyces boulardii-based probiotics twice daily, while Group-B was treated with rifaximin alone. All patients were followed up for six months to monitor for recurrence of hepatic encephalopathy. Data analysis was conducted using SPSS 25 and p-value of less than 0.05 was considered statistically significant.</p><p><strong>Results: </strong>Among 120 included patients with a mean age of 55.71years (±10.18) and a male-to-female ratio of 1.2 (66/54), hepatic encephalopathy recurred in nine patients (15%) in Group-A compared to 23 patients (38.3%) in Group-B, (p=0.004). The baseline characteristics, including liver disease severity and comorbidities, were comparable between the groups. Among patients who experienced recurrence of hepatic encephalopathy there were no significant differences in age, duration of liver disease, INR, serum creatinine, albumin levels, or presence of ascites, highlighting the treatment regimen as the primary factor influencing outcomes.</p><p><strong>Conclusion: </strong>The addition of probiotics to rifaximin therapy markedly decreased the recurrence of hepatic encephalopathy compared to rifaximin alone, suggesting a more effective strategy for secondary prevention.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 3","pages":"642-646"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13080052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A clinical study on the augmented therapeutic effects of transcutaneous auricular vagus nerve stimulation combined with repetitive transcranial magnetic stimulation in the treatment of moderate-to-severe depression.","authors":"Shuhui Gao, Yuan Zhang, Kun Mi, Haizhu Yu, Mengxue Wu, Lin Li","doi":"10.12669/pjms.42.3.13028","DOIUrl":"https://doi.org/10.12669/pjms.42.3.13028","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical efficacy of transcutaneous auricular vagus nerve stimulation (taVNS) combined with repetitive transcranial magnetic stimulation (rTMS) in the treatment of moderate-to-severe depression.</p><p><strong>Methodology: </strong>This was a retrospective study. A total of 180 patients diagnosed with moderate-to-severe depression and admitted to Hebei Provincial Mental Health Center between July 2023 to March 2025 were enrolled and randomized into three groups(<i>n=</i> 60 each) using a random number table: the taVNS group (Group-A), the rTMS group (Group-R) and the taVNS + rTMS group (Group-C). All patients underwent a 4-week treatment course. Clinical outcomes, changes in depression severity, sleep quality and incidence of adverse events were assessed post-treatment. All outcome assessments were conducted under blinded conditions using standardized rating scales.</p><p><strong>Results: </strong>The overall response rate was 85% in Group-C, significantly higher than the 70% in Group-A and the 66% in Group-R (<i>p=</i> 0.02). Additionally, patients in Group-C showed significantly greater reductions in both Clinical Global Impression and Pittsburgh Sleep Quality Index scores compared with Groups A and R (both <i>p=</i> 0.00). No statistically significant differences were observed among the three groups in the incidence of adverse events(<i>p=</i> 0.60).</p><p><strong>Conclusion: </strong>The combination of taVNS and rTMS demonstrates a synergistic effect in the treatment of moderate-to-severe depression, which is considered a safe and effective therapeutic strategy as it can significantly improve clinical symptoms and sleep quality without increasing adverse effects.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 3","pages":"660-665"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13080050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147698450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total knee Arthroplasty: Patient expectations and outcomes in a resource constrained setting.","authors":"Muhammad Ahmed Ghazni Khan, Mohammad Ahsan Sulaiman, Mohammad Motiwala, Shahryar Noordin","doi":"10.12669/pjms.42.3.13328","DOIUrl":"https://doi.org/10.12669/pjms.42.3.13328","url":null,"abstract":"<p><strong>Objective: </strong>Knee osteoarthritis significantly impacts the quality of life, particularly in advanced stages. Total knee arthroplasty (TKA) is a common treatment, but 20-30% of patients remain dissatisfied despite clinical improvements. This study evaluates TKA outcomes using patient-reported outcome measures (PROMs) in a low-middle-income country context.</p><p><strong>Methodology: </strong>A prospective cohort study from Aga Khan University Hospital of 70 patients with end-stage knee osteoarthritis undergoing TKA was conducted from May, 2023 to December, 2023, Improvement in Knee injury and Osteoarthritis Outcome Score (KOOS-42) at three months post-TKA was assessed. The secondary objectives were to evaluate the correlation between patient expectations and outcomes, a comparison of unilateral and bilateral TKA, and the effects of patellar resurfacing and home-based physiotherapy. Data were analyzed using Stata 17.0.</p><p><strong>Results: </strong>Significant improvements in KOOS scores were observed three months post-TKA (mean 71.0 ± 7.3, P<0.001) compared to preoperative scores (26.3 [21.6-30]). Patient expectations were higher than actual postoperative outcomes (P<0.001). The pre-operative functional score and Patellar resurfacing improved symptom scores (P=0.003), while other factors like unilateral vs. bilateral TKA and home-based physiotherapy showed no significant impact on overall KOOS scores.</p><p><strong>Conclusion: </strong>TKA significantly improves patient-reported outcomes, but a gap remains between expectations and actual outcomes. Tailored patient education is crucial to manage expectations and enhance satisfaction, especially in resource-limited settings. These findings support the need for patient-centered care approaches in TKA.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 3","pages":"653-659"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13080094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147698459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}