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

{"title":"Effects of Esketamine on Haemodynamics and Inflammatory Stress Response in Elderly Patients Undergoing Proximal Femoral Surgery.","authors":"Xuandong Jia, Xingzhi Liao, Maitao Zhou","doi":"10.29271/jcpsp.2025.02.141","DOIUrl":"https://doi.org/10.29271/jcpsp.2025.02.141","url":null,"abstract":"<p><strong>Objective: </strong>To determine the effects of esketamine combined with iliac fascia block on haemodynamics and inflammatory stress response in elderly patients undergoing proximal femoral nail anti-rotation (PFNA) surgery.</p><p><strong>Study design: </strong>A single-centre randomised controlled trial. Place and Duration of the Study: Deparment of Anaesthesiology, the 904th Hospital of the Joint Logistic Support Force of PLA, Wuxi, Jiangsu Province, China, from January to December 2023.</p><p><strong>Methodology: </strong>Eighty elderly patients undergoing PFNA surgery in the authors' hospital were selected as the research objects, regardless of gender, aged >65 years, with a body mass index (BMI) of 18-28 kg/m2, and the American Society of Anaesthesiologists (ASA) scores of II-III. Eighty elderly patients were randomly divided into the following two groups: The observation group (esketamine combined iliac fascia block) and the control group (remifentanil combined iliac fascia block). Heart rate (HR), mean arterial pressure (MAP), and pulse oxygen saturation (SpO2) were recorded at entry (T0), incision (T1), 15 minutes after incision (T2), and at the completion of surgery (T3). Before and 24 hours after surgery, interleukin-6 (IL-6) and C-reactive protein (CRP) were measured. Recovery quality was recorded 24 hours after surgery. The patients' anaesthesia-effect on adverse reactions were recorded during and after surgery.</p><p><strong>Results: </strong>There was a significant difference between the two groups in the following indices: HR, MAP, and SpO2 at T1 (p <0.05). The values of IL-6 and CRP in the control group were prominently higher than those in the observation group 24 hours after surgery (p <0.05). The quality of recovery-15 (QoR-15) score of the control group was prominently lower than that of the observation group. The total incidence of adverse reactions of the control group was prominently higher than that of the observation group (p <0.05).</p><p><strong>Conclusion: </strong>Implementing an anaesthesia regimen of esketamine combined with iliac fascia block for elderly patients undergoing PFNA surgery can help maintain haemodynamic stability and suppress the inflammatory stress responses.</p><p><strong>Key words: </strong>Esketamine, Iliac fascia block, Internal fixation with anti-rotation intramedullary nails in the proximal femur, Haemodynamics, Inflammatory stress response.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"35 2","pages":"141-146"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401118","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":"STN and GPi-Deep Brain Stimulation for Primary Cervical Dystonia.","authors":"Tian Wei, Zhu Guanyu, Fan Shiying, Meng Fangang, Yang Anchao, Zhang Jianguo","doi":"10.29271/jcpsp.2025.02.234","DOIUrl":"https://doi.org/10.29271/jcpsp.2025.02.234","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the safety and efficiency of deep brain stimulation (DBS) in the treatment of primary cervical dystonia (CD) and to compare the difference between the STN (subthalamic nucleus)-DBS and GPi (Globus Pallidus internus)-DBS.</p><p><strong>Study design: </strong>Experimental study. Place and Duration of the Study: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, from January 2012 to December 2021.</p><p><strong>Methodology: </strong>This study analysed the effects of DBS on 34 patients with primary cervical dystonia (CD) based on the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). It included 15 STN-DBS and 19 GPi-DBS cases, with TWSTRS scores collected at baseline and the final follow-up. Stimulation parameters and adverse events were also recorded.</p><p><strong>Results: </strong>The mean follow-up time was 42.77 ± 27.46 months. A significant improvement in TWSTRS total scores was observed in all patients (p <0.001), with no significant difference between STN-DBS and GPi-DBS groups (p = 0.481). The amplitude of stimulation in the GPi group was found to be higher than that in the STN group (p <0.001). Adverse events included one case of electrode breakage in the STN-DBS group, mild dyskinesias in 14 patients (twelve from the STN-DBS group and two from the GPi-DBS group), and other stimulation-related complications in four patients (one from the STN-DBS group and three from the GPi-DBS group). All stimulation-related complications were manageable with parameter adjustments.</p><p><strong>Conclusion: </strong>DBS can significantly improve the symptoms of primary CD patients, with no significant difference in outcomes between STN-DBS and GPi-DBS. It has a good long-term therapeutic effect and surgical safety.</p><p><strong>Key words: </strong>Cervical dystonia, Deep brain stimulation, Globus pallidus internus, Subthalamic nucleus.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"35 2","pages":"234-237"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400912","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":"The Relationship of Serum Vitamin B12 and Ferritin Levels with Disease Severity and Neuropathic Pain in Fibromyalgia Syndrome.","authors":"Meral Kirmizi Bingol, Semra Akturk, Raikan Buyukavci, Sezgin Zontul","doi":"10.29271/jcpsp.2025.02.209","DOIUrl":"https://doi.org/10.29271/jcpsp.2025.02.209","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the relationship of serum vitamin B12 (vB12) and ferritin levels with disease severity and neuropathic pain in fibromyalgia syndrome (FMS).</p><p><strong>Study design: </strong>Observational study. Place and Duration of the Study: Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Inonu University, Malatya, Turkiye, from October to December 2023.</p><p><strong>Methodology: </strong>A total of 110 patients, aged between 18 and 65 years, diagnosed with FMS according to the 2016 ACR diagnostic criteria, were included in this study. The participants were evaluated using the Fibromyalgia Impact Questionnaire (FIQ) to measure symptoms impacting daily activities such as pain, sleep disturbances, and fatigue. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) is a clinical scale used to investigate the neuropathic component of pain. The serum levels of vB12 and ferritin were compared between the patients with and without neuropathic pain symptoms and the impact of these parameters on disease severity and activities of daily life was analysed.</p><p><strong>Results: </strong>Among the participants, 105 were females and 5 were males. Sixty-nine patients reported neuropathic pain, while 41 did not. Patients with neuropathic pain had significantly higher VAS and FIQ scores and significantly lower vB12 and ferritin levels (p <0.05). A significant inverse relationship was found between FIQ scores and both vB12 levels (p = 0.047, r = -0.190) and ferritin levels (p = 0.007, r = -0.256).</p><p><strong>Conclusion: </strong>In this study, fibromyalgia patients with neuropathic pain had higher pain and disease activity scores, and low serum vB12 and ferritin levels were found to be associated with disease severity and neuropathic pain.</p><p><strong>Key words: </strong>Fibromyalgia syndrome, Neuropathic pain, Vitamin B12, Ferritin, Pain.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"35 2","pages":"209-212"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400917","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":"Treatment Outcome of Haematopoietic Stem Cell Transplant in Fanconi Anaemia: Experience from a Low- and Middle-Income Country.","authors":"Hashim Khan, Tariq Ghafoor, Tariq Azam Khattak, Nighat Shahbaz, Munazza Nabi Awan, Awais Siddiq","doi":"10.29271/jcpsp.2025.02.242","DOIUrl":"https://doi.org/10.29271/jcpsp.2025.02.242","url":null,"abstract":"<p><strong>Objective: </strong>To determine the outcome of haematopoietic stem cell transplantation (HSCT) in Fanconi anaemia (FA) patients.</p><p><strong>Study design: </strong>Retrospective observational study. Place and Duration of the Study: Department of Clinical Haematology, Armed Forces Bone Marrow Transplant Centre, CMH Rawalpindi, Pakistan,  from February 2009 to December 2023.</p><p><strong>Methodology: </strong>The data of 41 cases of FA undergoing HSCT were analysed retrospectively, from February 2009 to December 2023. Cases transformed into myelodysplastic syndrome (MDS) and acute myeloid leukaemia (AML) were excluded. All cases of FA under 18 years of age having fully HLA-matched HSCT were included. A non-myeloablative conditioning regimen consisting of Flu120/Cy30/ATG20 was used. Descriptive statistics were obtained for harvest source, complications, graft success, and survival.</p><p><strong>Results: </strong>The study included 27 (65.9%) boys and 14 (34.1%) girls with a mean age of 10.3 ± 3.1 years. Bone marrow as a stem cell source was harvested in 33 (80.5%) cases. Cyclosporin-induced hypertension was documented in 36 (87.8%) cases. The cumulative incidence of acute GVHD and chronic GVHD was 34.1% and 32.3%, respectively. Six (14.6%) patients had graft failure, three had primary graft failure, and three had secondary graft failure. At a median follow-up of 63.8 ± 46.1 months, the overall survival  (OS) rate was 73.2% and the disease-free survival (DFS) rate was 73.2%.</p><p><strong>Conclusion: </strong>Overall survival of more than 70% is promising but inferior to that in developed countries. Graft failure, infectious complications, and GVHD remain major challenges requiring improvement in the developing countries.</p><p><strong>Key words: </strong>Haematopoietic stem cell transplantation, Fanconi anaemia, Pakistan.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"35 2","pages":"242-246"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400924","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":"Role of PET/CT Imaging Thyroid Cancers.","authors":"Maseeh Uz Zaman, Nosheen Fatima","doi":"10.29271/jcpsp.2025.02.139","DOIUrl":"https://doi.org/10.29271/jcpsp.2025.02.139","url":null,"abstract":"<p><p>Null.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"35 2","pages":"139-140"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400970","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":"Alkaline Phosphatase: A Prognostic Biomarker in Non-Metastatic Colon Adenocarcinoma Patients - A Single-Centre Study.","authors":"Aminuddin Sheikh, Syed Amir Maqbool, Uzma Raza, Mahay Rookh Asif, Fatima Rizvi, Uzma Bukhari","doi":"10.29271/jcpsp.2025.02.185","DOIUrl":"https://doi.org/10.29271/jcpsp.2025.02.185","url":null,"abstract":"<p><strong>Objective: </strong> To determine the prognostic significance of liver enzymes in colon carcinoma occurrence in country lifestyle and treatment follow-ups and to correlate them with tumour histopathology.</p><p><strong>Study design: </strong>A cross-sectional study. Place and Duration of the Study: Department of Oncology, Karachi Institute of Radiotherapy and Nuclear Medicine, Karachi, Pakistan, from May 2023 to July 2024.</p><p><strong>Methodology: </strong>Two hundred non-metastatic colon cancer patients with adenocarcinoma were selected from all provinces and compared with one hundred control subjects. Histopathological patients were grouped based on tumour grade and location. Treatment grouping was according to the prescribed chemotherapy FOLFOX-6 (n = 59), FOLFIRI (n = 82), and FOLFIRI + Bevacizumab (n = 59). Liver enzymes (alkaline phosphatase, alanine transaminase) and CEA colon were estimated by SPSS version 23. ANOVA was used for continuous variable comparison.</p><p><strong>Results: </strong>Alanine transaminase (ALT) and Alkaline phosphatase (ALP) levels were significantly elevated in patients across all tumour grades before treatment (p <0.05). A progressive significant decrease in ALP and carcinoembryonic antigen (CEA) levels was observed in resectable carcinoma patients on chemotherapy across all treatment groups (p <0.05). FOLFOX and FOLFIRI significantly decreased ALT levels in well and moderately differentiated carcinoma patients (p <0.05), whereas adding bevacizumab to FOLFIRI decreased ALT levels in poorly differentiated carcinoma patients, depending on tumour location (p <0.05). ALP levels correlate with symptom duration (p <0.05). Lifestyle was found associated with tumour histological grade.</p><p><strong>Conclusion: </strong>A significant increase in ALP levels with symptom duration and decrease with treatment progress, identifies its significance as a prognostic marker in non-metastatic colon adenocarcinoma patients. Country lifestyle plays a role in colon adenocarcinoma occurrence.</p><p><strong>Key words: </strong>Colonic neoplasm, Alkaline phosphatase, Bevacizumab, Prognostic marker, Alanine transaminase.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"35 2","pages":"185-190"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401101","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":"CD9 as a Potential Prognostic Biomarker in Paediatric B-Cell Acute Lymphoblastic Leukaemia.","authors":"Fatima Meraj, Neelum Mansoor, Omer Javed, Saba Jamal","doi":"10.29271/jcpsp.2025.02.191","DOIUrl":"https://doi.org/10.29271/jcpsp.2025.02.191","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the role of CD9 for predicting ETV6::RUNX1, BCR::ABL1, and KMT2A fusion genes with prognostic significance in B-cell acute lymphoblastic leukaemia (B-ALL).</p><p><strong>Study design: </strong>An observational study. Place and Duration of the Study: Indus Hospital and Health Network, Karachi, Pakistan, from May 2020 to August 2022.</p><p><strong>Methodology: </strong>Data of 488 paediatric (B-ALL) children diagnosed by flow cytometry were retrieved. Recurrent genetic abnormalities for BCR::ABL1, ETV6::RUNX1, and KMT2A fusion genes were retrospectively monitored. Fisher's Exact, Pearson's Chi-Square, and Mann-Whitney U tests along with univariate and multivariate analyses were performed.</p><p><strong>Results: </strong>The frequency of BCR::ABL1 was 9.01% [p = 0.097]. The ETV6::RUNX1 gene rearrangement was observed in 37.0% vs. 52.6% (p = 0.168), and KMT2A gene rearrangement in 8.52% vs. 10.5% (p = 0.690) in CD9+ and CD9- groups, respectively. The potential significance of BCR::ABL1 suggests CD9's role in indicating the presence of this unfavourable genetic marker, while for ETV6::RUNX1, CD9 expression may be linked to a less positive genetic profile. Lymphadenopathy was significant in CD9+ group, while bone marrow blast counts were notable in CD9- group. The survival rates did not significantly differ between the two groups.</p><p><strong>Conclusion: </strong>CD9 can be used as a surrogate biomarker in predicting disease prognosis by recognising the patients with high-risk factors i.e., lymphadenopathy, elevated white blood cells, possible occurrence of BCR::ABL1, and the scarcity of ETV6::RUNX1 within the CD9+ group.</p><p><strong>Key words: </strong>Immunophenotyping, Cytogenetics, Gene rearrangement, CD9 expression, Prognostic marker.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"35 2","pages":"191-196"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401109","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":"Clinicohaematological Characteristics, Cytogenetic Profile, and Risk Stratification in Myelodysplastic Syndrome: A Study from Pakistan.","authors":"Alia Waheed, Saleem Ahmed Khan, Ayesha Khursheed, Rafia Mahmood, Humayoon Shafique Satti, Hamid Saeed Malik","doi":"10.29271/jcpsp.2025.02.162","DOIUrl":"https://doi.org/10.29271/jcpsp.2025.02.162","url":null,"abstract":"<p><strong>Objective: </strong>To determine the clinicohaematological characteristics, cytogenetic abnormalities, and risk profiles of treatment-naive Pakistani myelodysplastic syndrome (MDS) patients.</p><p><strong>Study design: </strong>Descriptive study. Place and Duration of the Study: Department of Haematology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from June 2019 to 2023.</p><p><strong>Methodology: </strong>MDS was diagnosed following the World Health Organization (WHO) criteria, with detailed documentation of clinicohaematological parameters and cytogenetic findings. Risk assessment was done using the Revised International Prognostic Scoring System (IPSS-R). Descriptive statistics summarised the patient characteristics, while Chi-square and parametric or non-parametric tests facilitated comparisons. Survival analysis utilised Cox proportional hazard models and Kaplan-Meier survival curves.</p><p><strong>Results: </strong>A total of 47 MDS patients were assessed, with a median age of 66 years (IQR = 20) and a male predominance (68%). Anaemia (haemoglobin <10 g/dL) was the most frequent presentation, observed in 95.7% of patients. MDS with multilineage dysplasia was the most common subtype, diagnosed in 59.6% of cases. Cytogenetic analyses revealed a normal karyotype in 55.3% of patients, while 44.7% revealed clonal abnormalities, including trisomy 8, monosomy 7, and complex karyotypes. Risk stratification identified 40.4% of patients as low-risk at presentation.</p><p><strong>Conclusion: </strong>Cytogenetic analysis showed that a normal karyotype was the most prevalent finding, with low-risk disease predominating in risk stratification. These findings provide valuable insights into the clinicohaematological and cytogenetic profiles of MDS patients in the Pakistani population.</p><p><strong>Key words: </strong>Myelodysplastic syndrome, Cytogenetics, Revised international prognostic scoring system, World Health Organization, Risk stratification.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"35 2","pages":"162-167"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401112","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":"Pattern of Referral of Patients with COVID-19 for Psychiatric Consultation: Experience at a Multidisciplinary Hospital in Karachi, Pakistan.","authors":"Aisha Noorullah, Bilal Ahmed, Muhammad Yusuf Hafiz, Shahina Pirani, Murad Khan","doi":"10.29271/jcpsp.2025.01.111","DOIUrl":"https://doi.org/10.29271/jcpsp.2025.01.111","url":null,"abstract":"<p><strong>Objective: </strong>To determine referral patterns for psychiatric consultations among COVID-19 patients encompassing both the in-patient and Emergency Department of a multidisciplinary hospital in Karachi, Pakistan.</p><p><strong>Study design: </strong>A retrospective chart review. Place and Duration of the Study: The Aga Khan University Hospital, Karachi, Pakistan, from March 2020 to December 2021.</p><p><strong>Methodology: </strong>The research team collected pertinent information from medical records using a standardised proforma, which encompassed data from physicians' notes, nurses' notes, assessment forms, and discharge summaries. The data were analysed using descriptive and inferential statistics.</p><p><strong>Results: </strong>This study examined 233 psychiatric referrals, with 67% male patients (n = 156) and 57.1% (n = 133) aged above 60 years. The primary psychiatric diagnosis was delirium (47.1%, n = 105), followed by adjustment disorders (10.8%, n = 27) and mood disorders (11.7%, n = 25). The main symptoms leading to consultation were agitation/confusion (45%, n = 106) and psychotropic adjustment (18%, n = 41). Clinical outcomes, including mortality, were associated with agitation/confusion (p = 0.001), delirium (p = 0.001), older age (p = 0.003), and longer length of stay (p = 0.001). Patients aged 61 years and above exhibited frequent agitation/confusion (p = 0.002) and delirium (p = 0.001). Longer stays correlated with agitation/confusion (p = 0.022), and a one-month hospital stay showed an association with delirium (p = 0.050).</p><p><strong>Conclusion: </strong>This study highlights the crucial role of consultation-liaison psychiatric services in addressing the psychological issues in COVID-19 patients. The significance of delirium and its high mortality risk underscores the need for focused research and integration of mental health care into pandemic responses for comprehensive patient care.</p><p><strong>Key words: </strong>Referrals, Psychiatric consultations, Hospitalised patients, COVID-19, Pakistan, Consultation-liaison services.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"35 1","pages":"111-115"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019093","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":"Prediction of In-Hospital Mortality after Emergency Laparotomy Using Glasgow Coma Scale, ASA Physical Status Classification, and P-POSSUM Score.","authors":"Muhammad Asif, Saeed Bin Ayaz, Faran Hamid, Muhammad Nabeel Imran, Adnan Mehraj, Naheed Akhtar","doi":"10.29271/jcpsp.2025.01.95","DOIUrl":"https://doi.org/10.29271/jcpsp.2025.01.95","url":null,"abstract":"<p><strong>Objective: </strong>To determine the importance of the Glasgow Coma scale (GCS), ASA physical status classification system, and P-POSSUM score in predicting mortality among patients undergoing emergency laparotomies.</p><p><strong>Study design: </strong>An analytical study. Place and Duration of the Study: Department of General Surgery, Sheikh Khalifa Bin Zayed Al-Nahyan Hospital Muzaffarabad, Pakistan, from October 2020 to January 2022.</p><p><strong>Methodology: </strong>All emergency laparotomies performed during the above-mentioned period were included consecutively, excluding trauma laparotomies, re-do laparotomies after elective surgery, appendectomies, cholecystectomies, pancreatectomies, organ transplantation surgeries, and laparotomies due to gynaecological or vascular causes such as ruptured abdominal aortic aneurysm. The GCS scores were broken down into mild (14-15), moderate (9-13), and severe (3-8) categories. The ASA scoring was classified into five classes, i.e., Classes I to V. The P-POSSUM scores were assessed for each of the following five groups: (≤10, 11-20, 21-30, 31-40, and ≥41).</p><p><strong>Results: </strong>Out of 50 patients (mean age: 47 ± 19 years), there were 39 (78%) males and 11 (22%) females. The median values for GCS and P-POSSUM scores were 15 and 11.1, respectively. According to the ASA, most patients (21, 42%) fit into Class II. Twelve (24%) patients died, while 38 (76%) survived. The mortality rate increased with an increasing P-POSSUM score, a lowering GCS score, and a higher class of ASA (all p <0.001). The ROC curve analysis showed that P-POSSUM had the best performance at 0.987, followed by ASA (0.951) and GCS (0.411).</p><p><strong>Conclusion: </strong>The ASA Physical Status Classification System and P-POSSUM scoring were significantly predictive of mortality after an emergency laparotomy.</p><p><strong>Key words: </strong>ASA Physical Status Classification System, Emergency laparotomy, Glasgow coma scale, Mortality, Outcome, P-POSSUM.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"35 1","pages":"95-99"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019168","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}