ORCID Profile
0000-0001-8997-2161
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Publisher: International College of Surgeons
Date: 09-2018
DOI: 10.9738/INTSURG-D-15-00332.1
Abstract: Diverticulitis affecting the transverse colon is uncommon, with perforation being exceptionally rare. It is not usually considered in the differential diagnosis of a patient with acute abdominal pain. We report a case of nonspecific abdominal pain secondary to a perforated erticulum in the transverse colon during preoperative bowel preparation. A 74-year-old Caucasian female had sudden onset abdominal pain and nausea with routine bowel preparation. This undifferentiated acute abdomen was suggestive of a bowel perforation, which was later confirmed by a computed tomography scan. Surgical exploration determined the location of the perforation in the transverse colon. We report an unusual presentation of preoperative abdominal pain during routine bowel preparation. It is extraordinarily uncommon to see rupture of a transverse colon erticulum in a patient with sigmoid involvement, and bowel preparation as a cause of rupture has not been previously documented. Because perforation of a transverse colon erticulum generally has a nonspecific clinical presentation, it should be considered in the differential diagnosis for a patient with known erticular disease who has acute onset abdominal pain and signs of peritonism.
Publisher: BMJ
Date: 12-09-2019
Publisher: Informa UK Limited
Date: 03-07-2022
DOI: 10.1080/17512433.2022.2108402
Abstract: Diabetes is the most common cause of end-stage kidney disease. Therapies such as sodium-glucose co-transporter-2 inhibitors have been identified over the last decade as effective oral hypoglycemic agents that also confer additional cardio and kidney protection. Knowledge of their mechanism of action and impact on patients with diabetes and albuminuria is vital in galvanizing prescriber confidence and increasing clinical uptake. This manuscript discusses the pathophysiology of diabetic kidney disease, patho-physiological mechanisms for sodium-glucose co-transporter-2 inhibitors, and their impact on patients with type 2 diabetes mellitus and albuminuric kidney disease. Sodium-glucose co-transporter-2 inhibitors reduce albuminuria with consequent benefits on cardiovascular and kidney outcomes in patients with diabetes and severe albuminuria. While they have been incorporated into guidelines, the uptake of these agents into clinical practice has been slow. Increasing the uptake of these agents into clinical practice is necessary to improve outcomes for the large number of patients with diabetic kidney disease globally.P LAIN LANGUAGE SUMMARYPeople with type 2 diabetes and severe urinary protein loss are at high risk of progression to kidney failure requiring dialysis or transplantation. Preventing or slowing down loss of kidney function is crucial to preventing kidney failure. This review will discuss how diabetic kidney disease occurs, how a new family of glucose-lowering agents, the sodium-glucose co-transporter-2 inhibitors, work and how they affect people with type 2 diabetes mellitus who also have protein leaking from their kidneys. It will also detail the current data that underpins the guideline recommendations for use of these agents in the management of patients with and without diabetes.
Publisher: Springer Science and Business Media LLC
Date: 06-01-2022
DOI: 10.1186/S12882-022-02660-7
Abstract: TAFRO syndrome is a rare clinical subtype of idiopathic multicentric Castlemans disease characterised by thrombocytopenia, anasarca, myelofibrosis, renal dysfunction, and organomegaly. Renal involvement is common, sometimes requiring temporary renal replacement therapy. Due to the associated thrombocytopenia, renal biopsies are rarely performed limiting descriptions of the renal histopathology in this condition. This case describes a patient with TAFRO syndrome and the associated renal histology. A 49-year-old Caucasian man presented to a tertiary hospital in Sydney with a six- week history of malaise, non-bloody diarrhoea, progressive shortness of breath, and drenching night sweats. A progressive bicytopenia and renal function decline necessitating temporary dialysis prompted a bone marrow aspirate and trephine, as well as a renal biopsy respectively. This noted a hypercellular bone marrow with increased granulopoiesis, reduced erythropoiesis, and fibrosis, with renal histology suggesting a thrombotic microangiopathic-like glomerulopathy. Alternate conditions were excluded, and a diagnosis of TAFRO syndrome was made. Glucocorticoids and rituximab were initiated with rapid renal recovery, and normalisation of his haematologic parameters achieved at six months. This case describes an atypical thrombotic microangiopathy as the predominant histologic renal lesion in a patient with TAFRO syndrome. This was responsive to immunosuppression with glucocorticoids and rituximab, highlighting the importance of early recognition of this rarely described condition.
Publisher: Elsevier BV
Date: 10-2010
DOI: 10.1016/J.UROLOGY.2010.04.020
Abstract: To review the surgical management of upper tract urothelial carcinoma (UTUC) on a population level. UTUC accounts for 5% of urothelial malignancies, making it less amenable to single-center reporting. Complete nephroureterectomy is the standard of care, and increasing evidence has shown that a suboptimal surgical technique is associated with an adverse prognosis. We obtained information for all patients diagnosed with UTUC (n = 830) and those treated surgically (n = 680) in the province of Ontario, Canada from the Ontario Cancer Registry from 1995 to 2004. Demographic, treatment, and vital status information was obtained for all patients, and pathology reports were available for 422 patients. The primary outcome was overall survival. The secondary outcomes included measures of surgical quality (ie, number of lymph nodes s led, ureteral length excised, surgical margin status, and 30-day mortality) and disease-specific survival. The unadjusted 5-year overall survival rate was 57.2%, with a median survival of 72.5 months. For those treated surgically, the 30-day mortality rate was 1.8%, and the positive surgical margin rate was 8.5%. Lymph nodes were identified in only 27% of the specimens, with a median yield of 1 (range 1-15). An estimated 25.8% of patients might have undergone incomplete ureteral resection at the time of nephroureterectomy. UTUC is a lethal malignancy, with nearly one half the patients dying within 5 years. Furthermore, lymphadenectomy was rarely performed and approximately one fourth of patients might have undergone incomplete ureterectomy. The published outcomes from "centers of excellence" do not appear to reflect the surgical quality seen on a population level for this rare, but significant, malignancy.
No related grants have been discovered for Nasir Shah.