Knowledge & Attitude regarding Stem Cells research and its applications among Residents of a Tertiary Care Hospital in Karachi, Pakistan.

Objectives: The importance and potential of the use of stem cells as therapeutic tools is enormous and therefore, health professionals should be expected to have thorough knowledge and a positive attitude towards their utilization in medical practice. Hence this study was carried out to report and assess the knowledge and attitude regarding stem cell in our region. Methodology: The study was conducted amongst the residents employed at the Aga Khan University hospital, Karachi Pakistan from September-October 2022 with a sample size of 57. RESULTS: Amongst our survey participants, 33 (54.2%) responded with a score of 48 and above (i.e., 60% or above); 25 (40.9%) of the study participants scored between 50-60% only 3 (4.9%) had a score 40-50. CONCLUSIONS: Our survey shows a reasonable level of knowledge of the generic principles and implications Stem cell therapy amongst the residents.

Mesenchymal stem cell therapy for treatment of osteoradionecrosis of mandible in head and neck surgery patients - A way forward into the future with promising clinical Outcomes.

Managing osteoradionecrosis is an integral part of complication management in head and neck cancer patients. While essentially an infection, the management of this complication has a considerable task for head and neck surgeons. While various measures have been discussed for the management, stem cells injection therapy is a potential management option. Mesenchymal stem cell therapy provides the local tissue with growth factors and proliferative cells that can aid a radiated tissue in the healing process. The article intends to review the bedrock of the pathology, ranging from pathophysiological and the epidemiological concerns to sparking a potential discussion on the use of mesenchymal stem cell therapy in osteoradionecrosis of mandible in head and neck cancer surgery and thus the ensuing future of the regenerative medicine. Moreover, the article has considered the management option in a developing nation thus explaining the procedural as well as the financial pitfalls and has highlighted the potential loop holes to be addressed in the management of osteoradionecrosis with stem cell therapy.

Unilateral Thyroid Lobectomy as Day Care Procedure: A Cross Sectional Study with Literature Review on the Safety and Cost Effectiveness.

Introduction Thyroid nodules are common globally in almost one fifth of the adult population. The gold standard treatment for thyroid nodule is thyroid lobectomy or total thyroidectomy depending upon the diagnosis. Thyroidectomy has a few known complications but, as per the ATA consensus statement, it is a safe surgery to be done as a day care procedure. Objective To access the feasibility and safety of thyroid lobectomy as a day care surgery and its effect on decreasing overall financial burdens. Methods This retrospective chart review was done from 2006 to 2022. A total of 736 patients underwent thyroid lobectomy among which only 56 were done as day care surgery. Data analysis was done using the IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, NY, USA). Results A total of 40% of the population was male. The mean age of the study population was 42 years. Bethesda II was the most encountered diagnosis, with a rate of 69%. The majority of patients were discharged after 6 hours of postoperative observation. The only complication encountered was seroma, which was seen in two patients. Conclusion Thyroid lobectomy appears to be a safe procedure with a drastic difference in overall cost as a day care procedure. We recommend switching the practice of inpatient thyroid lobectomy to a day care procedure in carefully selected candidates. The major hurdle in day care lobectomy can be approval from insurance.

Unilateral Thyroid Lobectomy as Day Care Procedure: A Cross Sectional Study with Literature Review on the Safety and Cost Effectiveness

Abstract Introduction Thyroid nodules are common globally in almost one fifth of the adult population. The gold standard treatment for thyroid nodule is thyroid lobectomy or total thyroidectomy depending upon the diagnosis. Thyroidectomy has a few known complications but, as per the ATA consensus statement, it is a safe surgery to be done as a day care procedure. Objective To access the feasibility and safety of thyroid lobectomy as a day care surgery and its effect on decreasing overall financial burdens. Methods This retrospective chart review was done from 2006 to 2022. A total of 736 patients underwent thyroid lobectomy among which only 56 were done as day care surgery. Data analysis was done using the IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, NY, USA). Results A total of 40% of the population was male. The mean age of the study population was 42 years. Bethesda II was the most encountered diagnosis, with a rate of 69%. The majority of patients were discharged after 6 hours of postoperative observation. The only complication encountered was seroma, which was seen in two patients. Conclusion Thyroid lobectomy appears to be a safe procedure with a drastic difference in overall cost as a day care procedure. We recommend switching the practice of inpatient thyroid lobectomy to a day care procedure in carefully selected candidates. The major hurdle in day care lobectomy can be approval from insurance.

Sudden sensorineural hearing loss: A rare presentation of dengue fever.

Sudden Sensorineural Hearing Loss (SSNHL) is described as a hearing loss of at least 30db in three frequencies in pure tone audiogram over 3 days or less. The cause may be infectious, vascular, systemic immune-mediated or idiopathic. Multiple viral infections have been associated with SSNL. However, dengue fever, which is an RNA viral disease that is directly transmitted by a mosquito of genus Aedes, has been reported to present with SSNHL only thrice in existing literature to the best of our knowledge. There are multiple different proposed mechanisms of SSNHL in viral infections and multiple viruses have been proven to cause hearing loss. However, dengue virus is not one of them. In majority of cases of SSNHL, the exact cause is very difficult to determine. We report the case of a gentleman who had unilateral SSNHL after dengue fever.

The Utility of Frozen Sections in the Evaluation of Clear Margins in Oral Squamous Cell Carcinomas: A Cross-Sectional Study From a Tertiary Care Center.

Background and objective Head and neck cancers are prevalent in Pakistan. Oral squamous cell carcinomas are primarily treated via surgical removal, and complete surgical resection is the paramount prognostic factor. A resection margin of 5 mm on the final histopathology report has been accepted as adequate in the existing literature. Negative margins on the frozen section do not guarantee adequate disease-free resections on the final histopathology report. In this study, we aimed to ascertain how accurately tumor-free margins can be detected on frozen sections, which are reported intraoperatively compared to permanent sections of the same tissues reported after proper staining in oral squamous cell carcinoma patients. Methods A cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan; 94 patients presenting between January and October 2016 were included in this study and a total of 432 tumor margins were assessed. Results Among the total 94 patients included in the study, 79% were male and 21% were female. Buccal mucosa was the most commonly involved subsite (57%), followed by the tongue (25%). The most common T stage was T4 (33%), followed by T2 and T3 at 28% and 21% respectively, while the most common N stage was N0 (55%) followed by N1 at 16% and N2 at 22%. The sensitivity of the frozen section in comparison to the permanent section was found to be 50%, while specificity was calculated to be 99.8%. The positive predictive value was 75% and the negative predictive value was 99.3%. Conclusion The frozen section is a highly useful tool for the evaluation of tumor margins. However, while it has high diagnostic accuracy rates, it can produce altered results and therefore requires high clinical correlation.

Rates of publication of FCPS dissertations in international and national peer-review journals among residents at AKUH; A cross sectional review of 15 years.

OBJECTIVE: To see the rate of publication of postgraduate residents' dissertation. METHODS: The single-centre retrospective cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, and comprised research publications from the residents of the departments of Surgery and Medicine who graduated between 2005 and 2020. The surgical subspecialties included Otolaryngology, Ophthalmology, Dentistry, General Surgery, Orthopaedics, Paediatric Surgery, Urology, Plastic Surgery and Cardiovascular Surgery. Data comprised demographics, current institution, current designation, information on dissertation/paper publication, topic of study, year of completion of dissertation, input from the research department, delay in exam due to incomplete dissertation and whether the paper got published in national or international journal. Data was analysed using SPSS 21. RESULTS: Of the 103 subjects, 70(68%) were males and 33(32%) were females, while 73(70.8%) belonged to surgical specialties and 30(29.2%) were from non-surgical specialties. Of the 22(22.9%) who were able to convert, 12(54.5%) publications were carried by national peer-reviewed journals, while 10(45.4%) were carried by international journals; 9(40.9%) unpaid peer review journals and 13(59.1%) paid journals. Delay in exam due to incomplete dissertation was faced by only 16(16.6%) candidates. CONCLUSIONS: The rate of publication for resident dissertation was found to be low.

Otorhinolaryngology consultations in a multidisciplinary hospital - their effects on residents training on floor.

OBJECTIVE: To determine all types and severity of Otolaryngology consultation requests at our tertiary care center and spectral records of problems related to otorhinolaryngology come across initially by residents which will help in re-shaping residency programmes and enhance patient related care. METHODOLOGY: All otorhinolaryngology consultation received over a three-month period were recorded prospectively. Information collected for each encounter included the time, date, reason for consult at primary service and admission with final ENT diagnosis, any surgical or non-surgical intervention, and basic patient demographics. RESULTS: A total of 127 consults for inpatients were reviewed from April 2020 to June 2020. Out of total, 84 (66.1%) patients were male and 43 (33.8%) were females. Adult patient consultations amounted to 87(68.5%) while 18(14.1%) were in the age range of 6-18 years. Only 4(3.1%) consultations were raised for neonatal patients. Routine consultation were had for 64(50.3%) while 45(35.4%) patients were reviewed as an emergency. Operative interventions were required by 43(33.8%) among which tracheostomy was the most common operative procedure performed in 26(20.7%) patients. If we broadly classified ENT consultations, 40 (31.4%) were of problems related to head and neck region while 38 (29.9%) were related to the laryngology sub-specialty. Most common consultation was for airway assessment in 26(20.7%) patients followed by otorrhoea, in 15 (11.8%) patients. CONCLUSIONS: In inpatients, upper airway assessment, aural discharge and epistaxis were the most frequent complaints for seeking ENT review. This study should prove to be beneficial in forming a curriculum of educational programme for junior residents.

Myoepithelioma of the Parotid Gland: A Case Report and Literature Review.

Tumors of the salivary glands are rare and have various histo-pathological subtypes. The overall incidence is 2.5-3 per 100,000 patients per year. Myoepithelioma of the parotid gland is very rare with an incidence of only 1-1.5% among all salivary gland tumors. The diagnostic criteria for benign myoepithelioma were laid down on the basis of the work of Barnes and Sciubba. A 30-year-old lady presented to our university with a mass slowly increasing in size. There were no aggravating and/or relieving factors found. On examination a 3 × 3 cm diffuse swelling was found around the right pre auricular area. Fine Needle Aspiration Cytology (FNAC) was performed. The findings were suggestive of a pleomorphic adenoma. The patient underwent a right sided superficial parotidectomy to remove the tumor. The final histopathology report revealed the tumor to be a myoepithelioma. Myoepithelioma is a benign salivary gland neoplasm formed almost entirely of myoepithelial cells arranged in a sheet, island or cord-like fashion. On CT scans, it presents as a well-circumscribed homogenous lesion with lobulated or smooth margins. Myoepitheliomas may also have nodules that enhance under contrast and areas of linear bands that do not. The recommended treatment for a myoepithelioma is complete surgical excision with wide margins. It has a very low recurrence rate compared to the 15-18% recurrence rate for pleomorphic adenomas. Utilization of immunohistochemical staining is of utmost importance in suspected myoepithelioma cases to ensure proper treatment and follow-up. Myoepitheliomas are rare tumors which must be included in the differential if a patient presents with a tumor of characteristics similar to those described above. Immunohistochemistry and electron microscopy are useful tools for the diagnosis of myoepitheliomas.

The Efficacy of Bethesda System for Prediction of Thyroid Malignancies- A 9 Year Experience from a Tertiary Center.

INTRODUCTION: The best initial investigation for thyroid nodule is fine needle aspiration (FNA). Bethesda System is an international standardized system of reporting thyroid nodules and recommends subsequent management. Every institution should assess the risk of malignancy in each category to avoid unnecessary thyroid surgeries, with this aim we conducted a review at our center to calculate risk of malignancy in each category. MATERIALS AND METHODS: Retrospective 9-year (2009-2018) review of thyroid FNAs done at a tertiary care Centre. The FNA was stratified according to The Bethesda System. Histopathology reports of the operated cases were used to evaluate the cytology for diagnostic accuracy. RESULTS: There were 495 patients who underwent thyroidectomy. The mean age of the cohort was 42.51 +/- 13.2 years and 387 (78.2%) were females. The frequency of Bethesda categories I, II, III, IV, V, and VI were 9.1%, 55.6%, 16.4%, 6.5%, 9.3%, and 3.2% respectively. Malignancy rate in operated thyroid nodules were 37.8%, 8.4%, 33.3%, 50.0%, 89.1%, and 100% for Bethesda categories I to VI, respectively. The sensitivity, specificity, negative predictive value and positive predictive value and their 95% CIs were calculated as 81.30 (73.28 - 87.76%), 77.06 (72.12 - 81.51%), 91.64 (88.3 - 94.1%) and 57.14 (51.79 - 62.33%). The overall diagnostic accuracy was 78.22 (74.12 - 81.95%). CONCLUSIONS: All the Bethesda categories showed greater malignancy risks than other reported studies. Knowledge of local rates of malignancy is important to accurately predict the risk of malignancy even when reported with internationally accepted nomenclature like the Bethesda System.

Role of contrast enhanced computed tomography in assessing cervical lymph node metastases in oral cavity squamous cell carcinoma.

OBJECTIVE: To evaluate the diagnostic accuracy of contrast-enhanced computed tomography scan in detecting cervical nodal metastasis in oral cavity squamous cell carcinoma. METHODS: The retrospective cross-sectional study was conducted at Aga Khan University Hospital, Karachi, Pakistan. and comprised records from January 1, 2015, to October 31, 2016, of patients diagnosed with oral cavity squamous cell carcinoma and who underwent surgical resection of primary tumour along with neck dissection after having a contrast-enhanced computed tomography scan of head and neck. Diagnostic accuracy of the scans was calculated using final histopathology as the gold standard. All scans were reviewed by a consultant radiologist. Data was analysed using SPSS 23. RESULTS: Of the 100 patients whose records were reviewed, 70(70%) were female, 55(55%) had buccal and 32(32%) had tongue cancer.. The scans had sensitivity 83%, specificity 61.7%, positive predictive value 70.9%, negative predictive value 76.3% and overall diagnostic accuracy 73%. CONCLUSIONS: Computed tomography scan was found to be a useful tool for preoperative staging of oral cavity squamous cell carcinoma. However, due to low specificity and negative predictive value, elective neck dissection should still be done in a negative scan for cervical lymph node metastases.

Training in temporal bone surgery: A review of current practices.

The temporal bone consists of complex anatomy, and the presence of various vital structures in close proximity makes the surgery of temporal bone highly challenging. Such a surgery requires years of training under the direct observation of trainers. Over the course of history, different training models have been adopted by experts to help train the young surgeons in this complex procedure. Cadaveric dissections of the temporal bone remains the gold standard in training of residents as the cadavers present the actual anatomical details which the surgeons encounter while operating on patients. However, due to scarcity of available cadavers, their one-time-only usage and high cost of involved in such trainings, experts have developed newer techniques of training, including three-dimensional reconstruction models and virtual reality simulators. Most of the literature on simulation in training of residents focuses on anatomical understanding and development of the surgical technique. There has been significant improvement in these techniques over time. With the addition of haptic feedback in the newer virtual simulation models, simulation has edged closer to basic modules of temporal bone dissection. the current review article was planned to have an overview of the different techniques in detail that are currently being in used.

Malignancy Rate in Thyroid Nodules with Atypia or Follicular Lesion of Undetermined Significance

Abstract Introduction Atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) is one of the six diagnostic categories of the Bethesda System for Reporting Thyroid Cytopathology. The prevalence of malignancy among Bethesda category III cytology is variable, ranging from 5% to 37% in the literature. Objective To determine the rate of malignancy in thyroid nodules reported as Bethesda category III. Methods A total of 495 patients underwent surgical intervention for thyroid nodules from January 2015 to December 2017. The present study included 81 cases reported as Bethesda category III, and their medical records were reviewed. Results Out of 495 fine-needle aspiration cytology samples, 81 (16.4%) samples were labeled as AUS/FLUS. Among these 81 patients, the mean age was 43.0 years (±13.9), with only 11 (14%) patients older than 55 years of age.Most of our patients were female (n=69; 85.2%), and the rest were male. The rate of malignancy based on the final histology was of 33.3% (n=27). The majority were 17 cases (21%) of papillary carcinoma, followed by follicular carcinoma (n=6) (7.4%). Conclusion The risk of malignancy can be higher than it is commonly believed, and guidelines should be based on the data from the institutions themselves for a better assessment of the outcomes.

Malignancy Rate in Thyroid Nodules with Atypia or Follicular Lesion of Undetermined Significance.

Introduction Atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) is one of the six diagnostic categories of the Bethesda System for Reporting Thyroid Cytopathology. The prevalence of malignancy among Bethesda category III cytology is variable, ranging from 5% to 37% in the literature. Objective To determine the rate of malignancy in thyroid nodules reported as Bethesda category III. Methods A total of 495 patients underwent surgical intervention for thyroid nodules from January 2015 to December 2017. The present study included 81 cases reported as Bethesda category III, and their medical records were reviewed. Results Out of 495 fine-needle aspiration cytology samples, 81 (16.4%) samples were labeled as AUS/FLUS. Among these 81 patients, the mean age was 43.0 years (± 13.9), with only 11 (14%) patients older than 55 years of age. Most of our patients were female ( n = 69; 85.2%), and the rest were male. The rate of malignancy based on the final histology was of 33.3% ( n = 27). The majority were 17 cases (21%) of papillary carcinoma, followed by follicular carcinoma ( n = 6) (7.4%). Conclusion The risk of malignancy can be higher than it is commonly believed, and guidelines should be based on the data from the institutions themselves for a better assessment of the outcomes.