Neurology Commons^™

Primary Headache Disorders In The Adult General Population Of Pakistan - A Cross Sectional Nationwide Prevalence Survey., A. A. Herekar,, A. Ahmad, , U. L. Uqaili, Bilal Ahmed, J Effendi, S. Z. Alvi, , M. A. Shahab, U. Javed, A. D. Herekar, Rafiq Khanani, T. J. Steiner

Department of Medicine

Background: The large geographical gaps in our knowledge of the prevalence and burden of headache disorders include almost all of Eastern Mediterranean Region (EMR). We report a nationwide population-based study in Pakistan, an EMR country with the sixth largest population in the world, conducted as a project within the Global Campaign against Headache.

Methods: We surveyed six locations from the four provinces of Pakistan: Punjab, Sindh, Khyber Pakhtunkhwa and Baluchistan. We randomly selected and visited rural and urban households in each. One adult member (18–65 years) of each household, also randomly selected, was interviewed by a trained non-medical interviewer ...

Functionally Pathogenic Ears2 Variants In Vitro May Not Manifest A Phenotype In Vivo, Nathan Mcneill, Alessia Nasca, Aurelio Reyes, Benjamin Lemoine, Brandi Cantarel, Adeline Vanderver, Raphael Schiffmann, Daniele Ghezzi

Neurology Faculty Publications

Objective: To investigate the genetic etiology of a patient diagnosed with leukoencephalopathy, brain calcifications, and cysts (LCC).

Methods: Whole-exome sequencing was performed on a patient with LCC and his unaffected family members. The variants were subject to in silico and in vitro functional testing to determine pathogenicity.

Results: Whole-exome sequencing uncovered compound heterozygous mutations in EARS2, c.328G>A (p.G110S), and c.1045G>A (p.E349K). This gene has previously been implicated in the autosomal recessive leukoencephalopathy with thalamus and brainstem involvement and high lactate (LTBL). The p.G110S mutation has been found in multiple patients with LTBL. In ...

“Can’T You Just Say?” – Contrasting Communication Preferences Between Surrogate Decision-Makers And Physicians During Outcome Prognostication In Critically-Ill Traumatic Brain Injury Patients, Thomas Quinn, Jesse Moskowitz, Muhammad Khan, Lori Shutter, Robert J. Goldberg, Nananda Col, Kathleen M. Mazor, Susanne Muehlschlegel

Kathleen M. Mazor

Objective: Surrogate decision-makers (“surrogates”) and physicians of incapacitated patients have different views of prognosis and how it should be communicated, but this has not been investigated in neurocritically-ill patients. We examined communication preferences in surrogates and physician practices during the outcome prognostication for critically-ill traumatic brain injury (ciTBI) patients in neuroICUs.

Design: Qualitative study using in-person semi-structured interviews with surrogates of ciTBI patients and physicians with expertise in TBI.

Setting: Two neuroICUs at two level-1 trauma centers (surrogates); seven academic U.S. medical centers (physicians).

Subjects: Sixteen surrogates for 15 ciTBI patients and 20 attending physicians from neurocritical care, neurosurgery ...

Variable Knowledge, Use And Perceptions Of The Impact Model Among Physicians During Prognostication Meetings For Critically-Ill Traumatic Brain Injury Patients – Results From A Qualitative Study, Jesse Moskowitz, Thomas Quinn, Muhammad Khan, Lori Shutter, Robert J. Goldberg, Nananda Col, Kathleen M. Mazor, Susanne Muehlschlegel

Kathleen M. Mazor

Introduction: The International Patient Decision Aid Standards, a framework for the creation of high-quality decision aids, calls for the presentation of probabilities. To inform the content of a goals-of-care decision aid in critically-ill TBI (ciTBI) patients, we examined physician’s awareness, perceptions, and use of the IMPACT-model, the most widely validated ciTBI outcome model, and explored their preferences for communicating prognostic information towards families.

Methods: We conducted a qualitative study using semi-structured interviews in 20 attending physicians (neurocritical care, neurosurgery, trauma, palliative care) at 7 U.S. academic medical centers. We used descriptive statistics and performed qualitative content analysis of ...

Alzheimer’S Disease: Dawn Of A New Era?, Farideh Amirrad, Emira Bousoik, Kiumars Shamloo, Hassan Al-Shiyab, Viet-Hong Nguyen, Hamidreza Montazeri Aliabadi

Pharmacy Faculty Articles and Research

Alzheimer’s disease (AD) is an irreversible neurodegenerative disease characterized by a progressive decline in cognition and memory, leading to significant impairment in daily activities and ultimately death. It is the most common cause of dementia, the prevalence of which increases with age; however, age is not the only predisposing factor. The pathology of this cognitive impairing disease is still not completely understood, which has limited the development of valid therapeutic options. Recent years have witnessed a wide range of novel approaches to combat this disease, so that they greatly increased our understanding of the disease and of the unique ...

Neurotransmitter, Summer 2017, George Washington Institute For Neuroscience Neurological Institute, George Washington University Hospital

Neurotransmitter

No abstract provided.

A Defect In Myoblast Fusion Underlies Carey-Fineman-Ziter Syndrome, S Digioia, S Connors, N. Matsunami, J Cannavino, M Rose, N Gillette, Andrea Gropman, +Several Additional Authors

Neurology Faculty Publications

Multinucleate cellular syncytial formation is a hallmark of skeletal muscle differentiation. Myomaker, encoded by Mymk (Tmem8c), is a well-conserved plasma membrane protein required for myoblast fusion to form multinucleated myotubes in mouse, chick, and zebrafish. Here, we report that autosomal recessive mutations in MYMK (OMIM 615345) cause Carey-Fineman-Ziter syndrome in humans (CFZS; OMIM 254940) by reducing but not eliminating MYMK function. We characterize MYMK-CFZS as a congenital myopathy with marked facial weakness and additional clinical and pathologic features that distinguish it from other congenital neuromuscular syndromes. We show that a heterologous cell fusion assay in vitro and allelic complementation ...

The Specific Vulnerabilities Of Cancer Cells To The Cold Atmospheric Plasma-Stimulated Solutions., Dayun Yan, Haitao Cui, Wei Zhu, Niki Nourmohammadi, Julian Milberg, Lijie G Zhang, Jonathan H Sherman, Michael Keidar

Neurological Surgery Faculty Publications

Cold atmospheric plasma (CAP), a novel promising anti-cancer modality, has shown its selective anti-cancer capacity on dozens of cancer cell lines in vitro and on subcutaneous xenograft tumors in mice. Over the past five years, the CAP-stimulated solutions (PSS) have also shown their selective anti-cancer effect over different cancers in vitro and in vivo. The solutions used to make PSS include several bio-adaptable solutions, mainly cell culture medium and simple buffered solutions. Both the CAP-stimulated medium (PSM) and the CAP-stimulated buffered solution (PSB) are able to significantly kill cancer cells in vitro. In this study, we systematically compared the anti-cancer ...

Ct Scanning Is Sufficient To Clear The Cervical Spine Of Elderly Falls Less Than 5 Feet., Douglas Lehman Md, Rovinder S. Sandhu Md, Leslie Baga Bsn, Farheen Hussain Ms, John J. Hong Md

John J. Hong, M.D.

No abstract provided.

Investigating The Acute Levodopa Response In Early To Advanced Parkinson’S Disease, Marcus M. Pieterman

Electronic Thesis and Dissertation Repository

Parkinson’s disease (PD) is a neurogenerative movement disorder that often requires surgical interventions such as deep brain stimulation (DBS) when motor complications arise from long term levodopa therapy. Understanding the level of motor improvement received by patients from levodopa (levodopa response; LR) at each stage of disease duration is integral to optimizing both current treatment and DBS implementation. In this study, the levodopa challenge test was employed to investigate the LR in early to advanced stages of disease in 70 PD participants. The LR only moderately correlated with disease duration, suggesting large interindividual variability in the LR between patients ...

Presynaptic Lrp4 Promotes Synapse Number And Function Of Excitatory Cns Neurons., Timothy J. Mosca, David J. Luginbuhl, Irving E. Wang, Liqun Luo

Department of Neuroscience

Precise coordination of synaptic connections ensures proper information flow within circuits. The activity of presynaptic organizing molecules signaling to downstream pathways is essential for such coordination, though such entities remain incompletely known. We show that LRP4, a conserved transmembrane protein known for its postsynaptic roles, functions presynaptically as an organizing molecule. In the Drosophila brain, LRP4 localizes to the nerve terminals at or near active zones. Loss of presynaptic LRP4 reduces excitatory (not inhibitory) synapse number, impairs active zone architecture, and abolishes olfactory attraction - the latter of which can be suppressed by reducing presynaptic GABAB receptors. LRP4 overexpression increases synapse ...

Single-Fiber Electromyography In The Orbicularis Oculi Muscle In Patients With Ocular Myasthenia Gravis Symptoms: Does Abnormal Jitter Predict Response To Treatment?, Goran Rakocevic, Mark Moster, Mary Kay Floeter

Department of Neurology Faculty Papers

BACKGROUND: Seronegative ocular myasthenia gravis (OMG) is diagnosed by ocular symptoms with supporting SFEMG, typically of frontalis or extensor digitorum muscles. We aimed to determine the sensitivity and specificity of orbicularis oculi SFEMG to diagnose and exclude myasthenia gravis and predict response to therapy.

METHODS: Orbicularis oculi SFEMG studies were conducted in 142 consecutive patients with symptoms and/or findings of OMG and negative AChR antibody during the period of 5 years. Retrospective chart review was conducted 2 years after the SFEMG to determine whether treatments were given and responses to treatment.

RESULTS: Orbicularis oculi SFEMG was abnormal in 31 ...

A Whole Lot Of Shakin' Going On: Movement Disorders Caused By Brain Trauma, Jack E. Hubbard, Samuel D. Hodge, Jr.

Cleveland State Law Review

There has been a lot of publicity directed to the consequence of brain trauma, such as headaches forgetfulness, irritability, and depression. That is only part of the sequelae. A little-known but challenging result of brain trauma is the development of or aggravation of a movement disorder such as a tremor, dystonia, a tic, or Parkinson’s Disease.

A movement disorder is an all-encompassing term that refers to a constellation of neurological issues that cause involuntary or voluntary movements or abnormal positioning of a body part. Various regions of the brain interact with each other to control movements of the body ...

Essential Medicines Management During Emergencies In Pakistan, S.K.S. Bukhari, J.A.R.H. Qureshi,, Rashid Jooma, K.M. Bile Ministry Of Health, Islamabad, Pakistan.

Rashid Jooma

ABSTRACT This paper illustrates the experiences of essential medicine management in providing cure and care to victims of Pakistan’s 2005 earthquake in a safe, rational and effective mode. The health interventions assured access to essential medicine, sustained supply, inventory control through a computerized logistic support system and rational use of medicines. World Health Organization Pakistan outlined modalities for acceptance of donated medicines, assisted in speedy procurement of medicines and designed customized kits. Proper storage of medicines at controlled temperature was ensured in warehousing facilities in 12 locations. A steady supply of medicines and their consumption without stock-outs in the ...

Impacts Of Signal Free Corridors On The Incidence Of Road Traffic Accidents In Karachi, Salman Zubair, Jamil H. Kazmi, Rashid Jooma, Syed Shahid Ali, Zeeshan Akhtar

Rashid Jooma

Abstract: Increase in road Traffic Accidents is a global phenomenon and Pakistan is no exception. In Karachi, this problem becomes severe due to rapid growth of population. This menace is ruining the lives of thousands of people and making Karachi a worrisome place to live. Recent road geometrical transitions in the city with insufficient accessories have been reducing the problem of traffic congestion to a limited extent. On the contrary, this has erupted as a problem of Road Traffic Accidents which is reaching out of proportions. Recently, induction of a unique feature named, Signal Free Corridor in Karachi has cost ...

Embolization Of An Intracranial Arteriovenous Malformation Followed By Immediate Surgical Resection : A Case Report, Imaad Ur Rehman, Tanveer Ul Haq, Rashid Jooma, Muhammad Azeemuddin, Zafar Sajjad

Rashid Jooma

Intracranial arteriovenous malformations (AVMs) are now a recognized entity because of improvements in imaging diagnosis. They are relatively uncommon but can cause serious neurological symptoms or death. We report a case of a 22- year-old man who presented with left parietal hemorrhage and on cerebral angiography was found to have a small AVM in the left middle cerebral artery (MCA) territory. Glue embolization followed by immediate surgical resection of the AVM was carried out, resulting in complete cure.

Effectiveness Of Helmets In Preventing Severe Injuries In A Setting With Poorly Enforced Quality Standards, Junaid A. Bhatti, Rashid Jooma, Junaid A. Razzak

Rashid Jooma

Helmets save lives, yet many countries do not have laws about their quality assessment or how they should be worn. We assessed the effectiveness of helmet use in preventing injuries in such a setting. The data were extracted from a large road traffic injury surveillance study in Karachi, Pakistan. We assessed the association of wearing helmets with several injury outcomes including deaths, injury severity (via New Injury Severity Score, NISS ≥ 9) and moderate or severe injury (via Abbreviated Injury Score, AIS ≥ 2) to head, face, or other regions of the body. The data about helmet use was available for about ...

Designing The First Ever Health Insurance For The Poor In Pakistan–A Pilot Project, Rashid Jooma, Sabeena Jalal

Rashid Jooma

Abstract Several developing countries lack a medical insurance system with universal coverage, so access to medical services is not easy, principally for people living in poverty. One of the biggest issues for designing healthcare systems in developing countries is how to include those not formally employed. Therefore, it is important to implement targeted interventions so that the most in need are not left out. The World Health Report 2000 distinguishes four functions for the health system to fulfill: (i) the provision of health services; (ii) the creation of the necessary investment and training resources for health; (iii) health financing; and ...

Cost-Effective Practice Of Neurology: An Idea Whose Time Has Come, Rashid Jooma

Rashid Jooma

Pakistanis spent $ 7.2 billion on healthcare in 2013 (3.1% of our Gross Domestic Product), representing a per capita expenditure of $ 39.4. The government contribution to this was no more than 31.4% ($ 12.4 per capita). The public allocations to health thus represent a paltry 4.7% of total government expenditure and are just shy of 1% of our GDP.

Comparison Of Two Surveys Of Head Injured Patients Presenting During A Calendar Year To An Urban Medical Centre 32 Years., Rashid Jooma, Shahid Ahmed, Abdul Malik Zarden

Rashid Jooma

Abstract OBJECTIVE: To study the patients presenting with head injuries to a tertiary hospital in Karachi during the year 2003. METHODS: During the calendar year 2003, a cross-sectional study was conducted of all patients presenting to the casualty department of Jinnah Postgraduate Medical Centre (JPMC) with head injury. Personal information was collected from the patient's attendants at presentation or later if the patient had been brought in by the emergency services as an unknown person. The circumstances of the injury were similarly established and the clinical features documented. RESULTS: During the year 2003, a total of 3008 patients reported ...