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  • 1
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    Online Resource
    Laparoscopic versus open esophagectomy for patients with esophageal cancer: Systematic review and meta-analyses of randomized controlled trials.
    American Society of Clinical Oncology (ASCO) ; 2021
    In:  Journal of Clinical Oncology Vol. 39, No. 3_suppl ( 2021-01-20), p. 194-194
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 39, No. 3_suppl ( 2021-01-20), p. 194-194
    Abstract: 194 Background: There has been an increase in the use of minimally invasive approaches for complex cancer operations. However, its benefit has not been clearly demonstrated for esophageal cancers when compared to open procedures. The purpose of this meta-analysis was to compare operative and postoperative outcomes for partial minimally invasive esophagectomy (MIE) versus open esophagectomy (OE) for patients with esophageal carcinoma. Methods: We conducted a systematic review using CENTRAL, PubMed, Global Index Medicus, ClinicalTrials.gov, EU Clinical Trials Register, and WHO ICTRP until August 30, 2020 without restrictions on publication date, language, or publication status. We included randomized controlled trials evaluating MIEs and partial MIEs including laparoscopic approach with OE for esophageal cancer. All trials including any one of our primary outcome measures -mortality and morbidity- were included. Two authors assessed trials for inclusion. Meta-analyses were conducted for categorical outcomes when heterogeneity was low ( I 2 〈 50%). We reported risk ratios with 95% confidence intervals and GRADE quality of evidence based on our risk of bias assessment. Results: Of 5638 retrieved studies, 10 studies representing 6 trials consisting of 951 patients were included. 347 underwent partial MIE, 106 total MIE, and 498 OE. These were categorized into four cohorts:Co-A: Partial MIE versus OE (4 trials); Co-B: Partial MIE with thoracotomy versus OE (2 trials); Co-C: Partial MIE with cervical incision versus OE (2 trials); Co-D: Complete MIE versus OE (2 trials). Co-A revealed that partial MIE was associated with lower risk of serious adverse events (0.54[0.36-0.83]; 3 trials; 471 participants; I 2 = 48%), with specifically lower rates of delayed gastric emptying (0.32[0.13-0.80]; 3 trials; 666 participants; I 2 = 0%), pulmonary complications (0.49[0.29-0.84]; 3 trials; 471 participants; I 2 = 27%), and mortality (0.67[0.54-0.83]; 4 trials; 692 participants; I 2 = 0%). Co-B revealed that partial MIE with thoracotomy was associated with lower risk of pulmonary complications (0.61[0.38-0.99]; 2 trials; 231 participants; I 2 = 0%) and mortality (0.66[0.50-0.87]; 2 trials; 231 participants; I 2 = 0%). Co-C revealed that partial MIE with cervical incisions were associated with lower risk of serious adverse events (0.38[0.22-0.64]; 1 trial; 240 participants), including pulmonary complications (0.29[0.13-0.65] ); 1 trial; 240 participants) and mortality (0.68[0.50-0.94]; 2 trials; 461 participants). Co-D revealed no significant differences between MIE and OE. All significant findings reported originated from high-quality evidence. Conclusions: When compared with completely open esophagectomy, partial MIE is associated with lower risk of mortality and serious adverse events, especially delayed gastric emptying and pulmonary complications.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2021.39.3_suppl.194
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2021
    detail.hit.zdb_id: 2005181-5
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  • 2
    Online Resource
    Online Resource
    Barriers to Surgical Outcomes Research in Low- and Middle-Income Countries: A Scoping Review
    Elsevier BV ; 2023
    In:  Journal of Surgical Research Vol. 290 ( 2023-10), p. 188-196
    Details
    In: Journal of Surgical Research, Elsevier BV, Vol. 290 ( 2023-10), p. 188-196
    Type of Medium: Online Resource
    ISSN: 0022-4804
    URL: Article
    DOI: 10.1016/j.jss.2023.04.017
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 1470806-1
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  • 3
    Online Resource
    Online Resource
    Molecular basis of non-alcoholic fatty liver disease and metabolic syndrome in a subset of South Asians
    Springer Science and Business Media LLC ; 2021
    In:  International Journal of Diabetes in Developing Countries Vol. 41, No. 3 ( 2021-07), p. 435-440
    Details
    In: International Journal of Diabetes in Developing Countries, Springer Science and Business Media LLC, Vol. 41, No. 3 ( 2021-07), p. 435-440
    Type of Medium: Online Resource
    ISSN: 0973-3930 , 1998-3832
    URL: Article
    DOI: 10.1007/s13410-020-00906-4
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2263351-0
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  • 4
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    Online Resource
    Deep learning applications in neuro-oncology
    Scientific Scholar ; 2021
    In:  Surgical Neurology International Vol. 12 ( 2021-08-30), p. 435-
    Details
    In: Surgical Neurology International, Scientific Scholar, Vol. 12 ( 2021-08-30), p. 435-
    Abstract: Deep learning (DL) is a relatively newer subdomain of machine learning (ML) with incredible potential for certain applications in the medical field. Given recent advances in its use in neuro-oncology, its role in diagnosing, prognosticating, and managing the care of cancer patients has been the subject of many research studies. The gamut of studies has shown that the landscape of algorithmic methods is constantly improving with each iteration from its inception. With the increase in the availability of high-quality data, more training sets will allow for higher fidelity models. However, logistical and ethical concerns over a prospective trial comparing prognostic abilities of DL and physicians severely limit the ability of this technology to be widely adopted. One of the medical tenets is judgment, a facet of medical decision making in DL that is often missing because of its inherent nature as a “black box.” A natural distrust for newer technology, combined with a lack of autonomy that is normally expected in our current medical practices, is just one of several important limitations in implementation. In our review, we will first define and outline the different types of artificial intelligence (AI) as well as the role of AI in the current advances of clinical medicine. We briefly highlight several of the salient studies using different methods of DL in the realm of neuroradiology and summarize the key findings and challenges faced when using this nascent technology, particularly ethical challenges that could be faced by users of DL.
    Type of Medium: Online Resource
    ISSN: 2152-7806
    URL: Article
    DOI: 10.25259/SNI_433_2021
    Language: English
    Publisher: Scientific Scholar
    Publication Date: 2021
    detail.hit.zdb_id: 2567759-7
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  • 5
    Online Resource
    Online Resource
    Disparities in presentation, treatment, and overall survival for South Asian American patients with colorectal cancer.
    American Society of Clinical Oncology (ASCO) ; 2023
    In:  Journal of Clinical Oncology Vol. 41, No. 16_suppl ( 2023-06-01), p. e15554-e15554
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 41, No. 16_suppl ( 2023-06-01), p. e15554-e15554
    Abstract: e15554 Background: The South Asian population in America is growing. Colorectal Cancer (CRC) is one of the most common cancers amongst South Asian Americans (SAA), however few studies have looked at differential presentation, treatment, and outcomes. The objective of this study was to compare differences in presentations, and investigate disparities in treatment and overall survival (OS) amongst SAAs compared with non-Hispanic whites (NHW). Methods: We performed a retrospective analysis of patients with colon or rectal adenocarcinoma in the National Cancer Database (NCDB) years 2004-2020. We compared differences in patient demographics, socioeconomics, stage at presentation, and treatments received between SAA and NHW populations using chi square, and t tests as applicable. OS was evaluated using Kaplan-Meier analysis and the log-rank test. Multivariable Cox regression stratified by stage was used to compare OS between the two groups. Results: We analyzed data from 773,223 NHW and 3,448 SAA patients with colon cancer (CC) and 285,769 NHW and 1,826 SAA patients with RC. At presentation SAAs were younger (61.2 years vs 69.2 years, p 〈 0.001 for CC, and 57.9 vs 63.9, p 〈 0.001 for RC), less likely to have government insurance (44.1% vs 64.1%, p 〈 0.001 for CC, and 35.4% vs 50.6%, p 〈 0.001 for RC), more likely to be living in metropolitan areas (97.9% vs 83.2%, p 〈 0.001 for CC, and 97.4% vs 81.0%, p 〈 0.001 for RC), and more likely to have advanced stages of disease (47.4% vs 42.7%, p 〈 0.001 for CC, and 40.9% vs 38.9%, p 〈 0.001 for RC). SAAs had significantly longer delay in receipt of surgical intervention or radiation therapy (p 〈 0.001) and were less likely to receive surgery for stage 4 for CC (54.6% vs 60.5%, p 〈 0.001). On multivariate cox regression, adjusted for age, sex, insurance status, urban/rural location, and comorbid conditions, SAAs with either colon or rectal cancer were more likely to survive across all cancer stages (p 〈 0.001). Conclusions: In this national study, when compared to NHW patients, SAA patients with CRC, present at younger ages and with more aggressive disease. Despite SAAs being less likely to receive timely cancer care, they have better overall survival. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2023.41.16_suppl.e15554
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2023
    detail.hit.zdb_id: 2005181-5
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  • 6
    Online Resource
    Online Resource
    Role of Denosumab in the Management of Giant Cell Tumor, a Cross Sectional Study
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  International Journal of Surgery Oncology Vol. 8, No. 1 ( 2023), p. 1-7
    Details
    In: International Journal of Surgery Oncology, Ovid Technologies (Wolters Kluwer Health), Vol. 8, No. 1 ( 2023), p. 1-7
    Abstract: Giant cell tumor (GCT) of bone is a benign lesion which is characterized by presence of multinucleated osteoclasts type giant cells. Nuclear factor kappa B (RANKL) serves as the trigger factor for osteoclasts cells formation. Although surgery is the primary treatment for GCT of bone but recurrence remains the concern. Therefore, the development of denosumab, a monoclonal antibody for treating GCT for both primary and recurrent disease cases. The present study aims to show the role of denosumab along with surgery when given as neo-adjuvant drug to patients of GCT for their treatment. Methodology: A total of 23 patients diagnosed with GCT were included in this study from January 2016–December 2019 and all of these patients had received neo adjuvant denosumab dose of 120 mg SC on day 0, 15, 30 & 45. All patients were treated at the section of Orthopedics, department of surgery, Aga Khan University hospital, Karachi. Other benign lesions were excluded from the study. Results: Out of 23 patients we had 12 (52.2%) males and 11 (47.8%) females. The mean age of our patients was 34±13.8 years and mean follow up duration of all patients was 20.5 ± 10.7 months. There were 15 (65.2%) primary cases of GCT while 8 (34.8%) were recurrent cases. In 8 (34.8%) of the cases primary site of lesion was distal femur followed by 7(30.4%) proximal tibia cases and 3(13%) distal radius cases. In surgical procedure 20 (87%) patients underwent wide margin excision and only 3 (13%) had intralesional curettage. Reconstruction was performed in 21 patients which consist of bone grafting in 9 patients and mega prosthesis insertion in 12 patients. Only two patients had no reconstruction. On final histopathology, there was no residual GCT and we observed no denosumab induced adverse effects. Post-operative complications included wound infection and peri prosthetic infection in 3 patients. On follow-up we had 4(17.4%) cases of recurrence that were offered revision surgery while 19 (82.6%) were disease free. Conclusion: Denosumab has shown successful results in treating patients with GCT along with surgical intervention and it can be a best option for treating recurrent disease as well. Highlights Research registration no: researchregistry4695
    Type of Medium: Online Resource
    ISSN: 2471-3864
    URL: Article
    DOI: 10.29337/ijsonco.146
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2898335-X
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  • 7
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    Online Resource
    Social Incubation in Pakistan: Enabling Student Mobilization During the COVID-19 Pandemic
    Pakistan Medical Association ; 2022
    In:  Journal of the Pakistan Medical Association Vol. 72, No. 2 ( 2022-04-01), p. 384-384
    Details
    In: Journal of the Pakistan Medical Association, Pakistan Medical Association, Vol. 72, No. 2 ( 2022-04-01), p. 384-384
    Abstract: To the Editor: Developing countries, like Pakistan, with limited resources and budding health systems, face intense fear and despondency amongst the public, leading to worsening outcomes as wave after wave of the pandemic hits. (1) This helplessness is felt most by students and various health profession trainees who are the least vulnerable, yet the most underutilized. Combatting this frustration led to five medical students strategizing a mechanism to amass the country's collective resilience, expertise, and knowledge. This endeavor has since grown from March 2020 into an international autonomous taskforce of 700+ volunteers: The Student Taskforce Against COVID-19, an assortment of ten distinct COVID related efforts. (2,3) As we transitioned from a social incubator to a need-of-the-hour platform, our experiences taught us that five key values were central to enabling trainee led reform: a) strong leadership amongst working groups, b) strategic innovation targeted at developing real-time solutions to emerging and existing healthcare problems, c) reliable communication of authentic and relevant information in the midst of rumor and misinformation overload, d) community support and partnerships on individual and regional levels, and e) multidisciplinary teamwork amongst diverse volunteer groups. (Read more about us at: http://www.stac19.org/). Our initiatives relied on synergism between backgrounds in allied health, engineering, media, marketing, and entrepreneurship. The diversely skilled volunteers from across Pakistan led efforts ranging from telehealth programmes focusing on national critical care support and virtual mental health counselling, to training and informational programs for staff and residents at senior citizen homes and for the general public via a centralized student-manned helpline. The approach to these programmes was founded on the balance between functionality and sustainability with stakeholder involvement integrated at every tier. Although our experiences in Pakistan did face educational and economic limitations, they were very similar to patterns of student involvement in combating this crisis globally. (4) What this initiative has shown is that the interplay between diversity, synergism and collaboration is the key foundation for large-scale impact. This model of student mobilization can be reproduced in other crisis settings beyond the pandemic, beyond healthcare settings and beyond socioeconomic barriers. Continuous...
    Type of Medium: Online Resource
    ISSN: 0030-9982
    URL: Article
    DOI: 10.47391/JPMA.4786
    Language: Unknown
    Publisher: Pakistan Medical Association
    Publication Date: 2022
    detail.hit.zdb_id: 2128872-0
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