Medicine and Health Sciences Commons^™

Bringing Efficiency Into Practice: A Quality Improvement Initiative To Reduce Operating Room Turnaround Time, Hasanat Sharif, , Noman Shehzad, Joveria Farooqi, Sana Karim

Department of Surgery

Abstract

Operating room (OR) turnaround time (TAT) is the minimal essential time required for cleaning of OR and preparation for the next case. The TAT inversely affects OR efficiency. Several factors related to personnel, equipment and scheduling have been identified as causes of increased TAT. We conducted the study to identify factors that affect OR TAT and to propose recommendations for its reduction. The retrospective study, conducted at Aga Khan University Hospital, Karachi, comprised TAT records related to March 2014. Of the 88 cases, 22(25%) showed a delay. Upon Pareto analysis it was found that in 8(36.6%) cases there was …

Lower Red Cell Transfusion Rates With Use Of Tranexamic Acid In Single-Stage Bilateral Total Knee Arthroplasty: A Retrospective Audit, Muhammad Aziz, Salman Bin Mahmood,, Riaz Hussain Lakdawala, Tashfeen Ahmad

Department of Surgery

Abstract

Bilateral total knee arthroplasty (BTKA) patients may require blood transfusion which has its risks. Anti-fibrinolytic drugs such as aprotinin, aminocaproic acid and tranexamic acid (TXA) have reduced transfusion requirements in major surgery. This retrospective audit was performed to assess effectiveness of TXA in reducing blood transfusion rate in single-stage sequential BTKA cases operated by a single surgeon. Records of 91 patients given TXA and 80 controls who were operated before 2012 and not given TXA were reviewed. TXA was given 15mg/kg intravenously (IV) before tourniquet deflation and 3 hours postoperatively.Blood transfusion was done in 9(10%) patients in the TXA …

Intravesical Foreign Body: Tertiary Care Center Experience From Pakistan., Hussam Uddin Soomro,, Imran K. Jalbani, Nuzhat Faruqui

Department of Surgery

Foreign body in bladder is relatively uncommon condition with variable presentations. Literature is limited to case reports and small series from region. Therefore, we planned this study to review our experience regarding intravesical foreign body. This retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised 14 patients having intravesical foreign bodies from March 1989 to March 2013. Demographics, presentation, mode of insertion, type of foreign body and management were noted. Of the 11(78.6%) patients included in the study, 10(90.9%) patients were male and 1(9.1%) was female. The mean age was 51± 20 years. In 5(45.5%) patients, …

Indications Of Enucleations And Eviscerations Performed At A Tertiary Eye Care Unit: A Case Series., Rashid Baig, Maheen Akhtar Syed, Khabir Ahmad, Tanveer Anjum Chaudhry

Department of Surgery

Abstract

The retrospective study was planned to look at the indications of eye enucleations and eviscerations, and comprised all such procedures done at the Aga Khan University Hospital, Karachi, from January 2006 to December 2015. Data was collected regarding age at the time of procedure, gender, procedure type, indication for enucleation or evisceration, type of implant if used and complications. Of the 66 eyes of 65 individuals, 47 (71.2%) underwent evisceration and 19 (28.8%) enucleation. The mean age at the time of the procedures was 37.86±23.09 years. The indication for enucleation or evisceration were keratitis 14(21.2%), introcular tumours 13(19.7%), trauma …

Neurosurgery Training In Pakistan: Follow-Up Survey And Critical Analysis Of National Training Programmes., Dr Saqib Kamran Bakhshi, Muhammad Waqas, Muhammad Mehboob Alam, Muhammad Shahzad Shamim, Mohsin Qadeer

Department of Surgery

No abstract provided.

Bacterobilia In Acute Cholecystitis: Bile Cultures' Isolates, Yousaf Bashir Hadi, Muhammad Waqas, Hafiz Muhammad Umer,, Ammar Alam, Abdul Rehman Alvi, Muhammad Rizwan Khan, Amir Hafeez Shariff

Department of Surgery

Abstract Acute cholecystitis is one of the most common acute surgical conditions. Laparoscopic cholecystectomy remains the mainstay of treatment. In patients managed non-operatively, antibiotics play an important role in the treatment of cholecystitis. The current retrospective observational study was conducted at a tertiary care hospital in Karachi, and comprised medical records of patients admitted between 2008 and 2014with acute cholecystitis and in whom bile cultures were obtained. Of the 509 patients with a mean age of 51.15 ± 13.4years, early laparoscopic cholecystectomy (within 72hours) was performed on 473(92.9%) cases, while the rest underwent percutaneous cholecystostomy. Bile cultureswere positive in 171(33.6%) …

Frequency Of Sensorineural Hearing Loss In Chronic Suppurative Otitis Media, Syed Sajjad Ali Zaidi, Hamdan Ahmed Pasha,, Anwar Suhail,, Talha Ahmed Qureshi

Department of Surgery

Abstract Chronic suppurative otitis media (CSOM) is defined as chronic otorrhea (i.e., lasting > 6-12 weeks) through a perforated tympanic membrane. It is generally associated with some degree of conductive hearing loss. However, recurrent ear infections due to perforated eardrum result in absorption of toxins and macromolecules into the cochlea leading to sensorineural hearing loss (SNHL). We planned to determine the frequency of sensorineural hearing loss in chronic suppurative otitis media. A descriptive cross-sectional study was conducted at Aga Kgan University Hospital, Karachi, from October 2013 to March 2014. Average threshold of speech frequencies was calculated via pure tone audiogram for …

Innovations In Cardiovascular Care: Historical Perspective, Contemporary Practice, Recent Trends And Future Directions, Hasanat Sharif, Mayera Tufail

Department of Surgery

Abstract

Cardiovascular diseases continue to be a major cause of mortality and morbidity in the world population. First open heart procedure was performed by Gibbon in 1953, since then many advancements have been introduced to the field of cardiac surgery. Minimally invasive techniques were introduced, which include minimally invasive coronary artery bypass grafting (CABG), off-pump technique, minimally invasive valve surgery or transcatheter techniques to implant stentless or sutureless valves. The hybrid strategy to address coronary disease combines catheterisation procedures with standard surgical techniques. Cardiac imaging has also progressed to provide three-dimensional images of the heart, enabling surgeons to plan procedures …

Breast Reconstruction At The Aga Khan University - A 10 Year Audit, Samiullah Abdullah, , Asif ,Ahsan, Tahir Shafi Khan

Department of Surgery

Abstract

Considering the high incidence of breast cancer and the subsequent need for a mastectomy, the number of patients having breastreconstruction remains relatively low the world over. Most studies from the west show that anywhere between 5% to around 50% of women proceed to reconstruction following a complete mastectomy. There is a great paucity of literature on the subject in Pakistan. Anecdotal and unofficial accounts would suggest that less than a fraction of 1% of women in Pakistan undergo reconstruction following a mastectomy.We reviewed our cases retrospectively over a 10 year study period from January 2005 to December 2014 with …

Exploration Of Variations In Positions Of Upper And Lower Incisors, Overjet, Overbite, And Irregularity Index In Orthodontic Patients With Dissimilar Depths Of Curve Of Spee., Nita Kumari, Mubassar Fida, Attiya Shaikh

Department of Surgery

Abstract

OBJECTIVE:

The position and arrangement of teeth as well as the entire scheme of occlusion differs from one individual to the other .The purpose of this study was to examine differences in position and inclination of incisors, overjet, overbite and lower arch crowding in subjects with different depths of curve of Spee and to determine correlations between depth of curve of Spee and these variables.

METHODS:

The sample comprised of 114 patients (55 females and 59 males) with fully erupted permanent second molars (age 12-25 years), having no history of previous orthodontic treatment, no craniofacial anomalies, and no missing …

Reliability Of Overbite Depth Indicator (Odi) And Anteroposterior Dysplasia Indicator (Apdi) In The Assessment Of Different Vertical And Sagittal Dental Malocclusions: A Receiver Operating Characteristic (Roc) Analysis, Farheen Fatima, Mubassar Fida, Attiya Shaikh

Department of Surgery

Abstract

INTRODUCTION::

Differential diagnosis of skeletal and dental relationships is crucial for planning orthodontic treatment. Overbite depth indicator (ODI) and anteroposterior dysplasia indicator (APDI) had been introduced in the past for assessment of vertical and sagittal jaw relationships, respectively.

OBJECTIVE: :

The objectives of this study were to evaluate the reliability of ODI and APDI in overbite and Angle malocclusions, as well as assess their diagnostic reliability among males and females of different age groups.

MATERIAL AND METHODS: :

This study was conducted using pretreatment dental casts and lateral cephalograms of 90 subjects. For ODI, subjects were divided into three …

Morbidity Of Colostomy Reversal, Salma Khan, Abdul Rehman Alvi, , Zara Awan, Naveed Haroon Rashid

Department of Surgery

Abstract

OBJECTIVE:

To determine morbidity after colostomy reversal at a tertiary care hospital.

METHODS:

The retrospective case series was conducted at the Aga Khan University Hospital, Karachi, and comprised records of patients aged 15 years or more who underwent colostomy reversal from January 2003 to December 2011. Data was collected regarding demographics, procedure dates, indication, as well as type and location of colostomy. Details of colostomy reversal, including pre-operative, intra-operative and post-operative variables were recorded.

RESULTS:

The mean age of the 96 patients was 40±16 years; 72(75%) of them being males. The most frequent indications for fashioning of colostomy were …

The Duration Of Pubertal Growth Peak Among Three Skeletal Classes, Waqar Jeelani, Mubassar Fida, Attiya Shaikh

Department of Surgery

ABSTRACT

Introduction:

Pubertal growth peak is closely associated with a rapid increase in mandibular length and offers a wide range of therapeutic modifiability.

Objective:

The aim of the present study was to determine and compare the mean ages of onset and duration of pubertal growth peak among three skeletal classes.

Methods:

A retrospective cross-sectional study was conducted using lateral cephalograms of 230 subjects with growth potential (110 males, 120 females). Subjects were categorized into three classes (Class I = 81, Class II = 82, Class III = 67), according to the sagittal relationship established between the maxilla and the mandible. …

Intertrochanteric Hip Fractures In Octogenarian Patients: Do We Need To Rethink Fixation Strategy?, Shahryar Noordin, Shahbano 1, Tashfeen Ahmad, Idrees Shah

Department of Surgery

Abstract

OBJECTIVE:

To compare outcomes in octogenarians with younger patients up to 1 year after undergoing dynamic hip screw fixation for intertrochanteric fractures to see the effectiveness of the implant.

METHODS:

The retrospective case-control study was conducted at The Aga Khan University and comprised records of patients who underwent dynamic hip screw surgery between January 1, 2010, and December 31, 2012. They were divided into two groups based on their age:. Group A <80 years; and Group B > 80 years. All patients had a one-year follow-up> Data including mortality, morbidity, radiological healing time, postoperative ambulatory status and Harris hip score were recorded.

RESULTS:

Of the …

Primary Melanotic Schwannoma With Typical Histology, Usman B. Mahmood, Fazal Wahab Khan, Benish Fatima, Muhammad Usman Tariq, Saulat Hasnain Fatimi

Department of Surgery

Abstract

We present a case of a 17-year male with a soft tissue density spreading from the neural foramina (T3) of the spinal cord and involving the right upper thoracic cavity. We managed the patient through surgical intervention and resected the complete tumor. Gross definition and microscopic findings of the resected tissue revealed the definitive diagnosis of melanotic schwannoma. The histological characteristics in this case were very specific and harbour an important diagnostic clue for this rare disease. Malignant melanoma was ruled out on the basis of histological findings. The patient recovered completely and was healthy on one-year follow-up.

Omitting Histopathology In Wrist Ganglions. A Risky Proposition, Akbar Jaleel Zubairi, Santosh Kumar, Yasir Mohib, Rizwan Haroon Rashid, Shahryar Noordin

Department of Surgery

ABSTRACT Objectives: To identify incidence and utility of histopathology in wrist ganglions. Methods: A retrospective study of 112 patients operated for wrist swellings between January 2009 and March 2014 at Aga Khan University Hospital, Karachi, Pakistan, was conducted. Medical records were reviewed for demographics, history, location and associated symptoms, provisional diagnosis and operative details. Histopathology reports were reviewed to confirm the final diagnosis. Results: One hundred and twelve patients were included in the study (34 males and 78 females) with a mean age of 28 ± 12 years. Ninety-five percent of ganglia were dorsally located and 85% were solitary in …

Adrenalectomy For Solitary Metastasis Of Hepatocellular Carcinoma Post Liver Transplantation: Case Report And Literature Review, Imran K. Jalbani, Nazim Syed Muhammad, Usman Tariq Siddiqui, Farahat Abbas

Department of Surgery

Abstract

Liver transplantation (LT) is the treatment of choice for localized hepatocellular carcinoma (HCC) associated with cirrhosis. Extra hepatic metastasis is the most common cause of death in these patients. There is very little evidence regarding the natural history and treatment options for patients developing HCC recurrence after LT. Surgical resection offers a unique opportunity for solitary metastasis. We report a 61 year old male with solitary right adrenal metastasis 15 months post LT which was managed with open adrenalectomy. The patient is alive and disease free 24 months after the surgery. The case, histo-pathological findings and literature review is …

Comparison Of Ureteric Stone Size, On Bone Window Versus Standard Soft-Tissue Window Settings, On Multi-Detector Non-Contrast Computed Tomography., Hussam Uddin Soomro, Hammad Ather, Basit Salam

Department of Surgery

Abstract

OBJECTIVE:

To compare the difference in mean stone size, as measured on bone window vs standard soft-tissue window setting using multi-detector computed tomography (MDCT) in patients with a solitary ureteric stone.

PATIENTS AND METHODS:

In all, 60 patients presenting to the emergency and outpatient departments of a University Hospital from May 2015 to October 2015 and fulfilling the inclusion criteria were included in the study. A 64-slice MDCT was used to assess the locations and size of the ureteric stones. A consultant radiologist independently analysed the MDCT scans of all the patients. The mean difference in stone size was …

In-Vitro Comparison Of Micro-Leakage Between Nanocomposite And Microhybrid Composite In Class V Cavities Treated With The Self-Etch Technique, Syeda Mahvish Hussain, Farhan Raza Khan

Department of Surgery

Abstract

BACKGROUND:

When a light cure composite resin is used to restore a class V lesion, certain stresses are generated at the tooth-restoration interface. If these stresses exceed the bond strength of the restorative material, microscopic gaps are formed which eventually cause micro-leakage at the tooth-restoration interface. The objective of the present study was to compare the micro-leakage values at the tooth-restoration interface using dye penetration method between a Nano filled and a Micro hybrid light cured composite resin in class V cavities using the self-etch technique.

METHODS:

Sixty class V cavities were made coronal to the cemento-enamel junction in …

Significantly Low Effective Dose From 18fdg Pet/Ct Scans Using Dose Reducing Strategies: "Lesser Is Better", Maseeh Uz Zaman, Nosheen Fatima, Unaiza Zaman, Rabia Tahseen

Department of Surgery

Abstract

BACKGROUND:

Fluorodeoxyglucose (18FDG) PET/CT imaging has become an important component of the management paradigm in oncology. However, the significant imparted radiation exposure is a matter of growing concern especially in younger populations who have better odds of survival. The aim of this study was to estimate the effective dose received by patients having whole body 18FFDG PET/CT scanning as per recent dose reducing guidelines at a tertiary care hospital.

MATERIALS AND METHODS:

This prospective study covered 63 patients with different cancers who were referred for PET/CT study for various indications. Patients were prepared as per departmental protocol and 18FDG …

Relationship Of Tumor Thickness With Neck Node Metastasis In Buccal Squamous Cell Carcinoma: An Experience At A Tertiary Care Hospital, Sadaf Qadeer Ahmed, Montasir Junaid, Sohail Awan, Moaz M. Choudhary, Maliha Kazi, Aria Masoom, Hareem Usman Khan

Department of Surgery

Introduction Squamous cell carcinoma is the most common malignancy of the head and neck, with the buccal mucosa being the most common site involved. Early locoregional metastasis is a hallmark of this disease, and early stage tumors may harbor metastatic nodes that are occult. Certain parameters can help identify high-risk patients for whom the pattern of occult nodal metastasis can be predicted. Tumor thickness is one such objective parameter. Objective To determine the relationship of tumor thickness with neck node metastasis in squamous cell carcinoma of the buccal mucosa. Methods A retrospective chart review of 102 patients with biopsy-proven squamous …

Cephalometric Evaluation Of The Effects Of The Twin Block Appliance In Subjects With Class Ii, Division 1 Malocclusion Amongst Different Cervical Vertebral Maturation Stages., Aisha Khoja, Mubassar Fida, Attiya Shaikh

Department of Surgery

Objectives: To evaluate the cephalometric changes in skeletal, dentoalveolar and soft tissue variables induced by Clark’s Twin Block (CTB) in Class II, Division 1 malocclusion patients and to compare these changes in different cervical vertebral maturation stages. Methods: Pre- and post-treatment/observation lateral cephalograms of 53 Class II, Division 1 malocclusion patients and 60 controls were compared to evaluate skeletal, dentoalveolar and soft tissue changes. Skeletal maturity was assessed according to cervical vertebral maturation stages. Pre- and post-treatment/observation mean changes and differences (T2 -T1 ) were compared by means of Wilcoxon sign rank and Mann-Whitney U-tests, respectively. Intergroup comparisons between different …

Perforated Sub-Hepatic Appendix; Rare Presentation Of A Common Disease., Huzaifa Ali Jaliawala, Fatima Mannan, Roger Gill, Abdul Rehman Alvi

Department of Surgery

Abstract

An elderly gentleman presented to our emergency with a 10-day history of right upper quadrant pain and nausea with associated tenderness on examination. His white cell counts were raised with predominant neutrophils with ultrasound evidence of a heterogeneous sub-hepatic collection, not associated with fever, diarrhoea or vomiting. He had a similar episode 3 weeks ago, which resolved with antibiotics. Initially thought to be a perforated acute appendicitis or a liver abscess a CT scan was done to further substantiate our finding. This to the contrary revealed a perforated sub hepatic appendix. Patient was treated conservatively with IV fluids and …

Patients' Satisfaction And Spectacle Independence After Cataract Surgery With Multifocal Intraocular Lens Implantation In A Tertiary Care Hospital, Rashid Baig, Tanveer Anjum Chaudhry, Saajan Kukreja,, Sidra Shakil, Khabir Ahmad

Department of Surgery

Abstract

This single group cohort study, undertaken at Aga Khan University Hospital, Karachi, from Jan 2012 to September 2013, assessed patients' satisfaction, spectacle independence and visual disturbance after implantation of multifocal IOLs. A total of 39 patients who underwent bilateral cataract surgery with multifocal IOL implantation were included for telephonic interviews. The mean age of participants was 55.5 ± 8.1 years. The mean follow up time was 9.60 ± 3.19 months. The overall satisfaction rate after surgery was found to be 84.6% and there was no statistically significant association of satisfaction with gender, age or education. In all 84.6%, 94.9% …

Unusual Case Of Non-Resolving Necrotizing Pneumonia: A Last Resort Measure For Cure., Naseem Salahuddin, Naila Baig Ansari, Saulat H. Fatimi

Department of Surgery

Abstract

To our knowledge, this is an unusual case of a community-acquired pneumonia (CAP) with sepsis secondary to Streptococcus pneumoniae that required lung resection for a non-resolving consolidation. A 74 year old previously healthy woman, presented with acute fever, chills and pleuritic chest pain in Emergency Department (ED). A diagnosis of CAP was established with a Pneumonia Severity Index CURB-65 score of 5/5. In the ER, she was promptly and appropriately managed with antibiotics and aggressive supportive therapy. She remained on ten days of intravenous antibiotics. However, 48 hours post antibiotic course, she returned to ER with fever and signs …

Comparison Of Wound Complications In Open Vs Closed Lateral Internal Sphincterotomy For Anal Fissure, Arthur Yushuva Md, Gregg M. Baranski Md, John S. Park Md

Department of Surgery

No abstract provided.

Results From Application Of An Absorbable Synthetic Membrane To Superficial And Deep Second Degree Wounds, Sigrid A. Blome-Eberwein Md, Patrick Pagella Rn, Cnp, Deborah Boorse Rn, Cnp, Hamed Amani Md

Department of Surgery

No abstract provided.

Using Elasticated Retractors In Head And Neck Surgeries, Montasir Junaid, Manal Shafiq, Sadaf Qadeer, Sohail Haleem, Maliha Kazi

Department of Surgery

Abstract

Elasticated retractors, a recent advancement in surgical techniques, provide an enhanced and effective way of retraction during head and neck surgeries. These have been used for a number of procedures and are known for their effective retraction and minimizing surgical time span. This article highlights the authors' experience and the pros and cons of this technique

Synovial Neuronal Changes In Knee Joint Osteoarthritis, Haq Nawaz, Masood Umer, Shahryar Noordin, Bo Christer Bertilson, Jian Li, Aisha Siddiqah Ahmed, Mahmood Ahmed

Department of Surgery

Abstract Purpose: The purpose is to study whether pain and inflammation in knee joint osteoarthritis (OA) are associated with local synovial neuronal changes. Methods: Synovial biopsies were harvested from the medial and lateral knee compartments from OA patients undergoing total joint replacement surgery. All patients had predominant pain at the medial joint compartment. Pain and knee joint function were evaluated by knee society score (KSS). Synovial inflammation was analyzed by histopathological analysis and expression of growth associated protein-43 (GAP-43), sensory (SP, CGRP) and autonomic (NPY, VIP, TH) neuropeptides was studied by single and double immunohistochemistry techniques. Results: We observed reduced …

Unintentional Injuries In Children: Are Our Homes Safe?, Ahmad Vaqas Faruque, Muhammad Arif Mateen Khan

Department of Surgery

Abstract

Unintentional injuries are a leading cause of death in childhood globally. Injuries lead to emotional trauma and financial burden for children, parents, and society. Here are the frequencies of unintentional injuries in children presented to the emergency and paediatric surgery clinics of the Aga Khan University Hospital, Karachi, Pakistan, from January to December 2012. Aretrospective chart review of children aged 0 day to 14 years presented with falls, burns, foreign body ingestion or inhalation, poisoning, fingers caught in doors, electrocution injuries and drowning, was conducted. Atotal of 165 children were included. Domestic injuries were frequently occurring injuries in our …