Leaking pseudoaneurysm of hepatic artery: A potentially life-threatening complication of a common procedure

We report a case of leaking pseudoaneurysm of right hepatic artery in a 54-year old female after laparoscopic cholecystectomy who presented with massive gastrointestinal haemorrhage and was successfully managed with angiography and coil embolization

Primary non-functioning paraganglioma of liver: A rare tumour at an unusual location

Pheochromocytomas are rare tumours, 22% of which are extra-adrenal and are known as paragangliomas. We report a case of a young male with non-functioning paraganglioma of the liver; a very uncommon primary site. A CT scan with contrast showed a huge, highly vascular mass lesion in the right lobe of the liver and a core biopsy confirmed it to be a paraganglioma. Whole body study with iodine-131-meta-iodobenzylguanidine (MIBG) tracer highlighted the liver tumour but was negative for any other active lesions depicting that the tumour was confined to the liver. The lesion was completely resected by extended right hepatectomy and the patient had an uneventful recovery. There is no evidence of disease recurrence at 3 years of follow up

Traumatic pancreatic injury: An elusive diagnosis: Experience from a developing country urban trauma referral centre

Objective: To determine the frequency of pancreatic injury in patients presenting with trauma and to review the mechanism of injury, management, subsequent complications and in-hospital mortality rate associated with these patients.Methods: The retrospective study included all patients over 18 years of age presenting with pancreatic injury due to trauma at the Aga Khan University Hospital, Karachi, between January 1990 and December 2009. Patients with iatrogenic pancreatic injury were excluded. The severity of the injury was assessed using the Injury Severity Score, while it was graded according to the scale defined by the American Association for the Surgery of Trauma. SPSS 17 was used for statistical analysis. Results: A total of 30 patients were identified representing just 1.5% of the total adult abdominal trauma patients. The mean age of the patients was 28±9.7 years. There were 28 (93.3%) males and just 2 (6.6%) females. The complication rate was 80% (n=24) and the mortality rate was 23.3% (n=7). Of the 30 patients, 19 (63%) had been transferred from some other medical facility. The mean length of hospital stay was 16.4±20.6 days (range 5-97 days). Conclusion: Surgical management in pancreatic trauma patients should be dictated by the degree and location of pancreatic injury, associated injuries and time from event to presentation. Mortality was primarily determined by associated life-threatening injuries

Characteristics of TIA and its management in a tertiary care hospital in Pakistan

<p>Abstract</p> <p>Background</p> <p>Transient ischemic attack (TIA) is described as a brief episode of neurological dysfunction caused by focal brain ischemia, with clinical symptoms typically lasting less than an hour, and without evidence of acute infarction. Recent studies depict TIA as a particularly unstable condition. Risk of stroke is greater than 10% in the first 90 days after an index TIA. The presentation, prognosis and intervention for TIA have not been reported in South-Asians in a developing country.</p> <p>Method</p> <p>A retrospective chart review was done for 158 patients who were admitted with the diagnosis of TIA, as defined by ICD 9 code 435, from January 2003 to December 2005 at the Aga Khan University Hospital, Karachi, Pakistan. The data was entered and analyzed in SPSS version 14.0.</p> <p>Findings</p> <p>Among 158 patients, 57.6% were male and 41.1% were female. The common presenting symptoms were motor symptoms (51.3%), speech impairment (43%), sensory impairment (34.8%) and loss of balance/vertigo (29.1%). The median delay in presenting to the hospital was 4 hours. Those with motor symptoms were found to present earlier. The study showed that only 60.8% of all the patients presenting with TIA received any immediate treatment out of which 44.7% received aspirin. Neuroimaging was used in 91.1% of the patients. Of all the TIA patients 9.1% converted to stroke with 50% doing so within the first 24 hours.</p> <p>Conclusion</p> <p>The natural history of TIA from this developing nation is comparable to international descriptions. A large percentage of patients are still not receiving any immediate treatment as recommended in available guidelines, even in a tertiary care hospital.</p

Patterns of tuberculosis in the central nervous system

Tuberculous involvement of central nervous system (CNS), although not very frequent, results in severe morbidity. Tuberculosis (TB) is endemic in developing countries but even in developed countries, after an initial decline up until 1980’s, incidence of TB is on the rise. The AIDS epidemic, emergence of multi-drug resistant strains and immigration of people from endemic areas are some of the factors significantly contributing to this increase. Consequently, the burden of central nervous system tuberculosis has increased significantly worldwide

Knowledge and practice of healthy lifestyle and dietary habits in medical and non-medical students of Karachi, Pakistan

OBJECTIVE: To objectively compare the differences in knowledge and practices regarding healthy lifestyle among medical and non-medical students of Karachi along with assessment of any perceived barriers.METHODS: This cross-sectional study included 350 students between ages 17-24 years from 6 private universities of Karachi--three medical and three non-medical Institutions. A self-reported questionnaire was employed to assess attitude and barriers to healthy practices among the simple random selection of students.RESULTS: On a 10-point scale, the average knowledge score of students on general and clinical nutritional knowledge was 5.7 +/- 1.51 and 4.4 +/- 1.77, respectively and the difference was statistically significant (p \u3c 0.01). Conversely the diet and lifestyle score (85-point scale) among medical (41.3) and non medical students (40.8) was not significant (p = 0.646). There was no difference between the perception of medical and non-medical students regarding \u27work-related stress\u27 in their life. \u27Lack of time\u27 was cited as the most important reason for skipping meals and as a barrier to exercising regularly among both groups.CONCLUSION: The knowledge, attitudes and practices of medical students in Karachi suggest that superior knowledge about healthy lifestyle does not necessarily result into better practices

Early complications after biliary enteric anastomosis for benign diseases: A retrospective analysis

Background:Biliary-enteric anastomosis (BEA) is a common surgical procedure performed for the management of biliary obstruction or leakage that results from a variety of benign and malignant diseases. Complications following BEA are not rare. We aimed to determine the incidence and the factors associated with early complications occurring after BEA for benign diseases. Methods: We reviewed the medical records of all Patients who underwent BEA for benign diseases at our institution between January 1988 and December 2009. The primary outcome was early post operative complication. Logistic regression analysis was done to identify factors predicting the occurrence of complications. Results: Records of 79 Patients were reviewed. There were 34 (43%) males and 45 (57% females). Majority (53%) had choledocholithiasis with impacted stone or distal stricture, followed by traumatic injury to the biliary system (33%). Thirty-four Patients (43%) underwent a hepaticojejunostomy, 19 Patients (24%) underwent a choledochojejunostomy, and choledochoduodenostomy was performed in 26 Patients (33%). Early complications occurred in 39 (49%) Patients - 41% had local complications and 25% had systemic complications. Most frequent complications were wound infection (23%) and bile leak (10%). Four (5%) Patients died. On multivariate analysis, low serum albumin level (odds ratio = 16, 95% CI = 1.14-234.6) and higher ASA levels (odds ratio = 7, 95% CI: 1.22-33.34) were the independent factors predicting the early complications following BEA. Conclusions: Half of the Patients who underwent BEA for benign diseases had complications in our population. This high incidence may be explained by the high incidence of hypoalbuminemia and the high-risk group who underwent operation

Evaluating Uptake of Risk Management Recommendations by Mutation-Positive Patients in the Cancer Genetics Clinic

An important benefit of cancer genetic testing is the potential for detection of an actionable mutation in genes conferring an increased lifetime risk for hereditary cancer. Individuals with a suggestive personal or family history may seek genetic counseling to assess their risk and pursue genetic testing. Genetic counselors review detected pathogenic variants, in combination with personal and family history, to make recommendations for cancer risk management. Two major recommendations include clinical screening (such as imaging) and surgical methodologies designed to prevent or detect cancer at an early and more treatable stage. Uptake of recommendations can vary significantly across patient populations with diverse medical histories, family histories, socioeconomic factors, and institutional factors. Previous studies have identified trends in risk management behavior for high-risk patients after genetic counseling, including facilitators and barriers to uptake. Cancer genetics clinics can apply this knowledge to improve outcomes for low-uptake groups through enhanced service delivery models, provider education, and community engagement. This study aimed to characterize a population of mutation-positive patients (n=149) who have received genetic counseling at UCI from 2018-2020 in order to evaluate uptake of risk management recommendations. In general, uptake of recommended screening and suggested surgery was high for this group of patients; 74% of those who were provided with screening recommendations were documented as having completed screening, and 36% of those who had discussed surgery with a genetic counselor were documented as having completed a subsequent surgery. Patient demographics, personal medical history, family history, and genetic counseling visit details were analyzed as possible predictors of uptake, and were ultimately not determined to be strong predictors. However, for a subset of the population (n=22, 14.8%), the charts which may have documented risk management behavior were not available, perhaps because these patients had on-going healthcare outside of the medical system. Whether patients initiated genetic testing outside of UCI, and whether they received only post-test counseling were predictors for availability of charts. The lack of complete information on all study participants limited the statistical power to identify significant predictors of risk management behavior. Overall, this study revealed high uptake for risk management recommended in the genetic counseling clinic, though significant predictors for uptake were not identified. The findings of this study underscore the importance of accessible, thorough documentation available between care sites to improve longitudinal research on genetic counseling outcomes and achieve comprehensive continuity of care

Portal hypertensive biliopathy: review of pathophysiology and management

Portal hypertensive biliopathy is described as abnormalities of the walls of the biliary tree secondary to portal hypertension. In literature it has also been named as Cholangiopathy associated with portal hypertension , Portal biliopathy and Portal cavernoma associated cholangiopathy . It is usually asymptomatic and found incidentally, but rarely patients do present with symptoms of abdominal pain, jaundice, asthenia and fever. Treatment is warranted in symptomatic cases only, and is dictated by the clinical manifestations and complications of the disease process. Due to presence of underlying severe portal hypertension, endoscopic biliary intervention is usually the first line of management, and is relatively safe and often sufficient. When surgery is resorted to, a porto-systemic shunt prior to biliary bypass procedure provides early relief of obstructive biliary symptoms and often precludes the need for a biliary bypass surgery. This review describes the pathophysiology, presentation, progression and management approaches to portal biliopathy