Medicine and Health Sciences Commons^™

Spontaneous Large Volume Hemothorax Managed With A Small-Bore Chest Tube, Moiz Salahuddin, Samia Ayub

Department of Medicine

A 67-year-old male with metastatic lung cancer presented with acute shortness of breath and increasing oxygen requirements. He had a decreasing hemoglobin for which he required red blood cell transfusions. His chest x-ray showed near complete white-out of the left lung. Bedside ultrasound (Handheld Sonostar C4PL) showed a large pleural effusion with swirling echogenic material suggestive of plankton sign. The pleural effusion was aspirated and showed frank blood, after which a small-bore chest tube (SBCT) was inserted. A total of 3200ml of blood was drained with the SBCT. There was complete clearance of the pleural space, and no further blood …

Does Individualized Guided Selection Of Antiplatelet Therapy Improve Outcomes After Percutaneous Coronary Intervention? A Systematic Review And Meta-Analysis, Naser Yamani, Samuel Unzek, Muhammad Hasnain Mankani, Talal Almas, Adeena Musheer, Humera Qamar, Shausha Farooq, Waqas Shahnawaz, Kaneez Fatima, Vincent Figueredo

Department of Medicine

Background: The potential benefits of individualized guided selection of antiplatelet therapy over standard antiplatelet therapy in improving outcomes in patients undergoing percutaneous coronary intervention (PCI) have not been established. Therefore, we pooled evidence from available clinical trials to assess the effectiveness by comparing the two regimens in patients undergoing PCI.
Methods: We queried two electronic databases, MEDLINE and Cochrane CENTRAL, from their inception to April 20, 2021 for published randomized controlled trials in any language that compared guided antiplatelet therapy, using either genetic testing or platelet function testing, versus standard antiplatelet therapy in patients undergoing PCI. The results from trials …

Gum Chewing, Added To Conventional Feeding, Reduces Risk Of Post-Operative Ileus After Elective Hip And Knee Arthroplasty Procedures In Elderly Population: A Protocol For A Parallel Design, Open-Label, Randomized Controlled Trial, Obada Hussein Hasan, Laraib Mazhar, Ahsun Jiwani, Dilshad Begum, Riaz Hussain Lakdawala, Shahryar Noordin

Department of Medicine

Introduction: Postoperative ileus (poi) is defined as a temporary cessation of bowel movement after a surgical procedure. Cessation of bowel movement not only leads to disturbing constipation but also may lead to nausea, loss of appetite, and food intolerance. Literature reports "sham feeding" (gum-chewing) effect as an increase in chewing and saliva which enhances the gastric emptying and overall motility of gut as a cephalic phase of digestion. Therefore, we aim to assess the effect of adding gum-chewing to the conventional postoperative feeding regimen on restoring postoperative bowel function and length of stay in hospital of patients undergoing elective hip …

Comparison Of Surgical Site Infection After Skin Closure By Prolene Or Staples In Bilateral Simultaneous Knee Arthroplasty Patients: A Parallel Design Randomized Controlled Trial Protocol, Obada Hussein Hasan, Ahsun Jiwani, Laraib Mazhar, Dilshad Begum, Riaz Hussain Lakdawala, Shahryar Noordin

Department of Medicine

Introduction: Knee arthroplasty also known as the total knee replacement is an orthopedic surgical procedure done to resurface the knee that has been severely damaged by arthritis. After the completion of the surgical procedure, the skin closure is done. The optimal goal of skin closure after the procedure is to promote rapid healing and an acceptable cosmetic result while minimizing the risk of infection. Skin closure after knee arthroplasty is done by using either of the two widely used sutures i.e., polypropylene (Prolene) sutures or the skin staple sutures. There are no standard guidelines as which type of the suture …

Does Early Surgery Prevent Postoperative Icu Admission After Surgery For The Fracture Of The Hip. Nested Case Control Study Of 911 Patients, Obada Hasan, Laraib Mazhar, Umar Rabbani, Amna Rabbani, Fatima Mahmood, Shahryar Noordin

Department of Medicine

Introduction: Since most hip fractures are treated surgically, it is imperative to find an optimum fracture-to-surgery time to decrease the potential complications and enhance postoperative outcomes. In comparison to the vast plethora of literature available on surgical delay and its implications on mortality, very little, if any, research is available on the impact of delayed surgery on postoperative ICU admission. The primary objective of our study is to examine the factors influencing post-surgical ICU admission in order to work on preventive strategies to reduce the potential associated morbidity.
Material and methods: Investigators did a nested case control study in a …

Convergent Ablation For The Treatment Of Long Standing Persistent Atrial Fibrillation - A Single Center Experience, Syed Rafay Ali Sabzwari, Lohit Garg Md, Nikhil A. Mehta Md, James R. Kimber, Hiwot Ayele, James K. Wu Md, Babak Bozorgnia Md

Department of Medicine

Introduction: The treatment of long standing persistent atrial fibrillation (AF) is very challenging and conventional catheter ablation strategies have provided only modest success. They often require multiple procedures and anti-arrhythmics to maintain sinus rhythm. The convergent ablation procedure is a hybrid approach, involving a minimally invasive epicardial ablation combined with a traditional transvenous endocardial ablation.

Hypothesis: Convergent ablation is an overall safe and effective procedure for the treatment of long standing persistent AF.

Methods: From February 2015 to September 2017, 30 patient (20 males) with long standing persistent AF underwent convergent ablation at a large tertiary care center. Rest of …

Primary Hyperparathyroidism As Initial Presentation Of Stage Iv Breast Cancer, Angela Magdaleno Do, Angel Lopez Md, Thomas A. Diven Md, Marc A. Vengrove Do, Facp

Department of Medicine

No abstract provided.

Malignant Ectopic Thyroid Tissue With Distant Metastasis: A Case Report, Shehla Tabassum, Najmul Islam, Saulat H. Fatimi, Mubasher Ikram, Arsalan Ahmed, Maseehuz Zaman

Department of Medicine

Introduction: Ectopic thyroid tissue is the most common form of thyroid dysgenesis. But primary malignant transformation in ectopic thyroid tissue is quite a rare entity, with follicular malignancy being the dominant form at ectopic sites. Very infrequently, malignant ectopic thyroid tissue can present with metastasis to lymph nodes. But we report a case of malignant ectopic thyroid tissue over manubrium sterni with distant metastasis.
Case presentation: A 42-year-old Pakistani female presented with gradually increasing swelling on anterior aspect of manubrium sterni for last 6 months. She had no goitre and was clinically and biochemically euthyroid. Rest of systemic exam …

Outcomes Of Splenectomy For Idiopathic Thrombocytopenic Purpura In Adults: A Developing Country Perspective., Amyn Pardhan, Aamir Hameed, Hasnain Zafar, Samia Mazahir, Ghulam Murtaza

Department of Medicine

Objective: to determine the outcome of splenectomy done in adult patients of Idiopathic Thrombocytopenic Purpura over a period of 10 years and, secondarily, to determine the predictors of complete response to therapy.

Methods: The retrospective review comprised of adult patients over 14 years of age who underwent open or laparoscopic splenectomy for Idiopathic Thrombocytopenic Purpura at Aga Khan University Hospital, Karachi, from January 2000 to December 2010. Data was reviewed in January 2011 by a surgical resident. Outcome was the response to splenectomy as per new definition of response set by the American Society of Haematology 2011 evidence based practice …

Adenomyomatous Hyperplasia Of The Ampulla Of Vater Masquerading As Malignancy: A Case Series, Patrick Hickey Do, Saba Ahmad Md, Matthew Sullivan Do, Miriam L. Enriquez Md, Jeffrey Brodsky Md, Hiral Shah Md

Department of Medicine

No abstract provided.

An Uncommon Complication During Trans-Aortic Valve Replacement, Sanjeev Nair Md, Yassir Nawaz Md, Nainesh C. Patel Md, David A. Cox Md, William Combs Md, Raymond L. Singer Md, J Patrick Kleaveland Md

Department of Medicine

No abstract provided.

Thoracic Multidisciplinary Clinic (Tmdc) And The Treatment Of Stage Iii Non-Small Cell Lung Cancer, Eliot L. Friedman Md, Michael F. Szwerc Md, Robert Kruklitis Md, Michael J. Weiss

Department of Medicine

No abstract provided.

Comparison Of Chronic Persistent And Post-Operative Atrial Fibrillation On Long Term Survival In Patients Undergoing Cardiac Valve Surgery, Nasir Shariff, Ravi V. Desai Md, Sherrine Eid, Michael J. Weiss, Matthew W. Martinez, Sultan M. Siddique, Ronald S. Freudenberger Md

Department of Medicine

No abstract provided.

Long-Term Effect Of Carotid Surgery In Asymptomatic Stenosis., Muhammad Faisal Wadiwala, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Spontaneous Coronary Artery Dissection: A Rare But Deadly Cause Of Acs In Younger Patients, Daniel J. Makowski Do, David A. Cox Md

Department of Medicine

No abstract provided.

Neo-Adjuvant Chemotherapy And Radiation Therapy In Patients With Stage Iiia (N2) Non-Small Cell Lung Cancer (Nsclc): A Retrospective Analysis With Lessons Learned, Eliot L. Friedman Md, Michael F. Szwerc Md, Charles Andrews Md, Robert Kruklitis Md, Kathleen A. Leies, Ferdy Santiago

Department of Medicine

No abstract provided.

Risk Factors Affecting Surgical Outcomes In Patients Undergoing Hypothermic Circulatory Arrest During Aortic Surgeries: A 10-Year Study, Bree Ann Young, James K. Wu, Martin E. Matsumura Md, Sanjay M. Mehta Md, Theodore G. Phillips Md, Michael F. Szwerc Md, Gary W. Szydlowski Md, Raymond L. Singer Md

Department of Medicine

No abstract provided.

Outcome Of Traumatic Aortic Rupture: A 14-Year Experience, Matthew Wilson, James K. Wu, Sanjay M. Mehta Md, Theodore G. Phillips Md, Raymond L. Singer Md, Michael F. Szwerc Md, Gary W. Szydlowski Md

Department of Medicine

No abstract provided.

Boerhaave's Syndrome: A Diagnostic Dilemma In The Emergency Room, Ab Zubairi, I Khalid, Saulat H. Fatimi, J Hussain, N Salahuddin

Department of Medicine

Boerhaave's syndrome is a potential lethal condition which presents not only a diagnostic but also a therapeutic challenge. Errors in diagnosis are usually caused by unawareness of its varied and atypical presentations. All clinicians need to be aware of this lethal disease, its frequent unusual presentations and the importance of early diagnosis.