Dr Ahmed Siddique Ammar - Academia.edu (original) (raw)

Papers by Dr Ahmed Siddique Ammar

Journal of the Pakistan Medical Association

Pilonidal disease occurs most commonly in those males who have to sit long hours at their work pl... more Pilonidal disease occurs most commonly in those males who have to sit long hours at their work place e.g. online office workers or drivers. It is caused by piercing of broken hairs into the sacrococcygeal region which causes localised inflammation. Inflammation in this area due to any other foreign body is very rare. Among many treatment options for pilonidal sinus, instillation of crystalloid phenol showed promising results in terms of low recurrence rates, low post-operative complications and less healing time. Here, we present the case of a 13-year-old female student who had pilonidal sinus in sacrococcygeal region for six months and was unresponsive to multiple treatments. Later, on exploration it was revealed to contain a small foreign body of 3cm of hard straw of grass. The patient was treated with crystalloid phenol and on regular follow-up she was completely fine by the end of the third week.

Journal of Gandhara Medical and Dental Science

Pneumoperitoneum caused by a perforated appendix is extremely rare. We encountered a case of a 24... more Pneumoperitoneum caused by a perforated appendix is extremely rare. We encountered a case of a 24 years old male presented in the emergency department of EAST surgical ward of MAYO Hospital Lahore with a history of epigastric pain for 10 days, which later became generalized. Chest X-ray showed free air under the right hemidiaphragm. On the basis of clinical examination and radiological correlations diagnosis of duodenal ulcer perforation was made. On exploration of abdomen through midline incision it was found to be a perforated appendix at its tip. The body and base of the appendix was normal. No per operative and postoperative complications were encountered and the patient discharged on the second postoperative day. Biopsy of appendix showed acute inflammation of appendix.

International Surgery Journal, 2021

Background: Enteric fever leading to enteric perforation is very common surgical emergency in the... more Background: Enteric fever leading to enteric perforation is very common surgical emergency in the developing nations. The two surgical solutions used worldwide are to repair or exteriorize the perforation as ileostomy. The aim of the study was to setup and validate a statistically reliable scoring system for decision between repair and ileostomy in patients with peritonitis due to enteric perforation.Methods: It was an observational cross-sectional study done at East Surgical Ward of Mayo Hospital, Lahore. 256 patients were selected by consecutive non-probability sampling after ethical approval. The duration of study was 2 years from 1st August to 2018 to 30th July 2020. Patients with age more than 13 years presented in emergency department with diagnosis of peritonitis due to enteric perforation were included. A preformed scoring criterion named as East surgical ward enteric perforation (ESWEP) score was set by giving each variable a score of 1 to 3. Cut-off value between repair an...

The Professional Medical Journal, 2021

Objective: This study is aimed to know the histopathological spectrum and outcome of surgery for ... more Objective: This study is aimed to know the histopathological spectrum and outcome of surgery for salivary gland tumors presented in a tertiary care hospital of Pakistan. Study Design: Retrospective study. Setting: Tertiary Care Hospital of Pakistan. Period: July 2018 to June 2020. Material & Methods: After approval from Institutional Review Board. Total 73 patients were selected with preoperative diagnosis of salivary gland tumors with consecutive non probability sampling. All surgical procedures were done by specialist general surgeons who had experience of more than 10 years of head and neck surgery. Results: Male to female ratio was 2:1 with mean age of patients was 46 years. Among males 29 (59.1%) were benign salivary gland tumors while 20 (40.81%) were malignant salivary gland tumors. Among females 13 (54.16%) were benign and 11 (45.83%) were malignant salivary gland tumors Most common benign tumor was pleomorphic adenoma 32 (43.8%) while mucoepidermoid carcinoma was most commo...

The Professional Medical Journal, 2022

Objective: To compare the open appendectomy with & without peritoneum closure in term of post-ope... more Objective: To compare the open appendectomy with & without peritoneum closure in term of post-operative pain and operative time. Study Design: Comparative study. Setting: EAST Surgical Ward, MAYO Hospital Lahore, Pakistan. Period: July 2019 to June 2020. Material & Methods: Sample size of 150 patients were selected by consecutive non probability sampling technique. Patients were divided into 2 groups with 75 patients in each group. In Group A patients, peritoneum was closed while in Group B patients, peritoneum was not closed. The results of both groups were compared. Data was collected by pre designed proforma and evaluated by SPSS 26. Results: Out of total 150 patients, 96 (64%) were male and 54 (36%) were females. Most common age group was between 31 years to 40 years. The mean operation time taken by the patients in which peritoneum was closed was about 41 minutes with standard deviation of ± 10.54 minutes as compared to the Group B in which peritoneum was not closed and it took...

Journal of the Pakistan Medical Association, 2022

Acute mesenteric ischaemia is one of the serious abdominal surgical emergency, which has got very... more Acute mesenteric ischaemia is one of the serious abdominal surgical emergency, which has got very high morbidity and mortality. During the pandemic of COVID -19, besides respiratory complications, the virus was causing venous and arterial thromboembolism that can lead to acute mesenteric ischaemia in otherwise healthy individuals. Early diagnosis and suitable surgical procedures are the key to the better outcome of this disease. Surgical resection of gangrenous gut, leaving healthy gut is an important step of this operation. Leaving less than 200 cm of small intestine leads to short bowel syndrome which has got its own complication. This case report is on a healthy COVID -19 positive patient who presented with acute mesenteric ischaemia. After surgical resection only 1.5 feet small bowel (60 cm) was left behind and anastomosis was done with healthy transverse colon. ---Continue

Journal of Gandhara Medical and Dental Science, 2022

OBJECTIVES: The objective of this study was to determine frequency of non-compliance to oral iron... more OBJECTIVES: The objective of this study was to determine frequency of non-compliance to oral iron therapy in pregnancy and common factors leading to it. METHODOLOGY: It was a cross-sectional study done in the Department of Obstetrics and Gynecology of Lady Willington Hospital Lahore, Pakistan. The duration of this study was six months i.e., 3rd October 2019 to 2nd March 2020. All antenatal patients between ages of 18 to 45 years presented in the obstetrics outdoors or admitted in the ward were included in this study. A total of 245 patients were included in this study by consecutive non-probability sampling. Patients with gynecological problems, patients dependent on others for their medication cost, patients with psychiatric illness or physical disability were excluded. Post stratification Chi-square test was applied keeping P-value ≤0.05 as significant RESULTS: Among 245 patients, mean age was 27±2.16 years. Iron supplement used by 245 patients was analyzed as 159 (65%) patients h...

Journal of the Pakistan Medical Association, 2020

A 36-year-old woman presented in the emergency department of East Surgical Ward of MAYO Hospital ... more A 36-year-old woman presented in the emergency department of East Surgical Ward of MAYO Hospital Lahore, Pakistan, in August 2019 with compliant of abdominal pain and vomiting for the past five days. The patient had a history of three Caesarean sections, the last one three years back. Off and on, she experienced abdominal pain and distension which was relieved after taking local medicines. She had no comorbid conditions and her baseline investigations were normal. On examination she had tachycardia with pulse 110/min and her whole abdomen was tender with exaggerated bowel sounds. X ray of the abdomen showed multiple air fluid levels in the small intestine. Exploration plan was made; a distended segment of ileum was later found to have abdominal sponge inside its lumen. Continuous...

JPMA. The Journal of the Pakistan Medical Association, 2021

OBJECTIVE To assess the risk factors for lower limb amputations in diabetic patients presenting w... more OBJECTIVE To assess the risk factors for lower limb amputations in diabetic patients presenting with foot ulcers. Methods The analytical cross-sectional study was conducted at the Mayo Hospital, Lahore, Pakistan, from December 1, 2019, to May 31, 2020, and comprised patients of either gender having type 1 or type 2 diabetes and foot ulcers. The wounds were assessed according to Wagner wound staging and wound sepsis was evaluated in terms of local infection of the wound, leucocytosis and osteomyelitis of the bone. The glycaemic control of these patients was assessed on presentation by measuring glycated haemoglobin levels. Data was analysed using SPSS 26. RESULTS Of the 135 patients, 82(60.7%) were males and 53(39.2%) were females. Majority patients 59(43.7%) were aged 50-60 years. All 135(100%) patients underwent some type of amputation. Of all the amputations, 91(67.4%) were done in patients with poor glycaemic control on presentation, and 56(41.5%) in those with stage 4 wound. Loc...

The Professional Medical Journal, 2021

Objective: The objective of this study is to compare the effect of pre-operative calcium and vita... more Objective: The objective of this study is to compare the effect of pre-operative calcium and vitamin D supplements in terms of hypocalcemia in patients with total thyroidectomy. Study Design: Comparative study. Setting: EAST Surgical Ward, MAYO Hospital Lahore, Pakistan. Period: 1st July 2018 to 30th June 2020. Material & Methods: Sample size of 342 patients and duration of 2 years. 2 groups were created including 171 patients each. Group A patients received calcium and vitamin D supplements 1 week prior to total thyroidectomy while Group B patients didn’t receive any supplements. The results of both groups were compared. Data was collected by pre designed proforma and evaluated by SPSS 21. Results: 164 (47.9%) patients were male and 178 (52.0%) were females. Most common age group which undergone total thyroidectomy was between 31 years to 40 years. Total 140 patients (40.93%) experienced hypocalcemia. In group A, 32 (18.71%) experienced hypocalcemia while in group B 108 (63.1%) exp...

Gallbladder perforation is a rare presentation encountered in the surgical emergency floor [1]. T... more Gallbladder perforation is a rare presentation encountered in the surgical emergency floor [1]. The most common mode of presentation of gall bladder perforation is peritonitis but the pre-operative diagnosis of gall bladder perforation is difficult to make especially where there is no availability of advance imaging techniques like CT scan [2]. This delay can result in morbidity and even mortality of the patient with significant influence on the outcomes. The reported incidence of gallbladder perforation in patients with acute cholecystitis is 2–18% while the incidence of gallbladder perforation because of acalculous cholecystitis is about 10 to 20%. The exact mechanism of gall bladder perforation in patients with acalculous cholecystitis is not understood [3]. In some patients of acalculous cholecystitis the impacted stone in the cystic duct fall back into gallbladder and this resolves the cholecystitis while if this inflammation don’t get resolved then persistent inflammation caus...

BACKGROUND: - After the start of COVID-19 pandemic from Wuhan city of China in December 2019 and ... more BACKGROUND: - After the start of COVID-19 pandemic from Wuhan city of China in December 2019 and appearance of first case in Pakistan in February 2020, health care professionals (HCPs) played the role of front-line soldiers around the globe especially in developing and limited resource nations like Pakistan. The understanding of HCPs played an important role in limiting the spread of this infection in Pakistan. METHODOLOGY: - It was an online cross-sectional study done by EAST Surgical ward MAYO hospital Lahore. An online generated proforma was created on Google forms and was sent through WhatsApp and Facebook contacts of authors to HCPs all over the Pakistan. This survey consists of total of 31 questions. Total 1000 questionnaires were collected. The completed questionnaires were compiled and analyzed by using SPSS software version 21. Frequencies of responses were calculated. RESULTS: 650 (65%) of the respondents were male and 350 (35%) were female. Majority of the respondents wer...

International Surgery Journal, 2021

Background: General surgery residency is considered a stressful field with residents facing many ... more Background: General surgery residency is considered a stressful field with residents facing many problems including learning operative procedures, competition with fellow colleagues, gender discrimination and balancing their marital and family life.Methods: A cross-sectional study was conducted using a self-structured questionnaire, containing questions about perspective of general surgical residents about residency structure and problems in Pakistan and about allotment of surgical procedures to them. A total of 1624 general surgical residents were conveniently enrolled in this study from different tertiary care hospitals of Pakistan.Results: Mean age of residents was 29 years (range 24-35 years).70.44% of residents were male while 29.55% were female. Majority of the residents were from 2nd year residency (30.66%). 889 (54.7%) of the residents thought that the general surgery residency had put negative effects on their family and marital life while 1365 (84%) stated that they suffer...

British Journal of Surgery, 2021

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numb... more Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst ...

Journal of the Pakistan Medical Association, 2020

A 47-year-old woman presented in the outpatient department of EAST Surgical ward of MAYO Hospital... more A 47-year-old woman presented in the outpatient department of EAST Surgical ward of MAYO Hospital Lahore, Pakistan, on February 2019 with complaint of swelling in the front section of the neck since five months which increased gradually in size and had been causing pain since two months. She had no comorbidities and insignificant family history. Examination revealed a 23×20 cm mass on the right side of the posterior triangle of the neck. Fine Needle Aspiration Cytology (FNAC) was inconclusive and CT of the neck showed a huge mass on the right side of the neck with cervical lymph nodes. Exploration was planned, and modified radical neck dissection Type III (Also known as Functional Neck dissection) was performed. The biopsy revealed synovial sarcoma of the neck. The patient’s post-operative condition was satisfactory and she was discharged on the fifth post-operative day. Continuous...

European Journal of Medical Case Reports, 2021

Emergency Medicine, Trauma and Surgical Care, 2020

A 47 years old male presented to emergency department with history of pain abdomen after road tra... more A 47 years old male presented to emergency department with history of pain abdomen after road traffic accident 6 hours back. He had deceleration injury while driving a minivan when he hit a truck parked on road side. On presentation, his Airway and breathing was intact with GCS 15/15.Pulse was 110/min and blood pressure was 100/70 mmHg. His abdomen was generalized tender, mostly in the hypogastrium. Digital rectal examination was normal. Ultrasound abdomen showed free fluid in the peritoneal cavity and chest and abdominal X-rays were unremarkable. On opening the abdomen there was 7×7 cm isolated perforation in sigmoid colon 5 cm proximal to recto sigmoid junction. Repair of perforation was done and proximal double barrel sigmoid colostomy was made. Patient was discharged on 3rd post-operative day. Later after 4 months reversal of sigmoid colostomy was done and patient was discharged.

Pakistan Journal of Medical Sciences, 2021

Objective: To assess the role of abdominal binder in patients with midline wound dehiscence after... more Objective: To assess the role of abdominal binder in patients with midline wound dehiscence after elective or emergency laparotomy in terms of pain, psychological satisfaction and need for reclosure. Methods: It was a comparative study done at EAST Surgical Ward of Mayo Hospital, Lahore from 1st January 2018 to 31st December 2019. One hundred and sixty-two (162) patients were included in this study with post-operative midline abdominal wound dehiscence and after informed consent by consecutive non probability sampling technique. Patients were divided into two groups by lottery method into eighty-one patients each. Group-A included patients where abdominal binder was applied and Group-B included patients without abdominal binder. In both groups pain score, psychological satisfaction and need for reclosure was assessed and compared. Results: Patients with abdominal binder shows significantly less pain (P value =0.000) and more psychological satisfaction (P value = 0.000) as compared t...

Journal of the Pakistan Medical Association

Pilonidal disease occurs most commonly in those males who have to sit long hours at their work pl... more Pilonidal disease occurs most commonly in those males who have to sit long hours at their work place e.g. online office workers or drivers. It is caused by piercing of broken hairs into the sacrococcygeal region which causes localised inflammation. Inflammation in this area due to any other foreign body is very rare. Among many treatment options for pilonidal sinus, instillation of crystalloid phenol showed promising results in terms of low recurrence rates, low post-operative complications and less healing time. Here, we present the case of a 13-year-old female student who had pilonidal sinus in sacrococcygeal region for six months and was unresponsive to multiple treatments. Later, on exploration it was revealed to contain a small foreign body of 3cm of hard straw of grass. The patient was treated with crystalloid phenol and on regular follow-up she was completely fine by the end of the third week.

Journal of Gandhara Medical and Dental Science

Pneumoperitoneum caused by a perforated appendix is extremely rare. We encountered a case of a 24... more Pneumoperitoneum caused by a perforated appendix is extremely rare. We encountered a case of a 24 years old male presented in the emergency department of EAST surgical ward of MAYO Hospital Lahore with a history of epigastric pain for 10 days, which later became generalized. Chest X-ray showed free air under the right hemidiaphragm. On the basis of clinical examination and radiological correlations diagnosis of duodenal ulcer perforation was made. On exploration of abdomen through midline incision it was found to be a perforated appendix at its tip. The body and base of the appendix was normal. No per operative and postoperative complications were encountered and the patient discharged on the second postoperative day. Biopsy of appendix showed acute inflammation of appendix.

International Surgery Journal, 2021

Background: Enteric fever leading to enteric perforation is very common surgical emergency in the... more Background: Enteric fever leading to enteric perforation is very common surgical emergency in the developing nations. The two surgical solutions used worldwide are to repair or exteriorize the perforation as ileostomy. The aim of the study was to setup and validate a statistically reliable scoring system for decision between repair and ileostomy in patients with peritonitis due to enteric perforation.Methods: It was an observational cross-sectional study done at East Surgical Ward of Mayo Hospital, Lahore. 256 patients were selected by consecutive non-probability sampling after ethical approval. The duration of study was 2 years from 1st August to 2018 to 30th July 2020. Patients with age more than 13 years presented in emergency department with diagnosis of peritonitis due to enteric perforation were included. A preformed scoring criterion named as East surgical ward enteric perforation (ESWEP) score was set by giving each variable a score of 1 to 3. Cut-off value between repair an...

The Professional Medical Journal, 2021

Objective: This study is aimed to know the histopathological spectrum and outcome of surgery for ... more Objective: This study is aimed to know the histopathological spectrum and outcome of surgery for salivary gland tumors presented in a tertiary care hospital of Pakistan. Study Design: Retrospective study. Setting: Tertiary Care Hospital of Pakistan. Period: July 2018 to June 2020. Material & Methods: After approval from Institutional Review Board. Total 73 patients were selected with preoperative diagnosis of salivary gland tumors with consecutive non probability sampling. All surgical procedures were done by specialist general surgeons who had experience of more than 10 years of head and neck surgery. Results: Male to female ratio was 2:1 with mean age of patients was 46 years. Among males 29 (59.1%) were benign salivary gland tumors while 20 (40.81%) were malignant salivary gland tumors. Among females 13 (54.16%) were benign and 11 (45.83%) were malignant salivary gland tumors Most common benign tumor was pleomorphic adenoma 32 (43.8%) while mucoepidermoid carcinoma was most commo...

The Professional Medical Journal, 2022

Objective: To compare the open appendectomy with & without peritoneum closure in term of post-ope... more Objective: To compare the open appendectomy with & without peritoneum closure in term of post-operative pain and operative time. Study Design: Comparative study. Setting: EAST Surgical Ward, MAYO Hospital Lahore, Pakistan. Period: July 2019 to June 2020. Material & Methods: Sample size of 150 patients were selected by consecutive non probability sampling technique. Patients were divided into 2 groups with 75 patients in each group. In Group A patients, peritoneum was closed while in Group B patients, peritoneum was not closed. The results of both groups were compared. Data was collected by pre designed proforma and evaluated by SPSS 26. Results: Out of total 150 patients, 96 (64%) were male and 54 (36%) were females. Most common age group was between 31 years to 40 years. The mean operation time taken by the patients in which peritoneum was closed was about 41 minutes with standard deviation of ± 10.54 minutes as compared to the Group B in which peritoneum was not closed and it took...

Journal of the Pakistan Medical Association, 2022

Acute mesenteric ischaemia is one of the serious abdominal surgical emergency, which has got very... more Acute mesenteric ischaemia is one of the serious abdominal surgical emergency, which has got very high morbidity and mortality. During the pandemic of COVID -19, besides respiratory complications, the virus was causing venous and arterial thromboembolism that can lead to acute mesenteric ischaemia in otherwise healthy individuals. Early diagnosis and suitable surgical procedures are the key to the better outcome of this disease. Surgical resection of gangrenous gut, leaving healthy gut is an important step of this operation. Leaving less than 200 cm of small intestine leads to short bowel syndrome which has got its own complication. This case report is on a healthy COVID -19 positive patient who presented with acute mesenteric ischaemia. After surgical resection only 1.5 feet small bowel (60 cm) was left behind and anastomosis was done with healthy transverse colon. ---Continue

Journal of Gandhara Medical and Dental Science, 2022

OBJECTIVES: The objective of this study was to determine frequency of non-compliance to oral iron... more OBJECTIVES: The objective of this study was to determine frequency of non-compliance to oral iron therapy in pregnancy and common factors leading to it. METHODOLOGY: It was a cross-sectional study done in the Department of Obstetrics and Gynecology of Lady Willington Hospital Lahore, Pakistan. The duration of this study was six months i.e., 3rd October 2019 to 2nd March 2020. All antenatal patients between ages of 18 to 45 years presented in the obstetrics outdoors or admitted in the ward were included in this study. A total of 245 patients were included in this study by consecutive non-probability sampling. Patients with gynecological problems, patients dependent on others for their medication cost, patients with psychiatric illness or physical disability were excluded. Post stratification Chi-square test was applied keeping P-value ≤0.05 as significant RESULTS: Among 245 patients, mean age was 27±2.16 years. Iron supplement used by 245 patients was analyzed as 159 (65%) patients h...

Journal of the Pakistan Medical Association, 2020

A 36-year-old woman presented in the emergency department of East Surgical Ward of MAYO Hospital ... more A 36-year-old woman presented in the emergency department of East Surgical Ward of MAYO Hospital Lahore, Pakistan, in August 2019 with compliant of abdominal pain and vomiting for the past five days. The patient had a history of three Caesarean sections, the last one three years back. Off and on, she experienced abdominal pain and distension which was relieved after taking local medicines. She had no comorbid conditions and her baseline investigations were normal. On examination she had tachycardia with pulse 110/min and her whole abdomen was tender with exaggerated bowel sounds. X ray of the abdomen showed multiple air fluid levels in the small intestine. Exploration plan was made; a distended segment of ileum was later found to have abdominal sponge inside its lumen. Continuous...

JPMA. The Journal of the Pakistan Medical Association, 2021

OBJECTIVE To assess the risk factors for lower limb amputations in diabetic patients presenting w... more OBJECTIVE To assess the risk factors for lower limb amputations in diabetic patients presenting with foot ulcers. Methods The analytical cross-sectional study was conducted at the Mayo Hospital, Lahore, Pakistan, from December 1, 2019, to May 31, 2020, and comprised patients of either gender having type 1 or type 2 diabetes and foot ulcers. The wounds were assessed according to Wagner wound staging and wound sepsis was evaluated in terms of local infection of the wound, leucocytosis and osteomyelitis of the bone. The glycaemic control of these patients was assessed on presentation by measuring glycated haemoglobin levels. Data was analysed using SPSS 26. RESULTS Of the 135 patients, 82(60.7%) were males and 53(39.2%) were females. Majority patients 59(43.7%) were aged 50-60 years. All 135(100%) patients underwent some type of amputation. Of all the amputations, 91(67.4%) were done in patients with poor glycaemic control on presentation, and 56(41.5%) in those with stage 4 wound. Loc...

The Professional Medical Journal, 2021

Objective: The objective of this study is to compare the effect of pre-operative calcium and vita... more Objective: The objective of this study is to compare the effect of pre-operative calcium and vitamin D supplements in terms of hypocalcemia in patients with total thyroidectomy. Study Design: Comparative study. Setting: EAST Surgical Ward, MAYO Hospital Lahore, Pakistan. Period: 1st July 2018 to 30th June 2020. Material & Methods: Sample size of 342 patients and duration of 2 years. 2 groups were created including 171 patients each. Group A patients received calcium and vitamin D supplements 1 week prior to total thyroidectomy while Group B patients didn’t receive any supplements. The results of both groups were compared. Data was collected by pre designed proforma and evaluated by SPSS 21. Results: 164 (47.9%) patients were male and 178 (52.0%) were females. Most common age group which undergone total thyroidectomy was between 31 years to 40 years. Total 140 patients (40.93%) experienced hypocalcemia. In group A, 32 (18.71%) experienced hypocalcemia while in group B 108 (63.1%) exp...

Gallbladder perforation is a rare presentation encountered in the surgical emergency floor [1]. T... more Gallbladder perforation is a rare presentation encountered in the surgical emergency floor [1]. The most common mode of presentation of gall bladder perforation is peritonitis but the pre-operative diagnosis of gall bladder perforation is difficult to make especially where there is no availability of advance imaging techniques like CT scan [2]. This delay can result in morbidity and even mortality of the patient with significant influence on the outcomes. The reported incidence of gallbladder perforation in patients with acute cholecystitis is 2–18% while the incidence of gallbladder perforation because of acalculous cholecystitis is about 10 to 20%. The exact mechanism of gall bladder perforation in patients with acalculous cholecystitis is not understood [3]. In some patients of acalculous cholecystitis the impacted stone in the cystic duct fall back into gallbladder and this resolves the cholecystitis while if this inflammation don’t get resolved then persistent inflammation caus...

BACKGROUND: - After the start of COVID-19 pandemic from Wuhan city of China in December 2019 and ... more BACKGROUND: - After the start of COVID-19 pandemic from Wuhan city of China in December 2019 and appearance of first case in Pakistan in February 2020, health care professionals (HCPs) played the role of front-line soldiers around the globe especially in developing and limited resource nations like Pakistan. The understanding of HCPs played an important role in limiting the spread of this infection in Pakistan. METHODOLOGY: - It was an online cross-sectional study done by EAST Surgical ward MAYO hospital Lahore. An online generated proforma was created on Google forms and was sent through WhatsApp and Facebook contacts of authors to HCPs all over the Pakistan. This survey consists of total of 31 questions. Total 1000 questionnaires were collected. The completed questionnaires were compiled and analyzed by using SPSS software version 21. Frequencies of responses were calculated. RESULTS: 650 (65%) of the respondents were male and 350 (35%) were female. Majority of the respondents wer...

International Surgery Journal, 2021

Background: General surgery residency is considered a stressful field with residents facing many ... more Background: General surgery residency is considered a stressful field with residents facing many problems including learning operative procedures, competition with fellow colleagues, gender discrimination and balancing their marital and family life.Methods: A cross-sectional study was conducted using a self-structured questionnaire, containing questions about perspective of general surgical residents about residency structure and problems in Pakistan and about allotment of surgical procedures to them. A total of 1624 general surgical residents were conveniently enrolled in this study from different tertiary care hospitals of Pakistan.Results: Mean age of residents was 29 years (range 24-35 years).70.44% of residents were male while 29.55% were female. Majority of the residents were from 2nd year residency (30.66%). 889 (54.7%) of the residents thought that the general surgery residency had put negative effects on their family and marital life while 1365 (84%) stated that they suffer...

British Journal of Surgery, 2021

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numb... more Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst ...

Journal of the Pakistan Medical Association, 2020

A 47-year-old woman presented in the outpatient department of EAST Surgical ward of MAYO Hospital... more A 47-year-old woman presented in the outpatient department of EAST Surgical ward of MAYO Hospital Lahore, Pakistan, on February 2019 with complaint of swelling in the front section of the neck since five months which increased gradually in size and had been causing pain since two months. She had no comorbidities and insignificant family history. Examination revealed a 23×20 cm mass on the right side of the posterior triangle of the neck. Fine Needle Aspiration Cytology (FNAC) was inconclusive and CT of the neck showed a huge mass on the right side of the neck with cervical lymph nodes. Exploration was planned, and modified radical neck dissection Type III (Also known as Functional Neck dissection) was performed. The biopsy revealed synovial sarcoma of the neck. The patient’s post-operative condition was satisfactory and she was discharged on the fifth post-operative day. Continuous...

European Journal of Medical Case Reports, 2021

Emergency Medicine, Trauma and Surgical Care, 2020

A 47 years old male presented to emergency department with history of pain abdomen after road tra... more A 47 years old male presented to emergency department with history of pain abdomen after road traffic accident 6 hours back. He had deceleration injury while driving a minivan when he hit a truck parked on road side. On presentation, his Airway and breathing was intact with GCS 15/15.Pulse was 110/min and blood pressure was 100/70 mmHg. His abdomen was generalized tender, mostly in the hypogastrium. Digital rectal examination was normal. Ultrasound abdomen showed free fluid in the peritoneal cavity and chest and abdominal X-rays were unremarkable. On opening the abdomen there was 7×7 cm isolated perforation in sigmoid colon 5 cm proximal to recto sigmoid junction. Repair of perforation was done and proximal double barrel sigmoid colostomy was made. Patient was discharged on 3rd post-operative day. Later after 4 months reversal of sigmoid colostomy was done and patient was discharged.

Pakistan Journal of Medical Sciences, 2021

Objective: To assess the role of abdominal binder in patients with midline wound dehiscence after... more Objective: To assess the role of abdominal binder in patients with midline wound dehiscence after elective or emergency laparotomy in terms of pain, psychological satisfaction and need for reclosure. Methods: It was a comparative study done at EAST Surgical Ward of Mayo Hospital, Lahore from 1st January 2018 to 31st December 2019. One hundred and sixty-two (162) patients were included in this study with post-operative midline abdominal wound dehiscence and after informed consent by consecutive non probability sampling technique. Patients were divided into two groups by lottery method into eighty-one patients each. Group-A included patients where abdominal binder was applied and Group-B included patients without abdominal binder. In both groups pain score, psychological satisfaction and need for reclosure was assessed and compared. Results: Patients with abdominal binder shows significantly less pain (P value =0.000) and more psychological satisfaction (P value = 0.000) as compared t...