Publications by authors named "Mohammed Muneer"

22 Publications

  • Page 1 of 1

In Vitro Comparison between the Pulvertaft Weave and the Modified Core Suture Pulvertaft Weave.

J Hand Surg Asian Pac Vol 2021 Sep;26(3):377-382

Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA.

The Pulvertaft weave was described more than 50 years ago and is still used in tendon transfers. The aim of this study was to evaluate the strength of a modified core suture Pulvertaft weave technique and compare it to the original Pulvertaft weave traditionally used in tendon transfer surgery. 12 extensor pollicis longus tendons and extensor indices proprius tendons were harvested from fresh frozen cadavers. Six Pulvertaft weaves were performed using FiberWire 4.0 and six core suture tendon weave were performed using FiberLoop 4.0. Biomechanical analysis was performed and stifness, first failure load and ultimate failure load were measured for both set of repairs. The stiffness of the core suture tendon repair (9.5 N/mm) was greater than that of the Pulvertaft repair (2.5 N/mm) The first failure load of the core suture tendon repairs (68.9 N) was greater than the Pulvertaft repairs (19.2 N) and the ultimate failure load of the core suture tendon repairs (101.8 N) was greater than the Pulvertaft repairs (21.9 N). All of these differences were statistically significant. The core suture Pulvertaft weave is a modification to the Pulvertaft weave used in tendon transfers. The results of this cadaveric study suggest it is 5 times stronger than the traditional Pulvertaft repair, potentially allowing it to be used with early active motion protocols after tendon transfers.
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http://dx.doi.org/10.1142/S2424835521500351DOI Listing
September 2021

Avascular necrosis of the lunate secondary to perilunate fracture dislocation: Case report and review of the literature.

SAGE Open Med Case Rep 2021 12;9:2050313X211032398. Epub 2021 Jul 12.

Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA.

This is a 39-year-old male, fell from a bike, left wrist with trans-styloid perilunate fracture dislocation that underwent open reduction internal fixation, 20 months after surgery the patient developed avascular necrosis of the lunate, final wrist fusion was performed secondary to the arthritic changes on the wrist. Anatomic dissection was performed and vascularity of the lunate was identified, its origin is from the volar palmar arch, when dislocated palmarly and more than 90 degrees the vessel is still intact. More than 512 patients with perilunate dislocation and perilunate fracture dislocation are included we identified in the literature transient avascular necrosis of the lunate in nine and seventeen of pure avascular necrosis of the lunate. Concluding that avascular necrosis of the lunate after perilunate dislocation or perilunate fracture dislocation is an infrequent finding especially when the volar ligaments are intact.
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http://dx.doi.org/10.1177/2050313X211032398DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8278458PMC
July 2021

Patterns, Management, and Outcome of Traumatic Femur Fracture: Exploring the Experience of the Only Level 1 Trauma Center in Qatar.

Int J Environ Res Public Health 2021 05 31;18(11). Epub 2021 May 31.

Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar.

Background: Femur is the most fractured long bone in the body that often necessitates surgical fixation; however, data on the impact of the mechanism of injury (MOI), age, and timing of intervention are lacking in our region of the Arab Middle East. We aimed to describe the patterns, management, and outcome of traumatic femoral shaft fractures.

Methods: A retrospective descriptive observational study was conducted for all trauma patients admitted with femoral shaft fractures between January 2012 and December 2015 at the only level 1 trauma center and tertiary hospital in the country. Data were analyzed and compared according to the time to intervention (intramedullary nailing; IMN), MOI, and age groups. Main outcomes included in-hospital complications and mortality.

Results: A total of 605 hospitalized cases with femur fractures were reviewed. The mean age was 30.7 ± 16.2 years. The majority of fractures were unilateral (96.7%) and 91% were closed fractures. Three-fourths of fractures were treated by reamed intramedullary nailing (rIMN), antegrade in 80%. The pyriform fossa nails were used in 71.6% while trochanteric entry nails were used in 28.4%. Forty-five (8.9%) fractures were treated with an external fixator, 37 (6.1%) had conservative management. Traffic-related injuries occurred more in patients aged 14-30 years, whereas fall-related injuries were significantly higher in patients aged 31-59. Thirty-one patients (7.8%) had rIMN in less than 6 h post-injury, 106 (25.5%) had rIMN after 6-12 h and 267 (66.8%) had rIMN after more than 12 h. The implant type, duration of surgery, DVT prophylaxis, in-hospital complications, and mortality were comparable among the three treatment groups.

Conclusions: In our center, the frequency of femoral fracture was 11%, and it mainly affected severely injured young males due to traffic-related collisions or falls. Further multicenter studies are needed to set a consensus for an appropriate management of femur fracture based on the MOI, location, and timing of injury.
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http://dx.doi.org/10.3390/ijerph18115916DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8198965PMC
May 2021

Epithelioid Sarcoma Presenting as Non-Healing Traumatic Ulcer: A Case Report and Review of the Literature.

Cureus 2021 Mar 20;13(3):e14014. Epub 2021 Mar 20.

Plastic Surgery, Hamad Medical Corporation, Doha, QAT.

Epithelioid sarcoma is a rare soft tissue sarcoma. It is a slow-growing neoplasm, which usually presents as a painless mass in the extremities and typically grows along deep dermal and subcutaneous planes. In contrast to other types of sarcoma, it has a strong tendency for nodal metastasis and local metastasis adjacent to the primary lesion within the affected limb.  In this article, we present a case of chronic traumatic ulcer in the upper extremity in an adolescent male that was subsequently diagnosed as epithelioid sarcoma, which is a very unusual mode of presentation of this particular tumour. The patient was treated with wide local excision and reconstruction with a free flap. Histopathological examination and immunochemistry studies confirmed the diagnosis and the patient underwent radiotherapy post-operatively as a part of the treatment regime. His post-treatment period was unremarkable, and he was put on regular surveillance to monitor the development of any signs of disease recurrence. Patients with epithelioid sarcomas often present late due to the slow-growing nature of the tumour. Unusual presentations like this will further delay the diagnosis and treatment, which will eventually worsen the prognosis. Awareness of such presentations can encourage primary care physicians to make early referrals to experts, which, in turn, may help the patients get early treatment and have a better prognosis.
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http://dx.doi.org/10.7759/cureus.14014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8057122PMC
March 2021

Psychological trauma in different mechanisms of traumatic injury: A hospital-based cross-sectional study.

PLoS One 2020 30;15(11):e0242849. Epub 2020 Nov 30.

Clinical Research, Trauma & Vascular Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar.

Background: Psychological distress following traumatic injury can influence the patient health, well-being and quality of life; however, this impact may partly vary according to the type and severity of injury. We aimed to study the predominant distress causing cluster and individual symptoms of Post-Traumatic Stress Disorders (PTSD) at the clinical and subthreshold level in patients with traumatic injuries, based on the mechanism of injury (MOI).

Methods: A hospital based cross-sectional study was conducted at a Level 1 Trauma Center utilizing PTSD Checklist to diagnose PTSD after one month of the traumatic event. All patients suffering from psychological distresses were assessed by a clinical psychologist in the trauma section. PTSD diagnostic criteria from DSM-5 were used to classify the patients. The inclusion criteria comprised of adult trauma patients who were directly involved in traumatic injuries and admitted under the Trauma Surgery services for a minimum of one day; have ability to provide written informed consent and can be assessed with the PCL-5 checklist after 4 weeks post-injury.

Results: Two hundred patients completed PCL-5 checklist, of them 26 (13.0%) were positive for PTSD and 174 (87%) had subthreshold scores. The mean age of participants was 34.4±11.8 years and males constituted 90.5%. Road traffic injury (RTI) was most the frequent injury mechanism (59%). PTSD positive patients with RTI, fall of heavy objects, pedestrian injury and assaults had highest average scores on clusters of negative alterations in mood and cognitions (16.9, 18.0, 18.5, 17.0 respectively), followed by hyperarousal. Symptom of always being on the guard and having repeated unwanted or disturbing memories of the incident, was reported by nearly 100% PTSD positive patients. Patients with subthreshold scores also reported distressing symptoms on all four clusters of PTSD.

Conclusions: Patients with different MOI showed a broad range of psychological problems with respect to symptom clusters. Negative alteration in mood and cognition followed by hyperarousal caused higher level of distress in patients post traumatic injuries. Subthreshold symptoms of PTSD are more common and deserve more attention.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0242849PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7703890PMC
January 2021

Flap based on the descending dorsal branch of the ulnar artery for large palmar surface defects: an anatomic study.

J Hand Surg Eur Vol 2021 May 11;46(4):435-437. Epub 2020 Nov 11.

Department of Hand and Micro-Vascular Surgery, Christine M Kleinert Institute, Louisville, KY, USA.

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http://dx.doi.org/10.1177/1753193420971939DOI Listing
May 2021

Laser-Machining of Microchannels in NiTi-Based Shape-Memory Alloys: Experimental Analysis and Process Optimization.

Materials (Basel) 2020 Jul 1;13(13). Epub 2020 Jul 1.

Raytheon Chair for Systems Engineering (RCSE), Advanced Manufacturing Institute, King Saud University, Riyadh 11421, Saudi Arabia.

Nickel-Titanium (NiTi)-based shape-memory alloys (SMA) are utilized in automotive, biomedical, microsystem applications because of their excellent shape memory effect, biocompatibility and super elastic properties. These alloys are considered difficult to cut-especially with conventional technologies because of the work hardening and residual stresses. Laser-machining is one of the most effective tools for processing of these alloys especially for microsystem applications. In this work, a thorough investigation of effect of process parameters on machining of microchannels in NiTi SMA is presented. In addition, a multi-objective optimization is carried out in order to find the optimal input parameter settings for the desired output performances. The results show that the quality of microchannels is significantly affected by input parameters. Layer thickness was found to have a significant effect on taper angle of the microchannel. Scan speed, layer thickness and scan strategy were found to have significant effects on both spatter thickness and top-width error, but in opposite directions. The multi-objective optimization-minimizing taper angle and spatter thickness revealed an optimal solution that was characterized by high frequency, moderate speed and low layer-thickness and track displacement.
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http://dx.doi.org/10.3390/ma13132945DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7372337PMC
July 2020

Percutaneous Tenodermodesis for Mallet Fingers: An Office-based Procedure.

Tech Hand Up Extrem Surg 2020 Jun 8;25(1):56-58. Epub 2020 Jun 8.

Christine M Kleinert Institute for Hand and Microsurgery, Louisville, KY.

Mallet fingers are injuries to the extensor tendon at the distal interphalangeal (DIP) joint and can present as a bony avulsion or as a soft tissue injury. Nonbony mallet fingers are frequently splinted in extension between 6 and 8 weeks. If splinted correctly, most results are good with a mean DIP joint extension lag between 5 and 10 degrees. However, decreased swelling, hygienic considerations and patient compliance can lead to splint removal and a less favorable outcome. We present a percutaneous tenodermodesis using only a digital block and a 4.0 nylon suture. This office-based procedure provides joint reduction and prevents joint movement during the immobilization period. The suture can be removed after 8 weeks, allowing active mobilization of the DIP joint. We present the results of 8 patients with a mean follow-up of 3 months and mean initial extension lag of 32 degrees, resulting in a mean final extension lag of 2 degrees and excellent outcomes using the Crawford criteria.
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http://dx.doi.org/10.1097/BTH.0000000000000298DOI Listing
June 2020

Recurrent Desmoid Tumor with Intra-Abdominal Extension After Abdominoplasty: A Rare Presentation.

Am J Case Rep 2019 Jul 4;20:953-956. Epub 2019 Jul 4.

Department of Plastic Surgery, Hamad Medical Corporation, Doha, Qatar.

BACKGROUND Desmoid tumors are fibrous neoplasms that originate from the musculoaponeurotic structures in the body. Abdominal wall desmoid tumors are rare, but they can be locally aggressive, with high incidence of recurrence. These tumors are more common in young, fertile women. They frequently occur during or after pregnancy. CASE REPORT We present the case of a 63-year-old post-menopausal woman with a desmoid tumor of the anterior abdominal wall. She had no relevant family history. During abdominoplasty, an incidental mass was excised and biopsied, and was identified as a desmoid tumor with free margins. One year later, the patient presented with vague abdominal discomfort and feeling of heaviness. An incision was made through the previous abdominoplasty scar to maintain the aesthetic outcome. A large mass, arising from the abdominal wall and extending intra-abdominally, was excised and was determined to be a recurrent desmoid tumor. CONCLUSIONS Recurrent anterior abdominal wall desmoid tumors in post-menopausal women are rare and locally aggressive, with a high risk of recurrence. During abdominal wall repair in abdominoplasty, desmoid tumor filaments might seed deep intra-abdominally. Therefore, it is necessary to take adequate safe margins before abdominal wall repair. Post-operatively, surgeons should keep a high index of suspicion for tumor recurrence.
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http://dx.doi.org/10.12659/AJCR.916227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6621933PMC
July 2019

A Rare Presentation of Axial Chordoma and the Approach to Management.

Am J Case Rep 2019 Jun 1;20:773-775. Epub 2019 Jun 1.

Department of Plastic Surgery, Hamad Medical Corporation, Doha, Qatar.

BACKGROUND Chordoma is a primary bone tumor that most commonly arises in the sacrococcygeal vertebrae and the spheno-occipital areas. Chordoma is a malignant tumor that should be distinguished from benign notochordal cell tumor (BNCT) of the spine. This report is of a rare case of axial chordoma and describes the challenging approach to diagnosis and management. CASE REPORT A 50-year-old woman presented with a one-year history of a slowly growing swelling in the sacral region. She complained of numbness and progressive weakness in both lower limbs, and urinary incontinence. Computed tomography (CT) imaging showed a large destructive lesion involving the sacrum and coccyx with cranial extension to level S2 and invasion of the right and left S2-S3 neural foramina, sacral nerves, left gluteus maximums muscle, and adjacent subcutaneous tissue. The management approach included the early involvement of a multidisciplinary clinical team. En bloc resection of the tumor through an anterior and posterior approach was performed, and the defect was reconstructed later using bilateral rotational gluteal fascial flaps. CONCLUSIONS Axial chordoma is a very rare, locally aggressive, and highly recurrent primary tumor of bone. The clinical management is challenging and requires early involvement of a multidisciplinary team. Following surgical resection, careful selection from limited available reconstructive surgical options is necessary to ensure that the surgical defect is repaired.
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http://dx.doi.org/10.12659/AJCR.913678DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561141PMC
June 2019

Clinical Presentation and Management of Pelvic Morel-Lavallee Injury in Obese Patients.

J Emerg Trauma Shock 2019 Jan-Mar;12(1):40-47

Department of Surgery, Trauma Surgery, HGH, Doha, Qatar.

Introduction: Morel-Lavallee lesion (MLL) is an infrequent or underreported serious consequence of closed degloving injuries. We aimed to describe the clinical presentation and management of pelvic MLL in obese patients.

Materials And Methods: A retrospective analysis was conducted for pelvic trauma patients with a diagnosis of MLL between 2010 and 2012. Patients' demographics, presentations, management, and outcomes were analyzed and compared based on the body mass index (BMI) and injury severity.

Results: Of 580 patients with pelvic region injuries, 183 (31.5%) had MLL with a mean age of 30.1 ± 12.2 years. The majority (75.4%) of MLL patients had a BMI ≥30 and 44% patients had pelvic fracture. Based on the initial clinical examination, MLL was diagnosed in 84% of patients and clinically missed in 16% of patients. Nonoperative management (NOM) was performed in 93.4% of patients, while primary surgical intervention was indicated in 6.6% of patients. Failed NOM was observed in seven cases, of them five were obese. The overall mortality in MLL patients was 12.6% and the frequency of deaths was nonsignificantly higher in Grade I obese patients. Multivariate analysis showed that injury severity score (odds ratio [OR]: 1.25, 95% confidence interval [CI]: 1.05-1.50) and Glasgow coma scale (OR: 0.72, 95% CI: 0.56-0.92) were the predictors of mortality in patients with MLL irrespective of BMI.

Conclusions: One-third of pelvic region injuries have MLL and three-quarter of them are obese. This significant association of obesity and MLL needs further prospective evaluation.
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http://dx.doi.org/10.4103/JETS.JETS_37_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6496989PMC
May 2019

Microchannels Fabrication in Alumina Ceramic Using Direct Nd:YAG Laser Writing.

Micromachines (Basel) 2018 Jul 27;9(8). Epub 2018 Jul 27.

Industrial Engineering Department, College of Engineering, King Saud University, Riyadh 11421, Saudi Arabia.

Ceramic microchannels have important applications in different microscale systems like microreactors, microfluidic devices and microchemical systems. However, ceramics are considered difficult to manufacture owing to their wear and heat resistance capabilities. In this study, microchannels are developed in alumina ceramic using direct Nd:YAG laser writing. The laser beam with a characteristic pulse width of 10 µs and a beam spot diameter of 30 µm is used to make 200 µm width microchannels with different depths. The effects of laser beam intensity and pulse overlaps on dimensional accuracy and material removal rate have been investigated using different scanning patterns. It is found that beam intensity has a major influence on dimensional accuracy and material removal rate. Optimum parameter settings are found using grey relational grade analysis. It is concluded that low intensity and low to medium pulse overlap should be used for better dimensional accuracy. This study facilitates further understanding of laser material interaction for different process parameters and presents optimum laser process parameters for the fabrication of microchannel in alumina ceramic.
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http://dx.doi.org/10.3390/mi9080371DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6187727PMC
July 2018

Correction to: Early versus late intramedullary nailing for traumatic femur fracture management: meta-analysis.

J Orthop Surg Res 2018 Jul 24;13(1):182. Epub 2018 Jul 24.

Department of Surgery, Westchester Medical Center Health Network and New York Medical College, Valhalla, NY, USA.

Following the publication of this article [1], the authors reported that they had submitted an incorrect version of Figs. 2, 3 and 4.
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http://dx.doi.org/10.1186/s13018-018-0884-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6058367PMC
July 2018

Early versus late intramedullary nailing for traumatic femur fracture management: meta-analysis.

J Orthop Surg Res 2018 Jun 28;13(1):160. Epub 2018 Jun 28.

Department of Surgery, Westchester Medical Center Health Network and New York Medical College, Valhalla, New York, USA.

Introduction: There is no consensus yet on the impact of timing of femur fracture (FF) internal fixation on the patient outcomes. This meta-analysis was conducted to evaluate the contemporary data in patients with traumatic FF undergoing intramedullary nail fixation (IMN).

Methods: English language literature was searched with publication limits set from 1994 to 2016 using PubMed, Scopus, MEDLINE (OVID), EMBASE (OVID), Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL). Studies included randomized controlled trials (RCTs), prospective observational or retrospective cohort studies, and case-control studies comparing early versus late femoral shaft fractures IMN fixation. Variable times were used across studies to distinguish between early and late IMN, but 24 h was the most frequently used cutoff. The quality assessment of the reviewed studies was performed with two instruments. Observational studies were assessed with the Newcastle-Ottawa Quality Assessment Scale. RCTs were assessed with the Cochrane Risk of Bias Tool.

Results: We have searched 1151 references. Screening of titles and abstracts eliminated 1098 references. We retrieved 53 articles for full-text screening, 15 of which met study eligibility criteria.

Conclusions: This meta-analysis addresses the utility of IMN in patients with FF based on the current evidence; however, the modality and timing to intervene remain controversial. While we find large pooled effects in favor of early IMN, for reasons discussed, we have little confidence in the effect estimate. Moreover, the available data do not fill all the gaps in this regard; therefore, a tailored algorithm for management of FF would be of value especially in polytrauma patients.
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http://dx.doi.org/10.1186/s13018-018-0856-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6022515PMC
June 2018

The emergence of multidrug-resistant in cystic fibrosis patients on inhaled antibiotics.

Lung India 2017 Nov-Dec;34(6):527-531

Weill Cornell Medicine; Department of Laboratory Medicine and Pathology, Microbiology Division, Hamad Medical Corporation, Doha, Qatar.

Introduction: Multidrug-resistant Pseudomonas aeruginosa (MDR-PA) is an important and growing issue in the care of patients with cystic fibrosis (CF), and a major cause of morbidity and mortality.

Objective: The objective of the study was to describe the frequency of MDR-PA recovered from the lower respiratory samples of pediatric and adult CF patients, and its antibiotic resistance pattern to commonly used antimicrobial agents including β-lactams, aminoglycosides, and fluoroquinolones.

Materials And Methods: The lower respiratory isolates of P. aeruginosa were obtained from inpatients and outpatients CF clinics from a tertiary care teaching hospital for the period from October 2014 to September 2015. The identification and antimicrobial susceptibility for all the isolates were performed by using the BD Phoenix™ and E-test in compliance with Clinical and Laboratory Standards Institute (CLSI) guidelines.

Results: A total of 61 P. aeruginosa samples were isolated from thirty CF patients from twenty families. Twelve sputum samples were positive for MDR-PA (seven nonmucoid and five mucoid isolates) from five CF patients (five families) with moderate-to-very severe lung disease given MDR-PA frequency of 19.7%. The median age of the study group was 20 (range 10-30) years. Three CF patients were on chronic inhaled tobramycin and two on nebulized colistin. The antimicrobial patterns of isolates MDR-PA showed the highest rate of resistance toward each gentamycin, amikacin, and cefepime (100%), followed by 91.7% to ciprofloxacin, 75% to tobramycin, 58.3% to meropenem, and 50% to piperacillin-tazobactam. None of the isolates were resistant to colistin during the study period.

Conclusion: The study results emphasize that the emergence of a significant problem in the clinical isolates of P. aeruginosa in CF patients that dictate appropriate attention to the antibiotic management after proper surveillance.
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http://dx.doi.org/10.4103/lungindia.lungindia_39_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5684810PMC
November 2017

Effect of Energy Input on Microstructure and Mechanical Properties of Titanium Aluminide Alloy Fabricated by the Additive Manufacturing Process of Electron Beam Melting.

Materials (Basel) 2017 Feb 21;10(2). Epub 2017 Feb 21.

Princess Fatima Alnijiris's Research Chair for Advanced Manufacturing Technology (FARCAMT Chair), Advanced Manufacturing Institute, King Saud University, Riyadh 11421, Saudi Arabia.

Titanium aluminides qualify adequately for advanced aero-engine applications in place of conventional nickel based superalloys. The combination of high temperature properties and lower density gives an edge to the titanium aluminide alloys. Nevertheless, challenges remain on how to process these essentially intermetallic alloys in to an actual product. Electron Beam Melting (EBM), an Additive Manufacturing Method, can build complex shaped solid parts from a given feedstock powder, thus overcoming the shortcomings of the conventional processing techniques such as machining and forging. The amount of energy supplied by the electron beam has considerable influence on the final build quality in the EBM process. Energy input is decided by the beam voltage, beam scan speed, beam current, and track offset distance. In the current work, beam current and track offset were varied to reflect three levels of energy input. Microstructural and mechanical properties were evaluated for these samples. The microstructure gradually coarsened from top to bottom along the build direction. Whereas higher energy favored lath microstructure, lower energy tended toward equiaxed grains. Computed tomography analysis revealed a greater amount of porosity in low energy samples. In addition, the lack of bonding defects led to premature failure in the tension test of low energy samples. Increase in energy to a medium level largely cancelled out the porosity, thereby increasing the strength. However, this trend did not continue with the high energy samples. Electron microscopy and X-ray diffraction investigations were carried out to understand this non-linear behavior of the strength in the three samples. Overall, the results of this work suggest that the input energy should be considered primarily whenever any new alloy system has to be processed through the EBM route.
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http://dx.doi.org/10.3390/ma10020211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5459183PMC
February 2017

Intravascular extra-digital glomus tumor of the forearm.

J Surg Case Rep 2016 Jul 15;2016(7). Epub 2016 Jul 15.

Department of Surgery, Hamad Medical Corporation, Doha, Qatar.

Intravascular glomus tumor in the forearm is very rare and usually presents with persistent pain and focal tenderness. The diagnosis of this condition can be easily missed or delayed. There is no successful treatment so far other than surgical excision in most of cases. We presented a 45-year-old female presented with intravascular glomus tumor in her left forearm. The swelling was excised and the post-operative course was uneventful. Intravascular glomus tumor of the forearm is extremely rare and the persistent pain and tenderness are very suspicious. Diagnostic imaging may not be indicated in every case.
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http://dx.doi.org/10.1093/jscr/rjw124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4946538PMC
July 2016

Portomesenteric Vein Thrombosis After Laparoscopic Sleeve Gastrectomy: 3 Case Reports and a Literature Review.

Am J Case Rep 2016 Apr 12;17:241-7. Epub 2016 Apr 12.

Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar.

Background: Porto-mesenteric venous thrombosis (PMVT) is an infrequent but severe surgical complication developing in patients who underwent laparoscopic bariatric surgery (sleeve gastrectomy). Herein, we describe the clinical presentation, management, and outcome of 3 rare cases of PMVT after laparoscopic sleeve gastrectomy (LSG), successfully treated at our center.

Case Report: All patients developed PMVT post-LSG and presented with diffused abdominal pain, nausea, and vomiting. Computed tomography (CT) of the abdomen confirmed the diagnosis of portal vein thrombosis. Two patients were treated conservatively with anticoagulation and thrombolytic therapy and the third patient required operative intervention with bowel resection.

Conclusions: PMVT is a rare presentation after LSG, which requires early diagnosis and management. Conservative management through anticoagulants and thrombolytic therapy is quite effective and, if indicated, should always be considered as the primary treatment option.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831301PMC
http://dx.doi.org/10.12659/ajcr.896892DOI Listing
April 2016

Spontaneous Atraumatic Urinary Bladder Rupture Secondary to Alcohol Intoxication: A Case Report and Review of Literature.

Am J Case Rep 2015 Nov 2;16:778-81. Epub 2015 Nov 2.

Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar.

Background: Spontaneous rupture of the urinary bladder (SRUB) secondary to alcohol intoxication is an uncommon presentation with high morbidity and mortality. Herein, we reported a rare case of spontaneous atraumatic rupture of the urinary bladder due to alcohol intoxication.

Case Report: A 45-year-old Sri Lankan man presented with drowsiness, diffuse abdominal pain, vomiting with odor of alcohol, and urinary retention 24 hours prior to the index admission. CT cystogram confirmed the urinary bladder rupture at the dome, which was repaired through exploratory laparotomy.

Conclusions: An SRUB patient with alcohol abuse often presents with non-specific symptoms due to absence of a traumatic event, which results in missed or delayed-diagnosis. Early diagnosis and management of SRUB is crucial for uneventful recovery.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4634162PMC
http://dx.doi.org/10.12659/ajcr.894992DOI Listing
November 2015

Acute Cholecystitis Complicated with Portal Vein Thrombosis: A Case Report and Literature Review.

Am J Case Rep 2015 Sep 17;16:627-30. Epub 2015 Sep 17.

Trauma Surgery Section, Hamad General Hospital, Doha, Qatar.

Background: Portal vein thrombosis (PVT) is an infrequent clinical condition usually associated with multiple etiological factors and diseases. In some cases, PVT remains undiagnosed and is incidentally detected during routine examination for a known etiology.

Case Report: Here, we present a rare case of portal vein thrombosis associated with acute cholecystitis in a 31-year-old man.

Conclusions: Conservative treatment may be a feasible and safe approach for the management of PVT with acute cholecystitis, if treated at an early stage. Moreover, initial diagnosis based on radiological evaluation is possible only if the surgeons are familiar with this unusual condition. Therefore, a high index of suspicion is required for early diagnosis and management of patients with acute cholecystitis-associated PVT.
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http://dx.doi.org/10.12659/AJCR.894846DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578645PMC
September 2015

Tailoring Morning Reports to an Internal Medicine Residency in Qatar.

J Grad Med Educ 2014 Dec;6(4):801-4

Background: Morning report, a case-based conference that allows learners and teachers to interact and discuss patient care, is a standard educational feature of internal residency programs, as well as some other specialties.

Objective: Our intervention was aimed at enhancing the format for morning report in our internal medicine residency program in Doha, Qatar.

Intervention: In July 2011, we performed a needs assessment of the 115 residents in our internal medicine residency program, using a questionnaire. Resident input was analyzed and prioritized using the percentage of residents who agreed with a given recommendation for improving morning report. We translated the input into interventions that enhanced the format and content, and improved environmental factors surrounding morning report. We resurveyed residents using the questionnaire that was used for the needs assessment.

Results: Key changes to the format for morning report included improving organization, adding variety to the content, enhancing case selection and the quality of presentations, and introducing patient safety and quality improvement topics into discussions. This led to a morning report format that is resident-driven, and resident-led, and that produces resident-focused learning and quality improvement activities.

Conclusions: Our revised morning report format is a dynamic tool, and we will continue to tailor and modify it on an ongoing basis in response to participant feedback. We recommend a process of assessing and reassessing morning report for other programs that want to enhance resident interest and participation in clinical and safety-focused discussions.
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http://dx.doi.org/10.4300/JGME-D-14-00489.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477585PMC
December 2014

External air compression: A rare cause of blunt esophageal injury, managed by a stent.

Int J Surg Case Rep 2014 27;5(9):620-3. Epub 2014 Jun 27.

Trauma Surgery Section, Hamad General Hospital, Doha, Qatar.

Introduction: Blunt esophageal injuries secondary to external air compression of anterior chest and abdomen complicated with esophageal perforation are uncommon events associated with worse outcomes.

Presentation Of Case: We reported a rare case of esophageal perforation following an external air-compression injury along with the relevant review of literatures. The patient presented with chest pain and shortness of breath and was managed with tube thoracostomy, followed by thoracotomy and eventually with temporary endoscopic stenting.

Discussion: In such trauma case, the external pressurized air forms a shock wave which usually directed to the hollow viscus. Patients with external air-compression injury presented with chest pain and pneumothorax should be suspected for esophageal perforation.

Conclusion: High index of suspicion is needed for early diagnosis of esophageal perforation after blunt trauma. Appropriate drainage, antibiotic and temporary endoscopic esophageal stenting may be an optimal approach in selected patients, especially with delayed diagnosis.
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http://dx.doi.org/10.1016/j.ijscr.2014.06.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4200878PMC
September 2014
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