OBJECTIVE To analyze various clinical presentations and the surgical management of ovarian pathol... more OBJECTIVE To analyze various clinical presentations and the surgical management of ovarian pathologies in pre-menarche girls. DESIGN Case series. PLACE AND DURATION OF STUDY Surgical Unit B, National Institute of Child Health, Karachi, from September 2002 to August 2004. PATIENTS AND METHODS Case records of all the pre-menarche girls child having an ovarian pathology and managed during the study period were reviewed. Age of the patients, presenting symptoms, investigations performed, surgical approaches, operative findings and final histological diagnosis were noted. Ovarian lesions were classified according to WHO criteria.System proposed by the Children's Cancer Group and the Paediatric Oncology Group was used for staging of tumors. Following resection, patients with malignant tumors were followed-up by oncologist. RESULTS There were 18 patients with ovarian lesions. Age range of patients was from day 1 to 13 years. Mass in abdomen was the most common presenting symptom (60% p...
Journal of the College of Physicians and Surgeons, 2006
To assess the correlation of the size of undescended testis with its location in children of vari... more To assess the correlation of the size of undescended testis with its location in children of various age groups, per-operatively. Cross-sectional study. Surgical Unit B, National Institute of Child Health, Karachi from February 2004 - November 2005. Children presenting with undescended testis at surgical outpatient were recruited. Physical examination and relevant investigations (haemoglobin, ultrasound for location and size of testes) were performed. Patients were divided randomly into three age groups, group I (8 months - 2.5 years), group II (2.6 - 8 years), group III (8.1-13 years). At orchiopexy location and size of undescended testis were noted. Patients were further sub-divided into groups according to peroperative location of undescended testis, group A (intra-abdominal), group B (intra-canalicular), group C (distal to superficial inguinal ring - pubic). Where no testis was found, a separate group D was assigned. The size of undescended testis at different locations in vario...
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2005
Two cases of congenital pyloric atresia (CPA) are, hereby, reported. One was suspected on antenat... more Two cases of congenital pyloric atresia (CPA) are, hereby, reported. One was suspected on antenatal ultrasound and turned out to be an isolated anomaly. Other patient had a rare association of aplasia cutis congenita with congenital pyloric atresia. The lesions of aplasia cutis congenita were multiple while congenital pyloric atresia was of type II. The patient with an isolated lesion survived following surgery while the other baby died of sepsis in postoperative period.
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2005
Sirenomelia is a rare anomaly that rarely occurs as an isolated lesion. Several theories have bee... more Sirenomelia is a rare anomaly that rarely occurs as an isolated lesion. Several theories have been proposed regarding the etiopathogenesis. In this communication, we report a case of sirenomelia. Our patient was referred to hospital at the age of four hours. On examination, fusion of both lower limbs with hook shaped appendage, attached distally, absent genitalia and absent anal orifice was found. Spine was deficient in sacral region. Upper torso looked normal. Baby also had frothing from mouth. Abdomen was non-distended. Feeding tube no.10 was tried to pass through mouth, which got obstructed at the level of upper esophagus that suggested oesophageal atresia. The skeletogram revealed absence of pelvic bones, sacral agenesis, absent fibulae and fracture of both femora. The patient died at the age of 12 hours.
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2005
This report describes the management of a 7-month-old baby who aspirated one and ingested two pap... more This report describes the management of a 7-month-old baby who aspirated one and ingested two paper pins at a time. Bronchoscopic removal was done for aspirated pin and ingested pins were observed for spontaneous passage in stool, which occurred in 48 hours without any untoward incidence.
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2005
OBJECTIVE To determine the percentage of patients of idiopathic rectal prolapse improving on spon... more OBJECTIVE To determine the percentage of patients of idiopathic rectal prolapse improving on spontaneously over the period of observation (phase I), and to determine the outcome of patients with rectal prolapse who received injection sclerotherapy (phase II). DESIGN Quasi-experimental study. PLACE AND DURATION OF STUDY National Institute of Child Health, Karachi from April 2001 to March 2002. PATIENTS AND METHODS The study was conducted in two phases. In phase I of the study, newly diagnosed patients of idiopathic rectal prolapse were followed without any treatment, till the spontaneous resolution of rectal prolapse. The time period at which 50% patients improved clinically was called 'time for spontaneous resolution 50%, (TSR 50%). In phase II, injection sclerotherapy (IST) was given to those patients whose prolapse was of more than three months duration. This was a separate cohort of patients. RESULTS One hundred patients were inducted in the study. They all had idiopathic rec...
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2010
Anterior sacral meningocele is a rare condition presenting as a lower abdominal mass. One such ca... more Anterior sacral meningocele is a rare condition presenting as a lower abdominal mass. One such case was seen in a baby girl aged 2 months, who was admitted with abdominal distension and urinary difficulty for one week. She had a lower abdominal mass which investigated by MRI, turned out to be an anterior sacral meningocele causing her symptoms. The meningocele was excised successfully via an open abdominal approach. Postoperative recovery and follow-ups remained uneventful. Presentation, various diagnostic modalities and treatment options for an anterior sacral meningocele are briefly discussed.
OBJECTIVE To assess the correlation of the size of undescended testis with its location in childr... more OBJECTIVE To assess the correlation of the size of undescended testis with its location in children of various age groups, per-operatively. DESIGN Cross-sectional study. PLACE AND DURATION OF STUDY Surgical Unit B, National Institute of Child Health, Karachi from February 2004 - November 2005. PATIENTS AND METHODS Children presenting with undescended testis at surgical outpatient were recruited. Physical examination and relevant investigations (haemoglobin, ultrasound for location and size of testes) were performed. Patients were divided randomly into three age groups, group I (8 months - 2.5 years), group II (2.6 - 8 years), group III (8.1-13 years). At orchiopexy location and size of undescended testis were noted. Patients were further sub-divided into groups according to peroperative location of undescended testis, group A (intra-abdominal), group B (intra-canalicular), group C (distal to superficial inguinal ring - pubic). Where no testis was found, a separate group D was assign...
OBJECTIVE To determine the postoperative complications of elective inguinal hernia surgery in chi... more OBJECTIVE To determine the postoperative complications of elective inguinal hernia surgery in children DESIGN Descriptive study. PLACE AND DURATION OF STUDY Surgical Unit B, National Institute of Child Health, Karachi, from February 2004 to November 2005. PATIENTS AND METHODS Children with inguinal hernia, admitted electively through surgical outpatient, were included. Patients operated earlier and presenting with complications were excluded. Patients with concomitant diseases, regarded as predisposing factors for hernia development, were also excluded. Physical examination and relevant investigations (hemoglobin level and ultrasound of scrotum) were performed. Inguinal hernia was repaired electively by Rehbein procedure. Patients were followed at day 7, 1 month, 3 months and 9 months to note the postoperative complications of the surgery. Ultrasound was repeated at 6 and 9 months postoperatively for the size of testes. RESULTS A total of 223 patients with inguinal hernia were inclu...
LEARNING WHILE USING AN INSTRUCTIONAL SIMULATION Tayyaba Batool Old Dominion University, 2017 Dir... more LEARNING WHILE USING AN INSTRUCTIONAL SIMULATION Tayyaba Batool Old Dominion University, 2017 Director: Dr. Ginger S. Watson Learner control is thought to be valuable by some scholars who believe that it allows learners to adapt instructions to their needs while reducing cognitive load (Mayer & Moreno, 2003). Although learner control offers some advantages to the learner, the importance of an instructor cannot be denied. In instructor-controlled settings the instructor provides guidance to the learners. Direct instructional guidance provides information to the learner that explains the concepts and procedures that are to be learned along with the instructional strategy support that is compatible with human cognitive architecture (Kirschner, Sweller, & Clark, 2006). This study compared the effects of learner-controlled simulation to instructor-guided presentation of an instructional simulation. Outcome variables were achievement, cognitive load, time-on-task, instructional efficiency...
Background Scientific conferences which are considered as an important event for dissemination of... more Background Scientific conferences which are considered as an important event for dissemination of research and related academic activities were badly affected during the COVID-19 pandemic. Virtual format for interaction was used as an alternative method to continue such academic discourse. However, this did not provide the same level of communication and interest as that of in-person meetings. With evolving knowledge about the COVID-19 pandemic especially its transmission, role of vaccine, and observing standard operating procedures (SOPs), fear among healthcare providers is mitigated to some extent. Keeping in mind the importance of scientific conferences in the context of sharing knowledge and its impact on the training of faculty members and postgraduate residents, a hybrid conference was planned by the national association of pediatric surgeons. The purpose of this study was to retrospectively review the challenges faced during the organization of this conference as well as to a...
BackgroundPeople from South Asia are at increased risk of type 2 diabetes (T2D). There is an urge... more BackgroundPeople from South Asia are at increased risk of type 2 diabetes (T2D). There is an urgent need to develop approaches for prevention of T2D in South Asians, that are cost-effective, generalisable and scalable across settings.HypothesisCompared to usual care, risk of T2D can be reduced amongst South Asians with central obesity or raised HbA1c, through a 12 month lifestyle modification programme delivered by community health workers.DesignCluster randomised clinical trial (1:1 allocation to Intervention or Usual care), carried out in India, Pakistan, Sri Lanka, and UK, with 30 sites per country (120 sites total). Target recruitment 3,600 (30 participants per site) with annual follow-up for three years.Entry criteriaSouth Asian, men or women, age 40-70 years with i. Central obesity (waist circumference ≥100cm in India and Pakistan; ≥90cm in Sri Lanka) and / or ii. Prediabetes (HbA1c 6.0-6.4% inclusive). Exclusion criteria: known type 1 or 2 diabetes, normal or underweight (bod...
Colorectal cancer (CRC) presenting with intestinal obstruction is uncommon in paediatric age and ... more Colorectal cancer (CRC) presenting with intestinal obstruction is uncommon in paediatric age and carries poor prognosis. We report a case of a 13-year-old boy who presented with acute intestinal obstruction, clinically appearing to be secondary to complicated appendicitis. Exploratory laparotomy revealed a caecal mass which was resected. Histopathology report showed only inflammatory cells with no sign of malignancy. The patient was discharged home after smooth recovery but re-admitted after 2 months with recurrence of intestinal obstruction. Considering clinical behavior of the patient, the tissue blocks obtained from first surgery were reviewed and it turned out to be a poorly differentiated adenocarcinoma with positive mesenteric lymph nodes for metastatic carcinoma.
OBJECTIVE To analyze various clinical presentations and the surgical management of ovarian pathol... more OBJECTIVE To analyze various clinical presentations and the surgical management of ovarian pathologies in pre-menarche girls. DESIGN Case series. PLACE AND DURATION OF STUDY Surgical Unit B, National Institute of Child Health, Karachi, from September 2002 to August 2004. PATIENTS AND METHODS Case records of all the pre-menarche girls child having an ovarian pathology and managed during the study period were reviewed. Age of the patients, presenting symptoms, investigations performed, surgical approaches, operative findings and final histological diagnosis were noted. Ovarian lesions were classified according to WHO criteria.System proposed by the Children's Cancer Group and the Paediatric Oncology Group was used for staging of tumors. Following resection, patients with malignant tumors were followed-up by oncologist. RESULTS There were 18 patients with ovarian lesions. Age range of patients was from day 1 to 13 years. Mass in abdomen was the most common presenting symptom (60% p...
Journal of the College of Physicians and Surgeons, 2006
To assess the correlation of the size of undescended testis with its location in children of vari... more To assess the correlation of the size of undescended testis with its location in children of various age groups, per-operatively. Cross-sectional study. Surgical Unit B, National Institute of Child Health, Karachi from February 2004 - November 2005. Children presenting with undescended testis at surgical outpatient were recruited. Physical examination and relevant investigations (haemoglobin, ultrasound for location and size of testes) were performed. Patients were divided randomly into three age groups, group I (8 months - 2.5 years), group II (2.6 - 8 years), group III (8.1-13 years). At orchiopexy location and size of undescended testis were noted. Patients were further sub-divided into groups according to peroperative location of undescended testis, group A (intra-abdominal), group B (intra-canalicular), group C (distal to superficial inguinal ring - pubic). Where no testis was found, a separate group D was assigned. The size of undescended testis at different locations in vario...
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2005
Two cases of congenital pyloric atresia (CPA) are, hereby, reported. One was suspected on antenat... more Two cases of congenital pyloric atresia (CPA) are, hereby, reported. One was suspected on antenatal ultrasound and turned out to be an isolated anomaly. Other patient had a rare association of aplasia cutis congenita with congenital pyloric atresia. The lesions of aplasia cutis congenita were multiple while congenital pyloric atresia was of type II. The patient with an isolated lesion survived following surgery while the other baby died of sepsis in postoperative period.
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2005
Sirenomelia is a rare anomaly that rarely occurs as an isolated lesion. Several theories have bee... more Sirenomelia is a rare anomaly that rarely occurs as an isolated lesion. Several theories have been proposed regarding the etiopathogenesis. In this communication, we report a case of sirenomelia. Our patient was referred to hospital at the age of four hours. On examination, fusion of both lower limbs with hook shaped appendage, attached distally, absent genitalia and absent anal orifice was found. Spine was deficient in sacral region. Upper torso looked normal. Baby also had frothing from mouth. Abdomen was non-distended. Feeding tube no.10 was tried to pass through mouth, which got obstructed at the level of upper esophagus that suggested oesophageal atresia. The skeletogram revealed absence of pelvic bones, sacral agenesis, absent fibulae and fracture of both femora. The patient died at the age of 12 hours.
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2005
This report describes the management of a 7-month-old baby who aspirated one and ingested two pap... more This report describes the management of a 7-month-old baby who aspirated one and ingested two paper pins at a time. Bronchoscopic removal was done for aspirated pin and ingested pins were observed for spontaneous passage in stool, which occurred in 48 hours without any untoward incidence.
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2005
OBJECTIVE To determine the percentage of patients of idiopathic rectal prolapse improving on spon... more OBJECTIVE To determine the percentage of patients of idiopathic rectal prolapse improving on spontaneously over the period of observation (phase I), and to determine the outcome of patients with rectal prolapse who received injection sclerotherapy (phase II). DESIGN Quasi-experimental study. PLACE AND DURATION OF STUDY National Institute of Child Health, Karachi from April 2001 to March 2002. PATIENTS AND METHODS The study was conducted in two phases. In phase I of the study, newly diagnosed patients of idiopathic rectal prolapse were followed without any treatment, till the spontaneous resolution of rectal prolapse. The time period at which 50% patients improved clinically was called 'time for spontaneous resolution 50%, (TSR 50%). In phase II, injection sclerotherapy (IST) was given to those patients whose prolapse was of more than three months duration. This was a separate cohort of patients. RESULTS One hundred patients were inducted in the study. They all had idiopathic rec...
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2010
Anterior sacral meningocele is a rare condition presenting as a lower abdominal mass. One such ca... more Anterior sacral meningocele is a rare condition presenting as a lower abdominal mass. One such case was seen in a baby girl aged 2 months, who was admitted with abdominal distension and urinary difficulty for one week. She had a lower abdominal mass which investigated by MRI, turned out to be an anterior sacral meningocele causing her symptoms. The meningocele was excised successfully via an open abdominal approach. Postoperative recovery and follow-ups remained uneventful. Presentation, various diagnostic modalities and treatment options for an anterior sacral meningocele are briefly discussed.
OBJECTIVE To assess the correlation of the size of undescended testis with its location in childr... more OBJECTIVE To assess the correlation of the size of undescended testis with its location in children of various age groups, per-operatively. DESIGN Cross-sectional study. PLACE AND DURATION OF STUDY Surgical Unit B, National Institute of Child Health, Karachi from February 2004 - November 2005. PATIENTS AND METHODS Children presenting with undescended testis at surgical outpatient were recruited. Physical examination and relevant investigations (haemoglobin, ultrasound for location and size of testes) were performed. Patients were divided randomly into three age groups, group I (8 months - 2.5 years), group II (2.6 - 8 years), group III (8.1-13 years). At orchiopexy location and size of undescended testis were noted. Patients were further sub-divided into groups according to peroperative location of undescended testis, group A (intra-abdominal), group B (intra-canalicular), group C (distal to superficial inguinal ring - pubic). Where no testis was found, a separate group D was assign...
OBJECTIVE To determine the postoperative complications of elective inguinal hernia surgery in chi... more OBJECTIVE To determine the postoperative complications of elective inguinal hernia surgery in children DESIGN Descriptive study. PLACE AND DURATION OF STUDY Surgical Unit B, National Institute of Child Health, Karachi, from February 2004 to November 2005. PATIENTS AND METHODS Children with inguinal hernia, admitted electively through surgical outpatient, were included. Patients operated earlier and presenting with complications were excluded. Patients with concomitant diseases, regarded as predisposing factors for hernia development, were also excluded. Physical examination and relevant investigations (hemoglobin level and ultrasound of scrotum) were performed. Inguinal hernia was repaired electively by Rehbein procedure. Patients were followed at day 7, 1 month, 3 months and 9 months to note the postoperative complications of the surgery. Ultrasound was repeated at 6 and 9 months postoperatively for the size of testes. RESULTS A total of 223 patients with inguinal hernia were inclu...
LEARNING WHILE USING AN INSTRUCTIONAL SIMULATION Tayyaba Batool Old Dominion University, 2017 Dir... more LEARNING WHILE USING AN INSTRUCTIONAL SIMULATION Tayyaba Batool Old Dominion University, 2017 Director: Dr. Ginger S. Watson Learner control is thought to be valuable by some scholars who believe that it allows learners to adapt instructions to their needs while reducing cognitive load (Mayer & Moreno, 2003). Although learner control offers some advantages to the learner, the importance of an instructor cannot be denied. In instructor-controlled settings the instructor provides guidance to the learners. Direct instructional guidance provides information to the learner that explains the concepts and procedures that are to be learned along with the instructional strategy support that is compatible with human cognitive architecture (Kirschner, Sweller, & Clark, 2006). This study compared the effects of learner-controlled simulation to instructor-guided presentation of an instructional simulation. Outcome variables were achievement, cognitive load, time-on-task, instructional efficiency...
Background Scientific conferences which are considered as an important event for dissemination of... more Background Scientific conferences which are considered as an important event for dissemination of research and related academic activities were badly affected during the COVID-19 pandemic. Virtual format for interaction was used as an alternative method to continue such academic discourse. However, this did not provide the same level of communication and interest as that of in-person meetings. With evolving knowledge about the COVID-19 pandemic especially its transmission, role of vaccine, and observing standard operating procedures (SOPs), fear among healthcare providers is mitigated to some extent. Keeping in mind the importance of scientific conferences in the context of sharing knowledge and its impact on the training of faculty members and postgraduate residents, a hybrid conference was planned by the national association of pediatric surgeons. The purpose of this study was to retrospectively review the challenges faced during the organization of this conference as well as to a...
BackgroundPeople from South Asia are at increased risk of type 2 diabetes (T2D). There is an urge... more BackgroundPeople from South Asia are at increased risk of type 2 diabetes (T2D). There is an urgent need to develop approaches for prevention of T2D in South Asians, that are cost-effective, generalisable and scalable across settings.HypothesisCompared to usual care, risk of T2D can be reduced amongst South Asians with central obesity or raised HbA1c, through a 12 month lifestyle modification programme delivered by community health workers.DesignCluster randomised clinical trial (1:1 allocation to Intervention or Usual care), carried out in India, Pakistan, Sri Lanka, and UK, with 30 sites per country (120 sites total). Target recruitment 3,600 (30 participants per site) with annual follow-up for three years.Entry criteriaSouth Asian, men or women, age 40-70 years with i. Central obesity (waist circumference ≥100cm in India and Pakistan; ≥90cm in Sri Lanka) and / or ii. Prediabetes (HbA1c 6.0-6.4% inclusive). Exclusion criteria: known type 1 or 2 diabetes, normal or underweight (bod...
Colorectal cancer (CRC) presenting with intestinal obstruction is uncommon in paediatric age and ... more Colorectal cancer (CRC) presenting with intestinal obstruction is uncommon in paediatric age and carries poor prognosis. We report a case of a 13-year-old boy who presented with acute intestinal obstruction, clinically appearing to be secondary to complicated appendicitis. Exploratory laparotomy revealed a caecal mass which was resected. Histopathology report showed only inflammatory cells with no sign of malignancy. The patient was discharged home after smooth recovery but re-admitted after 2 months with recurrence of intestinal obstruction. Considering clinical behavior of the patient, the tissue blocks obtained from first surgery were reviewed and it turned out to be a poorly differentiated adenocarcinoma with positive mesenteric lymph nodes for metastatic carcinoma.
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