Mohammed Wasif Hussain

Trigeminal neuralgia (TN) is a chronic, often debilitating neuropathic facial pain condition. First-line treatment is medical therapy, with carbamazepine (

Objective: We have updated the migraine prevention guideline of the Canadian Headache Society from 2012, as there are new therapies available, and additionally, we have provided guidelines for the prevention of chronic migraine, which was not addressed in the previous iteration. Methods: We undertook a systematic review to identify new studies since the last guideline. For studies identified, we performed data extraction and subsequent meta-analyses where possible. We composed a summary of the evidence found and undertook a modified Delphi recommendation process. We provide recommendations for treatments identified and additionally expert guidance on the use of the treatments available in important clinical situations. Results: We identified 61 studies that were included in this evidence update and identified 16 therapies we focused on. The anti-calcitonin gene-related peptide (CGRP) agents were approved by Health Canada between 2018 and 2024 and provide additional options for episodic and chronic migraine prevention. We also summarize evidence for the use of propranolol, topiramate and onabotulinumtoxinA in addition to anti-CGRP agents as treatments for chronic migraine. We have downgraded topiramate to a weak recommendation for use and gabapentin to a weak recommendation against its use in episodic migraine. We have weakly recommended the use of memantine, levetiracetam, enalapril and melatonin in episodic migraine. Conclusion: Based on the evidence synthesis, we provide updated recommendations for the prevention of episodic and chronic migraine utilizing treatments available in Canada. We additionally provided expert guidance on their use in clinical situations.

Background: This study explores the role of those frontline individuals working in care and support roles in ensuring that people receive Integrated Care and how they interact, collaborate and work in partnership with external professionals. Such staff are often central to the people’s experience of person-centred, co-ordinated care due to their frequent contact with people, their families and a multitude of professionals. Despite the centrality of their role, there is a lack of research on these individuals with most research around Integrated Care focused on formal professions such as Nurses and Social Workers. Who is it for? This research study has been conducted for frontline social care staff within Integrated Care services and for all stakeholders involved in a person’s care ranging from Social Workers, CPNs, Housing support, health and local authorities. This will also be of interest to those responsible for managing future integrated services and to those implementing new Integrated Care programmes. Who did you involve and engage with? This research study was led by a PhD Research student around an Integrated Mental Health Recovery Service for Adults in the Midlands region of England which had been implementing integrated care over the past five years. The service supports people to leave /avoid hospital or prison etc to develop new skills, manage their risks and to support the Mental Health Recovery journey for individuals. The emerging insights from this study will be shared with a lived experience panel in order to gain their perspectives. What did you do? A scoping literature review was conducted which highlighted the limited number of research studies involving frontline social care and support staff. With the premise that all involved in Integrated Care are equal partners, a lack of literature on these individuals highlighted a gap in data. Qualitative semi-structured interviews are being conducted with social care staff and various professionals involved in the case study site, based on themes which emerged in the literature review. What results did you get? This research study is part of a PhD Thesis due for completion in September 2023 and data gathering will be complete and initial analysis will be presented at the conference. What is the learning for the international audience? The areas of learning will be around the key themes which emerge from the findings of the qualitative interviews on barriers and facilitators of Integrated Care based on the role and experiences of frontline social care staff, a group which has been under researched both within the UK and internationally. What are the next steps? The insights from this research study will help to inform the Integrated service and the local areas to improve the support to people in services, to help advance practice within Integrated Care and for the future development of Integrated Care services and programmes.

أدرك الإنسان الدور الذي يؤدّيه المكان في حياته قديماً وحديثاً إذ تأصلت فكرة المكان في الفكر الإنساني وازدهرت بتطور الفكر البشري في تعامله مع العالم الخارجي المحيط به. إذ أنَّ حضور المكان في القصيدة العربية متجذِّر منذ العصر الجاهلي حتى يومنا هذا, ونلمس له حضوراً مميزاً في القصيدة الاندلسية نظراً لتمتع تلك البلاد بالجمال والبهاء, ولا سيَّما عند الشاعر ابن خفاجة الذي هو محور بحثنا هذا, والذي استطاع أن يمنح المكان أبعاداً أخرى غير البعد الجغرافي والهندسي بل أبعاداً تفوح منها دلالات وإيحاءات ورموز عديدة للكشف عن جمالياتها وفَكّ مغاليقها وتحليلها, كما ويتخذها المتنفس له للتعبير عن حالته النفسية وما يطرأ عليها من مشاعر الفرح أو الحزن فيتفاعل مع تلك الأماكن بل ويندمج معها إلى درجة انه يُشخّصها ويستنطقها ويضفي عليها صفات بشرية. يطمح هذا البحث إلى الاستدعاء الفني للمكان المفتوح والمغلق في شعر ابن خفاجة ودور هذه الأماكن في حياة الشاعر والأثر الذي تتركها عليه, كشعوره بالفرح والانشراح في المكان المفتوح, وشعوره بالحزن واليأس في المكان المغلق. وكان من رموزه المكانية المفتوحة ( بلاد الاندلس, ومجالس اللهو,...

Objective To compare the presentation of Post-Concussion Syndrome (PCS) based on whom the patient blames for the initial concussion. Background Psychological risk factors, such as pre-injury psychiatric disease and ongoing litigation, are associated with worsened PCS. We investigated whether blame attribution is another one of these psychological risk factors. Design/Methods 111 new patients presenting with PCS at a Canadian subspecialty concussion clinic were seen over 2 years. 91 patients (56 females, 35 males) were included. 20 patients were excluded for inability to define specific causative event (n = 13), underlying structural lesion (n = 1) or evidence of intracranial bleed (n = 6). Patients were separated into three groups: those attributing external blame (n = 70) those describing the incident as accidental (n = 20) and those attributing internal blame (n = 1). Patient observations included: subjective percentage of recovery (SPR), presence and severity of both headaches and psychiatric symptoms, and duration of symptoms at initial presentation. Psychiatric symptoms were graded 0–3 (0-absence, 1-mild, 2-moderate, 3-severe). Headache frequency was graded 0–4 (0-absence, 1-rare, 2-episodic, 3-chronic, 4-persistent). Results More patients belonged to the External group compared to Accidental or Internal groups (p < 0.0001). Mean SPR in the Accidental group was 73% as compared to 44% in External (p < 0.0001). Mean headache frequency was 1.7 for Accidental and 2.64 for External (p = 0.001) Mean severity of psychiatric symptoms was 0.55 in Accidental and 2.24 in External (p < 0.0001). 77% of patients in the External group were diagnosed with post-injury PTSD, with 0% diagnosed in the Accidental group (p < 0.0001). Post-injury depression and anxiety each occurred 3 times more frequently in the External group compared to Accidental (p < 0.0001). Mean symptom duration at initial presentation was 10.2 months in Accidental and 22.49 months in External (p = 0.001). The External and Accidental groups did not differ significantly in age (p = 0.938), number of concussions (p = 0.72), gender (p = 0.908), or preexisting psychiatric illness (p = 0.735). Conclusions This study suggests blame attribution may be an important factor in determining patients at risk of a more severe and prolonged course of PCS.

Some nonmotor symptoms (NMS) of Parkinson's disease (PD) have been shown to increase the risk of developing dementia. A total of 52 PD patients without dementia at baseline were examined for NMS over 36 months. Mini-Mental State Examination, Dementia Rating Scale-2, and caregiver-derived (Clinical Dementia Rating) scores were employed to rate patients as having either clear progression or not. Some 20 of 48 participants (41.7%) had clear cognitive decline. Univariate binary regression analysis was statistically significant for age (odds ratio [OR] (CI95%)=1.24, 1.07-1.45, p=0.006) and orthostatic hypotension (OH) (OR (CI95%)=4.91, 1.24-19.5, p=0.024). Multivariate analysis showed that only age (OR (CI95%)=1.19, 1.0-1.41, p=0.05) and OH (OR (CI95%)=5.57, 1.0-30.97, p=0.05) were correlated with an increased risk of cognitive decline. The presence of OH at baseline may be a significant predictor of progression to dementia in PD.

Facial Nerve Palsy from Cerebral Venous Sinus Thrombosis: An Effect of Increased ICP - Mohammed Wasif Hussain, Muzaffar Siddiqui