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Article ; Online: Diagnostic Accuracy of Intraoperative Brain Smear: A Meta-Analysis of Studies from Resource-Limited Settings.

Shakir, Muhammad / Irshad, Hammad Atif / Lodhi, Bilal Ahmed / Jehanzeb, Hamzah / Shaikh, Taha / Enam, Syed Ather

2024

Abstract: Background: Intraoperative brain smear is an easy, rapid, and cost-effective technique for immediate diagnosis of brain tumors. Earlier studies have gauged its application on limited number of samples, but its diagnostic accuracy especially in low- ... ...

Abstract	Background: Intraoperative brain smear is an easy, rapid, and cost-effective technique for immediate diagnosis of brain tumors. Earlier studies have gauged its application on limited number of samples, but its diagnostic accuracy especially in low-resource settings, where its practice would be extremely helpful, is still undetermined. To investigate the diagnostic accuracy of intraoperative brain smear in resource-limited settings for diagnosis of brain tumors. Methods: A systematic search was conducted on PubMed, Google Scholar, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Embase for all articles utilizing intraoperative brain smears that were extracted. Studies from low- and middle-income countries (LMICs) with test performance characteristics were selected and subsequent values were summarized using a hierarchical summary receiver operating characteristic (ROC) curve via STATA and pooled using a random-effects model on MetaDiSc 2.0. Results: Twelve studies consisting of 1124 patients were identified. Six studies included both adult and pediatric population groups, while 4 investigated adults and 2 included pediatric patients. The pooled diagnostic odds ratio (OR) was calculated to be 212.52 (CI: [104.27-433.13]) of Bivariable pooled specificity and sensitivity were 92% (CI: [86%-96%]) and 96% (CI: [93%-98%]), respectively. Conclusions: Our study shows that intraoperative brain smear is not only an accurate and sensitive diagnostic modality in resource-rich settings, but it is also equally useful in resource-limited settings, making it an ideal method for rapid diagnosis.
Language	English
Publishing date	2024-01-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2024.01.023
Database	MEDical Literature Analysis and Retrieval System OnLINE

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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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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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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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Article: Role of Stem Cells in Surgery - the Way Forward.

Zeeshan, Sana / Rahman, Mohammad Fazlur / Islam, Saleem / Enam, Syed Ather

JPMA. The Journal of the Pakistan Medical Association

2023 Volume 73Suppl 1, Issue 2, Page(s) S2

MeSH term(s)	Humans ; Stem Cells
Language	English
Publishing date	2023-02-15
Publishing country	Pakistan
Document type	Editorial
ZDB-ID	603873-6
ISSN	0030-9982
ISSN	0030-9982
DOI	10.47391/JPMA.AKUS-ED1
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Article: Surgical research: Exploring our history - navigating the future.

Siddiqui, Nadeem Ahmed / Shamim, Muhammad Shahzad / Enam, Syed Ather

JPMA. The Journal of the Pakistan Medical Association

2022 Volume 72Suppl 1, Issue 2, Page(s) S2

Language	English
Publishing date	2022-02-24
Publishing country	Pakistan
Document type	Editorial
ZDB-ID	603873-6
ISSN	0030-9982
ISSN	0030-9982
DOI	10.47391/JPMA.AKU-01
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Article: Surgical Outcomes of Endoscopic Endonasal Versus Transcranial Resections of Adult Craniopharyngioma: A Meta-Analysis.

Rafaqat, Wardah / Bajwa, Mohammad Hamza / Angez, Meher / Enam, Syed Ather

Brain tumor research and treatment

2022 Volume 10, Issue 4, Page(s) 226–236

Abstract: Background: The endoscopic endonasal approach (EEA) has been gaining popularity for resection of adult craniopharyngiomas. However, the safety and effectiveness of the procedure in comparison to the traditional transcranial approach (TCA) remains ... ...

Abstract	Background: The endoscopic endonasal approach (EEA) has been gaining popularity for resection of adult craniopharyngiomas. However, the safety and effectiveness of the procedure in comparison to the traditional transcranial approach (TCA) remains unestablished as previous reviews are outdated. Methods: A literature search without language restriction was conducted in PubMed, Cochrane database, and Web of Science from conception to July 9, 2021. Cohort studies and case series that compared EEA with TCA and assessed postoperative complications, recurrence, and 30-day mortality were included. Articles, where data for adult populations could not be extracted or calculated, were excluded. Article selection and data extraction in a predesigned data extraction form were conducted in duplicate. Pooled participant data were included in a random-effects model. Results: The search yielded 227 articles, from which eight cohort studies containing 11,395 patients were included (EEA: 6,614 patients, TCA: 4,781 patients). Six studies were good quality and two were fair quality according to the Newcastle Ottawa Scale. There were significantly higher rates of cerebrospinal fluid leak (risk ratio [RR]=0.23, 95% confidence interval [CI] 0.17-0.32, Conclusion: EEA may be associated with reduced postoperative hypopituitarism, hydrocephalus, visual impairment, and 30-day mortality and higher rates of cerebrospinal fluid leak. These findings do not account for differences in tumor size and extension between the EEA and TCA cohorts. Further research on patients with comparable tumor characteristics is required to fully assess outcomes.
Language	English
Publishing date	2022-11-08
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	3018737-0
ISSN	2288-2413 ; 2288-2405
ISSN (online)	2288-2413
ISSN	2288-2405
DOI	10.14791/btrt.2022.0014
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Article: Surgical education and training.

Enam, Syed Ather / Ather, Hammad / Siddiqui, Nadeem

JPMA. The Journal of the Pakistan Medical Association

2021 Volume 71Suppl 1, Issue 1, Page(s) S2–S3

MeSH term(s)	Clinical Competence ; Education, Medical, Graduate ; General Surgery/education ; Humans ; Internship and Residency
Language	English
Publishing date	2021-02-15
Publishing country	Pakistan
Document type	Journal Article
ZDB-ID	603873-6
ISSN	0030-9982
ISSN	0030-9982
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Article: Frequency of early postoperative adverse events (AEs) in adult patients undergoing elective neurosurgical intervention at tertiary care center in Pakistan.

Chandio, Mansoor / Shafiq, Faraz / Enam, Syed Ather

Pakistan journal of medical sciences

2021 Volume 37, Issue 4, Page(s) 939–944

Abstract: Objective: The postoperative period is critical in neurosurgical patients, where the incidence of postoperative AEs is significantly high. Most of events occurs during recovery phase and has got relation to anaesthetic management. The objective of study ...

Abstract	Objective: The postoperative period is critical in neurosurgical patients, where the incidence of postoperative AEs is significantly high. Most of events occurs during recovery phase and has got relation to anaesthetic management. The objective of study was to determine frequency of early AEs in elective neurosurgical patients. Methods: This cross sectional study was conducted at our tertiary care center. The duration of study was one year, from August 2017-July 2018. The data was collected using predesigned proforma. The assessment was done on arrival in recovery room (T1) and then at forty five minutes (T2), twenty-fourth hour (T3) and forty-eighth hour (T4) postoperatively. Results: Total ninety-five patients were included. Overall, five hundred and forty AEs were recorded at T1, T2, T3 and T4. Anaesthesia related events like pain, postoperative sore throat, hoarseness, shivering and hypothermia were the commonest (73%). There was a gradual decline in incidence of these events over period of 48 hours. There was no effect of age, sex, BMI and blood loss on incidence of AEs. Conclusions: Postoperative pain, PONV and shivering were frequently reported AEs. We did not identify the impact of age, sex, BMI, comorbid or type of surgery in terms of having these events.
Language	English
Publishing date	2021-07-09
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.37.4.3501
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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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