Surgery Commons^™

The National Burden Of Orthopedic Injury: Cross-Sectional Estimates For Trauma System Planning And Optimization, Molly P. Jarman, Michael J. Weaver, Adil H. Haider, Ali Saleem, Mitchel B. Harris

Department of Surgery Docs

Background: Management of orthopedic injuries is a critical component of comprehensive trauma care. As patterns of injury incidence and recovery change in the face of emerging injury prevention efforts and technologies and an aging US population, assessment of the burden of orthopedic injury is essential to optimize trauma system planning. We sought to estimate the incidence of orthopedic injury requiring emergency orthopedic surgery in the United States.
Methods: Using nationally representative samples from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project, we estimated the incidence of orthopedic injury, polytrauma with orthopedic injury, and emergency operative orthopedic …

Mycobacterium Abscessus: A Rare Cause Of Peri-Ductal Mastitis In Endemic Regions, Aisha Shaikh, Lubna Mushtaque Vohra

Department of Surgery Docs

Mycobacterium abscessus is a rapidly growing non-tuberculous, multi-drug resistant mycobacterium (NTM). Its common clinical presentation includes pulmonary infection followed by wide spectrum of skin and soft tissue infections. Chronic breast conditions, such as peri-ductal mastitis are rarely caused by NTM. Due to an intrinsic and acquired drug resistance to conventional antibiotics and anti-tuberculous therapy, it is often managed with a combination of antibiotics with or without surgical adjuncts. It is important to consider NTM in patients with chronic mastitis who show suboptimal response to initial broad-spectrum antibiotics, and especially when symptoms recur after complete resolution. This case report describes peri-ductal …

Recurrent Phyllodes Tumour Of The Breast Transforming To A Fibrosarcoma, Dua Jabeen, Lubna Mushtaque Vohra, Tariq Siddiqui, Aziz-Un-Nisa Raza

Department of Surgery Docs

Phyllodes tumours of the breast are characterized by having both an epithelial as well as stromal component and these usually comprise almost 3% of all fibroepithelial tumours. They are exceptional in this aspect to convert into a stromal sarcoma of the breast after multiple recurrences. To the best of our knowledge, there are only three case reports regarding this in the available literature as it is an exceptional change. In this case report, we present a case of recurrent phyllodes transforming into a breast fibrosarcoma in a middle age postmenopausal woman. Histopathological examination and immunohistochemistry of the lesion were performed …

Predictors Of Poor Quality Of Life After Primary Lower Limb Deep Venous Thrombosis: A Perspective From A Developing Nation, Nadeem Ahmed Siddiqui, Muhammad Asad Moosa, Fareed A. Shaikh, Noman Shahzad, Shahid Nazir, Ziad Sophie

Department of Surgery Docs

Objective: We aimed to determine predictors of poor long term quality of life, using the VEINES Quality of Life (QOL) questionnaire, in patients with lower limb deep venous thrombosis (DVT).
Material and Methods: This study included adult patients with primary lower limb DVT between January 2007 and December 2017. Post thrombotic syndrome (PTS) was assessed using the Villalta score and Quality of Life (QoL) by the VEINES quality of life questionnaire.
Results: Our study included 125 patients, 57 (45.6%) of whom were males. The patient population's median age was 41 years (IQR: 34-47 years). The median follow …

Cephalic Vein Transposition: An Effective Surgical Option For Dealing With The Cephalic Vein Stenosis, Zia Ur Rehman

Department of Surgery Docs

No abstract provided.

Free Flap Reconstruction After Lower Limb Trauma - Outcome Analysis Using National Surgical Quality Improvement Programme (Nsqip) Parameters, Muhammad Mehmood Alam Atiq, Shayan Shahid, Muhammad Ubaid, Mohammad Fazlur Rahman, Safdar Ali Shaikh

Department of Surgery Docs

Objective: To assess the outcomes of free flap reconstructions performed for the management of lower limb trauma.
Methods: This retrospective study was conducted at Aga Khan University Hospital (AKUH), Karachi and included data from June 2017 to May 2019 of patients who underwent free flap reconstruction as part of management of lower limb trauma.
Results: The mean age of the 8 adult patients was 34±11 years. Also included were two paediatric patients aged 7 and 8 years. Nine of the total 10 patients were male. Road traffic accidents were the most common mechanism of injury, occurring in 5(50%), followed by …

Outcome Of Traumatic Inferior Vena Caval Injuries: A Case Series, Zia Ur Rehman, Rimsha Farooq

Department of Surgery Docs

Inferior vena caval (IVC) injuries are uncommon and challenging. The objective of the study is to evaluate outcomes of patients operated for inferior vena caval injuries at a university hospital. This is a retrospective case series of all adult patients aged >18 years who had been operated for traumatic IVC injuries at a university hospital between Jan 1998 to December 2018. During the study period, 9 patients with IVC injuries were operated with mean age of 26±10.3 years and all were males. Five (55.5%) patients had penetrating injuries while 4 (44.4%) had blunt trauma. Four (44.4%) patients had infra-renal while …

Changing Face Of Trauma And Surgical Training In A Developing Country: A Literature Review, Qamar Riaz, Sabah Uddin Saqib, Rehan Nasir Khan, Nadeem Ahmed Siddiqui

Department of Surgery Docs

Trauma continues to be the major cause of disability and death globally and surgeons are often involved in immediate care. However there has been an exponential decrease in the number of the trained trauma surgeons. The purpose of the current review article is to summarize the published literature pertaining to trauma education in postgraduate surgical training programmes internationally and in a developing country as Pakistan. Several electronic databases like MEDLINE, PubMed, Google scholar and PakMediNet were searched using the keywords 'trauma education' or 'trauma training' AND 'postgraduate medical education', 'surgery residency training', 'surgery residents' and 'surgeons'. The current training in …

Knowledge Gain Of The Non-Vascular Surgeons After Attending A Course On Traumatic Vascular Emergencies, Zia Ur Rehman, Muhammad Asad Moosa, Qamar Riaz

Department of Surgery Docs

Objective: To measure the effectiveness of the workshop in enhancing the knowledge and skills of the non-vascular surgeons in dealing with traumatic vascular emergencies.
Methodology: It was a Quasi-experimental pre-post design study conducted at Section of Vascular Surgery, Aga Khan University Hospital, Karachi (Pakistan) in February 2019. One-day workshop was conducted to enhance the knowledge and operative skills of the non-vascular surgeons in managing traumatic vascular emergencies. A written test and course evaluation survey were used to evaluate the effectiveness of the course in achieving the desired objectives.
Results: Total of 21 participants attended the workshop with mean age of …

Psychological Distress And Its Associated Factors Among Informal Care Givers Of Disabled Young Adults With Traumatic Brain Injuries, Samera Punjwani, Yasmin Parpio, Rubina Barolia, Muhammad Shahzad Shamim, Nargis Asad

Department of Surgery Docs

Objective: To measure the psychological distress among the informal caregivers of disabled young adults with traumatic brain injuries (TBI) and to identify its associated factors.
Methods: An analytical cross sectional study was conducted with 76 informal caregivers of young adults (19 - 50 years) with TBI, using admission records of one of the tertiary care hospitals in Karachi, Pakistan from 2015 to 2016. Data were collected using a structured questionnaire comprising a general demographic questionnaire and the General Health Questionnaire- 28. The effect of the predictors on the psychological distress was determined by applying multiple linear regression analysis.
Results: The …

Lateral Sub-Cutaneous Route For Anterior Tibial Artery Revascularisation, Zia Ur Rehman

Department of Surgery Docs

No abstract provided.

Health Care Professionals’ Compliance To Tracheal Suctioning Policy At A Tertiary Care Hospital, Rozina Khimani, Fauziya Ali, Salma Amin Rattani, Mohammad Sohail Awan

Department of Surgery Docs

Objective: To assess the compliance of tracheal suctioning practices against the standard guidelines of a tertiary care hospital, with regard to the participants’ professional characteristics.
Methods: Using cross sectional study design, forty health care professionals (HCPs) were assessed twice, using a quantitative structured observational design, for tracheal suctioning practices, in one of the surgical care units of the tertiary care hospital. Tracheal suctioning policy which was used as a tool, its inter-rater reliability was tested and each step showed the Kappa value of 0.65 to 1.000. Data was analyzed using epidata info version 3.5.1 and SPSS version 19.
Results: From …

Percutaneous Venoplasty For Central Venous Stenosis: Effect On Patient's Symptoms And Patency Of Arteriovenous Accesses, Zia Ur Rehman, Abdul Hakeem Memon, Raza Sayani, Nida Zahid

Department of Surgery Docs

Objective: To determine symptomatic relief and patency rate of arteriovenous (AV) fistulae and grafts after venoplasty in patients with central venous stenosis (CVS) on hemodialysis.
Study Design: Case series.
Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 2012 to December 2017.
Methodology: The data of patients who had one session of successful venoplasty for CVS were reviewed. The outcomes measured were symptomatic recovery and improvement in the patency of AV accesses. Symptomatic recovery was termed 'complete', when there was complete symptomatic relief after venoplasty; and 'partial' when the procedure was technically successful, but symptoms were …

Distal Splenorenal Shunt (Dsrs) In Children With Extrahepatic Portal Hypertension, Zia Ur Rehman, Zafar Nazir

Department of Surgery Docs

Portal hypertension (PH) is infrequent in children as compared to adults. Currently, repetitive endoscopic ablation of varices is standard treatment. However, endoscopic facilities are not readily available in resource-limited settings. We reviewed the indications, operative morbidity, mortality, shunt patency and re-bleeding episodes in nine patients (age range 6-16 years, M:F 6:3) who had DSRS for recurrent GI bleeding not responding to endoscopic treatment and hypersplenism. DSRS is a safe and effective treatment alternative in resource limiting setting for preventing bleeding and improving hypersplenism in children with extrahepatic portal hypertension.

Creation Of Radiocephalic Arteriovenous Fistula In A Patient With Failed Brachiocephalic Arteriovenous Fistula, Zia Ur Rehman

Department of Surgery Docs

Abstract are not provided by the author/publisher

Resilience And Quality Of Life (Qol) Of Head And Neck Cancer And Brain Tumour Survivors In Pakistan: An Analytical Cross-Sectional Study Protocol, Nida Zahid, Wardah Khalid, Khabir Ahmad, Shireen Shehzad, Iqbal Azam Syed, Nargis Asad, Adnan Jabbar, Mumtaz J Khan, Ather Enam

Department of Surgery Docs

Background: Cancer is a devastating disease and has detrimental effects on the quality of life (QoL) of cancer survivors and interferes with their treatment compliance. The aim of the study is to assess resilience and QoL among cancer survivors and to evaluate the important factors affecting their resilience and QoL, with respect to the Pakistani cultural context.
Method and Analysis: A cross-sectional study will be conducted at a tertiary care hospital in Karachi, Pakistan. A minimum sample size of 250 head and neck cancers and 250 brain tumour survivors with 10% inflation for non-response rate will be required. The SD …

Incidence Of Intraocular Lens Exchange After Cataract Surgery, Maram E. A. Abdalla Elsayed, Khabir Ahmad, Abdulelah A. Al-Abdullah, Rizwan Malik, Rajiv Khandekar, Hernan Martinez-Osorio, Marco Mura, Patrik Schatz

Department of Surgery Docs

Intraocular lens (IOL) exchange after cataract surgery is unusual but may be associated with suboptimal visual outcome. The incidence of IOL exchange has not been consistently estimated. Such information is invaluable when counseling patients prior to cataract surgery. We examined the incidence of, and indications and risk factors for, IOL exchange after cataract surgery. We also assessed visual outcome of eyes that had an IOL exchange. A cohort design was used to estimate the incidence of IOL exchange and a case-control design to identify factors associated with it. All phacoemulsification surgeries with IOL (n = 17415 eyes) during 2010-2017 and …

Peripheral Vascular Injuries - Not To Miss Or Mess Them!, Zia Ur Rehman

Department of Surgery Docs

No abstract provided.

Ectopic Thyroid Mass Separately Present In Mediastinum And Not A Retrosternal Extension: A Report Of Two Cases, Abdul Ahad Sohail, Syed Shahabuddin, Moghira Iqbaluddin Siddiqui

Department of Surgery Docs

Retrosternal extension of goiter is one of the most common types of masses in the superior mediastinum. These types of goiters classically present with compressive symptoms such as dyspnea, dysphonia, dysphagia, or sleep apnea. Surgical treatment with a total thyroidectomy and complete removal of the intrathoracic portion of thyroid is the gold standard treatment. These cervicomediastinal lesions at times may not be continuous, and a sternotomy may be required for complete and safe excision of the mediastinal mass to achieve decompression of the surrounding structures and preventing the hemorrhagic complications if attempted from cervical incision. We present a summary of …

Association Between Leptin, Obesity, Hormonal Interplay And Male Infertility, Sofia Amjaad, Mukhtiar Baig, Nida Zahid, Sundus Tariq, Rehana Rehman

Department of Surgery Docs

Male infertility is a major health problem worldwide. We investigated a possible association between leptin, obesity, hormonal interplay and male infertility. This cross-sectional study of 313 males (178 infertile and 135 fertile) was carried out in 2017. The subjects were categorised by body mass index (BMI) and body fat percentage (BF%) into normal weight, overweight and obese. Significantly higher levels of BMI and BF% (p-value < 0.001) and lower levels of FSH, LH, testosterone, and SHBG (p-value < 0.001) were found in infertile males. However, no significant difference was observed in leptin levels (p-value = 0.35). Leptin levels were significantly higher, and all the sex hormones were significantly lower (p-value < 0.001) in obese subjects, whereas according to BF% only leptin, FSH and SHBG were significantly different. Leptin showed a significant positive correlation with BMI and BF% (p < 0.001). A strong positive link to serum testosterone was found with age, FSH, and LH (p < 0.001) and a negative one with BMI and BF% (p < 0.001). In mutivariable anlaysis, after adjusting for the other covariates, a significant association between FSH and testosterone (p-value <0.001) was found. Serum leptin levels did not differ significantly in fertile and infertile groups, and no association was found with infertility. Furthermore, male obesity was found to be associated with infertility with the decrease in levels of sex hormones.

Human Papillomavirus And Human Cytomegalovirus Infection And Association With Prognosis In Patients With Primary Glioblastoma In Pakistan, Syed Adnan Ali, Yumna Mirza, Zubair Ahmad, Nida Zahid, Ather Enam

Department of Surgery Docs

Objective: Glioblastoma multiforme (GBM) is the most common adult primary brain tumor. Human cytomegalovirus (HCMV) has been studied for the past decade, and conflicting results have been reported with no conclusive role established yet. Human papillomavirus (HPV) is involved in the pathogenesis of many cancers and has a high prevalence in patients with cervical and oral cancer in Pakistan. The objective of our study was to identify the prevalence of HCMV and HPV in Pakistani patients with primary GBM.
Methods: In total, 112 primary GBM biopsies were analyzed. HCMV and HPV infection was investigated using nested and conventional polymerase chain …

Inheritance Patterns, Challenges, And Outcomes Of Fracture Management In Osteopetrosis Patients. Case Series And Review Of Pertinent Literature, Obada Hussein Hasan, Aly Zaheer Pathan, Hammad Naqvi, Pervaiz Hashmi, Riaz Hussain Lakdawala

Department of Surgery Docs

Background: Osteopetrosis (OP) is a group of rare inheritable genetic disorders which show increased bone radiodensity on radiography. As no cure exists, careful symptomatic treatment is the mainstay in management due to brittle bone and frequent complications. We would like to present a case series of OP patients, their management, a review of literature about this rare disease and its genetic and inheritance patterns.
Materials and methods: Retrospective case series of 6 patients with OP seen at our institution from 2010 to January 2018. We searched PubMed and Google Scholar for articles using the following keywords: Osteopetrosis, Radiology, Fracture and …

Overexpression Of Egfr In Oral Premalignant Lesions And Oscc And Its Impact On Survival And Recurrence, Yumna Mirza, Syed Adnan Ali, Mohammad Sohail Awan, Romana Idress, Sana Naeem, Nida Zahid, Urooj Qadeer

Department of Surgery Docs

Introduction: Oral squamous cell carcinoma (OSCC) the sixth leading cancer worldwide ranks as the most common cancer in males, and the third most common in females in Pakistan. It is influenced by risk factors which are widely consumed in our population. The epidermal growth factor receptor (EGFR) is a tyrosine kinase receptor that is imperative for cell signalling, growth and differentiation. It is mutated and overexpressed in a variety of cancers, while in OSCC it has been linked to poor patient survival; premalignant to malignant transformation and recurrence. This study investigates the use of EGFR as a prognostic factor …

Recurrent Renal Cancer In Birt-Hogg-Dube Syndrome: A Case Report, Hammad Ather, Nida Zahid

Department of Surgery Docs

Introduction: Birt-Hogg-Dube syndrome (BHDS) is a rare autosomal dominant disease. It is caused by constitutional mutations in the FLCN gene. Since BHDS is a rare syndrome therefore it is unknown to many physicians. However, it is important to identify this rare syndrome at early stages because incidence of renal cancer in BHD patients is very high and its detection at early stages can prevent its metastasis. Hence, we want to present a case of BHDS and draw the attention of the treating physician to this rare inherited disorder and discuss its appropriate diagnosis and management.CASE PRESENTATION: We present a case …

Short-Term Outcomes After Hepatic Resection : Perspective From A Developing Country, Saleema Begum, Muhammad Rizwan Khan

Department of Surgery Docs

Abstract Objective: To review the early outcomes of hepatic resection at our hospital. Methods: This study was conducted at the Aga Khan University Hospital, Karachi, from January 2008 to December 2015, and comprised patients who underwent hepatic resection. We analysed the pathology, magnitude of hepatic resection and short-term outcomes in the patients. Mean and standard deviations were used to describe categorical data whereas frequencies and proportions to describe quantitative data. Univariate analysis was done to look at the factors associated with morbidity, mortality and blood loss during surgery. SPSS 19 was used for data analysis. Results: Of the 75 participants, …

Role Of Surgery In Brain Metastases, Altaf Ali Laghari, Syed Ijlal Ahmed, Muhammad Shahzad Shamim

Department of Surgery Docs

Abstract Brain metastases remain the commonest type of brain tumour, being four times more common than primary brain tumours. Although surgical intervention may be recommended for one of various reasons in the management of these tumours, including but not limited to conformation of diagnosis, relief of mass effect, improvement of neurological status and prolongation of survival, the guidelines for management of brain metastases remain largely subjective and therefore controversial. Herein the authors have attempted to review some of the existing evidence on role of surgery in the management of brain metastases and have presented their selected guidelines for the readers.

Role Of Early Contrast Enhanced Ct Scan In Severity Prediction Of Acute Pancreatitis, Noman Shahzad, Muhammad Rizwan Khan, K. M. Inam Pal, Dawar Khan, Muhammad Shahrukh Effendi

Department of Surgery Docs

Abstract

Severe pancreatitis occurs in approximately 15-25% of patients with acute pancreatitis. The objective of our study was to compare the CTSeverity Index (CTSI) with a clinical score (BISAP score) to predict severity of acute pancreatitis. Forty-eight consecutive patients with acutepancreatitis who underwent contrast enhanced CT scan within 72 hours of presentation were included. Results of our study showed that both CTSI and BISAP score were reliable predictors of mortality (p value = 0.019 and <0.001 respectively) and need for mechanical ventilation (p value = .002 and .006 respectively). Positive predictive value of CTSI to predict recovery without intervention was 91.4% as compared to 78% for that of BISAP score. Receiver Operating Characteristics (ROC) Curves showed CT scan was superior to BISAP Score in predicting need of percutaneous or surgical intervention. Early CT scan may be utilized for prediction of clinical course of patients with acute pancreatitis.

Antibiotics In Acute Calculous Cholecystitis : Do Tokyo Guidelines Influence The Surgeons’ Practices?, Hassaan Bari, Muhammad Rizwan Khan, Amir Hafeez Shariff, Amir Hafeez Shariff

Department of Surgery Docs

Abstract

OBJECTIVE:

To observe changes in surgeons' practice of antibiotic usage in patients with acute cholecystitis before and after the implementation of Tokyo Guidelines.

METHODS:

This retrospective, descriptive study was conducted at the Aga Khan University Hospital, Karachi, and comprised the medical records of all patients with the diagnosis of acute calculus cholecystitis who presented in 2009 and those who presented in 2014 after the implementation of Tokyo Guidelines. The major variables included patients' demographics, antibiotics used and surgical outcomes. SPSS 19 was used for data analysis.

RESULTS:

Of the 356 patients, 96(27%) were treated in 2009 and 260(73%) in …

Comparison Of Enteral Versus Intravenous Potassium Supplementation In Hypokalaemia In Paediatric Patients In Intensive Care Post Cardiac Surgery: Open-Label Randomised Equivalence Trial (Eips), Naveed Ur Rehman Siddiqui, Quratulain Merchant, Babar Hasan, Arjumand Rizvi, Muneer M Amanullah, Amina Rehmat, Anwarul Haque

Department of Surgery Docs

Objectives: The primary objective was to compare the efficacy of enteral potassium replacement (EPR) and intravenous potassium replacement (IVPR) as first-line therapy. Secondary objectives included comparison of adverse effects and number of doses required to resolve the episode of hypokalaemia.|
Trial design: The EIPS trial is designed as a randomised, equivalence trial between two treatment arms.
Study setting: The study was conducted at the paediatric cardiac intensive care unit (PCICU) at Aga Khan University Hospital, Karachi.
Participants: 41 patients (aged 1 month to 15years) who were admitted to PCICU post cardiac surgery were recruited (23 IVPR arm and 18 …

Perioperative Steroids For Lumbar Disc Surgery: A Meta-Analysis Of Randomized Controlled Trials, Muhammad Waqas, Hussain Shallwani, Muhammad Shahzad Shamim, Khabir Ahmed

Department of Surgery Docs

Background: Our review question was "Does perioperative steroids administration, in comparison with other treatments or placebo, improve either postoperative pain control, length of hospital stay, or return to work in patients undergoing lumbar disc surgery?"
Methods: We searched PubMed, CINAHL PLUS, and Cochrane databases for randomized control trials (RCTs) studying the role of steroids for lumbar disc surgery. Studies that compared perioperative steroids with other treatments or placebo were included. Study outcomes included postoperative back pain, leg pain, length of hospital stay, and return to work. Data was extracted through a proforma. Means and mean differences were calculated for continuous …