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

{"title":"Ultrasound-Guided, Indocyanine Green-Directed Robot-Assisted Breast Surgery for Benign Tumours.","authors":"Nanqiu Liu, Guochun Zhang, Chongyang Ren, Jiyuan Cao, Ning Liao","doi":"10.29271/jcpsp.2026.08.996","DOIUrl":"https://doi.org/10.29271/jcpsp.2026.08.996","url":null,"abstract":"<p><strong>Objective: </strong>To compare the feasibility, safety, and cosmetic satisfaction of ultrasound-guided, indocyanine green (ICG)-assisted robotic lumpectomy with open lumpectomy for benign breast tumours.</p><p><strong>Study design: </strong>A retrospective cohort study. Place and Duration of the Study: Department of Breast Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China, from June to September 2023.</p><p><strong>Methodology: </strong>A step-by-step protocol was developed for surgeons to guide ultrasound-guided ICG injections for robotic lumpectomy. Clinicopathological characteristics of the patients, intraoperative data, postoperative complications, and aesthetic outcomes were analysed. Continuous variables were compared using an independent-samples t-test if they were normally distributed; otherwise, the Mann-Whitney U test was used. Categorical variables were compared using a chi-square test or a corrected chi-square test.</p><p><strong>Results: </strong>A total of 68 patients treated concurrently were included in the study; of whom, 30 underwent a robot-assisted local tumour excision through an axillary incision, while 38 had their tumour excision through a standard open incision over the breast. Operation time was significantly longer in the robotic group (96.0 vs. 42.5 minutes; p <0.001). No significant intergroup difference was found in postoperative complications. Patients who underwent robotic surgery achieved significantly higher rates of the highest level of satisfaction with the wound site (96.7% vs. 52.6%; p <0.001), scar appearance (93.3% vs. 71.1%; p = 0.020), and overall breast look (86.7% vs. 60.6%, p = 0.017).</p><p><strong>Conclusion: </strong>This surgical approach, using ICG injection and ultrasound guidance, provides a potentially feasible and safe method for tumour localisation during robotic lumpectomy.</p><p><strong>Key words: </strong>Aesthetic outcome, Breast surgery, Indocyanine green, Robot-assisted surgery, Ultrasound-guidance.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 8","pages":"996-1003"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687293","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":"Challenges to Adequate Analgesia in Emergency Surgical Patients: Are We Still Falling Short?","authors":"Mostafa Ahmed Abdellah Ahmed, Maryum Sana, Amna Batool","doi":"10.29271/jcpsp.2026.08.967","DOIUrl":"10.29271/jcpsp.2026.08.967","url":null,"abstract":"<p><p></p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 8","pages":"967-968"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687328","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":"Experience with Hand-Sewn, Layered Telescoping Anastomosis in Oesophageal Cancer Surgery.","authors":"Genrong Yang, Han Wang","doi":"10.29271/jcpsp.2026.08.1103","DOIUrl":"10.29271/jcpsp.2026.08.1103","url":null,"abstract":"<p><p></p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 8","pages":"1103-1104"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687298","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 Citicoline in Neonates with Hypoxic-Ischaemic Encephalopathy.","authors":"Saqib Nawaz, Arshad Khushdil, Sajid Ali Shah, Bilal Ahmed Malik, Fiza Wali","doi":"10.29271/jcpsp.2026.08.1034","DOIUrl":"10.29271/jcpsp.2026.08.1034","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the short-term neurological outcomes in neonates with moderate-to-severe hypoxic-ischaemic encephalopathy (HIE) treated with citicoline.</p><p><strong>Study design: </strong>A randomised controlled trial. Place and Duration of the Study: Department of Paediatrics, Pak Emirates Military Hospital, Rawalpindi, Pakistan, from 2024 to 2025.</p><p><strong>Methodology: </strong>Seventy neonates presenting with moderate or severe HIE, according to the Sarnat scoring system, were enrolled. Participants were allocated into two equal groups (n = 35 each) by using a simple randomisation method. The citicoline-treated group received citicoline in addition to routine care, while the control group received only routine care. Clinical outcomes were compared. Data were analysed using the chi-square test for qualitative variables and the Student's t-test for quantitative variables. A p-value of <0.05 was considered statistically significant.</p><p><strong>Results: </strong>Out of 70 neonates, 37 (52.8%) were female, while 33 (47.2%) were male. In the citicoline-treated group, the mean duration of NICU stay was 6.23 ± 3.42 days, compared with 8.46 ± 3.26 days in the control group (p = 0.007). Furthermore, the suck and Moro reflexes were established significantly earlier than the control group, with p-values of 0.001 and 0.002, respectively.</p><p><strong>Conclusion: </strong>This study demonstrated the neuroprotective effects of citicoline in the treatment of HIE in neonates, with statistically significant earlier establishment of suck and Moro reflexes in the citicoline-treated group compared with the control group.</p><p><strong>Key words: </strong>Citicoline, Hypoxic-ischaemic encephalopathy, Neonates, Seizures, Suck reflex.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 8","pages":"1034-1038"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687264","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":"Prospective Validation of EDACS-ADP for 30-Day MACE in Patients with Chest Pain.","authors":"Kursat Kaan Kerimoglu, Burcu Tanay Demirdoven, Mehmet Karaman","doi":"10.29271/jcpsp.2026.08.977","DOIUrl":"10.29271/jcpsp.2026.08.977","url":null,"abstract":"<p><strong>Objective: </strong>To validate the Emergency Department Assessment of Chest Pain Score-Accelerated Diagnostic Pathway (EDACS-ADP) for predicting 30-day major adverse cardiac events (MACE) in patients with chest pain.</p><p><strong>Study design: </strong>An observational study. Place and Duration of the Study: Department of Emergency, Alsancak Nevvar-Salih Isgoren State Hospital, Izmir, Turkiye, from July to November 2025.</p><p><strong>Methodology: </strong>Adult patients with chest pain were prospectively evaluated using the EDACS-ADP. The predictive ability of EDACS-ADP for 30-day MACE was assessed by calculating sensitivity, specificity, positive predictive value, negative predictive value (NPV), likelihood ratios, and by receiver operating characteristic curve analysis with area under the curve estimation.</p><p><strong>Results: </strong>Of the 1,389 screened patients, 773 completed the 30-day follow-up period. The mean age was 45.3 ± 16.1 years, and 55.1% were male. MACE occurred in 49 patients (6.3%), including 32 patients with myocardial infarction and three patients with cardiac death. Using the EDACS-ADP, 608 patients (78.7%) were classified as low-risk, accounting for 6 (12.2%) of all 30-day MACE events. In contrast, 165 patients (21.3%) were classified as at risk, accounting for 43 (87.8%) MACE events (p = 0.001). The diagnostic performance of EDACS-ADP was significantly superior to that of EDACS alone, with a sensitivity of 87.8% versus 34.7% and an NPV of 99.0% versus 95.3%. The relative risk of MACE for at-risk patients was 5.2, with an odds ratio of 35.3.</p><p><strong>Conclusion: </strong>EDACS-ADP showed a high diagnostic accuracy and excellent NPV for detecting low-risk patients with chest pain in the emergency department, confirming its usefulness in secondary care settings in Turkiye.</p><p><strong>Key words: </strong>Chest pain, Emergency department, Acute coronary syndrome, Accelerated diagnostic pathway, Major adverse cardiac events, Risk stratification.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 8","pages":"977-984"},"PeriodicalIF":0.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687270","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":"Outcomes of Focused Parathyroidectomy in Hyperparathyroidism.","authors":"Farhan Ahmed Majeed, Sohail Saqib Chatha, Mubashara Badar, Ahmed Raza, Bilal Umair, Nabeela Farhan","doi":"10.29271/jcpsp.2026.07.929","DOIUrl":"https://doi.org/10.29271/jcpsp.2026.07.929","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the surgical outcome of focused parathyroidectomy (FP) in the management of hyperparathyroidism.</p><p><strong>Study design: </strong>A case series. Place and Duration of the Study: Department of Thoracic Surgery, Combined Military Hospital, Rawalpindi, Pakistan, from September 2018 to December 2024.</p><p><strong>Methodology: </strong>The study included 52 patients with primary hyperparathyroidism due to parathyroid adenoma who underwent FP during the study period. The recorded data included age, gender, pre- and postoperative calcium levels, pre- and postoperative parathyroid hormone (PTH) levels, preoperative localisation, and complications. The normalisation of post-operative PTH levels and serum calcium levels determined successful surgery. IBM SPSS version 26 was used as the data analysis tool.</p><p><strong>Results: </strong>A total of 52 patients with a mean age of 45 years (40.4%) were included. Seventeen (32.7%) were male, and 35(67.3%) were female. All patients had elevated PTH levels, with a mean of 200.5 pg/mL (range 100-700) and a preoperative calcium level of 10.5 mmol/L (range 6-20). Preoperative ultrasonography, CT scan of the neck, and MIBI scan were used to localise the adenoma in all patients, with an average size of 1.6-2cm. Twenty-five (48.1%) patients had a parathyroid adenoma in the left inferior pole. After 3 months of follow-up, all patients had decreased serum PTH and calcium levels by more than 50% preoperative values.</p><p><strong>Conclusion: </strong>FP with accurate preoperative localisation has an excellent cure rate with minimal morbidity and is the treatment of choice, replacing bilateral neck exploration.</p><p><strong>Key words: </strong>Parathyroidectomy, Parathyroid neoplasms, Primary hyperparathyroidism, Endocrine surgical procedures.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 7","pages":"929-932"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148393014","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":"Indigenous Hyperangulated Videolaryngoscope: Bridging a Critical Gap in Airway Management in Pakistan.","authors":"Hassam Zulfiqar","doi":"10.29271/jcpsp.2026.07.957","DOIUrl":"10.29271/jcpsp.2026.07.957","url":null,"abstract":"<p><p></p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 7","pages":"957-958"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148393055","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":"Serum Alanine Aminotransferase and Alkaline Phosphatase in Late Pregnancy as Predictors of Intrahepatic Cholestasis.","authors":"Maryam Khizar Hayat Khan, Shazia Ali, Ghazala Jawwad, Sana Nawab, Shagufta Feroz","doi":"10.29271/jcpsp.2026.07.888","DOIUrl":"https://doi.org/10.29271/jcpsp.2026.07.888","url":null,"abstract":"<p><strong>Objective: </strong>To compare serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) between women with intrahepatic cholestasis of pregnancy (ICP) and those without, to assess trimester-related changes, and to identify the strongest liver enzyme predictor of ICP.</p><p><strong>Study design: </strong>A descriptive study. Place and Duration of the Study: Department of Physiology, Islamic International Medical College, in collaboration with Holy Family Hospital and Prime Lab Diagnostics, Rawalpindi, Pakistan, from August 2024 to August 2025.</p><p><strong>Methodology: </strong>A total of 155 pregnant women were enrolled in the second trimester (T2) and followed into the third trimester (T3). Demographics were recorded. Serum ALT, AST, and ALP were measured in both trimesters. Participants were classified as ICP (n = 72) and non-ICP (n = 83) based on T3 clinical diagnosis. The Mann-Whitney U test was used for between-group comparisons, the Wilcoxon signed-rank test was used for within-group changes, and independent T3 predictors were identified using binary logistic regression.</p><p><strong>Results: </strong>ALT, AST, and ALP were similar between groups in T2  (p >0.05). In T3, all three enzymes were significantly higher in women with ICP (p <0.05). Within-group analysis showed significant increases from T2 to T3  in both groups. Logistic regression identified T3 ALT (OR = 1.044, p <0.001) and T3 ALP (OR = 1.027, p <0.001) as independent predictors of ICP.</p><p><strong>Conclusion: </strong>Liver enzyme abnormalities in ICP are most pronounced in T3. ALT and ALP are the strongest biochemical predictors and may aid in early detection and risk stratification of women at risk for ICP.</p><p><strong>Key words: </strong>Alanine aminotransferase, Alkaline phosphatase, Aspartate aminotransferase, Cholestasis, Trimester, Pregnancy.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 7","pages":"888-892"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148393053","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":"Imaging Appropriateness, Clinical Data, and Feedback: The Healthcare Challenges in Pakistan.","authors":"Mahnoor Hafeez, Nida Rafiq","doi":"10.29271/jcpsp.2026.07.949","DOIUrl":"https://doi.org/10.29271/jcpsp.2026.07.949","url":null,"abstract":"<p><p>Diagnostic radiology is a unique specialty focused primarily on diagnosis rather than treatment. It represents a partnership between clinical and radiology teams. Communication barriers can result in patient harm. Appropriateness and justification of imaging studies are frequently overlooked in Pakistan. This may be attributed primarily to a lack of awareness among referring clinicians; alternatively, economic considerations influenced by health insurance policies may also play a contributory role.  In the UK NHS setup, each radiological investigation must be justified due to government funding and concerns regarding the potential cancer risks associated with computed tomography (CT). Consequently, a radiologist can vet and decline imaging requests considered unjustified. In this article, cross-sectional imaging-related healthcare challenges encountered in clinical settings in Pakistan will be highlighted, and comprehensive solutions aimed at enhancing holistic patient care will be proposed. Key Words: Diagnostic radiology, MRI, ACR, Cross-sectional imaging, Appropriateness.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 7","pages":"949-950"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148393034","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":"Pros and Cons of Positive End-Expiratory Pressure Titration Guided by Electrical Impedance Tomography in Patients with Acute Respiratory Distress Syndrome: A Meta-Analysis.","authors":"Yunnan Hu, Mumu Fan, Peirong Zhang","doi":"10.29271/jcpsp.2026.07.920","DOIUrl":"10.29271/jcpsp.2026.07.920","url":null,"abstract":"<p><p>This study explored the effectiveness of an electrical impedance tomography (EIT)-based positive end-expiratory pressure (PEEP) titration strategy compared with traditional methods in patients with acute respiratory distress syndrome (ARDS). A systematic search of the literature was conducted through PubMed, Embase, and the Cochrane Library, resulting in the inclusion of 12 relevant studies. The results showed no significant differences between the EIT group and the traditional group with respect to PEEP levels, oxygenation index, lung compliance, ICU length of stay, or APACHE II scores. However, the mortality rate in the EIT group was significantly lower than that in the traditional group (OR = 0.59, p = 0.03), and their mean arterial pressure was also lower (SMD = -0.28, p = 0.03). Therefore, the EIT-guided PEEP titration protocol demonstrates superior mortality outcomes compared to traditional methods. Key Words: Electrical impedance tomography, Positive end-expiratory pressure, acute respiratory distress syndrome.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"36 7","pages":"920-928"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148393008","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}