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Zahid N, Martins RS, Brown N, Zahid W, Azam I, Hassan A, Ahmad K, Bhamani SS, Jabbar AA, Asad N, Shamim MS, Khan RJ, Javed G, Bari E, Enam SA. Psychosocial factors influencing quality of life in patients with primary brain tumors in Pakistan: an analytical cross-sectional study. BMC Res Notes 2023; 16:89. [PMID: 37231420 DOI: 10.1186/s13104-023-06358-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE Despite quality of life (QoL) being recognized as an important outcome in neuro-oncology, there is a lack of research from Pakistan where sociocultural differences may influence QoL. This study aimed to measure the QoL in patients with primary brain tumors (PBTs) and assess its association with mental health outcomes and social support. RESULTS Our study included a total of 250 patients, with a median age of 42 years (range 33-54 years). The commonest brain tumors were glioma (46.8%) and meningioma (21.2). The mean global QoL of the sample was 75.73 ± 14.9. The majority of patients had high social support (97.6%) and were not depressed (90%) or anxious (91.6%). On multivariable linear regression, global QoL was inversely associated with no or low income (beta coefficients: -8.75 to -11.84), having hypertension (-5.53), currently using a urine catheter (-13.55), having low social support (-28.16) suffering from mild (-15.31) or symptomatic (-23.84) depression, or mild anxiety (-13.22).
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Affiliation(s)
- Nida Zahid
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Russell Seth Martins
- Center for Clinical Best Practice, Clinical and Translational Research Incubator, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan.
| | - Nick Brown
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden
| | - Wajeeha Zahid
- Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Aneesa Hassan
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Khabir Ahmad
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Nargis Asad
- Department of Psychiatry, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Rashid Jooma Khan
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Gohar Javed
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Ehsan Bari
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Syed Ather Enam
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Hussain MM, Zaida SAA, Khalil M, Baqai W, Laghari AA, Bari E. Tailoring of neurosurgical practice during COVID-19 in a developing country: Insights gained and a way forward. Surg Neurol Int 2023; 14:117. [PMID: 37151428 PMCID: PMC10159316 DOI: 10.25259/sni_116_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/15/2023] [Indexed: 04/03/2023] Open
Abstract
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 staff was adopted at Aga Khan University. Patients were screened and seen either in person or through telemedicine, depending on the severity of the disease. All educational activities for residents were shifted online, and this helped in preventing overcrowding.
Conclusion:
Optimal surgical practice while ensuring team safety can be achieved through a multimodal strategy focusing on infection control, continuum of care, and the well-being of staff.
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Shah NZ, Masroor T, Zahid N, Zahid W, Hassan A, Azam I, Ahmad K, Bhamani SS, Jabbar AA, Asad N, Shamim MS, Khan RJ, Javed G, Bari E, Enam SA. Factors affecting well-being in brain tumor patients: An LMIC perspective. Front Psychol 2023; 14:1117967. [PMID: 37063536 PMCID: PMC10102647 DOI: 10.3389/fpsyg.2023.1117967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/03/2023] [Indexed: 04/03/2023] Open
Abstract
IntroductionBrain tumor is a devastating and often fatal diagnosis; quality of life and patient well-being are important goals of treatment. This study addresses the gap in culture-specific literature exploring the needs and coping strategies of brain tumor patients within an LMIC setting.MethodologyA qualitative approach was undertaken using an exploratory descriptive study design. In-depth interviews were conducted to capture the perspective of 250 brain tumor patients at a private tertiary center followed by extensive content analysis to identify major themes and sub-themes across responses.ResultsThe analysis identified three major themes: (i) Factors affecting the lives of brain tumor survivors (BTSs) and their impact (ii) What works to improve QoL according to the survivors’ perspectives, and (iii) Coping tactics & fostering healthy relationships. The need for financial navigation strategies improved patient-physician relationships, and reinforcing positive coping strategies were emphasized.ConclusionIn our population, family support and spiritual connection played an important role in helping patients mitigate the psychosocial burden of illness. However, financial concerns were pervasive and need to be addressed for better overall well-being.
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Affiliation(s)
- Nasim Zahid Shah
- School of Nursing and Midwifery, Aga Khan University Hospital, Karachi, Pakistan
| | - Taleaa Masroor
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Nida Zahid
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
- *Correspondence: Nida Zahid,
| | - Wajeeha Zahid
- Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Aneesa Hassan
- School of Nursing and Midwifery, Aga Khan University Hospital, Karachi, Pakistan
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Khabir Ahmad
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Nargis Asad
- Department of Psychiatry, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Rashid Jooma Khan
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Gohar Javed
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Ehsan Bari
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Syed Ather Enam
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Tariq Q, Ather M, Baig AN, Bari A, Bari E. Developmental delay in a patient with single cerebral varix. Surg Neurol Int 2022; 13:559. [PMID: 36600758 PMCID: PMC9805654 DOI: 10.25259/sni_793_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022] Open
Abstract
Background Cerebral varices are intracranial venous anomalies that are characterized as thin-walled vessels, with a single layer of endothelium lining it and a thin lamina or fibrous connective tissue surrounding it. These varices are usually associated with vascular abnormalities such as arteriovenous malformations or developmental venous anomalies, but may rarely be found as isolated lesions as well. Diagnosis of these isolated lesions on imaging is a challenge, because it is a rare entity and can mimic a space occupying lesion in the brain. The patients with isolated cerebral varix can present with neurological symptoms; however, majority are asymptomatic with the diagnosis made incidentally. Case Description The aim of this study is to report a case of a 21-month-old boy who was diagnosed with an isolated cerebral varix and had presented with delayed milestones in addition to seizures. His MRI scans showed a solid-cum-cystic lesion with contrast enhancing walls that was excised through craniotomy. Postoperatively, he regained his milestones. Conclusion The patients with isolated cerebral varix can present with neurological symptoms; however, majority are asymptomatic with the diagnosis made incidentally. These patients have a low risk of bleeding and are treated conservatively, with surgical intervention indicated only in symptomatic patients.
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Affiliation(s)
- Quratulain Tariq
- Department of Neurosurgery, Aga Khan University, Karachi, Pakistan
| | - Mishaal Ather
- Department of Neurosurgery, Aga Khan University, Karachi, Pakistan
| | - Ahmer Nasir Baig
- Department of Neurosurgery, Aga Khan University, Karachi, Pakistan
| | - Amman Bari
- Medical College, University of Western Australia, Crawley, Perth, Australia
| | - Ehsan Bari
- Department of Neurosurgery, Aga Khan University, Karachi, Pakistan,,Corresponding author: Ehsan Bari, Department of Neurosurgery, Aga Khan University, Karachi, Pakistan.
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Mushtaq N, Mustansir F, Minhas K, Usman S, Qureshi BM, Mubarak F, Bari E, Enam SA, Laghari AA, Javed G, Shamim S, Darbar A, Abbasi AN, Kirmani S, Resham S, Bilal A, Hamid SA, Zia N, Shaheen N, Wali R, Ghafoor T, Imam U, Maaz AUR, Khan S, Laperriere N, Desbrandes F, Dirks P, Drake J, Huang A, Tabori U, Hawkins C, Bartels U, Ramaswamy V, Bouffet E. Building the ecosystem for pediatric neuro-oncology care in Pakistan: Results of a 7-year long twinning program between Canada and Pakistan. Pediatr Blood Cancer 2022; 69:e29726. [PMID: 35484912 DOI: 10.1002/pbc.29726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/23/2022] [Accepted: 03/02/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Low- and middle-income countries sustain the majority of pediatric cancer burden, with significantly poorer survival rates compared to high-income countries. Collaboration between institutions in low- and middle-income countries and high-income countries is one of the ways to improve cancer outcomes. METHODS Patient characteristics and effects of a pediatric neuro-oncology twinning program between the Hospital for Sick Children in Toronto, Canada and several hospitals in Karachi, Pakistan over 7 years are described in this article. RESULTS A total of 460 patients were included in the study. The most common primary central nervous system tumors were low-grade gliomas (26.7%), followed by medulloblastomas (18%), high-grade gliomas (15%), ependymomas (11%), and craniopharyngiomas (11.7%). Changes to the proposed management plans were made in consultation with expert physicians from the Hospital for Sick Children in Toronto, Canada. On average, 24% of the discussed cases required a change in the original management plan over the course of the twinning program. However, a decreasing trend in change in management plans was observed, from 36% during the first 3.5 years to 16% in the last 3 years. This program also led to the launch of a national pediatric neuro-oncology telemedicine program in Pakistan. CONCLUSIONS Multidisciplinary and collaborative efforts by experts from across the world have aided in the correct diagnosis and treatment of children with brain tumors and helped establish local treatment protocols. This experience may be a model for other low- and middle-income countries that are planning on creating similar programs.
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Affiliation(s)
- Naureen Mushtaq
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Fatima Mustansir
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Khurram Minhas
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Sadia Usman
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Bilal Mazhar Qureshi
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Fatima Mubarak
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Ehsan Bari
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Syed Ather Enam
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Altaf Ali Laghari
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Gohar Javed
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Shahzad Shamim
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Aneela Darbar
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Ahmed Nadeem Abbasi
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Salman Kirmani
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Shahazadi Resham
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Afia Bilal
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi, Pakistan
| | | | - Nida Zia
- Indus Children Cancer Hospital, Karachi, Pakistan
| | - Najma Shaheen
- Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
| | - Rabia Wali
- Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
| | | | - Uzma Imam
- National Institute of Child Health, Karachi, Pakistan
| | | | - Sara Khan
- The Hospital for Sick Children, Toronto, Canada
| | | | | | - Peter Dirks
- The Hospital for Sick Children, Toronto, Canada
| | - James Drake
- The Hospital for Sick Children, Toronto, Canada
| | - Annie Huang
- The Hospital for Sick Children, Toronto, Canada
| | - Uri Tabori
- The Hospital for Sick Children, Toronto, Canada
| | | | - Ute Bartels
- The Hospital for Sick Children, Toronto, Canada
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Zahid N, Martins RS, Zahid W, Khalid W, Azam I, Bhamani SS, Asad N, Ahmad K, Jabbar AA, Shamim MS, Khan RJ, Javed G, Bari E, Enam SA. Translation and validation of the Urdu version of the European organization for research and treatment of cancer core quality of life questionnaire (EORTC QLQ-C30) and brain module (QLQ-BN20) in primary brain tumor patients. J Patient Rep Outcomes 2021; 5:79. [PMID: 34487251 PMCID: PMC8421474 DOI: 10.1186/s41687-021-00354-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/24/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction This study translated and validated the Urdu version of the European Organization for Research and Treatment of Cancer Quality of Life (QoL) Questionnaire (EORTC QLQ-C30) and Brain Module (QLQ-BN20) amongst patients with primary brain tumors (PBT) in Pakistan, and assessed the correlation of QoL with resilience, depression, and anxiety.
Methods Translation of the EORTC QLQ-C30 and QLQ-BN20 was performed as per EORTC guidelines. A survey comprising of Urdu translations of EORTC QLQ-C30, QLQ-BN20, Wagnild and Young Resilience Scale (RS-14) and Hospital Anxiety and Depression Scale was administered to patients with PBT at a tertiary care hospital in Pakistan. Reliability (via Cronbach alpha), content validity index (CVI) scores, construct validity, and inter-scale correlations were assessed. Results Our sample consisted of 250 patients with PBT, most commonly glioma (46.8%) and meningioma (21.2%). All patients were able to understand the Urdu translations. The Cronbach alphas for the QLQ-C30 and the QLQ-BN20 were 0.860 and 0.880, respectively. The CVI scores for clarity and relevance were high for both the EORTC QLQ-C30 (0.98 and 0.96, respectively) and the QLQ-BN20 tool (0.81 and 0.95, respectively). The global QoL domain (EORTC QLQ-C30) showed significant positive correlations with resilience (r = 0.422), and significant negative correlations with depression (r = − 0.541) and anxiety (r = − 0.502). Strong inter-scale correlations were observed between physical functioning and insomnia (r = − 0.690) and role functioning and insomnia (r = − 0.641). Conclusion Our study confirms the Urdu versions of the EORTC QLQ-C30 and QLQ-BN20 as valid clinical tools for the measurement of QoL in primary brain tumors patients within the cultural and socioeconomic context of Pakistan. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-021-00354-6. Quality of life (QoL) is an important facet of well-being for patients with primary brain tumors (PBTs), as these individuals face significant distress during the course of their illness and treatment. It is important to have valid and reliable tools to accurately measure the QoL of patients with PBTs. The EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) and its brain tumor-specific module EORTC QLQ-BN20 (EORTC QLQ-Brain Neoplasms 20) are exactly that. However, the use of the EORTC QLQ-C30 and QLQ-BN20 is limited in Pakistan, where the national language is Urdu, and the majority of patients are of low socioeconomic backgrounds. Since no Urdu translations of the EORTC QLQ-C30 and QLQ-BN20 exist, we aimed to translate and validate these tools to enable their applicability in Pakistan. The Urdu versions of the EORTC QLQ-C30 and QLQ-BN20 demonstrated good validity amongst patients with PBTs. Thus, our study confirms the EORTC QLQ-C30 and QLQ-BN20 as valuable clinical tools for the measurement of QoL in primary brain tumors patients within the linguistic, cultural and socioeconomic context of Pakistan.
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Affiliation(s)
- Nida Zahid
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan.
| | - Russell Seth Martins
- Medical College, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Wajeeha Zahid
- Department of Community Health Sciences, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Wardah Khalid
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Shireen Shehzad Bhamani
- School of Nursing and Midwifery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Nargis Asad
- Department of Psychiatry, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Khabir Ahmad
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Adnan Abdul Jabbar
- Department of Oncology, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | | | - Rashid Jooma Khan
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Gohar Javed
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Ehsan Bari
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Syed Ather Enam
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
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Bari E, Sistani A, Morrell JJ, Pizzi A, Akbari MR, Ribera J. Current Strategies for the Production of Sustainable Biopolymer Composites. Polymers (Basel) 2021; 13:2878. [PMID: 34502919 PMCID: PMC8434032 DOI: 10.3390/polym13172878] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 11/16/2022] Open
Abstract
Rapid global population growth has led to an exponential increase in the use of disposable materials with a short life span that accumulate in landfills. The use of non-biodegradable materials causes severe damage to the environment worldwide. Polymers derived from agricultural residues, wood, or other fiber crops are fully biodegradable, creating the potential to be part of a sustainable circular economy. Ideally, natural fibers, such as the extremely strong fibers from hemp, can be combined with matrix materials such as the core or hurd from hemp or kenaf to produce a completely renewable biomaterial. However, these materials cannot always meet all of the performance attributes required, necessitating the creation of blends of petroleum-based and renewable material-based composites. This article reviews composites made from natural and biodegradable polymers, as well as the challenges encountered in their production and use.
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Affiliation(s)
- Ehsan Bari
- Department of Wood Sciences and Engineering, Technical Faculty of No. 2, Mazandaran Branch, Technical and Vocational University (TVU), Sari 4816831168, Iran;
| | - Asghar Sistani
- Department of Wood Sciences and Engineering, Technical Faculty of No. 2, Mazandaran Branch, Technical and Vocational University (TVU), Sari 4816831168, Iran;
| | - Jeffrey J. Morrell
- National Centre for Timber Durability and Design Life, University of the Sunshine Coast, Brisbane, QLD 4102, Australia;
| | - Antonio Pizzi
- LERMAB-ENSTIB, University of Lorraine, 27 rue Philippe Seguin, 88000 Epinal, France;
| | - Mohammad Reza Akbari
- Department of Wood and Paper Sciences, Tarbiat Modares University, Jalal AleAhmad, Nasr, Tehran P.O. Box 14115-111, Iran;
| | - Javier Ribera
- Laboratory for Cellulose & Wood Materials, Empa-Swiss Federal Laboratories for Materials Science and Technology, CH-9014 St. Gallen, Switzerland
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Khan MK, Barakzai MD, Chaudhry MBH, Haq TU, Bari E, Sayani R. Endovascular coil embolization of ruptured and unruptured intracranial aneurysms: review of a 15 year single center experience in Pakistan. J PAK MED ASSOC 2021; 71:656-662. [PMID: 33941954 DOI: 10.47391/jpma.1042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess the outcome of endovascular treatment of intracranial aneurysm over 15 years. METHODS The retrospective study was conducted at the at Radiology Department of Aga Khan University Hospital, Karachi, and comprised medical records from April 2003 to April 2018 of patients who received endovascular treatment for intracranial aneurysm. Multiple variables reviewed included demographics, clinical presentation, aneurysm morphology, technique used, technique outcome and clinical outcome. Data was analysed using SPSS 22. RESULTS Of the 242 patients, 111(45.8%) were males and 131(54.1%) were female. The overall mean age was 46.3+/-13.543 years (range: 9-78years). Aneurysm size was <5mm in 95(40.4%) patients, 5-10mm in 98(41.7%) and >10mm in 42(17.9%) patients. Aneurysms were located in the anterior communicating artery in 93(38.4%) patients, internal carotid artery 48(19.8%) patients and posterior communicating artery 26(10.7%) patients. Patients with higher initial Hess and Hunt grade were more likely to have higher modified Rankin scale score after treatment (p=0.001). Overall, 222(91.7%) patients were treated successfully. Complications were noted in 37(15.2%) patients and 10(4.0%) patients died. CONCLUSIONS No correlation was found between Hess and Hunt grades and aneurysm severity based on aneurysm size, neck and ruptured/unruptured cases.
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Affiliation(s)
- Misha Khalid Khan
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Tanveer Ul Haq
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Ehsan Bari
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Raza Sayani
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
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Sajid MI, Malik N, Balouch SS, Bari E. Aspergillus flavus as a surprise space occupying lesion in an immunocompetent pediatric patient. Egypt J Neurosurg 2021. [DOI: 10.1186/s41984-021-00098-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Fungal infections of the CNS are almost always a clinical surprise. Aspergillus species although ubiquitous are more frequently observed in immuno-compromised individuals upon inhalation of conidia. Most of the fungal infections which happen in humans are opportunistic, mostly due to immunocompromised host.
Case description
We present the case of a 14-year-old boy who presented to the Emergency Department of Aga Khan University Hospital, Karachi, with complaints of right-sided weakness of the body. This was a rapid-onset condition which was associated with gait disturbances and multiple episodes of vomiting. MRI head showed encapsulated Space Occupying Lesion with puss in the left frontal lobe with surrounding edema. The patient was planned for a craniotomy to remove an intracerebral abscess. Histopathology report revealed the presence of chronic granulomatous inflammation with necrosis and numerous septate hyphae. A fungus culture was run which confirmed the presence of heavy colonies of Aspergillus flavus.
Conclusion
Fungal infections of the central nervous system are almost always a clinical surprise, have a subtle presentation and mistaken often as meningitis, brain abscess, or tumor. Any suspected lesion once removed should be sent for biopsy to rule out the presence of any fungal infection.
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Zahid N, Martins RS, Zahid W, Khalid W, Azam I, Bhamani SS, Ahmad K, Jabbar A, Shamim MS, Khan RJ, Javed G, Bari E, Asad N, Enam SA. Resilience and its associated factors in brain tumor patients in Karachi, Pakistan: An analytical cross-sectional study. Psychooncology 2021; 30:882-891. [PMID: 33609048 DOI: 10.1002/pon.5661] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/06/2021] [Accepted: 02/16/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This study assessed resilience in brain tumor patients at a tertiary care hospital in Pakistan (a lower middle-income country; LMIC) and explored its relationship with patients' sociodemographic factors, clinical characteristics, social support, and mental health. METHODS A cross-sectional survey was conducted amongst adult (≥18 years) patients with brain tumor at the Aga Khan University Hospital, Pakistan. Resilience was assessed by Wagnild and Young's Resilience Scale, and patients' psychosocial characteristics by the Hospital Anxiety and Depression Scale and the Enriched Social Support Instrument. RESULTS A total of 250 patients were included (mean age: 44 years; 68% males), with majority (97.6%) having high social support and only 4.4% and 2% having symptomatic depression and anxiety, respectively. On multivariable linear regression adjusted for covariates, lower resilience was associated with not being involved in household decision-making (Adjusted Beta Coefficient: 4.58 [95% Confidence Interval:-7.59, -1.56]), not currently working (-2.80 [-4.61, -0.99]), undergoing multiple neurosurgical interventions such as tumor biopsies or resections (-8.64 [-13.11, -4.16]), receiving chemotherapy (-5.17 [-9.51, -0.83]) or combination adjuvant therapy (-2.91 [-5.14, -0.67]), low social support (-7.77 [-13.73, 1.81]), mild depression (-13.00 [-17.00,-8.99]) or symptomatic depression (-19.79 [-24.69, -14.89]), and mild anxiety (-4.24 [-7.98, -0.50]). CONCLUSION Our study highlights the function of familial/household role and working status in mediating resilience, and demonstrates the well-known protective effect of resilience for mental health in brain tumor patients in Pakistan, a South-Asian LMIC. These findings are of clinical relevance with regards to the development of culture-specific evidence-based resilience-building interventions that may help patients with brain tumors to cope with the psychological distress of cancer.
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Affiliation(s)
- Nida Zahid
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Russell Seth Martins
- Medical College, Aga Khan University Hospital, Karachi, Pakistan.,Research and Development Wing, Society for Promoting Innovation in Education, Aga Khan University Hospital, Karachi, Pakistan
| | - Wajeeha Zahid
- Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Wardah Khalid
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Khabir Ahmad
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - AdnanAbdul Jabbar
- Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Rashid Jooma Khan
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Gohar Javed
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Ehsan Bari
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Nargis Asad
- Department of Psychiatry, Aga Khan University Hospital, Karachi, Pakistan
| | - Syed Ather Enam
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Bari E, Daniel G, Yilgor N, Kim JS, Tajick-Ghanbary MA, Singh AP, Ribera J. Comparison of the Decay Behavior of Two White-Rot Fungi in Relation to Wood Type and Exposure Conditions. Microorganisms 2020; 8:microorganisms8121931. [PMID: 33291813 PMCID: PMC7762025 DOI: 10.3390/microorganisms8121931] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 11/29/2022] Open
Abstract
Fungal wood decay strategies are influenced by several factors, such as wood species, moisture content, and temperature. This study aims to evaluate wood degradation characteristics of spruce, beech, and oak after exposure to the white-rot fungi Pleurotusostreatus and Trametesversicolor. Both fungi caused high mass losses in beech wood, while spruce and oak wood were more resistant to decay. The moisture content values of the decayed wood correlated with the mass losses for all three wood species and incubation periods. Combined microscopic and chemical studies indicated that the two fungi differed in their decay behavior. While T. versicolor produced a decay pattern (cell wall erosion) typical of white-rot fungi in all wood species, P. ostreatus caused cell wall erosion in spruce and beech and soft-rot type I (cavity formation) decay in oak wood. These observations suggest that P. ostreatus may have the capacity to produce a wider range of enzymes/radicals triggered by the chemical composition of wood cell walls and/or local compositional variability within the cell wall.
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Affiliation(s)
- Ehsan Bari
- Department of Wood Sciences and Engineering, Section of Wood Microbiology and Genetic, Technical Faculty of No. 1, Mazandaran Branch, Technical and Vocational University (TVU), Sari 4816831168, Iran
- Correspondence: (E.B.); (J.R.); Tel.: +98-9354367572 (E.B.); +41-587657607 (J.R.)
| | - Geoffrey Daniel
- Department of Biomaterial and Technology/Wood Science, Swedish University of Agricultural Sciences, P.O. Box 7008, 75007 Uppsala, Sweden;
| | - Nural Yilgor
- Department of Forest Products Chemistry and Technology Division, Forest Industry Engineering, Forestry Faculty, Istanbul University Cerrahpaşa, 34473 Istanbul, Turkey;
| | - Jong Sik Kim
- Department of Wood Science and Engineering, Chonnam National University, Gwangju 61186, Korea;
| | - Mohammad Ali Tajick-Ghanbary
- Department of Mycology and Plant Pathology, College of Agronomic Sciences, Sari Agricultural Sciences and Natural Resources University, Sari 4818166996, Iran;
| | | | - Javier Ribera
- Laboratory for Cellulose & Wood Materials, Empa-Swiss Federal Laboratories for Materials Science and Technology, CH-9014 St. Gallen, Switzerland
- Correspondence: (E.B.); (J.R.); Tel.: +98-9354367572 (E.B.); +41-587657607 (J.R.)
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Ahmed U, Shafiq F, Kumar D, Ahsan K, Ghaffar WB, Bari E. Anaesthetic management of patients undergoing deep brain simulation: A retrospective review of 8 cases from a tertiary care center of Pakistan. Pak J Med Sci 2020; 36:1737-1741. [PMID: 33235607 PMCID: PMC7674880 DOI: 10.12669/pjms.36.7.2870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives To review anaesthesia related outcome, perioperative complications and overall length of stay (LOS) in hospital for patients who had deep brain stimulation (DBS). Methods The study was retrospective review of patients medical records diagnosed with Parkinson disease (PD) and underwent DBS at The Aga Khan University Hospital, Karachi from 2017-2019. Data was reviewed from file notes and patient chart and recorded on predesigned Performa. Frequency and percentages were used to present the data. Results All patients were anaesthetized using Sleep-Awake-Sleep technique (SAS). Dexmedetomidine was mainly used for conscious sedation. Bispectral index monitor (BIS) was used to monitor the depth of sedation, and kept between 70-85 during sedative phase. All patients had successful intraoperative neurological monitoring, stimulation, and placement of electrodes. Total duration of anesthesia varied significantly in between the patients. Maximum duration was 600 minutes. None of our patient had any intraoperative event related to anaesthetic management. Overall five patients had some adverse events during ward stay. Mean LOS in hospital was four days. Conclusion Anaesthetic management of DBS is well-tolerated. It requires dedicated team. The SAS technique is excellent for intraoperative neurophysiological monitoring. Careful selection of sedative agents and monitoring depth of anaesthesia using BIS would be beneficial in terms of improving related outcomes.
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Affiliation(s)
- Usama Ahmed
- Usama Ahmed, Resident, Department of Anesthesiology, The Aga Khan University, Karachi, Pakistan
| | - Faraz Shafiq
- Faraz Shafiq, Assistant Professor, Department of Anesthesiology, The Aga Khan University, Karachi, Pakistan
| | - Dileep Kumar
- Dileep Kumar, Assistant Professor, Department of Anesthesiology, The Aga Khan University, Karachi, Pakistan
| | - Khalid Ahsan
- Khalid Ahsan, Assistant Professor, Department of Anesthesiology, The Aga Khan University, Karachi, Pakistan
| | - Waleed Bin Ghaffar
- Waleed Bin Ghaffar, Resident, Department of Anesthesiology, The Aga Khan University, Karachi, Pakistan
| | - Ehsan Bari
- Ehsan Bari, Associate Professor, Department of Surgery, The Aga Khan University, Karachi, Pakistan
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Abstract
Objective: The aim of this study was to analyze the clinical profiles and outcomes of pediatric brainstem gliomas treated at our institute. Methodology: We reviewed the files of 18 pediatric age group patients diagnosed with brainstem glioma at our institution. The following variables were recorded: age, sex, duration of symptoms, date of diagnosis, main clinical symptoms, Karnofsky performance status score, magnetic resonance imaging findings, histopathology findings, details of the treatment given, disease progression, and date of mortality/last follow-up. This data were then transferred to SPSS version 23 which was used for further analysis. Results: The mean age of our cohort was 8.6 years (range 3–15). There were 11 (61.1%) males and 7 (38.9%) females. There were 16 (88.9%) patients with diffuse intrinsic pontine gliomas (DIPGs), 1 (5.6%) patients with exophytic medullary gliomas, and 1 (5.6%) patient with midbrain/tectal glioma. Mean overall survival (OS) was 9.7 months. Mean progression-free survival (PFS) was 6.3 months. All patients with DIPG eventually passed away from their disease. Patients with DIPG who received radiotherapy had a longer OS and PFS than those who did not (9.8 and 6 months vs. 3.4 and 2.4 months). Diagnostic latency >1 month was found to have a statistically significant longer progression-free interval. Conclusion: DIPGs in the pediatric population have a poor prognosis. Radiotherapy serves to increase survival time but is not curative.
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Affiliation(s)
- Altaf Ali Laghari
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Mirza Zain Baig
- Rudy L. Ruggles Biomedical Research Institute, Danbury, Connecticut, USA
| | - Ehsan Bari
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Aneela Darbar
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Naureen Mushtaq
- Department of Pediatrics, Aga Khan University Hospital, Karachi, Pakistan
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Tichi AH, Bari E, Nicholas DD. How nano-wollastonite can change the fundamental properties of a wood fibre and rice straw composites? IET Nanobiotechnol 2019; 12:1027-1030. [PMID: 30964008 DOI: 10.1049/iet-nbt.2018.5163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The potential of using rice straw (RS) in combination with wood fibre in the production of medium density fibreboard was investigated. Nano-wollastonite (NW) was added to some of the panels to determine if it would enhance the physical and mechanical properties. It was found that satisfactory composite boards could be made with the addition of 10% RS to the wood fibre. Furthermore, the mechanical and physical properties of the composite were enhanced when NW was added.
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Affiliation(s)
- Ali Hassanpoor Tichi
- Department of Wood Science and Engineering, Technical Faculty of No. 2, Mazandaran Branch, Technical and Vocational University (TVU), Sari, Iran
| | - Ehsan Bari
- Department of Wood Science and Technology, Faculty of Natural Resources, University of Tehran, Karaj, Iran.
| | - Darrel D Nicholas
- Department of Sustainable Bioproducts, Mississippi State University, Mississippi State, MS 39762-9820, USA
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15
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Aghajani H, Bari E, Bahmani M, Humar M, Ghanbary MAT, Nicholas DD, Zahedian E. Influence of relative humidity and temperature on cultivation of Pleurotus species. Maderas, Cienc tecnol 2018:0-0. [DOI: 10.4067/s0718-221x2018005004501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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16
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Karim M, Daryaei MG, Torkaman J, Oladi R, Ghanbary MAT, Bari E, Yilgor N. Natural decomposition of hornbeam wood decayed by the white rot fungus Trametes versicolor. AN ACAD BRAS CIENC 2017; 89:2647-2655. [PMID: 29236849 DOI: 10.1590/0001-3765201720160714] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/28/2016] [Indexed: 11/22/2022] Open
Abstract
The impacts of white-rot fungi on altering wood chemistry have been studied mostly in vitro. However, in vivo approaches may enable better assessment of the nature of interactions between saprotrophic fungi and host tree in nature. Hence, decayed and sound wood samples were collected from a naturally infected tree (Carpinus betulus L.). Fruiting bodies of the white rot fungus Trametes versicolor grown on the same tree were identified using rDNA ITS sequencing. Chemical compositions (cellulose and lignin) of both sound and infected wood were studied. FT-IR spectroscopy was used to collect spectra of decayed and un-decayed wood samples. The results of chemical compositions indicated that T. versicolor reduced cellulose and lignin in similar quantities. Fungal activities in decayed wood causes serious decline in pH content. The amount of alcohol-benzene soluble extractives was severely decreased, while a remarkable increase was found in 1% sodium hydroxide soluble and hot water extractive contents in the decayed wood samples, respectively. FT-IR analyses demonstrated that T. versicolor causes simultaneous white rot in the hornbeam tree in vivo which is in line with in vitro experiments.
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Affiliation(s)
- Maryam Karim
- Department of Forestry, Faculty of Natural Resources, University of Guilan, 43619-96196 Guilan, Iran
| | - Mehrdad Ghodskhah Daryaei
- Department of Forestry, Faculty of Natural Resources, University of Guilan, 43619-96196 Guilan, Iran
| | - Javad Torkaman
- Department of Forestry, Faculty of Natural Resources, University of Guilan, 43619-96196 Guilan, Iran
| | - Reza Oladi
- Department of Wood Science and Technology, Faculty of Natural Resources, University of Tehran, 31585-4314 Karaj, Iran
| | - Mohammad Ali Tajick Ghanbary
- Department of Mycology and Plant Pathology College of Agronomic Sciences, Agriculture and Natural Resources University, 48181-68984 Sari, Iran
| | - Ehsan Bari
- Department of Wood Science and Engineering, Technical Faculty of Sari No 2, 48157-33944 Sari, Iran.,Department of Wood and Paper Science, Sari Agriculture Science and Natural Resources University, Sari, Iran
| | - Nural Yilgor
- Department of Forest Products Chemistry and Technology Division, Forest Industry Engineering, Forestry Faculty, Istanbul University, 34473 Istanbul, Turkey
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Michelato P, Cavaliere E, Pagani C, Bari E, Bonucci A. Vacuum Interface Analysis of a Windowless Spallation Target for Accelerator-Driven Systems. NUCL SCI ENG 2017. [DOI: 10.13182/nse07-a2715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- P. Michelato
- INFN-LASA, Via Fratelli Cervi 201, 20090 Segrate, Milano, Italy
| | - E. Cavaliere
- INFN-LASA, Via Fratelli Cervi 201, 20090 Segrate, Milano, Italy
| | - C. Pagani
- INFN-LASA, Via Fratelli Cervi 201, 20090 Segrate, Milano, Italy
| | - E. Bari
- ENEA, Via Martiri Monte Sole 4, 40129 Bologna, Italy
| | - A. Bonucci
- SAES Getters S.p.A., Viale Italia 77, 20020 Lainate, Milan, Italy
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Akhtar S, Sattar S, Bari E, Kayani N, Moeen S. Secretory paraspinal paraganglioma of thoracolumar spine: Case report and review of literature. Surg Neurol Int 2016; 7:S889-S892. [PMID: 27999715 PMCID: PMC5154198 DOI: 10.4103/2152-7806.194510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 09/28/2016] [Indexed: 11/10/2022] Open
Abstract
Background: Pheochromocytomas are catecholamine secreting tumors of the adrenal medulla chromaffin cells, however, when present extra-adrenally they are called paragangliomas. Paragangliomas rarely produce catecholamine in excess, which is evident by clinical symptoms, urine, and blood biochemistry. Total resection of these tumors can lead to complete clinical and biochemical resolution. This case report presents the clinical features, radiological findings, and neurological outcome in a middle-aged female with a secretory paraganglioma. Case Description: We present the case of a 34-year-old female who presented with a 2-year history of dizziness, flushing, headache, palpitations, and hypertension. Her blood workup showed raised urinary catecholamine levels. Magnetic resonance imaging (MRI) and iodine-123-meta-iodobenzylguanidine (MIBG) scans demonstrated a retroperitoneal mass located anterolateral to T11-T12 vertebral bodies reaching up to T12-L1 intervertebral disc. The patient was otherwise neurologically intact. She underwent resection of the tumor after alpha-adrenergic and beta-adrenergic blockade. En bloc resection was achieved without neurological complications. Postoperatively, the patient was initially hypotensive and subsequently became normotensive, and on follow-up, the patient had resolution of her symptoms and was stable. Conclusion: Secretory paraganglioma of the dorsal spine are rare and difficult to excise, needs preoperative preparation with pharmacological intervention, good operative technique, and postoperative care.
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Affiliation(s)
- Saad Akhtar
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Sidra Sattar
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Ehsan Bari
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Naila Kayani
- Department of Histopathology, Aga Khan University Hospital, Karachi, Pakistan
| | - Sarosh Moeen
- Department of Histopathology, Aga Khan University Hospital, Karachi, Pakistan
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Waqas M, Waheed S, Mangrio SA, Rashid S, Qadeer M, Bari E. Confusing presentation of chaetomium brain abscess. Br J Neurosurg 2014; 28:805-7. [DOI: 10.3109/02688697.2014.931346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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20
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Hashmi FA, Bari E, Khan SA. MS-08 * GLIOSARCOMA: FEATURES AND OUTCOMES IN A TERTIARY CARE HOSPITAL IN PAKISTAN. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou260.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Bashir MU, Tahir MZ, Bari E, Mumtaz S. Craniocerebral injuries in war against terrorism --- a contemporary series from Pakistan. Chin J Traumatol 2014; 16:149-57. [PMID: 23735549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Terrorism-related bomb attacks on civilian population have increased dramatically over the last decade. Craniocerebral injuries secondary to improvised explosive devices have not been widely reported in the context of unarmored civilians. This series intends to report the spectrum of these injuries secondary to suicidal and implanted bombs as encountered at the Aga Khan University Hospital, Pakistan (AKUH). Further, a few pertinent management guidelines have also been discussed. METHODS The hospital database and clinical coding during a 5-year period were examined for head injuries secondary to terrorism-associated blasts. In addition to patient demographics, data analysis for our series included initial Glasgow Coma Scale, presenting neurological complaints, associated non-neurological injuries, management (conservative or operative) to associated complications, and discharge neurological status. RESULTS A total of 16 patients were included in this series. Among them 9 were victims of suicidal blasts while 7 were exposed to implanted devices. The patients presented with diverse patterns of injury secondary to a variety of shrapnel. A follow-up record was available for 12 of the 16 patients (mean follow-up: 7.8 months), with most patients having no active complaints. CONCLUSION The results of this series show that civilian victims of suicidal and improvised bombings present with a wide range of neurological symptoms and injury patterns, which often differ from the neurological injuries incurred by military personnel in similar situations, and thereby often require individualized care.
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Abstract
AIM Traumatic brain injury is one of the leading causes of mortality and morbidity worldwide. The role of prophylactic anti-epileptic drugs has been established. Phenytoin used traditionally for this purpose carries a burden of adverse reactions and cumbersome need of monitoring and maintaining levels in serum. Therefore, as the evidence on levetiracetam, emerged part of neurosurgery section started using this drug for seizure prophylaxis after early loading with phenytoin. So we decided to assess the use of enteral levetiracetam in prophylaxis of early post-traumatic seizures. MATERIAL AND METHODS This was a retrospective cohort study done at the department of neurosurgery of Aga Khan University in Karachi from July 2010 to March 2011. Charts of patients who were started on levetiracetam enterally were reviewed and followed for occurrence of clinical seizures within one week of trauma. The results were then compared to the group of patients treated prophylactically with phenytoin alone over the same time period. RESULTS The study included 50 patients in each group. Both groups were comparable in terms of demographics and baseline characteristics. However, 2 patients in each group suffered from clinical seizures with a non-significant p value. CONCLUSION Enteral levetiracetam after initial phenytoin loading is a viable option in the armamentarium of anti-epileptic drugs. Further larger prospective studies are required to improve the evidence.
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Affiliation(s)
- Gohar Javed
- The abstract of this study is presented as a poster presentation at International Brain Injury Association's NINTH World Congress on Brain Injury Edİnburgh, Scotland
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23
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Ilyas A, Fasih N, Jabeen K, Bari E, Mahmood SF. Photo quiz: young girl with cough, headache, and visual loss. J Clin Microbiol 2013; 51:3167, 3473. [PMID: 24058140 PMCID: PMC3811662 DOI: 10.1128/jcm.01604-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Aisha Ilyas
- Section of Infectious Diseases, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Naima Fasih
- Section of Microbiology, Department of Pathology, Aga Khan University Hospital, Karachi, Pakistan
| | - Kausar Jabeen
- Section of Microbiology, Department of Pathology, Aga Khan University Hospital, Karachi, Pakistan
| | - Ehsan Bari
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Syed Faisal Mahmood
- Section of Infectious Diseases, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Tahir MZ, Khan MB, Bashir MU, Akhtar S, Bari E. Cerebrospinal fluid rhinorrhea: An institutional perspective from Pakistan. Surg Neurol Int 2011; 2:174. [PMID: 22276229 PMCID: PMC3262998 DOI: 10.4103/2152-7806.90689] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 11/14/2011] [Indexed: 12/02/2022] Open
Abstract
Background: The management of cerebrospinal fluid (CSF) rhinorrhea has evolved over the last two decades. We present here a review of our 11-year data on CSF rhinorrhea and its management at a tertiary care hospital in a developing country, with particular reference to the diagnosis, surgical management and outcome of the disease. Methods: The medical charts of all patients with a diagnosis of CSF rhinorrhea over an 11-year period were reviewed. The etiology of CSF rhinorrhea was classified into three categories: spontaneous, iatrogenic and traumatic. All the patients were divided into three categories based on the type of management as conservative, intracranial and transnasal endoscopic groups. Results: A total of 43 patients fulfilled our inclusion criteria and were included in the final analysis. Eleven of the 43 patients were managed conservatively, while 22 underwent intracranial repairs; 10 patients had transnasal endoscopic repairs. The primary success rate for the transnasal approach was 70% compared to 86% for the intracranial repair. Blood loss, special care unit (SCU) stay and total cost were found to be significantly less in the transnasal endoscopic group. Computed tomography (CT) cisternography was found to have the highest sensitivity and specificity. Further, no postoperative complications were found in the transnasal endoscopic group, while five patients from the intracranial group developed various complications. Conclusions: We conclude that the transnasal endoscopic approach has comparable success rates with the intracranial approach and significantly lower morbidity.
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Hussain M, Bari E. Intracerebral migration of stray bullet leading to sudden and fatal worsening. J Coll Physicians Surg Pak 2011; 21:182-3. [PMID: 21419030 DOI: 03.2011/jcpsp.182183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 01/17/2011] [Indexed: 11/17/2022]
Abstract
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 not survive.
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Affiliation(s)
- Manzar Hussain
- Department of Neurosurgery, The Aga Khan University Hospital, Karachi.
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Abstract
INTRODUCTION Gunshot wounds (GSW) to the head are the most lethal form of trauma; unfortunately, the frequency of children being involved in such form of trauma is increasing at an alarming rate worldwide. We present our experience with four children from 2 to 3 years of age with craniocerebral GSW admitted to the neurosurgery service at a tertiary care hospital. METHODS For this study, four children, 2 to 3 years old, injured solely from bullet injuries to the head were selected. Their history, arrival Glasgow Coma Scale (GCS), clinical presentation at the time of arrival in ER, radiological findings, management, and follow-up reviewed. RESULTS Out of four children, only one did not survive. The bullet entrance wound was in the parietal region in robbery-related incidences, and, in three cases, the injury was bihemispheric. The time taken to reach the emergency department was less than 2 h for all patients except one. Of four patients, three presented with GCS between 3 and 5 while 1 presented with GCS well above ten. CONCLUSION Our results show that even in children presenting with low GCS<5, an early act of aggressive surgical intervention can prove to be a life-saving measure.
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Affiliation(s)
- Furqan B Irfan
- Department of Neurosurgery, Aga Khan University, Karachi, 74800, Sindh, Pakistan.
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