Rana Hamid

European University Institute, Civil Engineering, Graduate Student

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Post traumatic avulsion of lumbar artery: A rare cause of retroperitoneal haemorrhage treated by glue embolization

Journal of the Pakistan Medical Association, 2010

Lumbar arterial injury after trauma is a rare cause of significant retroperitoneal haemorrhage. E... more Lumbar arterial injury after trauma is a rare cause of significant retroperitoneal haemorrhage. Early diagnosis followed by endovascular transcatheter embolization is a very effective treatment to control bleeding in patients who do not respond to conservative management. We present a case of post traumatic avulsion of left fourth lumbar artery which was successfully treated with percutaneous transcatheter arterial embolization with glue.

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An audit for peripherally inserted central catheter at tertiary care center

... Amin Rajani, Raza Sayani, Rana Shoaib Hamid, Basit Salam, Muhammad Asif Bilal ... PICC&am... more ... Amin Rajani, Raza Sayani, Rana Shoaib Hamid, Basit Salam, Muhammad Asif Bilal ... PICC&amp;#x27;s are we ll s uite d for tre atm e nts las ting se ve ral weeks to 6 m onth sw ith fre q ue nt ne ed ... Ris k of com plications is low when com pare dw ith s urgical com plications of CVC ins e rtion. ...

Safety and Complications of Double-Lumen Tunnelled Cuffed Central Venous Dialysis Catheters: Clinical and radiological perspective from a tertiary centre in Oman

Sultan Qaboos University Medical Journal, 2015

This study aimed to assess the technical success, safety and immediate and delayed complications ... more This study aimed to assess the technical success, safety and immediate and delayed complications of double-lumen tunnelled cuffed central venous catheters (TVCs) at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman. This retrospective study took place between January 2012 and October 2013. The clinical records and radiological data of all patients who underwent ultrasound- and fluoroscopy-guided TVC placement at SQUH during the study period were reviewed. Demographic data and information regarding catheter placement, technical success and peri- and post-procedure complications (such as catheter-related infections or thrombosis) were collected. A total of 204 TVCs were placed in 161 patients. Of these, 68 were female (42.2%) and 93 were male (57.8%). The mean age of the patients was 54.4 ± 17.3 years. The most common reason for catheter placement was the initiation of dialysis (63.4%). A total of 203 procedures were technically successful (99.5%). The right internal jugular vein was the most common site of catheter placement (74.9%). Mild haemorrhage which resolved spontaneously occurred in 11 cases (5.4%). No other complications were observed. Subsequent follow-up data was available for 132 catheters (65.0%); of these, thrombosis-related catheter malfunction was observed in 22 cases (16.7%) and catheter-related infection in 29 cases (22.0%). Radiological-guided placement of tunnelled haemodialysis catheters can be performed safely with excellent technical success. The success rate of catheter insertion at SQUH was favourable in comparison with other studies reported in the literature.

Successful Management of a Rare Complication After Percutaneous Native Renal Biopsy

Journal of Medical Cases, 2015

Primary Extradural Meningioma Presenting as Frontal Sinusitis with Extensive Bony Changes: Case report

Sultan Qaboos University medical journal, 2014

Primary extradural meningiomas are rare tumours and calvarial meningiomas with extensive bony cha... more Primary extradural meningiomas are rare tumours and calvarial meningiomas with extensive bony changes and frontal sinusitis are rarer still. We report a 40-year-old female patient who presented to the otorhinolaryngologist at the Sultan Qaboos University Hospital in Muscat, Oman, in October 2013 with headaches and frontal swelling. She was diagnosed with frontal sinusitis complicated by osteomyelitis. Further clinical examination and imaging revealed a left frontal calvarial meningioma with extensive bony changes and extracalvarial extension into the frontal sinus. She underwent a left frontal craniotomy during which the tumour was removed. The postoperative period was uneventful and a follow-up computed tomography scan after three months showed only postoperative changes. This report discusses the radiological differential diagnosis and management of this type of lesion.

An institutional review of transarterial embolization in haemorrhagic urological emergencies

JPMA. The Journal of the Pakistan Medical Association, 2012

To review the effectiveness of therapeutic transarterial embolization in controlling phagic urolo... more To review the effectiveness of therapeutic transarterial embolization in controlling phagic urological emergencies irrespective of the cause of emergencies. Thirty-seven vascular angiographies were performed in 32 patients (19 males and 13 females, age range 19-70 years) who were referred with haemorrhagic urological emergencies to Aga Khan University Hospital's angiography suite from July 2005 to June 2010. Embolization was performed with coils, polyvinyl alcohol particles, N-Butyl cyanoacrylate glue and gel foam according to the clinical indication. Data on clinical indication, technique, site and type of bleeding lesions were obtained from a retrospective review of medical records. Success rate, clinical outcome and complications of the procedure were analysed. Indications of procedure included iatrogenic injury (16), Renal mass on clinical examination and imaging (4), haematuria with pseudoaneurysm on examination (3), haematuria with no known cause (3), post traumatic renova...

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Transjugular intrahepatic portosystemic shunt (TIPS); review of initial experience at Aga Khan University Hospital

JPMA. The Journal of the Pakistan Medical Association, 2011

To retrospectively assess the therapeutic effectiveness and safety of transjugular intrahepafic p... more To retrospectively assess the therapeutic effectiveness and safety of transjugular intrahepafic portosystemic shunt (TIPS) in patients with portal hypertension related complications. Over a period of 7.5 years 19 patients (10 males and 9 females, age range 25-69 years) were referred for TIPS at our radiology department. Thirteen patients suffered from liver cirrhosis while 6 had Budd Chiari syndrome. All patients were evaluated with colour doppler ultrasonography and cross sectional imaging. Shunt procedures were performed under sedation or general anaesthesia through internal jugular approach. Metallic self expandable uncovered stents were placed in 15 patients and covered stent in 1 patient. Follow up of patency was evaluated with ultrasound in majority and by venography in some patients. Safety of the procedure and clinical outcome were analyzed. Indications of procedure included variceal bleeding (n=8), ascites (n=4), ascites and bleeding (n=1) and Budd-Chiari syndrome (n=6). Te...

Treatment of intracranial aneurysms using detachable coils; initial results at a university hospital in Pakistan

JPMA. The Journal of the Pakistan Medical Association, 2010

To evaluate the technical success, safety and outcome of endovascular coiling procedure in intrac... more To evaluate the technical success, safety and outcome of endovascular coiling procedure in intracranial aneurysms. From April 2003 to April 2009, 43 patients (23 males and 20 females), age range 11 to 70 years, mean age 46.67 +/- 11.57 years were treated for intracranial aneurysms by detachable coil deployment at Radiology Department of Aga Khan University Hospital. Aneurysm rupture with subarachnoid haemorrhage was the cause of presentation in 39 patients while 4 patients were diagnosed with un-ruptured aneurysms. At time of presentation, grading of subarachnoid haemorrhage was done according to Hunt and Hess grading system. Eleven patients presented with Grade I haemorrhage, other 11 presented with grade II haemorrhage, 8 patients had grade III haemorrhage and 9 patients had grade IV haemorrhage. Preliminary diagnostic workup was performed by cross sectional imaging, CT angiography or digital substraction angiography. Coiling procedures were performed under general anaesthesia thr...

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Post traumatic avulsion of lumbar artery: a rare cause of retroperitoneal haemorrhage treated by glue embolization

JPMA. The Journal of the Pakistan Medical Association, 2010

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Observer variation in MRI evaluation of patients with suspected lumbar disc herniation and nerve root compression: comparison of neuroradiologist and neurosurgeon's interpretations

JPMA. The Journal of the Pakistan Medical Association, 2012

To analyse inter-observer variation between a neuroradiologist and neurosurgeon in the MRI diagno... more To analyse inter-observer variation between a neuroradiologist and neurosurgeon in the MRI diagnosis of lumbar nerve root compression. Although lumbar MFI is primarily analyzed and reported by a radiologist, neurosurgeons often analyse it independently as they have sufficient clinical background as well as radiological expertise to diagnose most spinal pathologies on Magnetic Resonance Imaging (MRI). Retrospective analysis was carried out for images of 54 patients who underwent MRI between March and July 2010 of lumbar spine with suspected lumbar disc herniation and nerve root compression, at Aga Khan Hospital, Karachi, Pakistan. One fellowship trained neuroradiologist and one neurosurgeon evaluated the images on PACS system separately. Both observers were unaware of the patient's clinical history and each other's findings. Lumbar discs at L3-L4, L4-L5 and L5-S1 levels were evaluated by both observers for disc disease and nerve compression. Findings were recorded on a profor...

Transjugular Intrahepatic Portosystemic Shunt for the Management of Hepatic Hydrothorax in the Absence of Ascites

Journal of Clinical Gastroenterology, 1996

An Audit for Peripherally Inserted Central Catheter at Tertiary Care Center

PJR, 2011

Uterine artery embolization for the treatment of uterine fibroids: An outpatient procedure☆☆☆

American Journal of Obstetrics and Gynecology, 2001

Objective: Our objectives were to establish an outpatient program for uterine artery embolization... more Objective: Our objectives were to establish an outpatient program for uterine artery embolization of fibroids and to monitor the following: percentage of patients who required immediate hospitalization or admission within 2 weeks, outcomes in terms of the degree of ultrasound regression of the fibroids, patient satisfaction, reduction of pressure symptoms, and reduction of bleeding. Study Design: Patients were screened by

Osteochondroma of Clivus; An Unusual Cause of Headache

A fifty years old female presented in the emergency department of a tertiary care hospital with c... more A fifty years old female presented in the emergency department of a tertiary care hospital with complaints of migraine type headache for the last few months. Her last episode of headache was severe, increasing in intensity, associated with nausea but no fever, lasting more than 24 hours and not resolving with analgesics. On examination there was no neurological deficit. CT scan of brain showed a large Pedunculated, non-expansible, non-aggressive bony lesion in the clivus with its sharp fragment impinging into the pons. Findings were further confirmed with MRI brain. Trans-sphenoidal excision biopsy was done and histopathology proved the lesion to be osteochondroma of clivus.

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Supratentorial extraventricular anaplastic ependymoma in a child

Case Reports, 2014

A young child presented to the emergency department of a tertiary care hospital with on and off h... more A young child presented to the emergency department of a tertiary care hospital with on and off headache, focal seizures involving the left side of the body, weakness of left upper and lower limbs and vomiting for 2 weeks. Examination showed an alert child with grade 4/5 powers in left upper and lower limbs. Blood investigations were normal. An urgent CT of the brain showed intra-axial mass in the right frontal cerebral cortex, superolateral to the right lateral ventricle. MRI of the brain showed supratentorial extraventricular mass of 5.20 × 3.70 × 3.80 cm, in the right frontal cortex, emitting heterogeneous signals on T1, T2 and fluid-attenuated inversion recovery sequences and impression of astrocytoma, ependymoma or choroid plexus papilloma was made. Complete surgical resection of mass was performed. Histopathology of the mass proved it as WHO grade III anaplastic ependymoma. The child made an uneventful postoperative recovery and radiotherapy was followed.

Squamous Cell Carcinoma of the External Auditory Canal

American Journal of Clinical Oncology, 2009

Squamous cell carcinoma (SCCA) of the external auditory canal (EAC) is often treated with a combi... more Squamous cell carcinoma (SCCA) of the external auditory canal (EAC) is often treated with a combination of surgery and radiotherapy (RT) to optimize the chance of achieving locoregional control. This retrospective review describes a 27-year experience of treating these tumors at the University of Florida. Thirty patients with histologically confirmed SCCA of the EAC received external-beam radiation (RT) alone or combined with surgical resection between 1976 and 2003. Seven patients were treated with RT alone, 22 with postoperative RT, and 1with preoperative RT. Patients were grouped according to nodal status (N0/N1) and the Stell staging system for tumors of the EAC and middle ear. Early stage was defined as T1/T2 (n = 12) and advanced stage as T3 (n = 18). Median follow-up was 2 years (range, 0.1-19.4 years) with no patients lost to follow-up. The 5-year actuarial probabilities for local control, locoregional control, and cause-specific survival for patients with early stage (T1/T2) versus advanced-stage (T3) tumors were 74% and 55% (P = 0.27), 63% and 38% (P = 0.16), and 70% and 41% (P = 0.04), respectively. The regional control rate was 83% (P = 0.6). There were 12 local recurrences and 4 neck recurrences as the first site of failure. One failure was successfully salvaged with surgery. Five of 23 (21%) patients undergoing surgery had significant complications (grade 3 or 4), whereas 2 of 30 (7%) patients receiving RT experienced grade 3 complications. Patients with early stage disease achieved better local control, locoregional control, and cause-specific survival than those with advanced tumors. Less than half of the patients (13 of 30; 43%) were cured without significant complications, suggesting a suboptimal therapeutic ratio, using current treatment methods.

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Evaluation of Three Chitin Metal Silicate Co-Precipitates as a Potential Multifunctional Single Excipient in Tablet Formulations

Marine drugs, 2010

The performance of the novel chitin metal silicate (CMS) co-precipitates as a single multifunctio... more The performance of the novel chitin metal silicate (CMS) co-precipitates as a single multifunctional excipient in tablet formulation using direct compression and wet granulation methods is evaluated. The neutral, acidic, and basic drugs Spironolactone (SPL), ibuprofen (IBU) and metronidazole (MET), respectively, were used as model drugs. Commercial Aldactone ® , Fleximex ® and Dumazole ® tablets containing SPL, IBU and MET, respectively, and tablets made using Avicel ® 200, were used in the study for comparison purposes. Tablets of acceptable crushing strength (>40 N) were obtained using CMS. The friability values for all tablets were well below the maximum 1% USP tolerance limit. CMS produced superdisintegrating tablets (disintegration time < 1 min) with the three model drugs. Regarding the dissolution rate, the sequence was as follow: CMS > Fleximex ® > Avicel ® 200, CMS > Avicel ® 200 > Dumazole ® and Aldactone ® > Avicel ® 200 > CMS for IBU, MET and SPL, respectively. Compressional properties of formulations were analyzed using density measurements and the compression Kawakita equation as assessment parameters. On the basis of DSC results, CMS co precipitates were found to be compatible with the tested drugs. Conclusively, the CMS co-precipitates have OPEN ACCESS the potential to be used as filler, binder, and superdisintegrant, all-in-one, in the design of tablets by the direct compression as well as wet granulation methods.

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Squamous cell carcinoma of external auditory canal lacking epidermal growth factor receptor protein overexpression, in an elderly Omani with oculocutaneous albinism treated with palliative radiotherapy

BMJ case reports, 2014

We report a case of squamous cell carcinoma of external auditory canal in an Omani man with oculo... more We report a case of squamous cell carcinoma of external auditory canal in an Omani man with oculocutaneous albinism. The disease mimicked inflammatory process revealing positive cultures for various microorganisms during the course of his illness. He was eventually biopsied to rule out atypical infective process or presence of malignancy. He was staged as T4N0M0 and treated with radical doses of palliative radiation therapy which was very well tolerated and resulted in a complete resolution of disease clinically and a major soft tissue response on radiological imaging. Another unique finding was the absence of epidermal growth factor receptor (EGFR) protein overexpression in the tumour specimen. More than 90% of mucosal squamous cell carcinoma (SCC) involving the head and neck region overexpress the EGFR protein in normal skin patients. SCC is the predominant cutaneous malignancy in albinos, and the presence of EGFR protein overexpression in cutaneous SCC is believed to be 56-58% in normal skin patients. The scientific literature is scarce on reporting incidence of EGFR overexpression in either cutaneous or mucosal SCC in albinos, and it remains to be defined whether being albino is the cause for its absence.

Endovascular approach as primary treatment for traumatic carotid cavernous fistula: local experience from Pakistan

JPMA. The Journal of the Pakistan Medical Association, 2011

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