Bilateral Moyamoya Disease in a 2-Year-Old Pakistani Male Treated with Bilateral Encephaloduroarteriosynangiosis: A Positive Outcome.

Background. We present a rare case of bilateral moyamoya disease presenting as multiple strokes and neurological deficits, treated with the neurosurgical procedure, encephaloduroarteriosynangiosis (EDAS), in a 2-year-old male Pakistani minor. A positive outcome was achieved and the patient recovered fully. Case Summary. Our patient presented with a history of seizures and multiple episodes of hemiparesis (on and off weakness) at the age of 2 years. He had a delayed speech development and could not speak more than a few words. He had a slight slurring of speech too. He was diagnosed with bilateral moyamoya disease on Computed Tomography Angiography (CTA). Bilateral EDAS was done in the same year, after which his symptoms improved and patient had moderate functional recovery. Conclusion. A rare disease, moyamoya has been left unexplored in Pakistan; physicians and surgeons when dealing with cases in the pediatric population presenting with symptoms of stroke, signs of generalized weakness, and seizures should consider moyamoya disease as a possibility. Furthermore, this case demonstrates the effectiveness of EDAS procedure for the treatment of moyamoya disease

The Achievable Rate of Interweave Cognitive Radio in the Face of Sensing Errors

Cognitive radio (CR) systems are potentially capable of mitigating the spectrum shortage of contemporary wireless systems. In this paper, we provide a brief overview of CR systems and the important research milestones of their evolution, along with their standardization activities, as a result of their research. This is followed by the detailed analysis of the interweave policy-based CR network (CRN) and by a detailed comparison with the family of underlay-based CRNs. In the interweave-based CRN, sensing of the primary user's (PU) spectrum by the secondary user's (SU) has remained a challenge, because the sensing errors prevent us from fulfilling the significant throughput gains that the concept of CR promises. Since missed detection and false alarm errors in real-time spectrum sensing cannot be avoided, based on a new approach, we quantify the achievable rates of the interweave CR by explicitly incorporating the effect of sensing errors. The link between the PU transmitter and the SU transmitter is assumed to be fast fading. Explicitly, the achievable rate degradation imposed by the sensing errors is analyzed for two spectrum sensing techniques, namely, for energy detection and for magnitude squared coherence-based detection. It is demonstrated that when the channel is sparsely occupied by the PU, the reusing techniques that are capable of simultaneously providing low missed detection and false alarm probabilities cause only a minor degradation to the achievable rates. Furthermore, based on the achievable rates derived for underlay CRNs, we compare the interweave CR and the underlay CR paradigms from the perspective of their resilience against spectrum sensing errors. Interestingly, in many practical regimes, the interweave CR paradigm outperforms the underlay CR paradigm in the presence of sensing errors, especially when the SNR at the SU is below 10 dB and when the SNR at the PU is in the range of 10-40 dB. Furthermore, we also provide rules of thumb that identify regimes, where the interweave CR outperforms the underlay CR

Conceptual framework for a cardiac surgery simulation laboratory and competency-based curriculum in Pakistan - a short innovation report

Simulation is a commonly utilized technique in healthcare education as it provides trainees a realistic, but safe, environment to learn a variety of skills. Trainees belonging to fields known for high stakes with low margins for error, such as cardiac surgery, can greatly benefit from simulation-based education. We propose the establishment of the first multi-tier high fidelity cardiac surgery simulation lab with a structured curriculum that will eventually provide multidisciplinary training to promising cardiac surgeons across Pakistan. The simulation lab may also be used for research, grant acquisition and patent development. Our setup will include the following levels of simulation: a simple bench model, a virtual reality simulator and a unique human performance simulator. Our multitiered approach allows for appropriate sequential trainee skill progression. Finally, we hope that our model inspires the development of similar curricula and modules for trainees belonging to other surgica

Nigella Sativa's Effect on Biochemical as well as Anthropometric Parameters in Diabetic Rats on High Fat Diet

Objective: Black cumin (Nigella sativa L.) seeds and its crude extract or essential oils have been widely used traditionally for nutritional and medicinal applications in Asian countries. Its effects on diabetics with high fat diet consumption have not been adequately studied. This study was undertaken to study its effects on body weight, abdominal girth, lipid profile and plasma glucose levels in diabetic high fat diet fed rats. Materials and Methods : Streptozotocin induced male Wistar rats were fed high fat diet [5130 kcal] for 4 weeks after which they were given vehicle, Nigella sativa ethanolic extract (300mg/kg), Nigella sativa ethanolic extract (600 mg) or metformin (100 mg). Lipid profile, blood glucose, body weight & abdominal girth were measured. Results: Nigella sativa ethanolic extract (600 mg) caused significant reduction in blood glucose, total cholesterol, triglycerides, VLDL and non HDL cholesterol comparable to metformin. Conclusion : Nigella sativa shows anti-hyperglycemic effects and improvement in lipid profile in diabetic high fat diet fed rats which is comparable to metformin. Further studies are required to advocate its use in patients with diabetes and dyslipidemias. Keywords: Nigella sativa, diabetes mellitus, antihyperlipidemic, antihyperglycemic, high fa

Comparative trends in ischemic heart disease admissions, presentation and outcomes due to the COVID-19 pandemic: First insights from a tertiary medical center in Pakistan

Introduction: COVID-19 has manifested a striking disarray in healthcare access and provision, particularly amongst patients presenting with life-threatening ischemic heart disease (IHD). The paucity of data from low-middle income countries has limited our understanding of the consequential burden in the developing world. We aim to compare volumes, presentations, management strategies, and outcomes of IHD amongst patients presenting in the same calendar months before and during the COVID-19 pandemic.Methods: We conducted a retrospective cross-sectional analysis at the Aga Khan University Hospital, one of the premier tertiary care centres in Pakistan. Data were collected on all adult patients (\u3e18 years) who were admitted with IHD (acute coronary syndrome (ACS) and stable angina) from March 1 to June 30, 2019 (pre-COVID) and March 1 to June 30, 2020 (during-COVID), respectively. Group differences for continuous variables were evaluated using student t-test or Mann-Whitney U test. The chi-squared test or Fisher test was used for categorical variables. Values of p less than 0.05 were considered statistically significant. P-value trend calculation and graphical visualization were done using STATA (StataCorp, College Station, TX).Results: Data were assimilated on 1019 patients, with 706 (69.3%) and 313 (30.7%) patients presenting in each respective group (pre-COVID and during-COVID). Current smoking status (p=0.019), admission source (p\u3c0.001), month of admission (p\u3c0.001), proportions ACS (p\u3c0.001), non-ST-elevation-myocardial-infarction (NSTEMI; p\u3c0.001), unstable angina (p=0.025) and medical management (p=0.002) showed significant differences between the two groups, with a sharp decline in the during-COVID group. Monthly trend analysis of ACS patients showed the most significant differences in admissions (p=0.001), geographic region (intra-district vs intracity vs outside city) (p\u3c0.001), time of admission (p=0.038), NSTEMI (p=0.002) and medical management (p=0.001).Conclusion: These data showcase stark declines in ACS admissions, diagnostic procedures (angiography) and revascularization interventions (angioplasty and coronary artery bypass graft surgery, CABG) in a developing country where resources and research are already inadequate. This study paves the way for further investigations downstream on the short- and long-term consequences of untreated IHD and reluctance in health-seeking behaviour