Medicine and Health Sciences Commons^™

Surgery For Prolactinomas, Ashfaq A. Razzaq, Rashid Jooma

Rashid Jooma

A large proportion of prolactin secreting tumours of the pituitary gland are treatable by dopamine agonist drugs. However certain subgroups of these patients are better managed by surgical excision. The indications for surgery in prolactinomas remain controversial and this paper attempts to clarify these with illustrative cases. The factors favouring a surgical approach include poor tolerance of long term medical therapy, progression of visual deficits or recurrence while on medical treatment, cystic change in the tumour with pressure effects, CSF fistula secondary to tumour shrinkage and prophylactic surgery in tumours anticipated to cause CSF leak following medical therapy. The size …

The Trauma Centre: What It Should Mean, Rashid Jooma, Sabeena Jalal Khan, J. Razzak

Rashid Jooma

No abstract provided.

Spinal Disease Presenting As Acute Abdominal Pain, Rashid Jooma, Mj Torrens

Rashid Jooma

SIR,-Mr Flood and others are correct in what they write, but their discussion of spinal infection covers only part of the clinical problem. They have assumed that "spinal infection" means osteomyelitis of the spine, whereas the commonest infective cause of paraplegia is extradural spinal abscess, as in the case we reported. In such patients there are usually no changes on the plain radio- graphs, no osteomyelitis, and the abscess is diffusely distributed through the epidural space. Laminectomy and drainage are the correct treatment for extradural spinal abscess

Save A Life- Diagnose Subarachnoid Haemorrhage, Rashid Jooma, Iqtidar H. Bhatti

Rashid Jooma

No abstract provided.

Prevalence Of Hepatitis B And C Viral Infections In Pakistan: Findings Of A National Survey Appealing For Effective Prevention And Control Measures, H Qureshi, K.M. Bile, Rashid Jooma, S.E Alam, H.U.R. Afrid

Rashid Jooma

Abstract A prevalence survey on hepatitis B and C infections was carried out to obtain national estimates and assess epidemiological dynamics and underlying risk factors. Overall prevalence of hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (HCV) of 2.5% and 4.8%, respectively, reflected a combined infection rate of 7.6% in the general population, consistent with an ongoing high burden of chronic liver disease (CLD). There was significant association of these viral infections with a range of risk factors led by reuse of syringes. These findings validate currently implemented strategies by the national programme for the control of hepatitis viralinfections, …

Proposals For A Scheme For Continuing Professional Development In Pakistan, S.K.S. Bukhari, J.A.R.H. Qureshi, Rashid Jooma, K.M. Bile, G.N. Kazi, W.A. Zaibi

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 56 …

Political Determinants Of Health: Lessons For Pakistan, Rashid Jooma, Guido Sabatinelli

Rashid Jooma

ABSTRACT There is much concern about the capacity of the health system of Pakistan to meet its goals and obligations. Historically, the political thrust has been absent from the health policy formulation and this is reflected in the low and stagnant public allocations to health. Successive political leaderships have averred from considering healthcare is a common good rather than a market commodity and health has not been recognized as a constitutional right. Over 120 of world’s nation states have accepted health as a constitutional right but the 1973 Constitution of Pakistan does not mandate health or education as a fundamental …

Protecting Pakistan's Health During The Global Economic Crisis, Rashid Jooma, A. Khan, Khan A. A.

Rashid Jooma

Abstract The world is facing an unprecedented global economic crisis, with many countries needing to reconsider their level of health care spending. This paper explores the many consequences of the global economic turndown on Pakistan's health, including reduced government and donor spending and increased poverty with the consequent diversion of funds away from health. Nevertheless, these challenges may provide opportunities not only to mitigate the adverse effects of the economic crisis but also to institute some much-needed reforms that may not receive political support during more affluent times. Our suggestions focus on setting priorities based on the national disease burden, …

Primary Spinal T-Cell Rich B-Cell Lymphoma: A Case Report, Suhail Muzaffar, Yousuf A. Husein, Rashid Jooma

Rashid Jooma

Non-Hodgkin’s lymphoma is a heterogenous group of lymphoid malignancies with marked vanabiity in morphologic features, growth pattern, antigemc phenotype and biological behaviout T- cell rich B-cell lymphoma (TCRBCL) is a newly recognised entity of this large heterogenous group of lymphoid neopiasms which closely mimics Hodgkin’s disease and peripheral T-cell lymphoma (PTCL). Most of the cases of TCRBCL have been reported in the lymph nodes, however, a small number of cases have been described in the extranodal sites including skin, soft tissue, common bile duct and central nervous system. Primary spinal TCRBCL with symptoms of spinal cordcompressionhasbeen described in the literature.

Preventing Neural Tube Defects By Folic Acid Fortification Of Flour, Rashid Jooma

Rashid Jooma

No abstract provided.

Preventing Neural Tube Defects By Folic Acid Fortification Of Flour, Rashid Jooma

Rashid Jooma

No abstract provided.

Pakistan Human Resources For Health Assessment, 2009, A. Hafeez, Z Khan, K.M. Bile, Rashid Jooma, M Sheikh

Rashid Jooma

ABSTRACT Pakistan faces a human resources for health (HRH) crisis. A cross-sectional survey was conducted to overview frontline health workers. A total of 750 health facilities were surveyed across Pakistan. The median estimate of public sector health care workers in the district health system in Pakistan is 417 288, including 46 153 doctors and 41 032 nurses. Another estimated 20 000 doctors work in public sector tertiary care hospitals across the country. A total of 3549 health care workers were interviewed regarding job satisfaction and work environment. The private sector had better work environment scores compared with the public sector. …

Polio Eradication And Health Systems In Karachi: Vaccine Refusals In Context, Rashid Jooma, Emma Varley, Naina Qayyum1, Sonia Rodrigues, Akasha Sarwar, Patricia Omidian

Rashid Jooma

ABSTRACT Community and health worker engagement will be key to polio eradication in Karachi, Pakistan. In this study, the authors conducted participant observation, interviews, and a document review in SITE Town, Karachi, an area that in recent years has harbored poliovirus. SITE’s diverse population includes large numbers of internally displaced persons who are disproportionately affected by polio and are more likely than other populations to refuse the polio vaccine. Vaccine acceptance and worker motivation in SITE Town were shaped by the discrepancy in funding and attention for polio eradication campaigns as compared with routine services. Parental vaccine refusals stemmed from …

Intracranial Tumour In An Infant Presenting As Iron Deficiency Anaemia, Rashid Jooma, Iqtidar H. Bhatti

Rashid Jooma

Anaemia is common in patients with malignant neoplastic disease' but is not generally recognised as a complication of brain tumours in the absence of vomiting or anorexia. We report the case of an infant who came to medical attention because of iron deficiency anaemia for which no cause was found until an intracranial neoplasm was diagnosed. The anaemia remained refractory to dietary iron supplements but resolved promptly after excision of the neoplasm

Moyamoya Disease Presenting With Intracranial Haemorrhàge, Ali Akbar Zehri, Aftab Qureshi, Rashid Jooma

Rashid Jooma

Moyamoya disease is a spontaneous occlusion of the circle of Willis with abnonnal compensatory anastamotic vascular networks at the base of the brain. Early reports characterised the condition as a cause of cerebral ischaemia with progressive neurological deficits in infants and children or intracranial haemorrhage in adolescents and adults of Japanese Community1,2. However, it is now well known to occur in the other parts of the world as well - though being contingent on angiographic findings, the diagnosis depend on the level of the nation’s health care provision. Two cases of moyamoya diseases admitted to neurosurgical unit with intracranial haemorrhage …

Management Of Myelomeningocele, A Sattar M. Hashim, Shahid Ahmed, Rashid Jooma

Rashid Jooma

No abstract provided.

Lesionectomy Versus Electrophysiologically Guided Resection For Temporal Lobe Tumors Manifesting With Complex Partial Seizures, Rashid Jooma, Michael D. Privitera

Rashid Jooma

Complex partial seizures associated with tumors and other mass lesions are readily diagnosed by modern imaging techniques but their optimum surgical treatment remains unresolved. Lesionectomy has been reported to produce seizure outcomes equal to outcomes after resection that ablates the epileptogenic cortex with the lesion. However, some evidence suggests that when the lesion is in the temporal lobe, simple excision of the tumor or lesion more often fails to control seizures. After retrospectively reviewing the records of 30 patients with complex partial seizures and temporal lobe tumors who underwent surgical treatment at the University of Cincinnati hospitals (1985–1992), the authors …

Lady Health Workers Programme In Pakistan: Challenges, Achievements And The Way Forward, Assad Hafeez, Bile Khalif Mohamud, Mobasher Riaz Shiekh, Syed Ayyaz Imran Shah, Rashid Jooma

Rashid Jooma

Objectives: To review the Lady Health Workers programme and critically explore various aspects of the process to extract tangible implications for other similar situations. Methods: A descriptive study was carried out over a period of one year (2007-08). A detailed desk review of project documents, interaction with relevant stakeholders, performance validation and extensive feedback from the community were collected. The data so obtained was analyzed and evaluated against predetermined benchmarks. Results: Each LHW serves a population of 1,000 people in the community and extends her services in the catchment population through monthly home visits. The scope of work includes over …

Experience In 118 Consecutive Patients Undergoing Ct-Guided Stereotactic Surgery Utilizing The Cosman-Robert-Wells (Crw) Frame, Rashid Jooma, G. R. Sharma

Rashid Jooma

Aims: To evaluate the efficacy of CT-guided neurosurgical procedures done on patients operated by this modality. Methods: Between January 1997 and March 2000, 118 patients undergoing CT-guided stereotactic procedures were recruited to the study. The CRW III stereotactic system (Radionics, USA) and the TSX-00ZA CT Scanner (Toshiba, Japan) were used for all the procedures in the series. These procedures were directed to symptomatic brain lesions or for the treatment of Parkinsonian tremor. Results: Of 118 patients, 109 had intra-cranial lesions and 9 had Parkinson's Disease. The stereotactic procedures performed on these patients were: biopsies in 62, guided mini-craniotomies in 22, …

Epilepsy In Pakistan: National Guidelines For Clinicians (Part 2), Fowzia Siddiqui, Shaukat Ali, Mughis Sheerani, Tippo Sultan, Rashid Jooma

Rashid Jooma

No abstract provided.

Bilateral Cervical Radiculopathy As A Presentation Of Spinal Tuberculosis: Report Of Two Cases, G R. Sherma, Rashid Jooma

Rashid Jooma

Most patients with tuberculosis of the cervical spine present with localized neck pain and constitutional features like malaise, fever, anorexia, loss of body weight and night sweats, as early symptoms followed by long tract signs, with or without sphincter involvement, as the disease progresses. However, occasionally these patients may present with a radicular pain as an early presenting symptom, which can simulate the other pathological conditions of the cervical spine such as spondylosis, cervical disc prolapse, pyogenic cervical osteomyelitis or bone metastases. What is rare is bilateral radiculopathy and we present two such cases of cervical spinal tuberculosis whose initial …

A Successful Model Of Road Traffic Injury Surveillance In A Developing Country: Process And Lessons Learnt., Junaid Abdul Razzak, Muhammad Shahzad Shamim, Amber Mehmood, Syed Ameer Hussain, Mir Shabbar Ali, Rashid Jooma

Rashid Jooma

Background: Road Traffic Injuries (RTIs) are one of the leading causes of death and disability worldwide with 90% of global mortality concentrated in the low and middle income countries. RTI surveillance is recommended to define the burden, identify high risk groups, plan intervention and monitor their impact. Despite its stated importance in the literature, very few examples of sustained surveillance systems are reported from low income countries. This paper shares the experience of setting up an urban RTI surveillance program in the emergency departments of five major hospitals in Karachi, Pakistan. METHOD: We describe the process of establishing a surveillance …

Multi-Scale Motility Amplitude Associated With Suicidal Thoughts In Major Depression, Premananda Indic, Greg Murray, Carlo Maggini, Mario Amore, Tiziana Meschi, Loris Borghi, Ross J. Baldessarini, Paola Salvatore

Premananda Indic

Major depression occurs at high prevalence in the general population, often starts in juvenile years, recurs over a lifetime, and is strongly associated with disability and suicide. Searches for biological markers in depression may have been hindered by assuming that depression is a unitary and relatively homogeneous disorder, mainly of mood, rather than addressing particular, clinically crucial features or diagnostic subtypes. Many studies have implicated quantitative alterations of motility rhythms in depressed human subjects. Since a candidate feature of great public-health significance is the unusually high risk of suicidal behavior in depressive disorders, we studied correlations between a measure (vulnerability …

Scaling Behavior Of Human Locomotor Activity Amplitude: Association With Bipolar Disorder, Premananda Indic, Paola Salvatore, Carlo Maggini, Stefano Ghidini, Gabriella Ferraro, Ross J. Baldessarini, Greg Murray

Premananda Indic

Scale invariance is a feature of complex biological systems, and abnormality of multi-scale behaviour may serve as an indicator of pathology. The hypothalamic suprachiasmatic nucleus (SCN) is a major node in central neural networks responsible for regulating multi-scale behaviour in measures of human locomotor activity. SCN also is implicated in the pathophysiology of bipolar disorder (BD) or manic-depressive illness, a severe, episodic disorder of mood, cognition and behaviour. Here, we investigated scaling behaviour in actigraphically recorded human motility data for potential indicators of BD, particularly its manic phase. A proposed index of scaling behaviour (Vulnerability Index [VI]) derived from such …

Perampanel, Michael A. Rogawski

Michael A. Rogawski

No abstract provided.

Neurobiology Of The Premonitory Urge In Tourette’S Syndrome: Pathophysiology And Treatment Implications, Andrea E. Cavanna, Kevin J. Black, Mark Hallett, Valerie Voon

Kevin J. Black, MD

A New Sv2a Ligand For Epilepsy, Michael A. Rogawski

Michael A. Rogawski

A New Treatment For Psychosis In Parkinson’S Disease, Kevin J. Black

Kevin J. Black, MD

Brain Structure In Pediatric Tourette Syndrome, Alton C. Williams, Kevin J. Black

Kevin J. Black, MD

A Digital Atlas Of The Dog Brain, Ritobrato Datta, Jongho Lee, Jeffrey Duda, Brian B. Avants, Charles H. Vite, Ben Tseng, Jim C. Gee, Gustavo D. Aguirre, Geoffrey K. Aguirre

Gustavo D. Aguirre, VMD, PhD

There is a long history and a growing interest in the canine as a subject of study in neuroscience research and in translational neurology. In the last few years, anatomical and functional magnetic resonance imaging (MRI) studies of awake and anesthetized dogs have been reported. Such efforts can be enhanced by a population atlas of canine brain anatomy to implement group analyses. Here we present a canine brain atlas derived as the diffeomorphic average of a population of fifteen mesaticephalic dogs. The atlas includes: 1) A brain template derived from in-vivo, T1-weighted imaging at 1 mm isotropic resolution at 3 …