Publications by authors named "Usman Tariq"

32 Publications

Authentication through gender classification from iris images using support vector machine.

Microsc Res Tech 2021 May 14. Epub 2021 May 14.

MIS Department College of Business Administration, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia.

Soft biometric information, such as gender, iris, and voice, can be helpful in various applications, such as security, authentication, and validation. Iris is secure biometrics with low forgery and error rates due to its highly certain features are being used in the last few decades. Iris recognition could be used both independently and in part for secure recognition and authentication systems. Existing iris-based gender classification techniques have low accuracy rates as well as high computational complexity. Accordingly, this paper presents an authentication approach through gender classification from iris images using support vector machine (SVM) that has an excellent response to sustained changes using the Zernike, Legendre invariant moments, and Gradient-oriented histogram. In this study, invariant moments are used as feature extraction from iris images. After extracting these descriptors' attributes, the attributes are categorized through keycode fusion. SVM is employed for gender classification using a fused feature vector. The proposed approach is evaluated on the CVBL data set and results are compared in state of the art based on local binary patterns and Gabor filters. The proposed approach came out with 98% gender classification rate with low computational complexity that could be used as an authentication measure.
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http://dx.doi.org/10.1002/jemt.23816DOI Listing
May 2021

Oroesophageal Pemphigus vulgaris Secondary to Lisinopril Use: A New Side Effect.

Cureus 2021 Apr 6;13(4):e14333. Epub 2021 Apr 6.

Gastroenterology, Allegheny Health Network, Pittsburgh, USA.

Pemphigoid diseases are a group of blistering autoimmune pathologies including pemphigus vulgaris (PV) and pemphigus foliaceous, which affect mucocutaneous tissues. Non-steroidal anti-inflammatory drugs, penicillamine, and angiotensin-converting enzyme inhibitors such as captopril and enalapril are associated with drug-induced pemphigoid. We present a case of lisinopril-associated PV which has not been previously reported.
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http://dx.doi.org/10.7759/cureus.14333DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8105187PMC
April 2021

An intelligence design for detection and classification of COVID19 using fusion of classical and convolutional neural network and improved microscopic features selection approach.

Microsc Res Tech 2021 May 8. Epub 2021 May 8.

College of Computer Engineering and Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia.

Coronavirus19 is caused due to infection in the respiratory system. It is the type of RNA virus that might infect animal and human species. In the severe stage, it causes pneumonia in human beings. In this research, hand-crafted and deep microscopic features are used to classify lung infection. The proposed work consists of two phases; in phase I, infected lung region is segmented using proposed U-Net deep learning model. The hand-crafted features are extracted such as histogram orientation gradient (HOG), noise to the harmonic ratio (NHr), and segmentation based fractal texture analysis (SFTA) from the segmented image, and optimum features are selected from each feature vector using entropy. In phase II, local binary patterns (LBPs), speeded up robust feature (Surf), and deep learning features are extracted using a pretrained network such as inceptionv3, ResNet101 from the input CT images, and select optimum features based on entropy. Finally, the optimum selected features using entropy are fused in two ways, (i) The hand-crafted features (HOG, NHr, SFTA, LBP, SURF) are horizontally concatenated/fused (ii) The hand-crafted features (HOG, NHr, SFTA, LBP, SURF) are combined/fused with deep features. The fused optimum features vector is passed to the ensemble models (Boosted tree, bagged tree, and RUSBoosted tree) in two ways for the COVID19 classification, (i) classification using fused hand-crafted features (ii) classification using fusion of hand-crafted features and deep features. The proposed methodology is tested /evaluated on three benchmark datasets. Two datasets employed for experiments and results show that hand-crafted & deep microscopic feature's fusion provide better results compared to only hand-crafted fused features.
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http://dx.doi.org/10.1002/jemt.23779DOI Listing
May 2021

Internet of medical things embedding deep learning with data augmentation for mammogram density classification.

Microsc Res Tech 2021 Apr 27. Epub 2021 Apr 27.

Department of Computer Science & Software Engineering, International Islamic University, Islamabad, Pakistan.

Females are approximately half of the total population worldwide, and most of them are victims of breast cancer (BC). Computer-aided diagnosis (CAD) frameworks can help radiologists to find breast density (BD), which further helps in BC detection precisely. This research detects BD automatically using mammogram images based on Internet of Medical Things (IoMT) supported devices. Two pretrained deep convolutional neural network models called DenseNet201 and ResNet50 were applied through a transfer learning approach. A total of 322 mammogram images containing 106 fatty, 112 dense, and 104 glandular cases were obtained from the Mammogram Image Analysis Society dataset. The pruning out irrelevant regions and enhancing target regions is performed in preprocessing. The overall classification accuracy of the BD task is performed and accomplished 90.47% through DensNet201 model. Such a framework is beneficial in identifying BD more rapidly to assist radiologists and patients without delay.
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http://dx.doi.org/10.1002/jemt.23773DOI Listing
April 2021

Maltoma veiled in the lung-a rare case of pulmonary and gastric maltoma.

Respir Med Case Rep 2021 19;33:101403. Epub 2021 Mar 19.

Departement of Pulmonology and Critical Care, Allegheny Health Network, Pittsburgh, PA, USA.

Mucosa associated lymphoid tissue (MALT) is a type of B-cell lymphoma that is commonly observed in the gastrointestinal site, most frequently occurring in the stomach. However, the incidence of this type of lymphoma in the respiratory tract is very uncommon. We report a case of this rare clinical entity in a patient who presented with non-symptomatology and was diagnosed with pulmonary MALT lymphoma (pMALToma).
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http://dx.doi.org/10.1016/j.rmcr.2021.101403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039716PMC
March 2021

Gastroenterology Fellowship Applicants' Perspectives on GI Program Preferences.

Dig Dis Sci 2021 Apr 24;66(4):941-944. Epub 2021 Feb 24.

Department of Internal Medicine, Allegheny Health Network, Pittsburgh, USA.

Gastroenterology fellowship continues to be highly competitive among internal medicine subspecialties. Recruiting excellent applicants is also important for GI fellowship program directors. We aim to examine factors that influence GI fellowship applicants' perspectives about a fellowship program. The authors conducted an anonymous online survey of applicants focusing on program characteristics including location, faculty, research/clinical opportunities, website, and interview day experience. Anonymous survey responses were recorded regarding program characteristics, and subsequent candidate preferences were evaluated for factors influencing their decision. Candidates were also asked to evaluate their interview experience and share other comments about the program. Though GI fellowship applicants have varying preferences regarding the ideal training program, some opinions converged. The study of these trends can inform program directors regarding areas for improvement that in turn can help attract the best applicants.
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http://dx.doi.org/10.1007/s10620-021-06855-0DOI Listing
April 2021

Brain tumor detection and multi-classification using advanced deep learning techniques.

Microsc Res Tech 2021 Jun 5;84(6):1296-1308. Epub 2021 Jan 5.

School of Information and Communication Engineering, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.

A brain tumor is an uncontrolled development of brain cells in brain cancer if not detected at an early stage. Early brain tumor diagnosis plays a crucial role in treatment planning and patients' survival rate. There are distinct forms, properties, and therapies of brain tumors. Therefore, manual brain tumor detection is complicated, time-consuming, and vulnerable to error. Hence, automated computer-assisted diagnosis at high precision is currently in demand. This article presents segmentation through Unet architecture with ResNet50 as a backbone on the Figshare data set and achieved a level of 0.9504 of the intersection over union (IoU). The preprocessing and data augmentation concept were introduced to enhance the classification rate. The multi-classification of brain tumors is performed using evolutionary algorithms and reinforcement learning through transfer learning. Other deep learning methods such as ResNet50, DenseNet201, MobileNet V2, and InceptionV3 are also applied. Results thus obtained exhibited that the proposed research framework performed better than reported in state of the art. Different CNN, models applied for tumor classification such as MobileNet V2, Inception V3, ResNet50, DenseNet201, NASNet and attained accuracy 91.8, 92.8, 92.9, 93.1, 99.6%, respectively. However, NASNet exhibited the highest accuracy.
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http://dx.doi.org/10.1002/jemt.23688DOI Listing
June 2021

Microscopic brain tumor detection and classification using 3D CNN and feature selection architecture.

Microsc Res Tech 2021 Jan 21;84(1):133-149. Epub 2020 Sep 21.

School of Clinical Medicine, Zhengzhou University, Zhengzhou, China.

Brain tumor is one of the most dreadful natures of cancer and caused a huge number of deaths among kids and adults from the past few years. According to WHO standard, the 700,000 humans are being with a brain tumor and around 86,000 are diagnosed since 2019. While the total number of deaths due to brain tumors is 16,830 since 2019 and the average survival rate is 35%. Therefore, automated techniques are needed to grade brain tumors precisely from MRI scans. In this work, a new deep learning-based method is proposed for microscopic brain tumor detection and tumor type classification. A 3D convolutional neural network (CNN) architecture is designed at the first step to extract brain tumor and extracted tumors are passed to a pretrained CNN model for feature extraction. The extracted features are transferred to the correlation-based selection method and as the output, the best features are selected. These selected features are validated through feed-forward neural network for final classification. Three BraTS datasets 2015, 2017, and 2018 are utilized for experiments, validation, and accomplished an accuracy of 98.32, 96.97, and 92.67%, respectively. A comparison with existing techniques shows the proposed design yields comparable accuracy.
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http://dx.doi.org/10.1002/jemt.23597DOI Listing
January 2021

Dedifferentiated Liposarcoma With Meningothelial-Like Whorls: Five Additional Cases and Review of the Literature.

Int J Surg Pathol 2020 Oct 17;28(7):749-758. Epub 2020 May 17.

Aga Khan University Hospital, Karachi, Pakistan.

. Diagnosis of dedifferentiated liposarcoma (DDL) can sometimes be challenging due to a wide variety of histological features. "Meningothelial-like" whorl is an uncommon histological feature of DDL, which is also observed in neural tumors and follicular dendritic cell sarcoma. This feature is frequently associated with metaplastic bone formation. We conducted this study to describe the clinicopathological features of DDL with meningothelial-like whorls that would aid in establishing accurate diagnosis. . Microscopic glass slides of 5 cases of DDL with meningothelial-like whorls, diagnosed between January 2010 and December 2019, were reviewed. . Paratesticular region was the most common site. Whorls occupied 10% to 75% of tumor area and ranged in size from <0.1 cm to >2 cm. In 1 case, these whorls coalesced to form large areas of dedifferentiation. The cells forming whorls were spindle to epithelioid shaped and lacked significant nuclear pleomorphism and increased mitoses. Metaplastic bone formation was observed in 4 cases and cartilage formation in 3 cases. p16 and α-smooth muscle actin (α-SMA) immunohistochemical stains were positive in 2 cases, when performed. MDM2 gene amplification was observed in all cases by fluorescence in situ hybridization technique. These tumors showed aggressive behavior, similar to that of DDL without meningothelial-like whorls. Two patients died, 1 developed recurrence, 1 presented as recurrent tumor, and 1 developed metastasis. . Meningothelial-like whorls in DDL most likely represent an early stage of dedifferentiation. Presence of well-differentiated liposarcoma areas, metaplastic bone formation, positive expressions for p16 and α-SMA immunohistochemical stains, and MDM2 gene amplification are useful diagnostic clues. These tumors have the potential to behave aggressively.
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http://dx.doi.org/10.1177/1066896920921950DOI Listing
October 2020

Purpura Fulminans: a Rare but Fierce Presentation of Pneumococcal Sepsis.

Eur J Case Rep Intern Med 2020 30;7(1):001373. Epub 2019 Dec 30.

Departement of Pulmonology and Critical care, Allegheny Health Network, Pittsburgh, USA.

Infectious purpura fulminans (PF) is a rare presentation of disseminated intravascular coagulopathy (DIC) due to diffuse intravascular thrombosis and haemorrhagic infarction of the skin. PF can present in infancy/childhood or adulthood and usually presents as ecchymotic skin lesions, fever and hypotension. It is most commonly a consequence of sepsis related to , or . Despite aggressive management of sepsis with intravenous fluids, antibiotics, and conventional and nonconventional therapies, the condition still carries a mortality rate of 43%. mostly presents with community-acquired pneumonia. We present a case of PF secondary to DIC related to Pneumococcal sepsis in an otherwise healthy and immunocompetent patient.

Learning Points: Infectious purpura fulminans is a haematological emergency that demands early recognition and timely institution of therapy to prevent significant morbidity and mortality.A characteristic skin rash is a key diagnostic clue pointing to purpura fulminans, and should lead to prompt institution of therapy, as waiting for a skin biopsy result can delay the diagnosis and result in significant morbidity and mortality.Due to the lack of prospective data on management of the condition, various modalities, such as hyperbaric oxygen therapy and IVIG, still have questionable benefits. We therefore aim to expand knowledge of purpura fulminans management.
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http://dx.doi.org/10.12890/2019_001373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6993916PMC
December 2019

Classification of stomach infections: A paradigm of convolutional neural network along with classical features fusion and selection.

Microsc Res Tech 2020 May 27;83(5):562-576. Epub 2020 Jan 27.

College of Computer Engineering and Science, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.

Automated detection and classification of gastric infections (i.e., ulcer, polyp, esophagitis, and bleeding) through wireless capsule endoscopy (WCE) is still a key challenge. Doctors can identify these endoscopic diseases by using the computer-aided diagnostic (CAD) systems. In this article, a new fully automated system is proposed for the recognition of gastric infections through multi-type features extraction, fusion, and robust features selection. Five key steps are performed-database creation, handcrafted and convolutional neural network (CNN) deep features extraction, a fusion of extracted features, selection of best features using a genetic algorithm (GA), and recognition. In the features extraction step, discrete cosine transform, discrete wavelet transform strong color feature, and VGG16-based CNN features are extracted. Later, these features are fused by simple array concatenation and GA is performed through which best features are selected based on K-Nearest Neighbor fitness function. In the last, best selected features are provided to Ensemble classifier for recognition of gastric diseases. A database is prepared using four datasets-Kvasir, CVC-ClinicDB, Private, and ETIS-LaribPolypDB with four types of gastric infections such as ulcer, polyp, esophagitis, and bleeding. Using this database, proposed technique performs better as compared to existing methods and achieves an accuracy of 96.5%.
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http://dx.doi.org/10.1002/jemt.23447DOI Listing
May 2020

Brain Connectivity Analysis Under Semantic Vigilance and Enhanced Mental States.

Brain Sci 2019 Dec 9;9(12). Epub 2019 Dec 9.

Biosciences and Bioengineering Research Institute, Department of Electrical Engineering, American University of Sharjah, P.O. Box 26666, Sharjah, UAE.

In this paper, we present a method to quantify the coupling between brain regions under vigilance and enhanced mental states by utilizing partial directed coherence (PDC) and graph theory analysis (GTA). The vigilance state is induced using a modified version of stroop color-word task (SCWT) while the enhancement state is based on audio stimulation with a pure tone of 250 Hz. The audio stimulation was presented to the right and left ears simultaneously for one-hour while participants perform the SCWT. The quantification of mental states was performed by means of statistical analysis of indexes based on GTA, behavioral responses of time-on-task (TOT), and Brunel Mood Scale (BRMUS). The results show that PDC is very sensitive to vigilance decrement and shows that the brain connectivity network is significantly reduced with increasing TOT, 0.05. Meanwhile, during the enhanced state, the connectivity network maintains high connectivity as time passes and shows significant improvements compared to vigilance state. The audio stimulation enhances the connectivity network over the frontal and parietal regions and the right hemisphere. The increase in the connectivity network correlates with individual differences in the magnitude of the vigilance enhancement assessed by response time to stimuli. Our results provide evidence for enhancement of cognitive processing efficiency with audio stimulation. The BRMUS was used to evaluate the emotional states of vigilance task before and after using the audio stimulation. BRMUS factors, such as fatigue, depression, and anger, significantly decrease in the enhancement group compared to vigilance group. On the other hand, happy and calmness factors increased with audio stimulation, 0.05.
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http://dx.doi.org/10.3390/brainsci9120363DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6955710PMC
December 2019

Vigilance Decrement and Enhancement Techniques: A Review.

Brain Sci 2019 Jul 26;9(8). Epub 2019 Jul 26.

Department of Electrical Engineering, Biosciences and Bioengineering Research Institute, American University of Sharjah, Sharjah 26666, United Arab Emirates.

This paper presents the first comprehensive review on vigilance enhancement using both conventional and unconventional means, and further discusses the resulting contradictory findings. It highlights the key differences observed between the research findings and argues that variations of the experimental protocol could be a significant contributing factor towards such contradictory results. Furthermore, the paper reveals the effectiveness of unconventional means of enhancement in significant reduction of vigilance decrement compared to conventional means. Meanwhile, a discussion on the challenges of enhancement techniques is presented, with several suggested recommendations and alternative strategies to maintain an adequate level of vigilance for the task at hand. Additionally, this review provides evidence in support of the use of unconventional means of enhancement on vigilance studies, regardless of their practical challenges.
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http://dx.doi.org/10.3390/brainsci9080178DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6721323PMC
July 2019

Injectable dicalcium phosphate bone cement prepared from biphasic calcium phosphate extracted from lamb bone.

Mater Sci Eng C Mater Biol Appl 2019 Oct 5;103:109863. Epub 2019 Jun 5.

Laser Center, Ibnu Sina Institute for Scientific and Industrial Research, Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia; Department of Physics, Faculty of Science, Universiti Teknologi Malaysia, 81310 Johor Bahru, Johor, Malaysia.

Quick setting and poor injectability due to liquid-solid phase separation have limited the clinical use of brushite and monetite cements. The presence of certain ions in the cement during the setting reaction moderate the setting time and properties of the cement. This study reports the preparation of injectable bone cement by using biphasic calcium phosphate (BCP) extracted from femur lamb bone by calcination at 1450 °C. EDX analysis infers the presence of Mg and Na ions as trace elements in BCP. X-ray diffraction patterns of the prepared cement confirmed the formation of brushite (DCPD) along with monetite (DCPA) as a minor phase. DCPA phase diminished gradually with a decrease in powder to liquid ratio (PLR). Initial and final setting time of 5.3 ± 0.5 and 14.67 ± 0.5 min respectively are obtained and within the acceptable recommended range for orthopedic applications. Exceptional injectability of ≈90% is achieved for all prepared bone cement samples. A decrease in compressive strength was observed with increase in the liquid phase of the cement, which is attributed to the higher degree of porosity in the set cement. Immersion of bone cement in simulated body fluid (SBF) for up to 7 days resulted in the formation of apatite layer on the surface of cement with Ca/P ratio 1.71, which enhanced the compressive strength from 2.88 to 9.15 MPa. The results demonstrate that bone cement produced from BCP extracted from femur lamb bone can be considered as potential bone substitute for regeneration and repair of bone defects.
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http://dx.doi.org/10.1016/j.msec.2019.109863DOI Listing
October 2019

A Case of Anti-glomerular Basement Disease Without Pulmonary Involvement.

Cureus 2019 Feb 25;11(2):e4130. Epub 2019 Feb 25.

Internal Medicine, Shifa International Hospital, Islamabad, PAK.

Anti-glomerular basement membrane disease is a rare but classic example of an antibody-mediated disease. The scale of injury that it entails depends on the site where the antibodies are deposited, with some patients presenting with a composite of pulmonary and renal damage. In other scenarios, the renal system is the main site of affliction with patients deteriorating to a status of acute renal failure within days of diagnosis. Due to the paucity of its incidence, we present our findings of anti-glomerular basement disease with pulmonary sparing. Herein, we also review the array of different physical findings, different forms of perpetrating antibodies, the diagnostic tools at our disposal, and the treatment modalities utilized to prevent catastrophic tissue injuries.
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http://dx.doi.org/10.7759/cureus.4130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6485522PMC
February 2019

The Dilemma of Inadvertent Pontine Demyelinosis: A Review of Literature.

Cureus 2018 Aug 21;10(8):e3174. Epub 2018 Aug 21.

Medicine, Shifa International Hospital, Islamabad, PAK.

Osmotic demyelination syndrome is classically associated with a swift adjustment of previously low serum sodium levels which lead to cellular dehydration and subsequent neurological insult. We also review the epidemiology, different postulations to explain the underlying pathophysiology, current diagnostic modalities, subsequent therapeutic interventions used to manage this phenomenon, and the resultant prognosis of this ailment.
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http://dx.doi.org/10.7759/cureus.3174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197531PMC
August 2018

Acute Intermittent Porphyria: A Rare Cause of Acute Disseminated Encephalomyelitis.

Cureus 2018 Jul 17;10(7):e2989. Epub 2018 Jul 17.

Internal Medicine, Shifa College Of Medicine, Islamabad, PAK.

Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease of the central nervous system (CNS) with no distinct etiology but implications include infections and commonly administered vaccinations. In this case report, we present the case of ADEM in a young female who was subsequently diagnosed with acute intermittent porphyria (AIP) that was the instigator of the initial CNS assault. Our case highlights the peculiar presentation of ADEM which can present as a diagnostic challenge and brings forth AIP as a new and previously unknown affiliate of this rare CNS disease. We also discuss the pathophysiology, diagnostic criteria, and subsequent treatment options for this rare clinical entity.
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http://dx.doi.org/10.7759/cureus.2989DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6141216PMC
July 2018

Spilled Gallstones Silent for a Decade: A Case Report and Review of Literature.

Cureus 2018 Jul 5;10(7):e2921. Epub 2018 Jul 5.

Internal Medicine, Shifa Tameer E Millat University/shifa International Hospital, Islamabad, PAK.

Laparoscopic cholecystectomy is associated with complications such as gallbladder perforation and spillage of gallstones. While these shortcomings are common, the occurrence of the resultant nuisances, such as intra-abdominal abscesses, is infrequent. We present the case of an individual who developed an intra-abdominal abscess following a spillage of gallstones, which occurred after a laparoscopic cholecystectomy that was performed more than a decade ago. Herein, we also discuss the findings of a literature review that highlights the clinical presentations of an intra-abdominal abscess formed due to gallstone spillage after a decade of the laparoscopic intervention. We also discuss the underlying pathophysiology leading to abscess formation, the imaging modalities used to visualize the abscess, as well as the therapeutic strategy used to treat this rare clinical entity.
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http://dx.doi.org/10.7759/cureus.2921DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6128371PMC
July 2018

Paraneoplastic Mononeuritis Multiplex: A Unique Presentation of Non-Hodgkin Lymphoma.

Cureus 2018 Jun 26;10(6):e2885. Epub 2018 Jun 26.

Pathology, Shifa International Hospital, Islamabad, PAK.

Mononeuritis multiplex (MM) is a common variant of a peripheral neuropathy which is characterized by neurological discrepancies that afflict two noncontiguous nerve systems. It is mostly associated with systemic illnesses such as diabetes mellitus, vasculitis, systemic lupus erythematosus (SLE), viral infections including human immunodeficiency virus (HIV) and paraneoplastic syndromes. Lymphoma is a common antecedent to paraneoplastic syndromes that cause peripheral neuropathies but a specific presentation of MM is a rare predicament per our literature analysis.
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http://dx.doi.org/10.7759/cureus.2885DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110417PMC
June 2018

A Rare Case of Bilateral Adrenal Hemorrhage.

Cureus 2018 Jun 18;10(6):e2830. Epub 2018 Jun 18.

Internal Medicine, Shifa College of Medicine, Islamabad, PAK.

Bilateral adrenal hemorrhage (BAH) is a rare but potentially fatal entity that carries a mortality rate of 15%. Most cases are associated with sepsis, antiphospholipid syndrome, the use of anticoagulants, as well as trauma and surgery. In this case report, we present a case of BAH in a previously healthy man with a recent history of corticosteroid use. Our case emphasizes the ambiguous clinical presentation of BAH, which poses a challenge in the establishment of a correct diagnosis. We also illustrate the pathophysiology, diagnosis, and subsequent therapeutic approach to this rare clinical entity.
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http://dx.doi.org/10.7759/cureus.2830DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6101466PMC
June 2018

Amyand's Hernia: A Rare Surgical Pathology of the Appendix.

Cureus 2018 Jun 18;10(6):e2827. Epub 2018 Jun 18.

Medicine, Shifa International Hospital, Islamabad, PAK.

Amyand's hernia is characterized by the presence of an inflamed, non-inflamed or perforated appendix within the sac of an inguinal hernia. This is an exceedingly rare presentation and most of the cases are diagnosed incidentally during surgery. Here we describe a case of an Amyand's hernia in a patient who presented in our outpatient clinic with an irreducible right-sided inguinal hernia. There were no signs of ischemic complications. During the surgery, an appendix was found within the hernial sac. An uneventful appendectomy along with a tension-free darn repair was performed. The current case report emphasizes that this pathology must be kept in mind while treating a patient with a right-sided inguinal hernia.
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http://dx.doi.org/10.7759/cureus.2827DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6101460PMC
June 2018

Simultaneous Bilateral Spontaneous Pneumothorax: A Rare Complication of Osteosarcoma.

Cureus 2018 Jun 5;10(6):e2745. Epub 2018 Jun 5.

Orthopaedics, Shifa International Hospital, Islamabad, PAK.

The lungs are a common site of metastatic spread of an osteosarcoma. An affiliated simultaneous bilateral spontaneous pneumothorax (SBSP) is a rare clinical sequela of this malignancy. In this case report, we present the clinical circumstances of a young teenager who presented to our clinical setting following a diagnosis of osteosarcoma. We also illustrate the postulated pathophysiology, the tools for diagnosis and a subsequent management for this rare clinical entity.
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http://dx.doi.org/10.7759/cureus.2745DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075640PMC
June 2018

Skull Metastasis Extending to the Superior Sagittal Sinus: An Unfamiliar Presentation of Papillary Thyroid Carcinoma.

Cureus 2018 Jun 5;10(6):e2738. Epub 2018 Jun 5.

Internal Medicine, Shifa College Of Medicine, Islamabad, PAK.

Thyroid cancer is the most common endocrine cancer in the world, with a rising global incidence over the last three decades. Papillary thyroid cancer (PTC) is the most common type of thyroid neoplasia, accounting for 74%-80% of all cases. Skull metastasis from a differentiated thyroid malignancy is a rare occurrence, while a subsequent dural involvement is even more inimitable. As such, a clinician requires a high degree of clinical suspicion and resultant radiographic evidence in order to make the diagnosis. Here we present the case of a 54-year-old male patient who presented with a pathological fracture of his right humerus, a midline frontal bone swelling and an asymptomatic neck mass. Further workup revealed follicular variant papillary thyroid carcinoma (FV-PTC) with distant metastasis to the calvarium. The conventional therapy for metastatic PTC includes a total thyroidectomy, removal of resectable metastatic lesions and a supplementation with radioactive iodine (RAI) and/or external beam radiation at the sites of the metastases. This case and our literature review illustrate that skull metastases should be considered in the clinical course of PTC so that appropriate management can be started.
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http://dx.doi.org/10.7759/cureus.2738DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075641PMC
June 2018

Jejunal Intussusception: A Rare Manifestation of a Primary Thyroid Non-Hodgkin Lymphoma.

Cureus 2018 May 31;10(5):e2717. Epub 2018 May 31.

Student, Shifa College Of Medicine, Islamabad, PAK.

Primary thyroid lymphoma (PTL) is an uncommon malignancy of the thyroid gland, with most lymphomas of the thyroid being almost exclusively of the non-Hodgkin's B cell variety. PTL requires a prompt diagnosis because of its ability to cause progressive compression symptoms, and its unusual presentation can make the diagnosis very challenging. Herein, we present a case of PTL in a young woman with an uncommon initial presentation and discuss the complications she faced during the surgery, as well as postoperatively, due to the compression of the trachea by the thyroid mass.
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http://dx.doi.org/10.7759/cureus.2717DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6067809PMC
May 2018

Hemophagocytic Lymphohistiocytosis: A Case Series.

Cureus 2018 Apr 29;10(4):e2545. Epub 2018 Apr 29.

Internal Medicine, Shifa International Hospital, Islamabad, Pakistan, Islamabad, PAK.

Hemophagocytic lymphohistiocytosis (HLH) has been recognized as an inflammatory endpoint for a variety of conditions including autoimmune diseases, malignancies and infections. It can be further classified as primary and secondary HLH. Primary HLH is also known as familial HLH. It usually presents in childhood and can be associated with gene mutations. Secondary HLH is also known as acquired HLH and usually presents in adulthood. In comparison to children, it is difficult to diagnose adults with HLH since it occurs with a variety of different diseases and most of the literature on HLH is derived from a pediatric population. In this case series, we report two cases of HLH that illustrate the difficulty of making this diagnosis and a brief review of the literature on its pathophysiology, clinical presentation, diagnosis, and a subsequent therapeutic approach.
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http://dx.doi.org/10.7759/cureus.2545DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6021184PMC
April 2018

Heavy metal accumulation imparts structural differences in fragrant Rosa species irrigated with marginal quality water.

Ecotoxicol Environ Saf 2018 Sep 21;159:240-248. Epub 2018 May 21.

Department of Agronomy, Muhammad Nawaz Sharif University of Agriculture, Multan, Pakistan.

Wastewater is an alternative to traditional sources of renewable irrigation water in agriculture, particularly in water-scarce regions. However, the possible risks due to heavy metals accumulation in plant tissues are often overlooked by producers. The present study aimed to identify heavy metals-induced structural modifications to roots of scented Rosa species that were irrigated with water of marginal quality. The chemical and mineral contents from the experimental irrigation canal water (control) and treated wastewater were below the limits recommended by the Pakistan Environmental Protection Agency (Pak-EPA) for medicinal plants. The experimentally untreated wastewater contained electrical conductivity (EC), chemical oxygen demand (COD), biological oxygen demand (BOD), and heavy metals (Co, Cu, Cd, Pb) that were above the recommended limits. The responses by wastewater-treated Rosa species (Rosa damascena, R. bourboniana, R. Gruss-an-Teplitz, and R. centifolia) were evaluated. The experimental data revealed that treated wastewater significantly increased the thickness of collenchyma (cortex and pith) and parenchyma tissues (vascular bundle, xylem, and phloem) of R. Gruss-an-Teplitz. Root dermal tissues (epidermis) of R. bourboniana also responded to treated wastewater. R. damascena and R. centifolia were the least affected species, under the experimental irrigation conditions. Collenchyma and dermal tissues were thicker in R. damascena and R. Gruss-an-Teplitz under untreated wastewater conditions. In parenchyma tissues, vascular bundles were thicker in R. damascena in untreated wastewater conditions, while the xylem and phloem of R. Gruss-an-Teplitz were thicker where treated wastewater was applied. In tissues other than the vascular bundle, the differences in anatomical metrics due to the experimental irrigation treatments were greater during the second year of the experiment than in the first year. The contents of metals other than chromium in the roots and stems of roses were below the WHO limits, under all of the experimental irrigation conditions. Rosa centifolia contained higher heavy metals content than the other experimental species, and heavy metals content was associated with anatomical changes due to the treatments. We conclude that, under conditions of wastewater irrigation, R. Gruss-an-Teplitz was highly resistant; R. damascena was moderately resistant while R. bourboniana and R. centifolia were the most susceptible to irrigation with marginal quality water. This is the first report of plant tissue responses to wastewater irrigation by the experimental species. Regarding the accumulation of heavy metals in rose plant tissues, the results confirm that untreated wastewater must be treated to grow Rosa species where water is scarce.
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http://dx.doi.org/10.1016/j.ecoenv.2018.05.003DOI Listing
September 2018

Role of Sex Hormone Levels and Psychological Stress in the Pathogenesis of Autoimmune Diseases.

Cureus 2017 Jun 5;9(6):e1315. Epub 2017 Jun 5.

Department of Medicine, Shifa International Hospital, Islamabad, Pakistan.

The aim of this review article is to assess the connection between psychological stress and sex hormones and their effect on the development of autoimmune diseases. Psychological stress describes what people feel when they are under mental, physical, or emotional pressure. We searched for online articles using MEDLINE®, Embase, Cochrane Library and Google Scholar. Our research yielded a total of 165 articles out of which 30 articles were considered for further perusal. The articles were reviewed from February 2016 to February 2017. Case reports and patients suffering from hematolymphoid malignancies and active infections were excluded from the review. Estrogen and testosterone are potential physiological regulatory factors for the peripheral development of CD4+CD25+ T regulatory cells. Stress at any age leads to the depletion of estrogen and testosterone stores in the body, leading to the loss of expansion of T regulatory cells, making the immature B cells evade the negative selection at the germinal center, or in other words, leading to the loss of central tolerance, a triggering event in autoimmune diseases like systemic lupus erythematosus. Autoimmune diseases in women are most likely due to changes in estrogen levels during mental, physical, pre-menopausal, post-menopausal, and pregnancy-induced stress. We conclude that modulating estrogen in females (pre-menopausal and post-menopausal) and testosterone in males can be used to treat stress-related immune imbalance resulting in autoimmune diseases in both sexes.
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http://dx.doi.org/10.7759/cureus.1315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5498122PMC
June 2017

The Facilitator's Role in London's Air Ambulance's simulation "moulage" training.

Air Med J 2015 Mar-Apr;34(2):92-7

Barts and the London School of Medicine and Dentistry, London, United Kingdom.

Objective: This research focused on the facilitator's role in the simulated patient training "moulages" used by London's Air Ambulance (LAA) for their team training. Facilitators are chosen based on their experience and expertise in the field. The aim of this research was to gain insight into the role of moulage facilitator.

Methods: An ethnographic approach was employed, using the notion of "progressive focusing." Overt observational fieldwork was performed, with the resulting field notes evaluated by content analysis. Semistructured interviews were then conducted with 8 facilitators selected by convenience sampling in order to gain an understanding of the role according to their perspective.

Results: The research revealed the role of the facilitator to be challenging and multifaceted. The moulage process appeared appropriate to its function, and the facilitation methods were largely in accordance with recommended practice outlined in educational literature.

Conclusions: The London's Air Ambulance moulage facilitators have to prepare trainees for an intense and emotionally demanding job. Their methods are derived from experience, often with a subconscious application of sound educational practice. This research may help the team identify certain areas with scope for further refinement including feedback methods, fidelity, and reducing the burden of multitasking.
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http://dx.doi.org/10.1016/j.amj.2014.12.012DOI Listing
November 2016

Transcatheter versus surgical closure of atrial septum defect: a debate from a developing country.

J Cardiovasc Thorac Res 2014 30;6(4):205-10. Epub 2014 Dec 30.

Department of Cardiothoracic Surgery, The Aga Khan University Hospital (AKUH), Karachi, Pakistan.

Introduction: This study compares the effectiveness and cost of trans-catheter verses surgical closure of secundum atrial septum defect (ASD). ASD accounts for 10% of congenital cardiac defects. Trans-catheter closure of secundum ASD is increasingly used as the primary intervention. Surgical repair is advised in a proportion of secundum type defects which are unsuitable for device closure.

Methods: We reviewed the clinical course of 176 patients who underwent closure of isolated secundum ASD. The patients were assigned to either the device or surgical group depending upon the treatment they received. Successful closure was assessed immediately after the procedure. The following outcomes were studied: mortality, morbidity, hospital stay, and costs.

Results: Ninety five patients were in the surgical group and 81 patients were in the group undergoing device closure. The median age was 14.0 years (range 1.1-61.0) for surgical group and 24.0 years (range 0.5-68.0) for the device group. The mortality in both groups was 0. The procedure success rate was 100% for the surgical group and 96.3% for the device group. The complication rate was 13.7% for surgical group and 7.4% for the device group. The mean length of hospital stay was 5.0 ± 2.7 days for surgical group and 3.0 ± 0.4 days for device group. The procedure cost for surgery was found to be 12.3% lower than that of trans-catheter closure.

Conclusion: Successful closure is achieved by both methods. Trans-catheter closure results in lower rate of complication and hospital stay but the cost of the procedure tends to be higher than surgery.
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http://dx.doi.org/10.15171/jcvtr.2014.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291597PMC
January 2015

Nutritional status of primary school children in Abbottabad.

J Ayub Med Coll Abbottabad 2013 Jan-Jun;25(1-2):123-6

Background: In Abbottabad district, with the vast poverty stricken rural majority and 80% literacy rate, primary-level education faces great influx of students. This study was carried out to see the nutritional status of children 5-10 years of age attending primary schools of Abbottabad.

Methods: This was a descriptive, cross-sectional study carried out in June 2009 on 400 schoolchildren of 5-10 years of age from three randomly selected primary schools of Abbottabad. After informed consent by the parents/ teachers, a semi-structured Performa/questionnaire was filled for each child. Anthropometric measurements were recorded. Correlation of age of the child with height, and weight was calculated.

Result: The nutritional status of the study children was particularly optimum; 90% children were in optimal nutritional status and had sound skeletal growth irrespective of their socioeconomic background. There was a significant correlation of nutritional status and skeletal growth of children with parents socioeconomic status. There was a direct correlation between height and weight of children, and their age.

Conclusion: Anthropometric measurements indicate a high majority of children in healthy status despite the overall poor setup.
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September 2014