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Ashraf M, Sajjad F, Hussain SS, Cheema HA, Ali S, Umar H, Gillespie CS, Faiz U, Shahid A, Akmal M, Ashraf N. Long-term outcome of microvascular decompression for typical trigeminal neuralgia with autologous muscle: an analysis of 1025 patients from a developing country. J Neurosurg 2024:1-11. [PMID: 38608302 DOI: 10.3171/2023.9.jns231473] [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] [Received: 07/10/2023] [Accepted: 09/28/2023] [Indexed: 04/14/2024]
Abstract
OBJECTIVE The objective was to evaluate the long-term outcome of microvascular decompression (MVD) utilizing autologous muscle for trigeminal neuralgia (TGN). METHODS A retrospective review was performed of all first-time MVD patients for typical classic TGN without prior surgical intervention who were treated between 2000 and 2019 at a tertiary supraregional neurosurgery practice. Demographic characteristics, surgical findings, operative results, complications, and recurrence rates at 1 year, 5 years, and last follow-up were collected. Pain outcome was assessed using the Barrow Neurological Institute (BNI) pain score. The chi-square test with continuity correction was used to compare categorical variables, and Kaplan-Meier curves and Cox regression were used to identify factors associated with recurrence. RESULTS In total, 1025 patients were studied with a median (interquartile range [IQR]) (range) follow-up of 8 (5-13) (3-20) years. In the immediate postoperative period, 889 patients (86.7%) had complete pain relief and 106 (10.3%) had partial pain relief; neither group required medication, and 30 patients (2.9%) had no relief. One hundred forty-one recurrences (13.8%) occurred over a median (IQR) of 3 (2-6) years after surgery. The proportion of patients without recurrence was 97% at 1 year, 90% at 5 years, 85% at 10 years, 82% at 15 years, and 81% at 20 years. There was no significant difference in the probability of recurrence between patients with complete (114/907 [12.6%] recurrences) or partial (19/106 [17.9%] recurrences) postoperative pain relief (p = 0.124, log-rank test). Patients with venous compression (n = 322) had a significantly higher rate of MVD failure (n = 16 [5%]) compared to those with arterial compression (14/703 [2%]) (p = 0.015, chi-square test). In the Cox proportional hazards model, venous compression and lack of immediate postoperative pain relief had hazard ratios of 1.62 (95% CI 1.16-2.27) and 2.65 (95% CI 1.45-4.82) for recurrence, respectively. One hundred twenty-four (12.1%) complications were documented, including facial numbness (44 [4.3%]), facial nerve palsy (37 [3.6%]), CSF leak (13 [1.3%]), and diplopia (5 [0.5%]), which resolved in all patients. CONCLUSIONS MVD with autologous muscle provides long-lasting pain relief in TGN patients with vascular compression with minimum morbidity and is a viable alternative to synthetic materials.
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Affiliation(s)
- Mohammad Ashraf
- 1Wolfson School of Medicine, University of Glasgow & Queen Elizabeth University Hospital, Glasgow, United Kingdom
- 2Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan
- 3Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Fauzia Sajjad
- 2Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan
- 3Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
- 4Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
- 7Department of Neurosurgery, Khawaja Safdar Medical College, Sialkot, Pakistan
| | - Syed Shahzad Hussain
- 2Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan
- 3Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Huzaifa Ahmad Cheema
- 5Department of Neurosurgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Sundus Ali
- 5Department of Neurosurgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Hira Umar
- 4Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Conor S Gillespie
- 6Department of Clinical Neurosciences, University of Cambridge, United Kingdom; and
| | - Umar Faiz
- 7Department of Neurosurgery, Khawaja Safdar Medical College, Sialkot, Pakistan
| | - Abia Shahid
- 5Department of Neurosurgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Muhammad Akmal
- 2Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan
- 3Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Naveed Ashraf
- 2Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan
- 3Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
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Sajjad F, Baloch MF, Ashraf M, Gillespie CS, Umar H, Zafar A, Zulfiqar J, Ullah I, Ali S, Ashraf N. Focal dystonia and ataxic hemiparesis as the initial presentation of a thalamic tuberculoma: A diagnostic challenge in an immunocompetent pediatric patient. Surg Neurol Int 2023; 14:350. [PMID: 37810325 PMCID: PMC10559370 DOI: 10.25259/sni_581_2023] [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: 07/12/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Background Central nervous system (CNS) tuberculomas are rare and account for approximately 1% of all tuberculosis (TB) cases. These intracranial lesions are more commonly observed in immunocompromised individuals, often as part of disseminated miliary TB or after latent infection reactivation. This case report presents the occurrence of a thalamic tuberculoma in an immunocompetent girl. Case Description An 11-year-old girl presented with a 3-month history of progressive right-sided ataxic hemiparesis, hand dystonia/thalamic hand, and headache. There was only a mildly elevated erythrocyte sedimentation rate (25 mm/h.), and her remaining biochemistry and vitals were unremarkable. Magnetic resonance imaging (MRI) brain revealed an ill-defined intra-axial heterogeneous lobulated lesion with crenated margins involving the thalamus and the posterior limb of the internal capsule with significant vasogenic edema. Given the clinical picture, the working diagnosis was a high-grade brain tumor. Due to the absence of a viable operative corridor for a meaningful resection and the diagnostic uncertainty, a stereotactic biopsy was performed, and histopathological analysis confirmed the presence of granulomas consistent with TB. A human immunodeficiency virus test (negative) and interferon-gamma release assay (positive) were then obtained. The patient was commenced on a regimen of anti-TB drugs with a tapering steroid dose. At 8 months, her most recent MRI showed a significant reduction in the size of her tuberculoma, and there is a complete resolution of her hand dystonia and hemiparesis to allow for independence in her activities of daily living. Conclusion This report emphasizes the importance of considering causes other than degenerative, vascular, or neoplasms in patients with hemiparesis with dystonia. CNS tuberculomas can present as such without prior history or specific clinical symptoms of TB, making them a diagnostic challenge. In cases with such uncertainty regarding the nature of an intracranial lesion and the role of resection, a stereotactic biopsy is invaluable.
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Affiliation(s)
- Fauzia Sajjad
- Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | | | - Mohammad Ashraf
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Conor S. Gillespie
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Hira Umar
- Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Ammara Zafar
- Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Javaria Zulfiqar
- Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Imdad Ullah
- Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Sundus Ali
- Department of Neurosurgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
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Ashraf M, Zahra SG, Farooq M, Choudhary N, Ashraf N. PMMA Cranioplasty Making by Using Open-Source CAD Software, PLA Printers, and Silicone Rubber Molds: Technical Note with Two Illustrative Cases. Asian J Neurosurg 2023; 18:420-422. [PMID: 37397041 PMCID: PMC10313431 DOI: 10.1055/s-0043-1768604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Affiliation(s)
- Mohammad Ashraf
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Shah Gul Zahra
- School of Medicine, King Edward Medical University, Lahore, Punjab, Pakistan
| | - Minaam Farooq
- School of Medicine, King Edward Medical University, Lahore, Punjab, Pakistan
| | - Nabeel Choudhary
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Naveed Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
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Sultan KA, Ashraf M, Chaudhary A, Al Salloum L, Ghulam N, Ahmed N, Ismahel H, Farooq M, Iqbal J, Ashraf N. Negative Chronotropic Cardiovascular Changes in Lumbar Spine Surgery: A Potential Spinal-Cardiac Reflex? Asian J Neurosurg 2023; 18:404-409. [PMID: 37397037 PMCID: PMC10313433 DOI: 10.1055/s-0043-1769894] [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] [Indexed: 07/04/2023] Open
Abstract
Cardiovascular changes following lumbar spine surgery in a prone position are exceedingly rare. Over the past 20 years, a total of six cases have been published where patients experienced varying degrees of bradycardia, hypotension, and asystole, which could be attributed to intraoperative dural manipulation. As such, there is emerging evidence for a potential neural-mediated spinal-cardiac reflex. The authors report their experience of negative chronotropy during an elective lumbar spine surgery that coincided with dural manipulation and review the available literature. A 34-year-old male presented with a long-standing history of lower back pain recently deteriorating to bilaterally radiating leg pain, with restricted left leg raise, and numbness at the left L5 dermatomal territory. The patient was an athletic police officer with no comorbidities or past medical history. Magnetic resonance imaging lumbosacral spine revealed spinal stenosis most pronounced at L4/L5 and disc bulges at L3/L4 and L5/S1. The patient opted for lumbar decompression surgery. After an unremarkable comprehensive preoperative workup, including cardiac evaluation (electrocardiogram, echocardiogram), the patient was induced general anesthesia in a prone position. A lumbar incision was made from L2 to S1. When the left L4 nerve root was retracted while removing the prolapsed disc at L4/L5, the anesthetist cautioned the surgeon of bradycardia (34 beats per minute [bpm]), and the surgery was immediately stopped. The heart rate improved to 60 bpm within 30 seconds. When the root was later retracted again, a second episode of bradycardia occurred for 4 minutes with heart rate declining to 48 bpm. The surgery was stopped, and after 4 minutes, the anesthetist administered 600 µg of atropine. The heart rate then rose to 73 bpm within 1 minute. Other potential causes for bradycardia were excluded. The total blood loss was estimated to be 100 mL. He remains well at his 6-month follow-up and has returned to work as normal. Akin to previously published cases, each episode of bradycardia coincided with dural manipulation, which may indicate a possible reflex between the spinal dura mater and the cardiovascular system. Such a rare adverse event may occur even in seemingly healthy, young individuals, and anesthetists should caution the operating surgeon of bradycardias to exclude operative manipulation of the dura as the cause. While this phenomenon is only reported in a handful of lumbar spine surgery cases, it provides evidence for a potential spinal-cardiac physiological reflex in the lumbar spine that may be neural mediated and should be investigated further.
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Affiliation(s)
- Kashif Ali Sultan
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Mohammad Ashraf
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Attika Chaudhary
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Laulwa Al Salloum
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Naseeruddin Ghulam
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Nazir Ahmed
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Hassan Ismahel
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Minaam Farooq
- School of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Javed Iqbal
- School of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Naveed Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
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Ashraf M, Cheema HA, Farooq M, Mustafa B, Anwer A, Shahid S, Ashraf N. Gender bias and 'doctor brides'. A social dilemma of medical students in Pakistan. J PAK MED ASSOC 2023; 73:1013-1023. [PMID: 37218227 DOI: 10.47391/jpma.6965] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/24/2023]
Abstract
OBJECTIVE To assess gender bias, discrimination and bullying at medical schools, and to explore the phenomenon of 'doctor brides'. METHODS The multicentre survey was conducted at 14 medical education institutions across Pakistan from September 2020 to April 2021, and comprised medical students of either gender at both public-sector and private-sector institutions. The survey questions explored beliefs, experiences and knowledge related to common stereotypes and social issues in medical education, including female role models, work-life balance, gender roles, lack of support from family and faculty, and bullying. Association between gender with survey variables was explored. Data was analysed using SPSS 26. Thematic analysis was used to exploring knowledge around 'doctor-brides'. RESULTS Of the 377 subjects, 245(65%) were females. The overall mean age was 21.4±1.8 years. There were 211(53.8%) subjects aged 21-23 years, and 368(97.6%) were Muslims. Significantly more women than men were of the opinion that men are encouraged and are more likely to assume leadership roles (p=0.002). More women than males agreed that household chores and work had an impact on speciality choice (p<0.001). Most sexual assault victims were women (p<0.0001), but men generally faced more bullying and hostile behaviour (p=0.014). With regard to women being forced to quit medicine after marriage/childbirth by their in-laws/husbands or change their careers from clinical medicine to preclinical teaching, 99(26.25%) subjects knew first-hand of such cases, while 238(63.12%) had no such experience to share. CONCLUSIONS Gender bias, discriminatory behaviour and bullying were found to be widely prevalent in medical schools across Pakistan. The general perception of 'doctor brides' needs to be revisited.
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Affiliation(s)
- Mohammad Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Huzaifa Ahmad Cheema
- 5th Year MBBS Student, School of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Minaam Farooq
- 5th Year MBBS Student, School of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Biah Mustafa
- 5th Year MBBS Student, School of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Ammar Anwer
- Department of Neurosurgery, University College of Medicine and Dentistry, University of Lahore, Lahore, Pakistan
| | - Saman Shahid
- Department of Computer and Emerging Sciences (NUCES), FAST Lahore Campus, Pakistan
| | - Naveed Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
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Ashraf M, Iqbal J, Husnain A, Hussain SS, Ashraf N. Rathke's cleft cyst abscess from Klebsiella. J Neurosci Rural Pract 2023; 14:358-360. [PMID: 37181181 PMCID: PMC10174176 DOI: 10.25259/jnrp_53_2023] [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] [Received: 01/30/2023] [Accepted: 02/15/2023] [Indexed: 03/19/2023] Open
Abstract
Pituitary abscesses are uncommon lesions accounting for <1% of all pituitary diseases. We report a case of a female microbiology technician with a rare congenital heart disease who developed an Rathke's Cleft Cyst abscess from Klebsiella. A 26-year-old female biotechnician with a history of congenital heart disease and subclinical immunosuppression presented with a 10-month history of weight loss, amenorrhea, and visual deterioration. There was a history of previous unsuccessful transsphenoidal surgery. Radiology revealed a cystic lesion in the sellar region. The patient underwent an endoscopic endonasal intervention and the cystic cavity was washed with gentamicin, and the patient received meropenem postoperatively. The patient was followed up and had gradual improvement in her overall health, complete normality of her menstrual cycle, her visual field recovering to near normal and improving, no recurrence, and a stable cyst on magnetic resonance imaging.
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Affiliation(s)
- Mohammad Ashraf
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Javed Iqbal
- School of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Ali Husnain
- School of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Syed Shahzad Hussain
- Department of Neurosurgery, National Hospital and Medical Centre, Lahore, Pakistan
| | - Naveed Ashraf
- Department of Neurosurgery, National Hospital and Medical Centre, Lahore, Pakistan
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Azeem S, Ashraf M, Kamboh UA, Raza MA, Farooq M, Cheema HA, Tariq S, Choudhary N, Hussain SS, Ashraf N. Association of ABO Blood Group with Delayed Cerebral Ischemia and Clinical Outcomes Following Aneurysmal Subarachnoid Hemorrhage in Pakistan. Asian J Neurosurg 2023; 18:108-116. [PMID: 37056873 PMCID: PMC10089742 DOI: 10.1055/s-0043-1760859] [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: 03/17/2023] Open
Abstract
Abstract
Background The ABO blood type, due to its various hemostaseologic properties, has been associated with several vascular diseases, including aneurysmal subarachnoid hemorrhage (aSAH). However, the role of ABO blood type in delayed cerebral ischemia (DCI) onset and other clinical outcomes after aSAH is largely unexplored. This study aimed to investigate the association between ABO blood type and outcomes after aSAH, primarily DCI.
Methods A retrospective analysis was made on the data collected from 175 aSAH patients at a tertiary supraregional neurosurgery department over 5 years. Socio-demographic factors, clinical variables (DCI, mFG, WFNS grade, and Glasgow Outcome Scale at discharge), EVD placement, and aneurysm size were analyzed for their association with ABO blood type.
Results DCI was reported in 25% of patients with ‘O’ blood type and 9.6% with ‘non-O’ blood type. A stepwise logistic regression model showed that after adjusting for BMI, mFG, WFNS grade, and EVD placement, ‘O’ type blood group was an independent risk factor for DCI, greatly increasing the risk of DCI as compared to ‘non-O’ type groups (OR = 3.27, 95% CI: 1.21–8.82).
Conclusion This study provides evidence that individuals with ‘O’ blood type may have a higher risk of DCI onset after aSAH. However, further studies are essential to address the limitations of our work and confirm our findings.
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Affiliation(s)
- Saleha Azeem
- King Edward Medical University, Lahore, Pakistan
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Mohammad Ashraf
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Usman Ahmad Kamboh
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Muhammad Asif Raza
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Minaam Farooq
- King Edward Medical University, Lahore, Pakistan
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Huzaifa Ahmad Cheema
- King Edward Medical University, Lahore, Pakistan
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Simra Tariq
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Nabeel Choudhary
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Syed Shahzad Hussain
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
- Department of Neurosurgery, Gujranwala Medical College, Gujranwala, Pakistan
| | - Naveed Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
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Ashraf N, Tahir MJ, Khan F, Asghar MS, Yousaf Z. Abstract No. 114 Genicular Artery Embolization for Knee Joint Osteoarthritis: A Systematic Review. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.164] [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: 02/26/2023] Open
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Ashraf M, Naseeruddin G, Zahra SG, Sultan KA, Kamboh UA, Manzoor M, Farooq M, Ahmad M, Ashraf N. Intracerebral hemorrhage as the first symptomatic manifestation of chronic myeloid leukemia (chronic phase): A case report and literature review. Surg Neurol Int 2023; 14:5. [PMID: 36751457 PMCID: PMC9899481 DOI: 10.25259/sni_897_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: 09/27/2022] [Accepted: 12/27/2022] [Indexed: 01/08/2023] Open
Abstract
Background Chronic myeloid leukemia (CML) is mostly asymptomatic at diagnosis. Intracerebral hemorrhage (ICH), as the first presentation of CML in its chronic phase (CP) has only once been reported in the literature. In addition, CML (CP) patients developing ICH are equally rare, with only eight cases reported. ICH is more commonly associated with CML progressing to its end stage (accelerated phase [AP] and blast crisis [BC]). The pathophysiology of ICH in CML-CP is postulated to be due to leukostasis, unlike in the CML-AP/BC, where thrombocytopenia and coagulopathy are the underlying mechanisms. This case adds to the scarce literature on a rare and challenging complication of ICH in CML-CP, especially as these patients tend to rebleed and management is uncertain. Case Description A 22-year-old male presented with a 2-week history of headaches and vomiting, associated with a 1-week history of the left-sided weakness. Initial blood work revealed hyperleukocytosis. The patient was investigated for CML with intracranial involvement. During his stay, his Glasgow coma score (GCS) dropped (from 14 to 11), prompting an urgent CT scan which revealed a large resolving ICH with perifocal edema and midline shift. A decompressive hemicraniectomy with expansion duraplasty was performed to alleviate the mass effect and reduce intracranial pressure. Three hours postoperatively, the patient developed an extradural hematoma which needed prompt evacuation. A postoperative CT revealed an improved midline shift, and after 7 days, his GCS improved to 15, and he began oncological treatment. Neurological symptoms were experienced by our patient at presentation with hyperleukocytosis on full blood count, which may implicate leukostasis as an underlying mechanism. Conclusion Even in the CP, CML patients presenting with mild neurological symptoms should be investigated to exclude intracranial bleeds. As these patients tend to rebleed, they should be conservatively managed unless there is a need to alleviate intracranial pressure.
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Affiliation(s)
- Mohammad Ashraf
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom,,Corresponding author: Mohammad Ashraf, Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom.
| | - Ghulam Naseeruddin
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Shah Gul Zahra
- School of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Kashif Ali Sultan
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Usman Ahmad Kamboh
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Mehwish Manzoor
- Department of Oncology, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Minaam Farooq
- School of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Manzoor Ahmad
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Naveed Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
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Ashraf M, Ismahel H, Lub S, Gardee A, Evans VE, Middleton EES, Chaudhary A, Cheema HA, Shahid A, Salloum LA, Szilagyi-Nagy E, Omar S, Mathieson C, Baird TA, O'Kane R, Ashraf N. Role of a medical student neuro-society organized neurosurgical conference: The Glasgow neuro experience. Surg Neurol Int 2023; 14:70. [PMID: 36895225 PMCID: PMC9990638 DOI: 10.25259/sni_755_2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 08/19/2022] [Accepted: 02/13/2023] [Indexed: 03/11/2023] Open
Abstract
Background Entering neurosurgical training in the United Kingdom demands extensive prior commitment and achievement, despite little to no exposure to the specialty in medical school. Conferences run by student "neuro-societies" offer a means to bridge this gap. This paper describes one student-led neuro-society's experience of curating a 1-day national neurosurgical conference supported by our neurosurgical department. Methods A pre-and post-conference survey was distributed to attendees to ascertain baseline opinions and conference impact using a five-point Likert Scale, and free text questions explored medical students' opinions of neurosurgery and neurosurgical training. The conference offered four lectures and three workshops; the latter provided practical skills and networking opportunities. There were also 11 posters displayed throughout the day. Results 47 medical students participated in our study. Post-conference, participants were more likely to understand what a neurosurgical career involves and how to secure training. They also reported increased knowledge about neurosurgery research, electives, audits, and project opportunities. Respondents enjoyed the workshops provided and suggested the inclusion of more female speakers in future. Conclusion Neurosurgical conferences organized by student neuro-societies successfully address the gap between a lack of neurosurgery exposure and a competitive training selection. These events give medical students an initial understanding of a neurosurgical career through lectures and practical workshops; attendees also gain insight into attaining relevant achievements and have an opportunity to present research. Student neuro-society-organized conferences have the potential to be adopted internationally and used as a tool to educate on a global level and greatly aid medical students who are aspiring neurosurgeons.
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Affiliation(s)
- Mohammad Ashraf
- Glasgow Neuro Society, Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Hassan Ismahel
- Glasgow Neuro Society, Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Sytske Lub
- Glasgow Neuro Society, Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Ameerah Gardee
- Glasgow Neuro Society, Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Vivienne Eloise Evans
- Glasgow Neuro Society, Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | | | - Attika Chaudhary
- Glasgow Neuro Society, Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | | | - Abia Shahid
- School of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Laulwa Al Salloum
- Glasgow Neuro Society, Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Eva Szilagyi-Nagy
- Glasgow Neuro Society, Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Samia Omar
- Glasgow Neuro Society, Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Calan Mathieson
- Department of Neurosurgery, Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
| | - Tracey Anne Baird
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
| | - Roddy O'Kane
- Department of Neurosurgery, Institute of Neurological Sciences, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
| | - Naveed Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Lahore, Pakistan
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Ashraf M, Kamboh UA, Hussain SS, Raza MA, Mehboob M, Zubair M, Ahmad M, Ashraf N. Traumatic Brain Injury in Underage Motorcycle Drivers: Clinical Outcomes and Sociocultural Attitudes from a Lower-Middle-Income Country. World Neurosurg 2022; 167:e413-e422. [PMID: 35964900 DOI: 10.1016/j.wneu.2022.08.027] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Poor societal attitudes and inadequate law enforcement have greatly contributed to the increase in underage motorcycle driving in Pakistan. This study reports the burden of traumatic brain injury (TBI), clinical characteristics/outcomes, and reason for driving in underage motorcyclists. MATERIALS AND METHODS A prospective study was conducted throughout 2021. Demographics, mechanism of injury, helmet use, number of passengers, clinical outcomes, reason for driving and parental awareness/consent status, referral pathway, and transport duration were documented. RESULTS Of a total of 1052 motorcyclists with TBI, 112 were underage drivers. The mean age was 14.7 years (range, 10-17 years); 98.2% were male and 17% wore protective helmets. The most common reason for driving was recreational, followed by for domestic chores. In 66 patients, there was parental awareness and 30 of these patients had active parental consent. These patients reported domestic chores as the reason for their journey, whereas recreational purposes were a more prevalent reason in patients without parental awareness/consent (P < 0.001). Most patients were brought by provincial ambulance service (response time 12.8 minutes). Some patients came from peripheral hospitals (26.8%) and private hospitals (14.3%) that lacked neurosurgical cover, and these were associated with severer baseline injuries (P < 0.001). The average stay was 6.5 days, and 75.9% of patients were discharged with a good Glasgow Outcome Scale score. CONCLUSIONS Most underage patients with TBI resulting from motorcycle driving are adolescent boys who do not use helmets. Trauma prevention systems and involvement of multiple stakeholders are needed to reduce underage driving. Efficient referral systems must transport patients to appropriate neurosurgical cover, which is lacking outside major cities.
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Affiliation(s)
- Mohammad Ashraf
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom; Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan.
| | - Usman Ahmad Kamboh
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Syed Shahzad Hussain
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan; Department of Neurosurgery, Gujranwala Medical College, Gujranwala, Pakistan
| | - Muhammad Asif Raza
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Mehreen Mehboob
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Mohammad Zubair
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Manzoor Ahmad
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Naveed Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
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Kamboh UA, Ashraf M, Zahra SG, Raza MA, Manzoor M, Mehboob M, Farooq M, Ahmad M, Hussain SS, Ashraf N. Outcome of surgical treatment for neglected congenital muscular torticollis: A series of 28 adolescent patients. Surg Neurol Int 2022; 13:292. [PMID: 35855133 PMCID: PMC9282755 DOI: 10.25259/sni_314_2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 04/03/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Congenital muscular torticollis (CMT) is a common musculoskeletal anomaly that can be excellently managed at birth with conservative physiotherapy; as a result, literature on neglected cases of CMT in older patients is sparse, and there is controversy regarding the ideal surgical approach. This report aims to provide the outcome of 28 adolescent patients with neglected CMT who underwent unipolar release at the distal sternocleidomastoid muscle (SCM). Methods: Twenty-eight adolescent patients with untreated CMT presented to our department between 2016 and 2019 and underwent unipolar release at the distal end of their SCM. All patients had no other anomaly based on clinical examination and radiological investigations. At the time of surgery, the mean age of patients was 15.8 years (range 13–18 years). There were 10 male and 18 female patients with the right side affected in 20 cases. All patients were followed up for 2 years. Patients were evaluated using an adapted version of the modified Lee’s scoring system to assess cosmesis and the cervical-mandibular angle (CMA) to assess radiological change. Results: The adapted modified Lee’s scoring system indicated 17 patients (60.7%) had an excellent outcome, 6 patients (21.4%) had a good outcome, and 5 patients (17.9%) had a fair outcome. In particular, scarring was fine in 23 patients (82.1%) and only slight in the remaining. Independent to the categorical outcome, all patients subjectively reported high satisfaction with their cosmesis. The preoperative mean CMA was 19.6° (range, 8.5–31.5°), which was reduced to a mean of CMA of 14.0° (range, 3–28°) after surgery (P < 0.05). No patient developed any permanent complication or required surgery for recurrence. No serious postoperative complications such as infection or hematoma were observed. Conclusion: In uncomplicated cases of neglected CMT in adolescent patients, unipolar tenotomy of the distal SCM is a safe and reliable technique with good clinical outcomes.
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Affiliation(s)
- Usman Ahmad Kamboh
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan,
| | - Mohammad Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan,
- Wolfson School of Medicine, University of Glasgow, Glasgow, Scotland, United Kingdom,
| | - Shah Gul Zahra
- School of Medicine, King Edward Medical University, Lahore, Punjab, Pakistan,
| | - Muhammad Asif Raza
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan,
| | - Mehwish Manzoor
- Administration, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Mehreen Mehboob
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan,
| | - Minaam Farooq
- School of Medicine, King Edward Medical University, Lahore, Punjab, Pakistan,
| | - Manzoor Ahmad
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan,
| | - Syed Shahzad Hussain
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan,
| | - Naveed Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan,
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Ashraf M, Kamboh UA, Raza MA, Choudhary N, Mehboob M, Hussain SS, Ashraf N. Lhermitte-Duclos Disease: A Rare Cerebellar Hamartoma Presenting Following Traumatic Brain Injury And A Review Of The Literature. J Ayub Med Coll Abbottabad 2022; 34(Suppl 1):S733-S738. [PMID: 36414605 DOI: 10.55519/jamc-03-s1-9900] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Lhermitte-Duclos Disease (LDD) is an extremely rare hamartoma of the cerebellum and is associated with the cancer syndrome Cowden's disease. We report such a patient whose disease was diagnosed incidental to traumatic brain injury. A 40-year-old male presented after fall from stairs. CT scan revealed a large lesion in the right cerebellar hemisphere. Clinical history recounted multiple short episodes of vomiting (>10 a week) for the past 30 years and development of posterior fossa symptoms over the recent months. Neither of these had him referred due to lack of access to primary healthcare. T1 MRI with contrast showed an isointense focal mass, enhancement along the folia, and distortion of the 4th ventricle. On T2 MRI, tiger striped appearance was noted. Endoscopic third ventriculostomy was performed followed by gross total resection of the hamartoma. Histology confirmed LDD. All reported symptoms resolved following surgery. Due to lack of access to the expensive genetic testing for Cowden's he is in regular biannual follow up to be evaluated clinically for associated malignancies. We present this case to highlight the clinical-pathological characteristics of LDD, its treatment, and discuss management in the absence of genetic testing in our socio-economic demographic.
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Affiliation(s)
- Mohammad Ashraf
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom and Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Usman Ahmad Kamboh
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Muhammad Asif Raza
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore-Pakistan
| | - Nabeel Choudhary
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore-Pakistan
| | - Mehreen Mehboob
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore-Pakistan
| | - Syed Shahzad Hussain
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore-Pakistan
| | - Naveed Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore-Pakistan
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Ashraf M, Choudhary N, Kamboh UA, Raza MA, Sultan KA, Ghulam N, Hussain SS, Ashraf N. Early experience with patient-specific low-cost 3D-printed polymethylmethacrylate cranioplasty implants in a lower-middle-income-country: Technical note and economic analysis. Surg Neurol Int 2022; 13:270. [PMID: 35855120 PMCID: PMC9282781 DOI: 10.25259/sni_250_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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/08/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Polymethyl methacrylate (PMMA) cranioplasty, while widely prevalent, has limitations associated with freehand manual intraoperative molding. PMMA has been superseded by titanium or Polyetheretherketone implants, prefabricated commercially from preoperative CT scans, and boasting superior clinical and cosmetic outcomes. However, such services are extremely inaccessible and unaffordable in the lower-middle-income country (LMIC) settings. The study aims to describe, in detail, the process of making ultra-low-cost patient-specific PMMA cranioplasty implants with minimum resources using open-access software. We report the first such service from the public health-care system within Pakistan, a LMIC. Methods: Using open-source software, preoperative CT heads were used to prefabricate three-dimensional implants. Both implant and cranial defects were printed using polylactic acid (PLA) to assess the implant’s size and fit preoperatively. From the PLA implant, we fashioned a silicon mold that shapes the PMMA implant. Ten patients who underwent cranioplasty using our technique for various cranial defects with at least a 12-month follow-up were retrospectively reviewed. Clinical, cosmetic, and radiological outcomes were objectively assessed. Results: Etiology of injury was trauma (8), malignant MCA infarct (1), and arteriovenous fistula (1). We produced seven frontotemporal-parietal implants, one bifrontal, one frontal, and one frontoparietal. At 1 year, eight patients reported their cosmetic appearance comparable to before the defect. Radiological outcome was classified as “excellent” for eight patients. No postoperative complications were encountered, nor did any implant have to be removed. One patient’s implant involving the orbital ridge had an unsatisfactory cosmetic outcome and required revision surgery. The average cost per implant to the National Health Service was US$40. Conclusion: Prefabricated patient-specific PMMA cranioplasty implants are cost-effective. A single surgeon can fashion them in a limited resource setting and provide personalized medicine with excellent clinical/cosmetic-radiological results. Our method produces patient-specific cranioplasty implants in an otherwise unaffordable LMIC setting.
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Affiliation(s)
- Mohammad Ashraf
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom,
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Lahore, Pakistan
| | - Nabeel Choudhary
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Lahore, Pakistan
| | - Usman Ahmad Kamboh
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Lahore, Pakistan
| | - Muhammad Asif Raza
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Lahore, Pakistan
| | - Kashif Ali Sultan
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Lahore, Pakistan
| | - Naseeruddin Ghulam
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Lahore, Pakistan
| | - Syed Shahzad Hussain
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Lahore, Pakistan
| | - Naveed Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Lahore, Pakistan
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15
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Ashraf M, Hussain SS, Farooq M, Fatima L, Majeed N, Ashraf N. Isolated subdural hematoma due to dengue hemorrhagic fever: Surgical intervention and review of the literature. Surg Neurol Int 2022; 13:244. [PMID: 35855175 PMCID: PMC9282807 DOI: 10.25259/sni_334_2022] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/18/2022] [Indexed: 11/14/2022] Open
Abstract
Background: Central nervous system (CNS) complications of dengue fever, a mosquito-borne single standard RNA virus illness, are reported in <1% of all cases. Hemorrhagic complications in severe forms of the disease can be life-threatening. The literature on cases, where hemorrhagic CNS complications necessitated neurosurgical intervention, is exceedingly sparse. The authors report their experience of a patient who developed an isolated acute subdural hematoma (SDH) due to dengue hemorrhagic fever (DHF) in the critical period of the illness with a poor prognosis. Despite a moribund patient, the SDH was immediately evacuated, achieving a good outcome. Case Description: A 65-year-old male patient was admitted with high-grade febrile illness and diagnosed with dengue. The patient had no focal neurology and was managed adequately following the primary survey on admission but, then, developed severe thrombocytopenia and eventually the critical phase of dengue illness. On the 5th admission day, the patient collapsed. Glasgow Coma Score was 3/15 with bilaterally dilated, fixed pupils. Immediate computed tomography head revealed a large left SDH with a significant midline shift. SDH was emergently evacuated with two units of platelets transfused peroperatively and two additional units postoperatively. Thrombocytopenia resolved within 48 h, and interval scanning showed gradual resolution of SDH. The patient was discharged 18 days later. Five months later, on follow-up, the patient is well with mild left-sided weakness and an Extended Glasgow Outcome Score of 7. Conclusion: Isolated SDH is a rare but life-threatening hemorrhagic complication of DHF. Even in the critical phase of illness, with severe thrombocytopenia, surgical evacuation should be considered if the SDH is present in isolation, within an accessible area, and can be operated on immediately.
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Affiliation(s)
- Mohammad Ashraf
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom,
| | - Syed Shahzad Hussain
- Department of Neurosurgery, National Hospital and Medical Centre, Lahore, Punjab, Pakistan,
| | - Minaam Farooq
- School of Medicine, King Edward Medical University, Lahore, Punjab, Pakistan,
| | - Laveeza Fatima
- School of Medicine, Allama Iqbal Medical College, Lahore, Punjab, Pakistan,
| | - Nadia Majeed
- Department of Infectious Diseases, National Hospital and Medical Centre, Lahore, Punjab, Pakistan
| | - Naveed Ashraf
- Department of Neurosurgery, National Hospital and Medical Centre, Lahore, Punjab, Pakistan,
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16
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Ashraf M, Kamboh UA, Raza MA, Khan MI, Sultan KA, Choudhary N, Hussain SS, Ashraf N. Prospective Elective Neurosurgical Theater Utilization Audit in Pakistan: Problems in a Public Tertiary Care Hospital and Proposed Solutions from Lower-Middle-Income Country. Asian J Neurosurg 2022; 17:58-67. [PMID: 35873839 PMCID: PMC9298559 DOI: 10.1055/s-0042-1749110] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Abstract
Background In lower-middle-income countries such as Pakistan, public hospitals provide free healthcare but suffer from poor management and misgovernance, negatively impacting service provision. One aspect of this is operating theater time (OTT) utilization. In a 1,600-bed hospital with a 22 million catchment population, we noticed significant delays and inadequate OTT efficiency at the neurosurgery department of Jinnah Hospital, Lahore, Punjab, Pakistan. This audit aimed to analyze the neurosurgical OTT utilization, identify delays, and highlight managerial deficiencies and areas for improvement while comparing our workflow with contemporary international literature.
Materials and Methods We prospectively audited OTT utilization at the neurosurgical department. All elective surgeries from January to April 2021 were included to identify delays concerning patient transfer, anesthesia team arrival, preparation and intubation time, operative time, and anesthesia extubation time.
Results Fifty-six per cent of OTT was utilized operating. Sources of delay included the delayed arrival of anesthesia team (4.7%) and the delay in transferring patients to OT (9.7%). Anesthesia intubation and preparation time accounted for 23% of OT utilization and was significantly longer than the comparable international studies. Extubation time accounted for 5.7% of OT utilization. The issues surrounding transfer delays and prolonged anesthesia time were discussed, with strategies to address them developed with close vital input from our anesthesia colleagues and ward staff.
Conclusion Gross delays relatively simple in nature were identified due to poor management and less than ideal interspecialty coordination. Most delays were avoidable and can be addressed by proper planning, optimization of patient transfer and resources, and, most importantly, improved communication between surgeons, anesthetists, and ward staff. This can ensure optimal use of theater time and benefit all specialties, including ancillary staff, and, most importantly, the patient. A reaudit is warranted to assess the impact of interventions on OTT utilization.
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Affiliation(s)
- Mohammad Ashraf
- Wolfson School of Medicine, University of Glasgow, Glasgow, Scotland, United Kingdom
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Usman Ahmad Kamboh
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Muhammad Asif Raza
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Muhammad Irfan Khan
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Kashif Ali Sultan
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Nabeel Choudhary
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Syed Shahzad Hussain
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Naveed Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
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Ashraf M, Ashraf N. An affordable low-cost home-made skull model for interactive neurosurgical workshops: Experience with hands-on intracranial pressure monitoring at 2 international neurosurgical conferences. World Neurosurg 2022; 161:34-38. [PMID: 35134584 DOI: 10.1016/j.wneu.2022.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Undergraduate neurosurgery conferences are acknowledged to play an important role in bridging the gap between a limited exposure to neurosurgery within medical schools and a highly competitive application process. Hands-on workshops are attractive for any conference but can be prohibitively expensive, especially for student societies. MATERIALS AND METHODS We describe our method to manufacture a low-cost skull model, which we utilised for a hands-on intracranial pressure (ICP) monitoring workshop station at two international neurosurgical conferences. We describe the workflow for our ICP monitoring workshop utilising these models. RESULT Our model acts as an appropriate substitute for more professional simulators whilst adequately mimicking the sensation of skull drilling, dural puncture and intraparenchymal ICP bolt and probe insertion. All tools and resources are accessible from local markets and can be sourced online. A total of GB£100 was spent making five skull models and took 2 hours to manufacture by 3 individuals. The ICP monitoring workshop was carried out 3 times over 40 minutes, with each session accommodating 18 or 19 delegates (N=55). CONCLUSION Workshop models were praised by medical students for increasing exposure and awareness towards neurosurgical procedures and the sophistication of investigations utilised by the speciality. Consultant neurosurgeons had praised the simulation provided by these models to mimic the procedure in reality closely.
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Affiliation(s)
- Mohammad Ashraf
- President Glasgow Neuro Society, Wolfson School of Medicine, University of Glasgow, United Kingdom; Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan.
| | - Naveed Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
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Ashraf M, Ashraf N. Underage motorbike driving in Pakistan: A neurosurgical burden heading towards societal disaster. Surg Neurol Int 2022; 13:37. [PMID: 35242403 PMCID: PMC8888190 DOI: 10.25259/sni_1261_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/11/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Mohammad Ashraf
- Glasgow Neuro Society, Wolfson School of Medicine, University of Glasgow, Glasgow, Scotland, United Kingdom,
| | - Naveed Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Lahore, Punjab, Pakistan
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Farooq M, Mustafa B, Sultan KA, Ashraf M, Ashraf N, Siddique A. Extraosseous extradural ewing sarcoma of the thoracic spine: Case report and literature review. Surg Neurol Int 2021; 12:542. [PMID: 34754592 PMCID: PMC8571188 DOI: 10.25259/sni_790_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/08/2021] [Accepted: 10/02/2021] [Indexed: 01/03/2023] Open
Abstract
Background: As part of the ‘small round-cell tumor’ family, Ewing’s sarcoma (ES) is a malignant mesenchymal tumor classified as a primitive neuroectodermal tumor (PNET). Within the PNETs, spinal extraosseous extradural lesions are exceedingly rare. Case Description: A 19-year-old male presented with a one-month history of back pain and paraparesis with loss of urinary control. The MRI revealed an intradural, extramedullary mass at the T3-T4 level. Intraoperatively, the tumor was solely extradural, without evidence of local invasion; it was entirely removed. Due to the high risk of metastasis, the patient was subsequently treated with chemotherapy and radiation. In addition, similar studies on PNETs were reviewed. Conclusion: A 19-year-old male presented with a paraparesis attributed to an extraosseous extradural ES at the T3-T4 level. Following total gross resection, he was successfully managed with chemotherapy and radiation. The patient has been in remission for one month.
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Affiliation(s)
- Minaam Farooq
- Department of Neurosurgery, King Edward Medical University, Punjab, Pakistan
| | - Biah Mustafa
- Department of Neurosurgery, King Edward Medical University, Punjab, Pakistan
| | - Kashif Ali Sultan
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Lahore, Punjab, Pakistan.,Farooq Hospital, Westwood, Lahore, Pakistan
| | - Mohammad Ashraf
- President Glasgow Neuro Society, Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Naveed Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Lahore, Punjab, Pakistan
| | - Abubakar Siddique
- Farooq Hospital, Westwood, Lahore, Pakistan.,Department of Neurology, Ameeruddin Medical College, Lahore, Punjab, Pakistan
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Ashraf M, Kamboh UA, Raza MA, Haq NU, Choudhary N, Sultan KA, Hussain SS, Ashraf N. Usefulness of Intraoperative Computed Tomography on Extent of Resection of Large and Giant Pituitary Adenomas. Experience from a Developing Country. World Neurosurg 2021; 157:13-20. [PMID: 34619403 DOI: 10.1016/j.wneu.2021.09.114] [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] [Received: 08/18/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVE The literature on the use of intraoperative computed tomography (iCT) is sparse. We provide our experience of the usefulness of iCT in extent of resection in large and giant pituitary adenomas. METHODS A retrospective review was performed of cases using the endonasal endoscopic technique in which iCT was used. Demographic factors, number of scans, and impact on the extent of resection are reported, with visual acuity and field changes. Tumors were graded according to the Hardy classification. Patients with cavernous sinus invasion were excluded. RESULTS All patients received a perioperative computed tomography scan with our iCT scanner. Thirty patients are reported, including 14 large and 16 giant pituitary adenomas, including 14 nonfunctional and 16 growth hormone-secreting tumors. The overall gross total resection (GTR), near-total resection, and subtotal resection rates were 83.3%, 16.7%, and 3.3%, respectively. iCT scanning detected residual in 13 of 30 patients, including 4 with 14 large (29%) and 9 with 16 (56.3%) giant adenomas promoting further surgery. iCT use improved GTR from 43.8% to 81.3% in giant adenomas and from 71% to 86% in large adenomas. Of the 13 patients in whom iCT detected residual disease, none required >2 iCT scans. No intraoperative complications were observed. CONCLUSIONS iCT can improve extent of resection in large and giant pituitary adenomas and facilitate maximum safe resection such as GTR or near-total resection in patients where such should be attempted. iCT use may reduce iatrogenic complications and has select financial benefits in our patients' socioeconomic demographics. However, further prospective controlled studies are required to affirm our conclusions.
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Affiliation(s)
- Mohammad Ashraf
- Wolfson School of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan.
| | - Usman Ahmad Kamboh
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Muhammad Asif Raza
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Naseer Ul Haq
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Nabeel Choudhary
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Kashif Ali Sultan
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Syed Shahzad Hussain
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Naveed Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
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Khan MB, Irshad N, Ahmed B, Khan MR, Minhas RA, Ali U, Mahmood M, Muhammad A, Sheikh AA, Ashraf N. Food habits of indian crested porcupine (Hystrix indica) (Kerr 1792), in district Bagh, Azad Jammu and Kashmir. BRAZ J BIOL 2021; 82:e243063. [PMID: 34287526 DOI: 10.1590/1519-6984.243063] [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: 09/01/2020] [Accepted: 12/06/2020] [Indexed: 11/22/2022] Open
Abstract
The Indian Crested Porcupine (Hystrix indica) is classified as an agricultural pest species. It feeds on plants and crops; hence, it is responsible for massive financial losses worldwide. The current study was conducted to assess the diet composition of Indian Crested Porcupine in District Bagh, Azad Jammu and Kashmir (AJ&K). Thus, fecal samples were collected and examined from different sampling sites. Reference slides of the material collected from the study area were prepared for identification of dietary components in fecal pellets. A total of 80 fecal samples were collected and processed. Percent relative frequencies (P.R.F.) were calculated for each plant species recovered from pellets. Data revealed that Indian Crested Porcupine consumed 31 plant species in its diet, among them Zea mays (34.31±7.76) was the most frequently selected species followed by Rumex obtusifolius (15.32±2.57) and Melia azedarach (12.83±4.79). The study revealed that the greatest diversity of (n=20) plant species were consumed in summer season while minimum (n=13) species were used during winter. Among the parts of plants, stem was highly consumed in spring (57.2%) as compared to seed in fall (36.7%) while spikes and leaf were the least recovered parts from the fecal matter. The Berger-Parker diversity index showed highly diversified food (10.92) in the summer time of the year as compared to the autumn season (2.95). This study provides a baseline for the diet preference of this pest in the study area. Based on current findings, a detailed investigation on damage assessment, exploration, habitat use and management of Indian Crested Porcupine in AJ&K has been recommended.
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Affiliation(s)
- M B Khan
- Department of Zoology, University of Poonch, Rawalakot, AJ&K Pakistan
| | - N Irshad
- Department of Zoology, University of Poonch, Rawalakot, AJ&K Pakistan
| | - B Ahmed
- Department of Zoology, University of Azad Jammu and Kashmir Muzaffarabad, AJ&K Pakistan
| | - M R Khan
- Department of Zoology, University of Poonch, Rawalakot, AJ&K Pakistan
| | - R A Minhas
- Department of Zoology, University of Azad Jammu and Kashmir Muzaffarabad, AJ&K Pakistan
| | - U Ali
- Department of Zoology, Mirpur University of Science and Technology, Mirpur, AJ&K Pakistan
| | - M Mahmood
- Department of Zoology, University of Poonch, Rawalakot, AJ&K Pakistan
| | - A Muhammad
- Department of Zoology, University of Poonch, Rawalakot, AJ&K Pakistan
| | - A A Sheikh
- Department of Zoology, University of Poonch, Rawalakot, AJ&K Pakistan
| | - N Ashraf
- Department of Zoology, University of Azad Jammu and Kashmir Muzaffarabad, AJ&K Pakistan
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Abbas K, Hussain Z, Hussain M, Rahim F, Ashraf N, Khan Q, Raza G, Ali A, Khan DM, Khalil U, Irshad N. Statistical modeling for analyzing grain yield of durum wheat under rainfed conditions in Azad Jammu Kashmir, Pakistan. BRAZ J BIOL 2021; 82:e240199. [PMID: 34190802 DOI: 10.1590/1519-6984.240199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/19/2020] [Indexed: 11/22/2022] Open
Abstract
One of the most important traits that plant breeders aim to improve is grain yield which is a highly quantitative trait controlled by various agro-morphological traits. Twelve morphological traits such as Germination Percentage, Days to Spike Emergence, Plant Height, Spike Length, Awn Length, Tillers/Plant, Leaf Angle, Seeds/Spike, Plant Thickness, 1000-Grain Weight, Harvest Index and Days to Maturity have been considered as independent factors. Correlation, regression, and principal component analysis (PCA) are used to identify the different durum wheat traits, which significantly contribute to the yield. The necessary assumptions required for applying regression modeling have been tested and all the assumptions are satisfied by the observed data. The outliers are detected in the observations of fixed traits and Grain Yield. Some observations are detected as outliers but the outlying observations did not show any influence on the regression fit. For selecting a parsimonious regression model for durum wheat, best subset regression, and stepwise regression techniques have been applied. The best subset regression analysis revealed that Germination Percentage, Tillers/Plant, and Seeds/Spike have a marked increasing effect whereas Plant thickness has a negative effect on durum wheat yield. While stepwise regression analysis identified that the traits, Germination Percentage, Tillers/Plant, and Seeds/Spike significantly contribute to increasing the durum wheat yield. The simple correlation coefficient specified the significant positive correlation of Grain Yield with Germination Percentage, Number of Tillers/Plant, Seeds/Spike, and Harvest Index. These results of correlation analysis directed the importance of morphological characters and their significant positive impact on Grain Yield. The results of PCA showed that most variation (70%) among data set can be explained by the first five components. It also identified that Seeds/Spike; 1000-Grain Weight and Harvest Index have a higher influence in contributing to the durum wheat yield. Based on the results it is recommended that these important parameters might be considered and focused in future durum wheat breeding programs to develop high yield varieties.
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Affiliation(s)
- K Abbas
- University of Azad Jammu and Kashmir, Department of Statistics, Muzaffarabad, Pakistan
| | - Z Hussain
- National University of Sciences and Technology (NUST), Research Center for Modelling and Simulation (RCMS), H-12, Islamabad, Pakistan
| | - M Hussain
- University of Azad Jammu and Kashmir, Department of Statistics, Muzaffarabad, Pakistan
| | - F Rahim
- Department of Agriculture Research Azad Jammu and Kashmir, Muzaffarabad, Pakistan
| | - N Ashraf
- University of Azad Jammu and Kashmir, Department of Zoology, Muzaffrabad, Pakistan
| | - Q Khan
- University of Azad Jammu and Kashmir, Department of Botany, Muzaffarabad, Pakistan
| | - G Raza
- University of Baltistan, Department of Biological Sciences, Skardu
| | - A Ali
- Islamia College Peshawar, Department of Statistics, Khyber Pakhtunkhwa, Pakistan
| | - D M Khan
- Abdul Wali Khan University, Department of Statistics, Mardan, Khyber Pakhtunkhwa, Pakistan
| | - U Khalil
- Abdul Wali Khan University, Department of Statistics, Mardan, Khyber Pakhtunkhwa, Pakistan
| | - N Irshad
- University of Poonch, Department of Zoology, Rawalakot, Azad Jammu and Kashmir, Pakistan
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Ashraf M, Hussain SS, Kamboh UA, Mehboob M, Shahid S, Ashraf N. Improvement in the quality of patient notes: A report of a closed loop audit quality improvement project at a neurosurgical department in Pakistan. J PAK MED ASSOC 2021; 71:1515-1520. [PMID: 34091651 DOI: 10.47391/jpma.452] [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 identify the deficiencies in patient note record-taking with the aim of improving the quality to meet international standards. METHODS This prospective clinical quality improvement audit study was conducted at the department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore from January 2019 to February 2020. The first audit cycle was carried out in July 2019, after data anonymisation, the notes from 1st January to 31st June were analysed in the first audit cycle against a hybrid proforma containing entries deemed essential in operative notes according to the guidelines of the Royal College of Surgeons of England. The guidelines were subsequently disseminated among postgraduate trainees using various methods. Post-intervention, randomly selected patientnotes from 1st August to 31st December 2019 were analysed in the second audit which was done in February 2020. The result of the two audits were compared to assess significance of association between the cycles for each categorical variable. RESULTS Of the 100 patient-notes audited, 50(50%) were part of each of the two cycles. Significant improvements (p<0.05) were seen between the two cycles in time of operation, pre-op status, post-op care, monitoring instruction, mobilisation, feeding instructions, wound care and position. There was 100% improvement in entries including name, age and sex, date of operation, elective/emergency, name of the procedure and name of operating surgeon and assistant, and the name of anaesthetist. Overall, marked improvement was observed in all parameters except in 'use of antibiotic prophylaxes'. CONCLUSIONS Regular audits are needed to monitor and improve patient care.
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Affiliation(s)
- Mohammad Ashraf
- Visiting 3rd Year Medical Student, Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Syed Shahzad Hussain
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Usman Ahmad Kamboh
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Mehreen Mehboob
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Saman Shahid
- Department of Sciences and Humanities, National University of Computer and Emerging Sciences, Lahore, Pakistan
| | - Naveed Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
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Ashraf M, Kamboh UA, Ashraf N. Intraoperative Computed Tomography Scanner-Guided Craniovertebral Junction Surgery in a Patient with an Occipitalized C1. J Neurosci Rural Pract 2021; 12:603-607. [PMID: 34295121 PMCID: PMC8289552 DOI: 10.1055/s-0041-1730088] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Craniovertebral junction surgery is associated with unique difficulties. Type 2 odontoid fractures (Anderson and D Alonzo) have a great potential for nonunion and malunion. These fracture patients may require a circumferential decompression and fixation. The addition of intraoperative CT with neuronavigation greatly aids in craniovertebral junction surgery. We operated on a 59-year-old-male with a type 2 fracture with posterior subluxation of C1 anterior arch and a cranially displaced odontoid peg. First, a transoral odontoidectomy was performed followed by a craniocervical fixation. Occipital plates and C3-C4 lateral mass screws were used as C1 was discovered to be occipitalized intraoperatively and atlantoaxial facet joints could not be reduced as discovered by intraoperative CT resconstruction. Intraoperative CT scan was crucial to this circumferential decompression and fixation, allowed us to resect the odontoid peg safely and completely and to confirm adequate screw trajectory making this complex surgery easier for us and safer for the patient. The patient was discharged 4 months after admission with stable neurology. Intraoperative CT was fundamental to correct decision making.
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Affiliation(s)
- Mohammad Ashraf
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom.,Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Lahore, Pakistan
| | - Usman Ahmad Kamboh
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Lahore, Pakistan
| | - Naveed Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Lahore, Pakistan
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25
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Afzal T, Ashraf N, Munir S, Tabassum R. Megaloblastic anaemia in a 9-weeks old infant: A case report. J PAK MED ASSOC 2021; 70:923-925. [PMID: 32400755 DOI: 10.5455/jpma.23379] [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: 11/03/2022]
Abstract
Megaloblastic anaemia due to vitamin B12 and folic acid deficiency is uncommon in infancy and rarely reported in infants below 3 months of age. We hereby report a case of megaloblastic anaemia in a 9-weeks old infant having fever from 7th week of life. Blood picture showed pancytopenia and diagnosis was confirmed on bone marrow biopsy and serum level of vitamins. Patient positively responded to vitamin B12 and folic acid supplementation. Infants with pancytopenia even younger than 2 months, should also be investigated for vitamin B12 and folate deficiency. Mother of the baby was not antenatally investigated for anaemia. Prompt antenatal diagnosis and treatment of mothers can reduce the incidence in the infants.
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Affiliation(s)
- Tehreem Afzal
- Department of Paediatrics, Federal Government Polyclinic (PGMI), Islamabad, Pakistan
| | - Naveed Ashraf
- Department of Paediatrics, Federal Government Polyclinic (PGMI), Islamabad, Pakistan
| | - Shahzad Munir
- Department of Paediatrics, Federal Government Polyclinic (PGMI), Islamabad, Pakistan
| | - Rabia Tabassum
- Department of Paediatrics, Federal Government Polyclinic (PGMI), Islamabad, Pakistan
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26
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Ashraf M, Kamboh UA, Zubair M, Sultan KA, Raza MA, Hussain SS, Ashraf N. Prevalence of anemia in pediatric patients of traumatic brain injury and problems associated with management in a developing country: Unfolding of an underrated comorbidity. Surg Neurol Int 2021; 12:75. [PMID: 33767879 PMCID: PMC7982091 DOI: 10.25259/sni_944_2020] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/05/2021] [Indexed: 11/04/2022] Open
Abstract
Background Pediatric anemia has a high prevalence in developing countries such as Pakistan. It is common knowledge among hospital specialties but little is done to manage this condition by hospitalists. The issue is compounded with a poor primary care infrastructure nationally. The aim of this study is to bring to light the high prevalence of anemic children in neurosurgery and to describe the difficulties in managing their anemia in a tertiary hospital setting. A literature review is presented highlighting the socioeconomic difficulties that contribute to this widespread comorbidity and the difficulty in managing it from a hospital specialty point of view. Methods A prospective descriptive case series was carried out between March 2020 and September 2020. All patients under the age of 13 who presented to our department for traumatic brain injury (TBI) meeting our inclusion and exclusion criteria were enrolled and assessed for the presence and severity of anemia. Demographic data were collected. Following discharge, patients were referred to our hospital's pediatrics' anemia clinic which was before their first neurosurgery follow-up 2 weeks following discharge and attendance to follow up was documented. Results The prevalence of anemia was 78.9%. Over 95% of patients attended their neurosurgery follow-up but only 28% of patients attended their referral to the anemia clinic. Conclusion Anemia is highly prevalent in children presenting to neurosurgery for TBI and its longitudinal management has difficulties with lost to follow up in a tertiary hospital setting. There is a need for national initiatives to reduce the prevalence of anemia but concurrently better strategies need to be devised to manage anemic children in a hospital setting.
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Affiliation(s)
- Mohammad Ashraf
- Medical Student, Wolfson School of Medicine, University of Glasgow, Glasgow, Scotland, United Kingdom.,Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Lahore, Punjab, Pakistan
| | - Usman Ahmad Kamboh
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Lahore, Punjab, Pakistan
| | - Mohammad Zubair
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Lahore, Punjab, Pakistan
| | - Kashif Ali Sultan
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Lahore, Punjab, Pakistan
| | - Muhammad Asif Raza
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Lahore, Punjab, Pakistan
| | - Syed Shahzad Hussain
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Lahore, Punjab, Pakistan
| | - Naveed Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Lahore, Punjab, Pakistan
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27
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Ali S, Ejaz M, Dar KK, Nasreen S, Ashraf N, Gillani SF, Shafi N, Safeer S, Khan MA, Andleeb S, Akhtar N, Mughal TA. Evaluation of chemopreventive and chemotherapeutic effect of Artemisia vulgaris extract against diethylnitrosamine induced hepatocellular carcinogenesis in Balb C mice. BRAZ J BIOL 2020; 80:484-496. [DOI: 10.1590/1519-6984.185979] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 02/26/2019] [Indexed: 11/22/2022] Open
Abstract
Abstract The main objective of current study was to investigate the chemopreventive and chemotherapeutic activity of Artemisia vulgaris extract on diethylnitrosoamine induced hepatocarcinogenesis in Balb C mice. Diethylnitrosoamine (DEN: 0.9%) was prepared to induce hepatocarcinoma in Balb C mice. The extract Artemisia vulgaris (AV) was prepared by maceration technique. Mice were classified into four groups as follows: Group 1 a control group (N=7) received saline solution (3.5 μl/mg), group 2 (N=14) received diethylnitrosoamine (3.5 μl/mg) intraperitoneally once in a week for eight consecutive weeks, group 3 (N=7) received only plant extract (AV: 150 mg/kg (Body weight) once in a week, while group 4 (N=7) was given in combination of diethylnitrosoamine (3.5 μl/mg) and plant extract (AV: 150 mg/kg (body weight). After eight weeks of DEN administration, mice of group 2 were divided into two subgroups containing seven mice each; subgroup 1 was sacrificed while subgroup 2 was treated with plant extract only (150 mg/kg (body weight)) once in a week for eight consecutive weeks. The DEN injected mice significant decline in levels of albumin with concomitant significant elevations such as aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, alpha feto protein, gamma glutamyl transferase, 5 nucleotidase, glucose-6-phosphate dehydrogenase and bilirubin. The administration of A. vulgaris significantly decreased the DEN induced hepatotoxicity. Present study revealed the potential anti-cancerous nature of Artemisia vulgaris, both in case of chemopreventive and post-treatment of A. vulgaris. Further studies are needed to explore the mechanism of prevention and therapy.
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Affiliation(s)
- S. Ali
- Government College University, Pakistan
| | - M. Ejaz
- University of Azad Jammu and Kashmir, Pakistan
| | - K. K. Dar
- University of Azad Jammu and Kashmir, Pakistan
| | - S. Nasreen
- University of Azad Jammu and Kashmir, Pakistan
| | - N. Ashraf
- University of Azad Jammu and Kashmir, Pakistan
| | | | - N. Shafi
- University of Azad Jammu and Kashmir, Pakistan
| | - S. Safeer
- University of Azad Jammu and Kashmir, Pakistan
| | - M. A. Khan
- University of Azad Jammu and Kashmir, Pakistan
| | - S. Andleeb
- University of Azad Jammu and Kashmir, Pakistan
| | - N. Akhtar
- University of Azad Jammu and Kashmir, Pakistan
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Ashraf M, Choudhary N, Hussain SS, Kamboh UA, Ashraf N. Role of intraoperative computed tomography scanner in modern neurosurgery - An early experience. Surg Neurol Int 2020; 11:247. [PMID: 32905376 PMCID: PMC7468186 DOI: 10.25259/sni_303_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/22/2020] [Accepted: 07/16/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Intraoperative imaging addresses the limitations of frameless neuronavigation systems by providing real-time image updates. With the advent of new multidetector intraoperative computed tomography (CT), soft tissue can be visualized far better than before. We report the early departmental experience of our intraoperative CT scanner’s use in a wide range of technically challenging neurosurgical cases. Methods: We retrospectively analyzed the data of all patients in whom intraoperative CT scanner was utilized. Out of 31 patients, 24 (77.4%) were cranial and 8 (22.6%) spinal cases. There were 13 male (41.9%) and 18 (58.1%) female patients, age ranged from 1 to 83 years with a mean age of 34.29 years ±17.54 years. Seven patients underwent spinal surgery, 2 cases were of orbital tumors, and 16 intra-axial brain tumors, including 5 low- grade gliomas, 10 high-grade gliomas, and 1 colloid cyst. There were four sellar lesions and two multiloculated hydrocephalus. Results: The intraoperative CT scan guided us to correct screw placement and was crucial in managing four complex spinal instabilities. In intracranial lesions, 59% of cases were benefitted due to intraoperative CT scan. It helped in the precise placement of ventricular catheter in multiloculated hydrocephalus and external ventricular drain for a third ventricular colloid cyst. Conclusion: Intraoperative CT scan is safe and logistically and financially advantageous. It provides versatile benefits allowing for safe and maximal surgery, requiring minimum changes to an existing neurosurgical setup. Intraoperative CT scan provides clinical benefit in technically difficult cases and has a smooth workflow.
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Affiliation(s)
- Mohammad Ashraf
- rd Year Medical Student, University of Glasgow, Wolfson School of Medicine, Glasgow, Scotland, United Kingdom.,Visiting Medical Student, Allama Iqbal Medical College, Department of Neurosurgery, Jinnah Hospital, Lahore, Pakistan
| | - Nabeel Choudhary
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Syed Shahzad Hussain
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Usman Ahmad Kamboh
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Naveed Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
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Khan MI, Akhtar MN, Ashraf N, Najeeb J, Munir H, Awan TI, Tahir MB, Kabli MR. Green synthesis of magnesium oxide nanoparticles using Dalbergia sissoo extract for photocatalytic activity and antibacterial efficacy. Appl Nanosci 2020. [DOI: 10.1007/s13204-020-01414-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Isa Khan M, Majid A, Ashraf N, Ullah I. A DFT study on a borophene/boron nitride interface for its application as an electrode. Phys Chem Chem Phys 2020; 22:3304-3313. [PMID: 31971185 DOI: 10.1039/c9cp06626h] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In order to search for a new anode material for lithium-ion batteries (LIBs), a borophene/boron nitride (B/BN) interface was investigated in detail using density functional theory. Borophene is an excellent two-dimensional (2D) anode material that offers high charging capacity and a low energy barrier, but it suffers from stability issues when it is used in its free-standing form. The findings of this work indicate that the thermal and mechanical stabilities of the borophene epilayer are notably increased by preparing its interface with a boron nitride substrate. The electronic properties of the lithiated and delithiated interface exhibited metallic behavior, whereas the mechanical stiffness of the interface increased three times when compared with that of the pristine borophene. The thermal stability was calculated by molecular dynamics and indicated a six times increase in its value for the interface. The interface exhibited a specific charging capacity of 1698 mA h g-1, which is higher than that of bare borophene and several other 2D materials. Furthermore, nudged elastic band (NEB) calculations indicated a low energy barrier to diffusion of Li in the interface. These advantages of the B/BN interface make it an excellent choice as an anode material for LIBs.
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Affiliation(s)
- Muhammad Isa Khan
- Department of Physics, Faculty of Science, University of Gujrat, Hafiz Hayat Campus, Gujrat, 50700, Pakistan.
| | - Abdul Majid
- Department of Physics, Faculty of Science, University of Gujrat, Hafiz Hayat Campus, Gujrat, 50700, Pakistan.
| | - Naveed Ashraf
- Department of Physics, Faculty of Science, University of Gujrat, Hafiz Hayat Campus, Gujrat, 50700, Pakistan.
| | - Irslan Ullah
- Department of Physics, Faculty of Science, University of Gujrat, Hafiz Hayat Campus, Gujrat, 50700, Pakistan.
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Ashraf N, Izhar T, Abbas G, Awan AB, Farooq U, Balas VE. A New Single-Phase AC Voltage Converter With Voltage Buck Characteristics for Grid Voltage Compensation. IEEE Access 2020. [DOI: 10.1109/access.2020.2979506] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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32
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Dar KK, Ali S, Ejaz M, Nasreen S, Ashraf N, Gillani SF, Shafi N, Safeer S, Khan MA, Andleeb S, Mughal TA. In vivo induction of hepatocellular carcinoma by diethylnitrosoamine and pharmacological intervention in Balb C mice using Bergenia ciliata extracts. BRAZ J BIOL 2019; 79:629-638. [PMID: 31017181 DOI: 10.1590/1519-6984.186565] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/22/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma is the most frequent primary malignancy of liver and accounts for as many as one million deaths worldwide in a year. OBJECTIVES The aim of the present study was to evaluate the anti-cancerous efficiency of Bergenia ciliata rhizome against diethylnitrosoamine induced hepatocarcinogenesis in Balb C mice. METHODS One percent diethylnitrosoamine was prepared by using 99 ml of normal saline NaCl (0.9 percent) solution to which was added 1 ml of concentrated diethylnitrosoamine (DEN) solution (0.01 μg/μl). Extract of Bergenia ciliata was prepared by maceration technique. Mice were classified into four groups as follows: Group 1 a control group (N=7) received saline solution (3.5 μl/mg), group 2 (N=14) received diethylnitrosoamine (3.5 μl/mg) intraperitoneally once in a week for eight consecutive weeks, group 3 (N=7) received plant extract (150 mg/kg (Body weight)) once in a week, while group 4 (N=7) was given combination of diethylnitrosoamine (3.5 μl/mg) and plant extract (150 mg/kg (Body weight)). After eight weeks of DEN induction group 2 mice were divided into two subgroups containing seven mice each, subgroup 1 was sacrificed while subgroup 2 was treated with plant extract (150 mg/kg (Body weight)) once in a week for eight consecutive weeks. RESULTS The model of DEN injected hepatocellular carcinomic (HCC) mice elicited significant decline in levels of albumin with concomitant significant elevations in tumor markers aspartate aminotransferase, alanine aminotransferase (ALT), lactate dehydrogenase (LDH), alpha feto protein (AFP), gamma glutamyl transferase (Y-GT), 5 nucleotidase (5NT), glucose-6-phosphate dehydrogenase (G6PDH) and bilirubin. The intraperitoneal administration of B. ciliata as a protective agent, produced significant increase in albumin levels with significant decrease in the levels of tumor markers aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), alpha feto protein (AFP), gamma glutamyl transferase (Y-GT), 5 nucleotidase (5NT), glucose-6-phosphate dehydrogenase (G6PDH) and bilirubin. CONCLUSION Bergenia ciliata has potent antioxidant activity, radical scavenging capacity and anticancerous properties. Bergenia ciliata extracts may provide a basis for development of anti-cancerous drug.
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Affiliation(s)
- K K Dar
- College of Life Science and Technology, Beijing University of Chemical Technology, 100029, Beijing, China
| | - S Ali
- Department of Zoology, Government College University Lahore, Lahore-54000, Pakistan
| | - M Ejaz
- Microbial Biotechnology and Medical Toxicology Laboratory, Department of Zoology, University of Azad Jammu and Kashmir, Muzaffarabad-13100, Pakistan
| | - S Nasreen
- Microbial Biotechnology and Medical Toxicology Laboratory, Department of Zoology, University of Azad Jammu and Kashmir, Muzaffarabad-13100, Pakistan
| | - N Ashraf
- Microbial Biotechnology and Medical Toxicology Laboratory, Department of Zoology, University of Azad Jammu and Kashmir, Muzaffarabad-13100, Pakistan
| | - S F Gillani
- Microbial Biotechnology and Medical Toxicology Laboratory, Department of Zoology, University of Azad Jammu and Kashmir, Muzaffarabad-13100, Pakistan
| | - N Shafi
- Microbial Biotechnology and Medical Toxicology Laboratory, Department of Zoology, University of Azad Jammu and Kashmir, Muzaffarabad-13100, Pakistan
| | - S Safeer
- Microbial Biotechnology and Medical Toxicology Laboratory, Department of Zoology, University of Azad Jammu and Kashmir, Muzaffarabad-13100, Pakistan
| | - M A Khan
- Microbial Biotechnology and Medical Toxicology Laboratory, Department of Zoology, University of Azad Jammu and Kashmir, Muzaffarabad-13100, Pakistan.,School of Material Science and Engineering - MSE, Nanyang Technological University, Singapore
| | - S Andleeb
- Microbial Biotechnology and Medical Toxicology Laboratory, Department of Zoology, University of Azad Jammu and Kashmir, Muzaffarabad-13100, Pakistan
| | - T A Mughal
- Microbial Biotechnology and Medical Toxicology Laboratory, Department of Zoology, University of Azad Jammu and Kashmir, Muzaffarabad-13100, Pakistan
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Hussain SS, Raza A, Shahid S, Asif HH, Ahmad U, Ashraf N. Postoperative Reduction of Intraventricular Hemorrhage Volume: Single- Versus Dual-Catheter Drainage. J Neurol Surg A Cent Eur Neurosurg 2018; 79:279-284. [PMID: 29346831 DOI: 10.1055/s-0037-1617757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND/AIMS The use of single/dual external ventricular drains (EVD) for reducing intraventricular hemorrhage (IVH) is under investigation. A randomized controlled trial was conducted to compare postoperative reduction of IVH volume using single- and dual-catheter drainage in spontaneous IVH patients. We investigated factors that may influence an effective hematoma volume reduction by EVDs. MATERIALS AND METHODS The average cerebrospinal fluid (CSF) drainage volumes were analyzed. Computed tomography (CT) scans were performed on admission, 24 hours and 48 hours after EVD placement, and then on days 5 and 8. Patient group 1 was treated with a single EVD; patient group 2 was treated with bilateral EVDs. The IVH volume was calculated in all ventricles. A multivariate analysis was conducted to investigate variables that can influence the extent of hematoma volume reduction with a bilateral EVD. Regression followed by a Pearson correlation was performed to observe the strength of association of cofounders with the IVH volume reduction. RESULTS The percentage of IVH volume change was found to be significantly higher in the dual-catheter group compared with the single-catheter group (p = 0.0034) after 5 days of EVD. The mean reduction in IVH volume was 17.36 (mL) in patients ≤ 45 years of age and 20.50 (mL) in patients > 45 years. The multivariate analysis suggested the following significant predictors for IVH volume reduction: age of the patient (p = 0.011) and longer duration (days) of EVD (p = 0.028). The age of the patient had a weak positive association and duration of EVD had a positive association with the IVH volume reduction. CONCLUSION Intraventricular drainage via bilateral EVDs may provide a better draining of blood-mixed CSF because it led to faster clot clearance. It is suggested that a longer duration of bilateral EVDs may lead to a greater reduction in IVH volume. Older patients may experience a greater IVH volume reduction by EVD because the volume of CSF increases with cerebral atrophy.
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Affiliation(s)
| | - Asif Raza
- Department of Neurosurgery, Jinnah Hospital, Lahore, Pakistan
| | - Saman Shahid
- Foundation for Advancement of Science and Technology (FAST), National University of Computer and Emerging Sciences (NUCES), Lahore, Pakistan
| | - Hafiz Hamza Asif
- Department of Neurosurgery, Jinnah Hospital, Lahore, Pakistan.,National Hospital & Medical Care, DHA, Lahore, Pakistan
| | - Usman Ahmad
- Department of Neurosurgery, Jinnah Hospital, Lahore, Pakistan
| | - Naveed Ashraf
- Department of Neurosurgery, Jinnah Hospital, Lahore, Pakistan
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Kausar M, Ashraf N, Hayat F, Hashmi AH, Siddiqi S, Anees M. A Recurrent Mutation in CTSK Gene is Responsible for Autosomal Recessive Pycnodysostosis in Consanguineous Pakistani Families. PAK J ZOOL 2017. [DOI: 10.17582/journal.pjz/2017.49.5.1797.1802] [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: 11/24/2022]
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Ashraf N, Foden N, D'Souza A. Closure of the trans-columellar incision in open septorhinoplasty in 100 patients: Use of an absorbable multifilament suture. Clin Otolaryngol 2017; 42:1085-1087. [PMID: 28296204 DOI: 10.1111/coa.12861] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2017] [Indexed: 11/29/2022]
Affiliation(s)
- N Ashraf
- Department of Otolaryngology-Head & Neck Surgery, University Hospital Lewisham, London, UK
| | - N Foden
- Department of Otolaryngology-Head & Neck Surgery, University Hospital Lewisham, London, UK
| | - A D'Souza
- Department of Otolaryngology-Head & Neck Surgery, University Hospital Lewisham, London, UK
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Affiliation(s)
- N Ashraf
- Royal Hallamshire Hospital, Sheffield, UK.
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Ashraf N, Jebreel A. Re: Application of phenol as topical anaesthesia using the Derlacki elevator for myringotomy. Clin Otolaryngol 2016; 40:738. [PMID: 26769689 DOI: 10.1111/coa.12440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2015] [Indexed: 11/29/2022]
Affiliation(s)
- N Ashraf
- Royal Hallamshire Hospital, Sheffield, UK.
| | - A Jebreel
- Royal Hallamshire Hospital, Sheffield, UK
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Mathai D, Shamsuzzaman AKM, Feroz AA, Virani AR, Hasan A, Ravi Kumar KL, Ansari K, Forhad Hossain KA, Marda M, Wahab Zubair MA, Ali MM, Ashraf N, Basha R, Mirza S, Ahmed S, Akhtar S, Ashraf SM, Haque Z. Consensus Recommendation for India and Bangladesh for the Use of Pneumococcal Vaccine in Mass Gatherings with Special Reference to Hajj Pilgrims. J Glob Infect Dis 2016; 8:129-138. [PMID: 27942192 PMCID: PMC5126751 DOI: 10.4103/0974-777x.193749] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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] [Indexed: 12/30/2022] Open
Abstract
Respiratory tract infections are prevalent among Hajj pilgrims with pneumonia being a leading cause of hospitalization. Streptococcus pneumoniae is a common pathogen isolated from patients with pneumonia and respiratory tract infections during Hajj. There is a significant burden of pneumococcal disease in India, which can be prevented. Guidelines for preventive measures and adult immunization have been published in India, but the implementation of the guidelines is low. Data from Bangladesh are available about significant mortality due to respiratory infections; however, literature regarding guidelines for adult immunization is limited. There is a need for extensive awareness programs across India and Bangladesh. Hence, there was a general consensus about the necessity for a rapid and urgent implementation of measures to prevent respiratory infections in pilgrims traveling to Hajj. About ten countries have developed recommendations for pneumococcal vaccination in Hajj pilgrims: France, the USA, Kuwait, Qatar, Bahrain, the UAE (Dubai Health Authority), Singapore, Malaysia, Egypt, and Indonesia. At any given point whether it is Hajj or Umrah, more than a million people are present in the holy places of Mecca and Madina. Therefore, the preventive measures taken for Hajj apply for Umrah as well. This document puts forward the consensus recommendations by a group of twenty doctors following a closed-door discussion based on the scientific evidence available for India and Bangladesh regarding the prevention of respiratory tract infections in Hajj pilgrims.
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Affiliation(s)
- Dilip Mathai
- Apollo Institute of Medical Sciences and Research, Apollo Health City Campus, Hyderabad, Telangana, India
| | | | | | - Amin R Virani
- Prince Aly Khan Hospital, Mazagaon, Mumbai, Maharashtra, India
| | - Ashfaq Hasan
- Department of Pulmonary Medicine, Deccan College of Medical Sciences, Hyderabad, Telangana, India
| | - K L Ravi Kumar
- Department of Microbiology, Central Research Laboratory, Kempegowda Institute of Medical Sciences Hospital, Bengaluru, India
| | - Khalid Ansari
- Kalsekar Hospital, Thane, Mumbai, Maharashtra, India
| | | | - Mahesh Marda
- Premier Hospital, Mehdipatnam, Hyderabad, Telangana, India
| | - M A Wahab Zubair
- Princess Durru Shehvar Children and General Hospital, Hyderabad, Telangana, India
| | | | - N Ashraf
- Khadija National Hospital, New Delhi, India
| | - Riyaz Basha
- Rajiv Gandhi University of Health Sciences, Bengaluru, India
| | | | - Shafeeq Ahmed
- Haj Committee of India, Haj House, CST, Mumbai, Maharashtra, India
| | - Shamim Akhtar
- Department of Respiratory Medicine, St. Stephens Hospital, New Delhi, India
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Salim A, Ahmed A, Ashraf N, Ashar M. Deadly Heat Wave in Karachi, July 2015: Negligence or Mismanagement? Int J Occup Environ Med 2015; 6:249. [PMID: 26498054 PMCID: PMC6977045 DOI: 10.15171/ijoem.2015.678] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 09/15/2015] [Indexed: 12/03/2022]
Affiliation(s)
- A Salim
- Medical Student, Dow Medical College, DUHS, Karachi, Pakistan.
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Motson R, Ashraf N, Taylor H. Laparoscopic anterior resection in a patient with situs inversus--a video vignette. Colorectal Dis 2014; 16:1022-3. [PMID: 25116180 DOI: 10.1111/codi.12745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 08/08/2014] [Indexed: 02/08/2023]
Affiliation(s)
- R Motson
- Department of Colorectal Surgery, The ICENI Centre, Colchester University Hospital, Romfrod, UK
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Ashraf N, Capper R. Should we still be using bismuth iodoform paraffin paste-impregnated gauze as an ear canal dressing following ear surgery? Clin Otolaryngol 2013; 38:357-60. [DOI: 10.1111/coa.12149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2013] [Indexed: 12/01/2022]
Affiliation(s)
- N. Ashraf
- Department of Otolaryngology Head and Neck Surgery; Doncaster Royal Infirmary; Doncaster; UK
| | - R. Capper
- Department of Otolaryngology Head and Neck Surgery; Doncaster Royal Infirmary; Doncaster; UK
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Uzzaman MM, Ratnasingham K, Ashraf N. Meta-analysis of randomized controlled trials comparing lightweight and heavyweight mesh for Lichtenstein inguinal hernia repair. Hernia 2012; 16:505-18. [DOI: 10.1007/s10029-012-0901-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 02/07/2012] [Indexed: 12/01/2022]
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Ashraf N, Uzzaman M. Systematic review and meta-analysis of the use of lightweight versus heavyweight mesh in open inguinal hernia repair (Br J Surg 2012; 99: 29-37). Br J Surg 2012; 99:446; author reply 446. [PMID: 22287080 DOI: 10.1002/bjs.8682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Arbab-Zavar MH, Chamsaz M, Yousefi A, Ashraf N. Electrochemical hydride generation of thallium. Talanta 2009; 79:302-7. [PMID: 19559882 DOI: 10.1016/j.talanta.2009.03.052] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Revised: 03/21/2009] [Accepted: 03/23/2009] [Indexed: 11/26/2022]
Abstract
An electrochemical hydride generation (ECHG) technique was developed to improve the determination of thallium by atomic spectrometry. The technique is based on the catholyte variation system for production of thallium hydride. Using Pb-Sn alloy as cathode, a transient peak shaped signal was achieved and its height, the maximum absorbance value, was taken as an analytical parameter. Parameters that might affect the hydride generation efficiency were investigated and the analytical performance of the method under the optimized experimental conditions was assessed. The linear range was 1-250 ng mL(-1) for thallium and the relative standard deviation of the method was 4.2% (RSD, n=7). The LOD for thallium was found to be 0.8 ng mL(-1), showing a significant improvement relative to conventional chemical hydride generation techniques. The proposed method was applied to the determination of thallium in unalloyed zinc standard reference material. This method offers high sensitivity, simplicity, rapidness, freeness from reagent and low acid consumption.
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Affiliation(s)
- M H Arbab-Zavar
- Department of Chemistry, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran.
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Entezari MH, Sharifalhoseini Z, Ashraf N. Fast and efficient removal of Reactive Black 5 from aqueous solution by a combined method of ultrasound and sorption process. Ultrason Sonochem 2008; 15:433-437. [PMID: 17962064 DOI: 10.1016/j.ultsonch.2007.09.004] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Revised: 07/13/2007] [Accepted: 09/11/2007] [Indexed: 05/25/2023]
Abstract
Removal of Reactive Black 5 (RB5) from aqueous solutions was carried by the sorption process in the presence and in the absence of ultrasound. Sorption of the dye on the solid phase was investigated in a series of batch sorption experiments to determine the influence of different parameters such as contact time, amount of sorbent and concentration of pollutant on the removal efficiency of RB5 with and without ultrasound. The experimental data were fitted properly to the Freundlich model and the isotherm constants were 28.2 and 7.4 for k(f) and 0.13 and 0.38 for 1/n in the presence and in the absence of ultrasound (20 kHz) respectively. The data were analyzed with different sorption kinetic models and were better fitted with a pseudo-second-order kinetic model. Two ultrasonic generators at 20 and 500 kHz were used for sonication of the system. This investigation also reveals that RB5 can be removed by higher frequency apparatus (500 kHz) without sorbent in about 60 min sonication. The rate of removal was higher at the higher frequency than at the lower one.
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Affiliation(s)
- M H Entezari
- Department of Chemistry, Ferdowsi University of Mashhad, 91775 Mashhad, Iran.
| | - Z Sharifalhoseini
- Department of Chemistry, Ferdowsi University of Mashhad, 91775 Mashhad, Iran
| | - N Ashraf
- Department of Chemistry, Ferdowsi University of Mashhad, 91775 Mashhad, Iran
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Zino S, Ashraf N, Kingsmore D, Payne A, George W, Shiels P. 299 POSTER Altered SIRT2 and SIRT6 expression is associated with breast cancer. Eur J Surg Oncol 2006. [DOI: 10.1016/s0748-7983(06)70734-x] [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: 11/16/2022] Open
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Ashraf N, Zino S, George W, Shiels P. 270 POSTER Sirtuin expression correlates with irradiation and paclitaxel treatment in breast cancer. Eur J Surg Oncol 2006. [DOI: 10.1016/s0748-7983(06)70705-3] [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: 10/23/2022] Open
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49
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Ashraf N, Zino S, MacIntyre A, Kingsmore D, Payne AP, George WD, Shiels PG. Altered sirtuin expression is associated with node-positive breast cancer. Br J Cancer 2006; 95:1056-61. [PMID: 17003781 PMCID: PMC2360714 DOI: 10.1038/sj.bjc.6603384] [Citation(s) in RCA: 180] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Sirtuins are genes implicated in cellular and organismal ageing. Consequently, they are speculated to be involved in diseases of ageing including cancer. Various cancers with widely differing prognosis have been shown to have differing and characteristic expression of these genes; however, the relationship between sirtuin expression and cancer progression is unclear. In order to correlate cancer progression and sirtuin expression, we have assessed sirtuin expression as a function of primary cell ageing and compared sirtuin expression in normal, ‘nonmalignant’ breast biopsies to breast cancer biopsies using real-time polymerase chain reaction (PCR). Levels of SIRT7 expression were significantly increased in breast cancer (P<0.0001). Increased levels of SIRT3 and SIRT7 transcription were also associated with node-positive breast cancer (P<0.05 and P<0.0001, respectively). This study has demonstrated differential sirtuin expression between nonmalignant and malignant breast tissue, with consequent diagnostic and therapeutic implications.
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Affiliation(s)
- N Ashraf
- Division of Cancer Sciences and Molecular Pathology, Department of Surgery, University of Glasgow, Western Infirmary Glasgow, 44 Church Street, Glasgow G11 6NT, UK
| | - S Zino
- Division of Cancer Sciences and Molecular Pathology, Department of Surgery, University of Glasgow, Western Infirmary Glasgow, 44 Church Street, Glasgow G11 6NT, UK
| | - A MacIntyre
- Division of Cancer Sciences and Molecular Pathology, Department of Surgery, University of Glasgow, Western Infirmary Glasgow, 44 Church Street, Glasgow G11 6NT, UK
| | - D Kingsmore
- Renal Transplant Unit, Western Infirmary Glasgow, Glasgow, UK
| | - A P Payne
- IBLS, University of Glasgow, Glasgow, UK
| | - W D George
- Division of Cancer Sciences and Molecular Pathology, Department of Surgery, University of Glasgow, Western Infirmary Glasgow, 44 Church Street, Glasgow G11 6NT, UK
| | - P G Shiels
- Division of Cancer Sciences and Molecular Pathology, Department of Surgery, University of Glasgow, Western Infirmary Glasgow, 44 Church Street, Glasgow G11 6NT, UK
- E-mail:
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Sklavounou E, Hay A, Ashraf N, Lamb K, Brown E, Mac Intyre A, George WD, Hartley RC, Shiels PG. The use of telomere biology to identify and develop superior nitrone based anti-oxidants. Biochem Biophys Res Commun 2006; 347:420-7. [PMID: 16828709 DOI: 10.1016/j.bbrc.2006.06.087] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Accepted: 06/15/2006] [Indexed: 11/28/2022]
Abstract
We have employed a biological chemistry approach to dissect the mechanisms underpinning cellular responses to oxidant stress and to develop biologically relevant anti-oxidants. We have used telomere biology to define cellular stress responses and have observed telomere independent, p21- and p16-dependent stasis following oxidative insult in human fibroblasts. This was accompanied by a [corrected] reduction in XRCC5 expression and a reduction in [corrected] SIRT 1 expression. Using these markers in conjunction with senescence-associated beta-galactosidase expression, we have developed and screened novel nitrone based anti-oxidant compounds. We have identified functional compounds that are unsuitable for use in primary human cells. This has allowed subsequent identification of suitably structured compounds that act as superior biological anti-oxidants, which have potential for use in clinical interventions.
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Affiliation(s)
- E Sklavounou
- Division of Cancer Sciences and Molecular Pathology University of Glasgow, Glasgow G12 8QQ, UK
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