Welcome to Journal Of Pakistan Medical Association

 Supplement Vol:66, No:10 October, 2016

Editorial >>


It gives us immense pleasure to share this special JPMA supplement with our readers, published as a supplement to the 2nd Annual Surgical Meeting of the Aga Khan University Hospital. The theme of the meeting is \'Surgical Innovations for the Developin....

Breast Surgery >>

Breast reconstruction at The Aga Khan University - A 10 year audit

Samiullah Abdullah, Asif Ahsan, Tahir Shafi Khan,

Considering the high incidence of breast cancer and the subsequent need for a mastectomy, the number of patients having breast reconstruction remains relatively low the world over. Most studies from the west show that anywhere between 5% to around 50% of women ....

Cardiothoracic Surgery >>

Is Grown Up Congenital Heart (GUCH) disease different in a developing country?

Syed Shahabuddin, Shiraz Hashmi, Syed Ezze Rakhshan, Jamal Kabeer Khan, Shahid Ahmed Sami, Muneer Amanullah,

In the current era grown up congenital heart disease (GUCH) patients undergoing surgical interventions are increasing. Most of the interventions in the developed countries are either complex or redo-operations in patients who had previously undergone repair, pa....

Bringing efficiency into practice: A quality improvement initiative to reduce operating room turnaround time

Hasanat Sharif, Noman Shehzad, Joveria Farooqi, Sana Karim, Sana Akbar,

Operating room (OR) turnaround time (TAT) is the minimal essential time required for cleaning of OR and preparation for the next case. The TAT inversely affects OR efficiency. Several factors related to personnel, equipment and scheduling have been identified as causes of increased TAT. We conduc....

Cervical mediastinoscopy in the diagnosis of lymphadenopathy in South Asia

Sulaiman Bashir Hasan, Fazal Wahab Khan, Shiraz Hashmi, Ahsan Ehtesham, Rizwana Ahmed Magsi, Syed Shahabuddin,

We planned to determine the clinical utility and safety of mediastinoscopy in the pathologic diagnosis of mediastinal lymphadenopathy and to determine disease patterns in a tertiary care setting in Karachi. The retrospective review comprised record of patients who underwent mediastinoscopy over 2....

Peri-operative determinants of prolonged CICU stay after coronary artery bypass graft surgery in elderly at a private tertiary care hospital: A case control study

Fazal Wahab Khan, Shiraz Hashmi, Syed Saad Naeem, Benish Fatima, Hashim Hanif, Mubashir Zareen, Syed Shahabuddin,

Objective: To explore peri-operative risk factors associated with prolonged stay in cardiac intensive care unit among patients undergoing isolated coronary artery bypass grafting.
Methods: This retrospective case control study was conducted at the Aga Khan University Hospital....

Innovations in cardiovascular care: Historical perspective, contemporary practice, recent trends and future directions

Hasanat Sharif, Mayera Tufail,

Cardiovascular diseases continue to be a major cause of mortality and morbidity in the world population. First open heart procedure was performed by Gibbon in 1953, since then many advancements have been introduced to the field of cardiac surgery. Minimally invasive techniques were introduced, wh....

Dentistry >>

A review of the failed cases of dental implants at a university hospital in Karachi, Pakistan

Farhan Raza Khan, Rabia Ali, Sana Ehsan Nagi,

The retrospective study was conducted to assess the dental implants that experienced failure. It was conducted at the dental clinic of the Aga Khan University Hospital, Karachi, and comprised record of dental implants from July 2010 to June ....

Association between hypodontia and Angles malocclusion

Batool Ali, Sheeraz Hussain,

This study was planned to determine the prevalence of hypodontia in permanent dentition and to test whether an association was present between hypodontia and Angle's malocclusion. The retrospective study was conducted at a tertiary care hospital, Karachi, and comprised record of all patients vis....

Comparison of fracture and deformation in the rotary endodontic instruments: Protaper versus K-3 system

Sana Ehsen Nagi, Farhan Raza Khan, Munawar Rahman,

This experimental study was done on extracted human teeth to compare the fracture and deformation of the two rotary endodontic files system namely K-3 and Protapers. It was conducted at the dental clinics of the Aga Khan University Hospital,....

A 6-year Evaluation of 223 Tapered Dental Implants and associated prosthesis in 92 patients at a University Hospital

Sana Ehsen Nagi, Farhan Raza Khan, Rabia Ali,

The aim of the retrospective study was to assess the clinical and radiographic outcome of the dental implant surgery and prosthetics. It was conducted at the Aga Khan University Hospital, Karachi, and comprised of medical charts and radiogra....

Prevalence of musculoskeletal disorders among dentists in teaching hospitals in Karachi, Pakistan

Muhammad Hasan Hameed, Robia Ghafoor, Farhan Raza Khan, Sheikh Bilal Badar,

Work-related musculoskeletal pain is common among healthcare professionals, including dentists. This cross-sectional study was conducted to determine the prevalence of work-related musculoskeletal disorders (MSDs) among dentists. This study ....

Age estimation of a sample of Pakistani population using Coronal Pulp Cavity Index in molars and premolars on Orthopantomogram

Sheikh Bilal Badar, Robia Ghafoor, Farhan Raza Khan, Muhammad Hasan Hameed,

The aim of the present study was to assess the validity of tooth-coronal index (TCI) in the age estimation. This retrospective charts review was conducted at the Aga Khan University Hospital, Karachi from January 2016 to March 2016, and comprised 315 teeth of 80 individuals. The teeth were analys....

ENT, Head and Neck Surgery >>

Frequency of Sensorineural hearing loss in chronic suppurative otitis media

Syed Sajjad Ali Zaidi, Hamdan Ahmed Pasha, Anwar Suhail, Talha Ahmed Qureshi,

Chronic suppurative otitis media (CSOM) is defined as chronic otorrhea (i.e., lasting > 6-12 weeks) through a perforated tympanic membrane. It is generally associated with some degree of conductive hearing loss. However, recurrent ear infections due to perfo....

General Surgery and Trauma >>

Effect of intra-abdominal pressure on post-laparoscopic cholecystectomy shoulder tip pain: A randomized control trial

Irum Sabir Ali, Muhammad Fahd Shah, Ahmad Faraz, Mumtaz Khan,

Objective: To compare the effect of intra-abdominal pressure on postoperative shoulder-tip pain in laparoscopic cholecystectomy.

Methods: This was a randomized control study, conducted at Lady Reading Hospital Peshawar from January to August 2013 on160 patients, randomized t....

Bacterobilia in acute cholecystitis: Bile cultures' isolates, antibiotic sensitivities and antibiotic usage. A study on a Pakistani population

Yousaf Bashir Hadi, Muhammad Waqas, Hafiz Muhammad Umer, Ammar Alam, Abdul Rehman Alvi, Muhammad Rizwan Khan, Amir H. Shariff,

Acute cholecystitis is one of the most common acute surgical conditions. Laparoscopic cholecystectomy remains the mainstay of treatment. In patients managed non-operatively, antibiotics play an important role in the treatment of cholecystiti....

Nosocomial infections in the ICU: Pens and spectacles as fomites

Haris Farooq Murad, Khowaja Mohammad Inam Pal,

Nosocomial infections are a major cause of morbidity and mortality. Non-medical objects known as fomites may have a role in their genesis. We investigated the significance of writing pens and spectacles as fomites. The study was conducted at....

Prediction of asialoglycoprotein receptors by correlated liver function parameters before hepatectomy

Wen Jing, Jiang Li, Li Qin Tao, Jia Zhe, Li Bao Liang, Zhang Ke,

Flow cytometric analysis of asialoglycoprotein receptor (ASGPR) levels on the surface of hepatocytes, which were obtained from the liver specimens of patients that received hepatectomy, were used as predictors of liver dysfunction after majo....

The power peripherally inserted central catheter is superior to a central venous catheter in management of patients with esophageal variceal bleeding undergoing devascularization

Wen Jing, He Rong, Jiang Li, Zhang Hai Xia, Zhang Hong Yu, Zhang Ke,

Peripherally-inserted central catheters (PICC) have a greater retention time and less complications compared to central venous catheters (CVC). The study was conducted from From January of 2014 to December 2015 at Beijing DiTan Hospital, Bei....

Better outcome of splenectomy in younger patients suffering from chronic immune thrombocytopenia (ITP)

Sabah Saqib, Rizwan Sultan, Hasnain Zafar,

Immune thrombocytopenia purpura (ITP) may need splenectomy after failure of medical treatment. The aim of this study was to explore the outcome of splenectomy in chronic ITP and to point out factors which can predict better response to splen....

Neurosurgery >>

Paediatric traumatic brain injury: Presentation, prognostic indicators and Outcome analysis from a tertiary care center in a developing country

Badar Ujjan, Muhammad Waqas, Muhammad Babar Khan, Saqib Kamran Bakhshi, Muhammad Ehsan Bari,

Traumatic brain injury (TBI) is the leading cause of morbidity and mortality in children worldwide. This study was conducted to report the presentation, management, outcomes and prognostic indicators in a large series of patients from a tertiary care centre in ....

Awake craniotomy for brain tumours in Pakistan: An initial case series from a developing country

Saad Akhtar Khan, Karim Rizwan Nathani, Badar Uddin Ujjan, Muhammad Danish Barakzai, Syed Ather Enam, Faraz Shafiq,

Awake craniotomy offers safe resection of brain tumours in eloquent area. Aga Khan University Hospital, Karachi, recently started the programme in Pakistan, and the current study was planned to assess our experience of the first 16 procedures. The retrospective study comprised all such procedures....

Paediatric External Ventricular Drains: Experience from a tertiary care hospital of a Developing Country

Abbas Qalab, Rayaan Asad, Mahnaz Hakeem, Maria Ahmed, Haque Anwar, Aneela Darbar,

The aim of the study was to describe indications and complications of external ventricular drain (EVD) placement in children aged between 1 month and 16 years. This retrospective chart review was conducted at the Aga Khan University Hospital, Karachi, and compr....

Neurosurgery training in Pakistan: Follow-up survey and critical analysis of National Training Programmes

Saqib Kamran Bakhshi, Muhammad Waqas, Muhammad Mehboob Alam, Muhammad Shahzad Shamim, Mohsin Qadeer,

This cross-sectional nation-wide survey was planned to assess the current status of neurosurgery residency training in Pakistan and to compare it with the results of a previous study. The duration of study was from July to December 2015. It comprised of neurosu....

Ophthalmology >>

A review of scleral buckle procedures performed at a tertiary care center in Karachi, Pakistan

Farzeen Khalid Hashmi, Umair Razaque Arain, Azam Ali, Khabir Ahmad,

This retrospective study was done to evaluate the visual and anatomic outcomes of scleral buckling for the repair of rhegmatogenous retinal detachment (RRD). All scleral buckle procedures performed at the Aga Khan University Hospital, Karachi, from May 1999 to April 2012 were included. A to....

A systematic review of epidemiological literature on the eye health of marginalized fishing populations

Anthony B. Zwi, Khabir Ahmad, Bal Chand, Khabir Ahmad, Daniel J. M. Tarantola,

A systematic review was conducted in December 2013 to examine the extent to which health research has been focused on the eye health issues of fishing communities. We searched multiple databases to identify relevant citations, using a combination of Medical Subject Headings (MeSH) and text words ....

A 10-year review of indications for penetrating keratoplasty in a tertiary care setting in Karachi Pakistan

Tanveer Ajum Chaudhry, Salman Naveed Sadiq, Zubaida Sirang, Maheen Akhtar Syed, Mustafa Kamal, Khabir Ahmad,

The retrospective study was conducted to determine the indications and outomes of penetrating keratoplasty(PKP) in a tertiary care setting in Pakistan. All eyes that had undergone PKP between January 2005 and December 2014 at the Aga Khan University Hospital, K....

Indications of enucleations and eviscerations performed at a tertiary eye care unit: A case series

Rashid Baig, Maheen Akhtar Syed, Khabir Ahmad, Tanveer Anjum Chaudhry,

The retrospective study was planned to look at the indications of eye enucleations and eviscerations, and comprised all such procedures done at the Aga Khan University Hospital, Karachi, from January 2006 to December 2015. Data was collected regarding age at th....

Orthopaedics >>

Intra-operative implantation errors during Austin Moore Hemiarthroplasty

Zohaib Gulzar Naqvi, Javed Ali Markhand, Syed Kamran Ahmed, Amin Chinoy, Mansoor Ali Khan,

Austin Moore hemiarthroplasty is an established treatment in elderly patients with neck of femur fractures. Being commonly performed, it is also associated with several technical errors of implantation which results in complications and failure requiring revisi....

Two incision mini open carpal tunnel release- a minimally invasive alternative to endoscopic release

Pervaiz Mehmood Hashmi, Rizwan Haroon Rashid, Moiz Ali, Yasir Mohib, Naveed Baloch,

Surgical techniques for carpal tunnel release are constantly evolving to reduce complications. This retrospective study was planned to identify the outcome and complications associated with a new operating technique for release of carpal tunnel using two incisi....

Does obesity affects early infection after total knee arthroplasty. A comparison of obese vs non obese patients

Waseem Ahmed, Riaz Hussain Lakdawala, Yasir Mohib, Aurangzeb Qureshi, Rizwan Haroon Rashid,

Surgical site infection (SSI) is a disastrous complication after total knee arthroplasty (TKA) which can cause prosthesis loosening and may end up in septicaemia. The incidence of infection reported to be in the range of 0.3-12.4% for primary TKA. Significantly....

Improvement in quality of lifesix months after primary total hip arthroplasty in a Pakistani population

Akbar Jaleel Zubairi, Syed Usman Bin Mahmood, Moiz Ali, Shahryar Noordin,

This prospective, cohort study was carried out to assess the improvement in quality of life of patients undergoing elective primary total hip arthroplasty (THA). It was conducted at the orthopaedic department of the Aga Khan University Hospital, Karachi, from J....

Lower red cell transfusion rates with use of tranexamic acid in single-stage bilateral total knee arthroplasty: A retrospective audit

Muhammad Aziz, Salman Bin Mahmood, Riaz Hussain Lakdawala, Tashfeen Ahmad,

Bilateral total knee arthroplasty (BTKA) patients may require blood transfusion which has its risks. Anti-fibrinolytic drugs such as aprotinin, aminocaproic acid and tranexamic acid (TXA) have reduced transfusion requirements in major surgery. This retros....

Rotational Mal-Alignment after Reamed Intramedullary Nailing for tibial shaft fracture

Sher Baz Khan, Yasir Mohib, Rizwan Haroon Rashid, Haroonur Rashid,

Intra-medullary (IM) nailing is standard of care for unstable tibial shaft fractures. Malrotation is very common but it is under-recognised, inpart because of variation in normal anatomy and partly due to difficulty in accurately assessing rotation. This study ....

Diagnostic value of sinus tract culture versus intraoperative bone culture in patients with chronic osteomyelitis

Saifullah Soomro, Muhammad Ather Siddiqi, Intikhab Taufiq,

To compare the organisms isolated from the sinus tract culture and intraoperative bone culture in patients with chronic osteomyelitis. This cross sectional prospective study was conducted from February 2015 to March 2016. Ninety consecutive patients were enroll....

Percutaneous Ilio-sacral Screw Fixation for Unstable Pelvic Ring Injuries

Muhammad Suhail Amin, Muhammad Khurram Habib, Ammar Khalid,

This prospective interventional study was planned to determine the clinical and radiological outcome of percutaneous iliosacral screw fixation for unstable pelvic ring injuries. It was conducted from March 2008 to June 2014 at the Department of Orthopaedic Surg....

Paediatric Surgery >>

Pediatric laparoscopic surgery; initial experience from Pakistan; first 100 cases in single center

Hassan Ishaq, Saqib Hamid Qazi, Sohail Dogar, Muhammad Younus Khan Durrani, Ahmad Vaqas Faruque,

In a developing country like Pakistan, laparoscopic surgeries are not considered favourable by many, possibly because of high costs or a lack of expertise. It is an established fact that laparoscopic surgery offers better surgical treatments with a shorter hosp....

Clinical profile, treatment and survival outcomes of peadiatric germ cell tumours: A Pakistani perspective

Irfan Ul Islam Nasir, Muhammad Ijaz Ashraf, Nouman Ahmed, Muhammad Fahd Shah, Muhammad Taqi Pirzada, Amir Ali Syed, Abid Quddus Qazi,

Germ Cell Tumours (GCTs) are rare tumours. Generally 80% are benign and 20% malignant with a bimodal age distribution. The retrospective study was conducted at Shaukat Khanum Cancer Hospital, Lahore, Pakistan, and comprised all paediatric patients below 18 years of age who received treatment for ....

Plastic Surgery >>

Versatility of the Anterolateral Thigh Flap: An AKUH experience

M. Fazlur Rahman, Muhammad Asif Ahsan, Muhammad Ubaid Khan, Sami Ullah, Sara Khan,

Anterolateral thigh flap is used for reconstruction of various soft tissue defects. We planned the study to evaluate the versatility of the anterolateral thigh flap as it may be used for reconstruction of head and neck, torso and extremities with minimal donor-....

Urology >>

Frequency and predictors of recurrence of bladder tumour on first check cystoscopy - a tertiary care hospital experience

Muhammad Farhan, Syed Muhammad Nazim, Jibran Ahmed, Muhammad Hammad Ather,

Objective: To determine the frequency and predictors of non-muscle invasive bladder tumour recurrence on first-check cystoscopy after transurethral resection of bladder tumour.
Methods: This cross-sectional study was conducted at the Aga Kh....

Intravesical Foreign Body: Tertiary care center experience from Pakistan

Hussam Uddin Soomro, Imran Jalbani, Nuzhat Faruqui,

Foreign body in bladder is relatively uncommon condition with variable presentations. Literature is limited to case reports and small series from region. Therefore, we planned this study to review our experience regarding intravesical foreign body. This retrosp....

Vascular Surgery >>

Functional outcomes after successful lower extremity arterial injuries repair

Zia Ur Rehman, Ziad Sophie, Lekhraj Mal,

The study was conducted to measure functional outcome of patients who had successful lower extremity arterial reconstruction after vascular injury at a tertiary care centre in Karachi over 5 years from January 2008 to December 2013. In this descriptive cohort s....



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