Publications by authors named "Summaya Saeed"

9 Publications

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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

Malignant haemangiopericytomas of omentum presenting as left inguinal hernia: A case report.

Ann Med Surg (Lond) 2021 Feb 23;62:298-301. Epub 2021 Jan 23.

Dow University of Health Sciences, Karachi, Pakistan.

Background: Hemangiopericytomas (HPC) are vascular tumors and can be found at any place where vessels are present. These were previously known as 'extrapleural Solitary Fibrous Tumour'. These tumors may reoccur and metastasize after surgical excision. We present herein a HPC of the greater omentum, diagnosed as left inguinal hernia preoperatively.

Case Presentation: A 61-year-old male, presented with a huge painless mass in his left inguinoscrotal region secondary to weigh-lifting associated with malaise and vague abdominal pain. A well-defined, non-tender, and firm mass was found at the left lower abdomen extending to the left inguinoscrotal region. Based on the examination, a diagnosis of indirect inguinal hernia was made. Abdominal ultrasound showed a heterogeneous, hyporeflective, and vascularized mass. Contrast-enhanced computed tomography scan identified a localized, extraperitoneal, heterogeneously hypodense, well-defined, and lobulated mass, with marked contrast enhancement. On exploration, an encapsulated large mass originating from the omentum with enormously dilated blood vessels was excised. On histopathology, a neoplastic lesion, composed of spindle-shaped cells and moderate cytoplasm was identified. The blood vessels appeared thin-walled with a staghorn appearance in hemangiopericytic pattern. Omental sections showed fibro adipose tissue with dilated lymphatics and thick-walled blood vessels. Features were consistent with a malignant HPC of 20 × 14 × 10 cm.

Conclusion: We present an unusual presentation of primary omental malignant HPC as an inguinal hernia, treated by complete surgical resection. These tumors are rare therefore, timely diagnosis is important for proper evaluation, diagnosis, and treatment. It also requires long-term follow up for better survival.
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http://dx.doi.org/10.1016/j.amsu.2021.01.070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846890PMC
February 2021

Retrorectal Epidermal Inclusion Cyst: An Incidental Finding During Cesarean Section.

Cureus 2020 Nov 2;12(11):e11300. Epub 2020 Nov 2.

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

An epidermal inclusion cyst is a benign lesion, frequently observed throughout the body. However, its presence in the retrorectal region is a rare occurrence. With a higher incidence in women and non-specific symptoms, these cysts are mostly an incidental finding. Here, we report a case of a 33-year-old female presenting with complaints of abdominal pain and sensation of incomplete and painful defecation. The patient's history revealed that a large pelvic cyst was found incidentally during her first cesarean section (CS) owing to an arrest in labor. A presumptive diagnosis of rectal duplication cyst was made based on digital rectal exam (DRE), computed tomography (CT), and magnetic resonance imaging (MRI) findings. For cyst removal, the patient underwent a midline laparotomy. A postoperative biopsy led to the confirmed diagnosis of the retrorectal epidermal inclusion cyst. On follow-up, our patient showed a smooth recovery without any complications. We conclude that when dealing with a pregnant woman with a pelvic mass, developmental cysts should always be kept in mind. Timely diagnosis and management of a retrorectal mass is essential for effective treatment and to prevent subsequent complications.
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http://dx.doi.org/10.7759/cureus.11300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7710341PMC
November 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

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

Scalpel versus diathermy of midline skin incisions: comparison of mean pain scores on second post-operative day.

J Pak Med Assoc 2017 Oct;67(10):1502-1505

Consultant Surgeon, Aga Khan Health Services, Pakistan.

Objective: To determine the mean post-operative pain in scalpel versus diathermy opening of midline laparotomies.

Methods: The randomised controlled study was conducted at Civil Hospital and Dow University of Health Sciences, Karachi, from May to November 2010, and comprised patients undergoing midline laparotomy. Patients were equally divided into two groups; those who received incision with diathermy were placed in group A, and those who received incision with scalpel in group B. Mean post-operative pain scores were recorded using numerical analogue scale on second post-operative day. SPSS 16 was used for statistical analysis.

Results: Of the 58 patients, there were 29(50%) in each group. The overall mean age of the patients was 31.8±12.8 years. Besides, 40(68.9%) patients were male. The mean post-operative pain scores at 48 hours in diathermy group was 1.48±0.68 while in scalpel group it was 2.17±0.46 (p<0.05).

Conclusions: The use of diathermy for midline laparotomy incision had significant advantage over scalpel in reducing pain on second post-operative day.
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October 2017

Difficulties in laparoscopic cholecystectomy: Conversion versus surgeon's failure.

J Ayub Med Coll Abbottabad 2016 Oct-Dec;28(4):669-671

Mind and Brain Service Line, Aga Khan University Hospital, Karachi, Pakistan.

Background: Laparoscopic cholecystectomy is considered to be gold standard treatment for symptomatic gall stones. Despite several benefits there are still disadvantages of laparoscopic cholecystectomy in difficult cases where anatomy is disturbed even in experienced hand. Aim of this study is to identify advantages of early conversion to open cholecystectomy in difficult cases and how it should not be associated with surgeon's failure.

Methods: Observational study was conducted at tertiary care hospital of Karachi, Pakistan from January 2012 till June 2015. All patients who presented to general surgery department with symptomatic gall stones and planned for laparoscopic cholecystectomy was included in the study. Demographic data was collected. Preoperative workup includes baselines investigations with liver profile test and imaging study (ultrasound scan). All patient underwent laparoscopic cholecystectomy at first. Operative difficulties, incidence of conversion, reason for conversion and complication intra-operative or postoperative were recorded. Data was analyzed using SPSS 20.

Results: Out of 1026 patients, 78.26% (803) were female. Mean age of patients were 41.30±8.43 years (range 26-68 years). Common presenting symptoms were pain at upper abdomen and dyspepsia. Most of the patients had multiple gall stones (93.85%). Nine hundred and ninety-two patients (96.68%) of patients underwent successful laparoscopic cholecystectomy. This includes patients in whom dissections were difficult because of disturbed anatomy of calots triangle. Only 3.13% of patients were converted to open cholecystectomy. There was a significant difference (<0.05) in complications observed between completed and converted cholecystectomies.

Conclusions: Conversion from laparoscopic to open procedure should be done in cases of technically difficult situations to avoid significant mortality and morbidity. Surgeons experience had a pivotal role in determining its need and justification.
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November 2017

Trail without Catheter after Transurethral Resection of Prostate: Clamp It or Not?

Scientifica (Cairo) 2016 13;2016:1562153. Epub 2016 Mar 13.

Department of Surgery and Urology, Jinnah Medical College Hospital, SR-6, 7/A, Korangi Industrial Area, Karachi 74900, Pakistan.

Background. There has been argument between clinical practitioners about clamping catheter or not prior to its removal after transurethral resection of prostate (TURP). We conducted a clinical trial to assess whether clamping has any role in early bladder tone recovery particularly in patients who undergo TURP. Methods. Randomized clinical trial was conducted at a tertiary care hospital, Karachi from January 2014 to July 2015. Eighty-six study participants who underwent TURP were randomly allocated into two groups of 43 participants each. In Group I, patient's Foley catheter was not clamped prior to its removal and in Group II Foley catheter was clamped. Data of all subjects were analyzed using SPSS version 20. Results. There was no significant difference in age and weight of resected tissues between two groups. Among 4 patients in Group I who required recatheterization, 1 patient was discharged with catheter as compared to Group II in which 2 patients were discharged with catheter (P = 0.99). Only 1 patient (2.3%) in Group II had bleeding which required recatheterization. Length of stay was significantly affected by early and free removal of Foley catheter (P < 0.001). Conclusion. The results of current study identified that clamping whether done or not had no significant impact on urinary retention.
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http://dx.doi.org/10.1155/2016/1562153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4808546PMC
April 2016

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
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