Publications by authors named "Amjad Siraj Memon"

15 Publications

  • Page 1 of 1

Factors affecting delay in diagnosis of colorectal cancer: A cross-sectional study from a tertiary care hospital of Karachi, Pakistan.

Int J Clin Pract 2021 Jun 15:e14529. Epub 2021 Jun 15.

Surgical Unit 3, Dr. Ruth K.M Pfau Civil Hospital, Dow University of Health Sciences, Karachi, Pakistan.

Background: Colorectal cancer (CRC) incidence is increasing in our region. There is no specific CRC control programme or national cancer registry in Pakistan. Previously, no data have been published on presentation delay and diagnosis delay of CRC in our region. This study is conducted to determine the factors affecting delay in presentation and diagnosis and to provide baseline information to launch a CRC control programme. The primary objective is to determine factors causing delay in diagnosis of CRC. The secondary objective is to evaluate the relationship between tumour site and stage of CRC with presenting symptoms and symptom duration.

Methods: This project is a prospective cross-sectional study on 113 biopsy-proven CRC patients admitted to the surgical ward of Civil Hospital Karachi.

Results: The total number of participants was 113. Presentation delay was observed in 83.2% of patients. The main reasons for a reported delay in the presentation were lack of patients' knowledge that these symptoms may be cancer (60.4%), the wrong diagnosis by the primary physician (34.6%) or the patient did not want to visit the doctor (0.04%). Most tumours (95%) originated from the sigmoid and rectum; 44.2% and 38.9% of the patients were diagnosed at Stages 3 and 4, respectively.

Conclusions: This study revealed that CRC patients in Pakistan are facing delays in presentation and diagnosis. This is the reason behind diagnosis at the advanced stage with a poor prognosis. On the basis of this study findings, CRC control programme should be introduced to detect CRC at an early stage.
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http://dx.doi.org/10.1111/ijcp.14529DOI Listing
June 2021

Jejunal Adenocarcinoma as a Rare Cause of Small Bowel Obstruction: A Case Report.

Cureus 2020 Oct 2;12(10):e10763. Epub 2020 Oct 2.

Surgery, Dow Medical College, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, PAK.

Jejunal adenocarcinoma, a small bowel adenocarcinoma (SBA), is a rare cause of small bowel obstruction. Jejunal adenocarcinoma classically presents with vague clinical symptoms, i.e., abdominal pain, discomfort, and weight loss, making timely diagnosis challenging. Owing to its diagnosis at a late stage, the prognosis of jejunal adenocarcinoma is poor. Curative resection of the tumor at the early stages remains a treatment of choice. Here, we report a case of a 55-year-old man presenting with symptoms of nausea, vomiting, abdominal pain, abdominal distension, and relative constipation. Computed tomography (CT) scan showed dilated small bowel loops. Exploratory laparotomy was performed, which revealed a jejunal stricture and dilated small bowel loops proximal to it. Suspicious stricture, along with the diseased portion of the intestine, was removed through en-bloc resection. Histopathology and metastatic workup revealed moderately differentiated adenocarcinoma with stage IIB (T4aN0M0). We conclude that, although rare, jejunal adenocarcinoma should be kept in mind when dealing with a patient presenting with symptoms indicating small bowel obstruction. Our purpose is to emphasize laparotomy as both a diagnostic and surgical modality for SBAs in early stages, especially in setups of low economic countries where advanced imaging techniques are relatively inaccessible.
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http://dx.doi.org/10.7759/cureus.10763DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7606176PMC
October 2020

Spontaneous Axillary Cystic Hygroma: A Rare Entity in Adults.

J Coll Physicians Surg Pak 2020 Jul;30(7):769-770

General Surgical Unit 3, Dr Ruth KM Pfau, Civil Hospital Karachi, Pakistan.

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http://dx.doi.org/10.29271/jcpsp.2020.07.769DOI Listing
July 2020

Primary Rectal Amelanotic Malignant Melanoma: A Rare Case Report.

Cureus 2020 May 14;12(5):e8115. Epub 2020 May 14.

Surgery, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK.

Malignant melanoma of the rectum comprises 0.5%-4% of all anorectal cancers. Malignant melanoma of the rectum is exceptionally a rare disease. It commonly affects the fifth or sixth decade, with nonspecific symptoms such as rectal bleeding or anal pain. After skin and retina, anorectum is the third common site for malignant melanoma. Proper diagnosis is difficult in the majority of cases due to lack of pigmentation and amelanotic histological appearance. Prognosis is very poor with a median survival of 24 months and five-year survival of 10%-15%. Anorectal malignant melanomas disseminate along the submucosal planes, therefore complete resection at the time of diagnosis is usually not possible.
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http://dx.doi.org/10.7759/cureus.8115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292714PMC
May 2020

A CASE OF COMPLEX HEMATOMA FORMATION AFTER INSTITUTION OF ACS PROTOCOL IN A PATIENT WITH UNTREATED PRIMARY HYPOPARATHYROIDISM.

AACE Clin Case Rep 2019 Sep-Oct;5(5):e267-e270. Epub 2019 Jun 7.

Objective: We report an unusual case of untreated hypoparathyroidism in which the patient presented with a prolonged QT interval and unusual bleeding after the institution of acute coronary syndrome (ACS) protocol.

Methods: A 53-year-old female presented with sudden pain and diffuse tightness in the abdomen/limbs and profuse sweating for a few hours. Patient was admitted under cardiology services and ACS protocol was instituted.

Results: After 2 days of admission, she developed severe abdominal pain and distention, which was due to large hematomas in the bladder wall, rectus sheath, and retroperitoneal area. These hematomas were surgically drained, but the abdominal wall could not be closed due to gut distention and stiffness of the abdominal wall; a Bogota bag was applied for closure. The patient was shifted to oral calcium after 12 days of intravenous calcium and vitamin D replacement. Abdominal closure was done several weeks later as a follow-up procedure.

Conclusion: This case illustrates the neglected areas of the impact of hypoparathyroidism; the effects of chronic hypocalcemia on the cardiovascular system and coagulation cascade.
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http://dx.doi.org/10.4158/ACCR-2019-0021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6876960PMC
June 2019

Use of Abdominal Binders after a Major Abdominal Surgery: A Randomized Controlled Trial.

Cureus 2019 Oct 3;11(10):e5832. Epub 2019 Oct 3.

Surgery, Fazaia Ruth Pfau Medical College (FRPMC), Karachi, PAK.

Objective To compare the effect of abdominal binder versus no binder after major abdominal surgery and cesarean section on various post-operative recovery parameters. Materials and methods This is a randomized controlled trial conducted at the Department of General Surgery and Obstetrics, Civil Hospital, Karachi, Pakistan. All those patients aged ≥18 years having abdominal surgery including elective and emergency abdominal surgery and cesarean sections with American Society of Anesthesiologists Class I-III were included in the study. Randomization was done using the sealed envelope method by the principal investigator. The intervention group wore an abdominal binder postoperatively while the control group did not use it. Mobilization and the pain status of both groups were evaluated on the first, fourth, and seventh days after surgery. Results Primary outcome variables were mobility, assessed via 6-minute walk test (6MWT) and postoperative pain, evaluated via visual analogue scale. There was no statistically significant difference in the 6MWT distance before (p = 0.278) and on postoperative day one of the surgery (p = 0.0762). However, the difference was significant on fourth (p < 0.001) and seventh day (p value < 0.001). With regards to the pain status, patients in the binder group reported significantly less postoperative pain on first, fourth, and seventh (p value < 0.001) day compared to the non-binder group. Conclusion The use of abdominal binder postoperatively significantly reduced pain and improved mobility in both obstetric and surgery patients.
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http://dx.doi.org/10.7759/cureus.5832DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827701PMC
October 2019

Odyssey of an accidently ingested sewing needle from mouth to mesentery of small bowel in a young female - Case Report.

J Pak Med Assoc 2018 Sep;68(9):1418-1420

Civil Hospital Karachi.

Foreign body (FB) ingestion is one of the most common complaint in the emergency room and, extra-intestinal migration of penetrating sharp FBs is one of the most overlooked aspect of medical research. We report a case of accidental ingestion of a sewing needle which was recovered from the mesentery. The 28-year-old female presented to our hospital with abdominal pain and one-month's history of needle ingestion. Initially laparoscopy was performed, which was inconclusive. Afterward, through laparotomy, the needle was successfully removed from the mesentery of small bowel.
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September 2018

Gastric volvulus through Morgagni hernia and intestinal diverticulosis in an adult patient: a case report.

BMC Surg 2018 08 29;18(1):67. Epub 2018 Aug 29.

Department of General Surgery, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, Pakistan.

Background: Morgagni's hernia (MH) is a rare type of congenital diaphragmatic hernia with limited available literature. Late presentations are infrequent and the ones complicated due to gastric volvulus are even rarer. Another uncommon association of MH is with small bowel diverticulosis. We herein discussed a case of gastric volvulus as the content of MH, and small bowel diverticulosis present in a patient concomitantly.

Case Presentation: A 30 year old woman, who presented with a one year history of epigastric burning and indigestion, occasionally associated with pain and vomiting. On clinical examination, no clue to the diagnosis could be ascertained. Her chest and abdominal x-ray indicated an abnormal air-fluid level at right hemithorax, which prompted a Computed Tomography (CT) scan, showing organo-axial gastric volvulus. MH with gastric volvulus was observed during laparotomy and trans-thoracic reduction of the contents was performed, along with repair of the defect. Multiple intestinal diverticuli were also found and the largest diverticulum was excised.

Conclusions: Gastric volvulus through MH is a rare but potentially life-threatening condition. Non-specific symptoms like epigastric pain and vomiting can delay the diagnosis and management, however, advanced imaging techniques like CT scan can speed up this process. After the diagnosis is made, surgical repair should be attempted regardless of symptoms.
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http://dx.doi.org/10.1186/s12893-018-0399-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6116383PMC
August 2018

Levels of Depression and Anxiety Post-Mastectomy in Breast Cancer Patients at a Public Sector Hospital in Karachi.

Asian Pac J Cancer Prev 2016 ;17(3):1337-40

Clinical Psychology, The Indus Hospital, Karachi, Pakistan E-mail :

Background: There is a noticeable change in the approach with which women nowadays seek help for diseases like breast cancer, primarily due to awareness campaigns, but what happens after surgical procedures is of great significance too. This study focused on the several psychological connotations attached to mastectomy and how the patients cope.

Objective: To understand the pattern of anxiety and level of depression among Pakistani patients undergoing mastectomy.

Materials And Methods: The sample size consisted of 88 patients who had undergone mastectomy at the different surgical units of the Civil Hospital, Karachi, from January 2012- December 2014; The questionnaire was administered before they were discharged i.e. within 3 days of surgical procedures. The patients were asked if they were willing to participate in this study, those who agreed signed the consent form and then we preceded by asking questions with a standardized tool. A self made questionnaire was constructed keeping in mind the nature and specification of the disease, which consisted of 20 questions related to anxiety and depression, focusing on a mixture of psychological and physiological symptoms.

Results: There were a total of 88 patients out of which 36 (41%) were aged 51 to 60 years, 24 (27.2%) of the patients were in the age category of 41 to 50 years, 17 aged 61 and above (19.3%) and only 11 (12.5%) 30-40 years of age, the youngest of all the age categories. The pattern of depression and anxiety was found to be similar among all age categories, severe depression and anxiety predominating over moderate level of such symptoms, with only relatively few patients sufering mild or no depression symptoms.

Conclusions: It was concluded that going through mastectomy leads to moderate to severe levels of depression and anxiety, primarily because the females feel incomplete and insecure after losing a part of themselves.
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http://dx.doi.org/10.7314/apjcp.2016.17.3.1337DOI Listing
January 2017

Dietary Practices, Addictive Behavior and Bowel Habits and Risk of Early Onset Colorectal Cancer: a Case Control Study.

Asian Pac J Cancer Prev 2015 ;16(17):7967-73

Department of Surgical Oncology, Civil Hospital and Dow University of Health Sciences, Karachi, Pakistan E-mail :

Background: The abrupt rise of colorectal cancer in developing countries is raising concern in healthcare settings. Studies on assessing relationships with modifiable and non-modifiable risk factors in the Pakistani population have been limited. The present investigation was designed to examine associations of dietary practices, addictive behavior and bowel habits in developing colorectal cancer (CRC) among patients in a low-resource setup.

Materials And Methods: An age-gender matched case control study was conducted from October 2011 to July 2015 in Karachi, Pakistan. Cases were from the surgical oncology department of a public sector tertiary care hospital, while their two pair-matched controls were recruited from the general population. A structured questionnaire was used which included questions related to demographic characteristics, family history, dietary patterns, addictive behavior and bowel habits.

Results: A family history of cancer was associated with a 2.2 fold higher chance of developing CRC. Weight loss reduced the likelihood 7.6 times. Refraining from a high fat diet and consuming more vegetables showed protective effects for CRC. The risk of CRC was more than twice among smokers and those who consumed Asian specific addictive products as compared to those who avoid using these addictions (ORsmoking: 2.12, 95% CI: 1.08 - 4.17, ORpan: 2.92, 95% CI: 1.6 - 5.33, ORgutka: 2.13, 95% CI: 1.14 - 3.97). Use of NSAID attenuated risk of CRC up to 86% (OR: 0.14, 95% CI: 0.07 - 0.31).

Conclusions: Most of the findings showed concordance with the literature elucidating protective effects of consuming vegetables and low fat diet while documenting adverse associations with family history, weight loss, constipation and hematochezia. Moreover, this study highlighted Asian specific indigenous addictive products as important factors. Further studies are needed to validate the findings produced by this research.
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http://dx.doi.org/10.7314/apjcp.2015.16.17.7967DOI Listing
September 2016

Metastasis to ileostomy of mucinous adenocarcinoma of rectum.

J Pak Med Assoc 2013 Oct;63(10):1302-4

Surgical Unit-5, Civil Hospital, Karachi.

Carcinoma of colon and rectum is one of the most common malignancies of gastrointestinal tract. Primary ileostomy cancer following excision of primary tumour is a rare complication although a number of cases have been reported in the last 30 years. This case also reports lymph node metastasis to the adjacent mesenteric lymph nodes. Appearance of ileostomy tumour as synchronous or metachronous lesion is highly debatable. Once diagnosis is confirmed by biopsy enblock excision with or without stomal relocation is the main stay of treatment. Patient education and regular surveillance of patients with long-standing ileostomy is recommended for early detection of this unusual cancer.
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October 2013

Colorectal cancer in younger population: our experience.

J Pak Med Assoc 2013 Oct;63(10):1275-7

Dow University of Health Sciences, Civil Hospital, Karachi.

Objective: To promote awareness regarding increased occurrence of colorectal cancer in younger population and its clinicopathological features compared to older patients.

Methods: The cross-sectional study was conducted from February 2010 to January 2011 on patients with diagnosis of colorectal carcinoma admitted through emergency or outpatients' departments to Surgical Unit 5, Civil Hospital, Karachi. Data regarding age, gender, presentation, site of tumour, surgery performed and Dukes staging was collected and analysed.

Results: A total of 23 patients were operated during the study period: 13 (56.52%) males and 10 (43.47%) females. Of them 12 (52.17%) were below the age of 40 years, while 3 (13.04%) patients were in the 11-20 age group. In 7 (30.4%) patients, tumour was irresectable at the time of presentation so a palliative procedure (diversion colostomy or ileostomy) was performed.There was a higher proportion of younger patients with metastatic disease at the time of presentation (n = 9; 75%) while 10 out of 12 patients in the younger age group (83.3%) had a tumour of left colon, particularly rectum.

Conclusion: Although colorectal cancer is usually a disease of older patients, it is increasingly becoming more common in younger population. Data suggests a leftward distribution for colorectal carcinoma and that younger patients present with more advanced disease and poorer prognosis.
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October 2013

Mucinous adenocarcinoma of the appendix.

J Pak Med Assoc 2011 Dec;61(12):1233-5

Surgical Unit-V, Dow University of Health Sciences, Civil Hospital, Karachi.

Mucinous neoplasm is a rare malignancy of the gastrointestinal tract, the most common site being the appendix. There are different types of mucin producing tumours that can occur in the appendix, which can be benign as well as malignant. Mucin produced by these tumours results in ascites that makes it palpable as jelly belly.
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December 2011

Reasons of conversion of laparoscopic to open cholecystectomy in a tertiary care institution.

J Pak Med Assoc 2009 Jul;59(7):456-60

Department of Surgery, Fatima Hospital & Baqai Medical University, Karachi, Pakistan.

Objective: To determine the frequency and reasons of conversion of laparoscopic cholecystectomy (LC) to open cholecystectomy (OC) in a tertiary care teaching hospital.

Methods: A prospective analysis of conversion of laparoscopic to OC was performed in one Surgical Unit of Civil Hospital Karachi, from 1st September 1997 to 31st May 2005. There were 1238 patients in the series. The inclusion criteria were: all patients with symptomatic cholelithiasis, who were subjected to LC. The exclusion criteria were: cases with incomplete laboratory or histopathology data, patients who were lost to follow-up, and patients with preoperative diagnosis of carcinoma of gallbladder.

Results: Eighty-one (6.5%) patients were converted to OC, due to difficult anatomy, complication or equipment failure. The frequency during learning curve was 9% vs. 6.3% during skill curve. The conversion rate was higher in male patients (16.45% males vs. 5.09% females), and in patients with acute cholecystitis (24.39% acute vs. 5.06% chronic). In eight cases, conversion was due to major complication: bleeding (6), and bowel injury (2). In 73 cases, conversion was carried out electively; disturbed anatomy at Calot's triangle (44), wide cystic duct (7), choledocholithiasis (5), dense adhesions between gallbladder and bowel (4), biliodigestive fistula (1), and equipment failure (12).

Conclusion: The overall frequency of conversion of LC to OC was 6.5%; the risk was more during the learning curve, in male patients and in patients with acute cholecystitis.
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July 2009

Rural surgery in Pakistan.

World J Surg 2006 Sep;30(9):1628-9

Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi, Pakistan.

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http://dx.doi.org/10.1007/s00268-005-0641-5DOI Listing
September 2006
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