Medical Specialties Commons^™

A Multidisciplinary Approach To Triage Patients With Breast Disease During The Covid-19 Pandemic: Experience From A Tertiary Care Center In The Developing World, Abida K. Sattar, Hania Shahzad, Adnan Abdul Jabbar, Azmina Tajdin Valimohammad, Sadaf Khan, Yasmin Vellani, Romana Idrees, Nasir Ali, Imrana Masroor, Humera Saeed, Gulzar S. Lakhani, Nadia Ayoub, Atif Waqar, Muhammad Zia-Ul Islam, Salman Kirmani, Asad Latif, Ather Enam

Section of General Surgery

Background: The COVID-19 pandemic has created a need to prioritize care because of limitation of resources. Owing to the heterogeneity and high prevalence of breast cancers, the need to prioritize care in this vulnerable population is essential. While various medical societies have published recommendations to manage breast disease during the COVID-19 pandemic, most are focused on the Western world and do not necessarily address the challenges of a resource-limited setting.
Aim: In this article, we describe our institutional approach for prioritizing care for patients presenting with breast disease.
Methods and results: The breast disease management guidelines were developed and approved …

Feasibility And Initial Experience Of Left Radial Approach For Diagnostic Neuroangiography., Nohra Chalouhi, Ahmad Sweid, Fadi Al Saiegh, Kalyan C Sajja, Richard F. Schmidt, Michael B Avery, Nikolaos Mouchtouris, Omaditya Khanna, Joshua H Weinberg, Victor Romo, Stavropoula Tjoumakaris, Michael Reid Gooch, Nabeel Herial, Robert H Rosenwasser, Pascal Jabbour

Department of Neurosurgery Faculty Papers

Neuroangiography has seen a recent shift from transfemoral to transradial access. In transradial neuroangiography, the right dominant hand is the main access used. However, the left side may be used specifically for left posterior circulation pathologies and when right access cannot be used. This study describes our initial experience with left radial access for diagnostic neuroangiography and assesses the feasibility and safety of this technique. We performed a retrospective review of a prospective database of consecutive patients between April 2018 and January 2020, and identified 20 patients whom a left radial access was used for neurovascular procedures. Left transradial neuroangiography …

Genetic Murine Models Of Spinal Development And Degeneration Provide Valuable Insights Into Intervertebral Disc Pathobiology., J. Melrose, S. Tessier, M. V. Risbud

Department of Orthopaedic Surgery Faculty Papers

Disc degeneration and associated back and neck pain elicits a substantial burden on healthcare systems and the individuals affected, necessitating the development of novel therapeutic strategies. This goal can only be achieved by a better understanding of intervertebral disc development, homeostasis and pathogenesis. A number of genetic and in-bred murine models are reviewed to underscore the importance of the mouse as an animal model of choice for the assessment of intervertebral disc pathobiology. Appraisals of the differences between mouse and human musculoskeletal systems and proteoglycan structures are also included. A number of important target pathways and molecules have been identified, …

Colostomy Takedown: Ischemic Complication Following Anorectal Malformation Surgery., Wendy Jo Svetanoff, Justin A. Sobrino Md, Grace S. Mitchell, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

Introduction: Anorectal malformations (ARM) are complex disorders that often require staged reconstructions. We present a case and imaging findings of a child who developed issues following colostomy closure due to segmental colonic ischemia. Case Presentation. A 3-year-old female with Currarino syndrome presented with abdominal distention, blood-flecked stools, and prolonged cecostomy flush time. For her anorectal malformation, a colostomy was initially placed. A new colostomy was created at posterior sagittal anorectoplasty (PSARP) to allow the distal rectum to reach the anus without tension. Differentials for her presenting symptoms included a mislocation of the anus, stenosis at the anoplasty site, stricture …

A "Blinking" Left Ventricular Assist Device, Maya Guglin, Roopa Rao

The VAD Journal

A 61-year-old male with history of coronary artery disease and end stage ischemic cardiomyopathy underwent a successful implantation of a HeartMate 3 device with an uneventful recovery. However, after 6 months, he complained of increased fatigue, intermittent dizziness, and weakness after minor exertion. The pulsatility index was increased to 8, but the left ventricular assist device (LVAD) was otherwise functioning properly. No major changes in either medications or laboratory results were noted. The patient started getting low flow alarms seven months after the procedure and the dizziness increased. On the controller, a continuously changing (“blinking”) speed was noted (Supplemental Video …

Management Of The Sensitized Cardiac Transplantation Recipient, Michael Mazzei, Suresh Keshavamurthy, Olga Timofeeva, Yoshiya Toyoda

Surgery Faculty Publications

Preoperative sensitization of the cardiac transplant recipient, defined as the presence of anti-Human Leukocyte Antigen (HLA) antibodies before transplant, represents a significant management challenge for physicians. Sensitization prolongs the pre-transplant wait time and is associated with postoperative transplant complications and death. It is critical that sensitized heart transplant candidates be identified and optimized before surgery. In this review, we describe the risk for sensitization, discuss the means through which sensitization may be diagnosed, and highlight some of the new therapeutic options for managing the sensitized cardiac transplant patients.

Preoperative Atrial Fibrillation/Flutter Impact On Risk-Adjusted Repeat Aortic Intervention Patients[Protocol], Samantha Novotny, Julia Dokko, Xiaoyue Zhang, Sohaib Agha, Ashutosh Yaligar, Natalie Kolba, Vineet Tummala, Puja Parikh, Aurora Pryor, Henry Tannous, A. Laurie Shroyer, Thomas Bilfinger

Department of Surgery Faculty Publications

No abstract provided.

Transitioning Trainees From The Operating Room To The Covid-19 Intensive Care Unit In New York – Correspondence, M. A. Catalano, G. F. Coppa, V. M. Patel

Journal Articles

No abstract provided.

Predictors And Risk-Adjusted Outcomes Of New-Onset Postoperative Atrial Fibrillation In Surgical And Transcatheter Aortic Valve Replacement [Post-Af Ravr Protcol], Julia Dokko, Samantha Novotny, Xiaoyue Zhang, Sohaib Agha, Ashutosh Yaligar, Natalie Kolba, Vineet Tummala, Puja Parikh, Aurora Pryor, Henry Tannous, A. Laurie Shroyer, Thomas Bilfinger

Department of Surgery Faculty Publications

No abstract provided.

Publication Status Of Unpublished Research Manuscripts On Orthopaedic Surgery Residency Applications After 30 Months, J. T. Barnes

Scholarship in Medicine - All Papers

Objectives: The orthopaedic surgery residency applicant class of 2016 had a nationwide match rate of 67.8%. This institution received 573 applications for four residency spots. As orthopaedic surgery residency becomes more competitive, so does the drive among applicants to improve their residency applications. Research experience, in particular, is becoming an increasingly common component of applications. Previous research has demonstrated that the requirement for a PubMed Identification number on all published citations on residency applications since 2014 has led to a drastic decrease in misrepresentation of published research. While publication is the ultimate goal of most research projects, not all manuscripts …

Perceptions Of Self-Efficacy And Experiences Of Mindfulness On Pain And Anxiety In Patients Undergoing A Colorectal Surgery: A Prospective Mixed Methods Study, Rebecca Brown, Julie Fitzgibbons, Rachel Farrington

Costas T. Lambrew Research Retreat 2021

Introduction

• Pain and anxiety have a physiological response on the body.

• Increased heart rate, respiratory rate and blood pressure can lead to complications, and thus longer hospitalization along with decreased patient satisfaction.

Prolonged Thunder Before The Storm – Diagnosis Of Aortobronchial Fistula After 28 Months Of Recurrent Hemoptysis, Hilamber Subba, Truc Ta, Edmund Sears

Costas T. Lambrew Research Retreat 2021

Aortobronchial fistula (ABF) should always be considered in patients with hemoptysis and previous thoracic surgery, however the diagnosis is known to be difficult both clinically and radiographically1. We present a case with the longest indolent course of hemoptysis reported to date .

Would Surgeons Opt For Polypropylene Mesh If They Hypothetically Had Stress Urinary Incontinence Or Pelvic Organ Prolapse?, William J. Devan, Sanchita Bose, Dayron Rodriguez, Ricardo Munarriz, Linda Ng

Costas T. Lambrew Research Retreat 2021

Introduction

• Controversy surrounding vaginal mesh kits

• Many patients have negative connotations regarding mesh

• If patients were shown that their surgeons would opt for mesh –maybe this would help lessen the negativity?

The Introduction Of A Multimodal Clinical Pathway For Outpatient Total Knee Arthroplasty In The Era Of Covid-19, D Bunch, R Mountjoy, G Korsunsky, A Rana, C Sturgeon

Costas T. Lambrew Research Retreat 2021

The combination of a short acting spinal and muscle-sparing regional blocks, including adductor canal and iPACK blocks, can allow for successful outpatient total knee arthroplasty.

Strengthening Orthopaedic Care At National Level: Output Of A Structured Residency Programme At Aga Khan University, Fateh Ali Janjua, Shah Fahad, Tashfeen Ahmad, Masood Umer

Section of Orthopaedic Surgery

This descriptive review of the output of the orthopaedic residency programme of Aga Khan University, Karachi, comprised information regarding the number of graduated residents and their educational background which was retrieved from departmental records. Information about their work location, subspecialty, current working status, participation in medical camps and national disaster relief efforts were obtained from various sources, including fellow surgeons, and social media profiles. From 1989 to 2017, a total of 48 residents graduated from the programme, with only 2(4.2%) of them being females. Overall, 19(39.6%) residents hailed from areas outside Karachi; 28(58.3%) belonged to Karachi; 1(2%) came from Kenya; …

Simulation-Based Training In The Paediatric Surgery Population: A Review Of Current Trends And Future Direction, Areej Saleem, Zorays Moazzam, Sohail Asghar Dogar, Saqib Hamid Qazi

Section of Paediatric Surgery

In recent years, simulation-based training in surgery has emerged as a viable accompaniment to traditional teaching methods. Multiple studies have highlighted the benefits of simulation-based training in both learning and teaching aspects of surgical training, with a particular emphasis on the honing of technical skills. However, multiple issues still exist in widespread implementation of simulation-based training, especially in the developing countries. Furthermore, the existing literature needs to be expanded upon in both quantity and quality domains to ensure a more evidence-based transition to simulation-based training in surgery. The current review article was planned to take a look at the existing …

Current Standards Of Postgraduate Surgical Education And Training In Pakistan: Time To Bridge The Gaps In Lieu Of National Necessity, Sabah Uddin Saqib, Abdul Hakeem Memon, Omair Saleem, Amir Hafeez Shariff

Section of General Surgery

The provision of good-quality surgical care is a salient feature of every public health system. Pakistan is ranked among low and middle-income countries where the burden of surgical disease is rapidly increasing, but the capacity of the health system has not expanded at the same pace to cater current needs. One of the key components is the dearth of trained surgical specialists and lack of easy access to surgical care. College of Physicians and Surgeons, Pakistan is the main certifying institution for surgeons, while public and private teaching hospitals bear the burden of responsibility for surgical education and training. The …

Apprenticeship To Simulation - The Metamorphosis Of Surgical Training, Muhammad Rizwan Khan, Saleema Begum

Section of General Surgery

Surgery is a dynamic specialty and surgical competencies are a combination of both technical and non-technical skills. After the inception of the art of surgery, surgical education and training has undergone incredible evolution. The first model of surgical training was introduced in the 19th century and is known as the 'apprenticeship model', followed by the famous 'Halstedian' model. However, a report by the Institute of Medicine challenged the teaching institutions to formulate alternative methods of surgical education to ensure patients' safety and to reduce the fear among patients of them being practised on. Teaching surgical skills outside the operating room …

Mentorship In Surgical Training: Where Do We Stand?, Saleema Begum, Muhammad Rizwan Khan, Madeeha Safa

Section of General Surgery

Mentorship in medicine aims at professional and personal development of trainees in the early stages of their careers. It is more popular in surgical subspecialties since transfer of technical skills is an integral part of surgical training, which makes it distinct compared to other specialties. Effective mentoring in surgery plays a crucial role in academic success, professional development, career guidance and personal growth of residents, and provides guidance and support to mentees to excel in their respective fields, and increases the likelihood of success by enhancing motivation with positive impact on burnout among residents. Efforts have been made by accreditation …

Role Of Preoperative Embolization In Management Of Central Nervous System Tumours, Ummey Hani, Ahmer Nasir Baig, Muhammad Shahzad Shamim, Basit Salam

Section of Neurosurgery

Preoperative embolization plays a significant role as an adjunct to surgical intervention in the cases of certain vascular tumours of the brain. While the procedure has resulted in facilitated resection of the tumour, and has reduced morbidity and mortality, its application remains debatable within the neurosurgical community, owing to rare, but major post-procedural complications. Herein, we have reviewed the literature to assess the safety and efficacy of preoperative angiographic embolization for brain tumours.

Carotid Artery Dissections From Tcar As Reported By The Food And Drug Administration, Dongjin Suh Bs, Yuchi Ma Bs, Daniel H. Newton Md, Michael F. Amendola Md, Kedar S. Lavingia Md

Graduate Research Posters

BACKGROUND: Transcarotid artery revascularization (TCAR) is hybrid procedure that allows carotid stenting using direct surgical access of the carotid artery to restore blood flow through the carotid artery. It has shown the lowest perioperative stroke rate when compared with any prospective trial of transfemoral carotid artery stenting. However, intraoperative injuries related to the procedure and its management are not well characterized. We anticipate that this analysis will add qualitative insight in further characterizing adverse outcomes of this novel technology.

METHODS: The FDA maintains a database called the MAUDE (Manufacturer and User Facility Device Experience) for surveillance of all medical devices …

Morbidity And Mortality Meetings; A New Digital Portal To Enhance Learning And Objectivity, Saqib Kamran Bakhshi, Kiran Ehsan, Gulzar S. Lakhani, Ather Enam

Section of Neurosurgery

Morbidity and mortality meetings have long been part of surgical education and practice. They have undergone several modifications over time to include improvement in patient safety and outcomes as an essential utility of conducting morbidity and mortality meetings. Time and again, it has been proposed in literature that standardisation of case discussion results in the efficiency of these meetings. Learning opportunities can be compiled for system improvement. The current review article was planned to present a newly implemented digital morbidity and mortality portal at the Aga Khan University Hospital (AKUH), Karachi, aiming at homogenising the discussion and to add objectivity …

Relationship Between Preoperative Frailty And Postoperative Outcomes After Lvad Implantation, Katherine L. Wilhelm

DNP Projects

Abstract

Background: Frailty is common in many patients with advanced heart failure, including those who undergo left ventricular assist device (LVAD) implantation. Frailty has been associated with worse outcomes after other cardiac surgeries; however, little is known about the effect of frailty on postoperative outcomes after LVAD implant.

Purpose: The purpose of this project was to evaluate whether preoperative frailty [as determined by either short physical performance battery (SPPB) score ≤ 7/12 or 6-minute walk test (6-MWT) <200 >meters] is associated with poorer postoperative outcomes after LVAD implantation than non-frailty in adults with advanced heart failure.

Setting and Sample: This project …

Complications In Cardiac Surgery, Christine Williamitis

Theses and Dissertations--Nursing

Quality of care and outcomes from cardiac surgery have always been of primary importance to providers and the entire health care team when caring for cardiac surgical patients. Providers in cardiac surgery have had a long history of tracking procedural morbidity and mortality rates in programs nationally and internationally. Morbidity and mortality rates vary widely among hospitals. In most studies in which procedural outcomes from cardiac surgery are evaluated, the focus has been on operative morbidity and mortality and the probability of death after a cardiac surgical procedure. Less attention has been paid to predictors of perioperative complications, and sample …

Telementoring For Breast Surgeons Practicing In Remote Areas, Fatima Mubarik, Hania Shahzad, Syeda Sakina Abidi, Sana Zeeshan, Lubna Mushtaque Vohra, Sadaf Khan, Abida Khalil Sattar

Medical College Documents

Telementorship allows an expert surgeon to mentor another surgeon through an advanced procedure from a remote location via 2-way audio-visual communication. The current article was planned to review the existing literature and evaluate the utility of telementorship regarding educating rural surgeons in Pakistan about multidisciplinary breast cancer care. Publications from 2016 to 2020 were searched on PubMed and GoogleScholar and 10 most recent publications were selected. Review of literature revealed that even though telementorship in this context might be comparable to onsite mentorship, multiple concerns need to be addressed before its implementation. These include lack of concrete evidence regarding its …

Surgical Education And Training During The Covid-19 Pandemic: Strategies And Solutions For Pakistan, Edward Anthony Joseph, Russell S. Martins, Javeria Tariq, Namrah Aziz, Hina Inam, Mahim Malik

Medical College Documents

The coronovirus disease-2019 pandemic has severely impacted surgical education and training in Pakistan and worldwide, causing problems, such as risk of infection, limited hands-on training, examination delays, and trainee redeployment to non-surgical specialties. The current review was planned to describe innovative strategies adopted by surgical training programmes worldwide in order to suggest comprehensive recommendations at the level of the College of Physicians and Surgeons Pakistan and individual institutions to counter the challenges presented by the pandemic in Pakistan. The innovative use of technology, including open-access online educational portals, virtual educational activities and simulation-based learning, can help reform education delivery during …

Seasonal Impact In Admissions And Burn Profiles In A Desert Burn Unit, Syed F. Saquib, Joseph T. Carroll, Paul J. Chestovich

Department of Surgery Faculty Research

In much of the world, pattern of burn injuries can vary depending on the season. This study examines the seasonal impact of admissions, acuity, mortality, and resource utilization at an accredited burn center located in a desert climate. It is a retrospective analysis of patients admitted from March 1, 2014 to February 28, 2019 for acute burns. Patients were categorized into four groups according to each season based on their date of admission: Spring (March, April, May), Summer (June, July, August), Fall (September, October, November), and Winter (December, January, February).

A total of 1519 patients were included. 1016 were male …

Outcomes And Complications Of Scfe Surgery, Tyler Sanda

Scholarship in Medicine - All Papers

Objective: Slipped capital femoral epiphysis (SCFE) is a common hip disorder affecting children and adolescents. There is much debate concerning best treatment with regards to adverse outcomes, specifically avascular necrosis (AVN). This study analyzed the rates of adverse outcomes after the surgical treatment of SCFEs. It examined risk factors which may lead to the development adverse outcomes. This research will aid clinical decision-making, helping determine optimal surgical treatment of SCFEs and adding to external datasets of SCFE treatment.

Methods: This was a retrospective review of patient health records at a level 2 pediatric trauma hospital. The study included all SCFE …

Determining The Appropriate Technique For Appendix Stump Closure, Cynthia White

Scholarship in Medicine - All Papers

Background In a laparoscopic appendectomy, closure of the appendeceal stump can be done using an endostapler or endoloop. We compared outcome data of the two techniques in patients who underwent laparoscopic appendectomy.

Method We included all patient > 18 years who underwent laparoscopic appendectomy for acute appendicitis at a single institution over a 4-year period. Demographic and outcome data were compared between both groups. Results 501 patients, with no significant differences in age, gender or BMI, were identified for the study. No differences were noted in procedure length, readmission rates, complication rates (including intra-abdominal abscess) or hospital charges. There was a …

Local Impact Of Implementing Multimodal Anesthesia For Total Joint Arthroplasty, Mary Christine Gilliland

Doctor of Nursing Practice Projects

The opioid epidemic is at a critical point in the United States. This quality improvement project aims to determine which anesthesia strategies lessen the use of opioids in the surgical setting to reduce this raging epidemic. The process included total knee replacement record reviews. Reviews used general linear models to compare two multimodal anesthetic plans, including pre-medications in addition to an adductor canal and subarachnoid nerve block. The researcher reviewed the records for these patients comparing those receiving only an adductor canal and those receiving a subarachnoid nerve block. The record reviews identified postoperative pain level documentation and hospital inpatient …