6 research outputs found
Cerebral Flow Diverter: Pioneering Insights From A Tertiary Care Hospital In A Developing Nation
No full textAbstract:
Objective: To record the early experience about the cerebral flow diverters (CFD) utilization and outcomes at a tertiary care hospital of Pakistan.
Study design: Retrospective cohort study.
Place and duration: Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan.
Material and methods: A retrospective review was conducted on patients who underwent CFD placement for cerebral aneurysms at our tertiary care center between 2017 and 2025. Data collected included patient demographics, aneurysm features, procedural details, and both immediate and six-month post-procedure outcomes, such as occlusion rates and any complications. The extent of aneurysm occlusion—categorized as complete or incomplete—was determined based on angiographic imaging obtained immediately following CFD deployment.
Results: In a total of 27 patients, 16 (56.3%) were female and 11 (40.1%) male with mean age of 43.22 ± 17.86 years. The mean aneurysm size was calculated to be 17.87 ± 7.78 mm, whereas 22 (81.48%) were wide necked aneurysms (≥ 25 mm). Immediate post-procedural assessments displayed a 100% success rate in completing the intended procedure successfully across all 27 cases. Immediate angiogram revealed that 15 (55.56%) patients achieved complete contrast stasis/occlusion within the cerebral aneurysms, while 12 (44.4%) displayed partial contrast stasis/occlusion. In the shorter-term follow-up evaluation, 25 (92.59%) cases exhibited complete occlusion of the aneurysms with only 2 (7.41%) patients showing procedure failure, signifying a sustained positive outcome in terms of aneurysm closure. Complications were reported in 4 (4.2%) patients with 2 patients showing aneurysm wall enhancement, 1 patient showing acute thrombosis, and endoleak each.
Conclusion: Despite limited resources, our center achieved good clinical outcomes, aneurysm occlusion rates, and procedural success. The occurrence of complications in a subset of cases underscores the necessity for continued refinement of patient selection criteria and procedural techniques to optimize outcomes and mitigate risks in the evolving landscape of endovascular interventions for cerebral aneurysms
Raised levels of IFN-gamma and IL-13 are associated with pre-diabetes amongst newly diagnosed patients with tuberculosis
No full textObjective: To investigate pre-diabetes and diabetes in newly-diagnosed tuberculosis patients and to assess the association of serum cytokine levels with diabetes status. Methods: The cross-sectional study was conducted at Indus Hospital and The Aga Khan University Hospital, Karachi from May to November 2015, and included patients of either gender aged 18 years or more with a confirmed diagnosis of tuberculosis who were either newly diagnosed or had received up to 1 month of anti-tuberculosis therapy were included. Patients were enrolled from among those presenting to the clinics at Indus Hospital, Karachi, and the Department of Medicine, Aga Khan University Hospital (AKUH), Karachi. The patients were tested for glycosylated haemoglobin and random blood glucose. Diabetes was defined as HbA1c \u3e6.5%; pre-diabetes as HbA1c=5.7-6.4%; and normoglycaemic as HbA1c \u3c5.7%. Serum cytokines were investigated using the Bio-plex 27, Bio-Rad assay. SPSS version 19.0 was used for data analysis. Results: Of the 211 subjects, 110(52%) were females and 101(48%) were males. The overall median age of the sample was 26 years, and 100(47.3%) subjects were underweight. Of the total, 24(11.4%) had diabetes and 45(21.3%) had pre-diabetes. Of the diabetics, only 7(29%) knew their status prior to screening. Interferon-gamma and interleukin-13 were significantly different among tuberculosis patients with diabetes, pre-diabetes and normoglycaemia (p\u3c0.05). Glycosylated haemoglobin levels showed a significant correlation with interferon-gamma levels. Conclusions: Raised interleukin-13 and interferon-gamma levels in newly-diagnosed tuberculosis patients with pre-diabetes
Surviving the storm: Insights into the pericardial injuries and roller coaster of multisystem trauma in bomb-blast victims
No full textPericardial injuries due to penetrating trauma such as bomb-blast shrapnel are rare but are associated with significant mortality. Timely diagnosis and a multidisciplinary approach are essential for effective management. This case series, comprising two cases, emphasizes the need for rapid, appropriate imaging and multidisciplinary care in the management of all associated injuries in these complex polytrauma patients. It also underscores the need for a high index of suspicion despite negative clinical features of pericardial injuries for timely performing CT scans and adaptive treatment strategies, including life-saving surgical intervention
CT features with histopathological correlation in inflammatory versus benign & malignant neoplastic appendiceal mucoceles: A retrospective cross-sectional study
No full textBackground & objectives: Differentiation of histologic subtypes of appendiceal mucoceles may prove to be difficult on computed tomography (CT). The main objective of this study was to identify the CT features of mucocele of the appendix and correlate the imaging findings with histopathology in inflammatory, benign, and malignant neoplastic lesions, and whether these entities can be accurately differentiated on CT imaging.Materials and methods: CT scans of 31 patients with diagnosis of appendiceal mucocele were retrospectively reviewed and compared with histopathology. The appendix was evaluated for maximal luminal diameter, cystic dilatation, luminal attenuation, appendicolith, mural calcification and enhancement, periappendiceal fat stranding and fluid. CT findings were compared by use of Mann-Whitney U and Fisher\u27s exact tests. Receiver operating characteristics analysis was performed to assess the diagnostic utility of appendiceal luminal diameter in differentiating different types of mucoceles.Results: Patients were classified into three groups: those with inflammatory mucoceles (n = 10), benign mucoceles (simple mucocele, mucosal hyperplasia and low-grade appendiceal mucinous neoplasm (n = 17), and those with malignant mucinous adenocarcinoma (n = 4). The mean diameter was found to be significantly different in the three groups with the largest diameter in the benign subgroup. Soft tissue thickening (p-value 0.01), mural calcification (p-value \u3c 0.01), internal septation (p-value 0.02) and fat stranding (p-value 0.05) was found to be of statistical significance among the various groups. The best cut-off diameter for diagnosis of inflammatory mucoceles to be ≤ 2.3 cm with a sensitivity of 71% and specificity of 90%.Conclusion: Our study suggests that CT findings such as appendiceal diameter less than 2.3 cm, absence of soft tissue thickening, mural calcification and internal septation may be useful in preoperative diagnosis of inflammatory appendiceal mucocele
Effects of once-weekly exenatide on cardiovascular outcomes in type 2 diabetes
No full textBACKGROUND: The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. METHODS: We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The coprimary hypotheses were that exenatide, administered once weekly, would be noninferior to placebo with respect to safety and superior to placebo with respect to efficacy. RESULTS: In all, 14,752 patients (of whom 10,782 [73.1%] had previous cardiovascular disease) were followed for a median of 3.2 years (interquartile range, 2.2 to 4.4). A primary composite outcome event occurred in 839 of 7356 patients (11.4%; 3.7 events per 100 person-years) in the exenatide group and in 905 of 7396 patients (12.2%; 4.0 events per 100 person-years) in the placebo group (hazard ratio, 0.91; 95% confidence interval [CI], 0.83 to 1.00), with the intention-to-treat analysis indicating that exenatide, administered once weekly, was noninferior to placebo with respect to safety (P<0.001 for noninferiority) but was not superior to placebo with respect to efficacy (P=0.06 for superiority). The rates of death from cardiovascular causes, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, hospitalization for heart failure, and hospitalization for acute coronary syndrome, and the incidence of acute pancreatitis, pancreatic cancer, medullary thyroid carcinoma, and serious adverse events did not differ significantly between the two groups. CONCLUSIONS: Among patients with type 2 diabetes with or without previous cardiovascular disease, the incidence of major adverse cardiovascular events did not differ significantly between patients who received exenatide and those who received placebo
Prophylactic biological mesh reinforcement versus standard closure of stoma site (ROCSS): a multicentre, randomised controlled trial
No full textBackground: Closure of an abdominal stoma, a common elective operation, is associated with frequent complications; one of the commonest and impactful is incisional hernia formation. We aimed to investigate whether biological mesh (collagen tissue matrix) can safely reduce the incidence of incisional hernias at the stoma closure site. Methods: In this randomised controlled trial (ROCSS) done in 37 hospitals across three European countries (35 UK, one Denmark, one Netherlands), patients aged 18 years or older undergoing elective ileostomy or colostomy closure were randomly assigned using a computer-based algorithm in a 1:1 ratio to either biological mesh reinforcement or closure with sutures alone (control). Training in the novel technique was standardised across hospitals. Patients and outcome assessors were masked to treatment allocation. The primary outcome measure was occurrence of clinically detectable hernia 2 years after randomisation (intention to treat). A sample size of 790 patients was required to identify a 40% reduction (25% to 15%), with 90% power (15% drop-out rate). This study is registered with ClinicalTrials.gov, NCT02238964. Findings: Between Nov 28, 2012, and Nov 11, 2015, of 1286 screened patients, 790 were randomly assigned. 394 (50%) patients were randomly assigned to mesh closure and 396 (50%) to standard closure. In the mesh group, 373 (95%) of 394 patients successfully received mesh and in the control group, three patients received mesh. The clinically detectable hernia rate, the primary outcome, at 2 years was 12% (39 of 323) in the mesh group and 20% (64 of 327) in the control group (adjusted relative risk [RR] 0·62, 95% CI 0·43–0·90; p=0·012). In 455 patients for whom 1 year postoperative CT scans were available, there was a lower radiologically defined hernia rate in mesh versus control groups (20 [9%] of 229 vs 47 [21%] of 226, adjusted RR 0·42, 95% CI 0·26–0·69; p<0·001). There was also a reduction in symptomatic hernia (16%, 52 of 329 vs 19%, 64 of 331; adjusted relative risk 0·83, 0·60–1·16; p=0·29) and surgical reintervention (12%, 42 of 344 vs 16%, 54 of 346: adjusted relative risk 0·78, 0·54–1·13; p=0·19) at 2 years, but this result did not reach statistical significance. No significant differences were seen in wound infection rate, seroma rate, quality of life, pain scores, or serious adverse events. Interpretation: Reinforcement of the abdominal wall with a biological mesh at the time of stoma closure reduced clinically detectable incisional hernia within 24 months of surgery and with an acceptable safety profile. The results of this study support the use of biological mesh in stoma closure site reinforcement to reduce the early formation of incisional hernias. Funding: National Institute for Health Research Research for Patient Benefit and Allergan
