Fahim Anwar - Academia.edu (original) (raw)

Papers by Fahim Anwar

Supplemental material, APPROVED_Xeomin_Prescribing_information_UKIE_combined_June_2019_v4 for The... more Supplemental material, APPROVED_Xeomin_Prescribing_information_UKIE_combined_June_2019_v4 for The burden of sialorrhoea in chronic neurological conditions: current treatment options and the role of incobotulinumtoxinA (Xeomin®) by Francesca Morgante, Ganesh Bavikatte, Fahim Anwar and Biju Mohamed in Therapeutic Advances in Neurological Disorders

BMC Medicine

Background Traumatic brain injury (TBI) is a global public health challenge, affecting about 69 m... more Background Traumatic brain injury (TBI) is a global public health challenge, affecting about 69 million individuals annually and being one of the leading causes of mortality. It has adverse consequences in terms of cognitive and physical functioning, which makes rehabilitation interventions an integral part of its management. Early neuro-rehabilitation guidelines for traumatic brain injury have not yet been developed and implemented in most of Africa especially Sub-Saharan Africa. Body We aimed with this Opinion to propose a collective reflection on the development and implementation of early neuro-rehabilitation guidelines as an integral part of the care in traumatic brain injury. The different aspects to be considered for reflection have been highlighted: Traumatic brain injury severity to be considered in early neuro-rehabilitation; who should be assessed and receive early neurorehabilitation, barriers to be considered for early neurorehabilitation; what early neurorehabilitation...

The Journal of the International Society of Physical and Rehabilitation Medicine

Aim: The study aims to evaluate the effectiveness of tibial nerve block with phenol on ankle plan... more Aim: The study aims to evaluate the effectiveness of tibial nerve block with phenol on ankle plantarflexion and inversion spasticity caused by the upper motor neuron lesions. Materials and Methods: A single-center retrospective study was undertaken to assess the effectiveness of tibial nerve block on the spasticity of ankle plantar flexors and invertors in upper motor neuron lesions. Forty-four patients with ankle plantar flexion and inversion spasticity were included in the study. Clinical outcomes were measured before tibial nerve block at 6 and 24 weeks following the treatment. The outcome measures included Modified Ashworth Scale (MAS), the passive range of motion of the ankle dorsiflexion with the knee in a flexed position and with the knee in an extended position. The patients were advised to continue with the pharmacological and nonpharmacological interventions such as medications, splinting, and stretching. Friedman test of differences among repeated measures was conducted from data at 0, 6, and 24 weeks. Results: There was a statistically significant difference between the baseline MAS and ankle passive range of dorsiflexion motions (both with the knee flexed and extended) measured at 6 and 24 weeks following the phenol nerve block of the tibial nerve. Conclusions: This study highlights that phenol nerve block of the tibial nerve helps to reduce the spasticity of the ankles when combined with other pharmacological and nonpharmacological interventions such as splinting and stretching.

British Journal of Neurosurgery

BMJ Open

IntroductionCranioplasty is a widely practised neurosurgical procedure aimed at reconstructing a ... more IntroductionCranioplasty is a widely practised neurosurgical procedure aimed at reconstructing a skull defect, but its impact on a patient’s rehabilitation following a traumatic brain injury (TBI) or stroke could be better understood. In addition, there are many issues that a TBI patient or the patient who had a stroke and their families may have to adapt to. Insight into some of the potential social barriers, including issues related to social engagement and cosmetic considerations, would be beneficial. Currently, little is known about how this procedure impacts a patient’s recovery, the patient’s perceptions of rehabilitation precranioplasty and postcranioplasty and the broader issues of cosmesis and social reintegration. This study hopes to understand some of these issues and therefore help inform clinicians of some of the difficulties and perceptions that patients and their relatives may have.Methods and analysisA mixed-methods study. Data will be collected through focus groups ...

BACKGROUND Core outcome sets (COSs) are important and necessary as they help standardize reportin... more BACKGROUND Core outcome sets (COSs) are important and necessary as they help standardize reporting in research studies. Cranioplasty following traumatic brain injury (TBI) or stroke is becoming increasingly common, leading to an ever-growing clinical and research interest, especially regarding the optimal material, cost-effectiveness, and timing of cranioplasty concerning neurological recovery and complications. Consequently, heterogeneous reporting of outcomes from such diverse studies has led to limited meta-analysis ability and an ongoing risk of outcome reporting bias. This study aims to define a standardized COS for reporting in all future TBI and stroke cranioplasty studies. OBJECTIVE This study has four aims: (1) undertake a systematic review to collate the most current outcome measures used within the cranioplasty literature; (2) undertake a qualitative study to understand better the views of clinicians, patients' relatives, and allied health professionals regarding clin...

Background: Patients with significant brain swelling and/or raised intracranial pressure after a ... more Background: Patients with significant brain swelling and/or raised intracranial pressure after a traumatic brain injury (TBI) or middle cerebral artery infarct (MCA infarct) can undergo a craniectomy [ref:1], [ref:2] to help in the management of raised intracranial pressures.[for full text, please go to the a.m. URL]

$Research paper thumbnail of Cycling-related orthopaedic fractures admitted to the Major Trauma Centre in the cycling capital of the UK$

Archives of Orthopaedic and Trauma Surgery, 2021

Introduction The popularity of cycling in the United Kingdom is increasing, with a further rise l... more Introduction The popularity of cycling in the United Kingdom is increasing, with a further rise likely due to recent government cycling promotion schemes. This study aims to characterise fractures sustained due to cycling-related collisions in patients presenting to a Major Trauma Centre, in the region with the highest cycling rates in the United Kingdom. Methods A retrospective analysis of cycling injuries presenting to our centre between January 2012 and December 2020 was performed using a prospectively collected electronic database. Comparison of fracture characteristics was made according to patient age and mechanism of injury (collision with a motorised vehicle versus collision with a non-motorised object.). Results Of the 737 patients who suffered a cycling-related injury, 292 (39.6%) suffered at least 1 fracture to the appendicular skeleton. Overall, fractures were most commonly seen in those over 50 years of age. Upper limb fractures were more common than lower limb fracture...

Journal of Clinical Neuroscience, 2021

Degenerative Cervical Myelopathy (DCM) is one of the commonest causes of non-traumatic Spinal Cor... more Degenerative Cervical Myelopathy (DCM) is one of the commonest causes of non-traumatic Spinal Cord Injury (SCI) leading to significant neurological impairments and reduced health-related quality of life. Guidelines recommend surgical intervention to halt disease progression in moderate-to-severe cases, and whilst many do experience neurological recovery, this is incomplete leading to lifelong disability. A James Lind Alliance (JLA) research priority setting partnership for DCM highlighted novel therapies and rehabilitation as top 10 research priority in DCM. Neurological recovery following decompressive surgery in DCM has been attributed neuroplasticity, and therapies influencing neuroplasticity are of interest. Electrical neuromodulation interventions such as repetitive Transcranial Magnetic Stimulation (rTMS), are being increasingly explored in related fields such as spinal cord injury to improve recovery and symptoms. The aim of this systematic review was to determine the role and efficacy of rTMS as a therapeutic tool in managing neurological dysfunction in DCM. We searched the databases of Medline, EMBASE, CINAHIL and Cochrane Central Register of Controlled Trials (CENTRAL). No studies were identified that had investigated the therapeutic use of rTMS in DCM. A significant number of studies had explored TMS based neurophysiological assessments indicating its role as a screening and prognostication tool in DCM. Post-operative rehabilitation interventions including TMS and non-operative management of DCM is a field which requires further investigation, as required in the AO Spine JLA DCM research priorities. rTMS is a safe neuromodulatory intervention and may have a role in enhancing recovery in DCM. Further research in these fields are required.

Neurotrauma Reports, 2020

Post-concussion syndrome (PCS) refers to a constellation of physical, cognitive, and emotional sy... more Post-concussion syndrome (PCS) refers to a constellation of physical, cognitive, and emotional symptoms after traumatic brain injury (TBI). Despite its incidence and impact, the underlying mechanisms of PCS are unclear. We hypothesized that impaired cerebral autoregulation (CA) is a contributor. In this article, we present our protocol for non-invasively assessing CA in patients with TBI and PCS in a real-world clinical setting. A prospective, observational study was integrated into outpatient clinics at a tertiary neurosurgical center. Data points included: demographics, symptom profile (Post-Concussion Symptom Scale [PCSS]) and neuropsychological assessment (Cambridge Neuropsychological Test Automated-Battery [CANTAB]). Cerebrovascular metrics (nMxa coefficient and the transient hyperaemic-response ratio [THRR]) were collected using transcranial Doppler (TCD), finger plethysmography, and bespoke software (ICM+). Twelve participants were initially recruited but 2 were excluded after unsuccessful insonation of the middle cerebral artery (MCA); 10 participants (5 patients with TBI, 5 healthy controls) were included in the analysis (median age 26.5 years, male to female ratio: 7:3). Median PCSS scores were 6/126 for the TBI patient subgroups. Median CANTAB percentiles were 78 (healthy controls) and 25 (TBI). nMxa was calculated for 90% of included patients, whereas THRR was calculated for 50%. Median study time was 127.5 min and feedback (n = 6) highlighted the perceived acceptability of the study. This pilot study has demonstrated a reproducible assessment of PCS and CA metrics (non-invasively) in a real-world setting. This protocol is feasible and is acceptable to participants. By scaling this methodology, we hope to test whether CA changes are correlated with symptomatic PCS in patients post-TBI.

Trauma, 2021

Background Equestrian sports are regaining popularity in the United Kingdom. Due to horses’ consi... more Background Equestrian sports are regaining popularity in the United Kingdom. Due to horses’ considerable weight and speed, serious injuries can occur. Riding style and equipment differ between North America and the United Kingdom with previous studies focusing on the former. Objective This study aims to assess the pattern of horse-related injury admissions to a major trauma centre in the United Kingdom. Methods A retrospective study of our hospital’s trauma registry between years 2012 and 2020 was performed. Cases included those admitted for severe horse-related injuries (irrespective of age/sex) with Injury Severity Score (ISS) of ≥ 4. Demographics, injury characteristics (ISS, Glasgow Coma Scale (GCS), injury region and operations), hospital stay and Glasgow Outcome Scale (GOS) on discharge were extracted. Four groups were formed based on mechanism of injury: fall from horse, fall and horse landing on top (FL group), kicked, and fall and kicked (FK group). Comparisons in injury an...

The prolonged mechanical ventilation required by patients with severe COVID-19 is expected to res... more The prolonged mechanical ventilation required by patients with severe COVID-19 is expected to result in significant Intensive Care Unit – Acquired Weakness (ICUAW) in many of the survivors. However, in our post-COVID-19 follow up clinic we have found that, as well as the anticipated global weakness related to loss of muscle mass, a significant proportion of these patients also have disabling focal neurological deficits relating to an axonal mononeuritis multiplex. Amongst the 69 patients with severe COVID-19 that have been discharged from the intensive care units in our hospital, we have seen 11 individuals (16%) with such neuropathies. In many instances, the multi-focal nature of the weakness in these patients was initially unrecognised as symptoms were wrongly assumed to simply relate to “critical illness neuropathy”. While mononeuropathy is well recognised as an occasional complication of intensive care, our experience suggests that such deficits are common and frequently disabli...

Therapeutic Advances in Neurological Disorders, 2019

Sialorrhoea is a frequent symptom of neurological diseases (e.g. Parkinson’s disease, motor neuro... more Sialorrhoea is a frequent symptom of neurological diseases (e.g. Parkinson’s disease, motor neuron disease, cerebral palsy, and stroke) and is defined as excessive saliva accumulation leading to unintentional loss of saliva from the mouth. Sialorrhoea increases the overall burden on the patient and their caregivers, the impact of which can be both physical and psychosocial. Treatments for sialorrhoea range from lifestyle and behavioural guidance, to medications, surgery or radiation. Nonpharmacological interventions include advice on posture, swallowing control, cough management, dietary changes, eating and drinking techniques, and behavioural modification; however, these conservative measures may be ineffective for people with progressive neurological conditions. The pharmacological treatment of sialorrhoea is challenging because medications licensed for this purpose are limited, but treatments can include anticholinergic drugs and botulinum toxins. Surgical treatment of sialorrhoe...

Acta Neurochirurgica, 2019

Background Cranioplasty is an increasingly common procedure performed in neurosurgical centres fo... more Background Cranioplasty is an increasingly common procedure performed in neurosurgical centres following a decompressive craniectomy (DC), however, timing of the procedure varies greatly. Objectives The aim of this study is to compare the surgical outcomes of an early compared to a late cranioplasty procedure. Methods Ninety adult patients who underwent a prosthetic cranioplasty between 2014 and 2017 were studied retrospectively. Timing of operation, perioperative complications and length of stay were assessed. Early and late cranioplasties were defined as less or more than 3 months since craniectomy respectively. Results Of the 90 patients, 73% received a late cranioplasty and 27% received an early cranioplasty. The median interval between craniectomy and cranioplasty was 13 months [range 3-84] in late group versus 54 days [range 33-90] in early group. Twenty-two patients in the early group (91%) received a cranioplasty during the original admission while undergoing rehabilitation. Complications were seen in 25 patients (28%). These included wound or cranioplasty infection, hydrocephalus, symptomatic pneumocephalus, post-operative haematoma and cosmetic issues. The complication rate was 21% in the early group and 30% in the late group (P value 0.46). There was no significant difference in the rate of infection or hydrocephalus between the two groups. Length of stay was not significantly increased in patients who received an early cranioplasty during their initial admission (median length of stay 77 days versus 63 days, P value 0.28). Conclusion We have demonstrated the potential for early cranioplasty to be a safe and viable option, when compared to delayed cranioplasty.

Acta neurochirurgica, Jan 7, 2017

The outcome following traumatic brain injury (TBI) is heterogeneous and poorly defined and physic... more The outcome following traumatic brain injury (TBI) is heterogeneous and poorly defined and physical disability scales like the extended Glasgow Outcome Score (GOSE) while providing valuation information in terms of broad categorisation of outcome are unlikely to capture the full spectrum of deficits. Quality of life questionnaires such as SF-36 are emerging as potential tools to help characterise factors important to patients' recovery. This study assessed the association between physical disability and subjective health rating. The relationship is of value as it may help evaluate the impact of TBI on patients' lives and facilitate the delivery of appropriate neuro-rehabilitation services. A single-centre retrospective study was undertaken to assess the relationship between physical outcome as measured by GOSE and quality of life captured by the SF-36 questionnaire. Cronbach's alpha was calculated for each of the eight SF-36 domains to measure internal consistency of the...

International Journal of Therapies and Rehabilitation Research, 2017

International Journal of Therapies and Rehabilitation Research, 2015

Background: The role of rehabilitation medicine services in the management of cancer patients has... more Background: The role of rehabilitation medicine services in the management of cancer patients has not yet gained popularity despite the evidences supporting its use. Aim of the study: To identify the extent of gains made by cancer patients in a multidisciplinary rehabilitation setting Design, subjects and setting: Retrospective case series review of cancer patients undergoing inpatients multidisciplinary rehabilitation for functional impairment at a rehabilitation department Method: Clinical notes over 56 months period were reviewed. Information on FIM scores, length of hospital stay, psychological complications, discharge destination were collected Results: 35 patients (19:16 M: F) were identified. The mean hospital stay was 54 days. 32 (91.4%) patients were admitted from hospital or hospice; while only 3(8.6%) were admitted from home. 26 (74%) were discharged home following rehabilitation. Median FIM improved from 85 (41-118) on admission to 109 (58-125) on discharge. Goal planning was carried out for 29 (82.85%) patients. 20 (57%) patients fully achieved their rehabilitation goals and 9 (43%) patients partially achieved their rehabilitation goals. The remaining 6 patients did not engage in goal planning exercise; 4 patients were transferred to acute medical settings and 2 patients did not cooperate with any therapy input because of severe psychological comorbidities. Conclusion: Cancer patients appear to benefit from multidisciplinary rehabilitation. Inpatient multidisciplinary rehabilitation may help to improve the function of cancer patients in preparation for being discharged home. Developing psychiatric or medical complications may threaten the rehabilitation process.

Introduction: Acute gastrointestinal (GI) ulcerations and erosions are common in major trauma vic... more Introduction: Acute gastrointestinal (GI) ulcerations and erosions are common in major trauma victims and in intensive care units. The reported incidence of gastrointestinal haemorrhage in acute spinal cord injuries is between 5 and 22%. Aims: This study aims to review prophylactic management of GI bleeding after spinal cord injury at the Queen Elizabeth National Spinal Injuries Unit, Scotland and to analyse the morbidity and mortality associated with GI bleeding. Setting: Model spinal injury centre in Sctoland. A policy of stress ulcer prophylaxis is followed in all patients admitted to this centre. Material and Methods: Retrospective review of case notes of patients with a clnincally significant GI bleed from January 2006 to May 2008. Results: A total of 360 new injury patients were admitted. 19 (5.2%) had a clinically significant GI bleed during the study period. There were 2 females and 17 males with a mean age of 51.2 years. Cervical spine injury was present in 12 cases 63.1%. Eight (42.1%) patients underwent endoscopic treatment and 3(15.7%) patients required a had laprotomy. One death (5.2%) was reported. Conclusion: Gastrointestinal haemorrhage is potentially a serious complication in spinal cord injured patients. Appropriate prophylaxis, early diagnosis and prompt management may help avoiding a possible fatality.

JPMA. The Journal of the Pakistan Medical Association, 2010

A case of a large spinal epidural haematoma, in a 58 years old male, leading to paraplegia, in a ... more A case of a large spinal epidural haematoma, in a 58 years old male, leading to paraplegia, in a patient on long-term warfarin treatment is presented. Magnetic Resonance imaging (MRI) of the whole spine showed extensive epidural spinal haematoma distal to C4 level surrounding and displacing the spinal cord and the nerve roots up to T2 level. Near complete neurological recovery followed surgical evacuation and multidisciplinary rehabilitation.

JPMA. The Journal of the Pakistan Medical Association, 2008

Extra peritoneal bladder injuries are very difficult to diagnose on clinical examination alone. C... more Extra peritoneal bladder injuries are very difficult to diagnose on clinical examination alone. CT-scan with cystogram (Contrast: Ultavista300) is a reliable diagnostic tool to evaluate such injuries at an early stage. For accurate diagnosis of bladder injury, enhancement of bladder contents is necessary otherwise extravasated urine can be mistaken for haematoma or ascites. Retrograde filling of bladder with minimum 250 -300 ml of contrast material is necessary before performing abdominopelvic CT to rule out any form of bladder injury. Therefore in case of suspected bladder injury CT cystogram should be performed at the time of initial CT examination in the emergency room. We report a case of extraperitoneal bladder injury and foreign body in urinary bladder after a firework injury.