Omental Infarction In A Child

Omental infarction is a rare cause of acute abdomen in children. Typical findings on imaging establish the diagnosis. We present case of a 7 years old boy who presented with acute right iliac fossa pain with diagnosis of omental infarction on imaging and findings confirmed on laparotomy. Sound knowledge regarding this infrequent cause of acute abdomen in children is necessary for timely diagnosis

Role of simulation in open varicose veins surgery: A systematic review

Objective: To assess the types and effectiveness of simulators present for open varicose vein surgery. Methods: The systematic review was conducted at The Aga Khan University Hospital Karachi and comprised studies published from 1st January 2000 to 30th June 2020 related to open varicose vein surgical procedures done on simulators. Databases searched were PubMed, Medline, Google Scholar, Cochrane and Scopus using appropriate key words. The primary outcome of the review was to assess the effectiveness of different types of simulators used for varicose vein surgery. Results: Of the 286 articles found, 6(2%) were included. A variety of simulators ranging from animal models, homemade simulators and commercially designed models with high fidelity options had been used. Technical competence was the major domain assessed in most of the studies 5(83.3%), while 1(16.6%) study focussed on self-assessment. Blinding was done in 4(66.6%) studies for assessment purpose, and videorecording of the trainees\u27 performance was done in 5(83.3%) studies. Most studies 4(66.6%) found the use of simulation to be an effective tool in achieving technical competence. Conclusion: The use of simulation in the training of surgical residents for open varicose vein surgery was found to be beneficial, but most studies were heterogeneous in terms of design, simulator types and study participants. This makes it difficult to establish the superiority of any one type of simulator over the rest. Further research is needed to develop and validate simulators in open varicose vein surgery procedures

Ultrasound-guided peripheral nerve blocks in high-risk patients, requiring lower limb (Above and below knee) amputation

A case series of five high-risk patients with lower limb ischemia, sepsis, altered coagulation, and multi-organ dysfunction requiring emergent or urgent lower limb amputation is presented. Use of peripheral nerve blocks for below and above knee amputations is quite uncommon which provides better hemodynamic stability and pain management, especially in the very sick patients. The surgeries were successfully carried out under ultrasound-guided combined femoral and sciatic nerve blocks. All five patients obtained adequate level of block at the area of amputation. There were no complications related to anesthetic management. Patients remained hemodynamically stable and pain-free during surgery and postoperatively. Combined femoral-sciatic nerve block under ultrasound guidance is safe and satisfactory alternative anesthetic technique for such patients

Surgical research: Exploring our history - navigating the future

In the fifteenth century, trained individuals called' barber surgeons' mastered the art of handling sharp instruments and performing basic surgical procedures. They even founded a 'United Company of Barber Surgeons' in 1540.1 Besides shaving and haircutting, they were trained to perform dental extractions and a few surgical procedures. Later in 1745, qualified doctors and surgeons came together and founded 'Company of Surgeons' in the UK, which later became the Royal College of Surgeons in London.2 This progression from anecdotal experiences of the guild of barbers to a formal society that helped the implementation of scientifically reasoned decisions by Royal College Surgeons was only possible because surgeons were able to appreciate the value of the evidence and incorporate it into their practices. Continuous..

Relationship of Social Progress Index (SPI) with Gross Domestic Product (GDP PPP per capita): The moderating role of Corruption Perception Index (CPI)

This study investigated the impact of social progress on economic development in 119 countries, while taking their individual corruption perception into consideration. Simple linear regression was use on the secondary data for 119 countries and 5 continents while the SPSS PROCESS macro was used to test the moderating effect of corruption perception. As hypothesized, a positive relationship of the social progress index (SPI) with gross domestic product (GDP) PPP per capita was observe. This means that countries, which fulfill basic human needs, foundations of wellbeing and foster availability of opportunities have enhanced economic development. Moreover, the moderating role of corruption perception between the relationship of social progress and economic development was confirmed; thus indicating that countries with better corruption perception rating possess a stronger relationship of SPI and GDP (PPP) per capita and vice versa. When checked for continents, moderation results showed that the continents that have higher values of corruption perception index (CPI) are more socially and economically developed

Barriers in surgical research: A perspective from the developing world

Research in surgery has led to significant advances over the last century in terms of how medicine is practised in and outside the operating rooms today. Surgical research in the developed countries is responsible for most of this advancement, but it is often inapplicable in resource-limited settings in the developing world. Lower- and middle-income countries are in a unique position to take this work further, but they are limited by certain barriers. These barriers could broadly be classified under social and cultural, infrastructure, financial, ethical, and personal categories. These barriers are often not fully realised, but can potentially be addressed with concerted efforts to continue the advancement of medicine for everyone

Changing face of trauma and surgical training in a developing country: A literature review

Trauma continues to be the major cause of disability and death globally and surgeons are often involved in immediate care. However there has been an exponential decrease in the number of the trained trauma surgeons. The purpose of the current review article is to summarize the published literature pertaining to trauma education in postgraduate surgical training programmes internationally and in a developing country as Pakistan. Several electronic databases like MEDLINE, PubMed, Google scholar and PakMediNet were searched using the keywords \u27trauma education\u27 or \u27trauma training\u27 AND \u27postgraduate medical education\u27, \u27surgery residency training\u27, \u27surgery residents\u27 and \u27surgeons\u27. The current training in most surgical residency programmes, locally and globally, is suboptimal. Change in trauma management protocols, and decrease in volume of trauma cases results in variable and/ or inadequate exposure and hands-on experience of the surgical trainees in operative and non-operative management of trauma. This warrants collaborative measures for integration of innovative educational interventions at all levels of the surgical educational programmes

The Effect of Strategic Orientation on Green Supply Chain Practices and Performance: A Case of Manufacturing Companies in Pakistan

The aim of this study is to find out the direct impact of competence of strategic supply chain orientation, strategic environmental orientation and institutional pressure on Green Supply Chain Management (GSCM) and to overall performance. The data gathered from executives of 66 manufacturing firms of Pakistan. On the one hand, the relationship between strategic orientations of the environment, supply chain, institutional pressure, and adoption of GSCM practices is examined on the other hand GSCM practices, and its relationship with performance measures including Customer Effectiveness, Environmental Differentiation, Economic Performance, Operational Efficiency and Social Performance is examined. The Smart PLS software is used to compute content validity, convergent validity, discriminant validity, and predictive relevance model. The companies in Pakistan are less oriented towards environment and supply chain. However, due to the pressure from institutes, they are persuaded to adopt GSCM practices in their operations, which eventually boost their performance. The outcome of GSCM practices results in saving the environment, creating a better social image, cost reduction and profitability which would enable managers to be able to know strategic orientations (both environmental and SCM) rather than depending on the issues of institutional pressures and monitoring directions of strategies for Green SCM

Hypoglossal nerve paraganglioma depicting as glomus tumor of neck

Introduction: Paraganglioma are infrequent neuroendocrine tumors that are most commonly found in the carotid body, ganglia of the vagus, jugular and tympanic nerve. Very rarely they can involve other cranial nerves outside the cranial cavity, we present one such case of hypoglossal nerve paraganglioma in neck.Case report: A 48 years old male presented with 1-month history of right sided stroke and aphasia. Ultrasonography of neck revealed a highly vascular mass on the right side of the neck. CT angiogram confirmed a highly vascular mass arising above the carotid bifurcation. With the working diagnosis of Glomus tumor, he underwent right sided neck exploration, however, intra-operatively tumor was found to be arising from the hypoglossal nerve instead. Surgery was abandoned on basis of the available literature, with only 6 reported cases in the past 54 years. Patient had no immediate post op complications and was sent for cyber knife treatment. After completion of 5 cycles of cyber knife there was a total of 45% reduction in the size of the paraganglioma with the resolution of the patient\u27s symptoms after a follow up of 6 months.Conclusion: Hypoglossal nerve paraganglioma is an uncommon tumor of the neck and can be misdiagnosed with the other tumors in this region especially chemodectoma and glomus tumor. The diagnostic criteria and appropriate treatment modalities have not been established due to the rare presentation hence hypoglossal paraganliomas should be kept in mind when Highly vascular neck mass is encountered