Medicine and Health Sciences Commons^™

Gibbon Surgical Review, Volume 7, Issue 1, 2024

Gibbon Surgical Review

Table of Contents

6 - Socially Responsible Surgery: Better Practices for Better Outcomes

8 - Interview with Dr. Talar Tatarian - Assistant Professor

10 - Global Surgery : Current State and Involvement as a Trainee

12 - Interview with Dr. Ibnouf Sulieman - Transplant Surgery Fellow

14 - Resident Spotlight - Dr. Sam Nasser - PGY3

16 - A Review of the FIRST and SECOND Trials

18 - Residency Signaling in General Surgery

20 - Navigating Competency: Entrustable Professional Activities (EPAs)

22 - The Effect of Language Barriers on Surgical Outcomes

24 - Research Spotlight: The First Complete Human Eye …

Highlights Of The 2023 Brano Heart Failure Forum, Bela Merkely, Rajko Radovancevic, Bojan Vrtovec, Igor D. Gregoric

The VAD Journal

Since 2007, the Branislav “Brano” Radovancevic Heart Failure Forum (BHFF) has been held annually to provide a venue for experts to present and discuss “Innovations and New Treatment Strategies in Heart Failure.” Clinicians and researchers gather yearly in a different Eastern European city to discuss the latest in heart failure diagnostics and therapeutics. The 2023 BHHF forum was held on the 13^th thru 15^th of September 2023 in Budapest, Hungary. It was attended by over 100 faculty from 16 countries. In addition, participation through online streaming was available. Throughout the forum, 16 sessions focused on challenges and solutions …

Barriers To And Facilitators Of Using Cognitive Aids In Perioperative Emergencies: An Integrative Review, Simon Almoite, Paula Foran

Journal of Perioperative Nursing

Problem identification: Perioperative emergencies, although infrequent, may lead to significant morbidity and mortality associated with anaesthesia and/or surgery. Human factor errors account for between 43 to 65 per cent of sentinel events in the perioperative environment. Cognitive aids were introduced to reduce a user’s cognitive workload and assist in adherence to key interventions during emergencies. Despite the availability of these aids, implementation of their use remains low. This integrative literature review will identify the barriers to and facilitators of the implementation of cognitive aids during perioperative emergencies.

Literature search: An electronic database search of EBSCO databases (CINAHL Complete, Health Source: …

Assessment Of General Surgery Resident Wellness From The Perspectives Of Family, Friends, And Loved Ones, Dana Unninayar, Benjamin Sc Fung, Gordon Best, Isabelle Raiche

Journal of Wellness

Introduction: Surgical trainees have high rates of burnout compared to residents from other specialties. However, burnout is underreported by trainees, limiting potential interventions to improve wellness. Loved ones are an underused resource for assessing wellness and detecting burnout among residents. The purpose of this study is to assess the perceptions and concerns regarding resident wellness and burnout, as well as strategies to improve wellness, from the perspective of loved ones.

Methods: This cross-sectional survey study was conducted in 2022 at an urban academic center after ethics board approval. An anonymous 18-question survey to assess resident burnout, wellness, and …

Operative Versus Nonoperative Management For Diverticulitis Complicated By Abscess, Alix Bernholtz, Abbie R. Bauer

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

You K, Bendl R, Taut C, et al. Randomized clinical trial of elective resection versus observation in diverticulitis with extraluminal air or abscess initially managed conservatively. Br J Surg. 2018;105(8):971-979. https://doi.org/10.1002/bjs.10868

for a patient with a recurrent diverticulitis complicated by abscess formation.

Efficacy Of Observational Care Versus Antibiotic Therapy For Treatment Of Acute Uncomplicated Diverticulitis, Morgan Mooty, Abbie R. Bauer

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

van Dijk ST, Daniels L, Ünlü Ç, et al. Long-Term Effects of Omitting Antibiotics in Uncomplicated Acute Diverticulitis. Am J Gastroenterol. 2018;113(7):1045-1052. https://doi.org/10.1038/s41395-018-0030-y

for a patient with acute uncomplicated diverticulitis.

Pediatric Appendicitis Or Not? A Retrospective Cohort Study From A Single Institution - Our Management And Factors Determining The Disease, Nimmita Srisan, Teerasak Phewplung, Katawaetee Decharun, Prapapan Rajatapiti, Paisarn Vejchapipat

Chulalongkorn Medical Journal

Purpose: The aims were to assess our treatment guidelines and to determine factors in differentiating children with acute appendicitis from other diseases.

Methods: Pediatric surgery consultations for suspected appendicitis from October 2019 to October 2021 was retrospectively studied. The treatment guidelines of children with suspected appendicitis were elucidated. Moreover, factors identifying the diagnosis of appendicitis were analyzed using multi-variate logistic regression.

Results: Ninety-one children were consulted for suspected appendicitis. Forty-one children (45.1%) were promptly successfully treated without observation or ultrasonography, except one negative appendectomy (2.4%). The other 50 children (54.9%), showed equivocal clinical symptoms and signs, requiring further management either …

Endoscopic Management Of Boerhaave Syndrome: Are Outcomes Better Than Surgery? A Case Report And Review Of Literature, Ammar Qureshi, Uvesh Mansuri, Mona Roknsharifi, Youssef Ghobrial, Artin Asgeri, Mehrdad Asgeri

Journal of Community Hospital Internal Medicine Perspectives

Boerhaave syndrome (BS) is a rare clinical diagnosis associated with a high morbidity and mortality rate. Diagnosis of this condition is usually delayed which can lead to a very poor outcome. The timing of presentation and time to management plays a very important role in the prognosis and selection of the management method. With the advances seen in therapeutic endoscopy, many authors have been exploring the possibility of shifting the focus of management from surgery to interventional endoscopy. We present a case report of a patient presenting with BS that was successfully managed endoscopically. We also reviewed the literature on …

Structured Textbook Review And Individualized Learning Plans Successfully Remediate Underperforming Residents And Improve General Surgery Program Performance On The Absite, Aaron Pinnola, Christoph Kaufmann

HCA Healthcare Journal of Medicine

Background

We endeavored to create an evidence-based curriculum to improve general surgery resident fund of knowledge. Global and resident-specific interventions were employed to this end. These interventions were monitored via multiple choice question results on a weekly basis and American Board of Surgery In-Training Examination (ABSITE) performance.

Methods

This study was performed in a prospective manner over a 2-year period. A structured textbook review with testing was implemented for all residents. A focused textbook question-writing assignment and a Surgical Council on Resident Education (SCORE)-based individualized learning plan (ILP) were implemented for residents scoring below the 35th percentile on the ABSITE. …

What Did We Learn About Vads In 2023?, Maya Guglin

The VAD Journal

This is our 10^th annual literature review on mechanical circulatory support (MCS) devices. All of our previous reports were well received by the readers.^1-9

In this paper, we summarized the most interesting and important, from our standpoint, publications from 2023. There may be some slight overlap with the end of 2022, because some papers were published online first, and the year of publication changed when they became available in print.

For the seventh time this year, we wrote a section on extracorporeal membrane oxygenation (ECMO), which primarily addresses new developments in veno-arterial ECMO.

Readers who wish to supplement …

Late Cardiotoxicity From The Tyrosine Kinase Inhibitor, Dasatinib: Pleural Effusions, Pulmonary Arterial Hypertension, And Right Heart Failure, Mark Jay Zucker, Andrew M. Zucker

The VAD Journal

Despite the remarkable progress made over the past few decades in the management of patients with both solid and hematologic malignancies, radiation- and chemotherapy-related cardiotoxicity remains an ongoing problem. This is true even for newer highly targeted therapies, including tyrosine kinase inhibitors (TKIs). This report presents a case of late/severe right heart dysfunction secondary to pulmonary hypertension, developed after ten years of therapy with dasatinib. We also review the history of this known, but often unrecognized, and potentially reversible complication, and we suggest treatment options. Additionally, this case highlights the remarkable effectiveness of TKIs in patients with chronic myelogenous leukemia …

A Case Report And Review On The Anesthetic Considerations Of Anterior Mediastinal Masses, Carter A. Schulz, Joshua D. Mohs, Andrew M. Reuter

Aesculapius Journal (Health Sciences & Medicine)

Case summary: A 15-year-old female presented with chest pain, dyspnea, and weight loss. A chest X-ray and subsequent CT scan revealed a large anterior mediastinal mass with cervical lymphadenopathy and pericardial effusion. Two biopsies under general anesthesia were performed, with the latter confirming classic Hodgkin lymphoma, nodular sclerosis subtype.

Discussion: This case underscores the significant clinical challenges posed by anterior mediastinal masses due to their proximity to vital cardiovascular and respiratory structures. Physiologic changes during general anesthesia can exacerbate these challenges. Preoperative assessment, including imaging and symptom evaluation, is crucial to guide operative planning. It is key to individualize the …

Ogilvie's Syndrome: Acute Colonic Pseudoobstruction. A Review For Residents., Tyler Bayliss, Caleb Clark, Errington C. Thompson

Marshall Journal of Medicine

Ogilvie's syndrome (acute colonic pseudoobstruction) was first described in 1948. Acute colonic pseudoobstruction can occur in a variety of clinical settings, including postsurgical, obstetrics, pelvic surgery, critical care and sepsis. Clinicians need to recognize the syndrome early. Colonic distention without evidence of obstruction can be seen on plain films of the abdomen or CT scan. Successful therapies, including bowel rest, neostigmine and colonoscopic decompression, have been used. Avoiding respiratory compromise from abdominal distention and colonic perforation of the primary goals of treatment. Surgical intervention should be reserved for patients who are refractory to medical treatment or develops signs and symptoms …

Ultrasound – An Underutilized Diagnostic Tool For Ventricular Assist Device Driveline Infections, Kristina Krzelj, Tomislav Tokic, Tomislav Kopjar, Maja Cikes, Davor Milicic, Hrvoje Gasparovic

The VAD Journal

Patients with ventricular assist device (VAD) driveline infections (DLI) have reduced quality of life and increased risk of severe complications, such as sepsis, hemorrhagic or ischemic stroke, and wound infections. The management of VAD patients imposes a significant financial burden due to prolonged in-hospital stays, frequent re-admissions, expensive diagnostics, and the need for antibiotic therapy and/or surgical intervention. There is considerable room for improvement in DLI management, particularly in the early detection and treatment stages. Ultrasound, an easily applicable device available in almost every hospital, offers an unrecognized potential for the early detection of DLI. By increasing awareness about the …

La Incidencia Y El Tratamiento De Las Hernias En Ecuador En Comparación Con Los Estados Unidos Y Otros Países Del Mundo, Caleb Smith

NEXUS: The Liberty Journal of Interdisciplinary Studies

No abstract provided.

Whole Blood In Trauma, Jason P. Prevelige

Pacific Journal of Health

Abstract: Hemorrhage is a leading cause of death in trauma patients. Whole blood administration in trauma has gained a renewed interest in recent years, however the concept is not new at all, with its origins spanning over 100 years. Field experience in United States’ military conflicts has provided important data on the efficacy of whole blood in reducing mortality and amount of blood product administration. Civilian trials however have not necessarily shown similar results. The safety of whole blood however does not seem to be in question given the available data, and is an acceptable option for blood replacement in …

Using Of Fragment Specific Plate 2.5 Millimetre In Cases Of Distal Radius Fracture, Ibrahim Ahmed Hussien, Amro Ahmed Fouaad, Ahmed Samy Al-Noamany

Al-Azhar International Medical Journal

Background: Fractures of the distal radius inside the joint are a common injury. Whether caused by high-energy trauma or, more commonly among the elderly and those with osteoporosis, low-energy trauma, these fractures tend to be unstable and require immediate medical attention. The use of external fixators for intra-articular distal radius fractures has been supplanted by the use of internal fixators. Aim and objectives: to examine the radiological and clinical results of treating distal radius fractures that occurred on the dorsum of the individual's right and left arms (dorsal or dorso-radial) using a fragment-specific plate (2.5 mm). Subjects and methods: Hospitals …

Comparative Study Between Radical Hysterectomy With Or Without Pelvic Lymphadenectomy For Stage Ii Endometrial Carcinoma, Mohamed Esmat Abdelghany, Ahmed El Sayed Mohamed Abdelrahman, El-Sayed Ragab Mostafa Abdelghany

Al-Azhar International Medical Journal

Background: The removal of the uterus by surgical procedures is the standard treatment for endometrial cancer, which is the most common type of malignant gynecological tumor. Surgery for early-stage endometrial cancer often involves a total abdominal hysterectomy and bilateral salpingo-oophorectomy, with or without bilateral pelvic/para-aortic lymphadenectomy. In some cases, the patient may also have bilateral pelvic lymphadenectomy. Aim and objectives: The objective of the study is to evaluate the efficacy of radical hysterectomy with or without pelvic lymphadenectomy in the treatment of stage II endometrial cancer. Both approaches were examined in terms of the adverse effects they produced, as well …

A Randomized, Controlled Trial Comparing The Metformin, Oral Contraceptive Pills And Their Combination In Patients With Polycystic Ovarian Syndrome, Hamed Mohamed Hamed Abd El Rahman, Mohamed Ali Mohamed, Mohamed Ibrahem Mohamed Ibrahem

Al-Azhar International Medical Journal

Objectives: To assess the effectiveness of metformin also OCP in females with PCOS. Subject and Methods: This was a prospective study that included three hundred patients who were chosen at random from patients who attended outpatient obstetrics and gynecology clinics at Al-Azhar University Hospitals. Samples were obtained using a systematic random technique. Results: Variations in age, BMI, and waist-to-hip ratio among the groups were statistically significant. Blood pressure, heart rate, and temperature demonstrated no statistically significant distinctions among the 2 groups. There was significant variance among examined group as regard TG, LDL-cholesterol, fasting plasma glucose and Fasting insulin. There was …

The Usefulness Of The Added Dw-Mri In Differentiation Of Various Bone Tumors And Tumor Like Focal Lesions, Hesham Mahmoud Hamza, Hoda Abdel-Kareem Abdel-Samiae, Mohamed Ahmed Ahmed Ali, Tarek Mohamed Mohamed Mansour, Marwa Mahmoud Esmail

Al-Azhar International Medical Journal

Background: Any imaging method that is now available can be used to diagnose malignancies that originate in the bones. Plain radiography is the imaging modality that is utilized the vast majority of the time in order to arrive at a diagnosis and identify the characteristics of a variety of osseous lesions. The diagnosis of bone cancer can be challenging, but CT scans can provide useful information about the anatomical breadth of the disease. Magnetic resonance imaging (MRI) is the test that is considered to be the gold standard when it comes to diagnosing cancer and anomalies in the skeleton that …

Cold Snare Polypectomy Versus Hot Snare Polypectomy In Endoscopic Treatment Of Non Pedunculated Colorectal Polyps Larger Than Or Equal 1 Cm, Magdy Abd Al-Karim Al-Dahsha, Mohammed S. Hussein, Sadek Mosta, Abd Al Nabi Saeed Al Sham, Mohamed Fahmy Soliman Alsabagh

Al-Azhar International Medical Journal

Background: In most cases, hot polypectomy is used to treat colon polyps that are more than 1 centimeter in diameter. Electrocautery-induced damage accounts for the majority of adverse outcomes, including prolonged bleeding, post-polypectomy syndrome, and perforation. We postulated that cold resection of big polyps would be as effective as hot polypectomy while being significantly safer for the patient. Aim and objectives: for the purpose of comparing the rates of intraoperative bleeding, clinically significant postoperative bleeding, and perforation between Cold Snaring Polypectomy and Hot Snaring Polypectomy in patients with non-pedunculated colorectal polyps of 10 mm or larger. Subjects and methods: Prospective …

Role Of 4d Ultrasonography In Assessment Of Amniotic Fluid Disorders Of Fetal Renal Origin, Saad R. Al-Gebaly, Sileem A. Sileem, Lotfy A. Murad

Al-Azhar International Medical Journal

Background: Fetal anomalies are detected in approximately 2% of all fetuses and, among these, genitourinary tract abnormalities account for 30% to 50% of all structural anomalies present at birth. Aim : to assess the role of 3D ultrasound in detection of fetal causes of oligohydramnios. Patients and Methods: The study was conducted on 60 pregnant females aged between (19 years and 39 years) mean ± SD 26.6 ± 4.9 presented with olighydraminos, at Al-Azhar University Hospital Assuit branch at Obstetric and gynecological and Radoidaignostic departments in the period from 1st December 2021 to 31th October 2022 . Results: Causes of …

Intraventricalar Hemorrhge In Preterm Infants Identfication Of Risk Factors And Related Outcome, Tarek Mohamed M. Mansour, Mohamed Farouk Ahmad, Mostafa Abd El Azeem Hassan, Mahmoud Mohamed Abdelmotalep Mohamed Elfayoumy, Mohamed Talaat Mohamed Ibrahim, Mohamed M. El-Baroudy

Al-Azhar International Medical Journal

Background: Intraventricular hemorrhage is the most common intracranial hemorrhage in preterm newborns. The high incidence and problems made it important. Many etiologies and risk factors have been found. Newborns can get IVH. Methods: This study included 100 neonates, 59% cases were males & 41% cases were females. GA ranged from 27 to 36 weak, with a mean of 31.9 ±1.67 weak. The weight ranged from 750 g. to 2.93 kg., with a mean of 1.7 ± 0.44 kg. Trans cranial US was done at day one, three and day seven after delivery. Results: The study found that IVH rates were …

Comparative Evaluation Of Diosmectite Versus Nitazoxanide And Their Combination In The Treatment Of Cryptosporidiosis In Immunosuppressed Mice, Enas A. El Saftawy, Walla’A A. Osman, Rania M. Sarhan, Rabab S. Zalat, Shimaa A. Atta

Al-Azhar International Medical Journal

Abstract

Background

Cryptosporidiosis is a parasitic infection that affects immunocompromised patients and can result in systemic involvement of different organs and death.

Aim

To compare nitazoxanide (an antiprotozoal agent) and diosmectite (an antidiarrheal agent) and their combination in the treatment of cryptosporidiosis infection.

Materials and methods

Mice were divided into five groups: negative control, the infected untreated (positive control), diosmectite-treated, nitazoxanide-treated, and the group treated with nitazoxanide and diosmectite simultaneously. The evaluation was through measuring body weight, oocyst shedding, intestinal, and hepatic histopathological examination, as well as estimation of some inflammatory and oxidative markers.

Results

Body weight was improved significantly …

A Hanging Case Or A Hit And Run Accident, Mohamed M. Hussein, Ashraf I. Hassan

Al-Azhar International Medical Journal

When the victim's body was observed to be partially or totally hanged, a death by hanging occurred. The existence of both general and local indicators of hanging together with circumstantial evidence is typically used to diagnose the cause. After ruling out the presence of other important suspicious signs, such as those suggesting struggle, and when the victim is toxicologically free, the manner of death is tends to be suicidal. Circumstances also, should exclude homicide and accidental death. We present a man in the third decade of life, found on a road with head trauma but with signs of hanging including …

A Comparative Study Between Anterior Tunnel And Anterior Release Techniques In The Management Of Anterior Tympanic Membrane Perforation, Atef Abdullah El Maraghy, Yehia Mohamed Dawood, Abdulrahman Mohamed Ali Abdallah

Al-Azhar International Medical Journal

Introduction: When the perforation in the tympanic membrane is anteriorly located with a thin anterior rim, stabilizing the graft using the traditional underlay tympanoplasty approach may be challenging. It was attempted to solve this issue using tympanoplasty with anterior tunneling or anterior releasing. Aim and Objectives: This study aims to compare the efficiency of anterior tunnel and anterior release techniques in the management of anterior tympanic membrane perforation. Patients and Methods: A one-year prospective single blinded study with three-months follow-up was conducted on 60 patients divided into two groups: tympanoplasty with tunneling (Group A) and release (Group B) tympanoplasty for …

Characteristics Of Patients Newly Diagnosed With Diabetes Mellitus After Coronavirus Disease-19 (Covid-19), Alboraie Mohamed Aly, Megahed Mohamed Rabie, Abohasan Ahmed Mohamed, Abdelraouf Mahmoud Ezzat, Badr Gamal Aly

Al-Azhar International Medical Journal

Background: At this moment, there is a greater than ever level of concern over the 2019 (COVID-19) coronavirus illness pandemic and its related morbidities. Aim and objectives: Case series with systematic review of the frequency of newly diagnosed diabetes mellitus (DM) among COVID-19 patients, its varied symptoms, and glycemic control in diabetic patients. Patients and methodology: 100 patients altogether were split into two groups for this cross-sectional study. Every examination done at the time of diagnosis and two months afterwards. They were evacuated from Al-Hussein University Hospital between January and July 2022. Results: Our findings showed that the HbA1C levels …

Comparative Study Between Cardiac Mri And Echocardiography In Post-Operative Evaluation Of Fallot Tetralogy, Tarek Mohamed Abdel Hamid El-Zayyat, Hytham Mohamed Mahmoud Nafady, Ahmed Abd Elazeem Mohamed Youseif

Al-Azhar International Medical Journal

Background: Tetralogy of Fallot (TOF) represents the prevailing form of cyanotic congenital cardiac disease. Cardiac magnetic resonance imaging (CMR) plays a crucial role in monitoring adult patients with congenital heart disease. Transthoracic echocardiography (TTE) is capable of providing the majority of the requisite data for sequential monitoring in patients with tetralogy of Fallot (TOF). Aim of the work: To investigate the respective contributions of cardiac magnetic resonance imaging and echocardiography in the evaluation of post-operative Fallot tetralogy, using a comparative analysis. Methodology: This study will be carried out on 30 cases of patients referred to the Heart Institute diagnosed by …

Covid-19 Affects Cardiovascular System 6 Months After Symptoms In Pediatric, Al Hussein Mustafa Zahran Ahmed, Alsayed Ali Abdou Almarghany, Ahmed Ali Faheem Abdo, Moustafa Mohamed Mohamed Eldeib, Ali Elsayed Ali Elagamy, Abdou Mohamed Abdou Mahmoud, Mostafa Abd Elazeem Hassan Ahamed, Ahmed Ali Ali Assem, Hossam M. Farid El-Zamek, Abdelmaaboud M. M. Omar

Al-Azhar International Medical Journal

Background: Coronavirus disease 2019 (COVID-19), which resulted in a global pandemic, is caused by severe acute respiratory syndrome coronavirus 2. We aimed to highlight the cardiovascular involvement in children after 6 months of COVID-19 recovery, Aim and Objectives: To highlight the cardiovascular involvement in children after 6 months of COVID-19 since this has the potential for morbidity and mortality in this age group, Patients and Methods: This observational cross-sectional descriptive study was conducted on 42 pediatrics aged-19 after 6 months at hospitals from January 2022 to February 2023. All patients were subjected to full history taking, clinical examination, laboratory investigations …

Effect Of Low-Flux Versus High-Flux Dialyzers On Interleukin 6 (Il-6) Level In Patients Undergoing Maintenance Haemodialysis, Hussein Salem Farahat Salem, Mohamed Nabil Raafat, Ismail Mohamed El Mancy, Ibrahim Metwaly Bayomi

Al-Azhar International Medical Journal

Background: One of the leading causes of death and suffering in the 21st century is chronic kidney disease (CKD). Due to the rise in risk factors like obesity and diabetes, as well as the rising number of people affected with CKD, our study aimed to study the effect of using low-flux in comparison to high-flux dialyzers on serum IL-6 levels in patients undergoing regular hemodialysis (HD).

Patients and Methods: Our study was a randomized controlled trial. Sixty patients were enrolled: 20 CKD patients, 20 dialysis patients using low- flux, and 20 patients using high-flux polysulfone dialyzers. Dialysis sessions were four …