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Article: Case report and systematic review of mesenteric artery by-pass for non-atherosclerotic mesenteric vascular disease.

Zahra, Wajiha

International journal of surgery case reports

2020 Volume 70, Page(s) 249–250

Abstract: Introduction: Mesenteric artery re-vascularization using bypass or angioplasty is a standard of care in atherosclerotic mesenteric vascular disease. However, there are no certain guidelines for the management of non-atherosclerotic thrombophilic ... ...

Abstract	Introduction: Mesenteric artery re-vascularization using bypass or angioplasty is a standard of care in atherosclerotic mesenteric vascular disease. However, there are no certain guidelines for the management of non-atherosclerotic thrombophilic mesenteric vessel disease other than anti-coagulation. Case report: We are reporting a case of a 36 years old lady with post-prandial angina and weight loss on the background of anti-phospholipid syndrome having tripple mesentric vessel occlusive disease who underwent 2 vessel aorto-mesenteric bypass. During the post-op course, patient had laparotomy with diversion ileostomy for ischemic perforation of the bowel. At present, after 6 weeks patient is recovering well with improved appetite and resolution of symptoms. Discussion: There are very few cases reported with acute on chronic mesenteric ischemia in England. Nikolas Melas et al. reported similar history in a 57 yrs old Caucasian female. Morbi AH2 highlights timely diagnosis of acute mesmeric ischemia in a 53 yrs old. Conclusion: This case report is unique in a way that combined mesenteric ischemia and APS is a rare combination in a 36 years old. Mesenteric artery bypass is one of the possible solutions to thrombophilic mesenteric disease, however larger studies with longer follow up are needed.
Language	English
Publishing date	2020-05-11
Publishing country	Netherlands
Document type	Case Reports
ISSN	2210-2612
ISSN	2210-2612
DOI	10.1016/j.ijscr.2020.04.033
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Safety of tranexamic acid in surgically treated isolated spine trauma.

Zahra, Wajiha / Nayar, Sandeep Krishan / Bhadresha, Ashwin / Jasani, Vinay / Aftab, Syed

World journal of orthopedics

2024 Volume 15, Issue 4, Page(s) 346–354

Abstract: Background: Tranexamic acid (TXA), a synthetic antifibrinolytic drug, effectively reduces blood loss by inhibiting plasmin-induced fibrin breakdown. This is the first study in the United Kingdom to investigate the effectiveness of TXA in the surgical ... ...

Abstract	Background: Tranexamic acid (TXA), a synthetic antifibrinolytic drug, effectively reduces blood loss by inhibiting plasmin-induced fibrin breakdown. This is the first study in the United Kingdom to investigate the effectiveness of TXA in the surgical management of isolated spine trauma. Aim: To assess the safety of TXA in isolated spine trauma. The primary and secondary outcomes are to assess the rate of thromboembolic events and to evaluate blood loss and the incidence of blood transfusion, respectively. Methods: This prospective observational study included patients aged ≥ 17 years with isolated spine trauma requiring surgical intervention over a 6-month period at two major trauma centers in the United Kingdom. Results: We identified 67 patients: 26 (39%) and 41 (61%) received and did not receive TXA, respectively. Both groups were matched in terms of age, gender, American Society of Anesthesiologists grade, and mechanism of injury. A higher proportion of patients who received TXA had a subaxial cervical spine injury classification or thoracolumbar injury classification score > 4 (74% Conclusion: Our study demonstrated that TXA is safe for isolated spine trauma. It is challenging to determine whether TXA effectively reduces blood loss because most surgeons prefer TXA for open or multilevel cases. Further, larger studies are necessary to explore the rate, dosage, and mode of administration of TXA.
Language	English
Publishing date	2024-04-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2649712-8
ISSN	2218-5836
ISSN	2218-5836
DOI	10.5312/wjo.v15.i4.346
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Article: Clinical outcome of open ankle fractures in patients above 70 years of age.

Zahra, Wajiha / Seifo, Mina / Cool, Paul / Ford, David / Okoro, Tosan

World journal of orthopedics

2023 Volume 14, Issue 7, Page(s) 554–561

Abstract: Background: Open fractures of the ankle are complex injuries requiring multidisciplinary input and are associated with significant morbidity and mortality. However, data on the clinical outcomes of open ankle fracture management in patients older than ... ...

Abstract	Background: Open fractures of the ankle are complex injuries requiring multidisciplinary input and are associated with significant morbidity and mortality. However, data on the clinical outcomes of open ankle fracture management in patients older than 70 is minimal. Aim: To evaluate the clinical outcomes following open ankle fracture management in patients older than 70. Our secondary aim is to look at predictors of poor outcomes. Methods: Following local research and audit department registration, 22 years of prospectively collated data from an electronic database in a district general hospital were assessed. All patients older than 70 years of age with an open ankle fracture requiring surgical intervention were identified. Demographic information, the nature, and the number of surgical interventions were collated. Complications, including surgical site infection (SSI), venous thromboembolic events (VTEs) during hospital stay, and mortality rate, were reviewed. Results: A total of 37 patients were identified (median age: 84 years, range: 70-98); Conclusion: An open ankle fracture in a patient older than 70 years has at least a 20% chance of requiring repeated surgical intervention due to deep SSIs. The presence of a cardiac history appears to be the main predictor for wound complications.
Language	English
Publishing date	2023-07-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2649712-8
ISSN	2218-5836
ISSN	2218-5836
DOI	10.5312/wjo.v14.i7.554
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Article ; Online: Preventing the Cloud Networks through Semi-Supervised Clustering from Both Sides Attacks

Muhammad Nadeem / Ali Arshad / Saman Riaz / Syeda Wajiha Zahra / Ashit Kumar Dutta / Sultan Almotairi

Applied Sciences, Vol 12, Iss 15, p

2022 Volume 7701

Abstract: Cloud computing is a centralized data storage system providing various services worldwide. Different organizations are using the cloud for other purposes. As the number of users on the cloud server increases, so does the rate of attacks on the cloud. ... ...

Abstract	Cloud computing is a centralized data storage system providing various services worldwide. Different organizations are using the cloud for other purposes. As the number of users on the cloud server increases, so does the rate of attacks on the cloud. Various researchers have devised different solutions to solve these problems, the most widely used being the Intrusion Detection System (IDS). In this paper, a network architecture has been designed in which an efficient technique, semi-supervised clustering, has been used. In this technique, users’ responses inside and outside the cloud server have been observed, and various rules and mechanisms have been enforced based on these responses. The network is divided into three different scenarios. In the first scenario, attacks outside the cloud server have been detected, and then ways to prevent these attacks are discussed. The second scenario uses Cloud Shell, allowing authentic users to access the cloud server through authentic queries. In the third scenario, this tool’s performance and detection rate have been measured by applying different results to the confusion matrix. A comparative analysis has been done with other papers at the end of the paper, and conclusions have been drawn based on different results.
Keywords	intrusion detection system ; cloud security ; sids ; semi-supervised clustering ; network sensor ; networking ; Technology ; T ; Engineering (General). Civil engineering (General) ; TA1-2040 ; Biology (General) ; QH301-705.5 ; Physics ; QC1-999 ; Chemistry ; QD1-999
Subject code	006
Language	English
Publishing date	2022-07-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The impact of COVID-19 on elective and trauma spine service in a district general hospital.

Zahra, Wajiha / Karia, Monil / Rolton, Daniel

Bone & joint open

2020 Volume 1, Issue 6, Page(s) 281–286

Abstract: Aims: The aim of this paper is to describe the impact of COVID-19 on spine surgery services in a district general hospital in England in order to understand the spinal service provisions that may be required during a pandemic.: Methods: A prospective ...

Abstract	Aims: The aim of this paper is to describe the impact of COVID-19 on spine surgery services in a district general hospital in England in order to understand the spinal service provisions that may be required during a pandemic. Methods: A prospective cohort study was undertaken between 17 March 2020 and 30 April 2020 and compared with retrospective data from same time period in 2019. We compared the number of patients requiring acute hospital admission or orthopaedic referrals and indications of referrals from our admission sheets and obtained operative data from our theatre software. Results: Between 17 March to 30 April 2020, there were 48 acute spine referrals as compared to 68 acute referrals during the same time period last year. In the 2019 period, 69% (47/68) of cases referred to the on-call team presented with back pain, radiculopathy or myelopathy compared to 43% (21/48) in the 2020 period. Almost 20% (14/68) of spine referrals consisted of spine trauma as compared to 35% (17/48) this year. There were no confirmed cases of cauda equine last year during this time. Overall, 150 spine cases were carried out during this time period last year, and 261 spine elective cases were cancelled since 17 March 2020. Recommendations: We recommend following steps can be helpful to deal with similar situations or new pandemics in future:24 hours on-call spine service during the pandemic.Clinical criteria in place to prioritize urgent spinal cases.Pre-screening spine patients before elective operating.Start of separate specialist trauma list for patients needing urgent surgeries. Conclusion: This paper highlights the impact of COVID-19 pandemic in a district general hospital of England. We demonstrate a decrease in hospital attendances of spine pathologies, despite an increase in emergency spine operations.Cite this article:
Keywords	covid19
Language	English
Publishing date	2020-11-01
Publishing country	England
Document type	Journal Article
ISSN	2633-1462
ISSN (online)	2633-1462
DOI	10.1302/2046-3758.16.BJO-2020-0059.R1
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Midfoot Charcot Neuro-arthropathy Precipitated by First or Fifth ray Amputation.

Fontalis, Andreas / Doorgakant, Ashtin / Zahra, Wajiha / Blundell, Chris

Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons

2020 Volume 27, Issue 6, Page(s) 673–676

Abstract: Background: Charcot Neuro-arthropathy (CN) can occur spontaneously in a neuropathic foot but is often precipitated by an insult to the foot, such as trauma. We noted an association between 1st and 5th ray amputations and the development of midfoot CN in ...

Abstract	Background: Charcot Neuro-arthropathy (CN) can occur spontaneously in a neuropathic foot but is often precipitated by an insult to the foot, such as trauma. We noted an association between 1st and 5th ray amputations and the development of midfoot CN in our clinics. We therefore set out to analyse our data over a 6-year period to evaluate and improve our practice. Methods: Our project encompassed all diabetic adults with peripheral neuropathy undergoing an amputation of the first or fifth ray between January 2013 and January 2019. Patient demographics, stump length, progression to CN, imaging reports, the need for further operative management, length of stay and operating specialty were collected. Cases that developed CN after 1st or 5th ray amputation ("CN group") were compared with a cohort composed of patients that did not ("non-CN group"). Results: We identified 92 patients (98 surgical episodes) who had previous 1st or 5th ray amputations [77 males (83.7%), 15 females (16.3%), mean age 61.5 ± 13.5]. Midfoot CN developed in 16 cases (17.4%; nine following 1st ray and seven following 5th ray amputation). This represented 30.9% of all our new CN cases. CN was diagnosed within six months in six cases and up to three years in the remaining 12. Five of the 1st ray amputations were conducted with a stump length of ≤10 mm from the tarsometatarsal joint and a further one had resorbed down to it before the Charcot process. Three of the 5th ray amputations were carried out leaving a stump length ≤25 mm. Receiver Operator Curve (ROC) analysis showed no obvious diagnostic value of stump length in predicting CN (area under the curve 0.42 (95% CI 0.26 - 0.59)). Following a logistic regression analysis into effect of age, gender and peripheral vascular disease, only age was found to significantly affect the risk of developing CN (Nagelkerke R Conclusion: This is the first report of midfoot CN developing after 1st or 5th ray amputations. The foot could be destabilised following these procedures, leading to increased pressures across the midfoot. Our small sample was unable to demonstrate a significant correlation between stump length and CN risk. However, more work is needed to ascertain this. Meanwhile, we believe this translates clinically into a need for enhanced foot protection following 1st and 5th ray amputations in our practice.
MeSH term(s)	Adult ; Amputation ; Arthropathy, Neurogenic/diagnostic imaging ; Arthropathy, Neurogenic/etiology ; Diabetic Foot/etiology ; Diabetic Foot/surgery ; Female ; Foot/surgery ; Foot Joints ; Humans ; Male ; Middle Aged
Language	English
Publishing date	2020-10-11
Publishing country	France
Document type	Journal Article
ZDB-ID	1424533-4
ISSN	1460-9584 ; 1268-7731
ISSN (online)	1460-9584
ISSN	1268-7731
DOI	10.1016/j.fas.2020.08.012
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: The effect of COVID-19 on the trauma burden, theatre efficiency and training opportunities in a district general hospital: planning for a future outbreak.

Karia, Monil / Gupta, Vatsal / Zahra, Wajiha / Dixon, Joeseph / Tayton, Edward

Bone & joint open

2020 Volume 1, Issue 8, Page(s) 494–499

Abstract: Aims: The aim of this study is to determine the effects of the UK lockdown during the COVID-19 pandemic on the orthopaedic admissions, operations, training opportunities, and theatre efficiency in a large district general hospital.: Methods: The ... ...

Abstract	Aims: The aim of this study is to determine the effects of the UK lockdown during the COVID-19 pandemic on the orthopaedic admissions, operations, training opportunities, and theatre efficiency in a large district general hospital. Methods: The number of patients referred to the orthopaedic team between 1 April 2020 and 30 April 2020 were collected. Other data collected included patient demographics, number of admissions, number and type of operations performed, and seniority of primary surgeon. Theatre time was collected consisting of anaesthetic time, surgical time, time to leave theatre, and turnaround time. Data were compared to the same period in 2019. Results: There was a significant increase in median age of admitted patients during lockdown (70.5 (interquartile range (IQR) 46.25 to 84) vs 57 (IQR 27 to 79.75); p = 0.017) with a 26% decrease in referrals from 303 to 224 patients and 37% decrease in admissions from 177 to 112 patients, with a significantly higher proportion of hip fracture admissions (33% (n = 37) vs 19% (n = 34); p = 0.011). Paediatric admissions decreased by 72% from 32 to nine patients making up 8% of admissions during lockdown compared to 18.1% the preceding year (p = 0.002) with 66.7% reduction in paediatric operations, from 18 to 6. There was a significant increase in median turnaround time (13 minutes (IQR 12 to 33) vs 60 minutes (IQR 41 to 71); p < 0.001) although there was no significant difference in the anaesthetic time or surgical time. There was a 38% (61 vs 38) decrease in trainee-led operations. Discussion: The lockdown resulted in large decreases in referrals and admissions. Despite this, hip fracture admissions were unaffected and should remain a priority for trauma service planning in future lockdowns. As plans to resume normal elective and trauma services begin, hospitals should focus on minimising theatre turnaround time to maximize theatre efficiency while prioritizing training opportunities. Clinical relevance: Lockdown has resulted in decreases in the trauma burden although hip fractures remain unaffected requiring priorityTheatre turnaround times and training opportunities are affected and should be optimised prior to the resumption of normal services.Cite this article:
Keywords	covid19
Language	English
Publishing date	2020-08-18
Publishing country	England
Document type	Journal Article
ISSN	2633-1462
ISSN (online)	2633-1462
DOI	10.1302/2633-1462.18.BJO-2020-0074.R1
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Safety evaluation of a strategy to restart elective orthopaedic surgery during the de-escalation phase of the COVID-19 pandemic.

Zahra, Wajiha / Dixon, Joseph W / Mirtorabi, Negin / Rolton, Daniel J / Tayton, Edward R / Hale, Peter C / Fisher, Warren J / Barnes, Richard J / Tunstill, Simon A / Iyer, Shabnam / Pollard, Tom C B

Bone & joint open

2020 Volume 1, Issue 8, Page(s) 450–456

Abstract: Aims: To evaluate safety outcomes and patient satisfaction of the re-introduction of elective orthopaedic surgery on 'green' (non-COVID-19) sites during the COVID-19 pandemic.: Methods: A strategy consisting of phased relaxation of clinical ... ...

Abstract	Aims: To evaluate safety outcomes and patient satisfaction of the re-introduction of elective orthopaedic surgery on 'green' (non-COVID-19) sites during the COVID-19 pandemic. Methods: A strategy consisting of phased relaxation of clinical comorbidity criteria was developed. Patients from the orthopaedic waiting list were selected according to these criteria and observed recommended preoperative isolation protocols. Surgery was performed at green sites (two local private hospitals) under the COVID-19 NHS contract. The first 100 consecutive patients that met the Phase 1 criteria and underwent surgery were included. In hospital and postoperative complications with specific enquiry as to development of COVID-19 symptoms or need and outcome for COVID-19 testing at 14 days and six weeks was recorded. Patient satisfaction was surveyed at 14 days postoperatively. Results: There were 54 females and 46 males (mean age 44 years, mean body mass index (BMI) 25.6 kg/m Conclusion: In an environment with appropriate infrastructure, patient selection, isolation, screening, and testing, elective orthopaedic surgery is safe during the COVID-19 pandemic, and associated with high patient satisfaction. Further follow-up is required to establish that safety is maintained as the clinical restrictions are eased with the phased approach described.Cite this article:
Keywords	covid19
Language	English
Publishing date	2020-08-01
Publishing country	England
Document type	Journal Article
ISSN	2633-1462
ISSN (online)	2633-1462
DOI	10.1302/2633-1462.18.BJO-2020-0105.R1
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Case report and systematic review of mesenteric artery by-pass for non-atherosclerotic mesenteric vascular disease.

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Article: Safety of tranexamic acid in surgically treated isolated spine trauma.

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Article: Clinical outcome of open ankle fractures in patients above 70 years of age.

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Article ; Online: Preventing the Cloud Networks through Semi-Supervised Clustering from Both Sides Attacks

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Article ; Online: The impact of COVID-19 on elective and trauma spine service in a district general hospital.

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Article ; Online: Midfoot Charcot Neuro-arthropathy Precipitated by First or Fifth ray Amputation.

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Article ; Online: The effect of COVID-19 on the trauma burden, theatre efficiency and training opportunities in a district general hospital: planning for a future outbreak.

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Article ; Online: Safety evaluation of a strategy to restart elective orthopaedic surgery during the de-escalation phase of the COVID-19 pandemic.

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