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Zahid N, Martins RS, Dawood ZS, Zahid W, Azam I, Ikram M, Hassan A, Bhamani SS, Asad N, Jabbar AA, Akhtar S, Siddiqui MI, Awan MS, Ahmad K. Clinical and psychosocial factors associated with quality of life in patients with head and neck cancer: an analytical cross-sectional study from a lower-middle-income country. BMC Psychol 2023; 11:265. [PMID: 37670380 PMCID: PMC10478451 DOI: 10.1186/s40359-023-01264-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 07/26/2023] [Indexed: 09/07/2023] Open
Abstract
INTRODUCTION The disease course of head and neck (H&N) cancer can severely impair patients' quality of life (QoL). In Pakistan, a South Asian lower-middle-income country (LMIC), psychosocial factors may impact QoL. We aimed to assess QoL and associated factors amongst patients with H&N cancer in Pakistan. METHODS An analytical cross-sectional study was conducted amongst adult (≥ 18 years) patients with H&N cancer who were ≥ 4 weeks post-initiation of treatment. The survey assessed QoL (European Organization for Research and Treatment of Cancer Quality of Life Questionnaires), anxiety and depression (Hospital Anxiety and Depression Scale), and social support (Enriched Social Support Instrument). Multivariable linear regression was performed for analysis. RESULTS A total of 250 patients (mean age: 51.6 years) were included. The majority of patients were married (87%) and living with multigenerational/extended family households (53%). On multivariable linear regression, ongoing cancer treatment (beta coefficient: -13.93), having a tracheostomy (-10.02), and receiving adjuvant chemoradiotherapy (-8.17) were significantly associated with poorer global QoL. Additionally, poorer QoL was associated with depression (-24.37) and anxiety (-13.34). However, having more household family members was associated with better global QoL (0.34). CONCLUSION The QoL of patients with H&N cancer in Pakistan is affected by both the nature of cancer treatment as well as sociocultural factors such the number of household family members. Given that poorer QoL is associated with worse mental health outcomes, there is a need to develop and implement psychosocial interventions to improve the QoL of patients with H&N cancer in Pakistan, particularly during active treatment.
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Affiliation(s)
- Nida Zahid
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Russell Seth Martins
- Division of Thoracic Surgery, Department of Surgery, JFK University Medical Center, Hackensack Meridian Health, Edison, NJ, 08820, United States of America.
| | | | - 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
| | - Mubasher Ikram
- Department of Psychiatry, Aga Khan University Hospital, Karachi, Pakistan
| | - Aneesa Hassan
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Nargis Asad
- Department of Psychiatry, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Shabbir Akhtar
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Khabir Ahmad
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Zahid N, Martins RS, Zahid W, Azam I, Ikram M, Hassan A, Bhamani SS, Jabbar AA, Asad N, Akhtar S, Siddiqui MI, Awan MS, Ahmad K. Psychometric properties of the Urdu version of the EORTC QLQ-H&N35 (European organization for research and treatment of cancer head and neck module) quality of life tool. BMC Psychol 2022; 10:194. [PMID: 35934706 PMCID: PMC9358845 DOI: 10.1186/s40359-022-00900-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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background We translated and validated the Urdu version of the European Organization for Research and Treatment of Cancer Quality of Life (QoL) Questionnaire’s Head and Neck (H&N) Cancer Module (EORTC QLQ-H&N35) and assessed its convergent and discriminant validity by examining correlations of QoL with depression, anxiety, and resilience. Methods We translated the EORTC QLQ-H&N35 according to EORTC instructions. Patients at a tertiary care hospital in Pakistan completed a survey consisting of Urdu versions of EORTC QLQ-C30 (core QoL tool), QLQ-H&N35, Hospital Anxiety and Depression Scale, and Wagnild and Young Resilience Scale (RS-14). Content validity, convergent validity, discriminant validity, and reliability (using Cronbach’s alpha) of the EORTC QLQ-H&N35 were assessed. Results Our sample comprised 250 patients with H&N cancer, most commonly oral (82%). The Urdu translations were comprehensible for all patients. The Cronbach alpha for QLQ-H&N35 multi-item domains ranged from 0.75 to 0.98 (acceptable to excellent), barring “Senses Problems”, which was less than the generally acceptable level (0.50). The patient-reported content validity index (CVI) scores for relevance and clarity of the Urdu version of the QLQ-H&N35 were 0.93 and 0.92, respectively (both excellent). Our results revealed weak bidirectional correlations of the QLQ-H&N35 with resilience, depression, and anxiety, showing good discriminant validity. A weak-to-moderate but significant negative correlation (r: − 0.185 to − 0.613; p < 0.01) was seen between the QLQ-H&N35 and the global QoL measure of the QLQ-30. Conclusion Our Urdu translation of the EORTC QLQ-H&N35 demonstrated validity comparable to previous studies, with good discriminant construct validity when measured against resilience, depression, and anxiety. An issue of concern is the poor internal consistency of the “Senses Problems” domain. Nevertheless, the Urdu translation produced in this study serves as a valid and reliable measure to measure QoL in H&N cancer in clinical or research settings in Pakistan. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-022-00900-x.
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Zahid N, Zahid W, Khalid W, Azam I, Ikram M, Hassan A, Iftikar H, Bhamani SS, Jabbar AA, Akhtar S, Siddiqui MI, Awan MS, Asad N, Ahmad K. Resilience and its associated factors in head and neck cancer patients in Pakistan: an analytical cross-sectional study. BMC Cancer 2021; 21:888. [PMID: 34344346 PMCID: PMC8330007 DOI: 10.1186/s12885-021-08624-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/22/2020] [Accepted: 07/05/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The study aimed to assess resilience and its associated factors in head and neck cancer patients, post-treatment in a low middle income country (LMIC) such as Pakistan. METHODS An analytical cross-sectional study was conducted from November 2019 to May 2020 among head and neck cancer patients aged at least 18 years at the largest private tertiary care hospital, in Karachi, Pakistan. Information regarding their resilience scores was collected through Wagnild and Young's Resilience scale that comprises of 14 items (RS-14). Moreover, depression and anxiety were also assessed via Hospital Anxiety and Depression Scale (HADS) and social support was assessed by Enriched Social Support Instrument (ESSI). RESULTS The data was analyzed by linear regression modeling. Unadjusted and adjusted beta coefficients with 95% CI were reported. A total of 250 head and neck cancer patients were recruited, 79% of them were males. Mean age of the patients was 51.59 years with 93% having high social support and only 8% having severe depression and 3% having severe anxiety. After adjusting for the covariates in multivariable analysis resilience was associated with severe depression (- 17[- 20.98,-12.93]) or borderline depression (- 4[- 8.41,-0.39]), severe anxiety (- 11 [- 17.88,-4.18]), low social support (- 6[- 9.62,-1.71]), having family members of > 6 in the household (- 2[- 4.31,-0.29), smokeless tobacco users post- treatment (10[5.79, 14.45]), and those who underwent tracheotomy (- 4[- 7.67,-0.21]). There was a significant interaction between education and role in the family (decision maker). CONCLUSION In Pakistan, a South Asian LMIC, collectivist culture prevails, family ties are greatly promoted thus resilience and social support is highly prevalent in head and neck cancer patients resulting in lower prevalence of depression and anxiety. Our study highlights that higher resilience is prevalent among small families less than six members, as the welfare of the individual is prioritized over multiple needs of the family. Formal Education and role in household/decision making power are effect modifiers in our study, demonstrating its protective effect on the mental health of head and neck cancer patients. High resilience scores were reported among current smokeless tobacco users as compared to quitters post treatment. Resilience-building interventions should be formulated to aid head and neck cancer patients to cope with the disease and its sequel.
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Affiliation(s)
- Nida Zahid
- Department of Surgery, 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
| | - Mubasher Ikram
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Aneesa Hassan
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Haissan Iftikar
- Department of Surgery, 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
| | - Adnan Abdul Jabbar
- Department of Oncology, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Shabbir Akhtar
- Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | | | - Mohammad Sohail Awan
- Department of Surgery, 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
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Iftikhar H, Rozi S, Zahid N, Awan MS, Nathani KR. Lymph node ratio as a prognostic marker of oral tongue squamous cell carcinoma: a cohort study. Ann R Coll Surg Engl 2020; 102:726-732. [PMID: 32808800 DOI: 10.1308/rcsann.2020.0173] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Lymph node metastasis is a poor prognostic indicator and is well established in tongue squamous cell carcinoma. Based on the current staging system, accurate risk stratification is difficult. There is thus a need to evaluate an alternate method for predicting recurrence and survival. The objective of the study was to evaluate lymph node ratio as a prognostic marker as compared with N-staging for tongue squamous cell carcinoma. MATERIALS AND METHODS We conducted a retrospective cohort study with 56 patients with a lymph node ratio greater than 0.012 (exposed) and 74 patients with a lymph node ratio less than 0.012 (unexposed). Overall five-year survival and disease-free survival were assessed. The Cox proportional hazard model was used to analyse lymph node ratio as a predictor of outcome, together with other covariates. RESULTS A total of 130 patients were included in the study. Patients with lymph node ratio greater than 0.012 had a poor overall five-year (mean survival time 52.1 months vs 38.1 months) and disease-free survival (mean survival time 53.6 months vs 39.2 months). The hazard of death among patients with a lymph node ratio greater than 0.012 was 3.24 times higher than the hazard of death among patients with a lymph node ratio less than 0.012 (95% confidence interval 1.82-5.77). DISCUSSION Lymph node ratio is a superior prognostic marker compared with the currently used American Joint Committee on Cancer N-staging. Our findings also suggest that the margin status (involved) of the primary tumour resection adversely affects prognosis.
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Affiliation(s)
- H Iftikhar
- Aga Khan University Hospital, Karachi, Pakistan
| | - S Rozi
- Aga Khan University Hospital, Karachi, Pakistan
| | - N Zahid
- Aga Khan University Hospital, Karachi, Pakistan
| | - M S Awan
- Aga Khan University Hospital, Karachi, Pakistan
| | - K R Nathani
- Aga Khan University Hospital, Karachi, Pakistan
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Ghaloo SK, Dhanani R, Pasha HA, Awan MS, Memon A. Recurrent Dermatofibrosarcoma Protuberans of the Parotid: A case report and review of literature. J PAK MED ASSOC 2019; 69:113-115. [PMID: 30623924] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In 1924, Darier and Ferrand described Dermatofibrosarcoma Protuberans as a progressive and recurring dermatofibroma. It is a locally aggressive sarcoma originating from dermal and subdermal tissue of the skin. It usually begins as a small plaque that grows over a period and later manifests as multiple small subcutaneous nodules. It is more commonly found in females as compared to males and typically occurs in between 2nd and 5th decades of life. Most frequently involved regions of the body are torso and proximal ends of extremities and very rarely head and neck region is the site of involvement. The mainstay of treatment of this entity is surgery. The rate of recurrence of this disease is very high in about 50% of the cases and it may also express rare distant metastasis. It is a radiosensitive tumour and radiation may play a role in reducing risk of recurrence. We present a case of a 35 years old male with recurrent Dermatofibrosarcoma Protuberans of right parotid gland.
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Rasheed M, Hussain I, Rafiq S, Hayat I, Qayyum A, Ishaq S, Awan MS. Chemical composition and antioxidant activity of quince fruit pulp collected from different locations. International Journal of Food Properties 2018. [DOI: 10.1080/10942912.2018.1514631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Mohsin Rasheed
- Department of Food Science and Technology, The University of Poonch Rawalakot, Azad Kashmir, Pakistan
| | - Imtiaz Hussain
- Department of Food Science and Technology, The University of Poonch Rawalakot, Azad Kashmir, Pakistan
| | - Saima Rafiq
- Department of Food Science and Technology, The University of Poonch Rawalakot, Azad Kashmir, Pakistan
| | - Imran Hayat
- Department of Food Science and Technology, The University of Poonch Rawalakot, Azad Kashmir, Pakistan
| | - Aqsa Qayyum
- Food Science Research Institute, PARC-National Agricultural Research Centre, Islamabad, Pakistan
| | - Saira Ishaq
- Department of Food Science and Technology, The University of Poonch Rawalakot, Azad Kashmir, Pakistan
| | - MS Awan
- Department of Food Science and Technology, The University of Poonch Rawalakot, Azad Kashmir, Pakistan
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Qureshi TA, Awan MS, Hassan NH, Aftab AH, Ali SA. Effects of bomb blast injury on the ears: The Aga Khan University Hospital experience. J PAK MED ASSOC 2017; 67:1313-1317. [PMID: 28924266] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To evaluate the frequency and effects of blast-related otologic injuries. METHODS his retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised charts of patients who were victims of bomb explosions between January 2011 and July 2013. Frequency and percentages were reported using cross tabulation with size of bomb, distance of person from blast and the presence of victim in open or closed space. Association of associated variables were also analysed. RESULTS Of the 100 patients, 81(81%) were men and 19(19%) were women. Besides, 68(68%) patients were aged <30 years. Also, 78(78%) subjects were exposed to < 80kg of explosives and 68(68%) were at a distance of>10m. Furthermore, 61(61%) patients were exposed to explosion in openspace. The prevalence of ear injuries was 21(21%). The odds of experiencing various symptoms of ears was high in those who were exposed to >80 kg of explosives (odds ratio: 3.38; 95% confidence interval, 1.16, 9.91). The odds of hearing loss in those who were within 10m was 8.62 (95% confidence interval: 2.72, 27.28) times than those who were >10 m from the site of explosion. CONCLUSIONS Otologic injuries were frequently associated with large blasts.
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Affiliation(s)
- Talha Ahmed Qureshi
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | | | | | | | - Syed Adnan Ali
- Department of Surgery, Aga Khan University Hospital, Karachi
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Awan MS, Iqbal M. Nasal packing after septoplasty: a randomized comparison of packing versus no packing in 88 patients. Ear Nose Throat J 2008; 87:624-627. [PMID: 19006062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
The once-common practice of packing the nose after septoplasty was based on a desire to prevent postoperative complications such as bleeding, septal hematoma, and adhesion formation. However, it was since found that not only is nasal packing ineffective in this regard, it can actually cause these complications. Although the consensus in the world literature is that packing should be avoided, to the best of our knowledge, no truly randomized study has been undertaken in Southwest Asia upon which to justify this recommendation here. Therefore, we conducted a prospective randomized comparison of the incidence of a variety of postoperative signs and symptoms in 88 patients, 15 years of age and older, who did (n = 44) and did not (n = 44) undergo nasal packing following septoplasty. We found that the patients who underwent packing experienced significantly more postoperative pain, headache, epiphora, dysphagia, and sleep disturbance on the night of surgery. Oral and nasal examinations 7 days postoperatively revealed no significant difference between the two groups in the incidence of bleeding, septal hematoma, adhesion formation, and local infection. Finally, the packing group reported a moderate to high level of pain during removal of the packing. Our findings confirm that nasal packing after septoplasty is not only unnecessary, it is actually a source of patient discomfort and other signs and symptoms.
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Affiliation(s)
- Mohammad Sohail Awan
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan.
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Abstract
The once-common practice of packing the nose after septoplasty was based on a desire to prevent postoperative complications such as bleeding, septal hematoma, and adhesion formation. However, it was since found that not only is nasal packing ineffective in this regard, it can actually cause these complications. Although the consensus in the world literature is that packing should be avoided, to the best of our knowledge, no truly randomized study has been undertaken in Southwest Asia upon which to justify this recommendation here. Therefore, we conducted a prospective randomized comparison of the incidence of a variety of postoperative signs and symptoms in 88 patients, 15 years of age and older, who did (n = 44) and did not (n = 44) undergo nasal packing following septoplasty. We found that the patients who underwent packing experienced significantly more postoperative pain, headache, epiphora, dysphagia, and sleep disturbance on the night of surgery. Oral and nasal examinations 7 days postoperatively revealed no significant difference between the two groups in the incidence of bleeding, septal hematoma, adhesion formation, and local infection. Finally, the packing group reported a moderate to high level of pain during removal of the packing. Our findings confirm that nasal packing after septoplasty is not only unnecessary, it is actually a source of patient discomfort and other signs and symptoms.
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Affiliation(s)
- Mohammad Sohail Awan
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, Aga Khan University Hospital; Karachi, Pakistan
| | - Moghira Iqbal
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, Aga Khan University Hospital; Karachi, Pakistan
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Akhtar S, Awan MS. Role of fine needle aspiration and frozen section in determining the extent of thyroidectomy. Eur Arch Otorhinolaryngol 2007; 264:1075-9. [PMID: 17431657 DOI: 10.1007/s00405-007-0302-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2007] [Accepted: 03/15/2007] [Indexed: 11/28/2022]
Abstract
The routine use of fine needle aspiration (FNA) and frozen section (FS) in the management of a thyroid nodule is controversial and needs to be evaluated on an institution to institution basis. Our aim was to determine the role of FNA and FS in determining the extent of thyroidectomy. We performed a comparative study of FNA and FS examination of all patients presenting with nodular thyroid disease between September 2002 and December 2005. Data were collected on a proforma by reviewing FNA, FS and histopathological reports. Data were analyzed on SPSS 11. Sensitivity, specificity, accuracy, positive predictive value and negative predictive values were calculated. We included 44 patients with preoperative FNA, intraoperative FS examination and final histopathology reports available. We excluded patients with local invasion and distant metastases. Final histopathological report was taken as gold standard. FNA reported 8 benign, 7 papillary carcinoma, 22 follicular neoplasm, 1 medullary and 6 suspicious lesions. On final pathology there were 16 benign and 28 malignant cases. Thus a total of 20 carcinomas were missed by FNA. When routine FS was done, a total of ten patients who had malignancy were missed. Both FNA and FS have high specificity for diagnosis of thyroid cancer but lacked sensitivity at our institution. This is mainly because of high false negative results.
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Affiliation(s)
- Shabbir Akhtar
- Department of Otolaryngology Head and Neck Surgery, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi 74800, Pakistan.
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Awan MS, Iqbal M, Sardar ZI. Iatrogenic insertion of impression mould into middle ear and mastoid and its retrieval after 9 years: a case report. J Med Case Rep 2007; 1:3. [PMID: 17411445 PMCID: PMC1839759 DOI: 10.1186/1752-1947-1-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Accepted: 02/02/2007] [Indexed: 11/23/2022] Open
Abstract
The magnitude of hearing loss in Pakistan is enormous. One in twelve children of Pakistan suffers from some form of hearing impairment. Many of them are unable to afford surgical procedures and resort to the use of cheap hearing aids fitted by untrained individuals or people lacking the required expertise. This predisposes the patients to significant complications during a process that is otherwise considered safe. We report the case of a child, where the process of making the mould for a hearing aid led to the perforation of the tympanic membrane and pouring of mould material into the middle ear, necessitating surgical intervention. During initial surgery it was thought that all mould had been removed from the middle ear but 9 years later this child underwent cochlear implantation at the same center and remaining part of ear mould was discovered from mastoid cavity.
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Affiliation(s)
- Mohammad Sohail Awan
- Section of Otolaryngology Head and Neck Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Moghira Iqbal
- Section of Otolaryngology Head and Neck Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Zakariya Imam Sardar
- Section of Otolaryngology Head and Neck Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Rajoka MI, Khan SH, Jabbar MA, Awan MS, Hashmi AS. Kinetics of batch single cell protein production from rice polishings with Candida utilis in continuously aerated tank reactors. Bioresour Technol 2006; 97:1934-41. [PMID: 16226886 DOI: 10.1016/j.biortech.2005.08.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2004] [Revised: 07/29/2005] [Accepted: 08/15/2005] [Indexed: 05/04/2023]
Abstract
Single cell protein was produced from the defatted rice polishings by fermentation with Candida utilis in an aerated 14-L fermentor to optimize bioprocess variables. Maximum values of specific growth rate coefficient (mu, h(-1)), cell mass yield (Y(X/S), g/g) and cell mass productivity (g/Lh) were 0.31, 0.65, and 1.24, respectively under optimized conditions of aeration rate (1 v.v(-1) m(-1)), dissolved oxygen (50%), corn steep liquor (5%), temperature (35 degrees C), and substrate concentration (90 g rice polishings/L) in yeast salt medium (pH 6.0). The kinetic parameters for 50-L fermentor under same conditions were 0.33 h(-1), 0.66 g/g, 1.33 g/Lh, 2.25 g/Lh, 1.23 g/Lh, 0.45 g/g substrate and 0.20 g/g cell h for mu, Y(X/S), Q(X), Q(S), Q(CP), Y(TP/S), and q(CP), respectively and were significantly higher than their respective values reported on C. utilis in batch culture studies. This biomass protein contained 23.6%, 32.75%, 11.50%, 12.95%, 10.5%, and 0.275% true protein, crude protein, crude fiber, ash, cellulose and RNA content respectively. This implied that the fermentation process could be up scaled to manufacture animal feed. Gross metabolizable energy content of dried SCP was 29,711 kcal/kg and indicated that the SCP could serve both as energy as well as a protein source. Yeast can replace expensive feed ingredients currently being incorporated in poultry feed and can reduce cost of poultry ration by 0.33 US dollars-0.51 US dollars/100 kg bag and improve the economics of feed production in our country.
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Affiliation(s)
- M Ibrahim Rajoka
- National Institute for Biotechnology and Genetic Engineering, Faisalabad, Pakistan.
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Awan MS, Ahmed I, Ahmad YI, Ahmad D. Speech results with tracheoesophageal voice prosthesis after total laryngectomy. J PAK MED ASSOC 2005; 55:540-2. [PMID: 16438274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To assess the success rate of tracheoesophageal voice prosthesis as the primary mode of voice rehabilitation in patients after total laryngectomy. METHODS Medical record files of 35 patients subjected to total laryngectomy were reviewed for determining success or failure of the voice prosthesis. The indicators used were quality of speech and utility of the device. Subsequent complications that developed were also assessed. In addition other factors taken into consideration were pharyngeal myotomy, use of radiation, and timing of replacement. All thirty five patients (n=35) had prosthesis placed at the time of laryngectomy. RESULTS The success rate at one month and four months follow up was 85.18%. Of note, 3 patients were lost to follow-up, 3 patients died of disease and 2 had recurrence of disease. CONCLUSION Our results confirm the effectiveness, longevity and safety of the tracheoesophageal voice prosthesis for speech rehabilitation following total laryngectomy.
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Affiliation(s)
- Mohammad Sohail Awan
- Department of Otolaryngology-Head and Neck Surgery, The Aga Khan University Hospital, Karachi, Pakistan
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Awan MS, Salahuddin I. Tuberculous otitis media: two case reports and literature review. Ear Nose Throat J 2002; 81:792-4. [PMID: 12472035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
Tuberculous otitis media can be difficult to diagnose because it can easily be confused with other acute or chronic middle ear conditions. Compounding this problem is the fact that physicians are generally unfamiliar with the typical features of tuberculous otitis media. Finally, the final diagnosis can be difficult because it requires special culture and pathologic studies. To increase awareness of this condition, we describe two cases of tuberculous otitis media and we review the literature.
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Affiliation(s)
- Mohammad Sohail Awan
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Aga Khan University Hospital, Stadium Rd., Karachi 74800, Pakistan.
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Abstract
Tuberculous otitis media can be difficult to diagnose because it can easily be confused with other acute or chronic middle ear conditions. Compounding this problem is the fact that physicians are generally unfamiliar with the typical features of tuberculous otitis media. Finally, the final diagnosis can be difficult because it requires special culture and pathologic studies. To increase awareness of this condition, we describe two cases of tuberculous otitis media and we review the literature.
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Affiliation(s)
- Mohammad Sohail Awan
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Iftikhar Salahuddin
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Abstract
Electrosurgery in the presence of volatile anesthetic gases has been associated with operating-room fires. We report a case in which an operating-room fire occurred while an intubated patient underwent electrosurgical tracheostomy. The fire in this case was caused by a combination of an oxygen-rich environment, a polyvinyl chloride tube, and heat generated by an electrosurgical unit. We also discuss factors that increase the risk of this type of fire and the management steps that should be undertaken in the event that such afire occurs, and we briefly review the literature on this subject.
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Affiliation(s)
- Mohammad Sohail Awan
- Department of Surgery, Otolaryngology-Head and Neck Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Imtinan Ahmed
- Department of Surgery, Otolaryngology-Head and Neck Surgery, The Aga Khan University Hospital, Karachi, Pakistan
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18
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Awan MS, Ahmed I. Endotracheal tube fire during tracheostomy: a case report. Ear Nose Throat J 2002; 81:90-2. [PMID: 11868480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Electrosurgery in the presence of volatile anesthetic gases has been associated with operating-room fires. We report a case in which an operating-room fire occurred while an intubated patient underwent electrosurgical tracheostomy. The fire in this case was caused by a combination of an oxygen-rich environment, a polyvinyl chloride tube, and heat generated by an electrosurgical unit. We also discuss factors that increase the risk of this type of fire and the management steps that should be undertaken in the event that such a fire occurs, and we briefly review the literature on this subject.
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Affiliation(s)
- Mohammad Sohail Awan
- Department of Surgery, Otolaryngology-Head and Neck Surgery, Aga Khan University Hospital, Stadium Rd., Karachi-74800, Pakistan.
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19
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Awan MS, Qureshi HU, Sheikh AA, Ali MM. Vestibular schwannomas: clinical presentation, management and outcome. J PAK MED ASSOC 2001; 51:63-7. [PMID: 11321873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To review the demographic trends clinical spectrum, diagnosis, management and out come of patients with vestibular Schwannoma and to identify areas where improvements are needed. METHODS All patients with vestibular schwannoma admitted to the Aga Khan University Hospital over the past 11 years were reviewed retrospectively. RESULTS The age range of majority of 22 patients analyzed, was 41-50 years (23%). Hearing loss was the most common presenting symptom (96%). Other clinical features included cranial nerve palsies (59%) and headache (55%). Fifty percent had signs of raised intracranial pressure. Neuroimaging revealed "Stage IV b" (tumor distorting the brainstem and compressing the 4th ventricle) in 50% cases. Neurosurgical intervention was carried out in 86%; mainly using the retrosigmoid approach. Postoperative complications included facial nerve palsy in 13 (65%) and hydrocephalus in 5 (25%) patients. Hearing determined clinically was preserved in three patients (14%). One patient died during the inpatient stay. CONCLUSION Presentation of these patients is late and the outcome is poor.
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Affiliation(s)
- M S Awan
- Sections of Neurosurgery and Otolaryngology, Department of Surgery, Aga Khan University, Karachi
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Awan MS. Anti-Predator Ploys of Heliothis Punctiger (Lepidoptera: Noctuidae) Caterpillars Against the Predator Oechalia Schellenbergii (Hemiptera: Pentatomidae). AUST J ZOOL 1985. [DOI: 10.1071/zo9850885] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The escape responses of Heliothis punctiger Wallengren caterpillars to the attacks of juveniles and adults of Oechalia schellenbergii Guerin-Meneville were studied in the laboratory. Caterpillars avoided capture by head waving, dropping off the plant, ceasing movement, biting, rolling over, oral spitting and tail wagging. These responses occurred either individually or in unison. Smaller caterpillars tended to drop off the plant; larger ones defended themselves by aggressive retaliation, the value of which as a defence ploy increased with the size of the caterpillar relative to its predator. Larger caterpillars (fourth instars) were immune to predation by juveniles of O. schellenbergii and fifth instars to all stages of the predator.
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