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  1. Article ; Online: Does gender disparity exist in neurosurgery training? Evidence from a nationwide survey from Pakistan.

    Shakir, Muhammad / Irshad, Hammad Atif / Altaf, Ahmed / Ladak, Shamila / Aziz, Hafiza Fatima / Enam, Syed Ather

    Medical education online

    2024  Volume 29, Issue 1, Page(s) 2310385

    Abstract: Gender disparities are prevalent in the neurosurgical field, particularly for female trainees, despite the growing demand for neurosurgeons. The situation is bleaker in low-and middle-income countries, where gender disparities among neurosurgical ... ...

    Abstract Gender disparities are prevalent in the neurosurgical field, particularly for female trainees, despite the growing demand for neurosurgeons. The situation is bleaker in low-and middle-income countries, where gender disparities among neurosurgical trainees have not been evaluated. We aimed to gauge the gender differences in opportunities and perceptions of neurosurgery training in Pakistan by comparing responses between males and females. A nationwide web-based survey was conducted in Pakistan, covering 22 College of Physicians and Surgeons of Pakistan (CPSP) accredited neurosurgery training programs. Convenience sampling was used with a pilot-tested questionnaire. Data analysis was performed using SPSS version 26. A total of 120 trainees participated in our survey. The mean age of the participants was 30.4 ± 4.1 years, with 29.2% females and 70.8% males. Concerns about gender equity were more among females (34.3%) than males (27.1%). Poor work-life balance was reported by more females (34.3%) than males (30.6%). Burnout due to working hours was strongly agreed by more females (54.3%) than males (35.3%). More females (40%) acknowledged sufficient mentorship opportunities versus males (25%). Female respondents (65.7%) worked 50-100 hours per week, less than males (69.4%). Satisfaction with surgical exposure was lower among females (2.9%) compared to males (18.8%). More females reported access to teaching courses (82.9% vs. 77.6% males) and neurosurgical conferences (85.7% vs. 80.0% males), cadaver workshops (17.1% vs. 12.9% males), morbidity and mortality meetings (88.6% vs. 82.4% males), case-based sessions (82.9% vs. 75.3% males), and radiology discussions (82.9% vs. 74.1% males). Our study highlights substantial gender gaps in neurosurgical training, concerns over working hours, burnout, mentorship, work-life balance, and gender equity. These findings underscore the necessity for interventions to rectify these disparities and foster gender equity in neurosurgical training.
    MeSH term(s) Male ; Humans ; Female ; Adult ; Neurosurgery/education ; Pakistan ; Neurosurgeons ; Surveys and Questionnaires ; Burnout, Professional
    Language English
    Publishing date 2024-01-30
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2052877-2
    ISSN 1087-2981 ; 1087-2981
    ISSN (online) 1087-2981
    ISSN 1087-2981
    DOI 10.1080/10872981.2024.2310385
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  2. Article ; Online: Exploring the neurosurgery training landscape in Pakistan: A trainee's perspective in resource-limited settings.

    Shakir, Muhammad / Irshad, Hammad Atif / Khowaja, Aly Hamza / Altaf, Ahmed / Enam, Syed Ather

    World neurosurgery: X

    2024  Volume 22, Page(s) 100346

    Abstract: Background: Shortage of neurosurgeons in Pakistan, one per 720,000 people, stems from a lack of trainees. Therefore, it is vital to assess the training experience, career opportunities, and satisfaction levels of neurosurgical trainees in Pakistan.: ... ...

    Abstract Background: Shortage of neurosurgeons in Pakistan, one per 720,000 people, stems from a lack of trainees. Therefore, it is vital to assess the training experience, career opportunities, and satisfaction levels of neurosurgical trainees in Pakistan.
    Methods: A nationwide survey was conducted, covering 22 CPSP-accredited neurosurgery training programs in Pakistan. Convenience sampling was utilized with a pilot tested questionnaire and responses were analyzed using STATA 15.
    Results: The response rate was 98% (120/122) with 70.8% male and mean age of 30.4 ± 4.1 years. Training programs included teaching courses (79%) and journal club (66%); however, there was a lack of cadaver workshops (14%) and cranial model-based stimulation (22%). 67% of trainees lacked publications in indexed journals. 69% worked 50-100 h weekly, with 62% experiencing burnout due to workload and hours and a third reporting poor work-life balance. Trainees dedicated more to operating rooms (37%, 10-24 h/week) and clinics (34%, 24-48 h/week) compared to study (42%, <5 h/week) and research (64%, <5 h/week). Gender equality was rated poorly by 50%. Disparities emerged in subspecialty exposure, with over half of trainees lacking exposure to deep brain stimulation (67%), and epilepsy (75%). 52.5% of the training institutes did not offer fellowships and 64.1% of trainees planned to pursue fellowships abroad.
    Conclusions: Steps need to be taken to improve working hours, gender equity, and increase simulation courses, diversify subspecialty exposure, and promote research initiatives.
    Language English
    Publishing date 2024-02-24
    Publishing country United States
    Document type Journal Article
    ISSN 2590-1397
    ISSN (online) 2590-1397
    DOI 10.1016/j.wnsx.2024.100346
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  3. Article ; Online: Impact of medical school experiences on the career choice of neurosurgery: a cross- sectional study from Pakistan.

    Shakir, Muhammad / Irshad, Hammad Atif / Ali, Eisha Abid / Adil, Amna / Altaf, Ahmed / Enam, Syed Ather

    BMC medical education

    2024  Volume 24, Issue 1, Page(s) 465

    Abstract: Background: Pakistan grapples with the issue of an inadequate neurosurgery workforce but the reasons for such a disparity remain uncertain. Previous studies have highlighted how various factors including medical school experiences have an impact on ... ...

    Abstract Background: Pakistan grapples with the issue of an inadequate neurosurgery workforce but the reasons for such a disparity remain uncertain. Previous studies have highlighted how various factors including medical school experiences have an impact on career choice, but no study has delved into the impact of medical school exposure among Pakistani medical students, especially for the field of neurosurgery. This study aims to evaluate the impact of neurosurgery exposure, mentorship, and interest groups on medical students' decision to pursue neurosurgery.
    Methods: A national cross-sectional survey was conducted in Pakistan, collecting data from medical students, interns, and medical officers over a one-month period. Ethical approval was obtained from the Ethical Review Committee at Aga Khan University, Pakistan. The data was analyzed using SPSS version 26.
    Results: Out of 2618 participants, 38.0% were male and 62.0% were female, with an average age of 21.82 years (± 2.65). Among them, only 358 (13.6%) were interested in pursuing neurosurgery as a career, while the remaining 2,260 (86.3%) were not. More females (58.9%) than males (41.1%) expressed interest in pursuing neurosurgery as their intended career. Most medical students interested in pursuing neurosurgery were in the early years of their medical school (1st Year: 19.6%, 2nd Year: 26.0%, 3rd Year: 20.9%). In our study, students from public sector institutions (52.2%) showed more interest in neurosurgery as a career choice compared to those from private sector institutions (44.1%). The main deterrents for choosing neurosurgery were intense training (42.2%), work-life balance (39.9%), limited residency slots (56.7%), medical knowledge (34.1%), and surgical skills (36.6%).
    Conclusion: This study highlights the need for increased student engagement to inculcate the decision to pursue neurosurgery among medical students in Pakistan. A significant gap is highlighted, with the majority of interested students in early years. Public sector students show higher interest than their private sector counterparts. However, barriers like intense training, limited residency slots, and work-life balance concerns influence career choice. Targeted interventions like mentorship programs are crucial for fostering future neurosurgeons and advancing patient care and research. By addressing the identified disparities in experiences and promoting a supportive educational environment, it is possible to cultivate a future generation of skilled and dedicated neurosurgeons who can contribute to advancements in patient care and research in the field.
    MeSH term(s) Humans ; Career Choice ; Pakistan ; Cross-Sectional Studies ; Male ; Female ; Neurosurgery/education ; Students, Medical/psychology ; Young Adult ; Schools, Medical ; Adult ; Surveys and Questionnaires ; Mentors
    Language English
    Publishing date 2024-04-26
    Publishing country England
    Document type Journal Article
    ZDB-ID 2044473-4
    ISSN 1472-6920 ; 1472-6920
    ISSN (online) 1472-6920
    ISSN 1472-6920
    DOI 10.1186/s12909-024-05452-9
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Risk factors and predictors of intraoperative seizures during awake craniotomy: A systematic review and meta-analysis.

    Shakir, Muhammad / Khowaja, Aly Hamza / Altaf, Ahmed / Tameezuddin, Aimen / Bukhari, Syed Sarmad / Enam, Syed Ather

    Surgical neurology international

    2023  Volume 14, Page(s) 195

    Abstract: Background: Awake craniotomy (AC) aims to minimize postoperative neurological complications while allowing maximum safe resection. Intraoperative seizures (IOSs) have been a reported complication during AC; however, literature delving into the ... ...

    Abstract Background: Awake craniotomy (AC) aims to minimize postoperative neurological complications while allowing maximum safe resection. Intraoperative seizures (IOSs) have been a reported complication during AC; however, literature delving into the predictors of IOS remains limited. Therefore, we planned a systematic review and meta-analysis of existing literature to explore predictors of IOS during AC.
    Methods: From the inception until June 1, 2022, systematic searches of PubMed, Scopus, the Cochrane Library, CINAHL, and Cochrane's Central Register of Controlled Trials were conducted to look for published studies reporting IOS predictors during AC.
    Results: We found 83 different studies in total; included were six studies with a total of 1815 patients, and 8.4% of them experienced IOSs. The mean age of included patients was 45.3 years, and 38% of the sample was female. Glioma was the most common diagnosis among the patients. A pooled random effect odds ratio (OR) of frontal lobe lesions was 2.42 (95% confidence intervals [CI]: 1.10-5.33,
    Conclusion: Patients with lesions of the frontal lobe, a prior history of seizures, and patients on AEDs are at higher risk of IOSs. These factors should be taken into consideration during the patient's preparation for an AC to avoid an intractable seizure and consequently a failed AC.
    Language English
    Publishing date 2023-06-08
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2229-5097
    ISSN 2229-5097
    DOI 10.25259/SNI_135_2023
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  5. Article: Comparing the predicted accuracy of PO

    Furqan, Aamir / Rai, Shumaila Ali / Ali, Liaqat / Altaf Ahmed, Rana

    Pakistan journal of medical sciences

    2019  Volume 35, Issue 6, Page(s) 1605–1610

    Abstract: Objective: To compare the predicted accuracy of PFR with RSBI for successful spontaneous breathing trial before extubation in intensive care unit.: Methods: This cross sectional study was conducted at the ICU of Ch. Pervaiz Ellahi Institute of ... ...

    Abstract Objective: To compare the predicted accuracy of PFR with RSBI for successful spontaneous breathing trial before extubation in intensive care unit.
    Methods: This cross sectional study was conducted at the ICU of Ch. Pervaiz Ellahi Institute of Cardiology, Multan Medical and Nishtar Medical University Hospital from July, 2017 to January, 2019.PO
    Results: RSBI threshold of 130 had 40.4% sensitivity, 51.1% specificity, 55.2% positive predictive value, 36.4% negative predictive value and 44.7% diagnostic accuracy while RSBI threshold of 105 had 94.1% sensitivity, 43.6% specificity, 71.4% positive predictive value, 83.2% negative predictive value and 73.8% diagnostic accuracy. pO
    Conclusion: Even though neither rapid shallow breathing nor the PFR was enough accurate in prediction of successful extubation but rapid shallow breathing index 105 threshold had higher sensitivity and specificity as compared to RSBI threshold 130PFR. Therefore, RSBI105 is more accurate in predicting the outcome of extubation of ICU patients.
    Language English
    Publishing date 2019-09-30
    Publishing country Pakistan
    Document type Journal Article
    ZDB-ID 2032827-8
    ISSN 1681-715X ; 1682-024X ; 1017-4699
    ISSN (online) 1681-715X
    ISSN 1682-024X ; 1017-4699
    DOI 10.12669/pjms.35.6.788
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  6. Article ; Online: AMBA Based Advanced DMA Controller for SoC

    Abdullah Aljumah / Mohammed Altaf Ahmed

    International Journal of Advanced Computer Science and Applications, Vol 7, Iss 3, Pp 188-

    2016  Volume 193

    Abstract: this paper describes the implementation of an AMBA Based Advanced DMA Controller for SoC. It uses AMBA Specifications, where two buses AHB and APB are defined and works for processor as system bus and peripheral bus respectively. The DMA controller ... ...

    Abstract this paper describes the implementation of an AMBA Based Advanced DMA Controller for SoC. It uses AMBA Specifications, where two buses AHB and APB are defined and works for processor as system bus and peripheral bus respectively. The DMA controller functions between these two buses as a bridge and allow them to work concurrently. Depending on the speed of peripherals it uses buffering mechanism. Therefore an asynchronous FIFO is used for synchronizing the speed of peripherals. The proposed DMA controller can works in SoC along with processor and achieve fast data rate. The method introduced significant volume of data transfer with very low timing characteristics. Thus it is a better choice in respect of timing and volume of data. These two issues have been resolved under this research study. The results are compared with the AMD processors, like Geode GX 466, GX 500 and GX 533, and the presence and absence of DMA controller with processor is discussed and compared. The DMAC stands to be better alternative in SoC design.
    Keywords FPGA ; AMBA ; DMA ; DMA Controller ; SoC ; data transfer rate ; FIFO ; Electronic computers. Computer science ; QA75.5-76.95 ; Instruments and machines ; QA71-90 ; Mathematics ; QA1-939 ; Science ; Q
    Subject code 629
    Language English
    Publishing date 2016-03-01T00:00:00Z
    Publisher The Science and Information (SAI) Organization
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article: Unveiling the potential application of intraoperative brain smear for brain tumor diagnosis in low-middle-income countries: A comprehensive systematic review.

    Shakir, Muhammad / Altaf, Ahmed / Hussain, Hawra / Abidi, Syed Muhammad Aqeel / Petitt, Zoey / Tariq, Mahnoor / Gilani, Ahmed / Enam, S Ather

    Surgical neurology international

    2023  Volume 14, Page(s) 325

    Abstract: Background: Immediate intraoperative histopathological examination of tumor tissue is indispensable for a neurosurgeon to track surgical resection. A brain smear is a simple, rapid, and cost-effective technique, particularly important in the diagnosis ... ...

    Abstract Background: Immediate intraoperative histopathological examination of tumor tissue is indispensable for a neurosurgeon to track surgical resection. A brain smear is a simple, rapid, and cost-effective technique, particularly important in the diagnosis of brain tumors. The study aims to determine the effectiveness of intraoperative brain smear in the diagnosis of brain tumors in low- and middle-income countries (LMICs), while also evaluating its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy.
    Methods: A comprehensive search of the literature was conducted using PubMed, Scopus, and Google Scholar. The retrieved articles were independently screened by two reviewers. The data was extracted, processed, and organized using Microsoft Excel.
    Results: A total of 59 out of 553 articles screened were included in the final analysis. The sensitivity and specificity of the intraoperative smear of brain tumors were found to be over 90% in most studies. The PPV was consistently above 90% in 11 studies, reaching 100% in one study and the NPV varied, ranging from 63% to 100%, and the accuracy was found to be >80% in most studies. One recurrent theme in the majority of the included studies was that an intraoperative brain smear is a cost-effective, quick, accessible, and accurate method of diagnosing brain tumors, requiring minimal training and infrastructure.
    Conclusion: Intraoperative brain smear is a simple, rapid, cost-effective, and highly sensitive diagnostic modality for brain tumors. It can be a viable and accessible alternative to more traditional methods such as frozen sections and can be incorporated into neurosurgical practice in LMICs as a reliable and efficient diagnostic tool.
    Language English
    Publishing date 2023-09-08
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2229-5097
    ISSN 2229-5097
    DOI 10.25259/SNI_491_2023
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  8. Article: Intraoperative use of low-field magnetic resonance imaging for brain tumors: A systematic review.

    Altaf, Ahmed / Shakir, Muhammad / Malik, Muhammad Jawad Amin / Arif, Aabiya / Islam, Omar / Mubarak, Fatima / Knopp, Eddie / Siddiqui, Khan / Enam, S Ather

    Surgical neurology international

    2023  Volume 14, Page(s) 357

    Abstract: Background: Low-field magnetic resonance imaging (LF-MRI) has become a valuable tool in the diagnosis of brain tumors due to its high spatial resolution and ability to acquire images in a short amount of time. However, the use of LF-MRI for ... ...

    Abstract Background: Low-field magnetic resonance imaging (LF-MRI) has become a valuable tool in the diagnosis of brain tumors due to its high spatial resolution and ability to acquire images in a short amount of time. However, the use of LF-MRI for intraoperative imaging during brain tumor surgeries has not been extensively studied. The aim of this systematic review is to investigate the impact of low-field intraoperative magnetic resonance imaging (LF-IMRI) on the duration of brain tumor surgery and the extent of tumor resection.
    Methods: A comprehensive literature search was conducted using PubMed, Scopus, and Google Scholar from February 2000 to December 2022. The studies were selected based on the inclusion criteria and reviewed independently by two reviewers. The gathered information was organized and analyzed using Excel.
    Results: Our review of 21 articles found that low-field intraoperative MRI (LF-IMRI) with a field below 0.3T was used in most of the studies, specifically 15 studies used 0.15T LF-IMRI. The T1-weighted sequence was the most frequently reported, and the average scanning time was 24.26 min. The majority of the studies reported a positive impact of LF-IMRI on the extent of tumor resection, with an increase ranging from 11% to 52.5%. Notably, there were no studies describing the use of ultra-low-field (ULF) intraoperative MRI.
    Conclusion: The results of this systematic review will aid neurosurgeons and neuroradiologists in making informed decisions about the use of LF-MRI in brain tumor surgeries. Further, research is needed to fully understand the impact of LF-MRI in brain tumor surgeries and to optimize its use in the clinical setting. There is an opportunity to study the utility of ULF-MRI in brain tumor surgeries.
    Language English
    Publishing date 2023-10-06
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2229-5097
    ISSN 2229-5097
    DOI 10.25259/SNI_510_2023
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  9. Article ; Online: Factors Delaying the Continuum of Care for the Management of Traumatic Brain Injury in Low- and Middle-Income Countries: A Systematic Review.

    Shakir, Muhammad / Altaf, Ahmed / Irshad, Hammad Atif / Hussain, Nowal / Pirzada, Sonia / Tariq, Mahnoor / Trillo-Ordonez, Yesel / Enam, Syed Ather

    World neurosurgery

    2023  Volume 180, Page(s) 169–193.e3

    Abstract: Background: Considering the disproportionate burden of delayed traumatic brain injury (TBI) management in low- and middle-income countries (LMICs), there is pressing demand for investigations. Therefore, our study aims to evaluate factors delaying the ... ...

    Abstract Background: Considering the disproportionate burden of delayed traumatic brain injury (TBI) management in low- and middle-income countries (LMICs), there is pressing demand for investigations. Therefore, our study aims to evaluate factors delaying the continuum of care for the management of TBIs in LMICs.
    Methods: A systematic review was conducted with PubMed, Scopus, Google Scholar and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Observational studies with TBI patients in LMIC were included. The factors affecting management of TBI were extracted and analyzed descriptively.
    Results: A total of 55 articles were included consisting of 60,603 TBI cases from 18 LMICs. Road traffic accidents (58.7%) were the most common cause of injury. Among included studies, factors contributing to prehospital delays included a poor referral system and lack of an organized system of referral (14%), long travel distances (11%), inadequacy of emergency medical services (16.6%), and self-treatment practices (2.38%). For in-hospital delays, factors such as lack of trained physicians (10%), improper triage systems (20%), and absence of imaging protocols (10%), lack of in-house computed tomography scanners (35%), malfunctioning computed tomography scanners (10%), and a lack of invasive monitoring of intracranial pressure (5%), limited theater space (28%), lack of in-house neurosurgical facilities (28%), absence of in-house neurosurgeons (28%), and financial constraints (14%) were identified.
    Conclusions: Several factors, both before and during hospitalization contribute to delays in the management of TBIs in LMICs. Strategically addressing these factors can help overcome delays and improve TBI management in LMICs.
    MeSH term(s) Humans ; Developing Countries ; Hospitals ; Emergency Medical Services ; Brain Injuries, Traumatic/surgery ; Continuity of Patient Care
    Language English
    Publishing date 2023-09-07
    Publishing country United States
    Document type Systematic Review ; Journal Article ; Review
    ZDB-ID 2534351-8
    ISSN 1878-8769 ; 1878-8750
    ISSN (online) 1878-8769
    ISSN 1878-8750
    DOI 10.1016/j.wneu.2023.09.007
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  10. Article: Index testing among HIV-positive patients is feasible and successful in identifying additional HIV infections in Pakistan.

    Altaf, Arshad / Ali Shah, Syed Sharaf / Pasha, Safdar / Soomro, Altaf Ahmed / Farrukh, Nazia / Khanani, Rafiq

    JPMA. The Journal of the Pakistan Medical Association

    2021  Volume 71Suppl 4, Issue 8, Page(s) S6–S10

    Abstract: Objective: To assess the feasibility of index testing approach to test the parents and siblings of human immunodeficiency virus (HIV)-positive children, and identify HIV-positive individuals.: Methods: The study was conducted at Ratodero, Pakistan. ... ...

    Abstract Objective: To assess the feasibility of index testing approach to test the parents and siblings of human immunodeficiency virus (HIV)-positive children, and identify HIV-positive individuals.
    Methods: The study was conducted at Ratodero, Pakistan. Study participants were enrolled from September 2019 to February 2020. The list of HIV-positive persons was provided by the Sindh AIDS Control Programme. Families of 706 HIV-positive persons were approached and all of them agreed to participate. The first test was performed by trained outreach workers. All those with a reactive first test were transported to the nearest health facility for further testing and confirmation. Mothers and siblings were tested at home while additional visits were carried out to reach the fathers.
    Results: A total of 1766 persons were tested through HIV index testing. Biological siblings accounted for 81% of the contacts. We were able to test 413/463 (89.2%) mothers, 232/413 (56.2%) fathers and 1121/1392 (80.5%) siblings. Out of these, 7 mothers (1.7%) and 22 siblings (2.0%) were confirmed to be HIV-positive, while no one was found to be positive among the fathers. The overall HIV prevalence was 1.6% (29/1766). All HIV-positive persons were guided for treatment and care.
    Conclusions: Results indicate that index-testing approach is feasible in Pakistan to expand HIV testing services through home visits.
    MeSH term(s) Child ; HIV Infections/diagnosis ; HIV Infections/epidemiology ; HIV Testing ; Health Facilities ; Humans ; Pakistan/epidemiology ; Parents
    Language English
    Publishing date 2021-09-01
    Publishing country Pakistan
    Document type Journal Article
    ZDB-ID 603873-6
    ISSN 0030-9982
    ISSN 0030-9982
    DOI 10.47391/JPMA.0001
    Database MEDical Literature Analysis and Retrieval System OnLINE

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