Oral clefts: a review of the cases and our experience at a single institution.

OBJECTIVE: To identify the frequency of different types of oral clefts and presence of known risk factors among patients. METHODS: The retrospective review of 292 patients, presenting with oral clefts between 1992 and 2011, was conducted at the Aga Khan University Hospital, Karachi. A pre-designed questionnaire was used to collect details, including demographics, type of cleft, presence of known risk factors, surgical details, and follow-up visits. SPSS 16 was used for data analysis. Chi-square test and analysis of variance was used: whenever applicable. RESULTS: Of the total, 168 (57-53%) patients had cleft lip with or without cleft palate, and 124 (42.5%) had cleft palate alone. The most common defect was left-sided complete cleft lip and palate and midline incomplete cleft palate in the two groups respectively. Consanguinity among the parents was found to be the most common risk factor (n = 50; 17.1%). Median age of repair was 4 months for cleft lip and 10 months for cleft palate in the first group. For the other group, the median age of primary repair was 13 months. First-week follow-up after surgery was 50% (n = 84) for the lip repair, and 65% (n = 81) for palate repair. CONCLUSION: Our review revealed that most patients had cleft lip with or without cleft palate (CL/P). The most common risk factor was consanguinity among parents. Delay in seeking care, low follow-up rates after surgical repair of the anomaly and lack of involvement of speech therapist and orthodontist was observed.

Value of Dedicated Research Time for IMGs in Obtaining Surgical Residency Training Positions: A 10-Year Review of Applicants from a Medical College in Pakistan.

OBJECTIVE: International Medical Graduates (IMGs) secured greater than 10% of all general surgery (GS) residency positions in the US during the past decade. The Match process remains competitive, with a significant number of IMGs performing dedicated research before residency application. The impact of such research remains largely unknown. We aimed to provide an objective analysis of the impact of dedicated research time on obtaining a categorical GS residency position. DESIGN: Data for National Resident Matching Program Match results from 2008-2017 was compiled from annual Match lists of the Aga Khan University, Medical College (Karachi, Pakistan). Medical graduates provided this information voluntarily each year. Data was exported to Microsoft Excel and used for descriptive and statistical analysis using SPSS. Candidates were divided into quasi-experimental groups based on their preference for direct application (no-research group, n = 64) or research prior to Match (research group, n = 20). RESULTS: A total of 84 IMG applicants matched into GS residency positions in the US within the past decade. Amongst these, 18 matched directly into categorical positions while 66 applicants secured preliminary spots. A total of 37 (56%) preliminary candidates eventually secured categorical GS residency positions. Research group applicants had an overall 85% (n = 17) success rate of obtaining a categorical position, while no-research group had a 59% (n = 39) success rate (chi-square test, p = 0.04). Success rate was 69% (n = 38) for male applicants and 57% (n = 17) for female applicants. Median time to a categorical position was 4 years (2-6) for the research group and 3 years (1-6) for the no-research group. CONCLUSIONS: Our quasi-experimental study demonstrated a higher success rate for Aga Khan University, Medical College applicants with significant research background in the US, compared to those who did not. Better social integration, enhanced mentorship available during research, overcoming of cultural and linguistic barriers and a perception as better qualified candidate can be some factors contributing to higher success rates.

Low conversion rate during minimally invasive major hepatectomy: Ten-year experience at a high-volume center.

BACKGROUND: Minimally invasive approaches for major hepatectomy have been marred by significant rates of conversion and associated morbidity. This study aimed to determine risk factors for conversion as well as postoperative morbidity in patients undergoing minimally invasive right-sided hepatectomy (MIRH). METHODS: Data for patients undergoing MIRH between 2008 and 2017 at Emory University were reviewed. Risk factors for conversion were determined using multivariate regression analysis. Outcomes of conversion patients were compared with those who underwent successful MIRH or elective open surgery. RESULTS: Unplanned conversion occurred in 7 (6.25%) of 112 patients undergoing MIRH. Primary reason for conversion was difficult dissection secondary to inflammation and severe adhesions. No preoperative clinical factor was identified that predicted conversions. Converted cases had higher EBL and pRBC transfusion compared to non-converted cases however morbidity was similar to those undergoing primary open surgery. CONCLUSION: Difficult dissection and adhesions remained the only clinically applicable parameter leading to unplanned conversions. While these did offset benefits of a successful minimally invasive approach, it did not increase risk of postoperative complications compared with planned open surgery.