Surgery Commons^™

Artificial Intelligence In Dentistry, Orthodontics And Orthognathic Surgery: A Literature Review, Tania Arshad Siddiqui, Rashna Hoshang Sukhia, Dinaz Ghandhi

Section of Dental-Oral Maxillofacial Surgery

Artificial intelligence is the ability of machines to work like humans. The concept initially began with the advent of mathematical models which gave calculated outputs based on inputs fed into the system. This was later modified with the introduction of various algorithms which can either give output based on overall data analysis or by selection of information within previous data. It is steadily becoming a favoured mode of treatment due to its efficiency and ability to manage complex conditions in all specialities. In dentistry, artificial intelligence has also popularised over the past few decades. They have been found useful for …

A Bibliometric Analysis Of The Studies On Dental Implant Failure, Farhan Raza Khan, Syed Murtaza Raza Kazmi, Yusra Fahim Siddiqui

Section of Dental-Oral Maxillofacial Surgery

Objective: To identify top 30 studies related to dental implant failures based on bibliometric analysis.
Methods: The bibliometric study was conducted at Aga Khan University, Karachi from April 2021 to June 2021 and comprised database search on Google Scholar used key words "dental implant failures" for studies published between 1990 and 2020. The selected studies were reviewed based on citation count for which the cut-off date was June 1, 2021.
Results: The top 30 papers on dental implant failures had median citation count of 153 (range: 41-1583. Most of the studies were retrospective 11(36.7%), followed by literature reviews 6(20%). The …

Rates Of Publication Of Fcps Dissertations In International And National Peer-Review Journals Among Residents At Akuh; A Cross Sectional Review Of 15 Years, Ainulakbar Mughal, Syed Akbar Abbas, Abdul Basit Shah Vardag, Muhammad Wasif, Soubia Akhtar, Ayesha Abbasi

Section of Otolaryngology, Head & Neck Surgery

Objective: To see the rate of publication of postgraduate residents' dissertation.
Methods: The single-centre retrospective cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, and comprised research publications from the residents of the departments of Surgery and Medicine who graduated between 2005 and 2020. The surgical subspecialties included Otolaryngology, Ophthalmology, Dentistry, General Surgery, Orthopaedics, Paediatric Surgery, Urology, Plastic Surgery and Cardiovascular Surgery. Data comprised demographics, current institution, current designation, information on dissertation/paper publication, topic of study, year of completion of dissertation, input from the research department, delay in exam due to incomplete dissertation and whether the paper got …

In A Digitally Connected World Through Likes, Hashtags And Followers - Advancing Surgical Research Through A Social Media: A Narrative Review, Sabah Uddin Saqib, Qamar` Riaz, Russell Seth Martins, Amna Riaz, Hasnain Zafar

Department for Educational Development

In this era of modern information technology, the world is now digitally connected through various platforms on social media, which has changed the way medical professionals work, communicate and learn. The use of social media in surgery is expanding, and it is now becoming an essential tool for surgical training, research and networking. Articles, journal clubs and surgical conferences are within reach of everyone regardless of geographical location worldwide. Electronic publications have now resoundingly replaced printed editions of journals. Collaborative research through social media platforms helps collect diverse data, enhancing the research's global generalisability. The current narrative review was planned …

Bonded Amalgam As A Fissure Sealant In Low-Income Setting: A Randomised Controlled Trial, Farhan Raza Khan, Samreen Liaquat, Ghazala Rafique, Syed Iqbal Azam, Arshad Hasan

Section of Dental-Oral Maxillofacial Surgery

Objectives: To compare one year retention rate of bonded amalgam sealants (BAS) with that of conventional resin-based sealant (RBS).
Methods: It was a parallel group, equivalence, randomised controlled trial done during March 2018 to December 2019 at the dental clinics of Dow University of Health Sciences, and the Jinnah Sind Medical University, Karachi, Pakistan on children aged 12-16 years, who were randomly assigned to one of the two treatment groups (BAS vs. RBS). Complete retention of the sealant at one year follow-up was labeled as success. Multi-level mixed effect logistic regression model was employed. Study was registered at www.clinicaltrials.gov # …

Radiographic Evaluation Of The Margins Of Clinically Acceptable Metal-Ceramic Crowns, Sheikh Bilal Badar, Kamil Zafar, Rabia Ghafoor, Farhan Raza Khan

Section of Dental-Oral Maxillofacial Surgery

Objective: To radiographically evaluate the proximal marginal fit of the clinically acceptable metal-ceramic crowns.
Methods: The prospective study was conducted at the dental clinics of Aga Khan University, Karachi, from July to December 2018, and comprised metal-ceramic crowns that were evaluated prior to the cementation. Clinical examinations were conducted by seating the crown on the tooth preparation and visual assessment was done using sharp explorer along the margins. Clinically acceptable crowns were then evaluated on the bite-wing radiograph. Any horizontal or vertical inaccuracy of >0.5mm at the proximal margins was recorded as 'discrepancy'. Data was analysed using SPSS 22.
Results: …

Conceptual Framework For A Cardiac Surgery Simulation Laboratory And Competency-Based Curriculum In Pakistan - A Short Innovation Report, Ali Aahil Noorali, Asma A H. Merchant, Sardar Shahmir Babar Chauhan, Mustafa Ali Khan, Anam Noor Ehsan, Mohammad Bin Pervez, Muhammad Tariq, Saulat Fatimi

Medical College Documents

Simulation is a commonly utilized technique in healthcare education as it provides trainees a realistic, but safe, environment to learn a variety of skills. Trainees belonging to fields known for high stakes with low margins for error, such as cardiac surgery, can greatly benefit from simulation-based education. We propose the establishment of the first multi-tier high fidelity cardiac surgery simulation lab with a structured curriculum that will eventually provide multidisciplinary training to promising cardiac surgeons across Pakistan. The simulation lab may also be used for research, grant acquisition and patent development. Our setup will include the following levels of simulation: …

Radial Artery Coronary Bypass Grafting: Surgical Outcomes Of An Unexplored Innovation In A Developing Country, Russell Seth Martins, Laiba Masood, Mabrooka Kazi, Mishal Gillani, Ayesha Sadiq, Hina Inam, Saulat Fatimi

Medical College Documents

Objective: To explore postoperative outcomes, particularly prolonged length of hospital stay, in radial artery coronary artery bypass graft patients in a tertiary-care setting.
Methods: The pilot prospective cohort study was conducted at the Aga Khan University Hospital, Karachi, from September 2019 to September 2020, and comprised adult patients of either gender due to undergo coronary artery bypass grafting for coronary artery disease involving two or more vessels. The subjects were approached for the use of their radial artery as a conduit. Prolonged length of hospital stay was defined as postoperative stay >9 days. Multivariable logistic regression was used to identify …

The Environment Under The Knife: A Review Of Current Eco-Surgical Strategies And Recommendations For Pakistan, Russell Seth Martins, Edward Anthony Joseph, Javeria Tariq, Namrah Aziz, Saulat H. Fatimi

Medical College Documents

The healthcare sector at its core is based on the fundamentals belief to do no harm and bring about betterment in the lives of the people. Paradoxically, hospitals are one of the leading contributors to pollution, greenhouse gas (GHG) emissions and toxic waste material worldwide. Surgical care delivery is quite resource intensive, consuming significant amount of energy and equipment as well as producing large quantities of waste. With climate change being a global priority, it is crucial that hospitals re-evaluate the environmental impact of such practices. The current review was planned to identify areas of improvement in surgical care in …

Innovations In Surgery Between The Past And Future: A Narrative Review Of Targeted Literature, Obada Hasan, Ahmed Ayaz, Laiba Masood, Abdul Mannan Baig, Naveed Baloch

Medical College Documents

Innovation is the introduction of a new method or technology designed to change the way things are done. History is full of remarkable innovations in surgery over the years as surgeons have always been innovating and pioneering latest techniques and equipment that can benefit the mankind. Though persistent, progress has been far from uniform. Despite all the bells and whistles that these innovations bring to the table, the little acknowledged fact is that they are only accessible to a very small proportion of the global population. Five billion people on this planet do not even have access to an operating …

Otorhinolaryngology Consultations In A Multidisciplinary Hospital - Their Effects On Residents Training On Floor, Ambreen Abdullah Unar, Muhammad Hammad Deewani, Mohammad Sohail Awan, Syeda Amrah Hashmi, Abdul Basit Shah Vardag, Ainulakbar Mughal

Section of Otolaryngology, Head & Neck Surgery

Objective: To determine all types and severity of Otolaryngology consultation requests at our tertiary care center and spectral records of problems related to otorhinolaryngology come across initially by residents which will help in re-shaping residency programmes and enhance patient related care.
Methodology: All otorhinolaryngology consultation received over a three-month period were recorded prospectively. Information collected for each encounter included the time, date, reason for consult at primary service and admission with final ENT diagnosis, any surgical or non-surgical intervention, and basic patient demographics.
Results: A total of 127 consults for inpatients were reviewed from April 2020 to June 2020. Out …

Perioperative Registries In Resource-Limited Settings: The Way Forward For Pakistan, Usama Waqar, Shaheer Ahmed, Ayesha Nasir Hameed, Namrah Aziz, Hina Inam

Medical College Documents

Capable of improving surgical quality, perioperative registries can allow performance benchmarking, reliable reporting and the development of risk-prediction models. Well established in high-income countries, perioperative registries remain limited in lower- and middle-income countries due to several challenges. First, ensuring comprehensive data entry forums to power the registries is difficult because of limited electronic medical records requiring sustained efforts to develop and integrate these into practice. Second, lack of adequate expertise and resources to develop and maintain registry software necessitates the involvement of software developers and information technology personnel. Third, case ascertainment and item completion are challenging secondary to poor-quality medical …

Path To Publication: A Peer Mentorship Model For Student-Lead Surgical Research, Usama Waqar, Hareem Rauf, Muskaan Abdul Qadir, Hina Inam

Medical College Documents

Early and sustained involvement in research is imperative for medical students to ensure better career prospects in addition to provision of high-quality, evidence-based care to patients. However, involvement of students in surgical research still remains limited, owing to inadequate research training. The current paper was planned to describe the structure of the "Path to Publication" series, incorporating peer mentorship with capacity-building research workshops for medical students. A total of 25 students were grouped into 8 surgical subspecialty groups to conduct research, supervised by experienced student research and faculty mentors. In addition, a series of research workshops were organized in synchronization …

Surgical Management During The Covid-19 Era At A Private Tertiary Care Hospital Of Karachi, Pakistan: A Cross-Sectional Study, Nida Zahid, Erum Baig, Gulzar S. Lakhani, Hasnain Zafar, Asad Latif, Syed Ather Enam

Department of Surgery Docs

Background: The coronavirus disease 2019 (COVID-19), declared a pandemic in March 2020, has affected the entire healthcare system, including the surgical practice. Guidelines for the management of surgical patients during this COVID-19 era need to be established to provide timely yet safe surgical care. In this study, we aimed to evaluate the outcomes of the COVID-19 testing algorithm established for surgery patients presenting to a tertiary care hospital in Karachi, Pakistan, and to compare the outcomes among patients who underwent elective versus emergency surgery.
Methodology: This is a cross-sectional study conducted at a tertiary care hospital in Pakistan to apply …

Changes In Patterns And Outcomes Of Trauma Patients After Betterment In Law And Order Situation Of The City, Sabah Uddin Saqib, Hasnain Zafar

Section of General Surgery

Objective: To assess the impact of the law and order situation of a city on the pattern of traumatic injuries and the overall outcomes of trauma victims.
Methods: The retrospective study of prospective trauma surgery data was done at Aga Khan University Hospital, Karachi, and comprised data of patients with torso injuries before the improvement of law and order situation from January 2012 to March 2013 in Group A, and of those with similar injuries after the law and order situation improved in the city from January 2018 to March 2019 in Group B. The required data was collected by …

Role Of Micrornas In Non-Functioning Pituitary Adenoma, Mehak Ismail Rajani, Yumna Mirza, Rohan Advani, Syed Muhammad Adnan Ali, Ather Enam

Centre for Innovation in Medical Education

Non-functioning pituitary adenomas account for 30% of anterior pituitary tumours. Based on their inability to secrete hormones, these are often diagnosed incidentally or due to pressure symptoms. Understanding the pathogenesis of these adenomas can provide insight into factors leading to its progression and serving as biomarkers for early recognition. A literature search was performed in the current narrative review for articles published in PubMed for the last 10 years till January 2020 on micro-ribonucleic acid involved in the pathogenesis of non-functioning pituitary adenomas. Of the 478 articles found, 21(4.4%) were filtered. In total, 106 micro-ribonucleic acids were identified, 25(23.5%) of …

Authorship Equity And Gender Representation In Global Oncology Publications, Paula Hornstein, Hubert Tuyishime, Miriam Mutebi, Nwamaka Lasebikan, Fidel Rubagumya, Temidayo Fadelu

General Surgery, East Africa

Purpose: Authorship gender disparities persist across academic disciplines, including oncology. However, little is known about global variation in authorship gender distribution.

Methods: This retrospective cross-sectional study describes the distribution of author gender as determined from the first name across variables such as authorship position (first, middle, and last), country region, and country income level. The 608 articles with 5,302 authors included in this analysis were published in the Journal of Clinical Oncology Global Oncology, from its inception in October 2015 through March 2020. Primary outcome measure was author gender on the basis of first name probabilities assessed by …

Diagnostic Accuracy Of Computed Tomography In Adults With Suspected Acute Appendicitis At The Emergency Department In A Private Tertiary Hospital In Tanzania, Nyamuryekun'ge Miten, Miten Wr Patel, Ahmed Jusabani, Ali Akbar Zehri, Athar Ali

General Surgery, East Africa

Introduction: The increasing incidence of acute appendicitis in sub-Saharan Africa emphasizes the need for accurate and reliable diagnostic tools. However, the variability in the diagnostic performance of computed tomography for suspected acute appendicitis coupled with comparatively higher negative appendectomy rates in this setting highlight a possible concern regarding the diagnostic accuracy. This study evaluated the diagnostic accuracy of a computed tomography scan for suspected acute appendicitis at the emergency department in Tanzania.

Methods: A retrospective diagnostic accuracy study was conducted from July to October 2020. All patients above 14 years of age who presented at the emergency department with …

Comparison Of Surface Defects In Protaper Next And Hyflex Edm Files After Single Clinical Use: A Stereoscopic Evaluation, Faizan Javed, Momina Anis Motiwala, Farhan Raza Khan, Rabia Ghafoor

Section of Dental-Oral Maxillofacial Surgery

Objective: To compare the surface defects created on the ProTaper Next files versus HyFlex Electrical Discharge Machining files after single clinical use in molars.
Methods: The cross-sectional study was conducted in the dental department of the Aga Khan University Hospital, Karachi, from December 2018 to June 2019, and comprised Nickel-Titanium files belonging to HyFlex Electrical Discharge Machining and ProTaper Next to perform complete root canal treatment of molar teeth. The files were first visually examined and then analysed under 25.6x magnification using a stereomicroscope for the evaluation of surface defects. A photographic record was maintained and studied. Data was analysed …

Bibliometric Study On The Literature Related To Dental Research And Education Published In Journal Of Pakistan Medical Association, Samira Adnan, Kamil Zafar, Farhan Raza Khan, Rizwan Ullah

Section of Dental-Oral Maxillofacial Surgery

Objective: To analyse characteristics of literature related to dental research and education published in a single medical journal, The Journal of Pakistan Medical Association.
Method: The bibliometric study was conducted at the Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University from March till May 2020, and comprised electronic and hand search of scientific literature relevant to dentistry published in the Journal of Pakistan Medical Association from the first issue published in 1953 till March 2020. The selected articles were analysed for year of publication, field of study, type of article, institute and country of first author, number of …

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 …

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 …

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

Department of Surgery Docs

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 …

Baseline Mmp Expression In Periapical Granuloma And Its Relationship With Periapical Wound Healing After Surgical Endodontic Treatment, Muhammad Adeel Ahmed, Muhammad Faraz Anwar, Khalid Ahmed, Marziya Aftab, Fizza Nazim, Muhammad Furqan Bari, Mohammed Mustafa, Fahim Vohra, Ali Alrahlah, Muhammad Nouman Mughal, Syed Hani Abidi

Department of Biological & Biomedical Sciences

Background: Matrix metalloproteinases (MMPs) catalyzes the degradation of the extracellular matrix components and have a major role in many physiological processes including wound healing. In the current study, we examined the correlation of baseline MMPs 1, 2, 7, and 9 expressions with periapical wound healing after surgical endodontic treatment.
Methods: 27 patients aged between 15 and 57 years presenting with chronic apical periodontitis or chronic apical abscess of an anterior tooth with previously attempted or failed root canal treatment were included in this study. During surgical endodontic treatment, tissue from the periapical lesion sample was collected and used for gross …

Nanomedicine In The Treatment Of Glioblastoma, Syeda Kubra Kishwar Jafri, Syed Sarmad Bukhari, Muhammad Shahzad Shamim

Section of Neurosurgery

The current standard of care in glioblastoma management is surgery followed by chemotherapy and radiotherapy. Temozolomide is an alkylating agent most commonly used with a few other second line options. The efficacy of systemic chemotherapy in brain malignancies is limited due to the nature of the blood-brain barrier. Nanomedicine offers one avenue of improving drug delivery to these tumours in a more focussed and effective way in higher doses than currently possible, while simultaneously reducing systemic toxicity.

Extra-Articular Arthroscopic Release Of Lateral Epicondylitis: A Prospective Study, Njalalle Baraza, Mark P. Robinson, Nanda Kumar Sakaleshpura Chandrashekar, Jessica A. Perry, William D. Regan

General Surgery, East Africa

Background: Operative management of lateral epicondylitis can be managed with percutaneous, arthroscopic, or open surgical release. Extraarticular arthroscopic release is a new technique, and no study has compared its outcomes and risk profile.

Methods: A 26-patient cohort was reviewed before and after extraarticular arthroscopic release, which was performed by the senior author. The Mayo Elbow Performance Scores were used as a functional outcome score and obtained via a phone interview. Results were analyzed using a paired t-test with a statistical significance set at P < .05.

Results: Of the 26 patients, 10 were being treated under workers compensation. Preoperative Mayo Elbow Performance …

Hepatocellular Carcinoma With Extrahepatic Blood Supply From Right Renal Artery, Amir Humza Sohail, Ahmad Musa, Muhammad Salman Khan, Hassan Raza Hashmi, Basit Salam, Collin E M. Brathwaite

Department of Radiology

Extrahepatic blood supply is seen in around 17-27% of hepatocellular carcinoma lesions. Evidence suggests that this extrahepatic supply most commonly originates from a right intercostal artery (70-83%) followed by left intercostal, omental and right renal arteries. Thus a comprehensive knowledge of variations in standard vascular anatomy and cognisance of factors influencing or predicting extrahepatic blood supply in HCC is instrumental in ensuring the success of surgical and interventional procedures. We present the unusual case of a 66-year-old male with HCC in Segment I of the liver with aberrant blood supply from the right renal artery in the absence of any …

Prevalence Of Os Acromiale In An Indigenous East African Population: A Computerized Tomography Scan-Based Study, Mordicai Atinga, Njalalle Baraza, Sarah Wambui, Wachira Joseph Thiong’O, Angela Atinga

General Surgery, East Africa

Background: Failure of fusion to any of the acromion physes at maturity may lead to an os acromiale. A radiological review into the prevalence of os acromiale in an indigenous East African population was performed using computer tomography (CT) imaging. The study aimed to demonstrate a lower prevalence of os acromiale in an urban population compared with cadaveric studies.

Methods: This was a cross-sectional study with consecutive sampling. CT scans of both shoulders obtained for non-shoulder pathology were used for the analysis. CT scanning was performed at a tertiary referral hospital from January 2019 to July 2020.

Results …

Hip Replacement For Femur Neck Fracture In The Elderly, Effects Of Delayed Surgical Intervention On Morbidity And Mortality, A Retrospective Comparative Study, Ahmed Habib, Shah Fahad, Muhammad Atif, Javeria Saeed, Pervaiz Hashmi, Mujahid Jamil Khattak

Section of Orthopaedic Surgery

Hip fracture is one of the most common injuries in the elderly population. Delay in operating on patients with hip fracture is associated with greater mortality and morbidity. A retrospective review of medical charts of patients who underwent primary total hip replacement (THR) for neck of femur fractures at our tertiary care level 1 trauma was carried out. Data was collected from the patients' charts and analysed for 30-day mortality and morbidity. A total of 96 patients were included in the study. Out of the 36 patients in the delayed THR group, mortality within 30 days was observed in 4 …

Spontaneous Closure Of Full Thickness Macular Hole In The Presence Of An Epiretinal Membrane In A Vitrectomised Eye: A Case Report, Rehman Siddiqui, Muhammad Umar Fawad, Nida Ahsan

Section of Ophthalmology

We report the case of a spontaneous closure of full thickness macular hole (FTMH) in the presence of an epiretinal membrane (ERM) in a previously vitrectomised eye. The patient had undergone vitrectomy for rhegmatogenous retinal detachment and developed an ERM two weeks after the surgery, which converted into a FTMH after one week. Eight months after the vitrectomy, spontaneous closure of FTMH was observed with an improvement in best-corrected visual acuity (BCVA) from 20/200 to 20/40. The patient was followed up for four years, and the FTMH remained closed. Spontaneous closure of FTMH is possible even in the presence of …