Purpose: To assess the rate and factors associated with non-adherence of Rivaroxaban in patients with deep venous thrombosis. Methodology: An observational longitudinal study was conducted at the Department of Surgery, Aga Khan University & Hospital, Karachi between June 2022 to November 2022. Patients with known malignancy with or without chemotherapy, those with a known diagnosis of hypercoagulability disorder or a history of limb trauma leading to deep venous thrombosis were included in the study. Patients who have refused to start rivaroxaban treatment prescribed by vascular surgeons, those with cognitive disabilities, such as dementia, who need to rely on a caregiver for their medical care were excluded. The frequency of missed doses, side effects, and causes of non-adherence to the prescribed treatment were recorded. Results: A total of 180 patients were recruited with a mean age of 66.3 ± 8.2 years. Out of 180 patients, 111 (61.6%) missed at least one dose during treatment. We reported the self-reported adherence of 70%. 72 (30%) were non-adherent. Majority revealed that they forget to take medicine; 78 (43.3%) or experienced side effects; 60 (33.3%). Five patients were hospitalized due to serious adverse events (bleeding per rectal and gastrointestinal). Conclusion: A significant percentage of non-adherence among participants was found in our study. One of the primary causes of non-adherence was forgetfulness. We recommended that patients get appropriate counseling on the expected results and negative effects of the medicine in order to promote adherence to Rivaroxaban. Keywords: Adherence, compliance, deep venous thrombosis, Rivaroxaban
Objective: To assess the types and effectiveness of simulators present for open varicose vein surgery. Method: The systematic review was conducted at The Aga Khan University Hospital Karachi and comprised studies published from 1st January 2000 to 30th June 2020 related to open varicose vein surgical procedures done on simulators. Databases searched were PubMed, Medline, Google Scholar, Cochrane and Scopus using appropriate key words. The primary outcome of thereview was to assess the effectiveness of different types of simulators used for varicose vein surgery. Results: Of the 286 articles found, 6(2%) were included. A variety of simulators ranging from animal models, homemade simulators and commercially designed models with high fidelity options had been used. Technical competence was the major domain assessed in most of the studies 5(83.3%), while 1(16.6%) study focussed on self-assessment. Blinding was done in4(66.6%) studies for assessment purpose, and videorecording of the trainees' performance was done in 5(83.3%) studies. Most studies 4(66.6%) found the use of simulation to be an effective tool in achieving technical competence.Conclusion: The use of simulation in the training of surgical residents for open varicose vein surgery was found to be beneficial, but most studies were heterogeneous in terms of design, simulator types and study participants. This makes it difficult to establish the superiority of any one type of simulator over the rest. Further research is needed to develop and validatesimulators in open varicose vein surgery procedures. Continuous...
IntroductionDespite numerous advances, hepatic resection remains a challenging surgical procedure in developing countries. The objective of our study was to review the short term outcome of recent 75 cases of hepatic resection at our centre and compare the results with our previously published data.MethodsAll the patients who underwent a formal hepatic resection at Aga Khan University Hospital, Karachi between 2016 and 2018 were included in the current study. Group comparison was made between our previously published data [Group A] and the current results [Group B].ResultsThe mean age of the patients in the current study was 54 years and there were 40 [53%] males. Hepatic resection was performed for hepatobiliary malignancies in 42, metastatic malignancy in 18 and symptomatic benign conditions in 15 patients. Major hepatic resection [>3 segments] was performed in 24 [32%] patients and the mean estimated blood loss was 643 millilitres. Post-operative complications were observed in 21 [28%] patients, while 30-day and 90-day mortality were 2.6% and 4%, respectively. Group comparison with the previous data revealed that the estimated blood loss [p < 0.048] and transfusion requirements [P < 0.000] were significantly lower in group B. Group B also showed a trend towards lower postoperative complications, 30-day and 90-day mortality than Group A.ConclusionsDespite small numbers in our study, there was a trend towards lower estimated blood loss, fewer transfusion requirements, and improved outcomes in the recent patients.
Paragangliomas are rare tumours derived from the neural crest cells. Most common site for these tumours is the adrenal medulla, where they are called as pheochromocytomas. Biliary system is an extremely uncommon site for extra-adrenal paraganglioma. We report the case of a 55 year old female who presented with one-month history of jaundice and right upper quadrant discomfort. Imaging showed a well-defined rounded mass at porta hepatis with arterial enhancement causing compression over the proximal common bile duct, resulting in moderate intrahepatic biliary dilatation. The patient underwent radical excision of common bile duct and roux-en-y hepaticojejunostomy. Final histopathology confirmed paraganglioma. Approximately 10% of the patients may present with extra-adrenal disease, but biliary paraganglioma are extremely rare. Only few cases have been reported in literature and the management usually involves the surgical excision. ---Continue
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