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

{"title":"Association Between Oral Health Status and Oral Frailty in Older Inpatients.","authors":"Qiang Ren, Weican Chen, Bingjie Zhang","doi":"10.29271/jcpsp.2026.09.1194","DOIUrl":"10.29271/jcpsp.2026.09.1194","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the relationship between oral health status and oral frailty in older inpatients, provide a basis for the early detection and treatment of oral frailty, and improve their health and quality of life.</p><p><strong>Study design: </strong>An observational study. Place and Duration of the Study: Department of Stomatology, Baoding No.1 Central Hospital, Baoding, China, from January 2022 to June 2025.</p><p><strong>Methodology: </strong>A total of 200 older inpatients were divided into frailty (n = 55) and non-frailty (n = 145) groups by using the Oral Frailty Index-8 (OFI-8). Data on demographics, lifestyle, medication, nutrition, inflammation, and oral health, including the General Oral Health Assessment Index (GOHAI) and results of the water-swallowing test, were collected. Statistical analyses employed univariate analysis, multivariate logistic regression, Spearman's correlation, and receiver operating characteristic curve analysis.</p><p><strong>Results: </strong>Significant differences were found in age, oral health indicators, and dental function between the groups (p.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 9","pages":"1194-1199"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Obstructive Sleep Apnoea Severity with Nocturnal Blood Pressure and Autonomic Dysfunction in Patients with Hypertension.","authors":"Huirong Sun, le Xie, Luzhen Gan, Yiye Wang","doi":"10.29271/jcpsp.2026.09.1170","DOIUrl":"10.29271/jcpsp.2026.09.1170","url":null,"abstract":"<p><strong>Objective: </strong>To determine the association of obstructive sleep apnoea (OSA) severity with nocturnal blood pressure patterns, blood pressure variability (BPV), and heart rate variability (HRV) in patients with hypertension.</p><p><strong>Study design: </strong>An observational study. Place and Duration of the Study: Cardiac Function Laboratory, Department of Cardiology, Xianning Central Hospital, the First Affiliated Hospital of Hubei University of Science and Technology, Xianming, China, from January 2024 to May 2025.</p><p><strong>Methodology: </strong>Adult hypertensive patients who underwent polysomnography (PSG) were analysed. OSA severity was defined by the apnoea-hypopnoea index (AHI). Available ambulatory blood pressure monitoring (ABPM) and Holter data were used to assess nocturnal systolic blood pressure (SBP) fall, non-dipping, BPV, and HRV. Group comparisons were performed using the Kruskal-Wallis test, the chi-square test, or Fisher's exact test, as appropriate. Spearman's correlation and regression analyses were performed where appropriate.</p><p><strong>Results: </strong>Eighty-six patients comprised the PSG cohort; 44 had ABPM data, and 60 had HRV data. Body mass index differed across OSA severity categories (severe OSA: 30.00 [27.92-33.60] kg/m2; p = 0.001). In the ABPM+PSG sub-cohort, nocturnal SBP fall showed a decreasing trend with increasing OSA severity (severe OSA: 2.43 [-1.89 to 7.68%]; p = 0.105). For every 10 events/hour increase in the AHI, nocturnal SBP increased after adjustment (β = 3.63, 95% CI 0.42-6.83; p = 0.032).</p><p><strong>Conclusion: </strong>Greater OSA severity was associated with higher nocturnal SBP and possible autonomic imbalance. ABPM with OSA screening may help identify high-risk nocturnal blood pressure phenotypes in hypertensive patients.</p><p><strong>Key words: </strong>Obstructive sleep apnoea, Hypertension, Ambulatory blood pressure monitoring, Circadian rhythm, Blood pressure variability, Heart rate variability.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 9","pages":"1170-1174"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Infection after Laparoscopic Cholecystectomy: Benchmarking Machine-Learning Models in a Real-World Cohort.","authors":"Hongwei Zhao, Jianzhe Wang, Qi Chen, Hang Yang, Guohua Fan","doi":"10.29271/jcpsp.2026.09.1132","DOIUrl":"https://doi.org/10.29271/jcpsp.2026.09.1132","url":null,"abstract":"<p><strong>Objective: </strong>To benchmark machine-learning (ML) models for predicting postoperative infection after laparoscopic cholecystectomy (LC) in a real-world cohort.</p><p><strong>Study design: </strong>A descriptive study. Place and Duration of the Study: Department of General Surgery, Daqing People's Hospital, Daqing, China, from January 2016 to December 2025.</p><p><strong>Methodology: </strong>Consecutive patients undergoing LC were included. Postoperative infection was defined as a clinically diagnosed or culture-proven infection during index hospitalisation or within 30 days after surgery, using CDC/NHSN-based criteria where applicable. The cohort (n = 1,155; 186 infections) was randomly split into training (n = 816) and internal validation sets (n = 339). Four classifiers [decision tree (DT), support vector machine with a radial basis function kernel (SVM-RBF), random forest (RF), and naive Bayes (NB)] were developed. Performance was assessed using AUC, accuracy, sensitivity, and specificity at a prespecified probability threshold of 0.50, with precision-recall analysis, calibration, decision curve analysis, and permutation feature importance serving as complementary assessments.</p><p><strong>Results: </strong>On validation, NB and RF showed the best discrimination (AUCs = 0.824 and 0.809, respectively), while DT and SVM-RBF performed poorly (AUCs = 0.614 and 0.582, respectively). At the 0.50 threshold, SVM-RBF predicted all validation patients as non-infected, indicating complete classification failure for clinical use. RF achieved high specificity (0.974) and accuracy (0.903), whereas NB yielded higher sensitivity (0.417). The highest-ranked RF predictors were preoperative white blood cell group, age, perioperative acute cholecystitis, the preoperative length-of-stay group, obesity, and operation duration group.</p><p><strong>Conclusion: </strong>ML models showed heterogeneous performance for predicting postoperative infection after LC. NB and RF performed best on internal validation and may support early risk stratification when paired with model interpretability, clinical utility assessment, external validation, and threshold optimisation. SVM-RBF was unsuitable for this dataset at the fixed 0.50 threshold.</p><p><strong>Key words: </strong>Laparoscopic cholecystectomy, Postoperative infection, Real-world cohort, Machine learning, Risk stratification.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 9","pages":"1132-1137"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Implications of Refined CD4⁺ T-Lymphocyte Count Stratification for 30-Day and 180-Day Mortality in HIV-Associated Pulmonary Cryptococcosis.","authors":"Sitong Wang, Yunlong Xue, Yulin Zhang","doi":"10.29271/jcpsp.2026.09.1151","DOIUrl":"https://doi.org/10.29271/jcpsp.2026.09.1151","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between refined CD4+ T-lymphocyte count stratification and 30-day and 180-day all-cause mortality in human immunodeficiency virus (HIV)-associated pulmonary cryptococcosis (PC), thereby supporting risk stratification and treatment optimisation.</p><p><strong>Study design: </strong>A descriptive analytical study. Place and Duration of the Study: Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, Beijing, China, from September 2020 to June 2025.</p><p><strong>Methodology: </strong>Ninety-eight patients with HIV-associated PC were stratified into four groups by baseline CD4+ T-lymphocyte counts, with mortality at 30 and 180 days as the primary outcomes. Kaplan-Meier analysis and multivariable and piecewise Cox regression were used to assess the association between CD4+ T-lymphocyte count stratification and mortality, with discrimination evaluated using the area under the curve (AUC) of the receiver operating characteristic curve (ROC) and Brier scores. Statistical analyses were performed using SPSS, R software, and GraphPad Prism.</p><p><strong>Results: </strong>In HIV-associated PC, 30-day and 180-day all-cause mortality varied significantly across CD4+ T-lymphocyte count strata, with progressively lower mortality among patients with higher CD4+ T-lymphocyte counts (30-day: Log-rank p = 0.016, trend p = 0.004; 180-day: Log-rank p = 0.008, trend p = 0.002). Refined CD4+ T-lymphocyte count stratification was a predictor of 30-day and 180-day mortality in HIV-associated PC (30-day: HR = 0.10, 95% CI: 0.01-0.96, p = 0.046; 180-day: HR = 0.31, 95% CI: 0.12-0.81, p = 0.017). C-reactive protein (CRP) levels, coexisting cryptococcal meningitis (CM), and combination antifungal therapy showed time-dependent effects, primarily within 30 days. The multivariable model demonstrated superior discrimination for both 30-day and 180-day mortality compared with the model based solely on CD4+ T-lymphocyte count strata.</p><p><strong>Conclusion: </strong>Lower refined baseline CD4+ T-lymphocyte count strata are associated with higher 30-day and 180-day mortality in HIV-associated PC and may help guide risk assessment and treatment decision-making.</p><p><strong>Key words: </strong>Human immunodeficiency virus, Pulmonary cryptococcosis, CD4+ T-lymphocyte count stratification, Mortality.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 9","pages":"1151-1159"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decades of Dengue in Pakistan: Is It Finally Time for a Vaccine?","authors":"Versha Rani Rai","doi":"10.29271/jcpsp.2026.09.1226","DOIUrl":"10.29271/jcpsp.2026.09.1226","url":null,"abstract":"<p><p></p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 9","pages":"1226"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunohistochemical Expression of Fascin-1 in Colorectal Carcinoma and Its Association with Pathological Grade and Stage.","authors":"Parsa Kainat, Zahid Ali Nohri, Muhammad Rahil Khan, Riyasat Ahmed Memon, Yusra Shafquat, Ikram Din Ujjan","doi":"10.29271/jcpsp.2026.09.1145","DOIUrl":"https://doi.org/10.29271/jcpsp.2026.09.1145","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the expression of Fascin-1 in colorectal carcinoma and analyse its association with clinicopathological parameters and pathological stage.</p><p><strong>Study design: </strong>A cross-sectional Study. Place and Duration of the Study: Department of Pathology, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan, from July 2022 to June 2023.</p><p><strong>Methodology: </strong>Surgical resection specimens of colorectal carcinoma underwent histopathological processing for the preparation of haematoxylin and eosin-stained slides. Immunohistochemical evaluation for the biomarker Fascin-1 was then performed, and its expression was evaluated according to standard criteria.</p><p><strong>Results: </strong>There was a total of 73 cases of colorectal cancer in this study. The mean age of patients was 44.76 ± 15.83 years (13-75 years). Histopathological subtype adenocarcinoma NOS was the most common finding on microscopic examination. Moderately differentiated tumours were the most frequent finding (63%, n = 46). In this study, most tumours were of the rectosigmoid region (26%, n = 19). Fascin-1 had positive expression in 46.6% (n = 34) cases. In histopathologic subtype, poorly differentiated tumours had a statistically significant expression of Fascin-1 (p = 0.001). ROC curve analysis of the continuous Fascin-1 product score against pathological stage demonstrated excellent predictive performance (AUC = 0.859, p <0.001). Multivariate analysis demonstrated higher expression of Fascin-1 to be a significant predictor of advanced stage (OR = 6.131, 95% CI: 1.197-31.410; p = 0.030). However, lymphovascular invasion (p = 0.082), tumour deposits (p = 0.798), and tumour grade (p = 0.315) did not show a significant association with advanced stage.</p><p><strong>Conclusion: </strong>Fascin-1 expression is significantly associated with advanced tumour stage in colorectal carcinoma. Independent association of Fascin-1 with staging in multivariate analysis suggests its potential role as a biomarker for tumour progression. Its higher expression in poorly differentiated tumours and signet ring cell carcinoma also supports its role in tumour aggressiveness.</p><p><strong>Key words: </strong>Colorectal neoplasms, Fascin-1, Immunohistochemistry, Neoplasm grading, Neoplasm staging.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 9","pages":"1145-1150"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking Transfusion Strategies in CABG: Acute Normovolaemic Haemodilution <em>versus</em> Conventional Transfusion: A Systematic Review.","authors":"Diyan Muhammad, Taimur Asif Ali, Muhammad Anas Khan, Adil Khan, Sabir Shah, Izaz Iqbal","doi":"10.29271/jcpsp.2026.09.1181","DOIUrl":"https://doi.org/10.29271/jcpsp.2026.09.1181","url":null,"abstract":"<p><p>Coronary artery bypass grafting (CABG) is among the most commonly performed cardiac surgical procedures worldwide and frequently requires perioperative blood transfusion. Acute normovolaemic haemodilution (ANH) is a simple and economical strategy that aims to reduce the need for allogeneic blood transfusion. A systematic review was conducted between October 2024 and August 2025 and analysed randomised controlled trials comparing ANH with conventional transfusion practices in patients undergoing coronary bypass surgery. Eighteen studies were evaluated for outcomes such as transfusion rates, blood loss, coagulation profiles, myocardial protection, postoperative complications, and cost-effectiveness. ANH reduced the need for allogeneic blood transfusion without affecting haemodynamic stability or postoperative recovery. Moderate improvements were observed in coagulation preservation and myocardial protection, although the certainty of evidence varied across outcomes. Further large-scale trials are required to establish standardised ANH protocols and clarify long-term clinical outcomes. Key Words: Acute normovolaemic haemodilution, Coronary artery bypass grafting, Blood conservation, Allogeneic transfusion.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 9","pages":"1181-1186"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appropriateness of Antibiotic Dosing in Patients with Augmented Renal Clearance in Cardiovascular Surgery and Coronary Intensive Care Units.","authors":"Ayse Gul Kocoglu Kinal, Yunus Emre Ayhan","doi":"10.29271/jcpsp.2026.09.1200","DOIUrl":"https://doi.org/10.29271/jcpsp.2026.09.1200","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the appropriateness of antibiotic dosing in patients with augmented renal clearance (ARC) admitted to the cardiovascular surgery intensive care unit (CVS-ICU) and the coronary intensive care unit (CICU).</p><p><strong>Study design: </strong>A descriptive study. Place and Duration of the Study: CVS-ICU and CICU, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkiye, from January 2024 to January 2025.</p><p><strong>Methodology: </strong>Adult patients (≥18 years) hospitalised for ≥24 hours, diagnosed with ARC (eGFR ≥130 mL/min/1.73 m2), and receiving antibiotics were included. Dosing appropriateness was assessed based on UpToDate® recommendations. ARC risk was stratified using the ARC scoring system. Data were analysed using descriptive statistics, chi-square test, and Mann-Whitney U test.</p><p><strong>Results: </strong>Of the 3,334 screened patients, 83 (2.5%) met ARC criteria; 57 received antibiotics and were included in the analysis. At least one dosing error was identified in 84.2% of cases, mostly underdosing (73.1%). The most common antibiotics were cefazolin (42.6%), ampicillin-sulbactam (14.6%), and daptomycin (7.3%). A high ARC risk score was associated with a greater likelihood of dosing errors (90.4% vs. 66.6%; OR = 4.7, p = 0.044). Patients with dosing errors were younger (median 25.5 vs. 50 years, p = 0.004) and received more antibiotics (p = 0.038).</p><p><strong>Conclusion: </strong>Although ARC was uncommon, dosing errors were frequent. Early recognition of ARC and individualised dosing are critical to optimise therapy in ICU patients.</p><p><strong>Key words: </strong>Augmented renal clearance, Antibiotic dosing, Cardiovascular surgery intensive care unit, Coronary intensive care unit, Dose adjustment.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 9","pages":"1200-1204"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calcified Pilomatricoma (Calcifying Epithelioma of Malherbe) of the Right Thigh: A Slow-Growing Lesion Present for 20 Years.","authors":"Paras Abbas, Rakhshanda Rashid, Shaista Khursheed","doi":"10.29271/jcpsp.2026.09.1229","DOIUrl":"10.29271/jcpsp.2026.09.1229","url":null,"abstract":"<p><p></p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 9","pages":"1229-1230"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paired Oesophageal Diverticula: An Unusual Endoscopic Finding.","authors":"Chen Yuan, Zhenguo Qiao","doi":"10.29271/jcpsp.2026.09.1225","DOIUrl":"10.29271/jcpsp.2026.09.1225","url":null,"abstract":"<p><p></p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 9","pages":"1225"},"PeriodicalIF":0.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}