Laparoscopic Cholecystectomy in Cirrhotic Patients

Laparoscopic cholecystectomy can be an effective and safe treatment for symptomatic gallbladder disease in select patients with Child-Pugh A and B cirrhosis

Postoperative outcome of early appendectomy in patients having appendicular mass by laparoscopic surgery

Objective: To determine the frequency of postoperative outcome of early appendectomy in patients having appendicular mass by laparoscopic surgery.Methodology: It was a descriptive & case series study. Study was conducted in the department of surgery Liaquat University Hospital Jamshoro/Hyderabad, during the time period of Jan 2015 to Dec 2017. Patients were both gender and patients aged between 10-40 years having tender and palpable right iliac fossa mass on clinical examination confirmed on ultrasound abdomen as appendicular mass. Patients with mass in right iliac fossa but with associated features like fixed and immobile mass for more than 1 month, bleeding per rectum, history of weight loss, cardio respiratory diseases like recent myocardial infarction, congestive cardiac failure, chronic obstructive pulmonary disease and renal diseases like glomerulonephritis, nephrotic syndrome and renal failure etc, gynecological and obstetrical diseases in female patients were excluded from the study. The postoperative hospital stay was counted and wound infection was noted.Results: During the study period of one year, total of 73 patients with appendicular mass were included in this study.  The age range 10 to 40 years with mean age ± SD (range) was 25.75±9.2 years. Out of them 46 (63.0%) were male whereas 27(37.0 %) were females During operation we found appendicular abscess in 12(16.43%) cases followed by perforated appendix in   10(13.69%) cases, while during operations we found in adhesions in 15(20.5%) cases and difficulty in localisation of appendix 06 (8.21%) cases. The mean hospital stay + SD (range) was 4.91 +1.65 (3-9 days).  Wound infection was seen in 15(20.5 %) cases.Conclusion: Early appendectomy can be safely performed in appendix mass without any increased risk of mortality and morbidity. The outcome of early surgical management of appendicular lump showed benefits for single hospitalization, shorter hospital stay and lower treatment costs

Clinical Pattern and Post-Operative Complications of Post Tuberculous Meningitis Hydrocephalus in Patients Underwent Ventriculoperitoneal Shunt

Objective: To determine the clinical presentation of post tuberculous meningitis hydrocephalus and post-operative complications in patients underwent placement of a ventriculoperitoneal shunt.Study Design: This Quasi-experimental study was conducted at Department of Neurosurgery of Dow University of Health Sciences/ Civil Hospital, Karachi. Study duration was six months from October 2013 to March 2014.Methodology: Total 40 patients were studied who were diagnosed as cases of tuberculous meningitis and hydrocephalus on the basis of history, clinical examination, CSF findings, CT and MRI. Each patient underwent placement of a ventriculoperitoneal shunt. All the data regarding clinical presentation and postoperative complications was recorded in the proformaRESULTS: Total 40 patients having tuberculous meningitis hydrocephalus were selected; their mean age was 16.4+07.8 years. Male were found in the majority 62.50%, as compared to female 37.50%. According to the clinical presentation, most patients 70.0% were presented with a headache and 62.50% with fever, followed by nausea and vomiting was in 37.5% patients, Neck rigidity was in 27.50% cases, extra neural tuberculosis in 25.0% patients, papilledema in 22.50% cases, limb weakness in 10.0% patients, while fits were found only in 5.0% of the patients. Past history of tuberculosis was in 7.50% patients. According to postoperative complications infection was found in 10.0% of the cases, peritoneal pseudo-cyst without infection was in 7.5% cases, while 10.0% patients died. No significant difference was found in the postoperative complications according to gender p-value 0.94.Conclusion: It is concluded that a headache, fever and nausea/vomiting were the commonest clinical features and the Ventriculoperitoneal shunt is relatively simple and suitable for the patients of all age groups with hydrocephalus, its complications are relatively easy to manage

Comparison of Outcome of Bipolar Electrocautery versus Harmonic Scalpel in the Management of Third and Fourth Degree Hemorrhoids

Objective: To compare the outcome of bipolar electrocautery versus harmonic scalpel in the management of third degree hemorrhoids. Methodology: This is a comparative study performed at Different Private Clinics of Karachi from the duration of January 2020 to June 2020. Patients with symptomatic grade III hemorrhoids and grade IV hemorrhoids were randomly divided into two groups. . Either group had 64 patients. One group underwent hemorrhoidectomy using bipolar electrocautery (Group A), other group underwent hemorrhoidectomy using harmonic scalpel hemorrhoidectomy (Group B). Results: The total number of patients was 128 with 64 in either group. The mean operating time in group A was 22 ± 4.7 minutes, while that in group B was 35 ± 2.2 minutes. The mean duration of hospital stay among group A was 1.7 ± 0.5 days while among group B patients was 2.1 ± 1.2 days. Mean VAS score for pain at first post-operative day in group A patients was 7 ± 0.6 days while mean VAS score for pain among group B patients was 8.5 ± .2 days. Conclusion: Our study concludes that harmonic scalpel hemorrhoidectomy offers better post-operative patient satisfaction score as compared to bipolar diathermy. No significant difference in hospital stay was found. The number of patients with post-operative urinary retention were more in harmonic scalpel group while in diathermy group, more patients had post-operative hemorrhage

Approaches to Different Learning Styles in Undergraduate Medical Students of Al-Tibri Medical College Karachi

Objectives: The purpose of this study was to evaluate the different styles of learning preferred by undergraduate medical students from 1st to 5th year of Al-Tibri Medical College KarachiMethodology: This was a cross sectional observational study carried out on the undergraduate medical students of Al-Tibri Medical College Karachi from 1st year to 5th year for a period of six months. The sample consisted of 498 participants, distributed across the various academic years: 101 from the first year, 96 from the second year, 101 from the third year, 104 from the fourth year, and 96 from the fifth year. For collecting data, a self-administered and pre-tested questionnaire of VARK learning styles was distributed amongst students. The analysis of data was done using SPSS version 23.Results: From 498 undergraduate medical students included, mean age was 20.93 ± 2.27 years. Mean score for visual learning style was 2.75 ± 2.5, auditory was 3.4 ± 2.1, reading / writing was 3.9 ± 2.8 and kinesthetic was 4.75 ± 3.2. 56 % of 1st year students opted for uni-modal while 44 % multi-modal learning style. 51 % of 2nd year students preferred uni-modal while 49 % multi-modal learning style. 52 % of 3rd year students chose uni-modal while 48 % multi-modal learning style. 50 % of 4th year students picked uni-modal and multi-modal learning style each. 44 % of 5th year students opted for uni-modal while 56 % multi-modal learning style.Conclusion: Majority of students approached learning using kinesthetic style followed by reading / writing. A multi-modal mode of learning was preferred where a combination of either of VARK’s learning styles were put into practice for attaining and acquiring the best possible knowledge

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Approaches to Different Learning Styles in Undergraduate Medical Students of Al-Tibri Medical College Karachi

Objectives: The purpose of this study was to evaluate the different styles of learning preferred by undergraduate medical students from 1st to 5th year of Al-Tibri Medical College Karachi Methodology: This cross sectional observational study was carried out after ethical approval from the institute and all undergraduate medical students voluntarily agreeing to participate in the study were included while all those undergraduate medical students that refused to participate were excluded. For collecting data, a self-administered and pre-tested questionnaire of VARK learning styles was distributed amongst students. The analysis of data was done using SPSS version 23. Results: From 498 undergraduate medical students included, mean age was 20.93 ± 2.27 years. Mean score for visual learning style was 2.75 ± 2.5, auditory was 3.4 ± 2.1, reading / writing was 3.9 ± 2.8 and kinesthetic was 4.75 ± 3.2. 56 % of 1st year students opted for uni-modal while 44 % multi-modal learning style. 51 % of 2nd year students preferred uni-modal while 49 % multi-modal learning style. 52 % of 3rd year students chose uni-modal while 48 % multi-modal learning style. 50 % of 4th year students picked uni-modal and multi-modal learning style each. 44 % of 5th year students opted for uni-modal while 56 % multi-modal learning style. Conclusion: Majority of students approached learning using kinesthetic style followed by reading / writing. A multi-modal mode of learning was preferred where a combination of either of VARK’s learning styles were put into practice for attaining and acquiring the best possible knowledge. Keywords: Learning Styles, Andragogy, VARK, Undergraduate Medical Student