Medical Specialties Commons^™

Postnatal Growth Standards For Preterm Infants: The Preterm Postnatal Follow-Up Study Of The Intergrowth-21st Project, José Villar, Francesca Giuliani, Zulfiqar A. Bhutta, Enrico Bertino, Eric O. Ohuma, Leila Cheikh Ismail, Fernando C. Barros, Douglas G. Altman, Cesar Victora, Julia A. Noble, Michael G. Gravett, Manorama Purwar, Ruyan Pang, Ann Lambert, Aris T. Papageorghiou, Roseline Ochieng, Yasmin A. Jaffer, Stephen H. Kennedy

Paediatrics and Child Health, East Africa

Background: Charts of size at birth are used to assess the postnatal growth of preterm babies on the assumption that extrauterine growth should mimic that in the uterus.

Methods: The INTERGROWTH-21st Project assessed fetal, newborn, and postnatal growth in eight geographically defined populations, in which maternal health care and nutritional needs were met. From these populations, the Fetal Growth Longitudinal Study selected low-risk women starting antenatal care before 14 weeks’ gestation and monitored fetal growth by ultrasonography. All preterm births from this cohort were eligible for the Preterm Postnatal Follow-up Study, which included standardised anthropometric measurements, feeding practices based on …

Oncolog, Volume 60, Number 11 - 12, November - December 2015, Joe Munch, Bryan Tutt, C. Graber

OncoLog MD Anderson's Report to Physicians (All issues) Archives

• Multidisciplinary Treatment Maximizes Outcomes for malignant Tumors of the Anterior Skull Base: Malignant tumors of the anterior skull base occur in a delicate area but often need aggressive treatment. Determining the best course of therapy for patients with these tumors takes a multidisciplinary effort.
• Management of Eyelid and Conjunctival Tumors with Preservation of Slight, Function and Cosmesis: Tumors of the eyelid and extent of disease, and which treatments, if any, are needed after surgical excision depends on several factors, including the potential for metastasis.
• HOUSE CALL: "Other" Health Risks from Smoking-Besides cancer, tobacco causes many diseases.

Migrated Avalon Veno-Venous Extracorporeal Membrane Oxygenation Cannula: How To Adjust Without Interruption Of Flow., Daizo Tanaka, Harrsion T. Pitcher, Nicholas C. Cavarocchi, Hitoshi Hirose

Department of Surgery Faculty Papers

The Avalon dual lumen cannula is presently the cannula of choice for veno-venous extracorporeal membrane oxygenation (VV-ECMO) via right internal jugular cannulation. This cannula establishes VV-ECMO with a single cannulation; however, it requires appropriate positioning to gain adequate oxygenation. Malposition of this cannula can cause inadequate ECMO flow, hypoxia, and structural injury. We have experienced two cases of migration: one into the hepatic vein and the other into the right ventricle. The former was repositioned using echocardiographic guidance without using a guidewire. The latter was repositioned using a guidewire from the femoral vein under fluoroscopy, without antegrade wire placement into …

Department Of Surgery Update, November 2015, Wright State University Department Of Surgery

Department of Surgery Updates

A four page newsletter created by the Department of Surgery documenting changes to the department. This issue contains a message from the chair, a list of important dates, committee meetings, scholarly activity and more.

Abcc9/Sur2 In The Brain: Implications For Hippocampal Sclerosis Of Aging And A Potential Therapeutic Target, Peter T. Nelson, Gregory A. Jicha, Wang-Xia Wang, Eseosa T. Ighodaro, Sergey C. Artiushin, Colin G. Nichols, David W. Fardo

Sanders-Brown Center on Aging Faculty Publications

The ABCC9 gene and its polypeptide product, SUR2, are increasingly implicated in human neurologic disease, including prevalent diseases of the aged brain. SUR2 proteins are a component of the ATP-sensitive potassium (“K _ATP ”) channel, a metabolic sensor for stress and/or hypoxia that has been shown to change in aging. The K _ATP channel also helps regulate the neurovascular unit. Most brain cell types express SUR2, including neurons, astrocytes, oligodendrocytes, microglia, vascular smooth muscle, pericytes, and endothelial cells. Thus it is not surprising that ABCC9 gene variants are associated with risk for human brain diseases. For example, Cantu syndrome is …

Residual Impact Of Previous Injury On Musculoskeletal Characteristics In Special Forces Operators, Jeffrey J. Parr, Nicholas C. Clark, John P. Abt, Julie Y. Kresta, Karen A. Keenan, Shawn F Kane, Scott M. Lephart

Physical Therapy Faculty Publications

Background: Musculoskeletal injuries are a significant burden to United States Army Special Operations Forces. The advanced tactical skill level and physical training required of Army Special Operators highlights the need to optimize musculoskeletal characteristics to reduce the likelihood of suffering a recurrent injury.

Purpose: To identify the residual impact of previous injury on musculoskeletal characteristics.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: Isokinetic strength of the knee, shoulder, and back and flexibility of the shoulder and hamstrings were assessed as part of a comprehensive human performance protocol, and self-reported musculoskeletal injury history was obtained. Subjects were stratified based …

Clinic-Based Biopsy With A Small Curette: Is It A Reliable And Safe Option In Extremity Tumours?, Waseem Ahmed, Masood Umer, Yasir Mohib, Rizwan Haroon Rashid

Department of Surgery Docs

Objective: To establish the diagnostic accuracy and safety of clinic-based biopsy done with a small curette.
Methods: The retrospective study was conducted at Aga Khan University Hospital Karachi and comprised data of patients who underwent biopsy procedure of extremity tumours in clinic under local anaesthesia from July 2009 to June 2012. Patients who underwent the procedure in operating room under general anaesthesia were excluded and so were those with insufficient or missing information, or those who had the final procedure done elsewhere. Clinical parameters were evaluated and histo-pathology was compared with the final resected specimen.
Results: The mean age of …

A Prospective Analysis Of Factors Associated With Decreased Physical Activity In Patients With Cirrhosis Undergoing Transplant Evaluation, Anna Christina Dela Cruz, Valery Vilchez, Sooyeon Kim, Benjamin Barnes, Abhishek Ravinuthala, Anthony Zanni, Roberto Galuppo, Achuthan Sourianarayanane, Trushar Patel, Erin Colleen Maynard, Malay B. Shah, Michael F. Daily, Timothy L. Uhl, Karyn A. Esser, Roberto Gedaly

Internal Medicine Faculty Publications

BACKGROUND: Physical activity has been associated with improved recovery time after transplantation. Handgrip strength has been related to post-transplant outcomes.

AIM: To evaluate predictors of physical activity and grip strength in cirrhotic patients undergoing liver transplant evaluation.

METHODS: Single center, prospective analysis.

RESULTS: A hundred patients were evaluated (54% male, mean age 53 ± 9). Common etiologies of liver disease were non-alcoholic hepatitis (27%), hepatitis C (22%), and alcoholic liver disease (21%). Mean MELD score was 13.5. Forty one percent had a history of smoking. Ninety-three patients completed the International Physical Activity Questionnaire. The median total physical activity score of …

General Education Program In A New 4-Year University Curriculum In Hong Kong: Findings Based On Multiple Evaluation Strategies, Daniel T. L. Shek, Lu Yu, Florence K. Y. Wu

Pediatrics Faculty Publications

Since the 2012−2013 academic year, undergraduate programs in Hong Kong have been changed from 3 years to 4 years, with the additional year focusing primarily on general education. A new general education framework entitled General University Requirements (GUR) implemented at The Hong Kong Polytechnic University (PolyU) was examined in a 5-year longitudinal project. Based on different evaluation strategies, including objective outcome evaluation, subjective outcome evaluation and qualitative evaluation (focus groups, case studies, and document analyses), findings consistently showed that students had positive perceptions of the subject content, teachers as well as teaching and learning methods in GUR subjects. A large …

Evaluation Of A General Education Program In Hong Kong: Secondary Data Analyses Based On Student Feedback Questionnaires, Daniel T. L. Shek, Lu Yu, Joe Ngai

Pediatrics Faculty Publications

The General University Requirements (GUR) at The Polytechnic University of Hong Kong (PolyU) has been developed and implemented since the 2012–13 academic year under the reform of education system in Hong Kong. To examine the effectiveness of GUR at PolyU, the present study investigated student’s subjective perception in the academic years of 2012–13 and 2013–14 using the Student Feedback Questionnaires. Results showed that the GUR subjects were generally well-received by the students. Besides, students held different perceptions of different GUR components, and there was improvement in students’ learning experience and staff teaching over time. While there was an increased satisfaction …

Leadership And Mentorship: Service Leaders As Mentors Of The Followers, Daniel T. L. Shek, Li Lin

Pediatrics Faculty Publications

According to the Hong Kong Institute of Service Leadership and Management, an effective service leader serves as a mentor for his/her followers. Aside from promoting their followers’ professional and personal growth, mentoring also contributes to the development of the service leaders themselves. In this paper, a lecture addressing the concept and functions of mentoring is outlined, along with its relationship with service leadership. The professional and psychosocial functions of mentoring to service leaders and followers and various ways to promote mentoring in service leadership are highlighted. Students are also encouraged to reflect on the potential harmful effects of mentoring on …

Focus Group Evaluation Of A Service Leadership Subject In Hong Kong, Daniel T. L. Shek, Moon Y. M. Law, Ting Ting Liu

Pediatrics Faculty Publications

Two focus groups with six randomly selected students were conducted to understand the views and experiences of students taking a subject entitled “Service Leadership” at The Hong Kong Polytechnic University. Several observations were highlighted from the findings. First, students generally had positive views of the subject. Second, students felt that they had positive experience in the subject. Third, the instructors were seen in a positive light by the students. Fourth, the students perceived the subject to be beneficial to their development. Fifth, students had positive impression about the subject. Finally, recommendations regarding time allocation, teaching style, and classroom environment were …

The Role Of A Caring Disposition In Service Leadership, Daniel T. L. Shek, Xiang Li

Pediatrics Faculty Publications

A caring disposition is an important and fundamental attribute of a service leader. At the Hong Kong Polytechnic University, a lecture on a caring disposition in the subject “Service Leadership” was designed to help students understand the importance of caring dispositions. The curriculum design with reference to the basic concepts and theories as well as the content of the lecture are presented in this paper. In the first part of the paper, several uncaring cases are presented to serve as negative examples to inspire students’ reflection on caring leaders. Then, the three most important traits of a caring disposition, including …

Character Strengths In Chinese Philosophies: Relevance To Service Leadership, Daniel T. L. Shek, Rachel C. F. Sun, Ting Ting Liu

Pediatrics Faculty Publications

According to the Hong Kong Institute of Service Leadership and Management, moral character or character strength is an important attribute of an effective service leader. In connection to this, “Character Strengths in Chinese Philosophies” is one of the lecture topics taught in a course titled “Service Leadership” in a university in Hong Kong. Several topics are covered in that lecture. First, the relevance of Chinese philosophies to service leadership is discussed. Second, the core virtues in Confucian thoughts are presented. Third, the relevance of Confucian virtues to service leadership is examined. Finally, conclusions and reflections on the relevance of Confucian …

Character Strengths And Service Leadership, Daniel T. L. Shek, Lu Yu

Pediatrics Faculty Publications

Character strengths refer to the moral aspects of personality that have multiple dimensions. As a basic requirement of a service leader, character strengths provide the most inherent power for fulfilling different tasks and pursuing continuous development. In this paper, a lecture that aims to foster character strengths in undergraduate students is introduced. The theoretical foundation of the lecture on character strengths is first presented, including the concepts and theories related to character strengths, their relevance to service leadership and methods to promote the development of character strengths. The basic content and activities designed for this particular lecture are then outlined …

Subjective Outcome Evaluation Of A University Subject On Service Leadership, Daniel T. L. Shek, Jianqiang Liang

Pediatrics Faculty Publications

University students (n=58) responded to a 45-item subjective outcome evaluation scale after taking a credit-bearing elective subject titled “Service Leadership” at The Hong Kong Polytechnic University in the first semester of the 2013–14 academic year. Results showed that the students generally displayed positive perceptions of the program content and the instructors, and most of them perceived the subject to be beneficial to different aspects of their development. As predicted, three subscales of the scale (Program Content, Program Implementer, and Program Benefits) were significantly correlated. Similar to the previous studies, perceived quality of the program but not quality of instructors and …

Does Tranexamic Acid Reduce Blood Transfusion Following Surgery For Inter-Trochanteric Fracture? A Randomized Control Trial, Yasir Mohib, Rizwan Haroon Rashid, Moiz Ali, Akbar Jaleel Zubairi, Masood Umer

Department of Surgery Docs

Abstract

OBJECTIVE:

To compare the frequency of blood transfusion after surgery for fixation of inter-trochanteric fractures in patients given tranexamic acid versus placebo.

METHODS:

The randomised control trial was conducted at the Aga khan university hospital from May 1 to October 31, 2014, and comprised patients diagnosed with Inter-trochanteric fracture based on X-ray imaging. The patients were randomised into two equal groups based on a computer-generated random number table. The Intervention group received two doses of 10mg/kg body weight of tranexamic acid just before surgery and three hours later intravenously. The Control group received two doses of 10mg/kg body weight …

Prophylaxis Against Heterotopic Ossification After Elbow And Acetabular Fractures — Do We Really Need It, Rizwan Haroon Rashid, Irfan Qadir, Waseem Ahmed, Masood Umer

Department of Surgery Docs

Abstract

OBJECTIVE:

To compare the efficacy and safety of prophylactic modalities for heterotopic ossification prevention after elbow and acetabular surgeries.

METHODS:

The retrospective chart review was conducted at the Aga Khan University Hospital and comprised record of patients who underwent open reduction and internal fixation for elbow and acetabular fractures between 2010 and 2013. Data was classified into three groups: Group A patients had received single dose of radiotherapy; Group B patients had received indomethacin, and Group C patients had not received any prophylaxis. Outcome variables included time-to-fracture healing, heterotopic ossification, non-union and wound infection.

RESULTS:

Of the 104patients 70(67.3%) …

Osats For Total Knee Replacement: Assessment Of Surgical Competence In The Operating Room, Shahryar Noordin, Salim Allana

Department of Surgery Docs

No abstract provided.

K Wire Fixation Of Supra-Condylar Humerus Fractures In Children. Is Ulnar Nerve At Risk?, Waseem Ahmed, Haroon Rashid, Yasir Mohib, Rizwan Haroon Rashid

Department of Surgery Docs

Abstract

OBJECTIVE:

To compare iatrogenic ulnar nerve injury in lateral entry pin fixation versus medial and lateral entry pin fixation in the treatment of supracondylar fractures of the humerus in children. Measurement of clinical parameters in terms of elbow range of motion and postop radiographic alignment was also targeted.

METHODS:

The retrospective cohort study was conducted at Aga Khan University Hospital, Karachi, and comprised data of paediatric patients who underwent closed reduction and percutaneous pin fixation for the treatment of displaced extension type supracondylar fractures of the humerus between July 2007 and June 2012. Data regarding socio-demographic status, disease and …

Calcaneal Fractures: An Audit Of Radiological Outcome., Tashfeen Ahmad, Zehra Abdul Muhammad, Bilal Humayun Matin, Azeem Tariq Malik, S. A. Quadri

Department of Surgery Docs

Abstract

OBJECTIVE:

To assess radiological outcome of management of calcaneal fractures.

METHODS:

The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised data of calcanealfractures managed between February , 2008 and February, 2014 Cases were identified through medical records, and X-rays were reviewed through digital radiology archive. Bohler\'s angle, Gissane\'s angle, calcaneal height and width were assessed digitally on pre-operative and post-operative X-ray images.

RESULTS:

Of the27 patients, only 1(3.7%) was female. The cause of fracture was fall from height 15(56%), road traffic accidents 7(26%) and bomb blasts5(19%). Tongue type fractures were 16(59%) and 11(41%) were joint …

Clinic Based Biopsy Vs. Theatre Biopsy Of Bone And Soft Tissue Extremity Tumours: Comparable Diagnostic Modalities, Waseem Ahmed, Masood Umer, Yasir Mohib, Rizwan Haroon Rashid

Department of Surgery Docs

Abstract

OBJECTIVE:

To compare the diagnostic accuracy of clinic-based biopsy versus theatre biopsy against final histopathology in patients presenting with extremity tumours.

METHODS:

The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised record of patients who underwent biopsy procedure of extremity tumours from January 2008 to December 2011. Data regarding socio-demographic status, disease-related and procedure-related variables were collected from the files. Histopathology report of biopsy was compared with the final histopathology after definite procedure of the tumour for concordance.

RESULTS:

Of the 87 patients whose records were reviewed, 42(48%) had undergone biopsy in theatre and 45(52%) …

Trends In Management Of Neck Of Femur Fracture, Tashfeen Ahmad, Umair Ashraf, Omar Irfan, Zehra Abdul Muhammad

Department of Surgery Docs

Abstract

OBJECTIVE:

To identify trends related to surgical procedure for the management of neck of femur fracture to see how the choice is changing over time in relation to different age groups.

METHODS:

The retrospective audit was conducted at Aga Khan University Hospital, Karachi, and comprised data of all patients who presented with neck of femur fracture from 1995 to 2014. Patients with open fractures and those having external fixators were excluded. Data was retrieved from the hospital database, and analysed using SPSS 17.

RESULTS:

Records of 1039 patients were reviewed. The proportion of patients in the 70+ years age …

An Assessment Of Current Palliative Care Beliefs And Knowledge: The Primary Palliative Care Providers' Perspective, Yvonne Patten, Maria M. Ojeda, Carolyn Lindgren

All Publications

No abstract provided.

Tools For Economic Analysis Of Patient Management Interventions In Heart Failure Cost-Effectiveness Model: A Web-Based Program Designed To Evaluate The Cost-Effectiveness Of Disease Management Programs In Heart Failure., Shelby D. Reed, Matthew P. Neilson, Matthew Gardner, Yanhong Li, Andrew H. Briggs, Daniel E E. Polsky, Felicia L. Graham, Margaret T. Bowers, Sara C. Paul, Bradi B. Granger, Kevin A. Schulman, David J. Whellan, Barbara Riegel, Wayne C. Levy

Department of Medicine Faculty Papers

BACKGROUND: Heart failure disease management programs can influence medical resource use and quality-adjusted survival. Because projecting long-term costs and survival is challenging, a consistent and valid approach to extrapolating short-term outcomes would be valuable.

METHODS: We developed the Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model, a Web-based simulation tool designed to integrate data on demographic, clinical, and laboratory characteristics; use of evidence-based medications; and costs to generate predicted outcomes. Survival projections are based on a modified Seattle Heart Failure Model. Projections of resource use and quality of life are modeled using relationships with time-varying …

Effect Of Continuous Passive Motion On Knee Flexion Range Of Motion After Total Knee Arthroplasty, Naveed Baloch, Akbar Jaleel Zubairi, Rizwan Haroon Rashid, Pervaiz Hashmi, Riaz Hussain Lakdawala

Department of Surgery Docs

Abstract

OBJECTIVE:

To compare mean knee flexion in patients on continuous passive motion and those without it after total knee arthroplasty.

METHODS:

The randomised controlled study was conducted at Aga Khan University Hospital, from July 2013 to June 2014, and comprised patients who underwent total knee arthroplasty. Patients were randomly assigned to either group, with Group A receiving standardised physiotherapy from 1st postoperative day, and Group B receiving physiotherapy and one hour of continuous passive motion twice a day from 1st postoperative day until discharge. Outcome assessment was done on the day of discharge.

RESULTS:

Of the 76 patients, there …

Spectrum Of Histopathological Findings In Postmenopausal Bleeding, Muhammad Usman Tariq, Romana Idress, Ahmed Raheem, Naila Kayani

Department of Pathology and Laboratory Medicine

Objective:To determine the frequencies of histopathological findings in endometrial and endocervical biopsy samples with clinical history of Postmenopausal Bleeding (PMB). Study Design:Descriptive cross-sectional study. Place and Duration of Study:Section of Histopathology, Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from February 2012 to January 2013. Methodology:Atotal of 157 consecutive endometrial and endocervical biopsy specimens with history of postmenopausal bleeding were included. After microscopic examination, frequencies of histological findings in different age groups were generated. Chi-square and independent sample t-tests were applied to see whether the difference was significant which was set at p < 0.05. Results:One hundred and twenty-one (77.1%) specimens showed benign pathologies while 36 (22.9%) were malignant. Endometrial polyp was seen in 67 (42.7%) cases followed by endometrial carcinomas in 25 (15.9%), endometrial hyperplasia in 21 (13.4%), cervical carcinoma in 12 (7.6%) and cervical polyps in 9 (5.7%) cases. Ahighly significant increase in the percentage of malignant and pre-malignant lesions was seen with increasing age group (p < 0.001). Mean age of patients with type-2 endometrial carcinoma was higher than type-1 endometrial carcinoma but statistical significance was not observed (70.2 ±6.5 vs. 61.8 ±9.1 years respectively, p=0.069). Conclusion:Although benign pathologies were more common in postmenopausal bleeding but the collective proportion of endometrial and cervical malignancies and pre-malignant conditions was quite high. Therefore, PMB should be urgently evaluated for cause and early commencement of treatment

Right Ventricular Dysfunction After Resuscitation Predicts Poor Outcomes In Cardiac Arrest Patients Independent Of Left Ventricular Function., Vimal Ramjee, Anne V. Grossestreuer, Yuan Yao, Sarah M. Perman, Marion Leary, James N. Kirkpatrick, Paul R. Forfia, Daniel M. Kolansky, Benjamin S. Abella, David F. Gaieski

Department of Emergency Medicine Faculty Papers

OBJECTIVE: Determination of clinical outcomes following resuscitation from cardiac arrest remains elusive in the immediate post-arrest period. Echocardiographic assessment shortly after resuscitation has largely focused on left ventricular (LV) function. We aimed to determine whether post-arrest right ventricular (RV) dysfunction predicts worse survival and poor neurologic outcome in cardiac arrest patients, independent of LV dysfunction.

METHODS: A single-center, retrospective cohort study at a tertiary care university hospital participating in the Penn Alliance for Therapeutic Hypothermia (PATH) Registry between 2000 and 2012.

PATIENTS: 291 in- and out-of-hospital adult cardiac arrest patients at the University of Pennsylvania who had return of spontaneous …

Single Stage Bilateral Total Hip Replacement: Is It An Option Or A Risk?, S. A. Quadri, Rizwan Haroon Rashid, Akbar Jaleel Zubairi, Masood Umer, Pervaiz Hashmi

Department of Surgery Docs

Abstract

OBJECTIVE:

To evaluate safety and feasibility of two-stage total hip arthroplasty and to compare it with single-stage procedure.

METHODS:

The retrospective study was conducted at The Aga Khan University Hospital and comprised all cases of total hip replacements between January 2001 and December 2014 that were retrieved from the database using International Classification of Diseases (9th Revision) coding. A standardised questionnaire was completed, including patient demographics, primary diagnosis, peri and postoperative morbidity and mortality. Differences among patients\' data were analysed using chi square test for dichotomous variables and student t-test for continuous variables.

RESULTS:

Of the 48 cases, 34(71%) …

Bomb Blast Injuries: Tertiary Care Hospital In-Patient Experience Over The Last 20 Years, Naveed A. Pasha, Raja Samir Khan, Shahryar Noordin

Department of Surgery Docs

Abstract

OBJECTIVE:

To examine the distribution and nature of limb injuries in young bomb blast victimsand their management in a tertiary healthcare setting.

METHODS:

The retrospective study was conducted at the Aga Khan University Hospital, Karachi and data was searched using the University Medical Record Database with International Classification of Diseases-Ninth Revision-Clinical Modification codes for injuries and terrorism between 1990 and 2012. Data regarding injuries, including admission time, hospital stay duration, interventions and mortality, was collected and classified as per the New Injury Severity Score.

RESULTS:

There were 22 patients in the study; 19(86.3%) males and 3(13.7%) females. The mean …