Medicine and Health Sciences Commons^™

Factors Associated With Mammographic Breast Density Among Women In Karachi Pakistan, Uzma Shamsi, Shaista Afzal Saeed, Azra Shamsi, Syed Iqbal Azam, David Callen

Community Health Sciences

Background: There are no studies done to evaluate the distribution of mammographic breast density and factors associated with it among Pakistani women.
Methods: Participants included 477 women, who had received either diagnostic or screening mammography at two hospitals in Karachi Pakistan. Mammographic breast density was assessed using the Breast Imaging Reporting and Data System. In person interviews were conducted using a detailed questionnaire, to assess risk factors of interest, and venous blood was collected to measure serum vitamin D level at the end of the interview. To determine the association of potential factors with mammographic breast density, multivariable polytomous logistic …

Biochemical Testing For The Diagnosis Of Wilson's Disease: A Systematic Review, Hafiz Muhammad Salman, Mahwish Amin, Javaria Syed, Zouina Sarfraz, Azza Sarfraz, Muzna Sarfraz, Maria Jose Farfán Bajaña, Miguel Felix, Ivan Cherrez-Ojeda

Department of Paediatrics and Child Health

Background: Wilson's disease (WD) is a rare inherited disorder that leads to copper accumulation in the liver, brain, and other organs. WD is prevalent worldwide, with an occurrence of 1 per 30,000 live births. Currently, there is no gold standard diagnostic test for WD. The objective of this systematic review is to determine the diagnostic accuracy for WD of three biochemical tests, namely hepatic copper, 24-hour urinary copper, and ceruloplasmin using the Leipzig criteria.
Methods: Adhering to PRISMA guidelines, databases including PubMed/MEDLINE, CINAHL Plus, Web of Science, and Cochrane were searched. Studies that comprised of confirmed or suspected WD along …

Intensive Care Bundle With Blood Pressure Reduction In Acute Cerebral Hemorrhage Trial (Interact3): Study Protocol For A Pragmatic Stepped-Wedge Cluster-Randomized Controlled Trial, Lili Song, Xin Hu, Lu Ma, Xiaoying Chen, Menglu Ouyang, Laurent Billot, Qiang Li, Paula Muñoz-Venturelli, Carlos Abanto, Mohammad Wasay

Section of Neurology

Background: Early intensive blood pressure (BP) lowering remains the most promising treatment for acute intracerebral hemorrhage (ICH), despite discordant results between clinical trials and potential variation in the treatment effects by approach to control BP. As the third in a series of clinical trials on this topic, the INTEnsive care bundle with blood pressure Reduction in Acute Cerebral hemorrhage Trial (INTERACT3) aims to determine the effectiveness of a goal-directed care bundle protocol of early physiological control (intensive BP lowering, glycemic control, and pyrexia treatment) and reversal of anticoagulation, in acute ICH.
Methods: INTERACT3 is a pragmatic, international, multicenter, stepped-wedge (4 …

Does Digital Literacy Empower Adolescent Girls In Low- And Middle-Income Countries: A Systematic Review, Salima Meherali, Komal Abdul Rahim, Sandra Campbell, Zohra S. Lassi

School of Nursing & Midwifery

Background: The vast majority (90%) of the world's adolescents aged 10-19 live in low- and middle-income countries (LMICs); and in those resource-limited settings, girls face distinct challenges across multiple health, social, and economic domains. Gender equality and girls' empowerment are key goals in their own right and are central to all other development goals. Digital literacy is a great enabler for the empowerment of young girls. This systematic review aims to assess the range and nature of digital literacy interventions implemented to empower adolescent girls in LMICs and identify evidence about adolescent girls' access and use of digital technologies in …

The Curious Case Of Hla-Dr-Positive Apl, Kanta Devi, Natasha Bahadur Ali

Section of Haematology/Oncology

The triad of weak/absent CD34, negative HLA-DR expression, and positivity to CD117 is pathognomonic for the diagnosis of acute promyelocytic leukemia. However, in rare cases, strong positivity to HLD-DR and CD34 may be noted.

Lipid A-Ara4n As An Alternate Pathway For (Colistin) Resistance In Klebsiella Pneumonia Isolates In Pakistan, Kiran I. Masood, Seema Umar, Zahra Hasan, Joveria Farooqi, Safina Abdul Razzak, Nazish Jabeen, Jason Rao Jason Rao, Sadia Shakoor, Rumina Hasan

Department of Pathology and Laboratory Medicine

Objectives: This study aimed to explore mechanism of colistin resistance amongst Klebsiella pneumoniae isolates through plasmid mediated mcr-1 gene in Pakistan. Carbapenem and Colistin resistant K. pneumoniae isolates (n = 34) stored at - 80 °C as part of the Aga Khan University Clinical Laboratory strain bank were randomly selected and subjected to mcr-1 gene PCR. To investigate mechanisms of resistance, other than plasmid mediated mcr-1 gene, whole genome sequencing was performed on 8 clinical isolates, including 6 with colistin resistance (MIC > 4 μg/ml) and 2 with intermediate resistance to colistin (MIC > 2 μg/ml).
Results: RT-PCR conducted revealed absence of …

Generating Evidence From Contextual Clinical Research In Low- To Middle Income Countries: A Roadmap Based On Theory Of Change, Babar Hasan, Muneera Rasheed, Asra Wahid, Raman Krishna Kumar, Liesl Zuhlke

Department of Paediatrics and Child Health

Along with inadequate access to high-quality care, competing health priorities, fragile health systems, and conflicts, there is an associated delay in evidence generation and research from LMICs. Lack of basic epidemiologic understanding of the disease burden in these regions poses a significant knowledge gap as solutions can only be developed and sustained if the scope of the problem is accurately defined. Congenital heart disease (CHD), for example, is the most common birth defect in children. The prevalence of CHD from 1990 to 2017 has progressively increased by 18.7% and more than 90% of children with CHD are born in Low …

Bile Acid Profiling Reveals Distinct Signatures In Undernourished Children With Environmental Enteric Dysfunction, Xueheng Zhao, Kenneth D R. Setchell, Rong Huang, Indika Mallawaarachchi, Lubaina Ehsan, Edward Dobrzykowski Iii, Junfang Zhao, Sana Syed, Najeeha Talat Iqbal, Junaid Iqbal, Kamran Sadiq, Sheraz Ahmed, Syed Asad Ali

Department of Paediatrics and Child Health

Background: Intestinal inflammation and malabsorption in environmental enteric dysfunction (EED) are associated with early childhood growth faltering in impoverished settings worldwide.
Objectives: The goal of this study was to identify candidate biomarkers associated with inflammation, EED histology, and as predictors of later growth outcomes by focusing on the liver-gut axis by investigating the bile acid metabolome.
Methods: Undernourished rural Pakistani infants (n = 365) with weight-for-height Z score (WHZ) < -2 were followed up to the age of 24 mo and monitored for growth, infections, and EED. Well-nourished local children (n = 51) were controls, based on consistent WHZ > 0 and height-for-age Z score (HAZ) > -1 on 2 consecutive visits at 3 and 6 mo. Serum bile acid (sBA) profiles were measured by tandem MS at the ages of 3-6 …

Improving Stroke Unit Numbers And Care In Pakistan, Abubakar Siddique, Umair Rashid Ch, Ahsan Numan

Pakistan Journal of Neurological Sciences (PJNS)

t is self-evident that stroke remains one of the leading causes of death and disability not only in the world but also in Pakistan. The prevalence of stroke risk factors and epidemiological studies shows that the burden of stroke will not decrease in the next decades and beyond. It poses a huge challenge for the affected and their families, for medical services, governments and the society as a whole. The promising thing about stroke is that it is preventable, treatable and manageable and there is potential to drastically reduce the burden of stroke and the long term consequences.1 However, this …

Neonatal Outcomes And Congenital Anomalies In Pregnancies Affected By Hypothyroidism, Zareen Kiran,, Aisha Sheikh, Khadija N Humayun, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Background: Maternal hypothyroidism has been reported to have concerns over neonatal outcomes, not only in the context of neurocognitive development but also in the short term as birth weight and neonatal jaundice.
Patients and methods: We conducted a cross-sectional retrospective study on 638 cases who delivered live births in the Aga Khan University Hospital after ethical approval. Data were collected on hypothyroid pregnant females who were diagnosed before conception or during their antenatal visits during the year 2008-2016. Neonatal outcomes were noted for birth weight, maturity, and neonatal jaundice, neonatal hypothyroidism, neonatal respiratory distress syndrome, sepsis, hypocalcaemia, congenital anomalies, need …

Qualitative Exploration Of Feasibility And Acceptability Of The Modified Atkins Diet Therapy For Children With Drug Resistant Epilepsy In Kenya, Pauline Samia, Violet Naanyu, J. Helen Cross, Richard Idro, Paul Boon, Jo Wilmshurst, Stanley Luchters

Paediatrics and Child Health, East Africa

Purpose: Approximately one-third of children with epilepsy have clinical syndromes characterized by drug resistance. Modified Atkins dietary therapy (MADT) can reduce seizures and improve health out- comes for these children. This intervention is yet to be consistently offered as standard of care in sub- Saharan Africa.

Objectives: This study aimed to assess feasibility and acceptability of MADT for children with drug- resistant epilepsy and identify enabling strategies for implementation and adherence to the MADT. Methods: This qualitative inquiry utilized in-depth interviews with purposively selected caregivers and adolescent patients having used MADT for drug-resistant epilepsy. A qualified team consisting …

Surgical Management Of Subclavian And Proximal Axillary Artery Injuries, Zia Ur Rehman, Suleman Yousaf, Tehmeed Ahmad

Department of Surgery

Subclavian and proximal axillary arterial injuries are rare and difficult to manage. Eight patients were managed from January 2008 to December 2018 at The Aga Khan University Hospital, Karachi, Pakistan with mean age of 36.13 ± 14.48 years. All patients had penetrating injuries, from gunshot in 5 (62.5%), bomb blast in 2 (25%), and stab wound in 1 (12.5%) case. Six (75%) patients presented in haemodynamically stable condition. The mean time between the injury and patient presentation was 28 ± 8.39 hours. The injuries were approached via supraclavicular incision in 3 (37.5%) patients, infraclavicular incisions in 2 (25%) patients and …

The Mystery Of Covid-19 Reinfections: A Global Systematic Review And Meta-Analysis, Rubaid Azhar Dhillon, Mohammad Aadil Qamar, Jaleed Ahmed Gilani, Omar Irfan, Usama Waqar, Mir Ibrahim Sajid, Syed Faisal Mahmood

Department of Medicine

Background: As the COVID-19 pandemic rages on, reports on disparities in vaccine roll out alongside COVID-19 reinfection have been emerging. We conducted a systematic review to assess the determinants and disease spectrum of COVID-19 reinfection.
Materials and methods: A comprehensive search covering relevant databases was conducted for observational studies reporting Polymerase Chain Reaction (PCR) confirmed infection and reinfection cases. A quality assessment tool developed by the National Institute of Health (NIH) for the assessment of case series was utilized. Meta-analyses were performed using RevMan 5.3 for pooled proportions of findings in first infection and reinfection with a 95% confidence interval …

The Effect Of Saline Flush After Rocuronium Bolus On Intubating Conditions In Adult Patients Undergoing Elective Surgery: A Randomized Controlled Trial, Ian Odari, Vitalis Mung’Ayi, Rajpreet Bal, David Odaba

Anaesthesiology, East Africa

Background: In emergency surgeries requiring endotracheal intubation, the time to effect of neuromuscular blocking drugs is a crucial time to avoid hypoxia and aspiration into the lungs. Various strategies have been undertaken to shorten this time. All these methods have positive results but some are associated with side effects. The effectiveness of a muscle relaxant can either be assessed using the train of four or intubating conditions on the Goldberg scale. In this study, we investigated the effects of a 20 ml saline bolus following intravenous rocuronium at 0.6 mg/kg on the proportions of patients with excellent intubating conditions …

Artificial Intelligence And Neurology - Opportunities And Challenges In Pakistan, Adeel A. Memon, Junaid S. Kalia

Pakistan Journal of Neurological Sciences (PJNS)

The field of artificial intelligence (AI) has undergone rapid development in neurological disorders over the past few decades. AI relies on large volumes of high-quality data. As a result, their use in low-resource settings has been limited due to the lack of a digitized health care system. This article will address the challenges and opportunities involved in implementing AI for neurological care in Pakistan, as well as discuss the types of digital health care data and the benefits of applying AI in resource-limited countries

The Truth About Brain Cells: Is Adult Neurogenesis Possible?, Ekene Nnagha, Queen-Helen Egbai, Ahtesham Khizar

Pakistan Journal of Neurological Sciences (PJNS)

Brain cells regeneration involves renewal and repair of neurons and other cells in the brain, with restoration of their functions. Although this phenomenon was thought to end in early childhood, research has proven that adult neurogenesis is highly possible with some limitations. Regeneration of axons in the central nervous system is very slow and more complicated than neuronal regeneration, especially regeneration of peripheral nerves. Brain cell regeneration in the adult brain can help in recovery of damaged brain cells and correct cellular and brain tissue dysfunction that are commonly seen in some neurological disorders such as Stroke, Traumatic Brain Injury …

Pseudo-Torch- A Rare Mutation Causing Global Development Delay, Microcephaly And Extensive Band Like Brain Calcification, Javeria Raza Alvi, Saher Gul Ahdi, Mahrukh Sultan, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

Pseudo-TORCH 1 syndrome is an inherited autosomal recessive disorder that clinically and radiologically mimic congenital TORCH infection. We report a case of three and half years old child who presented with early infantile seizures, progressive microcephaly, facial dysmorphism and global developmental delay. There were symmetrical band like intra-parenchymal calcification as well as in pons and thalami. Serological testing for infectious agents was negative. His Whole exome sequencing revealed OCLN gene mutation consistent with Pseudo-TORCH syndrome-1.

A Rare Case Of Epilepsia Partialis Continua Secondary To Rasmussen’S Encephalitis, Waleed Shahzad, Muhammad Hassan, Haris Majid Rajput, Tehmina Inayat, Naveed Ullah Khan, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Rasmussen's encephalitis is a rare baffling disorder seen in nearly 1 % to 2 % of epilepsy population and in 7.4% of paediatric population. It is mostly seen in children and in most cases seizures are seen during 14 months to 14 years with peak age 3 to 6 years. Etiology includes viral infections, humoral autoimmunity and T-cell mediated cyto-toxicity of the brain tissue. The main clinical features are intractable epilepsy, hemiparesis, hemidystonia, hemiathetosis, epilepsia-partialis-continua and mental decline. Imaging shows unilateral hemispheric brain atrophy. Here we describe a unique case of a 15-year-old Pakistani girl with severe immune mediated brain …

A Rare Case Of Epilepsia Partialis Continua Secondary To Rasmussen’S Encephalitis, Waleed Shahzad, Muhammad Hassan, Haris Majid Rajput, Tehmina Inayat, Naveed Ullah Khan, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Rasmussen's encephalitis is a rare baffling disorder seen in nearly 1 % to 2 % of epilepsy population and in 7.4% of paediatric population. It is mostly seen in children and in most cases seizures are seen during 14 months to 14 years with peak age 3 to 6 years. Etiology includes viral infections, humoral autoimmunity and T-cell mediated cyto-toxicity of the brain tissue. The main clinical features are intractable epilepsy, hemiparesis, hemidystonia, hemiathetosis, epilepsia-partialis-continua and mental decline. Imaging shows unilateral hemispheric brain atrophy. Here we describe a unique case of a 15-year-old Pakistani girl with severe immune mediated brain …

Guillain–Barré Syndrome In Sars-Cov-2; A Case Report, Naveed Ullah Khan, Muhammad Hassan, Haris Majid Rajput, Waleed Shahzad, Hafsa Mobeen, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Multiple systems have been affected by COVID-19 infection, and neurological symptoms are not uncommon. A 45-year-old male presented to us in the emergency department without focal neurological deficits. He developed ascending paralysis soon after his admission, which was followed by worsening respiratory symptoms. The family of the patient refused a lumbar puncture, and his NCS/EMG showed features of acute motor axonal neuropathy (AMAN), a variant of Guillain-Barré syndrome (GBS). After being admitted on the 4th day, the patient developed type 2 respiratory failure and died on the 5th day of admission before any treatment could be started. Patients with COVID-19 …

The Constellation Of Centronuclear Myopathy And Craniofacial Dysmorphism, Mahnoor Hafeez

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT:

A 20 years old third-year MBBS female student from Dow Medical College in 2008 presented to the Neurology Dept. in Karachi with a short history of rapidly worsening bilateral lower limb weakness for 6 months. There was facial dysmorphism. Motor neuron disease was the suspicion; EMG/NCS study revealed non inflammatory myopathic process involving all limb muscles; Centro nuclear myopathy (CNM) was diagnosed via muscle biopsy. CNM is a group of congenital myopathies, where cell nuclei are abnormally located in skeletal muscle cells. Craniofacial dysmorphism is characterized by abnormal development of facial and skull structures. To the best of the …

Clinical Spectrum And Eeg Findings Of Non-Convulsive Status Epilepticus In Children, Shaila Ali, Natasha Ghani, Ather Khalily, Zia-Ur- Rehman, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT

OBJECTIVE:

To determine the clinical spectrum and EEG findings ofnon-convulsive status epilepticus in children. METHODS: A total of 38 children were included in this prospective cross sectional study, having EEG suggestive of NCSE after taking informed consent from guardians, keeping EEG as gold standard tracings were reviewed according to criteria of non-convulsive status epilepticus. Their clinical features were also noted leading to non- convulsive status epilepticus. Diagnostic workup will be done to find out the underlying cause, according to the suspected etiology of non-convulsive status epilepticus.

RESULTS: There were 26 male and 12 female patients, with ratio of 2:1. …

Neurological Syndromes After Recent Covid-19 Vaccination; A Possible Association, Ayisha Farooq Khan, Sajid Hameed, Sara Khan, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT OBJECTIVE:

Coronavirus disease 2019 (COVID-19) pandemic is one of the deadliest pandemics of our time. Vaccines are our best hope to put an end to this pandemic. An emergency use authorization (EUA) has been given to seven vaccines and more than 4 billion doses have been globally administered. Because of EUA, the large-scale safety trials were not conducted before their use and adverse effects were one of the chief concerns resulting in vaccine hesitancy.

METHODS: This is a retrospective observational study. All the inpatients admitted to the Department of Neurology, Aga Khan University during the period from 1st April …

Frequency And Types Of Cerebral Infarctions On Brain Imaging In 2257 Hospitalized Patients With Covid-19, Raima Kaleemi, Zainab Rauf, Muhammad Azeemuddin, Muhammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT BACKGROUND AND OBJECTIVE:

SARS-COV (COVID-19) virus is not solely a pulmonary disease but affect multiorgan system including the brain. The objective of this study was to see the frequency of neuroimaging findings especially cerebral infarcts in our covid population. METHODS: This study is a retrospective observational study conducted in a large tertiary care hospital which was also a Covid center from March 1, 2020 to December 30, 2020.The frequency of neurological manifestations in COVID19 positive patients admitting in the hospital was observed through charts review. All scans were reviewed by two trained neuroradiologists. RESULTS: Total of 2257 patients enrolled …

Action Leveraging Evidence To Reduce Perinatal Mortality And Morbidity (Alert): Study Protocol For A Stepped-Wedge Cluster-Randomised Trial In Benin, Malawi, Tanzania And Uganda, Joseph Akuze, Kristi Sidney Annerstedt, Lenka Benova, Effie Chipeta, Jean-Paul Dossou, Mechthild M. Gross, Hussein Kidanto, Bruno Marchal, Helle Mölsted Alvesson, Andrea B. Pembe

Obstetrics and Gynaecology, East Africa

Background: Insufficient reductions in maternal and neonatal deaths and stillbirths in the past decade are a deterrence to achieving the Sustainable Development Goal 3. The majority of deaths occur during the intrapartum and immediate postnatal period. Overcoming the knowledge-do-gap to ensure implementation of known evidence-based interventions during this period has the potential to avert at least 2.5 million deaths in mothers and their offspring annually. This paper describes a study protocol for implementing and evaluating a multi-faceted health care system intervention to strengthen the implementation of evidence-based interventions and responsive care during this crucial period.

Methods: This is a cluster …

Categorization And Frequency Of Indications For Packed Cell Transfusion In The Preterm Newborn During The Initial Hospital Stay At A Tertiary Care Hospital: A Cross-Sectional Study, Shirin Surani, Heeramani Lohana, Sheraz Ahmed, Rabia Hassan, Sapna Kewalani, Khalil Ahmed

Department of Paediatrics and Child Health

Introduction: Packed cell transfusion is a lifesaving procedure in premature babies as they have more complications as compared to babies who are born at term. Complications related to prematurity increase as gestational age decreases and anemia is one of the complications of prematurity which needs packed cell transfusions. To date, when to transfuse preterm babies and what would be the threshold for hemoglobin and hematocrit is still a point of argument as well as liberal versus restrictive transfusion protocols have been developed but what should be followed still needs more data. In our study, we have observed frequencies of different …

Effectiveness Of Simulation-Based Clinical Skills Training For Medical Students In Respiratory Medicine: A Pilot Study, Russell S. Martins, Saniya Sabzwari, Meesha Iqbal

Medical College Documents

Objective: To assess the effectiveness of high-fidelity simulation-based medical education (HF-SBME) in teaching and learning respiratory clinical examination in medical students.
Study design: Quasi-experimental pilot study.
Place and duration of study: The Aga Khan University, Karachi, from November 2018 to January 2020. Methodology: This study was conducted amongst third year medical students at the University. Students were assigned to intervention (IG) or control groups (CG). The IG underwent training for the respiratory clinical examination on a high-fidelity simulator mannequin, while the CG received the conventional practice session on standardised patients. Students were assessed on their respiratory clinical examination skills in …

Thrombosis With Thrombocytopenia Syndrome After Administration Of Azd1222 Or Ad26.Cov2.S Vaccine For Covid-19: A Systematic Review, Usama Waqar, Shaheer Ahmed, Syed M H Ali Gardezi, Muhammad Sarmad Tahir, Zain Ul Abidin, Ali Hussain, Natasha Bahadur Ali, Syed Faisal Mahmood

Medical College Documents

Background: Cases of thrombosis with thrombocytopenia syndrome (TTS) have been reported following vaccination with AZD1222 or Ad26.COV2.S. This review aimed to explore the pathophysiology, epidemiology, diagnosis, management, and prognosis of TTS.
Methods: A systematic review was conducted to identify evidence on TTS till 4th September 2021. Case reports and series reporting patient-level data were included. Descriptive statistics were reported and compared across patients with different sexes, age groups, vaccines, types of thrombosis, and outcomes.
Findings: Sixty-two studies reporting 160 cases were included from 16 countries. Patients were predominantly females with a median age of 42.50 (22) years. AZD1222 was administered …

Improving Maternal And Child Health In Pakistan: A Programme Evaluation Using A Difference In Difference Analysis, Muhammad Ashar Malik, Lara Riedige Rohm, Pieter Van Baal, Eddy Van Doorslaer Van Doorslaer

Community Health Sciences

Introduction: Pakistan is a country with high maternal and infant mortality. Several large foreign funded projects were targeted at improving maternal, neonatal and child health. The Norway-Pakistan Partnership Initiative (NPPI) was one of these projects. This study aims to evaluate whether NPPI was successful in improving access and use of skilled maternal healthcare.
Methods: We used data from three rounds (2009-2010, 2011-2012 and 2013-2014) of the Pakistan Social and Living Standards Measurement Survey (PSLM). A difference-in-difference regression framework was used to estimate the effectiveness of NPPI and its different programme components with respect to maternal healthcare seeking behaviour of pregnant …

Strocss 2021: Strengthening The Reporting Of Cohort, Cross-Sectional And Case-Control Studies In Surgery, Ginimol Mathew, Riaz Agha, Strocss Group, Joerg Albrecht, Prabudh Goel, Indraneil Mukherjee, Prathamesh Pai, Anil K. D'Cruz, Ather Enam, Hammad Ather

Section of Neurosurgery

Introduction: Strengthening The Reporting Of Cohort Studies in Surgery (STROCSS) guidelines were developed in 2017 in order to improve the reporting quality of observational studies in surgery and updated in 2019. In order to maintain relevance and continue upholding good reporting quality among observational studies in surgery, we aimed to update STROCSS 2019 guidelines.
Methods: A STROCSS 2021 steering group was formed to come up with proposals to update STROCSS 2019 guidelines. An expert panel of researchers assessed these proposals and judged whether they should become part of STROCSS 2021 guidelines or not, through a Delphi consensus exercise.
Results: 42 …