Gastroenterology Commons^™

Tuberculous Salpingitis - Possible Cause Of Salpingo-Enteric Fistula, Shayan Sirat Maheen Anwar, Anam Khan, Fahd Haroon, Frawa Mohsin

Department of Radiology

Salpingo-enteric fistula is a rare disease causing infertility. It occurs when there is a connection between fallopian tube and the intestine. It can be accurately diagnosed with hysterosalpingography. Fistulas mostly occur as a consequence of obstetric complications, however, inflammatory bowel disease, pelvic malignancy, pelvic radiation therapy, iatrogenic causes, and trauma are other potential causes. The possibility of tuberculous salpingitis as a possible cause of salpingo-enteric fistula should always be considered in the developing countries where tuberculosis is endemic.

Diagnostic Accuracy Of Artificial Intelligence For Detecting Gastrointestinal Luminal Pathologies: A Systematic Review And Meta-Analysis, Om Parkash, Asra Tus Saleha Siddiqui, Uswa Jiwani, Fahad Rind, Zahra Ali Padhani, Arjumand Rizvi, Zahra Hoodbhoy, Jai K. Das

Section of Gastroenterology

Background: Artificial Intelligence (AI) holds considerable promise for diagnostics in the field of gastroenterology. This systematic review and meta-analysis aims to assess the diagnostic accuracy of AI models compared with the gold standard of experts and histopathology for the diagnosis of various gastrointestinal (GI) luminal pathologies including polyps, neoplasms, and inflammatory bowel disease.
Methods: We searched PubMed, CINAHL, Wiley Cochrane Library, and Web of Science electronic databases to identify studies assessing the diagnostic performance of AI models for GI luminal pathologies. We extracted binary diagnostic accuracy data and constructed contingency tables to derive the outcomes of interest: sensitivity and specificity. …

Association Of Respiratory Symptoms And Lung Function With Occupation In The Multinational Burden Of Obstructive Lung Disease (Bold) Study, Jate Ratanachina, Andre F S Amara, Sara De Matteis, Herve Lawin, Kevin Mortimer, Daniel O. Obaseki, Imed Harrabi, Meriam Denguezli, Emiel F M Wouters, Asaad Ahmed Nafees

Community Health Sciences

Chronic obstructive pulmonary disease has been associated with exposures in the workplace. We aimed to assess the association of respiratory symptoms and lung function with occupation in the Burden of Obstructive Lung Disease study. We analysed cross-sectional data from 28,823 adults (≥40 years) in 34 countries. Eleven occupations were considered and grouped by likelihood of exposure to organic dusts, inorganic dusts and fumes. The association of chronic cough, chronic phlegm, wheeze, dyspnoea, FEV1/FVC and FVC with occupation was assessed, per study site, using multivariable regression. These estimates were then meta-analysed. Sensitivity analyses explored differences between sexes and gross national income …

Covad Survey 2 Long-Term Outcomes: Unmet Need And Protocol, Zoha Zahid Fazal, Parikshit Sen, Mrudula Joshi, Naveen Ravichandran, James B. Lilleker, Vishwesh Agarwal, Sinan Kardes, Minchul Kim, Jessica Day, Ashima Makol

Medical College Documents

Vaccine hesitancy is considered a major barrier to achieving herd immunity against COVID-19. While multiple alternative and synergistic approaches including heterologous vaccination, booster doses, and antiviral drugs have been developed, equitable vaccine uptake remains the foremost strategy to manage pandemic. Although none of the currently approved vaccines are live-attenuated, several reports of disease flares, waning protection, and acute-onset syndromes have emerged as short-term adverse events after vaccination. Hence, scientific literature falls short when discussing potential long-term effects in vulnerable cohorts. The COVAD-2 survey follows on from the baseline COVAD-1 survey with the aim to collect patient-reported data on the long-term …

Hepatocellular Carcinoma With Extrahepatic Blood Supply From Right Renal Artery, Amir Humza Sohail, Ahmad Musa, Muhammad Salman Khan, Hassan Raza Hashmi, Basit Salam, Collin E M. Brathwaite

Department of Radiology

Extrahepatic blood supply is seen in around 17-27% of hepatocellular carcinoma lesions. Evidence suggests that this extrahepatic supply most commonly originates from a right intercostal artery (70-83%) followed by left intercostal, omental and right renal arteries. Thus a comprehensive knowledge of variations in standard vascular anatomy and cognisance of factors influencing or predicting extrahepatic blood supply in HCC is instrumental in ensuring the success of surgical and interventional procedures. We present the unusual case of a 66-year-old male with HCC in Segment I of the liver with aberrant blood supply from the right renal artery in the absence of any …

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 …

Applying A Mixed-Method Approach To Improve On-The-Job Learning And Job Satisfaction In A Cohort Of Interns At A University Hospital, Amna Subhan Butt, Muhammad Shahzad Shamim, M Asghar Ali, Farah Naz Qamar, Irum Qamar Khan, Swaleha Tariq, Syeda Amrah Hashmi, Quratulain Hafeez, Muhammed Tariq

Section of Gastroenterology

Introduction: Job satisfaction is vital for the optimal functioning of medical practitioners. Herein, we report our experience of restructuring the internship program by identifying the gaps, developing, implementing strategies to overcome gaps and sharing the results of the pre-implementation and post-implementation audit, as an example for establishing a system for improving intern's work-based learning and satisfaction in a university hospital setting.
Methods: Using Kern's six-step instructional model, a prospective mixed-method study was conducted at Aga Khan University Hospital. In phase 1 (2013) gaps were identified by evaluating various aspects of the internship program. Strategies were developed and implemented to overcome …

Gastric Volvulus In Adults In A Tertiary Care Hospital Karachi, Pakistan: A Case Series, Om Parkash, Roger Christopher Gill, Iman Qaiser, Muhammad Sharoz Rabbani, Tabish Chawla, Hasnain Zafar

Section of Gastroenterology

Gastric volvulus is a rare surgical emergency which is rare in children and occasionally presents in adults. It results due to pathological malrotation of the stomach along its longitudinal or short axis. The condition, if not treated promptly, can result in increased morbidity and carries a high risk of death. Very few cases have been reported in literature regards this important clinical condition. Early decompression and repair of anatomical defects are the corner stone of its management. There is a dire need to develop guidelines and algorithms for management and treatment of this rare condition to improve patient outcome, prevent …

Demonstrating Competence In Endoscopic Retrograde Cholangiopancratico Graphy (Ercp): Recently Credentialed Operator's Performance For Deep Biliary Cannulation Over 1 Year Period From A Tertiary Care Hospital In Pakistan, Om Parkash, Umar Bhatti, Hasnain Zafar, Saeed Hamid

Section of Gastroenterology

Objective: To measure the success rate of endoscopic retrograde cholangiopancreaticography biliary cannulation of a recently credentialed endoscopist at a tertiary hospital.
Methods: The clinical audit was conducted at the Aga Khan University Hospital. Karachi, and comprised data of all patients who underwent endoscopic retrograde cholangiopancreaticography under the care of a single operator during 2016. Data was retrospectively extracted from patient charts by an assistant blinded to the study. Data extracted included demographics, admission type, details and indication for the procedure, diagnosis, cannulation outcome, duct clearance, complications, follow-up surgical intervention, radiological imaging and mortality post-endoscopy. Data was analysed using SPSS 19. …

Adenoma Detection Rate As A Quality Indicator For Colonoscopy: A Descriptive Cross-Sectional Study From A Tertiary Care Hospital In Pakistan, Mian Shah Yousaf, Shameel Shafqat, Roger Christopher Gill, Asfia Arham Khursheed, Om Parkash

Section of Gastroenterology

Background and study aims: Adenoma detection rate (ADR) is validated for measuring quality of colonoscopy, however there is lack of colorectal cancer (CRC) screening program in South Asia. The purpose of this study is to analyze and review the polyp detection rate (PDR) and ADR and provide insight into the factors that influence them in Pakistan.
Patients and methods: This retrospective, cross-sectional study was performed at the Aga Khan University Hospital, Karachi, Pakistan, on patients ≥ 18 years, who underwent colonoscopy between January 1, 2017 and June 30, 2018.
Results: Of 1985 patients, 59 % were male and 41 % …

Isolated Gallbladder Injury From Blunt Abdominal Trauma: A Rare Co-Incidence, Muhammad Rizwan Khan, Saleema Begum

Section of General Surgery

Gallbladder injury resulting from blunt abdominal trauma is a rare entity and generally associated with other intra-abdominal injuries. Incidence of isolated gallbladder injury has not been reported yet. The most common mechanism of injury reported is road traffic accident. Diagnosis is usually made on imaging as clinical presentation may vary from no symptoms to peritonitis due to extravasation of bile in the abdominal cavity. Cholecystectomy is the treatment of choice and minimally invasive approach can be considered in haemodynamically stable patients.

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 …

Early Complications After Biliary Enteric Anastomosis For Benign Diseases: A Retrospective Analysis, Syed Nabeel Zafar, M. R. Khan, Rushna Raza, Muhammad N. Khan, Mahwash Kasi, Ammar Rafiq, Omer H. Jamy

Department of Surgery

Background:Biliary-enteric anastomosis (BEA) is a common surgical procedure performed for the management of biliary obstruction or leakage that results from a variety of benign and malignant diseases. Complications following BEA are not rare. We aimed to determine the incidence and the factors associated with early complications occurring after BEA for benign diseases.

Methods:

We reviewed the medical records of all Patients who underwent BEA for benign diseases at our institution between January 1988 and December 2009. The primary outcome was early post operative complication. Logistic regression analysis was done to identify factors predicting the occurrence of complications.

Results:

Records …