Pakistan Journal of Medical Sciences最新文献

{"title":"Efficacy of Esketamine as an Adjuvant for Fascia Iliaca Compartment Block on Postoperative Analgesia in Elderly Patients Undergoing Total Hip Arthroplasty.","authors":"Xuandong Jia, Lidong Zhang, Maitao Zhou","doi":"10.12669/pjms.42.9.15889","DOIUrl":"https://doi.org/10.12669/pjms.42.9.15889","url":null,"abstract":"<p><strong>Objective: </strong>To study the efficacy of esketamine as an adjuvant for fascia iliaca compartment block (FICB) on postoperative analgesia in elderly patients undergoing total hip arthroplasty(THA).</p><p><strong>Methodology: </strong>This study is a single-center prospective randomized controlled study. Sixty elderly patients who underwent THA at the 904th Hospital of the Joint Logistics Support Force of PLA from August 2025 to December 2025 were randomly divided into the observation group and the control group by the random number table method. The observation group conducted FICB with esketamine at concentration of 0.3 mg/kg combined with 30 mL of 0.375% ropivacaine, while the control group conducted FICB with 30 mL of 0.375% ropivacaine alone. Postoperative pain intensity, intraoperative anesthetic consumption, first press time of patient-controlled intravenous analgesia (PCIA) pump , number of effective PCIA pump presses, frequency of rescue analgesia, duration of sensory block, patient satisfaction and adverse reactions were compared between two groups.</p><p><strong>Results: </strong>The observation group showed a significantly lower VAS score both at rest and exercise T6(P<0.05), T12(P<0.05).Whether at rest or at exercise, comparison of the VAS score trends over time between two groups showed statistically significant differences(P<0.05). Intraoperative anesthetic consumption, number of effective PCIA pump presses and frequency of rescue analgesia within 48 hours after opreation were also significantly lower in the observation group (P < 0.05). Duration of sensory block and time for PCIA pump first press were significantly longer in the observation group (P < 0.05).</p><p><strong>Conclusion: </strong>Esketamine used as an adjuvant in FICB is safe and effective for elderly patient undergoing THA, providing effective pain relief, prolonging postoperative analgesia duration, with few adverse reactions and high patient satisfaction. <b><i>Registration Number:</i></b> ChiCTR2500107235.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2398-2402"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113439","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":"Effect of early local cold compression therapy combined with rehabilitation exercises on local swelling and joint function recovery in patients with periarticular ankle fractures.","authors":"Yanan Zhao, Tiantian Wang, Yulin Liu, Li Zhu, Yuanyuan Liu","doi":"10.12669/pjms.42.9.15793","DOIUrl":"https://doi.org/10.12669/pjms.42.9.15793","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the effect of early local cold compression therapy combined with rehabilitation exercises on local swelling and joint function in patients with periarticular ankle fractures.</p><p><strong>Methodology: </strong>This was a retrospective study. A total of 60 patients with periarticular ankle fractures admitted to Baoding No.1 Central Hospital between June 2023 to June 2024 were enrolled in this study. The participants were divided into an observation group and a control group. The control group received conventional treatment (including bed rest, limb elevation, and intravenous sodium aescinate per institutional protocol) and functional exercises. The observation group received additional early local cold compression therapy (ice-water mixture, 20 minute sessions every four hours for 72 hours post-admission and post-surgery). Ankle swelling, pain intensity, range of motion (ROM), and the American Orthopaedic Foot and Ankle Society (AOFAS) scores were compared between groups.</p><p><strong>Results: </strong>Swelling and pain significantly decreased in both groups at all postoperative time points vs. baseline, with the observation group showing greater reductions(<i>P</i>< 0.05). Dorsiflexion, plantarflexion ROM, and AOFAS scores significantly increased in both groups, with the observation group showing greater improvement (<i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Early local cold compression therapy combined with rehabilitation exercises can significantly alleviate ankle swelling and pain, improve ankle function as assessed by the AOFAS Ankle-Hindfoot Scale, and accelerate the recovery of ankle ROM in patients with periarticular ankle fractures.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2330-2335"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113095","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 lenvatinib combined with sintilimab and transcatheter arterial chemoembolization in conversion therapy for unresectable hepatocellular carcinoma.","authors":"Jianwu Long, Jinli Zheng, Shiyi Chen, Peng Ou, Xianzhou Lu","doi":"10.12669/pjms.42.9.16251","DOIUrl":"https://doi.org/10.12669/pjms.42.9.16251","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the efficacy of lenvatinib combined with sintilimab versus transcatheter arterial chemoembolization (TACE) in the conversion therapy for unresectable hepatocellular carcinoma (HCC).</p><p><strong>Methodology: </strong>A retrospective analysis of the clinical data of 153 patients with unresectable HCC admitted to the Affiliated Hospital of Nanhua University from January 2023 to December 2024 was performed. According to the treatment regimens, the patients were divided into two groups: the study group (n=79) treated with lenvatinib plus sintilimab and the control group (n=74) treated with TACE. The efficacy of conversion therapy, tumor marker levels, tumor morphological features, blood supply, and adverse reactions were compared between the two groups.</p><p><strong>Results: </strong>Compared with those in the control group, the objective response rate (ORR) (67.09% vs. 47.30%, p=0.013), disease control rate (DCR) (91.14% vs. 79.73%, p=0.044), and conversion resection rate (48.10% vs. 28.38%, p=0.012) in the study group were significantly greater. Similarly, compared with the control group, the study group also exhibited lower levels of alpha-fetoprotein (AFP) (245.76±108.54 ng/mL vs. 186.42±95.37 ng/mL, p<0.0001), protein induced by vitamin K absence or antagonist II (PIVKA-II) (309.25±96.78 ng/mL vs. 245.68±82.35 ng/mL, p<0.0001), and chemokine (C-C motif) ligand 2 (CCL2) (71.76±23.81 ng/mL vs. 58.36±18.42 ng/mL, p<0.0001). Additionally, the blood flow signal intensity of tumor-feeding arteries (t=5.620; p<0.001), reduction rate of maximum tumor diameter (t=3.436; p<0.001), and tumor necrosis rate (t=7.025; p<0.001) were significantly better in the study group than in the control group. There was no significant difference in the incidence of adverse reactions, including hand-foot skin reactions (p=0.474), gastrointestinal reactions (p=0.875), liver function injury (p=0.672), myelosuppression (p=0.539), or fever (p=0.392), between the two groups (P>0.05).</p><p><strong>Conclusion: </strong>Compared with TACE, lenvatinib combined with sintilimab can improve the therapeutic efficacy of conversion therapy for unresectable HCC, with comparable safety.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2250-2257"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113453","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":"Heard, not judged: Adolescents' perspectives on quality of healthcare following self-harm.","authors":"Maryam Ayub, Nazish Imran, Amna Rashid, Taimia Ayub","doi":"10.12669/pjms.42.9.20335","DOIUrl":"https://doi.org/10.12669/pjms.42.9.20335","url":null,"abstract":"<p><strong>Objectives: </strong>The study aimed to identify the healthcare attributes most valued by adolescents with lived experience of self-harm, and to explore their qualitative experiences and recommendations to inform professional training.</p><p><strong>Methods: </strong>It was a convergent mixed-methods study done at Child and Family Psychiatry Department, Mayo Hospital, Lahore; over six months from 1^st January 2025 to 30^th June 2025. Ten adolescents with previous history of self-harm, were recruited via convenient sampling. In the quantitative component, participants ranked five care attributes by personal importance, which was analyzed via mean rank and Borda count. Four participants additionally participated in detailed qualitative interviews which were analyzed using framework analysis.</p><p><strong>Results: </strong>The mean age of participants was 15.3 years (Range: 13-17). In quantitative sample (n=10), <i>feeling heard and understood</i> ranked highest (M = 2.60; Borda = 24), followed by <i>empathy and non-judgmental attitude</i>, <i>clear communication</i>, and <i>privacy and confidentiality</i>. <i>Involvement in decision-making</i> ranked last. Through qualitative interviews (n=4), the findings reinforced and deepened these priorities across five themes: therapeutic relationship and emotional safety; communication style and interaction skills; understanding the young person's experience; support systems, agency, and recovery; and therapeutic techniques and practical interventions. Participants highlighted the harm caused by mocking or dismissive clinician behavior, and the value of calm, personalized, and play-inclusive care.</p><p><strong>Conclusions: </strong>The adolescents consistently prioritize relational and affective dimensions of care over procedural ones. These findings provide a coherent, patient-centered evidence base for designing healthcare professional training focused on adolescent self-harm.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2503-2511"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113475","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":"Placental Pathology in preeclampsia and gestational hypertension; A comparative study.","authors":"Ruqaiya Shahid, Muhammad Furqan Bari, Jahanara Hasan, Waqas Ahmed Farooqui","doi":"10.12669/pjms.42.9.16844","DOIUrl":"https://doi.org/10.12669/pjms.42.9.16844","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate placental histopathological lesions in hypertensive disorders of pregnancy and their association with maternal and fetal outcomes.</p><p><strong>Methodology: </strong>This cross-sectional study was conducted in the Departments of Pathology and Gynecology & Obstetrics, Dow Hospital, Dow University of Health Sciences, from January-December 2021. Seventy-six pregnant women were included: preeclampsia (n=29), gestational hypertension (n=24), and normotensive controls (n=23). Placentae were examined microscopically, and lesions were classified according to the Amsterdam criteria into maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), and inflammatory lesions. Association with clinical group was assessed by Poisson regression analysis, expressed as incidence rate ratio (IRR).</p><p><strong>Results: </strong>Placental lesion categories were significantly different across the clinical groups (p=0.018). MVM lesions, including accelerated villous maturation, distal villous hypoplasia, villous infarction, decidual arteriopathy, and low fetal-to-placental weight ratio, were increased in preeclampsia (IRR=4.4, p<0.001) and gestational hypertension (IRR=2.5, p=0.005). FVM showed no association. Inflammatory lesions demonstrated a borderline association with preeclampsia (IRR=3.2, p=0.039). Adverse maternal outcomes (eclampsia, ICU admission) and fetal outcomes (low birthweight, NICU admission, stillbirth) were significantly frequent in preeclampsia (p=0.002).</p><p><strong>Conclusion: </strong>Maternal vascular lesions were significantly increased, with a 4.4-fold increase in preeclampsia and a 2.5-fold increase in gestational hypertension, compared with normotensive pregnancies. These findings highlight the central role of maternal vascular pathology in the pathogenesis of hypertensive disorders and adverse maternal and fetal outcomes. We recommend high-quality antenatal care for early detection of hypertensive disorders and placental histopathology as a valuable diagnostic tool.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2526-2532"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113483","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":"Comparison of Flexural Strength and Flexural Modulus of Conventional and Graphene-Reinforced Polymethyl-Methacrylate under Thermocycled and Non-Thermocycled Conditions: An in-Vitro Study.","authors":"Wajiha Zia, Naseer Ahmed, Huda Adil, Rizwan Jouhar","doi":"10.12669/pjms.42.9.15454","DOIUrl":"https://doi.org/10.12669/pjms.42.9.15454","url":null,"abstract":"<p><strong>Background and objective: </strong>Polymethyl methacrylate (PMMA) is widely used as a denture base material, but its major disadvantage is its low flexural strength. Graphene has recently been proposed as a reinforcing nanofiller due to its superior mechanical properties, but evidence regarding its incorporation into PMMA and the influence of thermocycling remains limited. This study aimed to evaluate the effect of graphene reinforcement on the flexural strength (FS) and flexural modulus (FM) of PMMA and to assess the impact of thermocycling on these properties.</p><p><strong>Methodology: </strong>Seventy-six PMMA samples were fabricated and divided into two groups: conventional PMMA (n = 38) and G-PMMA reinforced with 0.25 wt% graphene (n = 38). Each group was further subdivided into thermocycled and non-thermocycled groups (n=19). All samples were subjected to three-point bending tests using a universal testing machine (UTM). Data was analyzed using a two-way ANOVA followed by Bonferroni correction. (p < 0.05).</p><p><strong>Results: </strong>G-PMMA displayed higher mean FS and FM than conventional PMMA in both thermocycled and non-thermocycled groups. Anova showed a statistically significant difference in flexural strength after thermocycling between PMMA and G-PMMA (p = 0.04), and for flexural modulus, PMMA vs G-PMMA, thermocycling, and their interaction had significant effects (p = 0.043, p = 0.016, and p < 0.001, respectively). Followed by pairwise comparisons, which revealed a statistically significant difference on FS between PMMA and G-PMMA after thermocycling. (p = 0.03).</p><p><strong>Conclusion: </strong>G-PMMA demonstrated significantly improved flexural strength and modulus compared to conventional PMMA. Thermocycling had no significant effect on flexural strength but influenced flexural modulus, indicating its impact on material stiffness rather than strength.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2540-2545"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113597","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 comparative analysis of cardiac bridging Integrator 1 (cBIN1) levels in patients with heart failure and healthy controls: A prospective case-control study.","authors":"Azhar Iqbal, Ruqaya Nangrejo, Muhammad Nauman Khan, Qamar Aziz","doi":"10.12669/pjms.42.9.16094","DOIUrl":"https://doi.org/10.12669/pjms.42.9.16094","url":null,"abstract":"<p><strong>Objectives: </strong>To compare cardiac bridging integrator 1 (cBIN1) levels between healthy individuals and patients with heart failure (HF), and to assess changes in cBIN1 levels following therapeutic intervention to evaluate its potential as a diagnostic and prognostic biomarker.</p><p><strong>Methodology: </strong>A case-control study with three months follow-up was conducted in the Department of Physiology, Baqai University Hospital, Karachi, Pakistan, from June 2024 to November 2024. A total of 200 adults aged 40-70 years were recruited, comprising 50 healthy controls with left ventricular ejection fraction (LVEF ≥60%) and 150 patients with heart failure (HF): Heart failure with reduced, moderatly reduced and preserved ejection fraction, HFrEF (LVEF ≤40%), HFmrEF (LVEF 40-49%) and HFpEF (LVEF ≥50%). Enzyme linked immuno-essay (ELISA) was used to measure the plasma cBIN1 level at baseline. For the statistical analysis, ANOVA and t-tests, as well as post-hoc testing with significance at p<0.05, were used.</p><p><strong>Results: </strong>Mean plasma cBIN1 was 9.221±0.440 ng/mL in healthy controls, 1.193±0.059 in HFpEF, 1.009±0.063 in HFmrEF and 0.799±0.050 in HFrEF (p<0.001), with the lowest levels in HFrEF on post-hoc testing (p<0.001 for all comparisons against controls). Levels were significantly lower in participants with higher BMI (3.19±3.65 vs 0.99±0.20; t=2.084, p=0.038) and did not differ significantly by gender (p>0.05). No significant change was observed after three months of follow-up (p=0.963).</p><p><strong>Conclusion: </strong>Plasma cBIN1 levels were significantly lower in patients with heart failure than in healthy controls, with the lowest levels observed in HFrEF. These findings suggest that cBIN1 may have value in stratifying HF severity and warrant evaluation in larger, multicenter cohorts.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2588-2594"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113508","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":"Sarcopenia and frailty in Parkinson's disease: A cross-sectional analytical study.","authors":"Tuba Tulay Koca, Cemile Buket Yildiz, Elif Ozel","doi":"10.12669/pjms.42.9.12273","DOIUrl":"https://doi.org/10.12669/pjms.42.9.12273","url":null,"abstract":"<p><strong>Objective: </strong>Sarcopenia and frailty are common geriatric syndromes characterized by high morbidity and low physical function. Here, we aimed to analyze risk of sarcopenia and frailty in patients with Parkinson's disease (PD).</p><p><strong>Methodology: </strong>The study was planned as cross-sectional and analytical at Physical Medicine and Rehabilitation Clinic between April and December in 2023. Sixty-two male/female patients diagnosed with PD were included in the study. SARC-F (Strength, Assistance, Rising, Climbing and Falls) (cut off ≥ 4) was used for sarcopenia risk. Muscle strength was evaluated with manual muscle strength and handgrip strength (HG). Clinical frailty scale (CFS) (<5 nonfrail) was used for frailty. Physical performance was evaluated with chair stand test and timed up and go test (TUG).</p><p><strong>Results: </strong>Total 23 female and 39 male patients with PD, with an average age of 66.2±11.4 years, were included in the study. Sarcopenia was detected in 35 (56.5%) of the participants, frailty was detected in 26 (41.9%) and malnutrition was detected in 12 (19.4%). Regardless of age (p=0.704), disease duration (p=0.157) and BMI (p=0.806); In the high sarcopenia risk group (n=35), the proportion of females sex (p=0.034) was high, while right handgrip strength (p=0.019) and left handgrip strength (p=0.003) were lower. In addition, Hoehn & Yahr staging was advanced (p=0.012), and Parkinson Disease Questionnaire (PDQ)-39 scores were higher (p<0.001) in the high sarcopenia risk group.</p><p><strong>Conclusion: </strong>Sarcopenia and frailty are commonly observed in PD and are associated with female sex, advanced disease stage and high severity, low physical performance, high kinesiophobia, higher prevalence of malnutrition, independent of age, disease duration and BMI.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2258-2263"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113532","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":"Carbetocin versus oxytocin during elective cesarean delivery: A randomized double-blind trial.","authors":"Baran Tureli, Nurettin Kurt, Erbil Karaman, Nureddin Yuzkat","doi":"10.12669/pjms.42.9.13879","DOIUrl":"https://doi.org/10.12669/pjms.42.9.13879","url":null,"abstract":"<p><strong>Objective: </strong>Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity following cesarean delivery. This study aimed to compare the effects of carbetocin and oxytocin on intraoperative blood loss during elective cesarean delivery, with secondary evaluation of uterine tone, additional uterotonic requirements, and intraoperative hemodynamic parameters.</p><p><strong>Methodology: </strong>This prospective, randomized, double-blind study was conducted at Van Yuzuncu Yil University Dursun Odabaş Medical Center between 2023 and 2024 and included 100 patients undergoing elective cesarean delivery. Patients were randomly assigned to receive either oxytocin (Group O; 0.6 IU intravenous bolus followed by a 15 IU/h infusion) or carbetocin (Group C; 100 μg administered intravenously over 30-60 seconds). Patients with major obstetric complications, placental invasion disorders, hypertensive disorders of pregnancy, significant cardiovascular or respiratory disease, or hepatic or renal dysfunction were excluded. Intraoperative blood loss, uterine tone, additional uterotonic requirements, and hemodynamic parameters were compared.</p><p><strong>Results: </strong>Baseline demographic characteristics were comparable between groups (p>0.05). Intraoperative blood loss was significantly lower in the carbetocin group than in the oxytocin group (p<0.001). The need for additional uterotonic agents was significantly lower in the carbetocin group both within the first 5 minutes (2% vs. 12%) and throughout surgery (10% vs. 26%) (p<0.05 for both). Uterine tone was significantly higher in the carbetocin group at 5 minutes (p=0.016), whereas higher scores were observed in the oxytocin group at 10 minutes (p=0.034). No clinically significant differences were observed in intraoperative hemodynamic parameters.</p><p><strong>Conclusion: </strong>Although carbetocin and oxytocin demonstrated comparable intraoperative hemodynamic profiles, carbetocin was associated with reduced intraoperative blood loss, improved early uterine tone, and a lower requirement for additional uterotonic agents. Its single-dose administration and favorable safety profile make it a practical and effective uterotonic option for elective cesarean delivery.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2227-2234"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113581","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":"The influence of recipient's pre-existing diabetes mellitus on outcomes of living donor kidney transplant.","authors":"Hina Shahabuddin, Zareen Kiran, Muhammad Tassaduq Khan, Abdur Rasheed","doi":"10.12669/pjms.42.9.13651","DOIUrl":"https://doi.org/10.12669/pjms.42.9.13651","url":null,"abstract":"<p><strong>Objective: </strong>To determine the influence of recipients' pre-existing diabetes mellitus on the outcomes of living donor kidney transplantation.</p><p><strong>Methodology: </strong>This prospective observational cohort study included 202 patients who underwent kidney transplantation between September 2022 and December 2023 at Dow University Hospital, Pakistan, and were stratified into two equal groups: pre-existing diabetes and non-diabetes. Patients with new-onset diabetes after transplantation were excluded. Demographic and clinical data were collected. Outcomes, including one-year patient survival and post-transplant complications, were assessed and compared.</p><p><strong>Results: </strong>Complications were high in the pre-existing diabetes group (57.4% vs. 28.7%, p <0.001). Infections occurred in 46.5% of patients with pre-existing diabetes versus 22.8% non-DM (p <0.001). Post-transplant cardiovascular events were observed in 6.9% of patients in the pre-existing DM group, whereas none were observed in the non-DM group (p = 0.014). One-year patient survival was 88.1% in the pre-existing DM group versus 95% in the non-DM group (p = 0.075). Graft-related complications did not differ significantly between the groups. Multivariate analysis identified pre-transplant congestive heart failure (HR = 99.431, [95% CI 7.709-128.441, p <0.001]), pre-transplant peripheral vascular disease (HR =7.787, [95% CI 1.197-50.682, p = 0.032]), post-transplant cardiovascular events (HR = 7.839, [95% CI 1.423-43.198, p = 0.018]), and post-transplant FBS (HR = 1.023, [95% CI 1.001-1.046, p = 0.040]) as independent predictors of mortality.</p><p><strong>Conclusion: </strong>Diabetes did not influence one-year patient survival and graft-specific outcomes but led to frequent post-transplant complications. Pre- and post-transplant cardiovascular disease and elevated post-transplant FBS levels were associated with mortality. Therefore, structured pre-transplant cardiovascular assessment and optimization, ongoing post-transplant cardiovascular surveillance, and strict glycemic control are required.</p>","PeriodicalId":19958,"journal":{"name":"Pakistan Journal of Medical Sciences","volume":"42 9","pages":"2199-2205"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113552","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}