Background: Most of Road traffic injuries are predicted to be the third leading contributor to th... more Background: Most of Road traffic injuries are predicted to be the third leading contributor to the global burden of disease by 2020 and patients end up into head injuries which leave devastating impacts on individual and society. Quality of Life After Brain Injury (QOLIBRI) is a specific tool that measures quality of life in head injury patients. Methods: This was a cross sectional study among 300 patients aged 15-45 years, attended emergency department of the Aga khan University Hospital. Structured questionnaire included demography, injury details, QOLIBRI, GOSE and WHO Disability Assessment Scale (WHODAS 12 items). Severity of injury was determined by Glasgow coma score of subjects reported in emergency department on admission. This was one time telephonic survey in which bidirectional data was collected from subjects about injury and outcome (QOLIBRI). To identify the determinants of QOL among RTI survivors with head injury multiple linear regressions was applied. Results: The mean QOL score for study sample was 69.86 ± (15.89. Most of the patients 210 (70%) were motorbike rider followed by four-wheelers 69 (23%). Mean age of RTI participants was 28.10 ± (7.68) years. The quality of life decreases with increase in severity of head injury by-697.32 (95% CI;-1006.44,-388.20). Conclusions: This study suggests severity of head injury, recovery time, surgery resulting from RTA, employment, family system and disability to have long term impact on QOL of RTI survivors.
A prevalence survey on hepatitis B and C infections was carried out to obtain national estimates ... more A prevalence survey on hepatitis B and C infections was carried out to obtain national estimates and assess epidemiological dynamics and underlying risk factors. Overall prevalence of hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (HCV) of 2.5% and 4.8%, respectively, reflected a combined infection rate of 7.6% in the general population, consistent with an ongoing high burden of chronic liver disease (CLD). There was significant association of these viral infections with a range of risk factors led by reuse of syringes. These findings validate currently implemented strategies by the national programme for the control of hepatitis viral infections, including universal vaccination of newborns and high-risk groups, support of auto-disable syringes, promotion of infection control and patient safety, public health education, and management of needy CLD patients as a poverty-reduction health intervention.
Journal of Pakistan Medical Association, Feb 7, 2023
Recovery after spinal cord injury (SCI) is highly variable, often leaving the victim disabled for... more Recovery after spinal cord injury (SCI) is highly variable, often leaving the victim disabled for life and having to deal with the complications of paraplegia. Stem cell therapy is a potential hope for these patients. Most of the research on use of stem cells for SCI has been on animal models in laboratories. Some recent clinical trials involving human subjects have shown positive outcomes with regards to tissue growth after transplantation, but meaningful functional recovery is yet to be seen. The emergence of lumbar cord simulation is a new approach and the recent identification of recovery organizing interneurons points to a pathway that could integrate neuromodulation with cellular therapy. Keywords: Spinal Cord, Paraplegia, Stem Cell, Transplantation, Interneurons
the youngest, a 50 year old woman with a complete D 1I paraplegia of several days' duration, had ... more the youngest, a 50 year old woman with a complete D 1I paraplegia of several days' duration, had only a minimal and transient improvement in her neurological state and died shortly thereafter. Early and accurate diagnosis and the appropriate surgical approach are essential.
Although radiographic and clinical appearance may suggest the pathological diagnosis of a mass le... more Although radiographic and clinical appearance may suggest the pathological diagnosis of a mass lesion located within vital areas of the brainstem, surgeons frequently have elected to treat patient without the benefit of a tissue diagnosis. Such an emperic approach often leads to inappropriate therapy. We present five patients with intrinsic brainstem lesions who underwent CT guided stereotactic biopsy using CRW stereotactic frame. Positive diagnosis was achieved in all cases. There was no operative morbidity, however, one patient died of postoperative intratumoural haematoma.
Injuries and deaths due to road traffic crashes (RTC) are major public health concern. The Road T... more Injuries and deaths due to road traffic crashes (RTC) are major public health concern. The Road Traffic Injury Research and Prevention Center, collects RTC data on injuries and fatalities from five emergency departments in Karachi. Data generating process (DGP) for RTC from 2007 to 2014, for monthly number of fatal and injured victims were analyzed using autoregressive integrated moving average and vector auto regression, time series models. Results provide strong evidence that the DGP for the current levels of the number of fatalities and injured owing to RTCs are significantly influenced by the own past history of the two series. The analysis with the impulseresponse function also indicated that there is a slight seasonality pattern in the number of injured and fatalities. The similar behaviour and association of the two variables suggest that certain conditions e.g. road conditions, weather, volume of vehicles, and accidents might be persistent in time in Karachi.
The age of most of the patients at the time of myelomeningocele repair was between 25-30 days; ho... more The age of most of the patients at the time of myelomeningocele repair was between 25-30 days; however, children with ruptured myelomeningocele were consistently repaired early. All paraplegic patients with dorsolumbar myelomeningocele were treated with either a low-pressure ventriculoperitoneal (VP) shunt only, direct repair or both. Patients with cervical, dorsal and lumbo-sacral myelomeningocele requiring VP shunt were operated either simultaneously for both procedures or with delayed insertions of a VP shunt after treatment of ventriculitis All 16 patients with ruptured myelomeningocele (3.8%) were treated for repair as well as ventriculitis. Complications including CSF leak, wound infection or necrosis after repair of myelomeningocele occurred in 22 cases (5.3%). The postoperative follow up for all patients was 1-2 years. Surgical intervention with a low-pressure VP shunt in large dorsolumbar myelomeningocele produced good results. Myelomeningocele, Spina bifida, Ventriculitis. Hydrocephalus.
Background: Each year world-wide about 65 million people sustain a mild traumatic brain injury (m... more Background: Each year world-wide about 65 million people sustain a mild traumatic brain injury (mTBI). Fatigue is a common and distressing symptom after mTBI. We examine the effect of tranexamic acid (TXA) on fatigue in patients with mTBI using data from the CRASH-3 trial. Methods: The CRASH-3 trial randomised 9,202 patients with traumatic brain injury and no significant extracranial bleeding to receive TXA or placebo within 3 hours of injury. The primary outcome was death from head injury within 28 days of injury. The methods and results are presented elsewhere. Fatigue was recorded as “None”, “Moderate” or “Extreme.” This study examines the effect of TXA on extreme fatigue in the 2,632 patients with mTBI (Glasgow Coma Scale [GCS] score≥13). Our analyses were not prespecified. Results: Our study primary outcome, extreme fatigue, was reported for 10 (0.8%) of 1,328 patients receiving TXA and 19 (1.5%) of 1,288 patients receiving placebo (risk ratio [RR]=0.51, 95% confidence interval...
JPMA. The Journal of the Pakistan Medical Association, 2020
The guidelines for management of traumatic brain injury (TBI) are based largely on measures to ma... more The guidelines for management of traumatic brain injury (TBI) are based largely on measures to maintain an optimum internal milieu for prevention of secondary brain injury and enhancing recovery. One of the most common reasons for worsening outcomes following TBI is expanding intracranial haematoma which is compounded by the fibrinolytic physiology that follows TBI. Tranexamic acid (TXA) has a time tested role in preventing poor outcomes linked to excessive haemorrhage in trauma patients. Historically, patients with isolated head trauma were excluded from TXA use due to a theoretical increased risk of thrombosis. Recent evidence that redefines the beneficial role of early TXA administration in preventing mortality amongst patients with TBI is now at hand and offers a real prospect of a pharmacological intervention that would be adopted as a recommendation based on Class l evidence.
Journal of Pakistan Medical Association, Dec 15, 2022
Objective: To observe the patient characteristics and centres providing neuro-oncological care in... more Objective: To observe the patient characteristics and centres providing neuro-oncological care in public and private health hospitals in Pakistan. Methods: The Pakistan Association of Neuro-oncology carried out a retrospective, cross-sectional study in 2019 on patients admitted to 32 hospitals in Pakistan, with dedicated neurosurgical facilities. Patients with a histopathological diagnosis of an intracranial tumour were included. Results: Public health care facilities catered for 84% patients with ages between 20 and 60 years and children having intracranial tumours. Private centres were utilised by 66.7% patients from the upper socioeconomic sector. More patients were lost to follow-up in the public sector (n = 784) versus in the private sector (n = 356). Mortality was also higher in the public sector hospitals, (13.9%) as compared to 9.6% in the private sector. Conclusion: Public and private sector health services for neuro-oncological care in Pakistan still have a long way to go to cover the gaps for unmet needs. Strengthening health systems for brain tumour care is imperative to increase both the access to care and the quality of care to fulfil this need. Keywords: Retrospective study, Health systems, Brain neoplasms, Health care, Epidemiology, Chemoradiotherapy.
INTRODUCTION: The concept of brain death was first formally presented in United States of America... more INTRODUCTION: The concept of brain death was first formally presented in United States of America in 1968 (Ad Hoc Committee of the Harvard Medical School to examine the definition of Brain Death, 1968) in part to facilitate organ donation. It is a widely accepted term in most countries but some like Japan do not consider it as death. According toAAN, brain death is defined as death due to irreversible loss of function of the entire brain-comparable to circulatory death, which is defined as irreversible loss of function of the circulatory system. The purpose of our study is to review brain death protocols from various parts of the world to ultimately formulate a concise brain death protocol for Pakistan. Methods: In this study, a secondary research design was used, comparing the different brain death protocols of Muslim and non-Muslim countries. This study was conducted at Aga Khan University Hospital, an urban tertiary care hospital. A convenient purposive sampling technique was used in which countries were selected on the basis of being either developed or non-developed and Muslim or Non-Muslim. In short, a total of 13 countries and their brain death protocols were selected and compared over a 6 month period from October 2019 to March 2020. Results: Thirteen countries were selected on the basis of religion and whether or not they had a brain death protocol made to be followed within their countries and their protocol documents were compared. Of these countries, 4 were Muslim and 9 Non-Muslim. Some of these did not have their own particular protocol fashioned but rather had one molded on the pattern of other developed countries for e.g., Bangladesh and Pakistan following the AAN, India following the UK and Japan do not consider brain death as death. Variations exist across countries over definition and protocols. In the absence of a national guideline or protocol in Pakistan, some centers have devised their own protocol. The Transplantation of Human Organs and Tissues Act 2010 of Pakistan provide the definition of brain death only for organ transplantation but no protocol is annexed with this law. This comparative study of brain death protocols across the globe clearly identifies a need for a national guideline related to brain death from health care authorities in Pakistan. Based on this study it is feasible to devise a culturally and ethically acceptable scientific protocol which fulfills current and future needs of the country. Conclusion: There is no official brain death protocol for Pakistan. Different institutions and hospitals have published their own protocols but with significant variation between those as well. Hence, the need arises for a standardized national brain death criterion for Pakistan that is approved by the medical regulatory institutions such as The Pakistan Health and Research Council ,
Bone biopsies have been obtained with a variety of manually operated devices over the years. Rece... more Bone biopsies have been obtained with a variety of manually operated devices over the years. Recently we have begun using an electric bone drill in select cases. We have observed that samples obtained with this device are longer, less fragmented, and have cleaner edges than those obtained with the same sized manual counterpart. We designed a simple study where manually acquired and drill-acquired cores from a pig model were reviewed in a blinded fashion by a pathologist to determine whether there was any histologic benefit to obtaining samples with the drill. Materials and Methods: A total of 30 11-gauge cores were obtained from the proximal femora of five previously healthy pigs in an animal lab under fluoroscopic guidance. Fifteen were obtained manually with the Osteo-Site Bone Biopsy Set (Cook Medical) and fifteen were obtained with the OnControl Powered Bone Access drill (Vidacare)-three of each per pig. Fresh samples were delivered to a single board-certified pathologist for blinded gross and microscopic characterization. Cores were evaluated grossly for size and number of fragments and edge characterization, and then microscopically for architectural and histologic preservation and presence or absence of "bone dust," which can degrade sample preparation. Gross and microscopic specimen photographs were obtained. Results: Number of fragments per core ranged from 2-6, and was not significantly different between the two groups (average: 3 fragments). Maximum fragment length did not vary significantly between the two groups. Cores obtained with the drill measured 1.5 mm in diameter while those obtained manually measured only 1 mm, despite both systems being 11-gauge. Microscopically, "bone dust" was visible on all manually obtained samples but on none of those acquired with the drill. While the edges of all samples acquired manually were irregular microscopically, tissue architecture and histologic characteristics were preserved in both groups. Conclusion: Despite easier sample acquisition and superior gross characteristics of specimens acquired with the drill, no significant microscopic differences were identified by our pathologist with architectural and histologic preservation in both groups.
International Journal of Clinical Practice, May 18, 2021
Low‐ and middle‐income countries account for over 90% of all road traffic injury deaths. Despite ... more Low‐ and middle‐income countries account for over 90% of all road traffic injury deaths. Despite this, formal training in trauma management is not widely adopted in these countries. No specific training was available in prehospital or emergency department for life support before primary trauma care (PTC) course. This study was conducted to assess the effectiveness of the PTC course in the improvement of knowledge and skills of trauma management among participant in Pakistan.
Background: Most of Road traffic injuries are predicted to be the third leading contributor to th... more Background: Most of Road traffic injuries are predicted to be the third leading contributor to the global burden of disease by 2020 and patients end up into head injuries which leave devastating impacts on individual and society. Quality of Life After Brain Injury (QOLIBRI) is a specific tool that measures quality of life in head injury patients. Methods: This was a cross sectional study among 300 patients aged 15-45 years, attended emergency department of the Aga khan University Hospital. Structured questionnaire included demography, injury details, QOLIBRI, GOSE and WHO Disability Assessment Scale (WHODAS 12 items). Severity of injury was determined by Glasgow coma score of subjects reported in emergency department on admission. This was one time telephonic survey in which bidirectional data was collected from subjects about injury and outcome (QOLIBRI). To identify the determinants of QOL among RTI survivors with head injury multiple linear regressions was applied. Results: The mean QOL score for study sample was 69.86 ± (15.89. Most of the patients 210 (70%) were motorbike rider followed by four-wheelers 69 (23%). Mean age of RTI participants was 28.10 ± (7.68) years. The quality of life decreases with increase in severity of head injury by-697.32 (95% CI;-1006.44,-388.20). Conclusions: This study suggests severity of head injury, recovery time, surgery resulting from RTA, employment, family system and disability to have long term impact on QOL of RTI survivors.
A prevalence survey on hepatitis B and C infections was carried out to obtain national estimates ... more A prevalence survey on hepatitis B and C infections was carried out to obtain national estimates and assess epidemiological dynamics and underlying risk factors. Overall prevalence of hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (HCV) of 2.5% and 4.8%, respectively, reflected a combined infection rate of 7.6% in the general population, consistent with an ongoing high burden of chronic liver disease (CLD). There was significant association of these viral infections with a range of risk factors led by reuse of syringes. These findings validate currently implemented strategies by the national programme for the control of hepatitis viral infections, including universal vaccination of newborns and high-risk groups, support of auto-disable syringes, promotion of infection control and patient safety, public health education, and management of needy CLD patients as a poverty-reduction health intervention.
Journal of Pakistan Medical Association, Feb 7, 2023
Recovery after spinal cord injury (SCI) is highly variable, often leaving the victim disabled for... more Recovery after spinal cord injury (SCI) is highly variable, often leaving the victim disabled for life and having to deal with the complications of paraplegia. Stem cell therapy is a potential hope for these patients. Most of the research on use of stem cells for SCI has been on animal models in laboratories. Some recent clinical trials involving human subjects have shown positive outcomes with regards to tissue growth after transplantation, but meaningful functional recovery is yet to be seen. The emergence of lumbar cord simulation is a new approach and the recent identification of recovery organizing interneurons points to a pathway that could integrate neuromodulation with cellular therapy. Keywords: Spinal Cord, Paraplegia, Stem Cell, Transplantation, Interneurons
the youngest, a 50 year old woman with a complete D 1I paraplegia of several days' duration, had ... more the youngest, a 50 year old woman with a complete D 1I paraplegia of several days' duration, had only a minimal and transient improvement in her neurological state and died shortly thereafter. Early and accurate diagnosis and the appropriate surgical approach are essential.
Although radiographic and clinical appearance may suggest the pathological diagnosis of a mass le... more Although radiographic and clinical appearance may suggest the pathological diagnosis of a mass lesion located within vital areas of the brainstem, surgeons frequently have elected to treat patient without the benefit of a tissue diagnosis. Such an emperic approach often leads to inappropriate therapy. We present five patients with intrinsic brainstem lesions who underwent CT guided stereotactic biopsy using CRW stereotactic frame. Positive diagnosis was achieved in all cases. There was no operative morbidity, however, one patient died of postoperative intratumoural haematoma.
Injuries and deaths due to road traffic crashes (RTC) are major public health concern. The Road T... more Injuries and deaths due to road traffic crashes (RTC) are major public health concern. The Road Traffic Injury Research and Prevention Center, collects RTC data on injuries and fatalities from five emergency departments in Karachi. Data generating process (DGP) for RTC from 2007 to 2014, for monthly number of fatal and injured victims were analyzed using autoregressive integrated moving average and vector auto regression, time series models. Results provide strong evidence that the DGP for the current levels of the number of fatalities and injured owing to RTCs are significantly influenced by the own past history of the two series. The analysis with the impulseresponse function also indicated that there is a slight seasonality pattern in the number of injured and fatalities. The similar behaviour and association of the two variables suggest that certain conditions e.g. road conditions, weather, volume of vehicles, and accidents might be persistent in time in Karachi.
The age of most of the patients at the time of myelomeningocele repair was between 25-30 days; ho... more The age of most of the patients at the time of myelomeningocele repair was between 25-30 days; however, children with ruptured myelomeningocele were consistently repaired early. All paraplegic patients with dorsolumbar myelomeningocele were treated with either a low-pressure ventriculoperitoneal (VP) shunt only, direct repair or both. Patients with cervical, dorsal and lumbo-sacral myelomeningocele requiring VP shunt were operated either simultaneously for both procedures or with delayed insertions of a VP shunt after treatment of ventriculitis All 16 patients with ruptured myelomeningocele (3.8%) were treated for repair as well as ventriculitis. Complications including CSF leak, wound infection or necrosis after repair of myelomeningocele occurred in 22 cases (5.3%). The postoperative follow up for all patients was 1-2 years. Surgical intervention with a low-pressure VP shunt in large dorsolumbar myelomeningocele produced good results. Myelomeningocele, Spina bifida, Ventriculitis. Hydrocephalus.
Background: Each year world-wide about 65 million people sustain a mild traumatic brain injury (m... more Background: Each year world-wide about 65 million people sustain a mild traumatic brain injury (mTBI). Fatigue is a common and distressing symptom after mTBI. We examine the effect of tranexamic acid (TXA) on fatigue in patients with mTBI using data from the CRASH-3 trial. Methods: The CRASH-3 trial randomised 9,202 patients with traumatic brain injury and no significant extracranial bleeding to receive TXA or placebo within 3 hours of injury. The primary outcome was death from head injury within 28 days of injury. The methods and results are presented elsewhere. Fatigue was recorded as “None”, “Moderate” or “Extreme.” This study examines the effect of TXA on extreme fatigue in the 2,632 patients with mTBI (Glasgow Coma Scale [GCS] score≥13). Our analyses were not prespecified. Results: Our study primary outcome, extreme fatigue, was reported for 10 (0.8%) of 1,328 patients receiving TXA and 19 (1.5%) of 1,288 patients receiving placebo (risk ratio [RR]=0.51, 95% confidence interval...
JPMA. The Journal of the Pakistan Medical Association, 2020
The guidelines for management of traumatic brain injury (TBI) are based largely on measures to ma... more The guidelines for management of traumatic brain injury (TBI) are based largely on measures to maintain an optimum internal milieu for prevention of secondary brain injury and enhancing recovery. One of the most common reasons for worsening outcomes following TBI is expanding intracranial haematoma which is compounded by the fibrinolytic physiology that follows TBI. Tranexamic acid (TXA) has a time tested role in preventing poor outcomes linked to excessive haemorrhage in trauma patients. Historically, patients with isolated head trauma were excluded from TXA use due to a theoretical increased risk of thrombosis. Recent evidence that redefines the beneficial role of early TXA administration in preventing mortality amongst patients with TBI is now at hand and offers a real prospect of a pharmacological intervention that would be adopted as a recommendation based on Class l evidence.
Journal of Pakistan Medical Association, Dec 15, 2022
Objective: To observe the patient characteristics and centres providing neuro-oncological care in... more Objective: To observe the patient characteristics and centres providing neuro-oncological care in public and private health hospitals in Pakistan. Methods: The Pakistan Association of Neuro-oncology carried out a retrospective, cross-sectional study in 2019 on patients admitted to 32 hospitals in Pakistan, with dedicated neurosurgical facilities. Patients with a histopathological diagnosis of an intracranial tumour were included. Results: Public health care facilities catered for 84% patients with ages between 20 and 60 years and children having intracranial tumours. Private centres were utilised by 66.7% patients from the upper socioeconomic sector. More patients were lost to follow-up in the public sector (n = 784) versus in the private sector (n = 356). Mortality was also higher in the public sector hospitals, (13.9%) as compared to 9.6% in the private sector. Conclusion: Public and private sector health services for neuro-oncological care in Pakistan still have a long way to go to cover the gaps for unmet needs. Strengthening health systems for brain tumour care is imperative to increase both the access to care and the quality of care to fulfil this need. Keywords: Retrospective study, Health systems, Brain neoplasms, Health care, Epidemiology, Chemoradiotherapy.
INTRODUCTION: The concept of brain death was first formally presented in United States of America... more INTRODUCTION: The concept of brain death was first formally presented in United States of America in 1968 (Ad Hoc Committee of the Harvard Medical School to examine the definition of Brain Death, 1968) in part to facilitate organ donation. It is a widely accepted term in most countries but some like Japan do not consider it as death. According toAAN, brain death is defined as death due to irreversible loss of function of the entire brain-comparable to circulatory death, which is defined as irreversible loss of function of the circulatory system. The purpose of our study is to review brain death protocols from various parts of the world to ultimately formulate a concise brain death protocol for Pakistan. Methods: In this study, a secondary research design was used, comparing the different brain death protocols of Muslim and non-Muslim countries. This study was conducted at Aga Khan University Hospital, an urban tertiary care hospital. A convenient purposive sampling technique was used in which countries were selected on the basis of being either developed or non-developed and Muslim or Non-Muslim. In short, a total of 13 countries and their brain death protocols were selected and compared over a 6 month period from October 2019 to March 2020. Results: Thirteen countries were selected on the basis of religion and whether or not they had a brain death protocol made to be followed within their countries and their protocol documents were compared. Of these countries, 4 were Muslim and 9 Non-Muslim. Some of these did not have their own particular protocol fashioned but rather had one molded on the pattern of other developed countries for e.g., Bangladesh and Pakistan following the AAN, India following the UK and Japan do not consider brain death as death. Variations exist across countries over definition and protocols. In the absence of a national guideline or protocol in Pakistan, some centers have devised their own protocol. The Transplantation of Human Organs and Tissues Act 2010 of Pakistan provide the definition of brain death only for organ transplantation but no protocol is annexed with this law. This comparative study of brain death protocols across the globe clearly identifies a need for a national guideline related to brain death from health care authorities in Pakistan. Based on this study it is feasible to devise a culturally and ethically acceptable scientific protocol which fulfills current and future needs of the country. Conclusion: There is no official brain death protocol for Pakistan. Different institutions and hospitals have published their own protocols but with significant variation between those as well. Hence, the need arises for a standardized national brain death criterion for Pakistan that is approved by the medical regulatory institutions such as The Pakistan Health and Research Council ,
Bone biopsies have been obtained with a variety of manually operated devices over the years. Rece... more Bone biopsies have been obtained with a variety of manually operated devices over the years. Recently we have begun using an electric bone drill in select cases. We have observed that samples obtained with this device are longer, less fragmented, and have cleaner edges than those obtained with the same sized manual counterpart. We designed a simple study where manually acquired and drill-acquired cores from a pig model were reviewed in a blinded fashion by a pathologist to determine whether there was any histologic benefit to obtaining samples with the drill. Materials and Methods: A total of 30 11-gauge cores were obtained from the proximal femora of five previously healthy pigs in an animal lab under fluoroscopic guidance. Fifteen were obtained manually with the Osteo-Site Bone Biopsy Set (Cook Medical) and fifteen were obtained with the OnControl Powered Bone Access drill (Vidacare)-three of each per pig. Fresh samples were delivered to a single board-certified pathologist for blinded gross and microscopic characterization. Cores were evaluated grossly for size and number of fragments and edge characterization, and then microscopically for architectural and histologic preservation and presence or absence of "bone dust," which can degrade sample preparation. Gross and microscopic specimen photographs were obtained. Results: Number of fragments per core ranged from 2-6, and was not significantly different between the two groups (average: 3 fragments). Maximum fragment length did not vary significantly between the two groups. Cores obtained with the drill measured 1.5 mm in diameter while those obtained manually measured only 1 mm, despite both systems being 11-gauge. Microscopically, "bone dust" was visible on all manually obtained samples but on none of those acquired with the drill. While the edges of all samples acquired manually were irregular microscopically, tissue architecture and histologic characteristics were preserved in both groups. Conclusion: Despite easier sample acquisition and superior gross characteristics of specimens acquired with the drill, no significant microscopic differences were identified by our pathologist with architectural and histologic preservation in both groups.
International Journal of Clinical Practice, May 18, 2021
Low‐ and middle‐income countries account for over 90% of all road traffic injury deaths. Despite ... more Low‐ and middle‐income countries account for over 90% of all road traffic injury deaths. Despite this, formal training in trauma management is not widely adopted in these countries. No specific training was available in prehospital or emergency department for life support before primary trauma care (PTC) course. This study was conducted to assess the effectiveness of the PTC course in the improvement of knowledge and skills of trauma management among participant in Pakistan.
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Papers by Rashid Jooma