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Covid-19 pandemic has significantly challenged the healthcare delivery across the world. Surgery departments across the country responded to this challenge by halting all non-emergency procedures. This delay in diagnosis and management of surgical disease could result in significant mortality and morbidity among the most vulnerable population-the children. In this manuscript, we discuss the measures adopted as well as the challenges faced by the pediatric surgery department at Aga Khan University Hospital, Karachi (AKUH), Pakistan, which is a private, not-for-profit entity and providing optimum surgical care to the patients. We also underscore the need for global strategies for tackling such crisis.
Part of the mission of the Department of Surgery is the creation of new knowledge, and general surgery residents are actively encouraged to participate in that creation throughout their residency years. Each categorical surgery resident must complete at least one project suitable for publication during the course of his/her training; many residents complete multiple projects within the five years of their training.
Opportunity exists within the general surgery residency for a dedicated one- to two-year research experience for selected residents. Residents may apply for such opportunities and will be chosen by the faculty on the basis of performance within the residency, career goals, and proven intellectual curiosity. Available mentors include the Division of General Surgery physician and research faculty members as well as other faculty across the UMMC campus.
The departmental research faculty welcome residents to their laboratories and will mentor residents to navigate the IRB process. Off-campus dedicated research years will be considered on an individual basis (e.g., NIH Clinical Centers). The timing of the research years within a resident's training may vary and will be individualized.
- Fellowship in colorectal surgery (Texas Children Hospital , Houston USA)
- Fellowship in Global Surgery (Duke University, NC, USA)
- Residency in Paediatric Surgery, The Aga Khan University, Pakistan, 2014
The pulmonary rehabilitation programs of scoliosis surgery comprised pursed lip and diaphragmatic breathing exercises that are used to enhance lung ventilation, increase the mobility of thorax, and prevent some complications such as atelectasis.[6]
Hippocrates introduced the AIS. It was shaped by Lenke later on. Lenke classification is a treatment-based classification system in AIS. With Lenke System, although instrumentation is not required for non-structural regions in AIS, instrumentation and fusion are needed for regions with structural curvature.[10] Third-generation posterior systems are widely used to provide a robust and reliable internal fixation in scoliosis surgery.
Benli et al[14] reported an average improvement of 7.9 in the kyphosis angle of the thoracic region. They published that 83.5% of the patients were found to have a normal kyphosis angle. In our study, the average thoracal kyphosis value of the patients was measured to be 38.5, and it declined to 33.4 after the surgery. Moreover, all patients were detected to have a normal kyphosis value after the surgery.
Alveolar hypoventilation and reduced tidal volume due to increased respiration frequency cause apparent hypoxemia during an effort in patients with scoliosis. pCO2 which is normal in the early period, increases in the long term. After the surgery, with the straightening of the spine, the mobility of the thorax, and the VC of the lungs increase, and pO2 values are improved.[27,28] The pO2 values of both groups after the surgery increased compared with those before the surgery, and it was found that the increase in the group who did not have a respiratory exercise was more than that in the group who had a respiratory exercise and was statistically significant. However, pCO2 and HCO3 values in both groups did not show a significant difference between preoperative and postoperative measurements. SaO2 values were determined to be significantly increased in postoperative measurement in both groups.
The Scoliosis Research Society designed a form to evaluate the results of spinal surgeries. The questions in the form were divided into 5 different categories: pain, function, appearance, mental health, and satisfaction from the surgery.[29] Bayraktar et al found that after scoliosis surgery, the average pain score was 4.2, the function score was 4.4, the appearance score was 4.2, the mental health score was 3.8, and the satisfaction score was 4.2.[30] In our study, the SRS-30 form was filled out by the patients in their last control, and it was observed that the function, appearance, mental health, and satisfaction scores of the group who had a respiratory exercise were higher than those of the group who had not.
Dr. Ismail Dogar is native Illinoisan from the west suburbs of Chicago. He attended Benedictine University in Lisle, Illinois where he received his dual Bachelors in International Business and Economics and Health Sciences. He then received his Doctor of Dental Medicine from Midwestern University College of Dental Medicine in Downers Grove, Illinois. Upon completion of dental school, Dr. Dogar choose to pursue a one year residency in advanced education in general dentistry (AEGD) at the University of New Mexico Hospital in Albuquerque, New Mexico. During his residency, Dr. Dogar was exposed to many aspects of dentistry, including management of medically complex patients, as well as surgery and hospital based dentistry.
Our case report evaluates a 2 year old boy who presented to emergency care, following multiple gunshot injuries and was managed emergently using a multidisciplinary surgical approach at our center. The patient was unresponsive, had poor perfusion, bilaterally decreased air entry, a distended abdomen, and multiple entry and exit wounds. A multidisciplinary team including Paediatric Surgery, Cardiothoracic Surgery, Paediatric anaesthesiology team and Orthopaedic surgery were taken on board. Following effective immediate management and stabilization, the patient was admitted to the ward under careful observation. He was discharged on post-operative day 28 after a successful recovery and on his 6 month follow-up, the patient had shown significant improvement, with normal bowel and pulmonary function. Rapid intervention along with a multidisciplinary surgical approach helped ensure the success of the treatment. Prior permission from the patient's guardians was acquired before the preparation of this manuscript.
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.
Leposa, T.,Johnston, B.,Dogar, S. A.,Rice, H.,Fitzgerald, T.(2019). Global surgery: building healthy surgical systems.. Journal of Pakistan Medical Association, 69(1), s90-s94.
Available at: _fhs_mc_surg_surg/766
Dr. Muhammad Akram Dogar expert specialization in general surgery involves surgical treatment of a wide range of diseases and disorders neurological conditions such as appendectomy, breast surgery, breast biopsy, laparotomy, hernia surgery, etc.
Dr. Muhammad Akram Dogar has been associated with renowned hospitals. He continued serving in different surgery departments for years surgically treating different types of conditions. A general surgeon also specializes in providing pre and post-surgical care to patients.
He has also been working on performing diagnostic tests and guiding patients regarding the need for surgery. Based on existing conditions, he provides customized surgical treatment plans for patients of all age groups. His expertise in advanced general surgery makes him one of the top certified general surgeons in Lahore.
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