A Successful Model Of Road Traffic Injury Surveillance In A Developing Country: Process And Lessons Learnt,
2012
Aga Khan University
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
Department of Emergency Medicine
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 …
Concurrent Intracranial And Spinal Arteriovenous Malformations: Report Of Two Pediatric Cases And Literature Review,
2012
Aga Khan University
Concurrent Intracranial And Spinal Arteriovenous Malformations: Report Of Two Pediatric Cases And Literature Review, Hussain Shallwani, Muhammad Zubair Tahir, Muhammad Ehsan Bari, Tanveer Ul Haq
Medical College Documents
Background: Concurrent intracranial and spinal arteriovenous malformations (AVMs) are very rare with only a few cases being reported in literature. Two of the rare concurrent intracranial and spinal AVM cases are presented.
Case description: Case 1 is a 12-year-old girl with headache and motor disturbances in the lower limbs. Her spinal and brain angiogram was done and she was diagnosed to have a spinal AVM at level T8-T9 and an intracranial AVM in the left mesial temporal lobe. Her spinal AVM was embolized, while no treatment was given for her intracranial AVM. Case 2 is a 10-year-old girl who presented …
Phenytoin Versus Leviteracetam For Seizure Prophylaxis After Brain Injury - A Meta Analysis,
2012
Aga Khan University
Phenytoin Versus Leviteracetam For Seizure Prophylaxis After Brain Injury - A Meta Analysis, Syed Nabeel Zafar, Abdul Ahad Khan, Asfar Ayaz Gauri, Muhammad Shahzad Shamim
Section of Neurosurgery
Background: Current standard therapy for seizure prophylaxis in Neuro-surgical patients involves the use of Phenytoin (PHY). However, a new drug Levetiracetam (LEV) is emerging as an alternate treatment choice. We aimed to conduct a meta-analysis to compare these two drugs in patients with brain injury.
Methods: An electronic search was performed in using Pubmed, Embase, and CENTRAL. We included studies that compared the use of LEV vs. PHY for seizure prophylaxis for brain injured patients (Traumatic brain injury, intracranial hemorrhage, intracranial neoplasms, and craniotomy). Data of all eligible studies was extracted on to a standardized abstraction sheet. Data about baseline …
The Effect Of The Retroperitoneal Transpsoas Minimally Invasive Lateral Interbody Fusion On Segmental And Regional Lumbar Lordosis,
2012
University of South Florida
The Effect Of The Retroperitoneal Transpsoas Minimally Invasive Lateral Interbody Fusion On Segmental And Regional Lumbar Lordosis, Tien V. Le, Andrew C. Vivas, Elias Dakwar, Ali A. Baaj, Juan S. Uribe
Neurosurgery and Brain Repair Faculty Publications
Background. The minimally invasive lateral interbody fusion (MIS LIF) in the lumbar spine can correct coronal Cobb angles, but the effect on sagittal plane correction is unclear. Methods. A retrospective review of thirty-five patients with lumbar degenerative disease who underwent MIS LIF without supplemental posterior instrumentation was undertaken to study the radiographic effect on the restoration of segmental and regional lumbar lordosis using the Cobb angles on pre- and postoperative radiographs. Mean disc height changes were also measured. Results. The mean follow-up period was 13.3 months. Fifty total levels were fused with a mean of 1.42 levels …
Early Outcomes Of Minimally Invasive Anterior Longitudinal Ligament Release For Correction Of Sagittal Imbalance In Patients With Adult Spinal Deformity,
2012
University of South Florida
Early Outcomes Of Minimally Invasive Anterior Longitudinal Ligament Release For Correction Of Sagittal Imbalance In Patients With Adult Spinal Deformity, Armen R. Deukmedjian, Elias Dakwar, Amir Ahmadian, Donald A. Smith, Juan S. Uribe
Neurosurgery and Brain Repair Faculty Publications
The object of this study was to evaluate a novel surgical technique in the treatment of adult degenerative scoliosis and present our early experience with the minimally invasive lateral approach for anterior longitudinal ligament release to provide lumbar lordosis and examine its impact on sagittal balance. Methods. All patients with adult spinal deformity (ASD) treated with the minimally invasive lateral retroperitoneal transpsoas interbody fusion (MIS LIF) for release of the anterior longitudinal ligament were examined. Patient demographics, clinical data, spinopelvic parameters, and outcome measures were recorded. Results. Seven patients underwent release of the anterior longitudinal ligament (ALR) to …
Peripheral Nerve Repair With Cultured Schwann Cells: Getting Closer To The Clinics,
2012
University of South Florida
Peripheral Nerve Repair With Cultured Schwann Cells: Getting Closer To The Clinics, Maria Carolina O. Rodrigues, Antonio Antunes Rodrigues, Loren E. Glover, Julio Voltarelli, Cesar V. Borlongan
Neurosurgery and Brain Repair Faculty Publications
Peripheral nerve injuries are a frequent and disabling condition, which affects 13 to 23 per 100.000 persons each year. Severe cases, with structural disruption of the nerve, are associated with poor functional recovery. The experimental treatment using nerve grafts to replace damaged or shortened axons is limited by technical difficulties, invasiveness, and mediocre results. Other therapeutic choices include the adjunctive application of cultured Schwann cells and nerve conduits to guide axonal growth. The bone marrow is a rich source of mesenchymal cells, which can be differentiated in vitro into Schwann cells and subsequently engrafted into the damaged nerve. Alternatively, undifferentiated …
A Critical Analysis Of The Current State Of Neurosurgery Training In Pakistan,
2011
Aga Khan University
A Critical Analysis Of The Current State Of Neurosurgery Training In Pakistan, Muhammad Shahzad Shamim, Muhammad Zubair Tahir, Saniya Siraj Godil, Rajesh Kumar, Arshad Ali Siddiqui
Section of Neurosurgery
Objective: To observe interdepartmental variation in the availability of resources and academic activities within the various neurosurgery programs of Pakistan.
Methods: This was a proforma-based survey of neurosurgery trainees and young neurosurgeons of Pakistan, looking at the academic infrastructure and output of their programs. The proforma was filled by 36 respondents from 11 neurosurgery centers of the country. All these centers were accredited for neurosurgery training in Pakistan.
Results: Out of the 36 respondents, 30 were completing a Fellowship training (FCPS) and six were enrolled for a Master in Surgery (MS) program. About 80% of the participants used the Youman's …
Variations In Practice Patterns Among Neurosurgeons And Orthopaedic Surgeons In The Management Of Spinal Disorders,
2011
Aga Khan University
Variations In Practice Patterns Among Neurosurgeons And Orthopaedic Surgeons In The Management Of Spinal Disorders, Manzar Hussain, Sadaf Nasir, Amber Moed, Ghulam Murtaza
Section of Neurosurgery
Study design: This is a case series.
Purpose: We wanted to identify variations in the practice patterns among neurosurgeons and orthopedic surgeons for the management of spinal disorders.
Overview of literature: Spinal disorders are common in the clinical practice of both neurosurgeons and orthopedic surgeons. It has been observed that despite the availability of various guidelines, there is lack of consensus among surgeons about the management of various disorders.
Methods: A questionnaire was distributed, either directly or via e-mail, to the both the neurosurgeons and orthopedic surgeons who worked at 5 tertiary care centers within a single region of Korea. …
Non-Operative Management Is Superior To Surgical Stabilization In Spine Injury Patients With Complete Neurological Deficits: A Perspective Study From A Developing World Country, Pakistan,
2011
Aga Khan University
Non-Operative Management Is Superior To Surgical Stabilization In Spine Injury Patients With Complete Neurological Deficits: A Perspective Study From A Developing World Country, Pakistan, Muhammad Shahzad Shamim, Syed Faizan Ali, Ather Enam
Section of Neurosurgery
Background: Surgical stabilization of injured spine in Patients with complete spinal cord injury is a common practice despite the lack of strong evidence supporting it. The aim of this study is to compare clinical outcomes and cost-effectiveness of surgical stabilization versus conservative management of spinal injury in Patients with complete deficits, essentially from a developing country's point of view.
Methods: A detailed analysis of Patients with traumatic spine injury and complete deficits admitted at the Aga Khan University Hospital, Pakistan, from January 2004 till January 2010 was carried out. All Patients presenting within 14 days of injury were divided in …
Endovascular Approach As Primary Treatment For Traumatic Carotid Cavernous Fistula: Local Experience From Pakistan,
2011
Aga Khan University
Endovascular Approach As Primary Treatment For Traumatic Carotid Cavernous Fistula: Local Experience From Pakistan, Rana Shoaib Hamid, Tanveer Ul Haq, Muhammad Shahzad Shamim, Syed Faraz Kazim, Basit Salam
Department of Radiology
Objective: To evaluate the technical success, complications and outcome of endovascular management of post traumatic carotid cavernous fistula (CCF) in patients presenting at a tertiary care hospital in Karahci.
Methods: Descriptive case series of 26 patients of post traumatic CCF treated by endovascular techniques was carried out at Radiology and Neurosurgery departments of Aga Khan University hospital between January 2010 to March 2010. Medical records and radiology reports were retrospectively reviewed from November 2000 to December 2009. The diagnosis was primarily clinical and was confirmed in all cases by CT or MRI. Endovascular procedures were performed under general anaesthesia through …
Cranioplasty After Decompressive Craniectomy: An Institutional Audit And Analysis Of Factors Related To Complications,
2011
Aga Khan University
Cranioplasty After Decompressive Craniectomy: An Institutional Audit And Analysis Of Factors Related To Complications, Zain A. Sobani, Muhammad Shahzad Shamim, Syed Nabeel Zafar, Mohsin Qadeer, Najiha Bilal, Syed Ghulam Murtaza, Ather Enam, Muhammad Ehsan Bari
Section of Neurosurgery
Background:Although a relatively simple procedure, cranioplasties have been associated with high complication rates. Keeping this in perspective, we aimed to determine the factors associated with immediate and long-term complications of cranioplasties at our institution.
Methods: A retrospective review of Patient records was carried out for Patients having undergone reconstructive cranioplasties at our institution during the last 10 years (2001-2010). All case notes, records, and investigations were reviewed and the data were recorded in a predesigned questionnaire. Complications were recorded along with existing comorbids and measures taken for their prevention and management. Univariate and multivariate logistic regression analysis was performed …
B-Cell Lymphoma Of The Brainstem With Central Neurogenic Hyperventilation,
2011
Aga Khan University
B-Cell Lymphoma Of The Brainstem With Central Neurogenic Hyperventilation, S. Ather Enam, Rushna Ali
Section of Neurosurgery
Non-Hodgkin's lymphoma of the brainstem is a rare entity. Central Neurogenic Hyperventilation (CNH), an associated manifestation of this disease, is an even rarer event. We report a case of an immunocompetent individual who presented to us with tachypnea and facial nerve palsy. Neuroimaging showed a Cerebellopontine angle tumour which on histopathology showed feature consistent with a Non-Hodgkin's B-Cell Lymphoma. The patient went on to develop severe respiratory alkalosis with findings consistent with CNH. Chemotherapy with Methotrexate was started and high dose Dexamethasone was added to the regimen a month later. Radiologically, the tumour size decreased by 50% but the patient's …
Management Of Penetrating Brain Injury,
2011
Aga Khan University
Management Of Penetrating Brain Injury, Syed Faraz Kazim, Muhammad Shahzad Shamim, Muhammad Zubair Tahir, Ather Enam, Shahan Waheed
Section of Neurosurgery
Penetrating brain injury (PBI), though less prevalent than closed head trauma, carries a worse prognosis. The publication of Guidelines for the Management of Penetrating Brain Injury in 2001, attempted to standardize the management of PBI. This paper provides a precise and updated account of the medical and surgical management of these unique injuries which still present a significant challenge to practicing neurosurgeons worldwide. The management algorithms presented in this document are based on Guidelines for the Management of Penetrating Brain Injury and the recommendations are from literature published after 2001. Optimum management of PBI requires adequate comprehension of mechanism and …
Cranial Reconstruction After Decompressive Craniectomy: Prediction Of Complications Using Fuzzy Logic,
2011
Aga Khan University
Cranial Reconstruction After Decompressive Craniectomy: Prediction Of Complications Using Fuzzy Logic, Saniya Siraj Godil, Muhammad Shahzad Shamim, Ather Enam, Uvais Qidwai, Mohsin Qadeer, Zain A. Sobani
Section of Neurosurgery
Introduction: Cranial reconstruction after decompressive craniectomy (DC) has been shown to be associated with a relatively high complication rate (16.4%-34%) compared with standard neurosurgical procedures (2%-5%). Most studies that have previously attempted to formulate a multivariate model for identifying factors predictive of postoperative complications of cranioplasty either were unsuccessful or yielded conflicting results. Therefore, fuzzy logic-based fuzzy inference system (FIS), which has proven to be a useful tool for risk prediction in medical and surgical conditions, was used in this study to identify predictors of complications of cranioplasty.
Methods: A retrospective chart review of all the patients who underwent DC …
Non-Traumatic Coma In Paediatric Patients: Etiology And Predictors Of Outcome,
2011
Dow University of Health Sciences, Karachi
Non-Traumatic Coma In Paediatric Patients: Etiology And Predictors Of Outcome, Saba Ahmed, Kiran Ejaz, Muhammad Shahzad Shamim, Maimoona Azhar Salim, Muhammad Umer Rais Khan
Department of Emergency Medicine
Objective: To determine the common etiological features of non-traumatic coma in children and evaluate possible predictors of morbidity and mortality in these patients.
Method: A cross sectional study was carried out at the Paediatric Department of Civil Hospital Karachi from February 2008 to February 2009. In total 100 children, up to 14 years of age having history of non-traumatic coma were included. At the time of enrolment demographic data, clinical features, laboratory parameters and radiological workup were recorded. Data was entered and analyzed with SPSS version 16. Descriptive statistics were generated for all variables. Relationships between categorical variables were evaluated …
Traumatic Retroclival Epidural Hematoma In Pediatric Patient- Case Report And Review Of Literature,
2011
Aga Khan University
Traumatic Retroclival Epidural Hematoma In Pediatric Patient- Case Report And Review Of Literature, Muhammad Zubair Tahir, S. A. Quadri, Sonia Hanif, Gohar Javed
Section of Neurosurgery
Background: Retroclival epidural hematoma (REDH) is a very rare entity in the practical field of neurosurgery. Only a few cases have been reported in literature. The authors present to you case of a 12-year-old female, a victim of road traffic accident (RTA), who had presented to us with loss of consciousness and seizures.
Case description: Magnetic resonance imaging revealed retroclival hematoma. She was managed on conservative grounds and discharged with assurance of multiple follow-up visits.
Conclusion: Very few cases of REDH have been reported in pediatric population to date. It should be suspected in children with head and neck injuries …
Terrorist Bombings: Medical Response In A Developing Country,
2011
Aga Khan University
Terrorist Bombings: Medical Response In A Developing Country, Hasnain Zafar, Ahmed Jawad, Muhammad Shahzad Shamim, Ayaz Ahmed Memon, Aamir Hameed Khan, Muhammad Shahrukh Effendi, Saeed Qureshi
Section of General Surgery
Objective: To evaluate the process of transport and immediate Emergency Department (ER) management of mass casualties following the recent bomb blasts in Karachi and review in detail the medical response and management of victims undertaken in these two incidents.
Methods: Eyewitness accounts of the victims, medical personnel and newspaper clippings were used to understand and identify difficulties faced during the rescue process. Data regarding presenting injuries and their outcomes was also collected from all victims presenting to the emergency department at Aga Khan University Hospital.
Results: Seventy nine individuals died and over 250 victims were injured in the two incidents. …
Microsurgical Excisions Of Vestibular Schwannomas: A Tumor-Size-Based Analysis Of Neurological Outcomes And Surgical Complications,
2011
Aga Khan University
Microsurgical Excisions Of Vestibular Schwannomas: A Tumor-Size-Based Analysis Of Neurological Outcomes And Surgical Complications, Syed Faraz Kazim, Muhammad Shahzad Shamim, Ather Enam, Muhammad Ehsan Bari
Section of Neurosurgery
Introduction: Vestibular schwannomas (VS) are benign tumors originating from Schwann cells in vestibulocochlear nerve. This study aimed at evaluating outcomes of microsurgical resections of VS based on tumor sizes in a South Asian country.
Methods: The chart notes of 71 Patients who underwent microsurgical resections of VS at a single academic center over a 20-year period (1990-2009) were reviewed, and relevant information was extracted. For analyzing outcomes, Patients were divided into two groups based on tumor size at initial presentation: (1) Group A (tumor size ≤ 4 cm) and (2) Group B (tumor size > 4 cm). Pearson's chi-square and Fisher's …
Diagnostic Accuracy Of Clinical Examination In Cervical Spine Injuries In Awake And Alert Blunt Trauma Patients,
2011
Aga Khan University
Diagnostic Accuracy Of Clinical Examination In Cervical Spine Injuries In Awake And Alert Blunt Trauma Patients, Manzar Hussain, Gohar Javed
Section of Neurosurgery
Study design: Observational, case series.
Purpose: To determine the sensitivity and specificity of clinical judgment as compared to the use of X-ray images in detecting cervical spine injuries in trauma patients presenting in the emergency department of Aga Khan University Hospital, Karachi.
Overview of literature: Cross-table cervical spine views are important in patients with signs and symptoms relating to cervical spine, but asymptomatic patients constitute a different subgroup. Accuracy of clinical examination in these patients has not been subjected to scrutiny.
Methods: All patients with blunt trauma who presented to the emergency department and underwent cross-table X-rays as part of …
Intracerebral Migration Of Stray Bullet Leading To Sudden And Fatal Worsening,
2011
Aga Khan University
Intracerebral Migration Of Stray Bullet Leading To Sudden And Fatal Worsening, Manzar Hussain, Muhammad Ehsan Bari
Section of Neurosurgery
Gunshot wounds to the cranium are one of the leading cause of death and disability in young adults. Stray bullets are also being increasingly seen in clinical setting. We report a case of a 14-year-old boy who sustained a stray bullet to the cranium during election festivities. He arrived at the health care facility institution nearly 24 hours after the event in good neurological condition. He remained neurologically stable for about 8 hours after his presentation and later on deteriorated due to intracranial bullet migration. This required immediate bifrontal decompressive craniotomy along with right frontal lobectomy. However, the patient could …
