Browsing by Author "Razrim Rahim"
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Publication The Choco-w Prospective Obervational Global Study: Does Covid-19 Increase Gangrenous Cholecystitis?(BioMed Central Ltd, 2022)Razrim RahimBackground: The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. Methods: Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month followup. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. Results: A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. Conclusions: The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVIDpatients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID- 19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy,in a case by case evaluation, in expert hands. - Some of the metrics are blocked by yourconsent settings
Publication Elective Surgery System Strengthening: Development, Measurement, and Validation of the Surgical Preparedness Index Across 1632 Hospitals in 119 Countries(The Lancet, 2022) ;James C Glasbey ;Ruhi Fadzlyana JailaniRazrim RahimBackground The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. Methods First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score. Findings In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45·6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84·5 (95% CI 84·1–84·9), which varied between HIC (88·5 [89·0–88·0]), MIC (81·8 [82·5–81·1]), and LIC (66·8 [64·9–68·7]) settings. In the third phase, 1217 (74·6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51·4%) were from HIC, 538 (44·2%) from MIC, and 54 (4·4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3·6% (95% CI 3·0–4·1; p<0·0001) increase in SVR. This was consistent in HIC (4·8% [4·1–5·5]; p<0·0001), MIC (2·8 [2·0–3·7]; p<0·0001), and LIC (3·8 [1·3–6·7%]; p<0·0001) settings. Interpretation The SPI contains 23 indicators that are globally applicable, relevant across different system stressors, vary at a subnational level, and are collectable by front-line teams. In the case study of COVID-19, a higher SPI was associated with an increased planned surgical volume ratio independent of country income status, COVID-19 burden, and hospital type. Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs. Funding National Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, NIHR Academy, Association of Coloproctology of Great Britain and Ireland, Bowel Research UK, British Association of Surgical Oncology, British Gynaecological Cancer Society, and Medtronic. - Some of the metrics are blocked by yourconsent settings
Publication Evidence of Rectal Carcinoma in the Background of Solitary Rectal Ulcer Syndrome with Pathological Complete Response after Preoperative Radiotherapy: A Case Report and Narrative Review of Literature(Surgical Society Of Northern Greece, 2023) ;Yasir Ahmad ;Rashidah Mohamad KhalidRazrim Rahim - Some of the metrics are blocked by yourconsent settings
Publication Extradigital glomus tumour in the arm: A case report(Universiti Sains Islam Malaysia, 2019-09) ;Mohd Shaffid Md Shariff ;Razrim RahimAffirul ChairilWe report a case of a 64-year-old lady preasented with a history of localised pain over the left arm which was aggravated by shower and cold weather. Physical examination showed bluish purplish swelling over the left arm which was tender. Diagnosis of glomus tumour was made. Glomus tumour are rare benign vascular related tumour and most interesting tumour of the hand because of its unique clinical findings. Clinically, glomus tumour are chracterized by a triad of severe pain, localising tenderness and cold sensitivity. The lesion usually located in the hand, but it may occur elsewhere. With good and precise clinical judgement, the diagnosis of glomus tumour can be made. We report a rare case of extradigital glomus tumour that present in the arm. - Some of the metrics are blocked by yourconsent settings
Publication Isolated Hypophosphataemia Mimicking Cerebrovascular Accident(Universiti Malaysia Sabah, 2019) ;Hanizah Ngadiron ;Razrim Rahim ;Firdaus Hayati ;Nornazirah AzizanAffirul Chairil AriffinHypophosphataemia occurs in an abnormally low serum phosphate level. Three main mechanisms are postulated: decreased intestinal absorption, increased renal excretion, and extracellular shifts to intracellular compartments. It is potentially a fatal disease if not intervene. The management is merely treating the underlying disorder, giving phosphate supplement and requiring close biochemical monitoring. The incidence of symptomatic isolated hypophosphataemia is extremely rare. In this case report, a 33-year-old man presented with three days history of dysphagia, inability to complete sentences and generalized muscle weakness. He developed blurred vision especially upon exposure to bright light. He had a history of single parathyroidectomy for parathyroid adenoma 2 years ago. Physical examinations were unremarkable. Laboratory investigations were normal except for phosphate level of 0.30 mmol/L. Intravenous KH2PO4 with a dosage of 10 mmol was administered in slow bolus in 3 hours. His symptoms resolved slowly after correction. Although isolated hypophosphataemia is rare but need to recognize the symptoms and signs of hypophosphataemia and treat accordingly. - Some of the metrics are blocked by yourconsent settings
Publication Optimal Treatment For Poor Responders To Ovarian Stimulation: Does In-vitro Insemination Offer Any Advantages To Intrauterine Insemination?(Taylor & Francis, 2003) ;Simon Wood ;Razrim Rahim ;Tom Searle ;Yasmin Sajjad ;Stephen Troup ;Iwan Lewis-JonesCharles KingslandA retrospective study was performed of 1832 consecutive in vitro insemination (IVF)/intracytoplasmic sperm injection (ICSI) cycles over 18 months, to analyse the benefits or otherwise to the patient of continuing with in vitro treatment or converting the assisted conception cycle to intrauterine insemination (IUI). Two hundred and seventy cycles were identified in which three follicles or fewer were obtained after controlled ovarian hyperstimulation; in 143 of these cycles, the clinicians or patients elected to abandon all treatment, whereas treatment was continued in 127 patients. In 79 cycles, the patients proceeded with IVF/ICSI and in 48 patients, the cycles were converted to IUI. Data were analysed with regard to the clinical pregnancy rate. In addition, the data for IUI were compared with eight cycles of supraovulation IUI (S/IUI) performed over the same period. There were no significant differences in clinical pregnancy rates among any treatment modality 6/48 (12.5%), 6/79 (7.7%) and 1/8 (12.5%) for IUI, IVF and S/IUI, respectively (P = 0.64). The lowest total number of motile spermatozoa required to achieve pregnancy using IUI was 2.0 x 10(6). In conclusion, it appears that, if the treatment is suitable, patients who respond poorly to controlled hyperstimulation for IVF would not be disadvantaged in achieving a pregnancy by offering them conversion to the medically and financially less interventional IUI. - Some of the metrics are blocked by yourconsent settings
Publication Pediatric Trauma And Emergency Surgery: An International Cross-sectional Survey Among Wses Members.(BMC, 2023) ;Martin Reichert ;Massimo Sartelli ;Ingolf H. Askevold ;Jaqueline Braun ;Markus A. Weigand ;Matthias Hecker ;Vanni Agnoletti ;Federico Coccolini ;Fausto Catena ;Winfried Padberg ;Jens G. Riedel ;Andreas HeckerRazrim RahimIn contrast to adults, the situation for pediatric trauma care from an international point of view and the global management of severely injured children remain rather unclear. The current study investigates structural management of pediatric trauma in centers of different trauma levels as well as experiences with pediatric trauma management around the world. - Some of the metrics are blocked by yourconsent settings
Publication A Rare Case of Intussusception Associated with Metastasize Small Cell Carcinoma of Lung(Tehran University of Medical Sciences, 2012) ;Razman Jarmin ;Azlanuddin Azman ;Razrim Rahim ;Nik Ritza KosaiSrijit DasIntussusception is common cause of bowel obstruction in the paediatric age group compared to the elderly population. Many times, the diagnosis may be difficult because of asymptomatic nature of this bowel disorder. We hereby describe the case of a 75-year-old male who presented with lethargy, weakness, loss of movement in the joints and was found to be anemic. The haemoglobin level was low so he was transfused with packed cells. On gastrointestinal (GI) endoscopy, upper GI bleed was observed. A mass was observed beyond ampulla at the 2nd and 3rd part of the duodenal junction. Computerized tomography (CT) scan also showed a mass at the head of pancreas and the lesion at the left lung. In view of persistent bleed, 'Whipple's procedure' was performed. Histopathological examination showed small cell carcinoma of the lungs with metastasis to the pancreas and the jejunum. We here discuss the case of intussusception with intestinal metastasis which presented with gastrointestinal bleeding. - Some of the metrics are blocked by yourconsent settings
Publication Spleen Autotransplantation In Rat(Faz Publishing, 2020) ;Adlina Mohammad ;Affirul Chairil Ariffin ;Fadlul Azim Fauzi Mansur ;Wan Omar Abdullah ;Asral Wirda Ahmad Asnawi ;Anuar SaniRazrim RahimAim: This paper describes the surgical procedure for spleen auto transplantation in rats. Splenectomy is an important surgery protocol in research studies involving immunology and hematopoietic diseases. Spleen auto transplantation is an alternative method undertaken to preserve the splenic function as the absence of spleen (asplenia) is associated with lifelong risk for sepsis, especially by encapsulated bacteria. Method: Four six weeks old male Sprague-Dawley rats, with range of weight from 248-281 grams, underwent spleen autotransplantation via midline laparotomy incision. In this procedure the spleen was completely removed (total splenectomy); it involved removing the spleen and re-transplanted in greater omentum. A piece of the spleen weighing approximately 0.34 grams was transplanted inside the greater omentum and held in place with an absorbable suture knot. The muscle layer and skin incision were then closed using absorbable suture. The surgery was conducted under deep sedation and the rat was monitored post-operatively until it fully recovered. Outcome: The post-operative recovery of the rat was uneventful. Six-weeks after the surgery, the rat underwent a re-look laparotomy and the auto-transplanted spleen was examined. There was a three-fold increase in the size and weight of the spleen. Conclusion: This spleen auto transplantation model, which utilized an omental pouch, was not only successful in preserving the spleen, but also allowed for spleen regeneration. This model provides future platform for further research in auto-transplanted spleen. - Some of the metrics are blocked by yourconsent settings
Publication Urinary Bladder Dome Necrosis And Adhesion Causing Small Bowel Obstruction: A Case Report.(Faz Publishing, 2019) ;Navin Raj ;Rashidah KhalidRazrim RahimIt is rare for a pathology originating from the urinary bladder to cause intestinal obstruction. We report a case where a 65-year-old man presented with acute urinary retention and concurrent small bowel obstruction. The cause was found to be adhesion of the jejunal mesentery to a necrotic segment of the urinary bladder dome. The necrosis was likely caused by overdistension of the bladder from urinary retention. The urinary retention was relieved and the patient underwent laparotomy, adhesiolysis and bladder wall repair.