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Article: Adipose derived stem cells for the peripheral nerve regeneration: review of techniques and clinical implications.

Arif, Fizzah / Rahman, Mohammad Fazlur / Khan, Ceemal Fareed

JPMA. The Journal of the Pakistan Medical Association

2023 Volume 73Suppl 1, Issue 2, Page(s) S148–S154

Abstract: Adipose tissue is considered as a multipotent organ with multiple cellular varieties, like adipose derived stem cells with ability to differentiate into nerve cells. This review is an attempt to summarize the techniques of harvesting, isolating and ... ...

Abstract	Adipose tissue is considered as a multipotent organ with multiple cellular varieties, like adipose derived stem cells with ability to differentiate into nerve cells. This review is an attempt to summarize the techniques of harvesting, isolating and delivery of adipose derived stem cells to injured nerve area and various interactions involved in the release of neurotrophic and angiogenic factors from stem cells. Neuro-regenerative potential of ADSCs is explained on the basis of "Paracrine hypothesis", according to which ADSCs secrete multiple neurotrophic factors and upregulates secretion of these neurotrophic factors by Schwann cells, leading to improved myelination, regeneration and decreases nerve fibrosis. ADSCs are easily available in abundance and undergo multi-step processing before grafting to nerve injury site. Acute inflammation, hypoxia and co-culturing with Schwann cells promotes neural differentiation of ADSCs. ADSCs and Schwann cells are reported to have similar mitogenic and differentiation factors, moreover, the micro-environment containing various growth factors and extracellular matrix plays a crucial role in promoting myelin formation by stem cells. Various animal model studies have shown improved outcomes when ADSCs were used for the management of peripheral nerve injuries after direct repair, nerve grafting, nerve conduit, nerve allograft. This review contains various pre-clinical studies that have shown outcomes of adipose derived stem cells in nerve regeneration in different grades of nerve injuries.
MeSH term(s)	Animals ; Peripheral Nerves ; Adipose Tissue ; Stem Cells/metabolism ; Nerve Regeneration ; Peripheral Nerve Injuries/therapy ; Nerve Growth Factors/metabolism
Chemical Substances	Nerve Growth Factors
Language	English
Publishing date	2023-02-14
Publishing country	Pakistan
Document type	Review ; Journal Article
ZDB-ID	603873-6
ISSN	0030-9982
ISSN	0030-9982
DOI	10.47391/JPMA.AKUS-24
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Article: Stem Cells On Youtube: National Vs International Content.

Arif, Fizzah / Rahman, Mohammad Fazlur / Safri, Mohammad Khozema

JPMA. The Journal of the Pakistan Medical Association

2023 Volume 73, Issue 10, Page(s) 2047–2053

Abstract: YouTube is one of the most popular video-based social media sites across the globe. The role of stem cell transplant has not been deeply explored on YouTube. The current narrative review was planned to assess the viewership of content available on ... ...

Abstract	YouTube is one of the most popular video-based social media sites across the globe. The role of stem cell transplant has not been deeply explored on YouTube. The current narrative review was planned to assess the viewership of content available on YouTube related to stem cells. The videos were classified based on type of content, duration, number of views, comments and number of likes. A total of 40 videos were downloaded under the search terms "stem cells in Pakistan" and "stem cells". Of them, 6(15%) were repeat videos, and 34(85%) were unique. The findings revealed that in 10(25%) most viewed videos from Pakistan, 6(60%) contained opinions from non-expert physicians. Among the 10(25%) most viewed international videos, the information providers were science educators in 4(40%) videos and researchers in 2 (20%). Notably, no content from Pakistan was present among the top relevant international videos. Over 27 million views were included in the total number of videos that were analysed. YouTube is a powerful tool to spread knowledge and support public health decision-making. However, misleading information regarding stem cell can lead to adverse outcomes.
MeSH term(s)	Humans ; Social Media ; Video Recording ; Pakistan ; Information Dissemination
Language	English
Publishing date	2023-10-25
Publishing country	Pakistan
Document type	Review ; Journal Article
ZDB-ID	603873-6
ISSN	0030-9982
ISSN	0030-9982
DOI	10.47391/JPMA.8530
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Article: Exploring the application of CHATGPT in plastic surgery: a comprehensive systematic review.

Arif, Fizzah / Safri, Mohammad Khozema / Shahzad, Zenab / Yasmeen, Sobia Fazlur / Rahman, Mohammad Fazlur / Shaikh, Safdar Ali

JPMA. The Journal of the Pakistan Medical Association

2024 Volume 74, Issue 4 (Supple-4), Page(s) S17–S28

Abstract: Objective: To determine the impact of ChatGPT in plastic surgery research and assess the authenticity of such contributions.: Methods: The study conducted a literature search in Sep'23 from databases like Pubmed, Google Scholar, SCOPUS, and OVID ... ...

Abstract	Objective: To determine the impact of ChatGPT in plastic surgery research and assess the authenticity of such contributions. Methods: The study conducted a literature search in Sep'23 from databases like Pubmed, Google Scholar, SCOPUS, and OVID Medline.The following keywords 'ChatGPT', 'chatbot', 'reconstruction', 'aesthetic' and 'plastic surgery' were used. 32 papers were included from the initial 131 results of articles. English language articles from November 2022 to July 2023 discussing ChatGPT's role in plastic and aesthetic surgery were included whereas non-English documents, irrelevant content, and non-academic sources were excluded from the study. Results: The manuscripts included in the systematic review had a diverse range, including original research articles, case reports, letters to the editor, and editorials. Among the included studies, there were 9 original research articles, 1 case report, 23 letters to the editor, and 2 editorials. Most publications originated from the United States (18) and Australia (7). Analysis suggested concerns, such as inaccuracies, plagiarism, outdated knowledge, and lack of personalized advice. Various authors recommend using ChatGPT as a supplementary tool rather than a replacement for human decision-making in medicine. Conclusions: ChatGPT shows potential in plastic surgery research, concerns about inaccuracies and outdated knowledge may provide deceiving information and it always requires human input and verification.
MeSH term(s)	Humans ; Surgery, Plastic ; Plastic Surgery Procedures/methods ; Social Media
Language	English
Publishing date	2024-04-28
Publishing country	Pakistan
Document type	Systematic Review ; Journal Article
ZDB-ID	603873-6
ISSN	0030-9982
ISSN	0030-9982
DOI	10.47391/JPMA.AKU-9S-04
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Article: Robotic-assisted free flap harvesting for diverse soft tissue reconstruction: a PRISMA scoping review of clinical outcomes over the last decade.

Arif, Fizzah / Ahmed, Owais / Rahman, Mohammad Fazlur / Yasmeen, Sobia / Shaikh, Safdar Ali

JPMA. The Journal of the Pakistan Medical Association

2024 Volume 74, Issue 4 (Supple-4), Page(s) S136–S144

Abstract: Introduction: The aim of our study was to assess the advantages and limitations of robotic technology in diverse reconstructive procedures.: Methods: A scoping review was conducted in Oct'23, on published studies from 2013 to 2023, focussing on ... ...

Abstract	Introduction: The aim of our study was to assess the advantages and limitations of robotic technology in diverse reconstructive procedures. Methods: A scoping review was conducted in Oct'23, on published studies from 2013 to 2023, focussing on robotic-assisted free flap harvesting. Three databases Ovid-MEDLINE, Scopus, and PubMed were searched. Original research studies reporting robotic-assisted free flap harvest were included. Studies on lesion excision, microvascular anastomosis, local flap harvest, roboticassisted flap inset, review articles, abstract-only studies, non-English documents, and animal studies were excluded from this review. Results: Sixteen studies met the inclusion criteria out of a total of 318, searched initially. These studies included a total of 128 patients, who underwent robotic-assisted free flap harvest for the reconstruction of various defects, with 140 free flaps harvested. The most common flaps harvested by robotic technique were deep inferior epigastric artery perforator (DIEP) flap 120 (85.7%), radial forearm free (RFF) flap 11 (7.9%), latissimus dorsii flap 4 (2.9%), rectus abdominus flap 4 (2.9%), and omental flap 1 (0.7%). Breast reconstruction was the major procedure done i.e. 120 (85.7%) followed by head and neck 11 (7.9%) and limb defects 9 (6.4%) reconstruction procedures. The reported clinical outcomes were acceptable in all the studies with a 99% flap success rate and minimal complications. Variability in operating time was observed depending upon surgical steps undertaken with robotic systems. Conclusions: This scoping review highlights the role of robotic-assisted free flap harvesting in plastic surgery and its potential benefits on clinical outcomes, due to its high precision and minimal invasiveness. However, challenges like cost effectiveness, resource distribution and learning curve are there.
MeSH term(s)	Humans ; Plastic Surgery Procedures/methods ; Robotic Surgical Procedures/methods ; Free Tissue Flaps ; Tissue and Organ Harvesting/methods
Language	English
Publishing date	2024-04-29
Publishing country	Pakistan
Document type	Journal Article ; Review
ZDB-ID	603873-6
ISSN	0030-9982
ISSN	0030-9982
DOI	10.47391/JPMA.AKU-9S-21
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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: Advancing Immediate Breast Reconstruction Surgery in Pakistan: Bridging Literature Gaps and Meeting Patient Needs

Faisal, Abdullah Bin / Shahid, Fatima / Khalid, Laiba / RAHMAN, MOHAMMAD FAZLUR

Archives of Plastic Surgery

2024

Abstract: Breast cancer ranks as the most diagnosed cancer globally and the leading cause of cancer mortality in women, with Pakistan exhibiting a particularly high incidence. However, breast reconstruction surgery, a critical intervention post-mastectomy, remains ...

Abstract	Breast cancer ranks as the most diagnosed cancer globally and the leading cause of cancer mortality in women, with Pakistan exhibiting a particularly high incidence. However, breast reconstruction surgery, a critical intervention post-mastectomy, remains underutilized in Pakistan due to various barriers. Recent studies shed light on patient perspectives and outcomes regarding immediate breast reconstruction (IBR), indicating its positive impact on psychosocial well-being. Despite these insights, significant literature gaps persist, including the need for comprehensive national data, addressing cultural and awareness barriers, improving access and education, and prioritizing patient-centered care. This short communication underscores the urgency of addressing these gaps to advance breast reconstruction surgery in Pakistan. By conducting comprehensive studies, tackling cultural barriers, and prioritizing patient-centered care, we can ensure improved care and quality of life for Pakistani breast cancer patients. This call to action aims to transform the landscape of breast reconstruction surgery in Pakistan, offering hope for a brighter future for patients.
Language	English
Publishing date	2024-04-24
Publisher	Thieme Medical Publishers, Inc.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2694943-X
ISSN	2234-6171 ; 2234-6163 ; 2234-6171
ISSN (online)	2234-6171
ISSN	2234-6163 ; 2234-6171
DOI	10.1055/a-2312-8945
Database	Thieme publisher's database

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Article ; Online: Median to Radial Nerve Transfer: An 8-Year Experience From a Lower-Middle Income Country.

Ahmed, Kaleem S / Rajput, Batool U / Siddiqui, Muhammad Ahsan Iqbal / Nadeem, Afifa / Rahman, Mohammad Fazlur

The Journal of surgical research

2023 Volume 291, Page(s) 231–236

Abstract: Introduction: With an incidence of 2-16%, radial nerve palsy is one of the common forms of nerve injuries globally. Radial nerve palsy causes debilitating effects including loss of elbow extension, wrist drop and loss of finger extension. Reparative ... ...

Abstract	Introduction: With an incidence of 2-16%, radial nerve palsy is one of the common forms of nerve injuries globally. Radial nerve palsy causes debilitating effects including loss of elbow extension, wrist drop and loss of finger extension. Reparative surgical pathways range from primary repair and neurolysis, to nerve grafting, nerve transfers, and tendon transfers. Due to ease of performance and acceptability and reproducibility of outcomes, tendon transfers are considered the gold standard of radial nerve palsy repair. However, independent finger function cannot be achieved and as such may not give truly desirable results. In lower-middle income countries, the question of nerve transfer versus tendon transfer for patients who are keen to get back to work is key. While tendon transfer recovery is faster, the functional loss is often considered devastating for fine hand function due to loss of grip secondary to lack of wrist and finger extension. In this study, we present our experience of performing median nerve transfers for radial nerve palsy in Pakistan. Methods: We performed a retrospective case-series of patients undergoing median to radial nerve transfer for radial nerve palsy over a period of 6 y, from 2012 to 2019. Patients with radial nerve palsy were diagnosed via electromyography and nerve conduction studies. The procedure involved coapting the branches of the flexor carpi radialis and flexor digitorum superficialis (long and ring finger) nerves to the posterior interosseous nerve and extensor carpi radialis brevis, respectively. Patients were assessed using the Medical Research Council scale for muscle strength of wrist, finger and thumb extension separately at 1 y time. Our results were then compared to results from similar nerve transfer studies. Results: We operated on 10 right-hand dominant patients, eight males and two females with a median age of 33 y (6-63 y). four sustained injury to the right hand and six to the left. Causes of the injuries included road traffic accident (n = 3), firearm injury (n = 4), shrapnel (n = 1), iatrogenic injury (injection in deltoid region (n = 1) and fall (n = 1). Types of fracture included mid humerus fracture, fracture of the surgical neck of the humerus, and supracondylar fracture of the humerus. Median time to surgery since injury was 4 mo (1-8 mo). Independent wrist extension was M4+ in all patients and independent finger extension was M4+ in seven and M4-in two patients. However, a patient who presented late at 8 mo had poorer finger outcomes with extension at M2-. All patients had independent movement of fingers. Conclusions: Nerve transfer is a reliable method of post traumatic nerve repair and reinnervation, particularly in lower-middle income countries, even in cases where the nerve damage is severe and extensive and up to 6 mo may have elapsed between injury and presentation. Timely median to radial nerve transfer is a highly recommended option for radial nerve palsy, with regular follow-ups and physical therapy added to ensure positive outcomes.
MeSH term(s)	Male ; Female ; Humans ; Nerve Transfer/methods ; Radial Neuropathy/etiology ; Radial Neuropathy/surgery ; Retrospective Studies ; Developing Countries ; Firearms ; Reproducibility of Results ; Wounds, Gunshot/surgery
Language	English
Publishing date	2023-07-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2023.04.013
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Association of the Depth of Invasion With Recurrence Rates of Basal Cell Carcinoma in a Tertiary Health Care Facility: A Retrospective Study Over a Period of Six Years.

Unar, Ambreen / Khan, Hira / Zahid, Nida / Khan, Mustafa A / Fatima, Saira / Shaikh, Safdar A / Rahman, Mohammad Fazlur

Cureus

2023 Volume 15, Issue 3, Page(s) e36276

Abstract: Background Basal cell carcinoma (BCC) is one of the most common types of cutaneous malignancies and the most frequently occurring form of cancer worldwide. The incidence of basal cell carcinoma is difficult to determine due to its wide geographic ... ...

Abstract	Background Basal cell carcinoma (BCC) is one of the most common types of cutaneous malignancies and the most frequently occurring form of cancer worldwide. The incidence of basal cell carcinoma is difficult to determine due to its wide geographic variations; however, it has been increasing worldwide with an annual increase of 7% in the number of reported cases. Although BCC is more prevalent in the aging population, diagnosis in younger individuals is steadily increasing. BCC has overall low mortality, however, it leads to significant economic and physical impact on patients and their families along with adding burden to the healthcare system. The primary risk factor for the development of BCC is increased cumulative sun exposure, particularly to UV radiation. The UV index of Karachi averages around 12 (extremely high) during summer months, putting the population at a significantly higher risk of developing BCC in the long term. Objectives This audit was undertaken with the following primary objectives: to use the data collected to determine possible prognostic factors for BCC, to measure the rate of recurrence and the number of new primary tumors detected, to study the completeness of follow-up by patients, and to co-relate histopathological findings with the recurrence rate of basal cell carcinoma. Methods A retrospective analysis was performed for all patients with BCC who had undergone surgical resection over a six-year time period. Patient charts were reviewed for demographic information, tumor size, onset-to-diagnosis, anatomic location, clinical subtype, histologic differentiation, method of surgical treatment, and recurrence. Data were entered and analyzed in SPSS version 23 (IBM Corp., Armonk, NY). Results The review identified cases of BCC in 99 patients. Of the 99 patients, 60.39% were men and 38.38% were women. The most frequent age group was 65-85-year-olds (42 patients, 42.85%) for BCC. Based on the aesthetic units of the face, the most common location was the nasal unit (30 cases, 30.30%) for BCC. Most of the lesions were closed primarily; however; local flaps were used in the case of surgical defects. The recurrence rate was 19.19% for BCC in this study. Our study included 1.0% of patients who were classified as Clark classification level 2 of BCC, 6.1% as Clark level 3, 23.4% as Clark level 4, and 0.16% as Clark level 5. Recurrence rates were seen to increase with increasing Clark classification level in this study. Conclusion In our study, many characteristics of BCC were compared to previously published reports and the results were seen to be generally similar. This study correlates the recurrence of BCC with Clark's classification, showing that depth of invasion is a significant factor in predicting recurrence. There is a paucity of literature regarding the depth of invasion of BCC along with its' Clarks classification and recurrence. Further studies can help explore and establish the characteristics of BCC.
Language	English
Publishing date	2023-03-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.36276
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Use of Cephalic Vein for Venous Anastomosis in Head and Neck Reconstruction: A Case Series.

Rahman, Mohammad Fazlur / Ahsan, Muhammad Asif / Shaikh, Safdar Ali / Khan, Muhammad Ubaid / Ullah, Sami

Eplasty

2020 Volume 20, Page(s) e9

Abstract: Purpose: ...

Abstract	Purpose:
Language	English
Publishing date	2020-07-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2412803-X
ISSN	1937-5719
ISSN	1937-5719
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Aboard the Smile Train: Outcomes of Primary Cleft Palate Repair at a Tertiary Care Center: À bord du Smile Train : les résultats cliniques de réparations de fentes palatines dans un centre de soins tertiaires.

Khan, Daniyal A / Farooq, Ayesha / Jiwani, Uswa / Ahsan, Muhammad Asif / Shahzad, Farooq / Rahman, Mohammad Fazlur

Plastic surgery (Oakville, Ont.)

2020 Volume 29, Issue 1, Page(s) 10–15

Abstract: Introduction: Cleft palate repair is considered to be a safe procedure, yet still carries a 5% to 30% risk of complications. This study sought to assess the outcomes of this procedure in a high-burden Asian country that partners with the Smile Train to ... ...

Abstract	Introduction: Cleft palate repair is considered to be a safe procedure, yet still carries a 5% to 30% risk of complications. This study sought to assess the outcomes of this procedure in a high-burden Asian country that partners with the Smile Train to perform cleft surgeries. Methods: The Aga Khan University medical records database was queried for pediatric patients undergoing cleft surgery between 2014 and 2017. Data were abstracted from the patient medical records, and details of the clinical, demographic factors, and postoperative outcomes were assessed. Results: Among 142 patients with orofacial clefts, 102 (72%) underwent primary cleft palate repair, one-third (n = 36, 35%) of whom were operated as part of the Smile Train. The median preoperative hemoglobin was 11.4 g/dL (interquartile range: 10.7-12.0 g/dL), whereas the median weight was 8.3 kg (7.7-11.4 kg). Nearly two-thirds (n = 64, 63%) of the cohort underwent preoperative cardiology screening, with only a minority undergoing orthodontic treatment (n = 6, 6%). Approximately 15% (n = 15) of patients experienced a postoperative complication, most often a fistula (n = 11, 73%). On multivariable analysis, with each unit increase in hemoglobin levels, there was a 50% reduction in the odds of experiencing a complication (odds ratio: 0.51, 95% CI: 0.28-0.87). There were no in-patient deaths among the cohort. Conclusion: The results of the current study provide useful information to key stakeholders including patients, plastic surgeons, and policy makers on the outcomes of cleft palate repair in a developing country.
Language	English
Publishing date	2020-06-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2869727-3
ISSN	2292-5511 ; 2292-5503
ISSN (online)	2292-5511
ISSN	2292-5503
DOI	10.1177/2292550320935969
Database	MEDical Literature Analysis and Retrieval System OnLINE

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