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Papers by faraz shafiq

Pakistan Journal of Medical Sciences, 2020

Objectives: To evaluate basic knowledge of Health Care Professionals (HCPs) of Pakistan in managi... more Objectives: To evaluate basic knowledge of Health Care Professionals (HCPs) of Pakistan in managing COVID 19 patients. It includes information regarding infection control measures, administrative and professional support. This was followed by evaluation of psychological factor that can act as a barrier in effective management of these patients. Methods: The survey was conducted on line using Google Form. After approval from hospital ethical committee survey link was disseminated to HCPs using social media. Results: Four hundred fifteen HCPs were participated. Most of them were younger than 30 years and majority of them were postgraduate trainees. Results showed gaps in the knowledge about basic infection control measure like donning/doffing and understanding about high-risk procedures. On job training, professional and administrative support is compromising. Many of HCPs are anxious nowadays, having symptoms related to burn out with logical reasons behind. Even with all those hurdle...

Pakistan Journal of Medical Sciences, 2021

Objective: The postoperative period is critical in neurosurgical patients, where the incidence of... more 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 ov...

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2015

Management of a case of ankylosing spondylitis can be very challenging as the airway and the cent... more Management of a case of ankylosing spondylitis can be very challenging as the airway and the central neuraxial blockade are extremely difficult to handle. Fiberoptic intubation may lead to predictable success in the face of difficult airway. We are presenting a new technique of fiberoptic intubation in a young patient, suffering from severe ankylosing spondylitis, came for total hip replacement surgery. There was anticipated difficult airway due to severe limitation in neck movement and it was successfully managed by using Aintree Intubation Catheter (AIC) with intubating fiberoptic bronchoscope.

The Internet Journal of Anesthesiology, 2013

OBJECTIVE: To assess the outcome of traumatic brain injury patients admitted at our centre. STUDY... more OBJECTIVE: To assess the outcome of traumatic brain injury patients admitted at our centre. STUDY DESIGN: A retrospective audit PLACE AND DURATION OF STUDY: All patients admitted with traumatic brain injury at the Aga Khan University Karachi between January 2009 to June 2009 were included in this audit. METHODOLOGY: Data was collected from the files of a total of 51 patients admitted with traumatic brain injury on a predesigned form. The form included the details for GCS at admission, pattern of referral and outcome of admitted patients like GCS at the time of discharge, focal deficit or disability and in hospital death. RESULTS: 41.1% (n=21) of the cases admitted had moderate or severe TBI and 58.8 % (n=30) had minor brain injuries. The mortality rate of severe TBI in our audit was 46.2 %(n=6) which is similar to that reported from underdeveloped countries but is significantly higher compared to countries following standardized protocols of prehospital and in hospital management (3...

Pakistan Journal of Medical Sciences, 2019

Meningioma is the benign tumor that can also occurs during pregnancy. We are reporting a case of ... more Meningioma is the benign tumor that can also occurs during pregnancy. We are reporting a case of 29 years, 13th weeks pregnant lady, who underwent supratentorial craniotomy using awake through out approach. The case report highlights the challenges we faced during anaesthetic management, which includes psychological preparation, institution of scalp block and successful neurological monitoring. Technique proven to be useful considering pregnancy related physiological and tumor related pathological changes, the impact of which lies directly on maternal & fetal wellbeing. doi: https://doi.org/10.12669/pjms.36.2.1853 How to cite this:Kumar D, Siraj S, Ahsan K, Shafiq F. Utilization of awake craniotomy for supra-tentorial tumor resection during pregnancy: A technique useful for fetal-maternal wellbeing. Pak J Med Sci. 2020;36(2):---------. doi: https://doi.org/10.12669/pjms.36.2.1853 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (...

Journal of the College of Physicians and Surgeons Pakistan, 2019

Pakistan journal of medical sciences

Acute pancreatitis (AP) is an inflammatory disease. Patients presenting with severe disease may r... more Acute pancreatitis (AP) is an inflammatory disease. Patients presenting with severe disease may require intensive care unit (ICU) admission. Factors predicting mortality and morbidity need to be identified for improving outcome. The objective of this study was to see the outcome of these patient presented to single center over a period of ten years. The secondary objective was to identify the factors responsible for adverse outcome. The medical records of adult patients from year 2006 to 2016 requiring ICU admission for AP were reviewed retrospectively. The data was collected on the predesigned Performa for patient's demographic, etiology, severity of disease and reason of ICU referral. Besides this physiological and biochemical parameters at time of arrival in ICU were also recorded. Management aspects related to disease course including the ICU related complications were also recorded. The outcome was predicted on the basis of mortality and length of stay (LOS) in ICU and hosp...

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, Mar 1, 2017

It is a case of severe anaphylactic reaction in a young female who had received aspiration prophy... more It is a case of severe anaphylactic reaction in a young female who had received aspiration prophylaxis preoperatively. Patient required intensive care and developed severe lactic acidosis. She responded very well to fluid and phenylephrine boluses and later on norepinephrine infusion.

IJS Short Reports, 2017

Benefits socioeconomic beneFits Patients undergoing primitive craniotomy under general anesthesia... more Benefits socioeconomic beneFits Patients undergoing primitive craniotomy under general anesthesia, especially for the lesion in an eloquent area, face a very high risk of postoperative neurological deficits due to iatrogenic damage while excision. [12-15] Awake craniotomy offers an advantage of intraoperative assessment of neurological functions, which allows surgeons to restrict the resection if the neurological status of the patient is deteriorating. Hence, the surgeon is able to avoid postoperative neurological deficits. Awake craniotomy has, therefore, contributed significantly to the art of safe neurosurgery, especially by ensuring the adequate functional capacity of the patient. [2,10,16-22] Furthermore, awake craniotomy avoids risks for general anesthesia, with significantly reduced operative time, Intensive Care Unit admissions, number of arterial lines and catheters, and overall length of hospital stay. [10,11,23-27] Review Article History A wake craniotomy is a neurosurgical procedure of performing craniotomy under local anesthesia. The patient is conscious and maintains interaction with the surgery team. It is now the preferred technique of surgery in eloquent areas considering reduced postoperative deficits and improved quality of life. [1-3] The documentation of awake craniotomy procedure dates back to the 17 th century for epilepsy treatment. [4] The idea of brain mapping with the use of electrical stimulation in humans was expressed in 1874 by Bartholow, who using an electrode stimulated the regions of cerebral cortex through a defect in the skull due to infiltration of epithelioma. [5] In late 1920s, Penfield used mild current to map brain of patients with intractable epilepsy. [6] He intended to reproduce the aura, his patient observed before seizure activity. This would allow him to locate the source of seizure, which he could then remove or destroy. He documented his experiences with the awake craniotomy, and his operating technique was successful and reproducible. [7-9] Awake craniotomy has played a key role in modern neurosurgery moreover in the developed countries. [10,11]

JPMA. The Journal of the Pakistan Medical Association, Oct 1, 2016

Awake craniotomy offers safe resection of brain tumours in eloquent area. Aga Khan University Hos... more Awake craniotomy offers safe resection of brain tumours in eloquent area. Aga Khan University Hospital, Karachi, recently started the programme in Pakistan, and the current study was planned to assess our experience of the first 16 procedures. The retrospective study comprised all such procedures done from November 2015 to May 2016. Pre-operative and post-operative variables were analysed. Of the 16 patients, 11(68.75%) were males and 5(31.25%) were females. The overall median age was 37 years (interquartile range[IQR]: 23-62 years). The most common presenting complaint was seizures 8(50%), followed by headache6(38%). The common pathologies operated include oligodendroglioma and glioblastoma. Pre-operative mean Karnofsky Performance Status score was 76±10, which increased to 96±7 post-operatively at discharge. Besides, 2(12.5%) intra-operative complications were observed, i.e. seizure and brain oedema, in the series. The study had median operative time of 176 minutes (IQR: 115-352) ...

JPMA. The Journal of the Pakistan Medical Association, Sep 1, 2016

Surviving sepsis guideline supports the placement of central venous cannulation (CVC) to target t... more Surviving sepsis guideline supports the placement of central venous cannulation (CVC) to target the deranged physiology. The placement of CVC is still challenging, which requires detailed knowledge of venous anatomy and orientation of congenital venous anomalies. Double or persistent left superior vena cava (PLSVC) is a common anomaly in thoracic venous system. Our patient had hidden PLSVC, though he was previously asymptomatic with no cardiac disease. We report the successful anaesthetic management of an adult male with septicaemia for emergency laparotomy. CVC was placed in left internal jugular vein under vision by ultrasonography for fluid and vasopressor requirement. The incidental PLSVC was initially diagnosed on routine post procedure chest X-ray. Later it was confirmed by transthoracic echocardiography with an agitated saline micro bubbles contrast media.We conclude that the routine post CVC chest X ray is mandatory not only to identify the correct positioning of CVC placeme...

JPMA. The Journal of the Pakistan Medical Association, 2011

To assess the incidence of PONV, delay in discharge or unplanned admissions in paediatric surgica... more To assess the incidence of PONV, delay in discharge or unplanned admissions in paediatric surgical cases done at the Surgical Day Care Unit at Aga Khan University between January and July 2009. All paediatric ASA 1-2 cases, from 6 months to 18 years of age undergoing day case surgeries at the Surgical day care unit were included in this retrospective audit. Data was collected on a designed form filled with information from preoperative, intraoperative and postoperative recovery forms. Any relevant data was also noted from nurses notes in recovery room and step down unit. Episodes of vomiting, delay in discharge, or unplanned admission due to PONV were documented. Data was analyzed on SPSS 14. Out of 163 patients only one patient (0.6%) had an episode of vomiting in the recovery room and two patients (1.2 %) had vomiting in the step down unit. There was no delay in discharge or unplanned admission due to PONV in paediatric day cases during the period of our audit. The incidence of po...

JPMA. The Journal of the Pakistan Medical Association, 2012

The percentage use of regional anaesthesia (RA) and failure rate of RA for different grades of ca... more The percentage use of regional anaesthesia (RA) and failure rate of RA for different grades of caesarean section (CS) has become a marker of quality for obstetric anaesthesia service. The objective of our prospective observational study is to find out the technique of anaesthesia used in different grades of CS, reasons for choosing general anaesthesia (GA) and failure rate of RA in our hospital setting. This prospective cross sectional study was carried in the obstetric unit of Aga Khan University Hospital from 1st January 2010 to 31st May 2011. The anaesthetist performing the procedure filled out the data collection proforma .Suggested Indicators were percentages of Grade 1-4 CS done under RA and GA, percent of failed regional, percent of failed regional in different grades of CS. A total of 407 patients having undergone Caesarian Section (CS) were reviewed. General Anaesthesia (GA) was used in 201(49%) patients and Regional Anaesthesia (RA) in 206 (51%) patients. There was no sign...

Journal of anaesthesiology, clinical pharmacology, 2014

Skill of a successful endotracheal intubation needs to be acquired by training and attaining seve... more Skill of a successful endotracheal intubation needs to be acquired by training and attaining several competencies simultaneously. It becomes more challenging when we have to deliver the key concepts in a limited period of time. The medium fidelity simulator is a valuable tool of training for such scenarios. For this purpose we aim to compare the efficacy of structured training in endotracheal intubation between real life simulation and the conventional teaching method. The year 4 medical students had their attachment in anaesthesia for a period of 6 months from Jun - Dec 2009 were randomly divided into Group (Gp) A who had conventional teaching and Group B who were taught by four simulated sessions of endotracheal intubation. Performance of both the groups was observed by a person blinded to the study against a checklist on a 7 point rating scale in anaesthetized patient. Total 57 students, 29 in Gp A and 28 in Gp B were rotated in the anaesthesia during the study period. Evaluation...

Cureus, 2021

Introduction Awake craniotomy (AC) has emerged as a better modality for resection of intra-axial ... more Introduction Awake craniotomy (AC) has emerged as a better modality for resection of intra-axial brain tumors. The advantages are not just related to the preservation of neurological function, but also include early recovery, short hospital stay and possibly lower costs. However, data on AC for meningioma resection is deficient, likely because of concerns related to intra-operative pain and blood loss. Methods All patients who underwent AC, using awake throughout technique for resection of meningioma, during the last five years, were included in the study. Non-probability consecutive sampling technique was employed. Variables for demographics, and details of diagnosis and surgical procedure were recorded. The outcomes measured were length of hospital stay, worsening of neurological function during surgery and significant intra-operative or post-operative pain. Results Seventeen patients underwent AC for resection of meningioma during the study period. Eleven of these were grade I meningioma, and six were grade II meningioma. The mean age was 45.8 ± 10.5 years. Presenting complaints were variable, with seizures being the most common (n = 7; 41.2%). The mean duration of surgery was 180.8 ± 36.2 minutes and median estimated blood loss was 450 ml (IQR: 225 ml-737.5 ml). The mean length of stay in the hospital was 3.1 ± 1.3 days. Only one patient had a prolonged hospital stay of seven days, because of post-operative seizures. Eleven patients (58.3%) had convexity meningioma, 4 (33.3%) had parasagittal meningioma and 1 each had a parafalcine and anterior skull-base meningioma. Simpson grade I resection was performed in 6 (41.7%) patients, grade II resection in 10 (50%) patients, and grade III resection in 1 (5.9%) patient. None of our patients had deterioration in their neurological deficits after surgery and no one required emergency intubation, conversion of surgery to general anesthesia, or redo exploration. Conclusion AC may be considered a safe modality for surgical resection of convexity and parasagittal meningioma, with no significant risk of intra-operative or post-operative pain, although it requires more evidence. It can be offered to patients who are at higher risk, or are not willing to undergo general anesthesia. Ultimately, it might also be beneficial in terms of reducing overall costs.

Middle East journal of …, 2010

INTRODUCTION: Epidural analgesia is one of the commonly used methods of postoperative pain contro... more INTRODUCTION: Epidural analgesia is one of the commonly used methods of postoperative pain control despite its associated complications. Early recognition and intervention is required to minimize the effect of these complications. Present audit was conducted to find ...