Combined Military Hospital

Sarcopenia affects 20%–40% of chronic obstructive pulmonary disease (COPD) patients, significantly reducing muscle strength and functional capacity, leading to a decline in quality of life. This study reviews the impact of sarcopenia in COPD and evaluates effective therapeutic strategies. Findings suggest that pulmonary rehabilitation, combined with aerobic and resistance exercises, and supplemented with protein and vitamin D, enhances muscle function and reduces the prevalence of sarcopenia. Additionally, emerging interventions such as inspiratory muscle training, myostatin inhibitors, selective androgen receptor modulators, and hormonal therapies show promise in improving patient outcomes. A multidisciplinary approach, incorporating personalized exercise programs, targeted nutrition, and psychological support, is crucial for addressing the complex challenges of sarcopenia in COPD. Given its substantial burden, this research highlights critical strategies for optimizing care and improving functional outcomes in this high-risk population.

Introduction An evaluation of new methods of surgery in otolaryngology is done with emphasis on four advanced surgical techniques: transoral robotic surgery (TORS), image-guided sinus surgery (IGSS), endoscopic skull base surgery, and 3D-printed implant-assisted procedures. The study evaluated a sample of 300 patients from Pakistan, ensuring that the evaluation was done in the light of these technologies vis-à-vis traditional ones. Objectives The aim of this study was to evaluate the impact of such surgical innovations in terms of quality of life (QoL), complication rates, follow-up compliance, and intra-operative parameters. In addition, this study aimed to identify predictors for postoperative complications, thereby profiling potential selection biases for using these advanced techniques in surgical interventions. Methodology A retrospective cohort analysis of 300 patients was conducted, including demographic variables, clinical events, tumor volumes, and comorbidities according to the Charlson Comorbidity Index and frailty scores. Assessment of postoperative outcome parameters included QoL, complication events, and intensive care unit (ICU) stay. A random forest model was trained to predict postoperative complications and showed an accuracy of 86.7% with an AUC-ROC of 0.91. Results The TORS and 3D-printed implant groups performed much better, showing significantly higher QoL scores (84.3 and 82.5 on average), low complication rates (9.7% and 6.8%), and high follow-up compliance (87% and 84%). They also show less blood loss and less time in ICUs. However, far fewer comorbidities and smaller tumors were found in these patients, which points toward a selection bias. Conclusion Emerging surgical innovations in otolaryngology, such as TORS and 3D-printed implants, create remarkable benefits in clinical scenarios associated with QoL and complications. However, patient selection bias creates barriers to realizing equitable access to the technologies, creating space for argumentation about evidence-based practice in clinical decision-making.

Melasma remains an important dermatological ailment affecting diverse types of skin across the world. Various treatment modalities are currently employed to control melasma; however, the ideal treatment remains elusive. Comparative data regarding the efficacy of intralesional tranexamic acid (TA) and ascorbic acid (AA) mesotherapy (MT) in the treatment of melasma in South Asian skin is sparse. The objective of this study was to compare the clinical efficacy and safety of intralesional tranexamic acid versus ascorbic acid mesotherapy for treating melasma in patients with skin of colour (SOC).

This quasi-experimental study was conducted at the Dermatology Department of Combined Military Hospital Kohat, a tertiary healthcare setup in Pakistan, between April 16, 2024, and October 16, 2024. A total of 110 volunteer patients with melasma, aged 18 to 55 years, were included. Individuals with a history of other dermatological conditions such as cutaneous infections, discoid lupus erythematosus, positive pregnancy tests, lactation, oral contraceptive use, or anaemia were excluded from the research. The patients were randomly assigned to two groups. In Group A, 55 patients were included and administered fortnightly sessions of intralesional TA MT, while in Group B, 55 patients received fortnightly sessions of intralesional AA MT. Both groups were also prescribed a daily Kligman regimen-based cream at night, along with sun protection measures in the form of broad-spectrum SPF 60 creams. Final evaluation was done at the end of 12 weeks, during which the Melasma Area Severity Index (MASI) was calculated and compared. The side effect profiles in both groups were also recorded.

Of the total 110 patients, around two-thirds (n = 77, 70%) were found to have mixed-type melasma, while the rest (n = 33, 30%) presented with dermal melasma. The average age of patients in Group A was 34.4 ± 5.1 years, while in Group B, it was 32.8 ± 4.5 years. Around two-thirds (n = 79, 71.8%) of the cohort were in the age bracket of 18-35 years. The efficacy of intralesional TA MT (Group A) was found to be higher than that of intralesional AA MT (Group B) when modified MASI scores were compared. For TA, the baseline MASI ranged from 6.4 to 8.1 (mean 7.2), and end-treatment MASI ranged from 3.3 to 5.6 (mean 4.45), showing a clear reduction of 2.75 in the mean MASI score. For AA, the baseline MASI ranged from 6.3 to 7.9 (mean 7.1), and end-treatment MASI ranged from 5.8 to 6.7 (mean 6.25), showing a clear reduction of 0.85 in the mean MASI score. The difference was statistically significant, with a p-value of 0.001. Intralesional TA MT was also associated with a lower incidence of irritation compared to intralesional AA MT, although this difference was not statistically significant.

The use of intralesional TA MT in melasma in South Asian skin appears more effective in clearing melasma than intralesional AA MT. It also remains a cheaper and safer treatment option for the control of melasma. Further large-scale randomised controlled studies are warranted to ascertain these findings.