Dogar Surgery Book Free Download
Karl Meinhardt
The study aimed to determine the prevalence of hereditary thrombophilia, and stratify its severity among live liver donors in Pakistan. Also, the authors evaluated the safety and efficacy of thrombophilia profile testing directed venous thromboembolic events (VTE) prophylaxis while balancing bleeding risk and the need for routine thrombophilia testing before live liver donation among living donor candidates.
Protein S (PS), protein C (PC), anti-thrombin (AT) III, and anti-phospholipid antibody panel (APLA) levels were measured in 567 potential donor candidates. Donors were divided into normal, borderline and high-risk groups based on Caprini score. The safety endpoints were VTE occurrence, bleeding complications or mortality.
Due to thrombophilia testing directed VTE prophylaxis, VTE events were comparable in normal, borderline and high-risk thrombophilia donor groups, but more evaluations are required to determine the lower safe levels for various thrombophilia parameters including PC, PS and AT-III before surgery among living donor candidates.
Global Surgery (GS) is a movement that advocates access of every individual to safe and affordable surgery despite geographic location or socioeconomic status. It has recently received increased attention within the global health arena, but many patients are still without access to care because of geographical, social and economic disparities. Due to the multi-disciplinary nature of surgical services, GS requires that a worldwide network of healthy surgical systems be developed and sustained. Healthy surgical systems have many components, and this paper will briefly address 3 of those components: Improved access to care, safety and quality, and multidisciplinary strengthening.
Congenital absence of the appendix is an extremely rare condition. Often found incidentally during surgical procedures, it poses a surgical dilemma. Surgeons must be well versed in the congenital abnormalities and positional variations of the appendix and must know the steps required during surgery to diagnose this abnormality. In this case report, we discuss the first ever occurrence of congenital absence of appendix in association with malrotation.
N2 - Congenital absence of the appendix is an extremely rare condition. Often found incidentally during surgical procedures, it poses a surgical dilemma. Surgeons must be well versed in the congenital abnormalities and positional variations of the appendix and must know the steps required during surgery to diagnose this abnormality. In this case report, we discuss the first ever occurrence of congenital absence of appendix in association with malrotation.
AB - Congenital absence of the appendix is an extremely rare condition. Often found incidentally during surgical procedures, it poses a surgical dilemma. Surgeons must be well versed in the congenital abnormalities and positional variations of the appendix and must know the steps required during surgery to diagnose this abnormality. In this case report, we discuss the first ever occurrence of congenital absence of appendix in association with malrotation.
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Copyright: 2022 Qazi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: The study was funded by Bill and Melinda Gates Foundation under grant number OPP 1148892 to JKD. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Surgical conditions are responsible for up to 15% of total disability-adjusted life years (DALYs) lost globally [1]. Worldwide estimates have found that approximately 4.8 billion people have no access to surgical care, and within South Asia, greater than 95% of the population do not have access to care for conditions that require surgical management [2]. Considering that greater than 50% of the population in the least developed regions worldwide is children, we can surmise that the surgical burden amongst children in Low and Low Middle-Income Countries (LMICs) is immense [3, 4]. Currently, a large disproportion exists between the wealthiest and poorest third of the population globally, with the wealthy receiving a major share of 73.6% of surgical procedures and the poor receiving only 3.5% [5]. Within poorer countries, surgical services are concentrated almost wholly in cities and reserved largely for those who can pay for them out of pocket [1].
Until recently, pediatric surgical care in low and middle-income countries (LMICs) was largely overlooked, with global health attention primarily addressing communicable diseases, and maternal and infant mortality [5]. However, improvement of surgical care delivery for children is now being prioritized as a fundamental component of health care in LMICs [6]. Improving surgical care delivery also has significant economic and welfare benefits for the population, as untreated surgical conditions increase medical costs, disability, and death [4]. Hence, the development of methods to enhance the quality of pediatric surgical care in low-resource regions can remarkably decrease childhood morbidity and mortality [7] and alleviate the associated financial and emotional stress.
Sindh is the second largest province by population (approximately six million people) and the third largest province in Pakistan [22]. TMK is one of the 29 districts in Sindh with an area of 1,814 square kilometers (km2), an overall population of 677,228, and a population density of 373 people/km2, Sindhi as the most commonly spoken language [23]. TMK district was chosen as the site for our project due to our established office in the district, the availability of skilled manpower and other resources to conduct this large-scale survey. TMK is also a representative of any rural district in Sindh.
The SOSAS survey consists of two portions. The first section collects demographic details, including the age and sex of household members, and number of deaths in the household within the past year. Household members are defined as people living in the same physical structure. The second half of the survey gathers information from caregivers on both current and previous surgical conditions of their children, which is categorized into six distinct anatomical regions: face, head, and neck; chest and breast; abdomen; groin, genitals, and buttocks; back; arms, hands, legs, and feet. The caregivers answered questions based on their recall and their perception of a surgical condition. Additional questions cover the type of injury/accident, timing of the condition, and health-seeking behavior, which includes the type of health care sought, type of health care received, and reasons if care was not accessed. The survey questions were translated into Sindhi, the primary language of TMK by coordination of experts in both English and Sindhi language and was pilot tested in the field.
The PediPIPES survey assesses gaps in the availability of essential and emergency surgical care (EESC) at the district health facilities. The data items were divided into five sections: Personnel; Infrastructure; Procedures; Equipment; and Supplies. PediPIPES scores were calculated by allocating 1 point for each personnel, infrastructure, procedures, equipment, and supplies present in the facility and summing it. This number was then divided by the total number of data items (118) and multiplied by 10 to create the PediPIPES index. There is no maximum number for the PediPIPES index. This index indicates the capacity of health facilities to provide EESC to infants and children.
Households in TMK districts were line-listed and a total of 3,643 eligible houses were randomized. The SOSAS survey was conducted by research personnel who were trained for data collection and were monitored by senior managers. A pilot study for trial and improvements was conducted in 50 households. Verbal consent was obtained from the caregivers, and surveys were administered in Sindhi language. Caregivers provided the survey information about their children below the age of five years. The information was recorded electronically via an application developed specially for this survey by the District Monitoring Unity (DMU). The application was developed for Android, and an IIS-10 webserver was setup with MySQL database to collect data in the remote areas. APIs were developed on webserver in PHP to send and receive data to and from devices. The purpose of the android-based survey application was to assist data collectors in conducting interviews in the remote field areas and capture data in electronic format. The application was used on Samsung tab A7 tablet. To restrict inappropriate access to the application, authorized data collectors were required to authenticate using login credentials that were specifically generated for the use of this application on the server.
The PIPES survey data from all facilities in TMK was collected. The data was collected on hard copies and then entered onto an excel sheet. A total of 233 photographs were also taken of children with lesions to understand how these could help diagnosis and future roll-out of such a strategy. These were reviewed by the relevant surgeons at the Aga Khan University Hospital (AKUH) for diagnosis, and confirmation of the previously established diagnosis. These pictures were taken via the same application developed and stored on the tablet/phone under password protection.
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