Cross-sectional study identifying forms of tobacco used by Shisha smokers in Pakistan.

OBJECTIVES: To estimate the frequency of different forms of tobacco intake such as smoker's tobacco, chewable tobacco and snuff tobacco among shisha smoker's and to study the patterns and predictors of shisha smoking affecting youth from different cities of Pakistan. METHODS: A cross-sectional study was conducted including youth from four cities. Participants were asked to fill out a data collection tool at shisha cafes, shopping malls and restaurants. Data was analyzed using SPSSv.18. RESULTS: A total of 406 participants, 296 (73%) males and 110 (27%) females were included in the study. There were 163 (40%) cigarette smokers; 65 (16%) chewed tobacco and 33 (8%) snuffed it. The median age at initiation of Shisha smoking was 20 years. 280 (69%) considered Shisha smoking to be less deleterious to health than cigarettes. Respiratory disease was the most commonly cited health effect reported. Most 248 (61%) of the participants were infrequent shisha smokers. CONCLUSION: There is high frequency of tobacco usage in the form of cigarettes, chewable tobacco and snuff tobacco among shisha smokers of Pakistan. The highest frequency is for cigarette smoking. The rise in Shisha smoking as a trendy social habit appears to be occurring despite emerging scientific evidence of its potential health risks.

Awake Craniotomy with Noninvasive Brain Mapping by 3-Tesla Functional Magnetic Resonance Imaging for Excision of Low-grade Glioma: A Case of a Young Patient from Pakistan.

The past few years have seen increasing support for gross total resection in the management of low-grade gliomas (LGGs), with a greater extent of resection correlated with better overall survival, progression-free survival, and time to malignant transformation. There is consistent evidence in literature supporting extent of safe resection as a good prognostic indicator as well as positively affecting seizure control, symptomatic relief in pressure symptoms, and longer progression-free and total survival. The operative goal in most LGG cases is to maximize the extent of resection for these benefits while avoiding postoperative neurologic deficits. Several advanced invasive and noninvasive surgical techniques such as intraoperative magnetic resonance imaging (MRI), fluorescence-guided surgery, intraoperative functional pathway mapping, and neuronavigation have been developed in an attempt to better achieve maximal safe resection. We present a case of LGG in a young patient with a 5-year history of refractory seizures and gradual onset walking difficulty. Serial MRI brain scans revealed a progressive increase in right frontal tumor size with substantial edema and parafalcine herniation. Noninvasive brain mapping by functional MRI (fMRI) and sleep-awake-sleep type of anesthesia with endotracheal tube insertion was utilized during an awake craniotomy. Histopathology confirmed a Grade II oligodendroglioma, and genetic analysis revealed no codeletion at 1p/19q. Neurological improvement was remarkable in terms of immediate motor improvement, and the patient remained completely seizure free on a single antiepileptic drug. There is no radiologic or clinical evidence of recurrence 6 months postoperatively. This is the first published report of an awake craniotomy for LGG in Pakistan. The contemporary concept of supratotal resection in LGGs advocates generous functional resection even beyond MRI findings rather than mere excision of oncological boundaries. This relatively aggressive approach is only possible with an awake craniotomy, which ensures preservation of functional status and thus less postoperative morbidity and better outcomes. Noninvasive mapping for intracranial space-occupying lesions, including fMRI and blood-oxygen-level dependent (BOLD) imaging modality, is an essential tool in a resource-limited setting such as Pakistan.

Microdiscectomy for lumbosacral disc herniation and frequency of failed disc surgery.

BACKGROUND: Microdiscectomy for lumbosacral disc herniations is one of the most commonly performed neurosurgical procedures. The patient demographics, symptomatology, and recovery are highly variable, and surgical outcomes depend on several factors, including patient demographics. Failed disc surgery refers to failure of improvement in patient's symptoms following microdiscectomy, and has been observed to occur in up to 12% of patients. To date, no study form Pakistan has looked into patient demographics and failed disc surgery rates within the local context. OBJECTIVE: The aim of this study was to review the demographics of the patient population presenting for surgical treatment of lumbosacral disc herniations and to review our results of lumbosacral microdiscectomy at a university hospital in Pakistan. METHODS: This is a retrospective analysis of all adult patients admitted from January 2003 to January 2008 for symptomatic lumbosacral disc herniation requiring microdiscectomy, at the Aga Khan University Hospital, Karachi. Data were collected through our medical records, on a standardized form. Basic information about the patient population, disease process, modes of nonsurgical treatment, and details on surgery and postoperative course were recorded and analyzed using SPSS. RESULTS: Five hundred one patients were studied, based on inclusion criteria. The mean age was 41.2 years; 347 (69%) patients were male and 154 (31%) female. Mean body mass index of the population was 26 and was higher in females. All patients primarily presented with radiculopathy, and the mean duration of these symptoms was 438 days. Mean duration of nonoperative management was 53 weeks. Fifty-one patients (10.2%) had previously undergone spine surgery. A total of 442 (88%) patients were operated at single disc level, and the rest at two levels. Sixty-six (13%) patients were operated for upper lumbar disc herniations. Mean operative time was 94 minutes, and the most common complication was dural tear. Mean length of hospital stay was 5 days (2-12 days). Mean follow-up was 48.3 weeks (4 weeks to 14 years). Complete resolution of symptoms was seen in 360 (71.9%) patients and failed disc surgery was diagnosed in 42 (8.4%) patients. Twenty-six patients (5.2%) were reoperated upon, with gradual improvement. The authors report an overall failed back surgery rate of 8.38%. CONCLUSIONS: Overall our results were comparable to published international literature. However, the authors observed significant differences in demographics, especially in terms of age, gender distribution, and mean BMI of patient population as well as frequency of involvement of upper lumbar discs.