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  Most popular articles (Since May 17, 2016)

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Roux limb volvulus and perforation as a rare complication of Roux-en-Y hepaticojejunostomy
Kunal Parasar, S Hari Govind, Sundeep Singh Saluja, Pramod Kumar Mishra
October-December 2016, 1(1):3-4
Roux-en-Y hepaticojejunostomy (RYHJ) is a versatile surgical procedure for various hepatobiliary disorders with success rate as high as 90 %. Complications such as cholangitis, biliary calculi, pancreatitis, liver failure, reflux induced peptic ulcer disease have been described in the literature. We describe a rare complication of RYHJ which we recently encountered which to our knowledge has not been reported previously.
  1,663 159 -
Perspectives on large bowel obstruction
Elroy Patrick Weledji
January-March 2017, 2(1):1-4
Large bowel obstruction (LBO) is a serious and costly medical condition, indicating often emergency surgery. The main clinical issue is to determine whether the obstruction affects the small bowel or the colon since the causes and treatments are different. Delay in operative intervention may lead to an unnecessary bowel resection, increased risk of perforation, and overall worsening of patient morbidity and mortality. With the advent of colonic endoluminal stent, the treatment of distal colonic obstruction should be individually tailored to each patient. This article discussed LBO and emphasized the importance of history taking, examination, and basic imaging in the early diagnosis of its cause, thus facilitating appropriate management.
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Stress management in a medical career
Mimi R Borrelli, Reem Farwana, Riaz Agha
July-September 2017, 2(3):41-45
Stress is both the psychological and physical experienced when an individual perceives their resources as insufficient to cope with the demands of a situation. A medical career can be stressful. The work of health-care professionals involves taking responsibility for other individuals' lives and mistakes can have detrimental consequences. Work can involve long hours, night shifts, and high-risk situations. High levels of stress among doctors contribute to job dissatisfaction, emotional burnout, and clinical depression, and can undermine the achievement of goals, both for individuals and for organizations. Stress management is therefore a fundamental skill for all medical professionals. This article discusses strategies for managing stress, starting with self-analysis and outlining two main stress management techniques that can be taken at an individual level.
  1,619 129 -
MicroRNAs in hepatocellular carcinoma – therapeutics and beyond: A systematic review
Gaurav Roy, Papai Roy
April-June 2017, 2(2):10-16
Hepatocellular carcinoma (HCC) causes major cancer-related deaths worldwide. The current therapeutic strategies pitted against early HCC are woefully inadequate with surgical interventions, radiation therapy, and chemotherapy to suffice for. Therefore, the quest for novel, effective, and decisive screening tools is paramount. In context, microRNAs (miRNAs) have emerged as useful biomarkers in HCC. Accordingly, PubMed, Medline, Embase, and Cochrane databases were explored for relevant literature in English with combination of keywords “microRNA and hepatocellular carcinoma,” “microRNA and diagnosis and hepatocellular carcinoma,” “microRNA and prognosis and hepatocellular carcinoma,” “microRNA and survival and hepatocellular carcinoma,” and “microRNA and therapy and hepatocellular carcinoma” that were extracted till January 2017. Manuscripts relating to long noncoding RNAs and other concomitant small molecules involved in HCC were excluded from the review. Studies revealed a plethora of miRNAs and their altered expression profiles being significantly implicated in the diagnosis, prognosis, recurrence, and overall survival in HCC. Several miRNAs are currently being tested in different phases of clinical trials. Efforts should aim at a better validation and establishment of miRNAs as powerful diagnostic and prognostic investigating aid for HCC. However, despite extensive research, a consensus on the universal set of miRNAs to be used as diagnostic, prognostic, or recurrence markers for HCC is yet to be achieved. In addition, various targeted approaches should focus to reduce the possibility of deleterious off-target effects of miRNAs. On this background, this systematic review discusses latest developments on miRNAs as a marker of diagnosis, prognosis, recurrence, overall survival as well as a therapeutic target in HCC (REVIEW registry216).
  1,397 272 1
Awake craniotomy in developing countries: review of hurdles
Saad Akhtar Khan, Karim Rizwan Nathani, Syed Ather Enam, Faraz Shafiq
January-March 2017, 2(1):5-9
Awake craniotomy is a neurosurgical approach, in which patient is operated under local anesthesia to assess his neurological function intraoperatively. It has multiple advantages over craniotomy under general anesthesia, mainly including improved postoperative neurological status, lower length of hospital, and lower overall cost of hospital stay. Awake craniotomy is commonly practiced in the developed world; however, its role in developing country is limited. Considering the benefits that awake craniotomy offers, it can contribute significant socioeconomic benefits to a developing country, especially with reduce expenditure on health care as well as maintenance of functional capacity of patients to continue work. Development of awake craniotomy in a developing country is a challenge. Multiple hurdles must be overcome before considering the possibility of the procedure. One of the key hurdles is limitation of resources. Others include neuroanesthesia training, extent of disease, and patient selection. Patient's awareness or literacy rate is also a factor to be considered, especially in developing countries where it can be difficult to explain the procedure to the patient. The authors have successfully implemented awake craniotomy in Pakistan recently and have shared how they managed to overcome the hurdles in their case. The hurdles are considerable, but they can be overcome with efforts. The program will be highly beneficial to a developing country and should be attempted for betterment of health-care facilities available to the population.
  1,297 249 -
The value of publishing negative studies: Introducing IJS Short Reports
Riaz A Agha
October-December 2016, 1(1):1-2
  1,295 151 -
Pitfalls and problems in the management of the acute abdomen
Elroy Patrick Weledji
October-December 2017, 2(4):54-57
The acute abdomen is defined as the rapid onset of severe symptoms that may indicate potentially life-threatening intra-abdominal pathology which requires urgent surgical intervention. The article reviewed the pitfalls and problems in the management of the acute abdomen. The importance of simultaneous examination and resuscitation, recognizing the need for physiological support, and maintaining the rapid progress toward a diagnosis and definitive treatment are emphasized.
  1,160 173 1
Neonatal brachial plexus injury with diaphragmatic eventration
Jayalaxmi S Aihole, Javaregowda Deepak, Vinay Jadhav, S Ramesh
October-December 2017, 2(4):63-65
Our case report describes obstetric right brachial plexus injury leading to Erb's palsy and Klumpke's palsy with ipsilateral paralysis of diaphragm in a 9-month-old baby without Horner's syndrome. The baby required initial right brachial plexus root exploration and nerve grafts, later requiring surgical plication of diaphragm. Now, the baby is free of bronchopneumonia and is in recovering phase of upper limb motor and sensory function.
  1,182 113 -
The role of plastic surgery in global health: A narrative review
Mimi R Borrelli
July-September 2017, 2(3):25-30
Background: There is growing awareness of the substantial global burden of surgical disease. Conditions treated effectively by plastic and reconstructive procedures make a large proportion of the global surgical diseases, and disproportionately affect individuals at the lower end of the economic spectrum. Methods: This article reviews the role of plastic surgery in global health, highlights the ongoing need for plastic and reconstructive surgery globally, and increasing efforts that have been made to meet these needs. Results: There global shortage of plastic surgeons in low and middle income countries, but plastic surgery has a long tradition of humanitarian aid, has been a leader in global surgery development. Plastic and reconstructive surgical care has increasingly been shown to be cost effective and to have an immense impact on the economy of a region, delivering a substantial return on investment. More sustainable global surgical care is essential in future, requiring ongoing efforts from the plastic surgery community, greater recognition of the problems that can be addressed at policy level, and research to help guide policy-makers when facing the decision of allocating scarce resources. Conclusion: There is a fundamental role of plastic surgery in global health.
  1,120 140 -
Hepatocellular adenoma: Review of contemporary diagnostic and therapeutic options
Saleema Begum, Muhammad Rizwan Khan
January-March 2018, 3(1):1-8
Hepatocellular adenoma (HCA) is a rare benign lesion most often seen in young women with a history of oral contraceptive use. It is typically a solitary lesion located in the right hepatic lobe although multiple lesions have been reported. Diagnosis of HCA is important for prompt treatment because of risk of hemorrhage and malignant transformation. Adenomas are not specifically diagnosed at ultrasonography, and further evaluation with computerized tomography and magnetic resonance imaging is required to differentiate from other hepatic lesions such as focal nodular hyperplasia. The gold standard for diagnosis is excision biopsy. Better understanding of clinical history and imaging appearance is important to avoid misdiagnosis and facilitate effective treatment.
  985 136 -
Management of oral complications in irradiated head and neck cancer patients: Literature review
Muhammad Hasan Hameed, Kamil Zafar, Robia Ghafoor
January-March 2018, 3(1):15-21
The incidence of head and neck cancer is increasing and it is regarded as one of the leading causes of morbidity and mortality. The treatment of head and neck carcinoma is very challenging and depends on the stage of the disease. Radiotherapy is largely employed as primary therapy, adjuvant to surgery, or in combination with chemotherapy for the treatment of head and neck carcinomas. Patients undergoing radiotherapy are prone to a range of short- and long-term complications which adversely affects their health and quality of life. Management of these complications is complex and based on early detection, prevention, and oral care before, during, and after the treatment, to establish the best oral care pathway for these patients. Dental management of these patients is especially important to maintain oral hygiene, overall health, and nutrition status. Management involves multidisciplinary team approach which includes dental practitioners and the oncology team not only in the primary treatment but also in the long-term care and maintenance. It is, therefore, essential for clinicians involved in cancer treatment and cancer survivors to be aware of prevention and management these complications. The aim of this review is to highlight importance of postoperative complications associated with radiotherapy and to draw attention of multidisciplinary teams involved in cancer management toward dental needs of patients treated with radiation therapy, to ensure good quality care and better quality of life in irradiated head and neck cancer patients.
  948 166 -
Liver transplantation for cholangiocarcinoma: Past, present, and the future
Saleema Begum, Muhammad Rizwan Khan, Stephen Chang
January-March 2018, 3(1):9-14
Management of hilar cholangiocarcinoma (CCA) remains a major challenge incorporating complex diagnostic and therapeutic modalities. The management has evolved over the decades in pursuit of optimal therapeutic outcome for this challenging pathology. The only curative therapeutic option for CCA is complete (R0) surgical resection with negative margins. Curative resection for hilar CCA (HCCA) remains a surgical challenge due to its high propensity for invasion into liver parenchyma, encasement of portal vessels, and metastasis to regional lymph nodes. Liver transplantation (LT) was proposed as an alternative therapeutic option, but the initial results were extremely disappointing due to high rate of recurrence. The management has evolved over decades with introduction of neoadjuvant treatment options followed by LT resulting in optimal outcomes for an otherwise lethal disease. The current review outlines the changing trends in the management of HCCA over the years.
  949 156 -
Financial management in a medical career
Mimi R Borrelli, Reem Farwana, Riaz Agha
July-September 2017, 2(3):31-34
Medical students often graduate with substantial debt, receive low incomes early in their careers postgraduation, and commence work having had little or no training in financial management. Furthermore, medical trainees fail to budget, have poor debt management, and hold overexpectations of increased income. Poor financial management can be a source of stress and has a negative impact on the quality of life. This article addresses some of the strategies for improving personal financial management, focusing on tracking of finances, creating a budget, debt management, and savings.
  944 116 -
Role of current strategies for preventing xerostomia in oropharyngeal cancer patients: A literature review
Muhammad Rizwan Nazeer, Shizrah Jamal, Surhan Aziz, Robia Ghafoor
April-June 2018, 3(2):65-70
Xerostomia occurring as sequelae of radiation therapy results in oral complications, i.e., acid erosion, dysphagia, dysgeusia, periodontal diseases, taste disturbance, and dental caries. The best strategy should be to prevent damage of any salivary acini during the course of radiotherapy; therefore, we planned to look for all the strategies for its prevention. We searched PubMed, Google Scholar, and Oral and Dentistry database thoroughly and included all the relevant articles published in the past 12 years (2005–2017). We found the following strategies for the prevention of xerostomia during radiation therapy: amifostine, pilocarpine, Vitamin C, and Vitamin E, acupuncture, bethanechol, botulism toxin, histamine, insulin growth factor, submandibular gland transfer, intensity-modulated radiation therapy, radiation stents, stem cell transplantation, intravenous injection of adipose stem cells, lasers, and lidocaine HCL. These preventive methods not only maintain the morphology and function of salivary glands but also reduces the need for saliva-enhancing therapies later.
  821 180 -
Extent of thyroidectomy for well-differentiated thyroid cancers
Shabbir Akhtar, Haissan Iftikhar
January-March 2018, 3(1):22-25
In patients with well-differentiated thyroid carcinoma (WDTC), the extent of thyroid surgery is controversial. There are proponents of both total thyroidectomy (TT) and thyroid lobectomy (TL). A review of literature was performed. We included studies investigating the extent of thyroid surgery, TT versus TL, for WDTC. Multiple studies have failed to show any significant difference in posttreatment recurrence between TT and lobectomy. In properly selected low-to-intermediate risk patients, the extent of initial thyroid surgery probably has little impact on disease-specific survival.
  887 109 -
Time management in a medical career
Mimi R Borrelli, Reem Farwana, Buket Gundogan, Riaz Agha
July-September 2017, 2(3):46-49
Time management is an essential skill in doctors. Work in the medical profession can be high stress, with multiple conflicting demands, and often involves unsocial hours. Time management is necessary to enhance patient care, management of teams, and delivery of health services. Balancing work and home life is also important for mental health and stress management. This article discusses some considerations and techniques to help individuals manage their time.
  865 116 -
Giant neck cyst not only a surgical concern
Gabriel Alejandro Molina, Cristhian Ramiro García, Diego Xavier De La Torre, Daniela Alexandra Gonzalez
April-June 2018, 3(2):71-73
Epidermoid cysts are slow-growing, usually benign lesions that derive from an abnormally located ectodermal tissue. Epidermoid cysts can appear anywhere on the body; they are usually small and frequently asymptomatic. Giant cysts are rare, with few cases ever described. We report a case of a 66-year-old male, with a giant mass in the neck that developed over the last 10 years. Due to geographic limitations and lack of access to health care, he allowed the mass to grow to giant proportions. Surgical treatment was decided, and the patient underwent full recovery. Giant epidermoid neck cyst was the final diagnosis.
  791 151 -
Unexpected foreign body in the neck: A case report
Anubhav Jannu, Ramdas Balakrishna, H Sudarshan, GC Veena, Bhuvaneshwari Srinivasan
October-December 2017, 2(4):66-68
Foreign bodies may be deposited, ingested, or inserted in the head and neck region by a traumatic or iatrogenic injury. The penetrating foreign body in the neck has a specific apprehension because of the constellations of vital structures in the neck. We report a 30-year-old male patient who presented with a mass in the neck. Radiographic examination revealed a sharp no. 11 surgical blade in the left side of the neck. He was unaware of the foreign body in his neck and was asymptomatic. The blade was surgically removed followed by primary closure under general anesthesia. The patient recovered well without any complication. The importance of this article is the presence of a surgical blade in the neck which has never been mentioned in the literature so far and the surgical technique in which it was removed followed by the postoperative care.
  821 121 -
Cone-beam computed tomography analysis of centering ability and transportation of curved root canals prepared with three rotary nickel-titanium systems (In Vitro-Study)
Hanan Yahya Fallatah, Samia Mohamed El Sherief
January-March 2018, 3(1):58-64
Objective: The aim of this study is to compare the degree of transportation, centering ability, and dentin thickness after mechanical preparation using three different nickel-titanium rotary instrumentation systems, ProTaper Next (PTN), twisted file (TF), and K3 Endo in curved root canals analyzed using cone-beam computed tomography (CBCT). Materials and Methods: Thirty moderately curved roots of extracted human maxillary and mandibular molars were divided into three groups with 10 root canals each. Group I, the root canals were prepared with PTN rotary system; Group II, the root canals were prepared with TF rotary system; and Group III, were prepared with K3 rotary file system. Preinstrumentation and postinstrumentation three-dimensional CBCT images were obtained from root cross sections in three levels; coronal, middle, and apical third. Results: It was observed that there were no significant differences in the degree of canal transportation at apical level and the remaining dentin thickness between the rotary instruments (P > 0.05). There were no statistical significant differences in centering ability between buccolingual centering ratio after using the three systems at coronal and middle levels (P > 0.05) except for apical level is significantly difference (P = 0.047). In addition, there were no statically significant differences between centering ratio after using the three systems at cervical, middle, and apical levels (P > 0.05). Conclusions: Under the conditions of this study, CBCT analysis showed that the TF has the ability to produce centered preparation maintaining the original root canal anatomy in the apical one-third of the root canal while PTN showed some degree of canal deviation and K3 showed the highest canal deviation.
  852 86 -
Weledji's clinicopathological classification of perianal paget's disease
Elroy Patrick Weledji
April-June 2017, 2(2):21-23
  806 115 -
Perspectives on stercoral perforation
Elroy Patrick Weledji, Theophile Chunteng Nana
April-June 2017, 2(2):17-20
Stercoral perforation results from ischemic necrosis of the colonic wall by a fecaloma. The cause is multifactorial and the diagnosis is usually made only at laparotomy. There is high mortality from fecal peritonitis and Hartmann's procedure in the ill and toxic elderly patient carries the lowest mortality.
  813 108 -
Career building starts in the mind
Mimi R Borrelli, Reem Farwana, Riaz Agha
July-September 2017, 2(3):35-40
There is enormous flexibility in the careers of medical professionals. Careers can be defining, motivating, and inspiring. Careers require continual and active engagement in their construction, and constantly evolve as new experiences and knowledge is gained. Career building starts with the development and identification of ideas, aims, and values, which alter attitudes, habits, and ultimately shape behaviors to achieve aspirations. This article discusses the ideas and strategic approaches to optimizing experiences and building a career within medicine.
  762 98 -
Sporadic association of Legg–Calve–Perthes disease with rare phakomatoses-Gomez-Lopez-Hernandez syndrome
Balaji Zacharia, M Thanveeruddin Sherule, Dhiyaneswaran Subramaniam, Rajesh Purushothaman
October-December 2017, 2(4):58-62
Gomez-Lopez-Hernandez syndrome (GLH) is a very rare phakomatosis, which is characterized by the triad of rhombencephalosynapsis, facial anesthesia in the trigeminal area, and scalp alopecia. A 9-year-old boy with pain and limping right hip for 6 months was presented. Clinically, he was having bilateral symmetrical temporal alopecia, strabismus, and pseudoproptosis. Magnetic resonance imaging brain shows cerebellar fusion. Examination of the hip was consistent with the diagnosis of Perthes disease. Even though some of the phakomatoses are associated with skeletal abnormalities, there is no association of any phakomatoses with Legg–Calve–Perthes disease (LCPD) of the hip. This will be the first ever report of an association of GLH syndrome with LCPD.
  761 83 -
Surgical prevention and management of radiation-induced xerostomia in head-and-neck cancer patients
Rashna Hoshang Sukhia, Hoshang Rumi Sukhia, Dinaz Ghandhi
January-March 2018, 3(1):26-29
Head-and-neck cancer is the sixth most commonly diagnosed cancer in the world and amounts to nearly 3% of all malignancies. Therapeutic irradiation is a common mode of treatment either alone or in conjunction with surgery for treatment of head-and-neck cancers which leads to irradiation-induced xerostomia which may in turn lead to disturbances in taste, speech, and prosthesis wear, etc. Xerostomia may also lead to infections in the oral cavity and rampant carious lesion in teeth. Salivary gland transfer is a surgical procedure done to prevent the gland from radiation exposure during radiotherapy of the head-and-neck region. Management of xerostomia is usually done with systemic or topical pilocarpine or cevimeline, artificial saliva compounds, herbal compounds, acupuncture and acupuncture-like transcutaneous nerve stimulation, low-level laser therapy, etc. with varying effectiveness.
  756 85 -
Evidence-based advances in glioma management
Muhammad Adeel Samad, Karim Rizwan Nathani, Usama Khalid Choudry, Muhammad Waqas, Saad Akhtar Khan, Syed Ather Enam
January-March 2018, 3(1):36-42
Glioma is primary brain tumors of the glial origin. Glioblastoma multiforme traditionally classified as Grade IV glial tumor carries the worst prognosis. Over the past decades, focus of the diagnosis and management has gradually shifted toward molecular and genetic profiling. This has been accompanied by advancement in radiology, radiation, and medical oncology. Despite significant progress in the individual disciplines, the overall prognosis has not increased significantly. There is consensus on the need of maximum safe resection for most of these tumors. Details of anatomy and white matter tracts obtained through preoperative imaging. These detailed radiological modalities allow the surgeons to plan a safe trajectory to the lesion, avoiding neurological complications. Five aminolevulinic acid and fluorescein guidance help increasing the extent of resection. Awake craniotomy with brain mapping has regained popularity for the safe resection of low-grade glioma, especially those located in eloquent areas. In this review article, we have discussed various aspect of glioma management including diagnosis and surgical resection.
  737 86 -