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Raymond SL, Sacks MA, Hashmi A, Robertson JO, Moores D, Tagge EP, Radulescu A, Islam S, Khan FA. Short-term outcomes of thoracoscopic versus open lobectomy for congenital lung malformations. Pediatr Surg Int 2023; 39:155. [PMID: 36944730 PMCID: PMC10030530 DOI: 10.1007/s00383-023-05445-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE Thoracoscopic and open approaches for the management of congenital lung malformations (CLM) has been debated. The aim of this study is to compare 30-day outcomes for non-emergent lobectomies in children. METHODS The National Surgical Quality Improvement Program-Pediatric database was queried for patients undergoing CLM resection from 2013 to 2020. Outcomes were compared by operative technique in an intention-to-treat model and then propensity matched. RESULTS 2157 patients met inclusion criteria and underwent non-emergent pulmonary lobectomy for CLM. The intended operative approach was thoracoscopic in 57.7% of patients. Patients in the open group compared to the thoracoscopic were more likely to be born premature, have chronic lung disease, require preoperative oxygen support, and be ventilator dependent. After propensity matching, there was no statistically significant difference in 30-day mortality, unplanned readmission, and other complications between the thoracoscopic and open groups. Thoracoscopic approach was associated with a shorter length of stay. The proportion of cases approached via thoracoscopy increased over time from 48.8% in 2013 to 69.9% in 2020. CONCLUSIONS This large multicenter retrospective matched analysis demonstrates thoracoscopic lobectomy in children has similar favorable 30-day outcomes and shorter length of stay for the non-emergent management of CLM, compared to open thoracotomy. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Steven L Raymond
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite 21111, Loma Linda, CA, USA
| | - Marla A Sacks
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite 21111, Loma Linda, CA, USA
| | - Asra Hashmi
- Division of Plastic Surgery, Department of Surgery, Kaiser Permanente, San Jose, CA, USA
| | - Jason O Robertson
- Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Donald Moores
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite 21111, Loma Linda, CA, USA
| | - Edward P Tagge
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite 21111, Loma Linda, CA, USA
| | - Andrei Radulescu
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite 21111, Loma Linda, CA, USA
| | - Saleem Islam
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Faraz A Khan
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus St, Suite 21111, Loma Linda, CA, USA.
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Sacks MA, Neal D, Pairawan S, Tagge EP, Hashmi A, Islam S, Khan FA. Optimal Timing of Inguinal Hernia Repair in Premature Infants: A NSQIP-P Study. J Surg Res 2023; 283:690-698. [PMID: 36459862 DOI: 10.1016/j.jss.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 10/19/2022] [Accepted: 11/06/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Among premature infants, the incidence of inguinal hernias is reported to be as high as 30%. Despite being one of the most commonly performed procedures, the optimal setting of inguinal hernia repair (IHR) that is inpatient versus outpatient remains debatable. We sought to compare the 30-day outcomes of each approach by querying the National Surgical Quality Improvement Program-Pediatric database. MATERIALS AND METHODS A retrospective cohort study comparing inpatient versus outpatient IHR using the National Surgical Quality Improvement Program-Pediatric database from 2013 to 2019 was performed. Demographic and clinical data were initially compared using univariate analysis. Continuous variables are presented as median and interquartile range and categorical variables are presented as n (%). Subsequently, cohorts were propensity matched using clinically and statistically significant patient characteristics. RESULTS 928 patients underwent IHR, 634 (68.3%) while inpatient, 294 (31.7%) following hospital discharge. Inpatient IHR was associated with lower age at the time of surgery (120 versus 147 d; P < 0.0001), younger gestational age (27 versus 33 wk; P < 0.0001), decreased probability of repair in elective setting (87.2% versus 97.3%; P < 0.0001), and increased preoperative supplemental oxygen need (42% versus 4.4%; P < 0.0001). Comparison of propensity matched cohorts revealed that inpatient IHR was associated with increased procedure time (82 versus 51 min; P < 0.0001) and anesthetic duration (146 versus 102 min; P < 0.0001), wound infection rates (3.8% versus 0%; P = 0.007), blood transfusions (4.2% versus 0.5%; P = 0.036), unplanned intubations (2.8% versus 0%; P = 0.03), ventilator days (0 versus 0; range [0,30 versus 0,2]; P = 0.002), reoperation rate (5.6% versus 0%; P < 0.001), postoperative hospital length of stay (4 versus 1 d; P < 0.0001), and unplanned readmissions (8.9% versus 0.9%; P = 0.002). CONCLUSIONS Inpatient IHR in premature neonates were associated with different postoperative outcomes than outpatient IHR. At least in the elective setting among premature infants, outpatient IHR can be considered safe in select patients while we await higher quality prospective data.
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Affiliation(s)
- Marla A Sacks
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, California
| | - Dan Neal
- Department of Surgery, University of Florida, Gainesville, Florida
| | - Seyed Pairawan
- Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, California
| | - Edward P Tagge
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, California
| | - Asra Hashmi
- Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Saleem Islam
- Department of Surgery, University of Florida, Gainesville, Florida
| | - Faraz A Khan
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, California.
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Sacks MA, Do Jeong Y, Mendez YS, Hashmi A, Radulescu A, Tagge EP, Robertson JO, Khan FA. Are pediatric surgery fellowship websites ready for the changing paradigms in the virtual interview era? Global Surg Educ 2023; 2:27. [PMID: 38013871 PMCID: PMC9874179 DOI: 10.1007/s44186-023-00104-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 11/26/2022] [Accepted: 01/07/2023] [Indexed: 01/26/2023]
Abstract
Purpose With the COVID-19 pandemic, in-person fellowship interviews were curtailed, leading candidates to seek information from other resources. Our main purposes were (1) to determine what information recent participants in the match needed to evaluate programs and (2) to assess which of these were available online. Methods A focus group of ten recent graduates/applicants identified information that was important in choosing a fellowship program. In August 2020 and December 2021, websites belonging to the American Pediatric Surgical Association (APSA) and individual programs were assessed. Results Recent applicants identified 55 pieces of information considered important to their decision making. Of 57 pediatric surgery fellowships, 98% were listed on APSA's website. Program descriptions on APSA's website listed on average 60% of program information desired by applicants. All listed fellowship director, accreditation status, faculty list, and current fellow(s). Other descriptors frequently noted were alumni (95%), graduate's board performance (83%), ECMO exposure (77%), and curriculum (70%). Information desired but less frequently available were fellow case logs (63%), trauma center designation (53%), burn center designation (40%), research opportunities (30%), candidate interview assistance (25%), and supplemental fellowships (12%). There were 7% of program descriptions that were not updated for at least a year. Conclusions APSA and individual program websites were complimentary. Websites often lacked data that applicants sought to inform their rank list. To best adapt to the evolving virtual interview paradigm, we suggest reporting key information on a central APSA website with more nuanced information available via links to program specific websites. Supplementary Information The online version contains supplementary material available at 10.1007/s44186-023-00104-w.
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Affiliation(s)
- Marla A. Sacks
- Division of Pediatric Surgery, Loma Linda University Children’s Hospital, Loma Linda University Medical Center, 11175 Campus Street, CP21111, Loma Linda, CA 92350 USA
| | - Young Do Jeong
- School of Medicine, Loma Linda University, Loma Linda, CA USA
| | - Yomara S. Mendez
- Division of Pediatric Surgery, Loma Linda University Children’s Hospital, Loma Linda University Medical Center, 11175 Campus Street, CP21111, Loma Linda, CA 92350 USA
| | - Asra Hashmi
- Department of Plastic Surgery, Loma Linda University Health, Loma Linda, CA USA
| | - Andrei Radulescu
- Division of Pediatric Surgery, Loma Linda University Children’s Hospital, Loma Linda University Medical Center, 11175 Campus Street, CP21111, Loma Linda, CA 92350 USA
| | - Edward P. Tagge
- Division of Pediatric Surgery, Loma Linda University Children’s Hospital, Loma Linda University Medical Center, 11175 Campus Street, CP21111, Loma Linda, CA 92350 USA
| | - Jason O. Robertson
- Department of Pediatric Surgery, Cleveland Clinic Children’s Hospital, Cleveland, OH USA
| | - Faraz A. Khan
- Division of Pediatric Surgery, Loma Linda University Children’s Hospital, Loma Linda University Medical Center, 11175 Campus Street, CP21111, Loma Linda, CA 92350 USA
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Khan FA, Nestor K, Hashmi A, Islam S. To Wrap or Not? Utility of Anti-reflux Procedure in Infants Needing Gastrostomy Tubes. Front Pediatr 2022; 10:855156. [PMID: 35321013 PMCID: PMC8936420 DOI: 10.3389/fped.2022.855156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/25/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Gastrostomy tube (GT) insertion is commonly performed in children with failure to thrive. Pediatric patients' frequently have gastroesophageal reflux (GER) and discerning pathological GER can be challenging. Moreover, there is some evidence that GT insertion may lead to worsening GER and to avoid a subsequent anti-reflux procedure (ARP), though controversial some surgeons advocate considering an ARP concomitantly. The purpose of this report is to assess outcomes in infants who underwent a GT vs. GT with ARP. METHODS Retrospective review of all infants who had a GT placed at a single institution from 2009-2014. The patients were then divided into two cohorts based on the index operation i.e., GT vs GT with ARP and outcomes compared. RESULTS 226 operations (104 GT, 122 GT with ARP) were performed. The cohorts were similar in gender, gestational age, race, weight, median age, LOS, and proportion of neurologically impaired patients. Preoperative GER was significantly higher in the GT with ARP cohort (91 vs. 18%). No difference in the rate of immediate complications was noted between the two groups. Postoperative increase in anti-reflux medications was significantly higher in the GT cohort (p = 0.01). Post-op GER needing a secondary procedure (ARP or GJ tube) was noted in 21/104 (20%) patients. Those needing an additional procedure vs. those with GT alone were similar in the proportion of patients with pre-op GER, neurologic impairment, type of feeds, and age. CONCLUSION Identifying patients who would benefit from a concomitant ARP remains challenging. A fifth of GT patients needed a subsequent procedure despite most high-risk patients having already undergone an ARP. Since the overall rate of complications remained similar, initial GT approach can be considered reasonable.
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Affiliation(s)
- Faraz A Khan
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University, Loma Linda, CA, United States
| | - Kelsey Nestor
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States
| | - Asra Hashmi
- Department of Plastic Surgery, Loma Linda University, Loma Linda, CA, United States
| | - Saleem Islam
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States
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Raheja H, Waheed M, Harris C, Patel N, Hashmi A, Kundal S, Patel J, Malik B, Frankel R, Shani J. Racial disparities in the use of mechanical circulatory support devices in cardiogenic shock. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Racial bias has always been a concern for healthcare. Lack of guideline directed utilization of mechanical circulatory support (MCS) devices in cardiogenic shock (CS) may lead to implicit and racial bias.
Purpose
To identify the racial differences in the use of mechanical circulatory support in cardiogenic shock and its association with outcomes.
Methods
National Inpatient Database from 2015–2018 using ICD 10 codes was used. Patients >18 years of age admitted for cariogenic shock were included.
Results
Among 1,021,274 patients hospitalized for cardiogenic shock, overall MCS was utilized in 11.4% (N=116,539). Use of MCS for patients stratified by race was 12.2% white (N=85543), 8% Blacks (N=14688), 11.3% Hispanics (N=11067), 13.8% Asian (N=4417), 12.3% Native American (N=825). IABP was the most commonly used MCS device, followed by Impella, ECMO and LVAD. Overall odds of MCS insertion was significantly higher in white population [1.18 (1.13–1.23) <0.001] and significantly lower in Blacks [0.65 (0.61–0.69) <0.001] and Hispanics [0.89 (0.83–0.97) 0.004]. Among black patients with CS requiring MCS, odds of LVAD insertion were similar compared to other races [1.03 (0.89–1.19) 0.714], while odds of all other types of MCS devices including ECMO [0.83 (0.72–0.95) 0.009], IABP [0.63 (0.59–0.68) <0.001] and Impella [0.61 (0.54–0.70) <0.001] were significantly lower compared to other races. This trend also holds true for patients with CS associated with acute myocardial infarction. Among all patients with CS, the odds of mortality were significantly lower among white patients [0.92 (0.90–0.95) <0.001], on the contrary, odds of mortality were significantly higher in Blacks [1.06 (1.02–1.10) 0.001] and Asians [1.11 (1.02–1.20) 0.012]. Interestingly, when only comparing patients who underwent MCS utilization for CS, odds of mortality were similar in black population compared to other races. [1.03 (0.91–1.17) 0.636].
Conclusion(s)
There still exist significant racial differences in the use of mechanical circulatory devices for cardiogenic shock potentially leading to significantly higher mortality in black population compared to whites. This difference in mortality is mitigated with equal use of MCS devices in cardiogenic shock among all races.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- H Raheja
- Maimonides Medical Center, Brooklyn, United States of America
| | - M Waheed
- Maimonides Medical Center, Brooklyn, United States of America
| | - C Harris
- Maimonides Medical Center, Brooklyn, United States of America
| | - N Patel
- Maimonides Medical Center, Brooklyn, United States of America
| | - A Hashmi
- Maimonides Medical Center, Brooklyn, United States of America
| | - S Kundal
- Maimonides Medical Center, Brooklyn, United States of America
| | - J Patel
- Maimonides Medical Center, Brooklyn, United States of America
| | - B Malik
- Maimonides Medical Center, Brooklyn, United States of America
| | - R Frankel
- Maimonides Medical Center, Brooklyn, United States of America
| | - J Shani
- Maimonides Medical Center, Brooklyn, United States of America
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Pairawan SS, Tagge EP, Sacks MA, Hashmi A, Radulescu A, Khan FA. Thoracoscopic segmentectomy for a large previously undiagnosed CPAM presenting as a spontaneous pneumothorax: A case report. Int J Surg Case Rep 2021; 87:106412. [PMID: 34560589 PMCID: PMC8473762 DOI: 10.1016/j.ijscr.2021.106412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/11/2021] [Accepted: 09/12/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Incidentally found congenital pulmonary airway malformations (CPAM) in older children are extremely rare and have traditionally been managed with minimally invasive versus open lobectomy of the affected lobe. Presentation of case In this report, we present a 11-year-old male who presented with a recurrent spontaneous pneumothorax and was found to have a large symptomatic CPAM confined to a single segment of the right lower lobe. The patient was successfully treated with thoracoscopic segmentectomy without any residual disease seen on follow up imaging. Discussion Minimally invasive thoracoscopic approach has many advantages over open approach including better pain control, reduced hospital length of stay, and decreased intraoperative blood loss. With increasing use of minimally invasive approaches, lung-sparing surgery has demonstrated to be a viable and an attractive option for definitive resection of CPAM, without compromising resection margins and/or future lung function. Conclusion This report demonstrates that minimally invasive lung-sparing surgical treatment of a large CPAM is feasible in older children. Older children with CPAM can present with a spontaneous pneumothorax. CPAM confined to a segment of a single lobe should be managed with segmentectomy. VATS segmentectomy for CPAM in older children can be successful.
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Affiliation(s)
- Seyed S Pairawan
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States of America
| | - Edward P Tagge
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States of America
| | - Marla A Sacks
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States of America
| | - Asra Hashmi
- Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States of America
| | - Andrei Radulescu
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States of America
| | - Faraz A Khan
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States of America.
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Bowen R, Hashmi A, Lewis J, Hassani A, Mohanraj R, Mott J, Pearson R. PO-1398 SRS for brain metastases from renal cell carcinoma; UK tertiary referral centre 5-year experience. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07849-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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8
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McRae JJLH, Hashmi A, Radulescu A, Carter CS, Khan FA. Lipoblastomas and liposarcomas in paediatric patients: A case series. J Int Med Res 2021; 49:300060520981362. [PMID: 33730887 PMCID: PMC8166409 DOI: 10.1177/0300060520981362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Lipoblastomas and liposarcomas are rare causes of soft tissue masses in paediatric patients. In this retrospective clinical case series we identified 11 patients from our paediatric database (10 with a lipoblastoma and one with a liposarcoma) who had attended our hospital between 1998 and 2019. The median age of patients with lipoblastoma was 29 months. All lipoblastoma cases were managed with surgical excision and histological examination. The 18-year old patient with liposarcoma presented with a metastatic and unresectable tumour that was unresponsive to chemotherapy and radiation. Our experience demonstrates the importance of differentiating the type of soft tissue mass in children.
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Affiliation(s)
| | - Asra Hashmi
- School of Medicine, Loma Linda University, Loma Linda, CA, USA.,Department of Plastic Surgery, Loma Linda University, Loma Linda, CA, USA
| | - Andrei Radulescu
- School of Medicine, Loma Linda University, Loma Linda, CA, USA.,Division of Paediatric Surgery, Department of Surgery, Loma Linda University, Loma Linda, CA, USA
| | - Cody S Carter
- School of Medicine, Loma Linda University, Loma Linda, CA, USA.,Division of Paediatric Surgery, Department of Surgery, Loma Linda University, Loma Linda, CA, USA
| | - Faraz A Khan
- School of Medicine, Loma Linda University, Loma Linda, CA, USA.,Division of Paediatric Surgery, Department of Surgery, Loma Linda University, Loma Linda, CA, USA
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Rahnemai-Azar A, Rajeswaran H, Hashmi A, Kondray V, Al-Natour M, Davidson J. Abstract No. 189 Characteristics of patients who died or underwent hospice care after inferior vena cava filter placement. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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10
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Hashmi A, Al-Natour M, Azar N, Sutter C, Davidson J, Tavri S. Abstract No. 589 Assessing the role of interventional radiology during the initial phase of COVID-19: a large health system experience. J Vasc Interv Radiol 2021. [PMCID: PMC8079606 DOI: 10.1016/j.jvir.2021.03.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Rahnemai-Azar A, Rajeswaran H, Hashmi A, Kondray V, Walker L, Al-Natour M, Davidson J. Abstract No. 542 Factors associated with increased fluoroscopy time during inferior vena cava retrieval procedure. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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12
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Pace S, Sacks MA, Minasian T, Hashmi A, Khan FA. Paraspinal plexiform schwannoma of unknown nerve origin: A case report. Int J Surg Case Rep 2021; 79:267-270. [PMID: 33486308 PMCID: PMC7829105 DOI: 10.1016/j.ijscr.2021.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/04/2021] [Accepted: 01/09/2021] [Indexed: 11/05/2022] Open
Abstract
Plexiform schwannomas are exceedingly rare in paediatric populations. This is a unique case located outside the spinal canal without a nerve of origin. Preoperative planning is imperative for complete resection and cosmesis.
Introduction and importance Schwannomas are benign, slow-growing nerve sheath tumors of neoplastic Schwann cells. They are the most common peripheral nerve tumors in adults and are typically discovered incidentally due to their asymptomatic presentation. Despite the fact that most schwannomas are unassociated with a syndrome, their etiology is thought to be related to alterations or loss of the neurofibromatosis type two tumor suppressor gene. Case presentation We present the case of a fifteen-year-old female who presented with a recurrent lower back/upper buttocks 9 cm mass with imaging suspicious for schwannoma. Needle biopsy revealed an S100 positive cellular schwannoma with patchy Ki-67. During surgical dissection down to the sacrum, no nerve of origin was identified. Clinical discussion Schwannomas have no pathognomonic findings on MRI and may occur at any location that Schwann cells are present; therefore, confirming a diagnosis relies on histopathology. Plexiform schwannomas are defined by a “network-like” intraneural growth pattern and are exceedingly rare in paediatric populations. A location distinct from the spinal canal is also very rare as schwannomas typically originate from the head and neck region. Conclusion Paediatric plexiform schwannomas have been rarely reported. Surgical planning relies on multiple factors such as tumor size, tumor location, pathologic features and symptomatic burden. The distinctive features of this case including an unknown nerve origin and a location outside the spinal canal provide a unique opportunity to discuss the diagnosis and management of paraspinal schwannomas and the impact on operative planning when a nerve of origin is not identified.
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Affiliation(s)
- Spencer Pace
- School of Medicine, Touro University California, Vallejo, CA, United States
| | - Marla A Sacks
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States
| | - Tanya Minasian
- Department of Neurosurgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States
| | - Asra Hashmi
- Department of Plastic and Reconstructive Surgery, Loma Linda University Hospital, Loma Linda, CA, United States
| | - Faraz A Khan
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States.
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13
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West N, Pearson R, Hashmi A, Jiang X, Ogilvie A, Simmons T. PO-1250: Palliation of vertebral metastases and cord compressions: single field or VMAT? Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01268-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Meldon S, Saxena S, Muir M, Briskin I, Masciarelli McFarland A, Delgado F, Hashmi A. 362 The Effect of Geriatric Consultation on Admission Rates of Older Patients in the Emergency Department. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rahnemai-Azar A, Azeze S, Rajeswaran H, Hashmi A, Walker L, Davidson J, Al-Natour M. Abstract No. 671 The effect of inferior vena cava size on filter complications: one size does not fit all. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Abstract
Congenital abdominal wall defects are one of the most common human birth defects with an incidence of about 1 in 2000 live births. While often discussed together abdominal wall defects consist mainly of two distinct entities namely gastroschisis and omphalocele. There is no clear consensus explaining the precise embryological mechanisms leading to the development of an omphalocele. Many clinicians and embryologists have attempted to explain congenital malformation as a result of failure of progression of normal embryonic development. This review summarizes the mechanisms involved in normal and abnormal development of the ventral abdominal wall.
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Affiliation(s)
- Faraz A Khan
- Division of Pediatric Surgery, Loma Linda University College of Medicine, Loma Linda, CA USA
| | - Asra Hashmi
- Division of Plastic Surgery, Loma Linda University College of Medicine, Loma Linda, CA USA
| | - Saleem Islam
- Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Rd. P.O. Box 10019, Gainesville, FL USA.
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Stevens A, Gilder ME, Moo P, Hashmi A, Toe SET, Doh BB, Nosten S, Chotivanich K, Somerset S, McGready R. Folate supplementation to prevent birth abnormalities: evaluating a community-based participatory action plan for refugees and migrant workers on the Thailand-Myanmar border. Public Health 2018; 161:83-89. [PMID: 29935473 PMCID: PMC6086336 DOI: 10.1016/j.puhe.2018.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 04/13/2018] [Accepted: 04/16/2018] [Indexed: 11/22/2022]
Abstract
Objectives Preconception folic acid (PFA) taken at least 3 months before conception can decrease the incidence of neural tube defects (NTDs) by approximately 46%. NTDs contribute significantly to neonatal morbidity and mortality in migrant and refugee populations on the Thailand-Myanmar border (incidence 1.57/1000 live births). This audit aimed to assess uptake of PFA among migrant and refugee women, evaluate knowledge about PFA among local healthcare workers and implement a participatory community intervention to increase PFA uptake and decrease NTD incidence in this population. Study design A mixed-methods baseline evaluation was followed by an intervention involving health worker education and a community outreach program. A follow-up audit was performed 18 months post-intervention. Methods Data were gathered via surveys, short interviews and focus group discussions. The intervention program included community-based workshops, production and distribution of printed flyers and posters, and outreach to various local organisations. Results Uptake of PFA was <2% both before and after the intervention. Despite a substantial increase in local healthcare worker knowledge of PFA, no significant improvement in PFA uptake after the intervention was detected. Most pregnancies in this local community sample were reported to be unplanned. Conclusions High rates of NTDs with low PFA uptake remains a major public health challenge in this transient population. Results indicate that improved health worker knowledge alone is not sufficient to enhance PFA uptake in this population. Integration of PFA education within expanded family planning programs and broad-based food fortification may be more effective. Audited preconception folic acid (PFA) campaign on Thai-Myanmar border. Low awareness of PFA among health workers and migrant/refugee pregnant women. Improved local health worker PFA knowledge after campaign and follow-up held after 18 months. Overall, campaign proved ineffective in increasing PFA uptake among pregnant women.
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Affiliation(s)
- A Stevens
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia.
| | - M E Gilder
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
| | - P Moo
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
| | - A Hashmi
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
| | - S E T Toe
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
| | - B B Doh
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
| | - S Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
| | - K Chotivanich
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Shawn Somerset
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia.
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.
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Hashmi A, Burkat AJ, Khan FA, McGee C, Al-Mufarrej F. Use of intraoperative index finger pulse oximetery during radial forearm flap harvest to prevent finger ischemia for reconstruction of hand burn and crush injuries. Burns 2017; 43:1604-1605. [DOI: 10.1016/j.burns.2017.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 11/16/2022]
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Hashmi A, Khan FA, Herman F, Narasimhan N, Khan S, Kubiak C, Gursel E, Edelman DA. A survey of current state of training of plastic surgery residents. BMC Res Notes 2017; 10:234. [PMID: 28655336 PMCID: PMC5488360 DOI: 10.1186/s13104-017-2561-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 06/19/2017] [Indexed: 11/24/2022] Open
Abstract
Background Plastic surgery training is undergoing major changes however there is paucity of data detailing the current state of training as perceived by plastic surgical trainees. Our aim was to determine the quality of training as perceived by the current trainee pool and their future plans. Methods A 25-item anonymous survey with three discrete sections (demographics, quality of training, and post-graduate career plans) was developed and distributed to plastic surgery residents during the academic year 2013. With the confidence interval of 95% and margin of error of 10%, our target response rate was 87 responders. Results We received a total of 114 respondents with all levels of Post Graduate Year in training represented. Upon comparison of residents with debt of <100,000 to residents with a debt of >250,000, those with higher debt were significantly less interested in fellowship training (p value 0.05) and were more likely to pursue private practice (p value <0.01). Disciplines within plastic surgery least offered as a separate rotation were microsurgery (45%) followed by aesthetic surgery (33%). 53.7% of the residents felt that they were least trained in aesthetic surgery followed by burn surgery 45.4%. Of note 56.4% intended to seek additional training after residency. Moreover residents with an average of 6.4 months of experience in an individual subspecialty were more likely to feel comfortable with that specialty. Conclusions This survey highlights the areas and subspecialties that deserve attention as perceived by the current trainee pool. Electronic supplementary material The online version of this article (doi:10.1186/s13104-017-2561-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Asra Hashmi
- Department of Plastic Surgery, Wayne State University/Detroit Medical Center, Detroit, USA
| | - Faraz A Khan
- Department of General Surgery, Wayne State University/Detroit Medical Center, Detroit, USA. .,, 4160 John R Street, Detroit, 48201, MI, USA.
| | - Floyd Herman
- Department of Plastic Surgery, Wayne State University/Detroit Medical Center, Detroit, USA
| | - Nathan Narasimhan
- Department of Plastic Surgery, Wayne State University/Detroit Medical Center, Detroit, USA
| | - Shaher Khan
- Department of Plastic Surgery, Wayne State University/Detroit Medical Center, Detroit, USA
| | - Carrie Kubiak
- Department of Plastic Surgery, Wayne State University/Detroit Medical Center, Detroit, USA
| | - Eti Gursel
- Department of Plastic Surgery, Wayne State University/Detroit Medical Center, Detroit, USA
| | - David A Edelman
- Department of Surgery, Wayne State University/Detroit Medical Center, Detroit, USA
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Hashmi A, Schumaier A, Khan FA, Gursel T, Nava G. Pseudoaneurysm of superficial and deep arch of the hand after penetrating wound. Eur J Plast Surg 2017. [DOI: 10.1007/s00238-016-1235-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hashmi A, Policherla R, Campbell H, Khan FA, Schumaier A, Al-Mufarrej F. How Informative are the Plastic Surgery Residency Websites to Prospective Applicants? J Surg Educ 2017; 74:74-78. [PMID: 27717704 DOI: 10.1016/j.jsurg.2016.08.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/19/2016] [Accepted: 08/04/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To evaluate the comprehensiveness of plastic surgery program websites. DESIGN American Medical Association interactive database was accessed for the list of integrated plastic surgery programs, in June 2015. Since then, 67 plastic surgery program websites were accessed and searched for the presence or absence of 31 criteria, which were further grouped into 5 categories: First, program contact information; second, training and research; third, program setup; fourth, benefits and facilities; and fifth, information for applicants. Programs were categorized based on US census bureau designated regions, and number of residency positions available. One-way ANOVA test was used for comparison. RESULTS Only 25% (17) program website had information available on more than two-thirds (21 or more of 31) of the criteria. The 3 least factors commonly available by program websites were: operative log (10%), contract (10%), and information on night float (25%). The 3 most commonly available factors included: coordinator information (92%), number of residents (92%), and comprehensive faculty list (88%). Less than 50% of the programs provided information regarding fellowship opportunities, active and previous research projects, and operative logs. There was no difference in amount of information on program websites when analyzed for program size or program geographic location. CONCLUSION Programs should consider revising their websites to include aforementioned 31 criteria. This would make applicants and potential resident physicians better informed of the programs before the interview process such that they would be more likely to apply to only those programs that match their specific aspirations.
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Affiliation(s)
- Asra Hashmi
- Division of Plastic and Reconstructive Surgery, Department of General Surgery, Detroit Medical Center, Wayne State University, Detroit, Michigan.
| | - Rohan Policherla
- Division of Plastic and Reconstructive Surgery, Department of General Surgery, Detroit Medical Center, Wayne State University, Detroit, Michigan
| | - Hector Campbell
- Division of Plastic and Reconstructive Surgery, Department of General Surgery, Detroit Medical Center, Wayne State University, Detroit, Michigan
| | - Faraz A Khan
- Division of Plastic and Reconstructive Surgery, Department of General Surgery, Detroit Medical Center, Wayne State University, Detroit, Michigan
| | - Adam Schumaier
- Division of Plastic and Reconstructive Surgery, Department of General Surgery, Detroit Medical Center, Wayne State University, Detroit, Michigan
| | - Faisal Al-Mufarrej
- Division of Plastic and Reconstructive Surgery, Department of General Surgery, Detroit Medical Center, Wayne State University, Detroit, Michigan
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Hashmi A, Baciewicz FA, Soubani AO, Gadgeel SM. Preoperative pulmonary rehabilitation for marginal-function lung cancer patients. Asian Cardiovasc Thorac Ann 2016; 25:47-51. [PMID: 27913735 DOI: 10.1177/0218492316683757] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background This study aimed to evaluate the impact of preoperative pulmonary rehabilitation in lung cancer patients undergoing pulmonary resection surgery with marginal lung function. Methods Short-term outcomes of 42 patients with forced expiratory volume in 1 s < 1.6 L who underwent lung resection between 01/2006 and 12/2010 were reviewed retrospectively. They were divided into group A (no preoperative pulmonary rehabilitation) and group B (receiving pulmonary rehabilitation). In group B, a second set of pulmonary function tests was obtained. Results There were no significant differences in terms of sex, age, race, pathologic stage, operative procedure, or smoking years. Mean forced expiratory volume in 1 s and diffusing capacity for carbon monoxide in group A was 1.40 ± 0.22 L and 10.28 ± 2.64 g∙dL-1 vs. 1.39 ± 0.13 L and 10.75 ± 2.08 g∙dL-1 in group B. Group B showed significant improvement in forced expiratory volume in 1 s from 1.39 ± 0.13 to 1.55 ± 0.06 L ( p = 0.02). Mean intensive care unit stay was 6 ± 5 days in group A vs. 9 ± 9 days in group B ( p = 0.22). Mean hospital stay was 10 ± 4 days in group A vs. 14 ± 9 days in group B ( p = 0.31). There was no significant difference in morbidity or mortality between groups. Conclusion Preoperative pulmonary rehabilitation can significantly improve forced expiratory volume in 1 s in some marginal patients undergoing lung cancer resection. However, it does not improve length of stay, morbidity, or mortality.
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Affiliation(s)
- Asra Hashmi
- 1 Department of General Surgery, Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Frank A Baciewicz
- 2 Division of Cardiothoracic Surgery, Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Ayman O Soubani
- 3 Department of Internal Medicine (Critical Care and Pulmonary Medicine), Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Shirish M Gadgeel
- 4 Department of Internal Medicine (Hematology/Oncology), Karmanos Cancer Institute, Detroit, MI, USA
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Hashmi A, Abdullah FE, Abdullah NE, Kazmi SU. Species Identification and Antibiotic Susceptibilities of Coagulase- Negative Staphylococci Isolated from Urinary Tract Infection Specimens. J Coll Physicians Surg Pak 2016; 26:581-584. [PMID: 27504549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 04/15/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine the incidence of Coagulase- negative S. aureusin urinary tract infections and sensitivities of these isolates to antimicrobial agents. STUDY DESIGN Cohort study. PLACE AND DURATION OF STUDY Dr. Essa Laboratory and Immunology and Infectious Disease Research Laboratory (IIDRL), Microbiology Department, University of Karachi, from January 2009 to January 2010. METHODOLOGY Urine specimens, suggestive of urinary tract infection (UTI), were identified. Speciation of isolates was done using API-20 Staph.system. Screening of extracellular products was done using SDS-PAGE electrophoresis and Hemolysin on blood-agar plates. Minimum inhibitory concentration (MICs) of antibiotics was estimated by microtiter well plate method. Frequency and percentages were determined and chi-square test was used for comparing proportions with significance at p < 0.05. RESULTS Coagulase - negative S. aureus(CONS) were the cause of urinary tract infection in 56 out of 1866 outpatient (3%) and 164 of 1261 inpatient (13%), urinary tract infections (p < 0.001). Two hundred and twenty CONS isolates were identified. The most common CONS identified was S. saprophyticus (31%, 68 strains). The relative frequency of Coagulase - negative S. aureuswas 6% (13 strains). All isolates were sensitive to Vancomycin and Linezolid. Resistance was 69% to Ampicillin, 53% to Methicillin, and 37.5% to Ciprofloxacin. CONCLUSION CONS are a potential uropathogens, with capability of slime production and resistance to common empirical prescriptions. This also warrants formulation of an appropriate antibiotic policy that covers CONS.
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Affiliation(s)
- Asra Hashmi
- Department of Pathology, Dow University of Health Sciences, Karachi
| | | | - Nihal Essa Abdullah
- Department of Internal Medicine, University of Texas Medical Branch at Galveston
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Khan FA, Hashmi A, Edelman DA. Small bowel obstruction caused by self-anchoring suture used for peritoneal closure following robotic inguinal hernia repair. J Surg Case Rep 2016; 2016:rjw117. [PMID: 27340230 PMCID: PMC4918405 DOI: 10.1093/jscr/rjw117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Laparoscopic inguinal herniorraphy is a commonly performed procedure given the reported decrease in pain and earlier return to activity when compared with the open approach. Moreover, robotic assistance offers the operating surgeon considerable ergonomic advantages, making it an attractive alternative to conventional laparoscopic herniorraphy. Robotic herniorraphy utilizes the transabdominal preperitoneal approach where following repair peritoneal closure is necessary to avoid mesh exposure to the viscera. Self-anchoring sutures are frequently used to this end given the ease of use and knotless application. We present an unusual case of post-operative small bowel obstruction following robotic inguinal hernia repair caused by the self-anchoring suture used for peritoneal closure. This patient presented 3 days post-procedure with symptoms and cross-sectional imaging indicative of small bowel obstruction with a clear transition point. Underwent laparoscopic lysis of a single adhesive band originating from the loose intraperitoneal end of the suture leading to resolution of symptoms.
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Affiliation(s)
- Faraz A Khan
- Department of Surgery, Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Asra Hashmi
- Department of Surgery, Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - David A Edelman
- Department of Surgery, Wayne State University/Detroit Medical Center, Detroit, MI, USA
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Qureshi H, Shehzad A, Mohsin R, Sultan G, Laghari R, Mubarak M, Hashmi A, Naqvi S, Rizvi S. Impact of radical nephrectomy on renal functional outcome in patients with no other co-morbidity as determined by 24-h urinary creatinine clearance. African Journal of Urology 2015. [DOI: 10.1016/j.afju.2015.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Hashmi A, Baciewicz FA. Modification of Cabrol Patch for Control of Aortic Root Bleeding. J Coll Physicians Surg Pak 2015; 25:835-6. [PMID: 26577972 DOI: 11.2015/jcpsp.835836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 08/08/2015] [Indexed: 11/06/2022]
Abstract
Rate of bleeding following aortic root replacement is reported in upto 24% of cases. Bleeding significant enough to require re-operation is reported in upto 4% of cases. We performed a modification of Cabrol patch to control bleeding from complicated aortic root replacement procedure. We used a perigraft - right-atrial fistula technique to control bleeding from aortic root area using a bovine pericardial patch. Patient had an uneventful hospital course and was discharged on postoperative day 14.
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Affiliation(s)
- Asra Hashmi
- Department of Plastic Surgery, Wayne State University, Detroit, MI, USA
| | - Frank A Baciewicz
- Department of Cardiothoracic Surgery, Wayne State University, Detroit, MI, USA
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Friese RS, Wynne J, Joseph B, Hashmi A, Diven C, Pandit V, O'Keeffe T, Zangbar B, Kulvatunyou N, Rhee P. Age and mortality after injury: is the association linear? Eur J Trauma Emerg Surg 2014; 40:567-72. [PMID: 26814513 DOI: 10.1007/s00068-014-0380-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 01/20/2014] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Multiple studies have demonstrated a linear association between advancing age and mortality after injury. An inflection point, or an age at which outcomes begin to differ, has not been previously described. We hypothesized that the relationship between age and mortality after injury is non-linear and an inflection point exists. METHODS We performed a retrospective cohort analysis at our urban level I center from 2007 through 2009. All patients aged 65 years and older with the admission diagnosis of injury were included. Non-parametric logistic regression was used to identify the functional form between mortality and age. Multivariate logistic regression was utilized to explore the association between age and mortality. Age 65 years was used as the reference. Significance was defined as p < 0.05. RESULTS A total of 1,107 patients were included in the analysis. One-third required intensive care unit (ICU) admission and 48 % had traumatic brain injury. 229 patients (20.6 %) were 84 years of age or older. The overall mortality was 7.2 %. Our model indicates that mortality is a quadratic function of age. After controlling for confounders, age is associated with mortality with a regression coefficient of 1.08 for the linear term (p = 0.02) and a regression coefficient of -0.006 for the quadratic term (p = 0.03). The model identified 84.4 years of age as the inflection point at which mortality rates begin to decline. CONCLUSIONS The risk of death after injury varies linearly with age until 84 years. After 84 years of age, the mortality rates decline. These findings may reflect the varying severity of comorbidities and differences in baseline functional status in elderly trauma patients. Specifically, a proportion of our injured patient population less than 84 years old may be more frail, contributing to increased mortality after trauma, whereas a larger proportion of our injured patients over 84 years old, by virtue of reaching this advanced age, may, in fact, be less frail, contributing to less risk of death.
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Affiliation(s)
- R S Friese
- Division of Trauma, Critical Care, Burn and Emergency Surgery, Department of Surgery, University of Arizona College of Medicine, 1501 N. Campbell Ave., Room 5411, P.O. Box 245063, Tucson, AZ, 85727, USA
| | - J Wynne
- Division of Trauma, Critical Care, Burn and Emergency Surgery, Department of Surgery, University of Arizona College of Medicine, 1501 N. Campbell Ave., Room 5411, P.O. Box 245063, Tucson, AZ, 85727, USA
| | - B Joseph
- Division of Trauma, Critical Care, Burn and Emergency Surgery, Department of Surgery, University of Arizona College of Medicine, 1501 N. Campbell Ave., Room 5411, P.O. Box 245063, Tucson, AZ, 85727, USA.
| | - A Hashmi
- Division of Trauma, Critical Care, Burn and Emergency Surgery, Department of Surgery, University of Arizona College of Medicine, 1501 N. Campbell Ave., Room 5411, P.O. Box 245063, Tucson, AZ, 85727, USA
| | - C Diven
- Division of Trauma, Critical Care, Burn and Emergency Surgery, Department of Surgery, University of Arizona College of Medicine, 1501 N. Campbell Ave., Room 5411, P.O. Box 245063, Tucson, AZ, 85727, USA
| | - V Pandit
- Division of Trauma, Critical Care, Burn and Emergency Surgery, Department of Surgery, University of Arizona College of Medicine, 1501 N. Campbell Ave., Room 5411, P.O. Box 245063, Tucson, AZ, 85727, USA
| | - T O'Keeffe
- Division of Trauma, Critical Care, Burn and Emergency Surgery, Department of Surgery, University of Arizona College of Medicine, 1501 N. Campbell Ave., Room 5411, P.O. Box 245063, Tucson, AZ, 85727, USA
| | - B Zangbar
- Division of Trauma, Critical Care, Burn and Emergency Surgery, Department of Surgery, University of Arizona College of Medicine, 1501 N. Campbell Ave., Room 5411, P.O. Box 245063, Tucson, AZ, 85727, USA
| | - N Kulvatunyou
- Division of Trauma, Critical Care, Burn and Emergency Surgery, Department of Surgery, University of Arizona College of Medicine, 1501 N. Campbell Ave., Room 5411, P.O. Box 245063, Tucson, AZ, 85727, USA
| | - P Rhee
- Division of Trauma, Critical Care, Burn and Emergency Surgery, Department of Surgery, University of Arizona College of Medicine, 1501 N. Campbell Ave., Room 5411, P.O. Box 245063, Tucson, AZ, 85727, USA
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Hashmi A, Rhee P, Pandit V, Kulvatunyou N, Tang A, O'Keeffe T, Zangbar B, Wynne J, Gries L, Vercruysse G, Friese R, Joseph B. Shock Index Predicts Mortality in Geriatric Trauma Patients: An Analysis of The National Trauma Data Bank. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sabegh BZ, Joseph B, Hashmi A, Kulvatunyou N, Aziz H, Wynne J, Tang A, O'keeffe T, Vercruysse G, Green D, Friese R, Rhee P. Mortality After Trauma Laparotomy in Geriatric Patients. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hashmi A, Friese R, Joseph B, Zangbar B, Wynne J, Gries L, Pandit V, O'Keeffe T, Tang A, Kulvatunyou N, Vercruysse G, Rhee P. The Effect of Age on Mortality In Patients With Traumatic Brain Injury. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rizvi SAH, Sultan S, Zafar MN, Naqvi SAA, Lanewala AA, Hashmi S, Aziz T, Hassan AS, Ali B, Mohsin R, Mubarak M, Farasat S, Akhtar SF, Hashmi A, Hussain M, Hussain Z. Pediatric kidney transplantation in the developing world: challenges and solutions. Am J Transplant 2013; 13:2441-9. [PMID: 23865679 DOI: 10.1111/ajt.12356] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 05/07/2013] [Accepted: 05/21/2013] [Indexed: 01/25/2023]
Abstract
The prevalence of pediatric RRT and transplantation are low in developing countries, 6-12 and <1 to 5 per million child population (pmcp), respectively. This is due to low GDP/capita of <$10 000, government expenditure on health of <2.6-9% of GDP and paucity of facilities. The reported incidence of pediatric CKD and ESRD is <1.0-8 and 3.4-35 pmcp, respectively. RRT and transplantation are offered mostly in private centers in cities where HD costs $20-100/session and transplants $10 000-20 000. High costs and long distance to centers results in treatment refusal in up to 35% of the cases. In this backdrop 75-85% of children with ESRD are disfranchised from RRT and transplantation. Our center initiated an integrated dialysis-transplant program funded by a community-government partnership where RRT and transplantation was provided "free of cost" with life long follow-up and medication. Access to free RRT at doorsteps and transplantation lead to societal acceptance of transplantation as the therapy of choice for ESRD. This enabled us to perform 475 pediatric transplants in 25 years with 1- and 5-year graft survival of 96% and 81%, respectively. Our model shows that pediatric transplantation is possible in developing countries when freely available and accessible to all who need it in the public sector.
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Affiliation(s)
- S A H Rizvi
- Department of Urology, Sindh Institute of Urology and Transplantation, Dewan Farooq Medical Complex, Karachi, Pakistan
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Hashmi A, Baciewicz FA, Soubani AO, Gadgeel S. Does preoperative pulmonary rehabilitation effect outcomes in patients with low forced expiratory volume in 1 second undergoing lung cancer resection. J Am Coll Surg 2013. [DOI: 10.1016/j.jamcollsurg.2013.07.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rafi M, Ali S, Hashmi A. AOSP38 TREATMENT OF LOCALISED PROSTATE CANCER STAGE T2B–T4A WITH EXTERNAL BEAM RADIOTHERAPY PLUS HIGH DOSE RATE BRACHYTHERAPY: SINGLE INSTITUTIONAL EXPERIENCE IN SINDH INSTITUTE OF UROLOGY AND TRANSPLANTATION, SIUT, KARACHI. Eur J Cancer 2013. [DOI: 10.1016/s0959-8049(13)70049-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Yu T, Chahrour M, Coulter M, Jiralerspong S, Okamura-Ikeda K, Ataman B, Schmitz-Abe K, Harmin D, Adli M, Malik A, D’Gama A, Lim E, Sanders S, Mochida G, Partlow J, Sunu C, Felie J, Rodriguez J, Nasir R, Ware J, Joseph R, Hill R, Kwan B, Al-Saffar M, Mukaddes N, Hashmi A, Balkhy S, Gascon G, Hisama F, LeClair E, Poduri A, Oner O, Al-Saad S, Al-Awadi S, Bastaki L, Ben-Omran T, Teebi A, Al-Gazali L, Eapen V, Stevens C, Rappaport L, Gabriel S, Markianos K, State M, Greenberg M, Taniguchi H, Braverman N, Morrow E, Walsh C. Using whole-exome sequencing to identify inherited causes of autism. Neuron 2013; 77:259-73. [PMID: 23352163 PMCID: PMC3694430 DOI: 10.1016/j.neuron.2012.11.002] [Citation(s) in RCA: 318] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2012] [Indexed: 01/01/2023]
Abstract
Despite significant heritability of autism spectrum disorders (ASDs), their extreme genetic heterogeneity has proven challenging for gene discovery. Studies of primarily simplex families have implicated de novo copy number changes and point mutations, but are not optimally designed to identify inherited risk alleles. We apply whole-exome sequencing (WES) to ASD families enriched for inherited causes due to consanguinity and find familial ASD associated with biallelic mutations in disease genes (AMT, PEX7, SYNE1, VPS13B, PAH, and POMGNT1). At least some of these genes show biallelic mutations in nonconsanguineous families as well. These mutations are often only partially disabling or present atypically, with patients lacking diagnostic features of the Mendelian disorders with which these genes are classically associated. Our study shows the utility of WES for identifying specific genetic conditions not clinically suspected and the importance of partial loss of gene function in ASDs.
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Affiliation(s)
- T.W. Yu
- Division of Genetics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- The Autism Consortium, Boston, Massachusetts, USA, 02115
- Harvard Medical School, Boston, Massachusetts, USA, 02115
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA, 02114
| | - M.H. Chahrour
- Division of Genetics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- The Autism Consortium, Boston, Massachusetts, USA, 02115
- Harvard Medical School, Boston, Massachusetts, USA, 02115
| | - M.E. Coulter
- Division of Genetics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Harvard Medical School, Boston, Massachusetts, USA, 02115
| | - S. Jiralerspong
- Department of Human Genetics and Pediatrics, McGill University, Montreal Children’s Hospital Research Institute, Montreal, Quebec, Canada, H3H1P3
| | - K. Okamura-Ikeda
- Institute for Enzyme Research, The University of Tokushima, Tokushima, Japan
| | - B. Ataman
- Department of Neurobiology, Harvard Medical School, Boston, Massachusetts, USA, 02115
| | - K. Schmitz-Abe
- Division of Genetics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Harvard Medical School, Boston, Massachusetts, USA, 02115
| | - D.A. Harmin
- Department of Neurobiology, Harvard Medical School, Boston, Massachusetts, USA, 02115
| | - M. Adli
- Department of Biochemistry and Molecular Genetics, School of Medicine, University of Virginia, Charlottesville, Virginia, USA, 22908
| | - A.N. Malik
- Department of Neurobiology, Harvard Medical School, Boston, Massachusetts, USA, 02115
| | - A.M. D’Gama
- Harvard Medical School, Boston, Massachusetts, USA, 02115
| | - E.T. Lim
- Analytic and Translational Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts, USA, 02114
| | - S.J. Sanders
- Department of Genetics, Center for Human Genetics and Genomics and Program on Neurogenetics, Yale University School of Medicine, New Haven, Connecticut, USA, 06510
| | - G.H. Mochida
- Division of Genetics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Harvard Medical School, Boston, Massachusetts, USA, 02115
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA, 02114
| | - J.N. Partlow
- Division of Genetics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
| | - C.M. Sunu
- Division of Genetics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
| | - J.M. Felie
- Division of Genetics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
| | - J. Rodriguez
- Division of Genetics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
| | - R.H. Nasir
- Harvard Medical School, Boston, Massachusetts, USA, 02115
- Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
| | - J. Ware
- Harvard Medical School, Boston, Massachusetts, USA, 02115
- Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
| | - R.M. Joseph
- The Autism Consortium, Boston, Massachusetts, USA, 02115
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts, USA, 02118
| | - R.S. Hill
- Division of Genetics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Harvard Medical School, Boston, Massachusetts, USA, 02115
| | - B.Y. Kwan
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada, N6A 5C1
| | - M. Al-Saffar
- Division of Genetics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Department of Paediatrics, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - N.M. Mukaddes
- Istanbul Faculty of Medicine, Department of Child Psychiatry, Istanbul University, Istanbul, Turkey
| | - A. Hashmi
- Armed Forces Hospital, King Abdulaziz Naval Base, Jubail, Kingdom of Saudi Arabia
| | - S. Balkhy
- Department of Neurosciences and Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia
| | - G.G. Gascon
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA, 02114
- Istanbul Faculty of Medicine, Department of Child Psychiatry, Istanbul University, Istanbul, Turkey
- Clinical Neurosciences and Pediatrics, Brown University School of Medicine, Providence, Rhode Island, 02912
| | - F.M. Hisama
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, Washington, USA, 98195
| | - E. LeClair
- Harvard Medical School, Boston, Massachusetts, USA, 02115
- Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
| | - A. Poduri
- Harvard Medical School, Boston, Massachusetts, USA, 02115
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts, USA,02115
| | - O. Oner
- Department of Child and Adolescent Psychiatry, Dr Sami Ulus Childrens’ Hospital, Telsizler, Ankara, Turkey
| | - S. Al-Saad
- Kuwait Center for Autism, Kuwait City, Kuwait
| | | | - L. Bastaki
- Kuwait Medical Genetics Center, Kuwait City, Kuwait
| | - T. Ben-Omran
- Section of Clinical and Metabolic Genetics, Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
- Departments of Pediatrics and Genetic Medicine, Weil-Cornell Medical College, New York and Doha, Qatar
| | - A. Teebi
- Section of Clinical and Metabolic Genetics, Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
- Departments of Pediatrics and Genetic Medicine, Weil-Cornell Medical College, New York and Doha, Qatar
| | - L. Al-Gazali
- Department of Paediatrics, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - V. Eapen
- Academic Unit of Child Psychiatry South West Sydney (AUCS), University of New South Wales, Sydney, New South Wales, Australia
| | - C.R. Stevens
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA, 02142
| | - L. Rappaport
- The Autism Consortium, Boston, Massachusetts, USA, 02115
- Harvard Medical School, Boston, Massachusetts, USA, 02115
- Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
| | - S.B. Gabriel
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA, 02142
| | - K. Markianos
- Division of Genetics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Harvard Medical School, Boston, Massachusetts, USA, 02115
| | - M.W. State
- Department of Genetics, Center for Human Genetics and Genomics and Program on Neurogenetics, Yale University School of Medicine, New Haven, Connecticut, USA, 06510
| | - M.E. Greenberg
- Department of Neurobiology, Harvard Medical School, Boston, Massachusetts, USA, 02115
| | - H. Taniguchi
- Institute for Enzyme Research, The University of Tokushima, Tokushima, Japan
| | - N.E. Braverman
- Department of Human Genetics and Pediatrics, McGill University, Montreal Children’s Hospital Research Institute, Montreal, Quebec, Canada, H3H1P3
| | - E.M. Morrow
- The Autism Consortium, Boston, Massachusetts, USA, 02115
- Department of Molecular Biology, Cell Biology and Biochemistry, Brown University, Providence, Rhode Island, 02912
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, 02912
| | - C.A. Walsh
- Division of Genetics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- Howard Hughes Medical Institute, Boston Children’s Hospital, Boston, Massachusetts, USA, 02115
- The Autism Consortium, Boston, Massachusetts, USA, 02115
- Harvard Medical School, Boston, Massachusetts, USA, 02115
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Hashmi A, Zerfas D, Baciewicz FA. Sternoclavicular osteomyelitis: a new complication of misplaced tracheostomy tube. Ann Thorac Surg 2012; 92:2240-1. [PMID: 22115234 DOI: 10.1016/j.athoracsur.2011.04.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 04/07/2011] [Accepted: 04/18/2011] [Indexed: 11/26/2022]
Abstract
We report a patient who presented with erythema and swelling over the chest and neck several days after the placement of a tracheostomy tube. Sternoclavicular osteomyelitis and anterior mediastinal abscess occurred, as complications of inadvertent pretracheal tracheostomy tube placement, which were treated with right sternoclavicular resection and mediastinal drainage.
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Affiliation(s)
- Asra Hashmi
- Dow University of Health Sciences, Karachi, Pakistan
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Rizvi SAH, Naqvi SAA, Zafar MN, Hussain Z, Hashmi A, Hussain M, Akhtar SF, Ahmed E, Aziz T, Sultan G, Sultan S, Mehdi SH, Lal M, Ali B, Mubarak M, Faiq SM. A renal transplantation model for developing countries. Am J Transplant 2011; 11:2302-7. [PMID: 21883911 DOI: 10.1111/j.1600-6143.2011.03712.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The estimated incidence of end-stage renal disease (ESRD) in Pakistan is 100 per million population. Paucity and high costs of renal replacement therapy allows only 10% to get dialysis and 4-5% transplants. Our center, a government organization, started a dialysis and transplant program in 1980s where all services were provided free of charge to all patients. It was based on the concept of community government partnership funded by both partners. The guiding principles were equity, transparency, accountability and development of all facilities under one roof. This partnership has sustained itself for 30 years with an annual budget of $25 million in 2009. Daily 600 patients are dialyzed and weekly 10-12 receive transplants. One- and 5-year graft survival of 3000 transplants is 92% and 85%, respectively. The institute became a focus of transplantation in Pakistan and played a vital role in the campaign against transplant tourism and in promulgation of transplant law of 2007, and also helped to increase altruistic transplants in the country. This model emphasizes that in developing countries specialized centers in government sector are necessary for transplantation to progress and community support can make it available to the common man.
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Affiliation(s)
- S A H Rizvi
- Department of Urology, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan.
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Khan U, Hashmi A, Zia N, Awan S, Razzak J. P2-520 Injury- related mortality among women aged 12-49 years: Demographic and Health Survey (DHS) Pakistan. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976m.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
BACKGROUND Splenic tumors are rare. Malignant fibrous histiocytoma (MFH) of the spleen is one of the least common primary splenic tumors. Review of the literature shows that a laparoscopic resection has never been tried. METHOD We discuss the case of a 76-year-old man with a 7-cm MFH in the spleen and present a review of splenic sarcomas. RESULTS The patient underwent a successful laparoscopic splenectomy; pathology revealed a rare undifferentiated pleomorphic sarcoma of the spleen. A review of the international literature identified 15 additional cases of primary splenic MFH. Survival was rarely longer than 15 months. CONCLUSION Malignant fibrous histiocytoma of the spleen is an exceedingly rare tumor with a poor prognosis. In experienced hands, laparoscopic splenectomy is a feasible operative choice for primary splenic sarcoma.
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Affiliation(s)
- Asra Hashmi
- Mayo Clinic, Rochester, Minnesota, USA; Dow University of Health Sciences, Karachi, Pakistan
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Tunio MA, Hashmi A, Rafi M. Need for a new trial to evaluate postoperative radiotherapy in renal cell carcinoma: a meta-analysis of randomized controlled trials. Ann Oncol 2010; 21:1839-1845. [PMID: 20139152 DOI: 10.1093/annonc/mdq028] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A meta-analysis was conducted to assess the impact of postoperative radiotherapy (PORT) in renal cell carcinoma (RCC) on overall survival (OS), disease-free survival (DFS) and locoregional failure (LRF). MATERIALS AND METHODS The Medline, CANCERLIT, Cochrane library database and search engines were searched to identify randomized controlled studies comparing radical nephrectomy alone with radical nephrectomy followed by PORT for localized RCC. Further, radiotherapy techniques and associated side-effects were evaluated. RESULTS Seven controlled trials with a total patient population of 735 were identified. Pooled results from these trials showed a significant reduction of LRF in patients treated with PORT (P < or = 0.0001). However, there was no difference in OS (P = 0.29) and DFS (P = 0.14). The majority of patients was treated with larger field sizes with parallel-opposed anteroposterior fields. PORT was generally well tolerated; in total, six PORT-related deaths were seen. The resultant funnel plot was broader (Egger test P = 0.14) due to low number of patients. CONCLUSIONS PORT significantly reduces LRF but has no effect on OS and DFS. However, due to poor patient accrual and older radiotherapy techniques in previous studies, there is a need for a new trial to evaluate PORT using conformal and intensity-modulated radiotherapy techniques.
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Affiliation(s)
| | - A Hashmi
- Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - M Rafi
- Departments of Radiation Oncology
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Rizvi SAH, Anwar Naqvi SA, Zafar MN, Hussain Z, Hashmi A, Akhtar F, Hussain M, Ahmed E. Pakistan abolishes kidney market and ushers in a new era of ethical transplantation. Int J Organ Transplant Med 2010; 1:193-7. [PMID: 25013586 PMCID: PMC4089237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Shamim MS, Hanif F, Hashmi A, Hanif SM. Laparoscopic cyst-gastrostomy for pancreatic pseudocyst. J Coll Physicians Surg Pak 2009; 19:526-8. [PMID: 19651020 DOI: 08.2009/jcpsp.526528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Accepted: 05/08/2009] [Indexed: 12/01/2022]
Abstract
Pancreatic pseudocyst is a complication following resolution of pancreatitis. The optimum treatment for this condition has been under much debate. Laparoscopic surgery has changed the outlook of surgical management for the condition by reducing the operation related morbidity. The procedure has not been reported in local literature and is relatively new for the medical-surgical community. We report a case of pseudocyst gastrostomy and explain the procedure through laparoscopic approach.
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Hashmi A, Enns E, Frost T, Schäfer S, Frey W, Rominger F. Gold-Catalysis: Reactions
of Furandialkynes. SYNTHESIS-STUTTGART 2008. [DOI: 10.1055/s-0028-1083144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hashmi A, Hanif F, Hanif SM, Abdullah FE, Shamim MS. Complete Androgen Insensitivity Syndrome. J Coll Physicians Surg Pak 2008; 18:442-4. [PMID: 18760072 DOI: 07.2008/jcpsp.442444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Accepted: 06/02/2008] [Indexed: 11/05/2022]
Abstract
The incidence of Complete Androgen Insensitivity Syndrome (CAIS) is about 1 in 20,000. People with CAIS are normal appearing females, despite the presence of testes and a 46, XY chromosome constitution. We came across a case in which a 17 years old girl presented with the complaint of inguinal hernia and amenorrhea. Subsequent investigations were done revealing absence of female internal genitalia and the presence of abdominal mass, possibly testes. Syndrome has been linked to mutations in AR, the gene for the human Androgen Receptor, located at Xq11-12 leading to the insensitivity of the receptor to testosterone. Gonadectomy was performed and life long Hormone replacement therapy was advised.
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Rizvi SAH, Naqvi SAA, Hashmi A, Akhtar F, Hussain M, Ahmed E, Zafar MN, Abbas Z, Jawad F, Sultan S, Hasan SM. Improving kidney and live donation rates in Asia: Living donation. Transplant Proc 2004; 36:1894-5. [PMID: 15518688 DOI: 10.1016/j.transproceed.2004.08.135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Organ transplantation started with organs donated by living subjects. Increasing demands brought cadaveric organ donation. The brain-death law, mandatory for this procedure, is prevalent in all countries involved in organ transplantation except Pakistan. Spain is the leading country in cadaveric organ donation (32.5 pmp). Despite the sources of living and cadaveric organs, both heart-beating and non-heart-beating, the gap between the demand and supply has widened. An example is the United States, where the numbers of patients on the waiting list for kidney transplantation have risen from 30,000 in 1988 to more than 116,000 in 2001. This has caused a resurgence in living donors all over the world. These can be related, unrelated, spousal, marginal, or ABO-incompatible donors. Family apprehensions, medical care costs, and nonexistent social security can be barriers to this form of organ donation. Unrelated organ donation can open the doors to commercialism. To make this process more successful, transplantation should be made reachable by all sectors of the population. This is possible when transplantation is taken to the public sector institutions and financed jointly by the government and community. To increase living organ donation especially in Asian countries, which face barriers of low literacy rates, ignorance, and cultural and religious beliefs, more efforts are needed. Public awareness and education play an important role. Appreciation and supporting the donors is necessary and justified. It is a noble act and should be recognized by offering job security, health insurance, and free education for the donor's children.
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Affiliation(s)
- S A H Rizvi
- Sindh Institute of Urology and Transplantation, Dow Medical College, Karachi, Pakistan.
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Ahmed E, Akhtar F, Hashmi A, Imtiaz S, Hussain Z, Hafeez S, Naqvi A, Rizvi A. Acute graft dysfunction due to pyelonephritis: value and safety of graft biopsy. Ren Fail 2003; 25:509-12. [PMID: 12803516 DOI: 10.1081/jdi-120021813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- E Ahmed
- Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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Rizvi SA, Naqvi SA, Hussain Z, Hashmi A, Hussain M, Zafar MN, Sultan S, Mehdi H. Management of pediatric urolithiasis in Pakistan: experience with 1,440 children. J Urol 2003; 169:634-7. [PMID: 12544331 DOI: 10.1097/01.ju.0000041402.50707.c0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We evaluated the efficacy and safety of different modalities for pediatric urolithiasis in a developing country in 2 eras, namely before and after the advent of minimally invasive surgery. MATERIALS AND METHODS We retrospectively reviewed the records of 1,440 children younger than 14 years treated with various modalities during a 14-year period. From 1987 to 1995, 486 and 50 patients were treated with open surgery, and extracorporeal shock wave lithotripsy (ESWL, Dornier Medical Systems, Inc., Marietta, Georgia) and minimally invasive methods, respectively. Between 1996 and 2000, 518 and 386 children were treated with surgery and minimally invasive methods, respectively. RESULTS Of the 1,440 children 795 (55.2%) had renal, 198 (13.8%) had ureteral and 447 (31%) had bladder calculi. Of the renal stones 556 (70%), 177 (22%) and 62 (7.8%) were treated with open surgery, ESWL and percutaneous nephrolithotomy, respectively. Of the ureteral calculi 85 (43%), 37 (18.6%) and 76 (38%) were managed by ESWL, ureterorenoscopy and open surgery, respectively. Of the bladder calculi 307 (68%), 77 (17.2%) and 63 (14%) were treated with open vesicolithotomy, transurethral pneumatic cystolithotripsy and ESWL, respectively. The renal stone clearance rate was 98% after open surgery, 84% after ESWL and 68% after percutaneous nephrolithotomy monotherapy at 3 months of followup. Similarly the ureteral stone-free rate was 54% after ESWL and 86.9% after ureterorenoscopy. Of the patients with bladder calculi 48% and 93% become stone-free after ESWL and transurethral pneumatic cystolithotripsy, respectively. CONCLUSIONS The use of ESWL, percutaneous nephrolithotomy and ureterorenoscopy has resulted in treating a large number of children with a short hospital stay and early return to school. Open surgery is reserved only for complex stones.
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Affiliation(s)
- S A Rizvi
- Sindh Institute of Urology and Transplantation, Dow Medical College, Karachi, Pakistan
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Rizvi SAH, Naqvi SAA, Hussain Z, Hashmi A, Akhtar F, Hussain M, Ahmed E, Zafar MN, Muzaffar R, Hafiz S. Emerging challenges in transplantation in developing countries. Transplant Proc 2002; 34:3146-9. [PMID: 12493403 DOI: 10.1016/s0041-1345(02)03680-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S A H Rizvi
- Sindh Institute of Urology and Transplantation (SIUT), Dow Medical College, Karachi, Pakistan.
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Abstract
PURPOSE We evaluated epidemiology, etiology, dietary and urinary risk factors, and the composition of calculi in pediatric stone formers in Pakistan. MATERIALS AND METHODS This retrospective study includes 1,440 children treated between 1987 and 2000. Case records were reviewed for demographics, etiology and clinical symptoms. Dietary and urinary risk factors were analyzed prospectively in idiopathic stone formers. Stone composition was analyzed by infrared spectroscopy. RESULTS There were 1,075 males and 365 females for a male-to-female ratio of 3:1. The peak age for renal and bladder stones was 6 to 10 and 1 to 5 years, respectively. Overall 795 stones (55%) were renal, 198 (14%) were ureteral and 447 (31%) were vesical. Bladder stones were present in 60% of cases in the mid 1980s but decreased to 15% in the mid 1990s. The clinical symptoms were abdominal pain in 511 patients (51%) and fever in 193 (19.5%). There were anatomical abnormalities in 96 patients (12%), metabolic abnormalities in 206 (25%), infection stones in 60 (7%) and idiopathic stones in 444 (55%). Urinary analysis in idiopathic stone formers revealed hypercalciuria in 17 (11%), hyperoxaluria in 62 (40%), hyperuricosuria in 41 (27%) and hypocitruria in 97 (63%). Diet involved a low intake of protein in 60 cases (44%), calcium in 45 (33%), potassium in 105 (77%) and high oxalate in 75 (55%). The composition was calcium oxalate in 362 stones (47%), ammonium hydrogen urate in 210 (27%) and struvite in 49 (6.4%). Stones recurred in 30 patients (2%). CONCLUSIONS The pattern of calculous disease changed from a predominantly lower tract site in the mid 1980s to the upper tract in the mid 1990s. Stone composition, urinary risk factors and dietary analysis suggest that diet, dehydration and poor nutrition are the main causative factors of stone disease.
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Affiliation(s)
- S A H Rizvi
- Sindh Institute of Urology and Transplantation, Dow Medical College, Karachi, Pakistan
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