Tahir Hashmi - Academia.edu (original) (raw)

Papers by Tahir Hashmi

Research paper thumbnail of Recurrent aseptic meningitis- a rare clinical presentation of Sjogrens syndrome

Journal of the Pakistan Medical Association, 2019

Sjogren's syndrome most commonly presents with dry eyes, dry mouth, joint pain and fatigue. Howev... more Sjogren's syndrome most commonly presents with dry eyes, dry mouth, joint pain and fatigue. However, recurrent aseptic meningitis, reported as the most uncommon initial symptom, was the presenting feature in our case. We present the case of a 19-year-old female with recurrent episodes of aseptic meningitis. She presented with fever, headache, vomiting and photophobia. Neurological examination showed neck stiffness. Fundoscopy was normal. On two previous occasions her cerebrospinal fluid analysis was consistent with meningitis; however, it was normal at this presentation. Review of system revealed history of fatigue and sicca symptoms since early childhood. Autoimmune workup showed antinuclear antibodies with a titer of 1:400 and positive anti SSA (Ro) antibodies that led to the diagnosis of Sjogren's syndrome. She responded well to intravenous steroids, followed by oral prednisolone and hydroxychloroquine. To conclude, diagnosis of Sjogren's syndrome may also be considered in a patient presenting with recurrent aseptic meningitis.

Research paper thumbnail of Nodular posterior scleritis with associated choroiditis masquerading as a choroidal tumour- A Case Report

Journal of the Pakistan Medical Association

We report a case of nodular posterior scleritis in a 25-year-old male who presented with a 14-day... more We report a case of nodular posterior scleritis in a 25-year-old male who presented with a 14-day history of unilateral decline in vision, pain, and redness in his right eye. Slit lamp examination of the right eye revealed dilated episcleral vessels present nasally as well as a choroidal mass at the nasal periphery of the fundus, associated with choroidal oedema. Systemic evaluation and imaging of the choroidal mass were performed to rule out choroidal tuberculoma and choroidal metastasis. Ultrasound B-scan of the right eye showed marked thickening of the nasal sclera resulting in sympathetic choroidal oedema without the characteristic T-sign. Nodular posterior scleritis with associated choroiditis, was diagnosed without any underlying systemic illness. The patient was immediately started on systemic steroids and later on subcutaneous Methotrexate as advised by the rheumatologist, to which he responded well and his vision significantly improved from 6/60 to 6/9, gradually during his...

Research paper thumbnail of Large vessel vasculitides

Medicine, 2010

The two major primary large vessel vasculitides are giant cell arteritis (GCA) and Takayasu's art... more The two major primary large vessel vasculitides are giant cell arteritis (GCA) and Takayasu's arteritis (TA). Both are idiopathic systemic inflammatory conditions characterized by granulomatous inflammation of large and medium-sized arteries. Although they share similar histological features, the demographics and clinical presentation of the two diseases are quite different. TA affects a younger age set, predominantly affects the aorta and its main branches and tends to be a two-phase disease with inflammatory and occlusive stages. GCA increases in prevalence with age and classically affects the temporal and other cranial arteries, although the aorta and its primary branches can be affected. Constitutional symptoms are a feature of both diseases. Vascular symptoms are dependent on the pattern of arterial involvement. Headache, jaw claudication and visual disturbance are typical symptoms of GCA. Limb claudication and diminished limb pulses are characteristic of TA. Temporal artery biopsy and angiography remain the gold standard for diagnosis of GCA and TA, respectively. New imaging modalities are challenging this practice; they also have the potential to allow monitoring of disease activity. Treatment has seen major advances in the last decade. With the advent of vigorous immunosuppressive therapy and new means for intervention with percutaneous transluminal angioplasty supported by stenting, it is hoped that the prognosis of patients with large vessel vasculitis will improve.

Research paper thumbnail of The perplexity of prescribing and switching of biologic drugs in rheumatoid arthritis: a UK regional audit of practice

BMC musculoskeletal disorders, Jan 2, 2014

Biologic drugs are expensive treatments used in rheumatoid arthritis (RA). Switching among them i... more Biologic drugs are expensive treatments used in rheumatoid arthritis (RA). Switching among them is common practice in patients who have had an inadequate response or intolerable adverse events. The National Institute of Health and Clinical Excellence (NICE) UK, which aims to curtail postcode prescribing, has provided guidance on the sequential prescription of these drugs. This study sought to evaluate the extent to which rheumatology centres across the Midlands were complying with NICE guidance on the switching of biologic drugs in RA, as well as analyse the various prescribing patterns of these drugs. Data was collected via a web-based tool on RA patients who had undergone at least one switch of a biologic drug during 2011. The standards specified in NICE technology appraisals (TA130, TA186, TA195, TA198, and TA225) were used to assess compliance with NICE guidance. Descriptive statistical analysis was performed. There were 335 biologic drug switches in 317 patients. The most commo...

Research paper thumbnail of Recurrent aseptic meningitis- a rare clinical presentation of Sjogrens syndrome

Journal of the Pakistan Medical Association, 2019

Sjogren's syndrome most commonly presents with dry eyes, dry mouth, joint pain and fatigue. Howev... more Sjogren's syndrome most commonly presents with dry eyes, dry mouth, joint pain and fatigue. However, recurrent aseptic meningitis, reported as the most uncommon initial symptom, was the presenting feature in our case. We present the case of a 19-year-old female with recurrent episodes of aseptic meningitis. She presented with fever, headache, vomiting and photophobia. Neurological examination showed neck stiffness. Fundoscopy was normal. On two previous occasions her cerebrospinal fluid analysis was consistent with meningitis; however, it was normal at this presentation. Review of system revealed history of fatigue and sicca symptoms since early childhood. Autoimmune workup showed antinuclear antibodies with a titer of 1:400 and positive anti SSA (Ro) antibodies that led to the diagnosis of Sjogren's syndrome. She responded well to intravenous steroids, followed by oral prednisolone and hydroxychloroquine. To conclude, diagnosis of Sjogren's syndrome may also be considered in a patient presenting with recurrent aseptic meningitis.

Research paper thumbnail of Nodular posterior scleritis with associated choroiditis masquerading as a choroidal tumour- A Case Report

Journal of the Pakistan Medical Association

We report a case of nodular posterior scleritis in a 25-year-old male who presented with a 14-day... more We report a case of nodular posterior scleritis in a 25-year-old male who presented with a 14-day history of unilateral decline in vision, pain, and redness in his right eye. Slit lamp examination of the right eye revealed dilated episcleral vessels present nasally as well as a choroidal mass at the nasal periphery of the fundus, associated with choroidal oedema. Systemic evaluation and imaging of the choroidal mass were performed to rule out choroidal tuberculoma and choroidal metastasis. Ultrasound B-scan of the right eye showed marked thickening of the nasal sclera resulting in sympathetic choroidal oedema without the characteristic T-sign. Nodular posterior scleritis with associated choroiditis, was diagnosed without any underlying systemic illness. The patient was immediately started on systemic steroids and later on subcutaneous Methotrexate as advised by the rheumatologist, to which he responded well and his vision significantly improved from 6/60 to 6/9, gradually during his...

Research paper thumbnail of Large vessel vasculitides

Medicine, 2010

The two major primary large vessel vasculitides are giant cell arteritis (GCA) and Takayasu's art... more The two major primary large vessel vasculitides are giant cell arteritis (GCA) and Takayasu's arteritis (TA). Both are idiopathic systemic inflammatory conditions characterized by granulomatous inflammation of large and medium-sized arteries. Although they share similar histological features, the demographics and clinical presentation of the two diseases are quite different. TA affects a younger age set, predominantly affects the aorta and its main branches and tends to be a two-phase disease with inflammatory and occlusive stages. GCA increases in prevalence with age and classically affects the temporal and other cranial arteries, although the aorta and its primary branches can be affected. Constitutional symptoms are a feature of both diseases. Vascular symptoms are dependent on the pattern of arterial involvement. Headache, jaw claudication and visual disturbance are typical symptoms of GCA. Limb claudication and diminished limb pulses are characteristic of TA. Temporal artery biopsy and angiography remain the gold standard for diagnosis of GCA and TA, respectively. New imaging modalities are challenging this practice; they also have the potential to allow monitoring of disease activity. Treatment has seen major advances in the last decade. With the advent of vigorous immunosuppressive therapy and new means for intervention with percutaneous transluminal angioplasty supported by stenting, it is hoped that the prognosis of patients with large vessel vasculitis will improve.

Research paper thumbnail of The perplexity of prescribing and switching of biologic drugs in rheumatoid arthritis: a UK regional audit of practice

BMC musculoskeletal disorders, Jan 2, 2014

Biologic drugs are expensive treatments used in rheumatoid arthritis (RA). Switching among them i... more Biologic drugs are expensive treatments used in rheumatoid arthritis (RA). Switching among them is common practice in patients who have had an inadequate response or intolerable adverse events. The National Institute of Health and Clinical Excellence (NICE) UK, which aims to curtail postcode prescribing, has provided guidance on the sequential prescription of these drugs. This study sought to evaluate the extent to which rheumatology centres across the Midlands were complying with NICE guidance on the switching of biologic drugs in RA, as well as analyse the various prescribing patterns of these drugs. Data was collected via a web-based tool on RA patients who had undergone at least one switch of a biologic drug during 2011. The standards specified in NICE technology appraisals (TA130, TA186, TA195, TA198, and TA225) were used to assess compliance with NICE guidance. Descriptive statistical analysis was performed. There were 335 biologic drug switches in 317 patients. The most commo...