Surgery Commons^™

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 …

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 …

Temporary Epicardial Pacing Wires In Isolated Coronary Artery Bypass Graft: Necessity Or Force Of Habit?, Mian Mustafa Kamal, Abdul Ahad Sohail, Majid Osman, Shiraz Hashmi, Muhammad Mehdi, Asma Altaf Hussain Merchant, Hasanat Sharif

Section of Cardiothoracic Surgery

Objective: To determine the frequency of Temporary epicardial pacing wires usage and its predictors in the immediate postoperative period in isolated coronary artery bypass graft surgery.
Methods: The longitudinal study was conducted at the Aga Khan University Hospital, Karachi, from September 2019 to August 2020, and comprised adult patients of either gender who underwent isolated coronary artery bypass graft in the Department of Cardiothoracic Surgery. Demographic, peri-operative and post-operative Temporary Epicardial Pacing Wires use data was extracted from patient's files and the institutional electronic database. Logistic regression models were built to explore predictors of Temporary epicardial pacing wires usage. Data …

Surgeons And Ethical Challenges In Operating Room, Nazim Syed Muhammad, Syed Shahabuddin

Section of Urology

Ethics lie in the heart of professionalism. In surgery, it represents an essential element, with surgeons facing ethical challenges in their routine practice. The rapid expansion of surgical technology and innovation along with the use of resources and consideration of conflict of interest have brought up the need for the development of current surgical code of ethics. Operating room represents a stressful environment where patients' lives depend upon careful preparation, planning and execution. The progression of surgery within the operating room must be done in harmony and in line with the ethical principles of autonomy, beneficence, non-maleficence and justice. Discussion …

What After Bcg Fails In Non-Muscle Invasive Bladder Cancer?, M Hammad Ather

Section of Urology

No abstract provided.

Analysing The Trends In Breast Surgery Practice During Covid-19 Pandemic: A Comparative Study With The Pre-Covid Era, Lubna M. Vohra, Dua Jabeen, Nargis Khan, Azmeena Nizar, Anum Jamil, Tariq Siddiqui

Section of General Surgery

Background: The emergence of coronavirus disease 2019 (COVID-19) pandemic has crippled the healthcare systems all over the world. Cancer treatment is indispensable and disruption in its provision can lead to unanticipated consequences. No local data exists that has quantified the impact of COVID-19 pandemic on breast cancer surgery in a lower middle-income country (LMIC), therefore, the present retrospective comparative cohort study is directed to determine the trends in breast surgery operative volumes and its outcomes at our institution in Pakistan.
Materials and methods: Data was collected retrospectively from Pre-COVID-19 and COVID-19 era to determine impact of the current pandemic on …

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 …

Β-Aminopropionitrile-Induced Aortic Aneurysm And Dissection In Mice, Hisashi Sawada, Zachary A. Beckner, Sohei Ito, Alan Daugherty, Hong S. Lu

Saha Cardiovascular Research Center Faculty Publications

The mechanistic basis for the formation of aortic aneurysms and dissection needs to be elucidated to facilitate the development of effective medications. β-Aminopropionitrile administration in mice has been used frequently to study the pathologic features and mechanisms of aortic aneurysm and dissection. This mouse model mimics several facets of the pathology of human aortic aneurysms and dissection, although many variables exist in the experimental design and protocols that must be resolved to determine its application to the human disease. In the present brief review, we have introduced the development of this mouse model and provided insights into understanding its pathologic …

Developing Novel Therapies For Degenerative Cervical Myelopathy [Ao Spine Recode-Dcm Research Priority Number 7]: Opportunities From Restorative Neurobiology., Aref-Ali Gharooni, Brian K Kwon, Michael G Fehlings, Timothy F Boerger, Ricardo Rodrigues-Pinto, Paul Aarne Koljonen, Shekar N Kurpad, James Harrop, Bizhan Aarabi, Vafa Rahimi-Movaghar, Jefferson R Wilson, Benjamin M Davies, Mark R N Kotter, James D Guest

Department of Neurosurgery Faculty Papers

Study design: Narrative review.

Objectives: To provide an overview of contemporary therapies for the James Lind Alliance priority setting partnership for degenerative cervical myelopathy (DCM) question: 'Can novel therapies, including stem-cell, gene, pharmacological and neuroprotective therapies, be identified to improve the health and wellbeing of people living with DCM and slow down disease progression?'

Methods: A review of the literature was conducted to outline the pathophysiology of DCM and present contemporary therapies that may hold therapeutic value in 3 broad categories of neuroprotection, neuroregeneration, and neuromodulation.

Results: Chronic spinal cord compression leads to ischaemia, neuroinflammation, demyelination, and neuronal loss. Surgical …

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 …

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 …

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: …

Optimizing The Application Of Surgery For Degenerative Cervical Myelopathy [Ao Spine Recode-Dcm Research Priority Number 10], Ricardo Rodrigues-Pinto, Thiago Montenegro, Benjamin M Davies, So Kato, Yoshiharu Kawaguchi, Manabu Ito, Mehmet Zileli, Brian K Kwon, Michael G Fehlings, Paul A Koljonen, Shekar N Kurpad, James D Guest, Bizhan Aarabi, Vafa Rahimi-Movaghar, Jefferson R Wilson, Mark R N Kotter, James Harrop

Department of Neurosurgery Faculty Papers

Study design: Literature Review (Narrative).

Objective: To introduce the number 10 research priority for Degenerative Cervical Myelopathy: Individualizing Surgery.

Methods: This article summarizes the current recommendations and indications for surgery, including how known prognostic factors such as injury time, age, disease severity, and associated comorbidities impact surgical outcome. It also considers key areas of uncertainty that should be the focus of future research.

Results: While a small proportion of conservatively managed patients may remain stable, the majority will deteriorate over time. To date, surgical decompression is the mainstay of treatment, able to halt disease progression and improve neurologic function and …

Establishing Diagnostic Criteria For Degenerative Cervical Myelopathy [Ao Spine Recode-Dcm Research Priority Number 3], Bryn Hilton, Emma L Gardner, Zhilin Jiang, Lindsay Tetreault, Jamie R F Wilson, Carl Moritz Zipser, K Daniel Riew, James D Guest, James Harrop, Michael G Fehlings, Ricardo Rodrigues-Pinto, Vafa Rahimi-Movaghar, Bizhan Aarabi, Paul A Koljonen, Mark R N Kotter, Benjamin M Davies, Brian K Kwon

Department of Neurosurgery Faculty Papers

Study design: Narrative review.

Objectives: To discuss the importance of establishing diagnostic criteria in Degenerative Cervical Myelopathy (DCM), including factors that must be taken into account and challenges that must be overcome in this process.

Methods: Literature review summarising current evidence of establishing diagnostic criteria for DCM.

Results: Degenerative Cervical Myelopathy (DCM) is characterised by a degenerative process of the cervical spine resulting in chronic spinal cord dysfunction and subsequent neurological disability. Diagnostic delays lead to progressive neurological decline with associated reduction in quality of life for patients. Surgical decompression may halt neurologic worsening and, in many cases, improves function. …

Understanding Deep Learning - Challenges And Prospects, Niha Adnan, Fahad Umer

Department of Surgery Docs

The developments in Artificial Intelligence have been on the rise since its advent. The advancements in this field have been the innovative research area across a wide range of industries, making its incorporation in dentistry inevitable. Artificial Intelligence techniques are making serious progress in the diagnostic and treatment planning aspects of dental clinical practice. This will ultimately help in the elimination of subjectivity and human error that are often part of radiographic interpretations, and will improve the overall efficiency of the process. The various types of Artificial Intelligence algorithms that exist today make the understanding of their application quite complex. …

Degenerative Cervical Myelopathy: Development And Natural History [Ao Spine Recode-Dcm Research Priority Number 2]., Aria Nouri, Enrico Tessitore, Granit Molliqaj, Torstein Meling, Karl Schaller, Hiroaki Nakashima, Yasutsugu Yukawa, Josef Bednarik, Allan R Martin, Peter Vajkoczy, Joseph S Cheng, Brian K Kwon, Shekar N Kurpad, Michael G Fehlings, James S Harrop, Bizhan Aarabi, Vafa Rahimi-Movaghar, James D Guest, Benjamin M Davies, Mark R N Kotter, Jefferson R Wilson

Department of Neurosurgery Faculty Papers

Study design: Narrative review.

Objectives: To discuss the current understanding of the natural history of degenerative cervical myelopathy (DCM).

Methods: Literature review summarizing current evidence pertaining to the natural history and risk factors of DCM.

Results: DCM is a common condition in which progressive arthritic disease of the cervical spine leads to spinal cord compression resulting in a constellation of neurological symptoms, in particular upper extremity dysfunction and gait impairment. Anatomical factors including cord-canal mismatch, congenitally fused vertebrae and genetic factors may increase individuals' risk for DCM development. Non-myelopathic spinal cord compression (NMSCC) is a common phenomenon with a prevalence …

Developing Peri-Operative Rehabilitation In Degenerative Cervical Myelopathy [Ao Spine Recode-Dcm Research Priority Number 6]: An Unexplored Opportunity?, Timothy F Boerger, Allison S Hyngstrom, Julio C Furlan, Sukhvinder Kalsi-Ryan, Armin Curt, Brian K Kwon, Shekar N Kurpad, Michael G Fehlings, James Harrop, Bizhan Aarabi, Vafa Rahimi-Movaghar, James D Guest, Jefferson R Wilson, Benjamin M Davies, Mark R N Kotter, Paul A Koljonen

Department of Neurosurgery Faculty Papers

Study design: Narrative review.

Objective: Degenerative cervical myelopathy is one of the most frequent impairments of the spinal cord encountered internationally in adults. Currently, surgical decompression is the recommended treatment for people with DCM (PwCM) presenting with moderate to severe symptoms or neurological deficits. However, despite surgical intervention, not all patients make a complete recovery due to the irreversible tissue damage within the spinal cord. The objective of this review is to describe the state and gaps in the current literature on rehabilitation for PwCM and possible innovative rehabilitation strategies.

Methods: Literature search.

Results: In other neurological disorders such as …