Surgery Commons^™

Variability Of Magnification On Digital Pelvic Radiographs From Patients With Fractures Of The Femoral Neck - A Retrospective Audit, Akbar Jaleel Zubairi, Tashfeen Ahmad

Department of Surgery Docs

Abstract

OBJECTIVE:

To determine the variability in magnification of radiographs in an emergency setting.

METHODS:

The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised records of patients who underwent Austin Moore hemiarthroplasty over a two-year periodfrom 1st January 2006 to 31st December 2007. Magnification factor was determined using measurements obtained from preoperative and postoperative radiographs and comparing them with the actual size of implant used. Intra-observer and inter-observer reliability of measurements were calculated. SPSS 19 was used for data analysis.

RESULTS:

Of the 63 patients studied, 25(39.7%) were males and 38(60.3%) were females with an overall …

Competing Interests Of Undergraduate Medical Education And Industry: Integration Into Longitudinal Curricular Themes., Shahryar Noordin, Sheilla Pinjani

Department of Surgery Docs

Abstract

Recent changes in curricula around the globe with emphasis on teaching/learning and assessing professionalism in medical schools has been the priority. With the changing public expectations and professional demands, it has become imperative to develop clear guidelines and policies for students and faculty to better understand and meet the expectations of them as part of professionalism. In order to analyse this problem and highlight potential solutions, a literature search was conducted using Eric, Medline, Google Scholar and CINAHL Plus databases from 1985 to February 2013. We reviewed publications regarding the relationship between the pharmaceutical and device industry and medical …

Mode Of Coronary Revascularization And Short Term Clinical Outcomes In Patients With Chronic Kidney Disease, Ashique Ali Khoso, K. Kazmi, Saqiba Tahir, Hasanat Sharif, Safia Awan

Department of Surgery Docs

Abstract

BACKGROUND AND OBJECTIVE:

Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery are two alternative methods for coronary revascularization, but it remains controversial as which one is associated with lower risks of worse clinical outcomes for chronic kidney disease (CKD) patients. We determined the mode of coronary revascularization (PCI vs. CABG) which is associated with lower risk of mortality and morbidity in CKD patients.

METHODS:

In this cross sectional study, 159 patients with CKD were enrolled from single center of coronary revascularization at Aga Khan University Hospital Karachi between January 2012 and August 2013. All patients with …

Choledochal Cyst--A Different Disease In Newborns And Infants, Zafar Nazir, Munira Abdul Aziz

Department of Surgery Docs

Abstract

We report experience of managing Choledochal Cyst (CC) in different paediatric ages. Eleven neonates and infants (aged 0-8 months) and 24 paediatric cases (aged 2.5 - 18 years) were managed over 24 years (1988 to 2012). Neonates and infants presented with jaundice, acholic stools and abdominal mass whereas most of the paediatric cases presented with intermittent non-specific abdominal pain. Morphology of CC was mostly cystic in neonates whereas it was fusiform in majority (62%) of paediatric cases. Biliary amylase was high and correlated with the presence of abnormal pancreaticobiliary junction (PBJ) in 20 /24 paediatric patients. Obstruction at the …

Patients’ Visual Experience During Phacoemulsification Cataract Surgery And Associated Fear, Tanveer Anjum Chaudhry, Amash Aqil, Kanza Aziz, Ammar Asrar Javed, Mohammad Zain Tauqir, Khabir Ahmad

Department of Surgery Docs

Abstract Background: Data from several published studies indicate that patients undergoing phacoemulsification cataract surgery can experience a variety of visual sensations which can result in fear. This phenomenon has not been studied in Pakistan to-date. We examined the visual experience and its associated fear among patients undergoing phacoemulsification cataract surgery under topical anaesthesia. Methods: This cross-sectional study was carried out in Aga Khan University Hospital, a tertiary care hospital, in Karachi, Pakistan from August 2010 to July 2011. Adults >18 years of age scheduled to undergo cataract surgery (phacoemulsification with intraocular lens implantation) under topical anaesthesia by a single surgeon …

The Accuracy Of Three-Dimensional Bladder Ultrasonography In Determining The Residual Urinary Volume Compared With Conventional Catheterisation, Imran K. Jalbani, Hammad Ather

Department of Surgery Docs

Abstract

OBJECTIVE:

To determine the accuracy of three-dimensional bladder ultrasonography (US, using the BVI 3000, Verathon, WA, USA) for determining the residual urinary volume, compared with the conventional catheterisation method.

PATIENTS AND METHODS:

We conducted a cross-sectional study at day-care unit of a University hospital after obtaining approval from the Ethics Review Committee of the hospital. Thirty-four patients with lower urinary tract symptoms requiring cystometrography were included. The postvoid volume was measured by bladder US, with three readings taken, and then patient was catheterised using a 12-F Nelaton catheter to measure the urinary volume. The mean of the three readings …

Vogt-Koyanagi-Harada Syndrome, Sharmeen Akram, Khabir Ahmad

Department of Surgery Docs

ABSTRACT Vogt-Koyanagi-Harada (VKH) syndrome is a rare multisystem disease of melanocyte containing organs. It is characterized by diffuse granulomatous inflammation involving various organs including eye. VKH syndrome is usually sporadic, but some familial cases have also been reported indicating a hereditary basis. VKH is not associated with mortality but it may result in long-term complications such as decreased vision associated with cataract, glaucoma and choroidal neovascularization. For successful outcomes, early aggressive treatment using systemic steroids with gradual tapering is essential. This report describes a case of VKH syndrome in a 26-year-old male of Pakistan origin who was successfully treated with …

Bilateral Maxillary Canine-First Premolar Transposition In Permanent Dentition, Sarwat Memon, Mubassar Fida

Department of Surgery Docs

ABSTRACT Transposition is a dental anomaly characterized by the exchange of position between two adjacent teeth, especially in relation to their roots, or development and eruption of a tooth in a position normally occupied by a nonadjacent tooth. Transposition of the maxillary canine and first premolar has a low prevalence in the population and it primarily affects maxillary canines and premolars. The aetiology of the transposition remains unclear, although it has been associated with genetic factors. It may also be related to a combination of localised factors such as malformation of adjacent teeth, tooth agenesis, retention of the deciduous canine …

Inter-Observer Variability In Diagnosing Radiological Features Of Aneurysmal Subarachnoid Hemorrhage; A Preliminary Single Centre Study Comparing Observers From Different Specialties And Levels Of Training, Usman T Siddiqui, Anjum F. Khan, Muhammad Shahzad Shamim, Rana Shoaib Hamid, Muhammad Mehboob Alam, Emaduddin Siddiqui

Department of Surgery Docs

No abstract provided.

Vascular Surgery In Pakistan: Critical Issues, Zia Ur Rehman, Ziad Sophie

Department of Surgery Docs

No abstract provided.

Current Trends In Undergraduate Medical And Dental Research: A Picture From Pakistan, Waqar Jeelani, Sanaa Masood Aslam, Asrar Elahi

Department of Surgery Docs

Abstract

BACKGROUND:

Initiatives taken over the last few years have led us to the day when most of the medical and dental institutions in the developed countries have established a strong research culture at undergraduate level but the situation is quite the contrary in Pakistan. This study was carried out to investigate the current trends in undergraduate medical and dental research and to highlight the research barriers.

METHODS:

A cross-sectional study was conducted at six medical and dental colleges of Rawalpindi and Islamabad. A structured questionnaire was used to collect data from 300 students. Results were recorded as percentages. Findings …

Retinopathy Of Prematurity: An Evaluation Of Existing Screening Criteria In Pakistan, Tanveer Anjum Chaudhry, Farzeen Khalid Hashmi, Muhammad Sohail Salat, Qazi Assad Khan, Abdul Ahad, Ather M Taqui, Reema Syed, Khabir Ahmad

Department of Surgery Docs

Abstract

AIM:

To evaluate if broadening the criteria for retinopathy of prematurity (ROP) screening to include babies with gestational age ≥32 weeks and/or birth weight ≥1500 g, would have an impact on the number of babies diagnosed as having ROP.

METHODS:

A prospective cohort study was carried out at the Aga Khan University Hospital, Karachi, Pakistan. Infants with gestational age ≤35 weeks or birth weight ≤2000 g born in this hospital from May 2010 to December 2012 were screened for the presence of ROP 4-6 weeks after birth. Subsequent examinations were performed at intervals based on the findings of initial …

Late Presentation Of Posterior Urethral Valves, Imran Khan Jalbani, Syed Raziuddin Biyabani

Department of Surgery Docs

ABSTRACT Presence of posterior urethral valves (PUV) is the most common cause of urinary tract obstruction in the male neonate. Late presentation occurs in 10% of cases. We present a case of PUVs in an adult male who presented with history of obstructive lower urinary tract symptoms and hematuria. On evaluation, he was found to have raised serum creatinine level. A voiding cystourethrogram (VCUG) could not be completely performed because of narrowing in the posterior urethra. A rigid urethrocystoscopy was performed at which he was found to have type-I posterior urethral valve which were fulgurated. A repeat uroflowmetry revealed maximum …

Self-Reported Comfort With Tracheostomy Tube Care. Cross-Sectional Survey Of Non-Ear, Nose And Throat Health Care Professionals, Salma Al Sharhan, Momena Sohail, Khabir Ahmad, Moghira I Siddiqui

Department of Surgery Docs

OBJECTIVE: To assess self-reported comfort of non-ear, nose and throat (ENT) health professionals in tracheostomy care and identify its associated factors. METHODS: This was a cross-sectional survey of non-ENT health care professionals, carried out from December 2011 to February 2013 at the Prince Sultan Military Medical City, and King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia. A self-administered questionnaire was used to collect data on self-rated comfort levels in performing tracheostomy tube change and factors, such as speciality, duration of dedicated ENT rotation in medical school, and years of experience as a practicing consultant. RESULTS: A …

Conversion Of Cardiac Bypass Into An Extracorporeal Membrane Oxygenation Circuit: A Case From Pakistan, Riffat Rasheed, Ijaz Hidayat, Muneer Amanullah, Babar Hasan

Department of Surgery Docs

A 35 days old neonate with d-loop transposition of great arteries, underwent an arterial switch operation following which he developed hypotension attributed to left ventricular failure. During cardiopulmonary resuscitation decision was made to place him on cardiac bypass again. Due to limited resources and unavailability of a specialized extracorporeal membrane oxygenator machine, the CPB was modified and converted an ECMO. The neonate was successfully decannulated after 72 hours and discharged home after 3 weeks of the operation without any sequel. ECMO is a viable option in developing countries and may help in improving the outcome especially in neonatal congenital heart …

Rectal Carcinoma Under 40 Years Of Age: Seven-Year Post-Treatment Follow-Up At A Tertiary Care Hospital In Pakistan, Naveed Haroon, Salma Khan, Rehman Alvi

Department of Surgery Docs

Objectives: To determine epidemiological characteristics, clinical presentation, histopathological features, and long-term follow-up of patients below 40 years of age with carcinoma rectum.Methods: The retrospective case series comprised all patients presenting with histopathological diagnosis of carcinoma rectum with age 15-40 years at the Aga Khan University Hospital between January 1994 and December 2004. Details regarding patient demographics, pre-operative assessment, management and tumour grade and stage were obtained from a prospectively maintained database. Continuous and categorical variables in the data were analysed.Results: Of the 23 patients in the study, 14 (60.89%) were male and 9 (39.13%) were female. Mean age of the …

Psychosocial Experiences Of Women With Vesicovaginal Fistula: A Qualitative Approach., Farah Naz Farid, Maimoona Azhar, Sunil Sadruddin Samnani, Saleema Allana, Angeela Naz, Farzana Bohar, Shershah Syed

Department of Surgery Docs

Abstract

Vesicovaginal fistula (VVF) is a condition associated with a number of physical and psychological consequences. In order to gain a deeper understanding of the issues faced by women diagnosed with VVF, a qualitative exploratory study was carried out to explore the experiences of women suffering from VVF. The study included 8 women hospitalized with the diagnosis of vesicovaginal fistula at Kohi Goth Women's Hospital, Karachi, Pakistan. Semi structured interviews of each participant were conducted, recorded, and transcribed. Five major themes were identified, among which all of the participants experienced physical discomforts, psychological disturbances, issues with social and interpersonal relationships …

Hip Fracture Surgery: Does Type Of Anesthesia Matter?, Rizwan Haroon Rashid, Adil Aijaz Shah, Amarah Shakoor, Shahryar Noordin

Department of Surgery Docs

Background: Hip fracture surgery is a common procedure, and the geriatric population with its multiple comorbid conditions is at most at risk of developing anesthesia-related complications. Data on the impact of type anesthesia on postoperative morbidity and mortality is limited.The effects of regional and general anesthesia on postoperative outcomes need to be clearly elucidated.

Methods: In this study, all patients who underwent dynamic hip screw (DHS) fixation for intertrochanteric fractures, between January 2005 and December 2010, at the Aga Khan University Hospital, were included. Patients were divided into two groups; group A included those patients who received general anesthesia, and …

Benign Granulomatous Polyp Obstructing The Bronchus., Saulat H. Fatimi, Ali Khawaja, Ranish Deedar-Ali-Khawaja, Mehar Hoda, Salima Ahmed Bhimani

Department of Surgery Docs

Abstract

Inflammatory endobronchial polyps are rarely encountered. We report a case of a 14 years old girl with a benign granulomatous polyp originating in the bronchus. Computed tomography scan showed an intraluminal soft tissue opacity while fiberoptic bronchoscopy revealed a large soft tissue mass completely occluding the left lower lobe. Rigid bronchoscopy under general anaesthesia identified a fleshy mass in the left main stem bronchus which was excised via bronchoscopy. The histopathology showed benign polyp with non-specific inflammation. The patient's symptoms improved subsequently and no recurrence was reported till two years of follow-up

Abdominal Tuberculosis With Massive Jejunal Haemorrhage, Abdul Rehman Alvi, Tanveer Ui Haq, Amyn Pardhan

Department of Surgery Docs

ABSTRACT Jejunum is a rare site of involvement in intestinal tuberculosis (TB) and massive lower gastrointestinal haemorrhage is an even rare reported condition. The authors report a 15-year-old female student, who presented with fever, anaemia, hypoalbunemia and developed massive lower gastrointestinal haemorrhage during hospital stay. The diagnosis of abdominal TB was established on tissue biopsy; tissue culture was positive for Mycobacterium TB. Optimal outcome was achieved with aggressive resuscitation, repeated mesenteric angio-embolization and anti-tuberculosis chemotherapy

Visual Outcome Of Cataract Surgery, Farzeen Khalid Hashmi, Qazi Assad Khan, Tanveer Anjum Chaudhry, Khabir Ahmad

Department of Surgery Docs

The aim of this study was to assess whether the visual outcome of cataract surgery in the institution was in accordance with the World Health Organization recommendations. In this retrospective case series, all patients who underwent cataract surgery by a single surgeon from January 2009 till June 2011 were included. Date were collected from medical records on age, gender, visual acuity and causes of sub-optimal outcome. The main outcome was best-corrected visual acuity in the operated eye, measured 4 – 6 weeks after surgery. Data on visual outcome was grouped using WHO's classification. Of the 495 eyes that underwent cataract …

Visual Outcome Of Cataract Surgery, Farzeen Khalid Hashmi, Qazi Assad Khan, Tanveer Anjum Chaudhry, Khabir Ahmad

Department of Surgery Docs

The aim of this study was to assess whether the visual outcome of cataract surgery in the institution was in accordance with the World Health Organization recommendations. In this retrospective case series, all patients who underwent cataract surgery by a single surgeon from January 2009 till June 2011 were included. Date were collected from medical records on age, gender, visual acuity and causes of sub-optimal outcome. The main outcome was best-corrected visual acuity in the operated eye, measured 4 – 6 weeks after surgery. Data on visual outcome was grouped using WHO's classification. Of the 495 eyes that underwent cataract …

Lasik In Hyperopic Eyes With Congenital Nystagmus: A Case Report, Sharmeen Akram, Zarksis H, Khabir Ahmad

Department of Surgery Docs

Patients with nystagmus are considered to be poor candidates for laser in situ keratomileusis (LASIK), because they are unable to fixate. This case report presents the first reported use of LASIK surgery with a solid-state laser in hypermetropia and congenital nystagmus. A 23 year old woman with congenital nystagmus had LASIK surgery to correct a refractive error of +2.25/+1.75 90º in the right eye and + 2.00 / +1.75 90º in the left one. Baseline uncorrected visual acuity (UCVA) was 20/200 in both eyes, and best spectacle corrected visual acuity was 20/40 in both the eyes. The procedure was performed …

Successful Surgical Intervention Of Total Anomalous Pulmonary Venous Drainage In The Third Decade Of Life, Awais Ashfaq, Nilay Shah, Mubashir Z. Khan, Mehnaz Atiq, Muneer Amanullah

Department of Surgery Docs

Total anomalous pulmonary venous drainage (TAPVD) accounts for approximately 1.5% of all congenital heart diseases. It is usually diagnosed in the neonatal period and is rarely seen in adults. We report an unusual case of a patient with TAPVD who was successfully treated at the age of 28 years. We believe that this is the oldest person in the South Asian literature to undergo surgical correction of TAPVD.

Clinical Outcomes Of Surgically Corrected Atrial Septal Defects, Waleed Tariq Siddiqui, Shazia Parveen, Maria Tariq Siddiqui, Muneer Amanullah

Department of Surgery Docs

Objective: To examine the outcomes of surgical repair of atrial septal defects in paediatric and adult patients.
Methods: The retrospective study comprised data of 84 patients who had undergone surgical correction of atrial septal defect at the Aga Khan University Hospital, Karachi, between June 2006 and December 2011. All patients with isolated atrial septal defect (ostium secundum, ostium primum and sinus venosus with or without partial anomalous pulmonary venous connection) were included. Clinical and transthoracic echocardiographic data was reviewed. SPSS 17 was used for statistical analysis.
Results: There were no deaths in the study population. The mean time for follow-up …

Knowledge Attitude And Practices Among Urban Women Of Karachi, Pakistan, Regarding Breast Cancer, Zain-Ul-Abedeen Sobani, Zeb Saeed, Hafiza Noor-Ul-Ain Baloch, Amina Majeed, Sana Chaudry, Adil Sheikh, Jalal Umar, Hira Waseem, Murtaza Mirza, Irfan Qadir

Department of Surgery Docs

Objective: To determine the knowledge,attitudes and practices of urban women regarding breast cancer and its available screening modalities.Methods: The cross-sectional, questionnaire-based, descriptive study was conducted in the urban population of Karachi in November 2010. Female attendants (n=373) visiting a tertiary care centre and four of its urban outreach centres during the study period were administered a questionnaire. The answers were then scored with regard to their knowledge. Frequencies and percentages were computed through SPSS 17, and analysis of variance was used to confirm significance.Results: Of the 373 participants with a mean age of 32.4+/-10.9 years, 293 (78.6%) were married, and …

Knowledge Of Patients' Visual Experience During Cataract Surgery: A Survey Of Eye Doctors In Karachi, Pakistan, Mohammad Zain Tauqir, Tanveer Anjum Chaudhry, Sehreen Mumtaz, Khabir Ahmad

Department of Surgery Docs

Abstract

BACKGROUND:

Several recent studies have recommended that ophthalmologists must be aware of the visual sensations (and their associated anxiety/fear) experienced by patients undergoing cataract surgery. We assessed the knowledge of a group of eye doctors in Pakistan regarding these phenomena.

METHODS:

This was a cross-sectional survey. Eye doctors (ophthalmologists, residents and medical officers) attending the Ophthalmological Society of Pakistan Annual Conference 2011, in Karachi were invited to participate in the study. A self-administered structured questionnaire was used to examine their knowledge of visual sensations and their associated anxiety/fear experienced by patients during cataract surgery. Simple frequencies and proportions were …

Mechanical Complications Following Acute Myocardial Infarction, Awais Ashfaq, Hasanat Sharif

Department of Surgery Docs

Objective: To outline the outcome and management of patients with acute myocardial infarction presenting with mechanical complications such as post-infarction ventricular septal defect, mitral regurgitation and left ventricular rupture.Methods: The retrospective study, conducted in September and October, 2010 at the Aga Khan University Hospital, Karachi, included cases from January 1990 to December 2009. Only 18 cases were found who had presented with such complications. They were assessed for demographics as well as pre-operative, per-operative and post-operative management patterns. Data was analysed using SPSS version 17.0.Results: Out of the 18 patients, 10 had post-infarction ventricular septal defect, while 8 had mitral …

Healing Of Cornea Following An Electric Burn, Tanveer Anjum Chaudhry, Farheen Shaikh, Khabir Ahmad

Department of Surgery Docs

ABSTRACT Electrical injuries have become a significant health problem in developing countries because of increase in access to electricity in the last few decades and lack of adequate safety measures. Electrical injuries of eyes are relatively uncommon. A case report of a rapid and complete corneal healing accompanied by satisfactory visual recovery after an electric burn event in a 20-year-old male is reported. The patient had accidental exposure to high voltage live wire while he was repairing it, resulting in severe ocular and superficial body burn. He was not wearing any protective equipment at the time of injury. On examination, …

A Comparative Analysis Of Toluidine Blue With Frozen Section In Oral Squamous Cell Carcinoma, Montasir Junaid, Moaz M. Choudhary, Zain A. Sobani, Ghulam Murtaza, Sadaf Qadeer, Naeem S. Ali, Mumtaz J. Khan, Anwar Suhail

Department of Surgery Docs

Background:Surgical excision of the primary tumor with safe margins remains the mainstay of treatment for oral cavity squamous cell carcinoma (OSCC). The standard of care for assessment of intraoperative margins is frozen section histopathology. Unfortunately the facility is not available at most centers in limited resource countries. Toluidine blue, a metachromatic dye, has been well described in clinical identification of malignant and premalignant lesion in the oral cavity. Considering this we decided to explore intraoperative use of toluidine blue staining, in comparison with frozen sections, for the assessment of tumor-free margins.

Methods:

After obtaining clearance from the in-house ethical …