Medicine and Health Sciences Commons^™

A Case Of Parkinsonian Symptoms Secondary To Chronic Subdural Hematoma, Willbroad Kyejo, Frank Swai, Clement Mugisha, Philip Adebayo

Internal Medicine, East Africa

Chronic subdural hematoma is a known neurosurgical entity often associated with a spectrum of neurological manifestations. While primarily recognized for its characteristic accumulation of blood between the dura mater and arachnoid membrane, emerging literature suggests a rare association between chronic subdural hematoma and Parkinsonian symptoms. This report aims to underscore this unique neurological relationship by presenting a case of a 70-year-old male who developed Parkinsonism following chronic subdural hematoma post-head trauma. This case underscores the rare association between chronic subdural hematoma and Parkinsonian symptoms, emphasizing the importance of timely diagnosis and intervention in managing such cases.

The Impact Of Covid-19 Pandemic On Global Neurosurgery Collaborations., Alvan Emeka Ukachukwu, Nancy Abu Bonsrah, Andreas Seas, Zoey Petitt, Romaric Waguia Kouam, Samantha Ramos, Alyssa Edwards, Di Deng, Michael Haglund, Mahmood Qureshi

General Surgery, East Africa

No abstract provided.

Women, Power, And Cancer: A Lancet Commission, Ophira Ginsburg, Verna Vanderpuye, Ann Marie Beddoe, Nirmala Bhoo-Pathy, Freddie Bray, Carlo Caduf, Narjust Florez, Ibtihal Fadhil, Nazik Hammad, Miriam Mutebi

General Surgery, East Africa

Women interact with cancer in complex ways, as healthy individuals participating in cancer prevention and screening activities, as individuals living with and beyond a cancer diagnosis, as caregivers for family members and friends, as patient advocates, as health workers and healthcare professionals, and as cancer researchers and policy makers. The topic of women and cancer spans broad terrain, beyond women’s cancers and the biomedical aspects of any type of cancer that women in all their diversities might experience. It is inclusive of the ways in which sex and gender influence exposures to cancer risk factors, interactions with the cancer health …

Phenytoin-Induced Cerebellar Atrophy: A Case For Reversibility Of Neurological Decline, Edwin Mogere, Davis Cheruiyot, Manakhe Nassiuma

General Surgery, East Africa

This case serves as a reminder of the infrequent, yet consequential occurrence of cerebellar degeneration linked to phenytoin usage. Whilst emphasizes the importance of monitoring patients on long-term phenytoin therapy, and it further suggests considering employing bedside imaging tools such as Ultrasound fusion imaging for follow-up of patients at risk of this type of disorder. We present a case study involving a 23-year-old woman who experienced significant neurological impairment resulting in severe cerebellar atrophy while undergoing phenytoin treatment. On cessation of phenytoin, the patient exhibited improvement with enhanced cerebellar function.

Unveiling The Potential Application Of Intraoperative Brain Smear For Brain Tumor Diagnosis In Low-Middle-Income Countries: A Comprehensive Systematic Review, Muhammad Shakir, Ahmed Altaf, Hawra Hussain, Syed Muhammad Aqeel Abidi, Zoey Petitt, Mahnoor Tariq, Ahmed Gilani, Syed Ather Enam

Section of Neurosurgery

Background: Immediate intraoperative histopathological examination of tumor tissue is indispensable for a neurosurgeon to track surgical resection. A brain smear is a simple, rapid, and cost-effective technique, particularly important in the diagnosis of brain tumors. The study aims to determine the effectiveness of intraoperative brain smear in the diagnosis of brain tumors in low- and middle-income countries (LMICs), while also evaluating its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy.
Methods: A comprehensive search of the literature was conducted using PubMed, Scopus, and Google Scholar. The retrieved articles were independently screened by two reviewers. The …

Tailoring Of Neurosurgical Practice During Covid-19 In A Developing Country: Insights Gained And A Way Forward, Mustafa Mushtaq Husaain, Syeda Alisha Ali Zaida, Mujtaba Khalil, Muhammad Waqas Saeed Baqai, Altaf Ali Laghari, Muhammad Ehsan Bari

Section of Neurosurgery

Background: The coronavirus disease-19 pandemic has aggravated the already neglected neurosurgical specialty in developing countries with a mounting shortage of specialists, long queues of operative patients, and a lack of adequate critical care units.
Methods: We have reviewed the innovative strategies adopted for maintaining an optimal surgical practice while ensuring team safety at the Aga Khan University Hospital, Karachi Pakistan.
Results: There is already a scarcity of resources in developing countries. The international guidelines had to be tailored to the context of the developing world. A multimodal strategy that focused on infection control, continuum of care, and the well-being of …

Protocol For Validation Of The Global Scales For Early Development (Gsed) For Children Under 3 Years Of Age In Seven Countries, Vanessa Cavallera, Gillian Lancaster, Melissa Gladstone, Maureen M. Black, Gareth Mccray, Ambreen Nizar, Salahuddin Ahmed, Muhammad Imran Nisar, Farzana Begum, Fyezah Jehan

Department of Paediatrics and Child Health

Introduction: Children's early development is affected by caregiving experiences, with lifelong health and well-being implications. Governments and civil societies need population-based measures to monitor children's early development and ensure that children receive the care needed to thrive. To this end, the WHO developed the Global Scales for Early Development (GSED) to measure children's early development up to 3 years of age. The GSED includes three measures for population and programmatic level measurement: (1) short form (SF) (caregiver report), (2) long form (LF) (direct administration) and (3) psychosocial form (PF) (caregiver report). The primary aim of this protocol is to validate …

Amplification Of The Plag-Family Genes-Plagl1 And Plagl2-Is A Key Feature Of The Novel Tumor Type Cns Embryonal Tumor With Plagl Amplification, Michaela-Kristina Keck, Martin Sill, Andrea Wittmann, Piyush Joshi, Damian Stichel, Pengbo Beck, Konstantin Okonechnikow, Philipp Sievers, Annika K. Wefers, Nasir Uddin

Department of Pathology and Laboratory Medicine

Pediatric central nervous system (CNS) tumors represent the most common cause of cancer-related death in children aged 0-14 years. They differ from their adult counterparts, showing extensive clinical and molecular heterogeneity as well as a challenging histopathological spectrum that often impairs accurate diagnosis. Here, we use DNA methylation-based CNS tumor classification in combination with copy number, RNA-seq, and ChIP-seq analysis to characterize a newly identified CNS tumor type. In addition, we report histology, patient characteristics, and survival data in this tumor type. We describe a biologically distinct pediatric CNS tumor type (n = 31 cases) that is characterized by focal …

Human Amniotic Membrane As A Dural Substitute In Neurosurgery: A Systematic Review, Zara Shah, Saqib Kamran Bakhshi, Mohammad Hamza Bajwa, Mujtaba Khalil, Michael C. Dewan, Muhammad Shahzad Shamim

Medical College Documents

Background: Several studies have highlighted the use of human amniotic membrane (HAM) in neurosurgical procedures as an effective dural substitute. HAM has inherent antifibrotic and anti-inflammatory properties and exhibits immunomodulatory effect that makes it an ideal dural substitute. Other advantages including easy availability, low cost of procurement, and storage also render it a promising dural substitute especially in low- and middle-income countries.
Methods: A systematic literature search was performed using PubMed, Scopus, and Google Scholar databases, using the search terms "human amniotic membrane," "dural repair," and "neurosurgery." To be eligible for inclusion in our review, papers had to report primary …

What Do We Know So Far About Ofatumumab For Relapsing Multiple Sclerosis? A Meta-Analytical Study, Hafiza Munazza Taj, Maryam Talib, Sania Siddiqa, Azza Sarfraz, Zouina Sarfraz, Karla Robles-Velasco, Ivan Cherrez-Ojeda

Department of Paediatrics and Child Health

Ofatumumab is a monoclonal antibody that reduces the level of B cells that alter the progression of relapsing multiple sclerosis. Originally approved by the Food and Drug Administration (FDA) in August 2020, this meta-analysis determines the outcomes of four randomized controlled trials (RCTs) for endline outcomes of Gadolinium-enhancing T1 lesions on MRI scans reported as Cohen's d and relapse rate reported as risk ratio. All four RCTs reported favorable findings of gadolinium-enhancing T1 lesions (Cohen's d = -0.44, p < 0.00001). The relapse rate was reduced by 46% post ofatumumab administration (RR = 0.54, p < 0.00001). With 14 ongoing trials in this area, more data is required to consolidate our findings.

Neurodevelopment And Recovery From Wasting, Harriet M. Babikako, Celine Bourdon, Emmie Mbale, Peace Aber, Annet Birabwa, Josephine Chimoyo, Wieger Voskuijl, Zaubina Kazi, John Mukisa, Ali Faisal Saleem

Department of Paediatrics and Child Health

Background and objectives: Acute illness with malnutrition is a common indication for hospitalization among children in low- and middle-income countries. We investigated the association between wasting recovery trajectories and neurodevelopmental outcomes in young children 6 months after hospitalization for an acute illness.
Methods: Children aged 2 to 23 months were enrolled in a prospective observational cohort of the Childhood Acute Illness & Nutrition Network, in Uganda, Malawi, and Pakistan between January 2017 and January 2019. We grouped children on the basis of their wasting recovery trajectories using change in mid-upper arm circumference for age z-score. Neurodevelopment was assessed with the …

Pineal Cyst Apoplexy And Memory Loss: A Novel Complication, Areez Shafqat, Hanin Jaber Algethami, Shameel Shafqat, Syed Shafqat Ul Islam

Medical College Documents

An 8-year-old boy presented to our hospital complaining of a bilateral headache associated with episodes of anterograde amnesia. He had a road traffic accident 3 years ago when a computed tomography (CT) scan revealed traumatic brain injury. In addition, a small pineal cyst (PC) was noted with minor intramural calcifications. A follow-up CT a day later demonstrated increased density in the pineal gland of 60 Hounsfield Units, suggestive of apoplectic changes in the PC. However, the patient was lost to follow-up and presented with memory loss a year and a half later, upon which CT and magnetic resonance imaging revealed …

Role Of Surgery In Multifocal Glioblastoma, Syeda Kubra Kishwar Jafri, Syed Sarmad Bukhari, Muhammad Shahzad Shamim

Section of Neurosurgery

The management of multifocal glioblastomas is a point of constant discussion amongst neuro-oncologists. Best outcomes in glioblastoma management come from gross total resection (GTR) followed by concomitant radiation and chemotherapy (CCRT). Multifocal disease is resistant to GTR. Conventional management of these lesion is usually biopsy only followed by CCRT. Recent evidence has shown that there may be some benefit to attempting GTR of the largest lesion whenever safe to do so.

Surgical Management During The Covid-19 Era At A Private Tertiary Care Hospital Of Karachi, Pakistan: A Cross-Sectional Study, Nida Zahid, Erum Baig, Gulzar S. Lakhani, Hasnain Zafar, Asad Latif, Syed Ather Enam

Department of Surgery

Background: The coronavirus disease 2019 (COVID-19), declared a pandemic in March 2020, has affected the entire healthcare system, including the surgical practice. Guidelines for the management of surgical patients during this COVID-19 era need to be established to provide timely yet safe surgical care. In this study, we aimed to evaluate the outcomes of the COVID-19 testing algorithm established for surgery patients presenting to a tertiary care hospital in Karachi, Pakistan, and to compare the outcomes among patients who underwent elective versus emergency surgery.
Methodology: This is a cross-sectional study conducted at a tertiary care hospital in Pakistan to apply …

Stereotactic Radiosurgery For Pituitary Adenomas: A Review Of Literature, Kaynat Siddiqui, Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Section of Neurosurgery

Stereotactic radiosurgery (SRS) is a choice of treatment for pituitary adenomas (PA), particularly for residual or recurrent disease, apart from surgery. It has a progression free survival and endocrine remission rate comparable to surgery, with fewer side effects, making it an ideal tool for dealing with PA. In this review, we have discussed the role of SRS for primary as well as post-operative residual/ recurrent PA, and have assessed its safety and outcomes.

Intensive Care Bundle With Blood Pressure Reduction In Acute Cerebral Hemorrhage Trial (Interact3): Study Protocol For A Pragmatic Stepped-Wedge Cluster-Randomized Controlled Trial, Lili Song, Xin Hu, Lu Ma, Xiaoying Chen, Menglu Ouyang, Laurent Billot, Qiang Li, Paula Muñoz-Venturelli, Carlos Abanto, Mohammad Wasay

Section of Neurology

Background: Early intensive blood pressure (BP) lowering remains the most promising treatment for acute intracerebral hemorrhage (ICH), despite discordant results between clinical trials and potential variation in the treatment effects by approach to control BP. As the third in a series of clinical trials on this topic, the INTEnsive care bundle with blood pressure Reduction in Acute Cerebral hemorrhage Trial (INTERACT3) aims to determine the effectiveness of a goal-directed care bundle protocol of early physiological control (intensive BP lowering, glycemic control, and pyrexia treatment) and reversal of anticoagulation, in acute ICH.
Methods: INTERACT3 is a pragmatic, international, multicenter, stepped-wedge (4 …

Strocss 2021: Strengthening The Reporting Of Cohort, Cross-Sectional And Case-Control Studies In Surgery, Ginimol Mathew, Riaz Agha, Strocss Group, Joerg Albrecht, Prabudh Goel, Indraneil Mukherjee, Prathamesh Pai, Anil K. D'Cruz, Ather Enam, Hammad Ather

Section of Neurosurgery

Introduction: Strengthening The Reporting Of Cohort Studies in Surgery (STROCSS) guidelines were developed in 2017 in order to improve the reporting quality of observational studies in surgery and updated in 2019. In order to maintain relevance and continue upholding good reporting quality among observational studies in surgery, we aimed to update STROCSS 2019 guidelines.
Methods: A STROCSS 2021 steering group was formed to come up with proposals to update STROCSS 2019 guidelines. An expert panel of researchers assessed these proposals and judged whether they should become part of STROCSS 2021 guidelines or not, through a Delphi consensus exercise.
Results: 42 …

Nanomedicine In The Treatment Of Glioblastoma, Syeda Kubra Kishwar Jafri, Syed Sarmad Bukhari, Muhammad Shahzad Shamim

Section of Neurosurgery

The current standard of care in glioblastoma management is surgery followed by chemotherapy and radiotherapy. Temozolomide is an alkylating agent most commonly used with a few other second line options. The efficacy of systemic chemotherapy in brain malignancies is limited due to the nature of the blood-brain barrier. Nanomedicine offers one avenue of improving drug delivery to these tumours in a more focussed and effective way in higher doses than currently possible, while simultaneously reducing systemic toxicity.

Awake Craniotomy For Resection Of Intracranial Meningioma: First Case Series From A Low- And Middle-Income Country, Saqib Kamran Bakhshi, Noyan Jawed, Faraz Shafiq, Ather Enam

Section of Neurosurgery

Introduction: Awake craniotomy (AC) has emerged as a better modality for resection of intra-axial brain tumors. The advantages are not just related to the preservation of neurological function, but also include early recovery, short hospital stay and possibly lower costs. However, data on AC for meningioma resection is deficient, likely because of concerns related to intra-operative pain and blood loss.
Methods: All patients who underwent AC, using awake through-out technique for resection of meningioma, during the last five years, were included in the study. Non-probability consecutive sampling technique was employed. Variables for demographics, and details of diagnosis and surgical procedure …

Role Of Multidisciplinary Neuro-Oncology Tumour Boards In Cancer Management, Mohammad Hamza Bajwa, Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Section of Neurosurgery

Multidisciplinary care, including a tumour board discussion for all patients with oncological problems is now considered a standard. However, this is not uniformly implemented within many centres, especially in developing countries. The structure of these tumour boards allows for comprehensive discussion and debate regarding various treatment pathways, with inputs from all specialties. This creates a consensus regarding management for each patient that is unique and holistic. Despite its widespread implementation, published data on neuro-oncology tumour boards is quite limited. The presented literature review briefly discusses the structure, goals, outcomes achieved by multidisciplinary tumour boards within the field of neuro-oncology.

Deep Learning Applications In Neuro-Oncology, Adnan Khan, Hamza Ibad, Kaleem Ahmed, Zahra Hoodbhoy, Muhammad Shahzad Shamim

Medical College Documents

Deep learning (DL) is a relatively newer subdomain of machine learning (ML) with incredible potential for certain applications in the medical field. Given recent advances in its use in neuro-oncology, its role in diagnosing, prognosticating, and managing the care of cancer patients has been the subject of many research studies. The gamut of studies has shown that the landscape of algorithmic methods is constantly improving with each iteration from its inception. With the increase in the availability of high-quality data, more training sets will allow for higher fidelity models. However, logistical and ethical concerns over a prospective trial comparing prognostic …

Solitary Langerhans Cell Histiocytosis Of Skull: Case Report With One-Year Follow-Up, Muhammad Junaid, Syed Sarmad Bukhari, Ali Afzal

Section of Neurosurgery

Langerhans cell histiocytosis (LCH) is a rare disorder characterised by increased production of Langerhans-type histiocytes. It is more common in the pediatric age group with a predilection for osseous involvement, though any organ may be involved. A 10-year male child was brought to the neurosurgical clinic with a slow growing painful tender mass on the head. Initial attempt to biopsy the lesion failed due to excessive bleeding. It was later imaged and removed with a frontal craniotomy. Histopathological evaluation along with immunohistochemistry revealed the true nature of the lesion. Follow-up revealed complete excision of the lesion and no recurrence at …

Seizure Control After Surgical Resection Of Insular Glioma, Fatima Gauhar, Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Medical College Documents

Insular gliomas most commonly present with drug-resistant seizures, irrespective of the tumour grade. Even though surgery is the mainstay of treatment, complex anatomical location and close proximity to eloquent cortex makes surgical resection difficult. Herein the authors have reviewed the literature with regards to seizure control after surgical management of these tumours. The review does not address quality of life, or survival benefits of surgery. In summary, excision of these gliomas significantly improves seizure control, and extent of resection along-with trans-cortical approach are important predictors of seizure outcome.

Use Of Ultrasonic Aspirator For Cns Tumour Resection, Noman Ahmad, Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Section of Neurosurgery

Ultrasonic aspirator (UA), or the Cavitron Ultrasonic Aspirator (CUSA) as it is commonly referred to, utilizes ultrasonic waves of variable range of frequencies to disintegrate and excise tumours. It is developed as a substitute of bipolar diathermy; a tool commonly employed for coagulation that uses focussed electric current and may damage tissues by virtue of contact, or by the heat that it produces. Over the last 30 years, CUSA has become increasingly popular in several soft tissue surgeries, especially brain and spine tumour resection, as it allows reduction in the use of bipolar diathermy. It is assumed that CUSA improves …

Frequency Of Early Postoperative Adverse Events (Aes) In Adult Patients Undergoing Elective Neurosurgical Intervention At Tertiary Care Center In Pakistan, Mansoor Chandio, Faraz Shafiq, Ather Enam

Department of Anaesthesia

Objective: The postoperative period is critical in neurosurgical patients, where the incidence of postoperative AEs is significantly high. Most of events occurs during recovery phase and has got relation to anaesthetic management. The objective of study was to determine frequency of early AEs in elective neurosurgical patients.
Methods: This cross sectional study was conducted at our tertiary care center. The duration of study was one year, from August 2017-July 2018. The data was collected using predesigned proforma. The assessment was done on arrival in recovery room (T1) and then at forty five minutes (T2), twenty-fourth hour (T3) and forty-eighth hour …

Applying A Mixed-Method Approach To Improve On-The-Job Learning And Job Satisfaction In A Cohort Of Interns At A University Hospital, Amna Subhan Butt, Muhammad Shahzad Shamim, M Asghar Ali, Farah Naz Qamar, Irum Qamar Khan, Swaleha Tariq, Syeda Amrah Hashmi, Quratulain Hafeez, Muhammed Tariq

Section of Gastroenterology

Introduction: Job satisfaction is vital for the optimal functioning of medical practitioners. Herein, we report our experience of restructuring the internship program by identifying the gaps, developing, implementing strategies to overcome gaps and sharing the results of the pre-implementation and post-implementation audit, as an example for establishing a system for improving intern's work-based learning and satisfaction in a university hospital setting.
Methods: Using Kern's six-step instructional model, a prospective mixed-method study was conducted at Aga Khan University Hospital. In phase 1 (2013) gaps were identified by evaluating various aspects of the internship program. Strategies were developed and implemented to overcome …

Post-Operative Seizure Control In Patients With Glioblastoma, Ummey Hani, Muhammad Ammar Haider, Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Section of Neurosurgery

While the median survival in patients with glioblastoma has not improved significantly over the past decade, aggressive attempts have been made on palliation and improving quality of life in these patients. A confluence of two debilitating pathologies which massively distorts the normal day-to-day functioning of the patients who experience it, seizures in glioblastoma patients portends a poor prognosis. There exists a paucity of reported seizure outcomes after glioblastoma treatment in neurosurgical literature. Herein we present a review examining post-operative seizure control in patients with glioblastoma.

Postdischarge 24/7 Hotline Service For Neurology And Neurosurgery Patients And 1-Year Impact On Readmission Rates, Unplanned Emergency Department Visits, And Patient Satisfaction, Shafqat Bibi, Rida Mitha, Kiran Bano, Farida Datoo, Nadia Karim, Muhammad Shahzad Shamim

School of Nursing & Midwifery

Objective: Telephone triage is a system in which trained nurses use standardized protocols to evaluate symptoms over the phone and determine the appropriate course of action.
Materials and methods: We implemented a protocol for systematic follow up phone calls and telephonic triage to families of neurology and neurosurgery patients after discharge, primarily to improve care transition and to assess its impact on the ratio of visits in the emergency department, readmissions, and overall satisfaction of patients and families. The intervention comprised the implementation of nurse led telephone triage and postdischarge follow up phone calls. After implementing hotline services in mind …

Role Of Intra-Operative Ultrasound In Brain Tumour Surgeries, Mohammad Hamza Bajwa, Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Section of Neurosurgery

The use of intra-operative ultrasound remains a largely underutilized option in brain tumour surgeries. The widespread availability of neuronavigation may be the reason why such a useful modality has become less popular even though recent advances in ultrasound technology have greatly improved its utility. The available literature also clearly shows that it offers additional advantages especially when used with neuronavigation. Herein the authors have briefly touched upon the available literature on the role of intraoperative ultrasound in brain tumour surgeries.

Needs Of Young African Neurosurgeons And Residents: A Cross-Sectional Study, Ulrick S. Kanmounye, Faith C. Robertson, Nqobile S. Thango, Alvin Nah Doe, Nourou Dine Adeniran Bankole, Pape Aicha Ginette, Solomon Ondoma, James A. Balogun, Beverly Cheserem, Mahmood Qureshi

General Surgery, East Africa

Introduction: Africa has many untreated neurosurgical cases due to limited access to safe, affordable, and timely care. In this study, we surveyed young African neurosurgeons and trainees to identify challenges to training and practice.

Methods: African trainees and residents were surveyed online by the Young Neurosurgeons Forum from April 25th to November 30th, 2018. The survey link was distributed via social media platforms and through professional society mailing lists. Univariate and bivariate data analyses were run and a P-value < 0.05 was considered to be statistically significant.

Results: 112 respondents from 20 countries participated in this study. 98 (87.5%) were male, 63 (56.3%) were from sub-Saharan Africa, …