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Transcriptional Alterations In Hereditary And Sporadic Nonfunctioning Pancreatic Neuroendocrine Tumors According To Genotype., Xavier M Keutgen, Suresh Kumar, Sudheer Gara, Myriem Boufraqech, Sunita Agarwal, Ralph H Hruban, Naris Nilubol, Martha Quezado, Richard Finney, Maggie Cam, Electron Kebebew 2017 George Washington University

Transcriptional Alterations In Hereditary And Sporadic Nonfunctioning Pancreatic Neuroendocrine Tumors According To Genotype., Xavier M Keutgen, Suresh Kumar, Sudheer Gara, Myriem Boufraqech, Sunita Agarwal, Ralph H Hruban, Naris Nilubol, Martha Quezado, Richard Finney, Maggie Cam, Electron Kebebew

Surgery Faculty Publications

BACKGROUND

Nonfunctioning pancreatic neuroendocrine tumors (NFPanNETs) may be sporadic or inherited because of germline mutations associated with von Hippel-Lindau disease (VHL) or multiple endocrine neoplasia type 1 (MEN1). The clinical behavior of NFPanNETs is difficult to predict, even in tumors of the same stage and grade. The authors analyzed genotype-specific patterns of transcriptional messenger RNA (mRNA) levels of NFPanNETs to understand the molecular features that determine PanNET phenotype.

METHODS

Thirty-two samples were included for genome-wide mRNA gene expression analysis (9 VHL-associated, 10 MEN1-associated, and 9 sporadic NFPanNETs and 4 purified normal islet cell [NIC] samples). Validation of genes was performed ...


Allergic Contact Dermatitis To 2-Octyl Cyanoacrylate After Surgical Repair: Humidity As A Potential Factor, Avi Bitterman, Karanjit Sandhu 2017 Sidney Kimmel Medical College; Jersey Shore University Medical Cente

Allergic Contact Dermatitis To 2-Octyl Cyanoacrylate After Surgical Repair: Humidity As A Potential Factor, Avi Bitterman, Karanjit Sandhu

Student Papers

Allergic contact dermatitis to 2-octyl cyanoacrylate (Dermabond; Ethicon, Somerville, NJ) after surgical repair is an extremely rare condition with few reported cases. In recent years, contact dermatitis to Dermabond has been reported with increasing frequency.Cyanoacrylates are the most commonly used surgical adhesives and rely on their rapid polymerization to prevent sensitization from antigen presenting cells (APCs), because APCs are only capable of monomeric recognition of cyanoacrylates. It is thought that arid climates may contribute to increased sensitization of cyanoacrylates because water drives the polymerization reaction, decreasing the number of monomers capable of recognition by APCs. With less water present ...


The Effects Of Obesity On Outcomes In Trauma Injury: Overview Of The Current Literature, Milad Modarresi, Brad Gillon, Javad Najjar Mojarrab, Rodrigo Aguilar, Zackary Dylan Hunter, Matthew Steven Schade, Jackie Sanabria, Rebecca Klug, Seth Adkins, Juan R. Sanabria 2017 Marshall University Joan C. Edwards School of Medicine

The Effects Of Obesity On Outcomes In Trauma Injury: Overview Of The Current Literature, Milad Modarresi, Brad Gillon, Javad Najjar Mojarrab, Rodrigo Aguilar, Zackary Dylan Hunter, Matthew Steven Schade, Jackie Sanabria, Rebecca Klug, Seth Adkins, Juan R. Sanabria

Marshall Journal of Medicine

Obesity has reached epidemic proportions and is now considered a chronic disease by the National Institute of Health (NIH) in the West. Its impact on trauma outcomes is of particular interest with several studies presenting conflicting information. The present overview suggests a strong association between obesity and injury severity, hospital length of stay (LOS), intensive care unit (ICU) admission, pattern of injury, rate of complications and mortality. The nature of the observations may relate to an underlying physiological state of the obese patient and its associated comorbidities with a constant heightened inflammatory state aggravated by the second hit on an ...


Sex Differential In 15-Hydroxyprostaglandin Dehydrogenase Levels In The Lumen Of Human Intracranial Aneurysms., Nohra Chalouhi, Pascal Jabbour, Mario Zanaty, Robert M. Starke, James Torner, Daichi Nakagawa, David M. Hasan 2017 Thomas Jefferson University

Sex Differential In 15-Hydroxyprostaglandin Dehydrogenase Levels In The Lumen Of Human Intracranial Aneurysms., Nohra Chalouhi, Pascal Jabbour, Mario Zanaty, Robert M. Starke, James Torner, Daichi Nakagawa, David M. Hasan

Department of Neurosurgery Faculty Papers

BACKGROUND: Aspirin is a promising medical therapy for the prevention of intracranial aneurysm (IA) rupture. Recently, we found that men have a better response to aspirin than women. The purpose of this study was to determine whether a sex differential exists in the level of 15-hydroxyprostaglandin dehydrogenase (15-PGDH) in the lumen of human IAs.

METHODS AND RESULTS: Consecutive patients undergoing coiling or stent-assisted coiling for a saccular IA at our institution were enrolled. Two samples (A and B) were collected from IA lumens, and the plasma level of 15-PGDH was measured using an ELISA-based method. The study included 38 patients ...


Traumatic Pancreatic Injury - An Elusive Diagnosis: Experience From A Developing Country Urban Trauma Referral Centre, Ayaz Ahmed Memon, Hasnain Zafar, Rushna Raza, Ghulam Murtaza 2017 Aga Khan University

Traumatic Pancreatic Injury - An Elusive Diagnosis: Experience From A Developing Country Urban Trauma Referral Centre, Ayaz Ahmed Memon, Hasnain Zafar, Rushna Raza, Ghulam Murtaza

Hasnain Zafar

Objective: To determine the frequency of pancreatic injury in patients presenting with trauma and to review the mechanism of injury, management, subsequent complications and in-hospital mortality rate associated with these patients.Methods: The retrospective study included all patients over 18 years of age presenting with pancreatic injury due to trauma at the Aga Khan University Hospital, Karachi, between January 1990 and December 2009. Patients with iatrogenic pancreatic injury were excluded. The severity of the injury was assessed using the Injury Severity Score, while it was graded according to the scale defined by the American Association for the Surgery of Trauma ...


Terrorist Bombings: Medical Response In A Developing Country, Hasnain Zafar, Ahmed Jawad, M. Shahzad Shamim, Ayaz Ahmed Memon, Aamir Hameed, M. Shahrukh Effendi, Saeed Qureshi 2017 Aga Khan University

Terrorist Bombings: Medical Response In A Developing Country, Hasnain Zafar, Ahmed Jawad, M. Shahzad Shamim, Ayaz Ahmed Memon, Aamir Hameed, M. Shahrukh Effendi, Saeed Qureshi

Hasnain Zafar

OBJECTIVE: To evaluate the process of transport and immediate Emergency Department (ER) management of mass casualties following the recent bomb blasts in Karachi and review in detail the medical response and management of victims undertaken in these two incidents. METHODS: Eyewitness accounts of the victims, medical personnel and newspaper clippings were used to understand and identify difficulties faced during the rescue process. Data regarding presenting injuries and their outcomes was also collected from all victims presenting to the emergency department at Aga Khan University Hospital. RESULTS: Seventy nine individuals died and over 250 victims were injured in the two incidents ...


T-Tube Management Of Late Esophageal Perforation, Irfan Qadir, Hasnain Zafar, Mubashir Zareen Khan, Hasanat Sharif 2017 Aga Khan University

T-Tube Management Of Late Esophageal Perforation, Irfan Qadir, Hasnain Zafar, Mubashir Zareen Khan, Hasanat Sharif

Hasnain Zafar

Esophageal perforation is a serious condition with a high mortality rate. Management strategy of such a patient depends on the extent of perforation and the time interval between perforation and diagnosis. The use of a T tube to treat delayed esophageal perforation with complete resolutionand no need for future definitive surgery has been less frequently described. We adapted this principle in successful management of a 73 year old patient with four days history of fever, shortness of breath, chest pain and radiologicalevidence of perforation


T-Tube Management Of Late Esophageal Perforation, Irfan Qadir, Hasnain Zafar, Mubashir Zareen Khan, Hasanat Mohammad Sharif 2017 Aga Khan University

T-Tube Management Of Late Esophageal Perforation, Irfan Qadir, Hasnain Zafar, Mubashir Zareen Khan, Hasanat Mohammad Sharif

Hasnain Zafar

Esophageal perforation is a serious condition with a high mortality rate. Management strategy of such a patient depends on the extent of perforation and the time interval between perforation and diagnosis. The use of a T tube to treat delayed esophageal perforation with complete resolution and no need for future definitive surgery has been less frequently described. We adapted this principle in successful management of a 73 year old patient with four days history of fever, shortness of breath, chest pain and radiological evidence of perforation.


Outcomes Of Splenectomy For Idiopathic Thrombocytopenic Purpura In Adults: A Developing Country Perspective., Amyn Pardhan, Aamir Hameed, Hasnain Zafar, Samia Mazahir, Ghulam Murtaza 2017 Aga Khan University

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

Hasnain Zafar

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 ...


Paucity Of Trauma Literature From A Highly Burdened Developing Country, Rizwan Sultan, Hasnain Zafar 2017 Aga Khan University

Paucity Of Trauma Literature From A Highly Burdened Developing Country, Rizwan Sultan, Hasnain Zafar

Hasnain Zafar

Abstract Introduction: Trauma is the leading cause of death among a younger population not only in USA but in Pakistan as well. The high prevalence of disease should result in a larger amount of data and a larger number of publications resulting in the ability to explore improvements in the field. This study aimed to review the trauma literature generated from Pakistan. Methods: Journals indexed with PubMed from January 2010 to December 2014 were searched using the search term ‘‘Trauma AND Pakistan’’ filtering for relevant dates and human reports only. The abstracts and articles were reviewed by the authors to ...


Laparoscopic Splenectomy For Haematological Disorder: Our Experience, Hasnain Zafar, Aamir Hameed, Amyn Pardhan, Ghulam Murtaza, Samia Mazahir 2017 Aga Khan University

Laparoscopic Splenectomy For Haematological Disorder: Our Experience, Hasnain Zafar, Aamir Hameed, Amyn Pardhan, Ghulam Murtaza, Samia Mazahir

Hasnain Zafar

Laparoscopic splenectomy has universal acceptance due to less morbidity and decreased incidence of per-operative and postoperative complication. It is not a popular procedure in Pakistan due to technical challenges. Here, we are presenting our experience of laparoscopic splenectomy for haematological disorders at Aga khan university hospital. A total of seven cases, underwent elective laparoscopic splenectomy for haematological disorders. The operative time was less than 3 hours with minimal blood loss with rapid and uneventful recovery. There was no procedure related morbidity or mortality; however, one patient expired due to overwhelming post splenectomy sepsis.Our initial report highlights the safety of ...


Isolated Adult Hypoganglionosis Presenting As Sigmoid Volvulus: A Case Report., Irfan Qadir, Muhammad Musa Salick, Abrar Barakzai, Hasnain Zafar 2017 Aga Khan University

Isolated Adult Hypoganglionosis Presenting As Sigmoid Volvulus: A Case Report., Irfan Qadir, Muhammad Musa Salick, Abrar Barakzai, Hasnain Zafar

Hasnain Zafar

Introduction:Isolated hypoganglionosis is a rare cause of intestinal innervation defects. It is characterized by sparse and small myenteric ganglia, absent or low acetylcholinesterase activity in the lamina propria and hypertrophy of the muscularis mucosae, principally in the region of the colon and rectum. It accounts for 5% of all intestinal neuronal malformations. To the best of our knowledge, only 92 cases of isolated hypoganglionosis were reported from 1978 to 2009. Isolated hypoganglionosis usually manifests as enterocolitis or poor bowel function, and is diagnosed in infancy or childhood. We report the first case of isolated hypoganglionosis presenting with sigmoid volvulus ...


High Pati Score Is Associated With Increase Mortality In Patients With Penetrating Abdominal Injuries; A Retrospective Review, Syed Zohaib Gulzar Naqvi, Shahrukh Effendi, Hasnain Zafar 2017 Aga Khan University

High Pati Score Is Associated With Increase Mortality In Patients With Penetrating Abdominal Injuries; A Retrospective Review, Syed Zohaib Gulzar Naqvi, Shahrukh Effendi, Hasnain Zafar

Hasnain Zafar

Background: Worldwide, injuries due to violence constitute eighth leading cause of death. Penetrating abdominal injuries account for third most common area involved. Inliterature PATI has been utilized to estimate the severity of abdominal trauma, decision making regarding repairing the damage and even risk of post-operative complications. We aimed and intended to use PATI score (penetrating abdominal trau-ma index) as a more accurate method of quantifying the extent of damage in patients with the penetrat-ing abdominal trauma and association of high PATI score (>25) with mortality. Objective: To determine the association of mortality in patient with penetrating abdominal trauma with high ...


Earthquake Relief Experience Of Aga Khan University Trauma Team, Masood Umer, Haroon Rashid, Hasnain Zafar, Kamran Majeed 2017 Aga Khan University

Earthquake Relief Experience Of Aga Khan University Trauma Team, Masood Umer, Haroon Rashid, Hasnain Zafar, Kamran Majeed

Hasnain Zafar

The volatile geo-political situation of the country after the events of September 11, compelled the department of Surgery at Aga Khan University (AKU) to initiate the formation of a comprehensive disaster plan and trauma team. Since its inception the trauma team has stood the test of time during multiple disaster situations in Karachi. This includes the bus bombing of the French engineers, Hyderi mosque bomb blast and various other bomb blasts inside the city of Karachi. All these disasters were successfully managed within the premises of AKU. This earthquake relief activity was the first of its kind when the AKU ...


Emergency Incisional Hernia Repair: A Difficult Problem Waiting For A Solution, Hasnain Zafar, Masooma Zaidi, Irfan Qadir, Ayaz Ahmed Memon 2017 Aga Khan University

Emergency Incisional Hernia Repair: A Difficult Problem Waiting For A Solution, Hasnain Zafar, Masooma Zaidi, Irfan Qadir, Ayaz Ahmed Memon

Hasnain Zafar

Background Emergency repair of incarcerated incisional hernia with associated bowel obstruction in potentially or contaminated field is technically challenging due to edematous, inflamed and friable tissues with occasional need for concurrent bowel resection and carries high rates of post-operative infectious complications. The aim of this study was to retrospectively assess the wound related morbidity of use of permanent prosthetic mesh in emergency repair of incarcerated incisional hernia with associated bowel obstruction. We also describe a new technique of leaving the mesh exposed to heal by secondary intention with granulation tissue. Methods Between 2000 and 2010 a total of 60 patients ...


Duhamel's Procedure For Adult Hirschsprung's Disease, Mehreen Adhi, Salma Khan, Hasnain Zafar, Muhammad Arshad 2017 Aga Khan University

Duhamel's Procedure For Adult Hirschsprung's Disease, Mehreen Adhi, Salma Khan, Hasnain Zafar, Muhammad Arshad

Hasnain Zafar

An adult presented with chronic constipation and abdominal mass. Clinical features, abdominal radiographs and barium enema revealed features consistent with Hirschsprung's disease. Full-thickness rectal biopsy was planned, but patient was lost to follow-up and presented 3 years later with intestinal obstruction. Exploratory laparotomy with resection of affected sigmoid colon and end colostomy were performed. Sequential rectal biopsies were obtained during the procedure to confirm the diagnosis. Later, Duhamel's procedure with a diverting loop ileostomy was successfully performed. Ileostomy reversal was done thereafter. There was complete resolution of symptoms and dramatic improvement in bowel function.


Bomb Blast In A Tertiary Care Hospital, The Challenges Faced During Management Of Victims In A Resource Limited Country, Rizwan Sultan, Hasnain Zafar, Umar B, Khabir Ahmed 2017 Aga Khan University

Bomb Blast In A Tertiary Care Hospital, The Challenges Faced During Management Of Victims In A Resource Limited Country, Rizwan Sultan, Hasnain Zafar, Umar B, Khabir Ahmed

Hasnain Zafar

Abstract Introduction: A bomb blast in a hospital results in a many fold increase in the casualties. The affected health care in the region is the next challenge faced by the administration of the city. We discuss the challenges faced after a bomb blast in the civil hospital of Quetta, Pakistan on 8 August 2016. Methods: A retrospective review of the medical records of patients who were transferred by air to the Aga Khan University Hospital Karachi over a period of 86 h after the blast in Quetta. Results: Seventy-five patients were received in three separate waves; those received in ...


Better Outcome Of Splenectomy In Younger Patients Suffering From Chronic Immune Thrombocytopenia, Sabah Saqib, Rizwan Hashim, Hasnain Zafar 2017 Aga Khan University

Better Outcome Of Splenectomy In Younger Patients Suffering From Chronic Immune Thrombocytopenia, Sabah Saqib, Rizwan Hashim, Hasnain Zafar

Hasnain Zafar

Abstract Immune thrombocytopenia purpura (ITP) may need splenectomy after failure of medical treatment. The aim of this study was to explore the outcome of splenectomy in chronic ITP and to point out factors which can predict better response to splenectomy. This retrospective chart review was conducted at the Aga Khan University Hospital, Karachi, and comprised adult patients who underwent splenectomy for ITP from October 2005 to December 2015. Of the 51 patients, 37(72.5%) were females and 14(27.5%) were males. The overall median age was 32 years (interquartile range: 18-65 years). Complete response was seen in 43 ...


#Ilooklikeasurgeon: Embracing Diversity To Improve Patient Outcomes., Heather Logghe, Christian Jones, Alison McCoubrey, Edward Fitzgerald 2017 Thomas Jefferson University

#Ilooklikeasurgeon: Embracing Diversity To Improve Patient Outcomes., Heather Logghe, Christian Jones, Alison Mccoubrey, Edward Fitzgerald

Department of Surgery Faculty Papers

No abstract provided.


Necrotizing Fasciitis Of The Neck: Case Presentation, Emil Marginean, Ciprian Venter, Maria Domuta, Oana Valenas, Ildiko Sorban, Alina Pantis, Bogdan Popescu, Razvan V. Scăunașu 2017 University of Medicine and Pharmacy Oradea, Department of Otorhinolaryngology, Surgery and Neurosurgery, Oradea, Romania

Necrotizing Fasciitis Of The Neck: Case Presentation, Emil Marginean, Ciprian Venter, Maria Domuta, Oana Valenas, Ildiko Sorban, Alina Pantis, Bogdan Popescu, Razvan V. Scăunașu

Journal of Mind and Medical Sciences

Necrotizing fasciitis represents a severe and rare infectious disease, which is accompanied by extended necrosis of subcutaneous tissues and fascia layers, having as a result gangrene of the teguments. To reduce mortality associated with this disease, a rapid diagnosis is necessary as well as aggressive surgical treatment, accompanied by adequate, aggressive antibiotic therapy. As a rule, etiology is teeth related, with the condition more common in immunology-depressed patients. This article presents the experience of the authors regarding a case presentation of necrotizing fasciitis with typical clinical expression and management of the disease in an immunological-depressed patient. Further data on diagnosis ...


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