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Biomedical subjects

N Husain

Publications and source records attributed to N Husain.

At least 19 recordsLinked to original sources

Dumbbell-shaped paraganglioma of the cervical spine in a child.

Paragangliomas are tumors arising from extra-adrenal paraganglia and account for 0.3% of all neoplasms. The carotid body and temporal bone are the most frequent sites of paraganglioma, though it has been reported to occur in almost every part of the body. Spinal paragangliomas are uncommon and mainly take the form of intradural compression of the cauda equina or thoracic cord. Extradural paragangliomas are still rare; only few cases involving the dorsolumbar spine have been reported. We are reporting an interesting case of a dumbbell-shaped primary extradural paraganglioma of the cervical spine in an 8-year-old boy that presented with progressively increasing spastic quadriparesis.

Cervical Vertebrae↗

Life stress and depression in a tribal area of Pakistan.

BACKGROUND: Depression is common in Pakistan but no research on this subject has been reported from the North West Frontier Province (NWFP), host to numerous Afghan refugees. AIMS: To measure depressive symptoms and associated features in a population-based sample. METHOD: A Pushto translation of the Self Reporting Questionnaire (SRQ) was administered to 471 adults living in a village in one of the federally administered tribal areas. Respondents were also assessed with a life events checklist for social problems, a social support questionnaire and the Brief Disability Questionnaire. RESULTS: Sixty per cent (95/158) of women and 45% (140/313) of men scored 9 or more on the SRQ. High SRQ score was associated with few years of education, higher social problem score, less social support and greater disability. High social problem score was the strongest correlate. CONCLUSIONS: This population reports more depressive symptoms than other communities in Pakistan and this probably reflects the very high degree of social stress experienced in the NWFP, which has been affected by years of turmoilin neighbouring Afghanistan.

Adolescent↗

The validation of personal health questionnaire amongst people of Pakistani family origin living in the United Kingdom.

BACKGROUND: The Personal Health Questionnaire (PHQ) was developed to screen for depressive disorder in an English speaking population. Its validity in Urdu speaking people of Pakistani family origin living in UK is yet to be established. METHODS: The PHQ was used to screen for depression in a two phase primary care based study of depressive disorder in people of Pakistani family origin residing in Manchester, UK. A proportion of high scorers (PHQ> or =7) and a random selection of low scorers (PHQ 0-6) were interviewed with the Psychiatric Assessment Schedule (PAS) to confirm caseness (ID> or =5). A receiver operator characteristic curve (ROC) analysis was carried out to confirm the optimum threshold value. RESULTS: The PHQ was used to screen 218 subjects with cut off of PHQ> or =7. 46 high scorers and 31 low scorers were interviewed in second stage using PAS. At this threshold PHQ has a sensitivity of 70.4% and specificity of 89.3%. CONCLUSIONS: Findings of this study confirm high sensitivity and specificity of PHQ amongst people of Pakistani family origin. It can be used as a screening instrument to detect depression in Urdu speaking population in UK.

Adult↗

Prevalence and social correlates of postnatal depression in a low income country.

BACKGROUND: Postnatal depression is an important public health problem worldwide. Recent evidence suggests that rates may be relatively higher in developing countries. We aimed to explore the prevalence of postnatal depression and its association with social support and other risk factors in a sample of Pakistani women. METHODS: Population-based survey of 149 women at 12 weeks postnatal using the Edinburgh Postnatal Depression Scale (EPDS), Multidimensional Scale of Perceived Social Support (MSPSS) and Personal Information Questionnaire (PIQ). RESULTS: Thirty six percent women scored > or =12 on EPDS. High depression score was associated with lower social support, increased stressful life events in the preceding year and higher levels of psychological distress in the antenatal period. CONCLUSIONS: There is a high prevalence of postnatal depression in Pakistani women. Early interventions should be developed that target the antenatal period and strengthen social support networks in women at risk.

Adolescent↗

Higher succinate than acetate levels differentiate cerebral degenerating cysticerci from anaerobic abscesses on in-vivo proton MR spectroscopy.

We present three patients with large intraparenchymal isolated degenerating cysticerci in whom the diagnosis was primarily based on in-vivo proton MR spectroscopy, and subsequently confirmed histologically. We suggest that the presence of succinate alone or more succinate acetate indicates the presence of degenerating cysticerci and differentiates them from anaerobic brain abscesses, which show acetate alone or in higher concentration than succinate, even when the clinical and imaging features are similar.

Acetates↗

Neuro-endoscopic surgery--experience and outcome analysis of 102 consecutive procedures in a busy neurosurgical centre of India.

BACKGROUND: Neuro-endoscopic surgery is finding increasing application for various clinical conditions. We present our experience of 100 cases of diverse intracranial lesions, including infections, managed by neuro-endoscopy in a busy neurosurgical department in the developing world. MATERIAL AND METHODS: One hundred patients treated from March 1996 to February 2002 formed the study group. Management of hydrocephalous by Endoscopic third ventriculostomy (ETV) was the aim in 75 patients with or without diagnostic biopsy. Excision or resection was attempted in 25 patients with juxtaventricular or intraventricular lesions. Endoscopic procedures included total tumour resection, partial resection, biopsy, stent placement, Monroplasty, septostomy and third ventriculostomy. Outcomes of endoscopic surgery were evaluated with respect to clinical and/or radiological improvement, complications and need for additional therapy. FINDINGS: Endoscopy was the only surgical treatment in 59 patients. Intermittent lumbar drainage for cerebrospinal fluid leak, shunt, microsurgery and/or repeat endoscopic surgery were additional treatments needed in 39 patients, who subsequently had increased hospital stay, postoperative morbidity and a higher cost of treatment. Peroperative bleeding due to distorted anatomy and obscured vision in 2 patients with post-infective loculated hydrocephalus (LH) resulted in two fatalities (2%) in the early post-operative period. INTERPRETATION: Neuro-endoscopic surgery cuts down operative time and hospital stay, reduces cost and results in a faster turnover of the patients. It is a versatile and useful tool for a busy neurosurgical department.

Adolescent↗

Is neurocysticercosis a risk factor in coexistent intracranial disease? An MRI based study.

BACKGROUND: Previous reports have suggested that neurocysticercosis is associated with glioma and Japanese encephalitis, and that it is a risk factor for stroke. OBJECTIVE: To determine if neurocysticercosis has a significant association with, or is a risk factor for, coexistent pathologies such as Japanese encephalitis, glioma, abscess, tuberculoma, or infarction. SUBJECTS: 10 350 patients from the hospital population who underwent 1.5 T cranial magnetic resonance imaging during the previous 12 years were evaluated for the presence of neurocysticercosis and coexisting pathology. DESIGN: Retrospective cohort analysis. RESULTS: The prevalence of neurocysticercosis in cases with dual pathology was significantly less than in a control group (1.1% v 8.3%; z = 11.05; p < 0.001, power of test = 1). Neurocysticercosis lesions were less common (p < 0.05) in the different subgroups of coexistent pathology than in the control group except in the case of Japanese encephalitis, where the difference was non-significant (z = 0.69, p = 0.49). The relative risk was less than 1 in all subgroups except Japanese encephalitis, where it was 1.23. The location of neurocysticercosis lesions and the presence of perilesional oedema did not affect coexistent lesion location or severity on a particular side (p = 0.413 and 0.623 for location and perilesional oedema, respectively). When the above factors were analysed separately in patients with Japanese encephalitis, they also did not affect coexistent lesion location or severity (p = 0.659 and 0.548, respectively). CONCLUSIONS: The coexistence of neurocysticercosis and other lesions may be an incidental observation in a few patients referred from areas of high prevalence and endemicity. It appears unlikely that neurocysticercosis is a risk factor for other intracerebral pathology. The location of neurocysticercosis lesions and whether or not there is surrounding perilesional oedema do not appear to affect the location or severity of coexisting lesions.

Adolescent↗

Cerebellar hemangioblastoma simulating arachnoid cyst on imaging and surgery.

A case of posterior fossa hemangioblastoma simulating arachnoid cyst on imaging and peroperatively is presented. In vivo proton MR spectroscopy showed evidence of large lactate and resonance at 2.37 ppm not observed earlier in the cystic lesions, including arachnoid cyst. The demonstration of this resonance may help in characterization of these lesions that may be confused with arachnoid cysts on imaging and during surgery.

Adult↗

Demonstration of scolex in calcified cysticercus lesion using gradient echo with or without corrected phase imaging and its clinical implications.

AIM: This study was performed to determine the magnetic resonance imaging (MRI) sequence that was best suited to demonstrate the scolex in a calcified lesion and to seek the explanation for the appearance of a negative phase in a calcified scolex on corrected gradient refocused echo (GRE) phase imaging. MATERIALS AND METHODS: Forty-nine patients with single/multiple computed tomography (CT) documented homogeneous calcified lesions and/or calcified scolices in cysts were studied with conventional spin echo and corrected GRE phase imaging. Calcium and different paramagnetic substances from cysticerci scolices of a sample of infected swine muscle were quantified. RESULTS: The scolex could be demonstrated in 29/39 patients with single calcified lesion. GRE imaging with an echo time of 35ms was the only sequence that demonstrated scolex in all these 29 cases. 15/29 patients with a single calcified lesion, in all 10 patients with multiple calcified lesions and infected swine muscle with multiple cysts and calcified scolex, corrected GRE phase imaging showed negative phase in all these scolices. Estimation of minerals from the calcified scolices from the swine muscle showed by spectroscopic techniques 41.2% of the total mineral contents as paramagnetic substances. CONCLUSION: We conclude that GRE imaging is the imaging method of choice for demonstration of the scolex in a CT calcified lesion. The negative phase on corrected GRE phase imaging is due to the presence of large amount of paramagnetic substances.

Adolescent↗

Spectroscopic increase in choline signal is a nonspecific marker for differentiation of infective/inflammatory from neoplastic lesions of the brain.

We report in vivo proton magnetic resonance (MR) spectroscopic findings in three benign infective/inflammatory lesions (one case each of tuberculoma, fungal granuloma, and xanthogranuloma), which showed high choline along with the presence of lipid/lactate, a feature characteristically described in neoplastic lesions. Histopathology of the lesions showed inflammatory cellular infiltrates with areas of necrosis/caseation. The spectroscopic-visible increased choline resonance in these lesions is probably the result of cellularity. We conclude that increased choline, along with the presence of lipid/lactate is a nonspecific finding and may not be of much value in the differentiation of neoplastic from nonneoplastic infective/inflammatory intracranial mass lesions.

Adolescent↗

Prospective evaluation of in vivo proton MR spectroscopy in differentiation of similar appearing intracranial cystic lesions.

Proton MR spectroscopy (PMRS) has been found to be useful in differentiating various cystic intracranial lesions. The purpose of the present study was to prospectively evaluate the spectral pattern of various cystic lesions of brain with similar imaging appearances and to determine the accuracy of this technique in the differential diagnosis of these lesions. Fifty-one patients with intracranial cystic lesions (21 abscesses, 20 gliomas, 3 hydatid cysts, 3 arachnoid cysts, 1 case each of glioependymal cyst, xanthogranuloma, infarction and acoustic neuroma) were evaluated with conventional MR imaging and in vivo PMRS. Ex vivo PMRS of the cystic contents aspirated at surgery in 31 cases was also done to confirm the in-vivo results. Preoperative diagnosis of the lesions was based on the results of in vivo PMRS. In vivo PMRS accurately predicted the pathology in 92% of the cases. We conclude that in-vivo PMRS complements imaging in better characterization of cystic intracranial mass lesions.

Adolescent↗

Magnetization transfer MR imaging correlation with histopathology in intracranial tuberculomas.

OBJECTIVE: The purpose of this study was to correlate the differences in the magnetization transfer (MT) ratios of different components of the tuberculoma with histopathology and to see whether MT or conventional MR imaging correlates better with histopathology. METHODS: MT T1 and conventional spin echo MR imaging was performed in six patients with intracranial tuberculomas. The tuberculomas were excised as a single mass and ex vivo MR imaging was performed using the same protocol. The gross histopathology was compared with in vivo imaging with respect to the MR signal intensity (MT ratio) in all six specimens. RESULTS: The size of the tuberculomas was larger on MT T1-weighted images compared to T2-weighted images and matched the gross measurements of each specimen. The MT hyperintense rim matched the cellular component of the tuberculoma that was masked on T2-weighted images because of the associated perifocal oedema. The cellular component had a lower MT ratio compared to the necrotic components. CONCLUSION: The outer hyperintense rim and hyperintense strands are due to the cellular infiltrate, noncaseating granulomas, and gliosis while the hypointense core represents solid caseation. The cellular outer rim shows lower MT ratio compared to the core of the tuberculoma. Histological correlation of the cellular and necrotic components of tuberculomas is best shown with MT T1 imaging.

Adult↗

Vancomycin and ceftazidime bioactivities persist for at least 2 weeks in the lumen in ports: simplifying treatment of port-associated bloodstream infections by using the antibiotic lock technique.

The residual antibiotic concentration of vancomycin (2 mg/ml)- or ceftazidime (2 mg/ml)-heparin solutions instilled in ports in pediatric hematology-oncology patients 1 to 34 days earlier was measured. Antibiotic concentrations of > or = 100 microg of either antibiotic per ml persisted for at least 21 days. For treatment of lumenal port infections, antibiotic-heparin dwell times of > or = 2 weeks may be appropriate.

Adolescent↗

Differentiation of tuberculous from pyogenic brain abscesses with in vivo proton MR spectroscopy and magnetization transfer MR imaging.

BACKGROUND AND PURPOSE: MR imaging features are nonspecific with respect to the causative organism for patients with brain abscesses. On the basis of the hypothesis that the biochemical environment depends on the infecting organism and might be different in tuberculous compared with pyogenic brain abscesses, this study attempted to determine whether pyogenic brain abscesses can be differentiated from tuberculous brain abscesses by use of magnetization transfer (MT) MR imaging and in vivo proton MR spectroscopy. METHODS: Twenty-seven patients with a total of 33 pyogenic brain abscesses and three patients with a total of 12 tuberculous abscesses were evaluated with in vivo MR spectroscopy and MT MR imaging. The diagnosis in all cases was based on the culture of the causative organisms and histopathology whenever done as a part of clinical management. RESULTS: All 27 patients with pyogenic brain abscesses had lipid and lactate levels of 1.3 ppm and amino acid levels of 0.9 ppm with or without the presence of succinate, acetate, alanine, and glycine, while the three patients with tuberculous abscesses showed only such lipid and lactate levels. The MT ratio from the wall of the pyogenic abscesses was significantly higher (P <.001) than that from the tuberculous abscess wall. CONCLUSION: It might be possible to differentiate tuberculous abscesses from pyogenic abscesses by using MT MR imaging and in vivo MR spectroscopy, which could be of value in influencing the management of such cases.

Adolescent↗

Evaluation of cysticercus fasciolaris antigen for the immunodiagnosis of neurocysticercosis.

Cysticercus cellulosae antigen has been frequently used to detect antibodies for immunodiagnosis of neurocysticercosis. We have, for the first time, used membrane extract of cysticercus fasciolaris, the larval stage of Taenia taeniaeformis, in ELISA, with successful results. IgM and IgG antibodies against cysticercus were measured in serum from cases of neurocysticercosis (217), normal and diseased controls (89). 203 sera from cases of neurocysticercosis were positive for either or both IgG and IgM antibodies while 157/217 cases showed IgM and 158/217 showed IgG antibodies. Ten controls showed false postivity in IgG ELISA. Eight of these cases also had IgM antibodies. The test had an overall sensitivity of 93.54% and a specificity of 84.2% with a positive predictive value of 93.54% and a negative predictive value of 84.2%. Cysticercus fasciolaris can be conveniently produced in the experimental laboratory host, Rattus rattus, and would be of practical value in the immunodiagnosis of cysticercosis in humans.

Animals↗

Depression and social stress in Pakistan.

BACKGROUND: The high prevalence of depression in developing countries is not well understood. This study aimed to replicate the previous finding of a high prevalence of depression in Pakistan and assess in detail the associated social difficulties. METHOD: A two-phase survey of a general population sample in a Pakistani village was performed. The first-phase screen used the Personal Health Questionnaire (PHQ) and the self-rating questionnaire (SRQ). A one in two sample of high scorers and a one in three sample of the low scorers were interviewed using the Psychiatric Assessment Schedule (PAS) and Life Events and Difficulties Schedule (LEDS). RESULTS: A total of 259 people were screened (96% response rate). The second stage yielded 55 cases, of whom 54 had depressive disorder, and 48 non-cases. The adjusted prevalence of depressive disorders was 44-4% (95% CI 35.3 to 53.6): 25.5% in males and 57.5% in females. Nearly all cases had lasted longer than 1 year. Comparison of the cases and non-cases indicated that cases were less well educated, had more children and experienced more marked, independent chronic difficulties. Multivariate analysis indicated that severe financial and housing difficulties, large number of children and low educational level were particularly closely associated with depression. CONCLUSION: This study confirms the high prevalence of depressive disorders in Pakistan and suggests that this may be higher than other developing countries because of the high proportion of the population who experience social adversity.

Adult↗