Differences In Risk-Adjusted Outcome Of Road Traffic Injuries In Urban Tertiary Care Centers Of Pakistan,
2015
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Differences In Risk-Adjusted Outcome Of Road Traffic Injuries In Urban Tertiary Care Centers Of Pakistan, Amber Mehmood, Junaid Abdul Razzak, Mohammed Umer Mir, Rashid Jooma
Department of Emergency Medicine
Objective: To assess the differences in road injury survival in three tertiary care hospitals in an urban setting.
Methods: The study was conducted in and comprised all road traffic injury victims presenting to the three state-run tertiary care centres in Karachi from September 2006 to October 2009. Patients' age, gender, mode, and delay in arrival, severity of injury were noted. Data was stratified by hospital of presentation. A logistic regression model was developed and probability of survival was assessed after adjusting for various risk factors, including patient characteristics and injury severity.
Results: There were 93,657victims in the study, but complete …
Fasting Headache, A Cross-Sectional Study,
2015
Aga Khan University
Fasting Headache, A Cross-Sectional Study, Adnan Salim, Muhammad Ahmed Ilyas, Mehwish Rizvi, Arzlan Ullaha Baig, Syed Hassaan Ahmed, Zuha Pandit, Muhammad Saleem Ilyas
Section of Neurosurgery
Headache is a predominant disorder in general population and is classified into primary and secondary forms by the International Headache Society. Fasting headache is currently classified in Group 10 of ICHD-III as “Headache attributed to disorders of homeostasis”. In spite of continuing research, there is still indistinctness regarding the exact cause of fasting headache. Hypoglycaemia, previous history of headache, stress, caffeine withdrawal, lack of sleep and female gender have been speculated as causative factors. Our rationale for this study is to find out what percentage of the population experiences fasting headache and to find out any link between the occurrence …
Multiple Cerebral Hydatid Cysts In 8-Year-Old Boy: A Case Report And Literature Review Of A Rare Presentation,
2015
Aga Khan University
Multiple Cerebral Hydatid Cysts In 8-Year-Old Boy: A Case Report And Literature Review Of A Rare Presentation, Muhammad Baba Khan, Muhammad Riaz, Muhammad Ehsan Bari
Section of Neurosurgery
Background: Multiple cerebral hydatid cysts are very rare with only a few reports in the literature detailing diagnostic workup, medical management, surgical techniques, possible complications, and outcomes.
Case description: We present the case of an 8-year-old boy who presented with progressively worsening headaches, vomiting, and intermittent fever since 20 days. Diagnostic workup was performed, and magnetic resonance imaging revealed multiple intracranial cysts predominantly in the right frontal region with significant mass effect. A total of 19 intracranial cysts were removed surgically, and the child recovered uneventfully.
Conclusions: Neurosurgeons should keep hydatidosis in the list of differentials when evaluating patients with …
Epilepsy In Pakistan: National Guidelines For Clinicians,
2015
Aga Khan University
Epilepsy In Pakistan: National Guidelines For Clinicians, Fowzia Siddiqui, Tipu Sultan, Shahid Mustafa, Sarwar Jamil Siddiqui, Shaukat Ali, Abdul Malik, Zafar Sajjad, Saleem Barech, Rashid Jooma
Section of Neurology
Introduction: Epilepsy is one of the most common chronic neurological disorders requiring prolonged treatments and drugs. According to The World Health Organization (WHO), epilepsy is one of those serious brain disorders that affect not only the individual but has a deep impact on the family and society in general. Approximately 50 million people are affected with epilepsy around the world36, though proper epidemiological studies do not exist for Pakistan it is estimated that the prevalence of epilepsy is 9.99/1000. Highest prevalence is seen in people younger than 30 years of age, i.e. about 2 million people and 1/10th of the …
Computed Tomography-Guided Biopsy For Potts Disease: An Institutional Experience From An Endemic Developing Country,
2015
Aga Khan University
Computed Tomography-Guided Biopsy For Potts Disease: An Institutional Experience From An Endemic Developing Country, Muhammad Waqas, Mohsin Qadeer, Faizuddin Faiz, Mohammad Ali Alvi, Muhammad Ehsan Bari
Section of Neurosurgery
Study design: A retrospective chart review.
Purpose: In endemic resource poor countries like Pakistan, most patients are diagnosed and treated for Potts disease on clinical and radiological grounds without a routine biopsy. The purpose of this study was to evaluate the use and effect of computed tomography (CT)-guided biopsy in the management of Potts disease since the technique is becoming increasingly available.
Overview of literature: CT-guided biopsy of spinal lesions is routinely performed. Literature on the utility of the technique in endemic resource poor countries is little.
Methods: This study was conducted at the Neurosurgery section of Aga Khan University …
Clinical Outcome And Cost Effectiveness Of Early Tracheostomy In Isolated Severe Head Injury Patients,
2015
Aga Khan University
Clinical Outcome And Cost Effectiveness Of Early Tracheostomy In Isolated Severe Head Injury Patients, Usman Tariq Siddiqui, Muhammad Zubair Tahir, Muhammad Shahzad Shamim, S. Ather Enam
Section of Neurosurgery
Background: Early tracheostomy (ET) has been shown to be effective in reducing complications associated with prolong mechanical ventilation. The study was carried out to evaluate the role of ET in reducing the duration of mechanical ventilation, duration of intensive care unit (ICU) stay, ICU-related morbidities, and its overall effect on outcome, in patients with isolated severe traumatic brain injury (TBI).
Methods: This 7-year review included 100 ICU patients with isolated severe TBI requiring mechanical ventilation. ET was defined as tracheostomy within 7 days of TBI, and prolonged endotracheal intubation (EI) as EI exceeding 7 days of TBI. Of 100 patients, …
Clinoidal Meningioma Associated With An Internal Carotid Artery Aneurysm,
2015
Aga Khan University
Clinoidal Meningioma Associated With An Internal Carotid Artery Aneurysm, Muhammad Waqas, Yousuf Bashir Hadi, Badar Uddin Ujjan, Gohar Javed
Section of Neurosurgery
Coexistence of primary brain neoplasms with intracranial aneurysms is rare but presents a diagnostic and therapeutic challenge to healthcare providers. We describe the case of a 60-year-old woman who had a left internal carotid artery aneurysm with a small ipsilateral clinoidal meningioma. The meningioma was an unexpected finding encountered during the surgery for aneurysmal clipping. Both the lesions were dealt with simultaneously.
Factors Affecting Ventriculoperitoneal Shunt Survival In Adult Patients,
2015
Aga Khan University
Factors Affecting Ventriculoperitoneal Shunt Survival In Adult Patients, Farid Khan, Abdul Rehman, Muhammad Shahzad Shamim, Muhammad Ehsan Bari
Section of Neurosurgery
Background: Ventriculoperitoneal (VP) shunt insertion remains the mainstay of treatment for hydrocephalus despite a high rate of complications. The predictors of shunt malfunction have been studied mostly in pediatric patients. In this study, we report our 11-year experience with VP shunts in adult patients with hydrocephalus. We also assess the various factors affecting shunt survival in a developing country setting.
Methods: A retrospective chart analysis was conducted for all adult patients who had undergone shunt placement between the years 2001 and 2011. Kaplan-Meier curves were used to determine the duration from shunt placement to first malfunction and log-rank (Cox-Mantel) tests …
Impacts Of Signal Free Corridors On The Incidence Of Road Traffic Accidents In Karachi,
2015
University of Karachi, Karachi, Pakistan
Impacts Of Signal Free Corridors On The Incidence Of Road Traffic Accidents In Karachi, Salman Zubair, Jamil H. Kazm, Syed Shahid Ali, Rashid Jooma, Zeeshan Akhtar
Section of Neurosurgery
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 many …
Polio Eradication And Health Systems In Karachi: Vaccine Refusals In Context,
2015
Middlebury College, Middlebury, Vermont, USA.
Polio Eradication And Health Systems In Karachi: Vaccine Refusals In Context, Svea Closser, Rashid Jooma, Emma Varley, Naina Qayyum, Sonia Rodrigues, Akasha Sarwar, Patricia Omidian
Section of Neurosurgery
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 a …
Effectiveness Of Helmets In Preventing Severe Injuries In A Setting With Poorly Enforced Quality Standards,
2015
Aga Khan University
Effectiveness Of Helmets In Preventing Severe Injuries In A Setting With Poorly Enforced Quality Standards, Junaid Ahmad Bhatti, Junaid A. Razzak, Rashid Jooma
Department of Emergency Medicine
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 …
Mobile Stroke Unit (Msu): The Future Of Acute Stroke Treatment,
2015
University of South Florida
Mobile Stroke Unit (Msu): The Future Of Acute Stroke Treatment, Waldo R. Guerrero
Neurosurgery and Brain Repair Faculty Publications
No abstract provided.
Application And Histology-Driven Refinement Of Active Contour Models To Functional Region And Nerve Delineation: Towards A Digital Brainstem Atlas,
2015
Old Dominion University
Application And Histology-Driven Refinement Of Active Contour Models To Functional Region And Nerve Delineation: Towards A Digital Brainstem Atlas, Nimal Patel, Sharmin Sultana, Tanweer Rashid, Dean Krusienski, Michel A. Audette
Electrical & Computer Engineering Faculty Publications
This paper presents a methodology for the digital formatting of a printed atlas of the brainstem and the delineation of cranial nerves from this digital atlas. It also describes on-going work on the 3D resampling and refinement of the 2D functional regions and nerve contours. In MRI-based anatomical modeling for neurosurgery planning and simulation, the complexity of the functional anatomy entails a digital atlas approach, rather than less descriptive voxel or surface-based approaches. However, there is an insufficiency of descriptive digital atlases, in particular of the brainstem. Our approach proceeds from a series of numbered, contour-based sketches coinciding with slices …
A Microsurgical Anterior Cervical Approach And The Immediate Impact Of Mechanical Retractors: A Case Control Study,
2015
Universidad de Guadalajara
A Microsurgical Anterior Cervical Approach And The Immediate Impact Of Mechanical Retractors: A Case Control Study, Rodrigo Ramos-Zúñiga, Laura Rocio Díaz-Guzmán, Shannen Velasquez, Ana Magdelena Macías-Ornelas, Martín Rodríguez-Vázquez
Faculty Publications
Introduction: A microsurgical anterior cervical approach with discectomy and fusion (MACDF) is one of the most widely used procedures for treating radicular disorders. This approach is highly successful; however, it is not free from complications. These can be associated with soft tissue injuries. Aim of the Study: The recognition of the risks for these complications should be identified for timely prevention and safe treatment. Materials and Methods: Study Design: Retrospective case control study. This study includes a retrospective case series of 37 patients, paying special attention to immediate complications related to the use of mechanical retraction of soft tissue (dysphagia, …
The Impact Of Polio Eradication On Routine Immunization And Primary Health Care: A Mixed-Methods Study,
2014
Middlebury College, Middlebury
The Impact Of Polio Eradication On Routine Immunization And Primary Health Care: A Mixed-Methods Study, Svea Closser, Kelly Cox, Thomas M. Parris, R Matthew Landis, Judith Justice, Ranjani Gopinath, Kenneth Maes, Hailom Banteyerga Amaha, Ismaila Zango Mohammed, Rashid Jooma
Section of Neurosurgery
Background: After 2 decades of focused efforts to eradicate polio, the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization (RI) and primary healthcare (PHC).
Methods: Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review.
Results: Our quantitative analysis did not find compelling evidence of widespread and …
A Unique Mri Presentation Of Fungal Infection In The Brain,
2014
Good Samaritan Hospital, Cincinnati, OH, USA.
A Unique Mri Presentation Of Fungal Infection In The Brain, Muhammad Bilal Salman Khan, Saad Shafqat, Ather Enam
Section of Neurology
Fungal infections of CNS are common in certain geographic locations. MRI with or without contrast is a useful prediagnostic tool. However, the findings may sometimes be misleading. In this case report, the authors present unusual imaging findings in the MRI of fungal infection in an immunocompetent host, whereby hyper-intense signals were seen on T2-weighted images and patchy post-contrast enhancement was observed with surrounding edema. These findings were suggestive of a neoplastic lesion but it was identified as aspergillosis on subsequent histopathology. This unusual MRI finding of CNS highlights the need to consider fungal infection as a differential diagnosis of all …
Magnetic Resonance Spectroscopy Of Enhancing Cerebral Lesions: Analysis Of 78 Histopathology Proven Cases,
2014
Aga Khan University
Magnetic Resonance Spectroscopy Of Enhancing Cerebral Lesions: Analysis Of 78 Histopathology Proven Cases, Muhammad Shahbaz Alam, Humera Ahsan, Zafar Sajjad, Madiha Beg, Umer Bhatti, Ather Enam, Mohammad Wasay
Department of Radiology
Objectives: To investigate the efficacy of magnetic resonance spectroscopy in differentiating various types of neoplastic and non-neoplastic enhancing cerebral lesions.
Methods: The prospective study was conducted from January 2007 to December 2009 at the Department of Radiology, Aga Khan University Hospital, Karachi. All patients with enhancing brain lesions on magnetic resonance imaging who underwent magnetic resonance spectroscopy and a biopsy with histopathological analysis were included in study. The lesions were categorised into neoplastic and non-neoplastic lesions on the basis of spectroscopy findings. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of magnetic resonance spectroscopy were calculated. …
Prospective Validation Of A Blood Ordering Protocol For Elective Spine Arthrodesis And Its Impact On Cost Reduction,
2014
Aga Khan University
Prospective Validation Of A Blood Ordering Protocol For Elective Spine Arthrodesis And Its Impact On Cost Reduction, Muhammad Waqas, Muhammad Shahzad Shamim, Badar Uddin Ujjan, Saqib Kamran Bakhshi
Section of Neurosurgery
Background: On the basis of an institutional audit, the authors published an individual patient-based protocol for preoperative arrangement of blood products in patients undergoing elective spine arthrodesis. The present study was conducted for the prospective validation of the proposed protocol in reducing cross match to transfusion ratio, and its implications on overall cost.
Methods: This cross-sectional study was conducted over 1 year (2012). All adult patients who underwent elective spinal arthrodesis were included and prospectively observed. The actual transfusion index was calculated for individual patients with the formula C1/T, where C1 is the number of units of packed RBCs cross …
Lumbar Morphometry: A Study Of Lumbar Vertebrae From A Pakistani Population Using Computed Tomography Scans,
2014
Aga Khan University
Lumbar Morphometry: A Study Of Lumbar Vertebrae From A Pakistani Population Using Computed Tomography Scans, Muhammad M. Alam, Muhammad Waqas, Hussain Shallwani, Gohar Javed
Section of Neurosurgery
Study design: A cross-sectional study.
Purpose: To describe the characteristics of lumbar vertebrae of Pakistani patients reporting at a tertiary care hospital and compare with studies from other populations.
Overview of literature: Several studies have been conducted to determine morphometry of lumbar vertebrae. Most of the studies involve Caucasian populations, still data on other populations still sparse. This is the first study describing lumbar morphometry of a Pakistani population.
Methods: An observational study was conducted based on a review of thin-cut (3 mm) computed topographic images of lumbar vertebrae. Two-hundred and twenty vertebrae from forty-nine patients were studied, and various …
Polio Travel Restrictions: A Sledgehammer To Crack A Nut?,
2014
Aga Khan University
Polio Travel Restrictions: A Sledgehammer To Crack A Nut?, Rashid Jooma
Section of Neurosurgery
Imposition by WHO of mandatory vaccination for international travelers from Pakistan has caused confusion and panic amongst travelers besides the adverse effect on the country's image from the widely reported statement. It is felt that the announced measure is not primarily supported by science but is rather a response to disillusionment in the donors about the repeatedly missed eradication targets set by WHO. In the past few years, exportation of poliovirus from Pakistan has caused outbreaks in China, Iraq and Syria besides the ongoing two way transmission with Afghanistan, but the carriers in these spreads are mainly land route travelers. …
