H Malik’s research while affiliated with St Luke's General Hospital Carlow / Kilkenny and other places

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Publications (4)


381 Is There A Role for Tranexamic Acid in Upper GI Bleeding? A Systematic Review and Meta-Analysis
  • Article

May 2021

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32 Reads

BJS (British Journal of Surgery)

E Burke

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H Malik

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F Awan

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P Balfe

Introduction Upper Gastrointestinal bleeding is associated with increased morbidity and mortality. It has been suggested that tranexamic acid (TXA) may be useful in arresting bleeding. Aim To synthesise available evidence of the effect of TXA on upper GI bleeding. Method A systematic review was conducted. PubMed, EMBASE and Cochrane central register of controlled trials were searched for relevant studies. A random effects meta-analysis was performed to determine the risk ratio of primary and secondary outcomes. Results 8 studies were included in the review. Total number of patients included was 12994 including 4550 females (35%). The effect of TXA on mortality: risk ratio was 0.95 which favoured TXA however the 95% CI ranged from 0.80 to 1.13 and was not statistically significant. The re-bleeding rate risk ratio was 0.64, which favoured the TXA group and with a 95% CI ranging from 0.47 to 0.86 this was statistically significant. The risk of adverse thromboembolic events: risk ratio was 0.93 favoured the TXA group however the 95% CI extended from 0.62 to 1.39 and so was not statistically significant. Conclusions We cannot recommend the routine use of TXA in the setting of acute upper GI bleeding outside its use in randomised controlled clinical trials.


262 Analysis of the Factors Contributing to Unplanned Admissions of Surgical Day Cases

May 2021

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26 Reads

BJS (British Journal of Surgery)

Introduction Day surgery has many benefits including a reduction in waiting lists, cancellations, hospital acquired infections and need for inpatient beds. It is also highly cost effective. The aim of this study is to identify which factors lead to the unanticipated admission of day cases, in order to adjust future patient selection, and retain efficiency Method A list of day cases that took place in 2017 was obtained from the HIPE department in St. Luke’s General Hospital. Day case patients who required admission were retrospectively analysed with the use of patient charts. Patient factors such as age, gender and co morbidities were recorded. The root cause of admission was identified, and the data collated. Results 457-day cases took place during 2017. 35/457 patients were admitted postoperatively (admission rate of 7.8%). The majority of patients were admitted post cholecystectomy (22) and incisional hernia repair (8). Surgical factors were responsible for almost all admissions. Conclusions Surgical factors/complications are not always predictable, but a thorough review of a patient’s background history and imaging can lead to the identification of patients, who should be directed away from day surgery, minimising the need for unexpected admissions, and maximising the efficiency of the unit.


Rapunzel syndrome causing partial gastric outlet obstruction requiring emergency laparotomy

January 2020

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22 Reads

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11 Citations

BMJ Case Reports

A 16-year-old girl with a background of childhood trichophagia presented with a 2-day history of epigastric pain and associated anorexia with vomiting. An epigastric mass was palpable on examination. A CT scan revealed an intragastric trichobezoar, extending into the duodenum consistent with Rapunzel syndrome with evidence of partial gastric outlet obstruction and a possible perforation. The patient underwent an urgent laparotomy and extraction of the trichobezoar. The bezoar was removed without complication and no intraoperative evidence of perforation was detected. After an uncomplicated postoperative recovery, she was discharged home with psychiatric follow-up.


Citations (1)


... In some cases, the condition can lead to fatal outcomes, especially when complications like bowel perforation or aspiration occur, often exacerbated by delayed recognition of the syndrome. The rarity of Rapunzel syndrome, coupled with its potential for sudden and severe clinical deterioration, highlights the need to better understand its pathophysiology and diagnostic challenges [14][15][16][17][18]. Therefore, to provide a clearer understanding of the risk factors, clinical manifestations, and causes of death associated with Rapunzel syndrome, we ...

Reference:

Rapunzel Syndrome: Clinical, Diagnostic and Forensic Aspects in Related Deaths—A Review of the Literature
Rapunzel syndrome causing partial gastric outlet obstruction requiring emergency laparotomy
  • Citing Article
  • January 2020

BMJ Case Reports