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Usmani SUR, Hasan SU, Ali SH, Ahmed SH, Pervez N, Danial M, Khan O, Tucker DL, Zubair MM. Perioperative sildenafil therapy in pulmonary hypertension associated with congenital cardiac disease: An updated meta-analysis. Asian J Surg 2024:S1015-9584(24)00430-5. [PMID: 38531747 DOI: 10.1016/j.asjsur.2024.03.003] [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: 09/07/2023] [Revised: 12/31/2023] [Accepted: 03/01/2024] [Indexed: 03/28/2024] Open
Abstract
To provide an updated meta-analysis to evaluate the efficacy and safety of sildenafil on pediatric patients with pulmonary hypertension (PH) associated with congenital heart disease (CHD). To assess the efficacy and safety of sildenafil, five outcomes, time duration of post-operative need for mechanical ventilation, time duration of post-operative ICU stay, length of hospitalization (LOH), the incidence of mortalities and pulmonary arterial pressure to aortic pressure ratio (PAP/AoP) were regarded as primary efficacy outcomes. Standardized mean difference (SMD) was calculated for continuous data. In comparison to the control group (CG), there was a significant decrease in the time duration of ICU stay in the sildenafil group (SG) (SMD = -0.61 [95% CI -1.17, 0.04]; P < 0.01, I2 = 85%). Length of hospitalization was assessed in the sildenafil and control groups (SMD = -0.18 [95% CI -0.67, 0.31] P = 0.05, I2 = 62%). However, there was no significant difference seen in mortality rates between the SG and CG (SMD = 0.53 [ 95% CI 0.13, 2.17] p = 0.61, I2 = 0%), in the time duration of postoperative mechanical ventilation between the SG and CG (SMD = -0.23 [95% CI -0.49, 0.03] p = 0.29, I2 = 19%), or PAP/AoP ratio between the SG and CG (SMD = -0.42 [95% CI -1.35, 0.51] P < 0.01, I2 = 90%). Based on our analysis, sildenafil has little to no effect in reducing postoperative morbidity and mortality due to PH in infants and children with CHD.
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Affiliation(s)
| | - Syed Umar Hasan
- Dow University of Health Sciences, Karachi, Sindh, Pakistan.
| | - Syed Hasan Ali
- Dow University of Health Sciences, Karachi, Sindh, Pakistan.
| | | | - Neha Pervez
- Dow University of Health Sciences, Karachi, Sindh, Pakistan.
| | - Muhammad Danial
- Dow University of Health Sciences, Karachi, Sindh, Pakistan.
| | - Owais Khan
- Dow University of Health Sciences, Karachi, Sindh, Pakistan.
| | | | - M Mujeeb Zubair
- Department of Cardiac Surgery, Cedars-Sinai Hospital, Los Angeles, CA, USA.
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Ahmed A, Zehra T, Moin A, Rehman Usmani SU. Battling a rarity: A case of kindler syndrome from a developing country. SAGE Open Med Case Rep 2024; 12:2050313X241231518. [PMID: 38371949 PMCID: PMC10874135 DOI: 10.1177/2050313x241231518] [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: 11/18/2023] [Accepted: 12/11/2023] [Indexed: 02/20/2024] Open
Abstract
Kindler syndrome, a rare branching of inherited epidermolysis bullosa, is an autosomal recessive condition characterized by the eruption of painful blisters and hemorrhagic vesicles in infancy. With age, the eruption of blisters are seen to decline leaving behind fibrosed, scarred, and paper-like skin, and poikilodermic features. To this date, about 400 cases have been reported worldwide for this disease only. This report aims to discuss the presence and diagnosis of Kindler Syndrome using limited resources in developing countries. It describes the presence of clinically diagnosed Kindler Syndrome in a young male of Pakistani descent that started in infancy and presented with a variety of clinical features over the years. Even though genetic analysis remains the gold standard diagnostic for Kindler syndrome, for third world countries, relying on Diagnostic clinical criteria remains helpful in establishing a diagnosis of Kindler syndrome for further management, as seen in our patient.
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Affiliation(s)
- Alina Ahmed
- Department of Dermatology, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, Pakistan
| | - Tasheen Zehra
- Geriatric Medicine, Sherwood Forest Hospitals NHS Foundation Trusts, Mansfield, UK
| | - Alina Moin
- Dow University of Health Sciences, Karachi, Pakistan
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Baig A, Lakhani M, Usmani SUR. Laparoscopic Transabdominal Pre-peritoneal Repair of a Bilateral Inguinal Hernia in a Pediatric Female Patient in Pakistan: A Case Report. Cureus 2024; 16:e54186. [PMID: 38496120 PMCID: PMC10941969 DOI: 10.7759/cureus.54186] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/19/2024] Open
Abstract
Inguinal hernias, although a common occurrence, pose a significant threat to the surgical community on account of their complexity and socioeconomic consequences. Bilateral inguinal hernias, which are a rare subtype of inguinal hernias, in particular, are problematic since there are no existing definitive international guidelines for their repair. It is estimated that between 8% and 30% of inguinal hernia patients have bilateral hernias, but there is still no clarity as to whether a bilateral hernia represents a special type of inguinal hernia or two different hernias in one patient. The transabdominal pre-peritoneal repair (TAPP), totally extra-peritoneal repair (TEP), and Lichtenstein repair techniques are commonly employed depending on the resources and surgical expertise available, but there is a need to conduct large-scale, prospective, randomized-controlled trials to guide the formation of evidence-based guidelines that could be followed globally. Herein, we present the first known case of a bilateral inguinal hernia in a female pediatric patient repaired by the laparoscopic TAPP technique from Pakistan.
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Affiliation(s)
- Arsalan Baig
- General Surgery, Dr. Ruth Pfau Hospital, Karachi, PAK
| | - Murk Lakhani
- Surgery, Dow University of Health Sciences, Karachi, PAK
- Surgery, Civil Hospital Karachi, Karachi, PAK
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Hasan SU, Pervez A, Usmani SUR, Tahseen MU, Asghar S, Ahmed JW, Manal I. Comparative analysis of pinning techniques for supracondylar humerus fractures in paediatrics: A systematic review and meta-analysis of randomized controlled trials. J Orthop 2023; 44:5-11. [PMID: 37637498 PMCID: PMC10457683 DOI: 10.1016/j.jor.2023.08.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/29/2023] [Accepted: 08/15/2023] [Indexed: 08/29/2023] Open
Abstract
Purpose Supracondylar humeral fractures (SCHFs) rank among the frequently observed fractures in children. Nonetheless, there exists a dearth of consensus regarding the optimal surgical approach. This meta-analysis aims to thoroughly evaluate and compare two distinct pinning techniques (cross pinning versus lateral pinning) for SCHFs, using data from Randomized controlled trials (RCTs). Methods Literature review was done using PubMed, CINAHL, Scopus, and The Cochrane Library for RCTs comparing the two pinning methods and providing information on at least one of the following: Loss of Baumann's angle, loss of carrying angle, elbow function assessed based on Flynn criteria, pin tract infection, and iatrogenic ulnar nerve injury. Random effect model was used to calculate standardized mean difference or Odds Ratio (OR) for the outcomes. Review Manager 5.4.1. was used to perform quality assessment and statistical analysis. Results A total of 22 RCTs were included. 20 studies reported data for iatrogenic ulnar nerve injury, the OR was calculated to be 3.76 (95% CI 1.75-8.06), showing a significantly lower risk of surgical ulnar nerve injury with the lateral technique. However, no significant difference was found between the pinning techniques in regard to the other outcomes. Conclusion In comparison to lateral pinning, the utilization of cross pinning technique exposes the patient to a heightened susceptibility of iatrogenic nerve injury. Therefore, it is recommended that surgeons prioritize the implementation of the lateral pinning technique whenever feasible, as it offers greater protection against iatrogenic ulnar nerve injury. For the other intraoperative and postoperative outcomes, both surgical techniques yield comparable results.
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Affiliation(s)
| | | | | | | | - Sohaib Asghar
- Foundation University School of Health Sciences, Islamabad, Pakistan
| | | | - Ishba Manal
- Dow University of Health Sciences, Karachi, Pakistan
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Ali SW, Usmani SUR, Khan MAM. Near-total penile amputation secondary to hair Torniquet syndrome - Case of a staged repair with a satisfactory outcome. Urol Case Rep 2023; 50:102509. [PMID: 37560441 PMCID: PMC10407027 DOI: 10.1016/j.eucr.2023.102509] [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: 06/22/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 08/11/2023] Open
Abstract
Penile Hair Tourniquet Syndrome, a subtype of Penile Tourniquet Syndrome, is a rare condition and a pediatric surgical emergency seen in infants whereby a constricting hair coil strangulates the penis most often at the coronal sulcus, leading to edema, ischemia and necrosis, If untreated, it can potentially lead to development of a urethrocutaneous fistula or even urethral transection and penile amputation. Therefore, a well-timed intervention can prevent complications and lifelong unhappiness. Herein, we present a case of an 11-month-old boy who presented with near total amputation of the glans and underwent two-staged repair with a satisfactory outcome.
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Affiliation(s)
- Syed Waqas Ali
- Department of Pediatric Surgery, Dow University of Health Sciences, Baba-e-Urdu Road, Saddar, Karachi, Pakistan
| | - Shajie Ur Rehman Usmani
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Baba-e-Urdu Road, Saddar, Karachi, Pakistan
| | - Muhammad Arif Mateen Khan
- Department of Pediatric Surgery, Dow University of Health Sciences, Baba-e-Urdu Road, Saddar, Karachi, Pakistan
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Ali SW, Usmani SUR, Khan MAM. A Rare Entity With Dangerous Potential-Clinical Images From a Case of An Isolated Congenital Lumbar Hernia. J Pediatr Gastroenterol Nutr 2023; 77:e12. [PMID: 37027139 DOI: 10.1097/mpg.0000000000003787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- Syed Waqas Ali
- From the Department of Pediatric Surgery, Dow University of Health Sciences, Karachi, Pakistan
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Ahmed SH, Usmani SUR, Mushtaq R, Samad S, Abid M, Moeed A, Atif AR, Farhan SA, Saif A. Role of laparoscopic surgery in the management of gallbladder cancer: Systematic review & meta-analysis. Am J Surg 2023; 225:975-987. [PMID: 36693774 DOI: 10.1016/j.amjsurg.2023.01.008] [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: 11/15/2022] [Revised: 12/26/2022] [Accepted: 01/08/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND This meta-analysis evaluates the safety and short-term oncological outcomes of laparoscopic vs. open surgery for gallbladder carcinoma(GBC). METHODS Meta-analysis was performed on laparoscopic(LG) and open group(OG) studies. Data for survival outcomes were extracted from Kaplan-Meier curves and combined with Tierney's method to estimate hazard ratios(HRs) and 95% CIs. RESULTS There was no significant difference in overall survival(HR: 1.01), disease-free survival(HR: 0.84), 30-day mortality(RR:1.10), overall recurrence(RR:0.93), intraoperative gallbladder violation(RR:1.17), operative time(WMD:8.32), number of patients receiving adjuvant chemotherapy(RR:1.06) and blood transfusion(RR: 0.81). A significant difference was seen in survival of T3 subgroup(HR:0.77) and number of lymph node dissections (LND)(WMD: 0.63) favoring OG, along with a decrease in postoperative complications(RR:0.65), greater incidence of R0 resections(RR:1.04), lower volume of intraoperative blood loss(WMD: 128.62), lower time in removing drainage tube(WMD: 1.35), shorter diet recovery time(WMD: 1.88), shorter hospital stay(WMD: 3.51), lower incidence of 90-day mortality(RR:0.49) favoring LG. A higher incidence of port-site recurrence(RR:1.99) was reported in LG. CONCLUSION Laparoscopic surgery is non-inferior to the open approach in terms of oncological outcomes and has an improved rate of postoperative complications.
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Affiliation(s)
- Syeda Hoorulain Ahmed
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan.
| | - Shajie Ur Rehman Usmani
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan
| | - Rabeea Mushtaq
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan
| | - Saba Samad
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan
| | - Minaam Abid
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan
| | - Abdul Moeed
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan
| | - Abdul Raafe Atif
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan
| | - Syed Ali Farhan
- Department of Surgery, Virginia Commonwealth University Health, 1200 E Marshall St, Richmond, VA, 23219, United States
| | - Areeba Saif
- Department of Surgery, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, United States
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Ali SW, Rehman Usmani SU, Zia A. Seed bezoars as a rare cause of fecal impaction in pediatric patients: A report of two cases from Pakistan. Journal of Pediatric Surgery Case Reports 2022. [DOI: 10.1016/j.epsc.2022.102457] [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] Open
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Moin A, Usmani SUR, Khan H. Impending disaster: rise of the epsilon variant in Pakistan and the way forward. Int Health 2021; 14:540-541. [PMID: 34618895 PMCID: PMC9450649 DOI: 10.1093/inthealth/ihab068] [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] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
The constantly mutating severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) does not appear to be slowing down any time soon. All countries, particularly developing countries, must adapt and strategically plan their way of life around the pandemic, while doing everything possible to keep the mortality rate and spread of the newly emerging variants as low as possible, in order to avoid a further blow to the economy and way of life. Pakistan is one such developing country that is currently battling the dangerous delta strain of SARS-COV-2 with limited resources and has recently seen the emergence of an equally transmissible and highly infectious epsilon strain. This is a concerning situation considering that Pakistan's already overburdened health system and faltering economy cannot withstand another dangerous SARS-COV-2 variant attack. This article highlights some strategies for the country to fortify its defences to prevent the epsilon variant from spreading before it is too late, and emphasises that while identifying potential immune evasion mechanisms in SARS-COV-2 variants is critical in the fight against COVID-19, it is also critical to develop methods of efficient and cost-effective detection to identify an early outbreak and then vigilantly and systematically plan area lockdowns before any hope of conquering this pandemic is lost.
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Affiliation(s)
- Alina Moin
- Dow University of Health Sciences, Baba e Urdu Road, Karachi 74200, Pakistan
| | | | - Hashim Khan
- Dow University of Health Sciences, Baba e Urdu Road, Karachi 74200, Pakistan
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