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lupine-publishers-igwhc · 3 years ago

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Lupine Publishers | Two Consecutive Successful Pregnancy Outcomes in a woman with Eisenmenger’s Syndrome: A Case Report

Lupine Publishers | Interventions in Gynaecology and Women's Healthcare

Abstract

Eisenmenger’s syndrome is a very rare condition in pregnant women. The incidence of ES is about 3% of the pregnant patients with congenital heart defects; however, it can be accompanied with high incidence of maternal and neonatal morbidity and mortality. Therefore, these patients should have efficient contraception or termination of pregnancy in the first trimester. We present two poorly-controlled consecutive pregnancies with good outcomes in a woman with ES to clarify the appropriate function of teamwork in the management of emergency situations in similar cases. Alongside teamwork, good prenatal care is also important because it can result in elective termination in higher gestational age of pregnancy.

A 21-year old woman, Repeat II cesarean belonging to a very low socioeconomic class, with ES was admitted to the emergency ward of Imam Hossein teaching hospital affiliated to Shahid Beheshti University of Medical Sciences with labor pain and severe dyspnea in 28 weeks of pregnancy. Echocardiography indicated a PAP of 120 mmHg. The patient had supportive treatment in intensive care unit until she was discharged. Despite previous reports of poor pregnancy outcomes in women with ES, high quality and significant treatment through labor and postpartum period lead to good outcomes in both mother and neonate.

Keywords:Eisenmenger complex; outcome; pregnancy; pulmonary hypertension

Introduction

Several congenital heart defects may result in Eisenmenger’s syndrome (ES) [1]. The progress of ES in patients with congenital heart defects depends on the heart defect size and location [2]. Signs and symptoms of ES include right ventricular (RV) failure due to right ventricular hypertrophy, nail clubbing, cyanosis, dyspnea, edema, fatigue, dizziness, and arrhythmia [1]. For the first time in 1897, Victor Eisenmenger described a 23-year-old man with a large ventricular septal defect and pulmonary arterial hypertension and termed the condition as ES [3]. The major causes of death in ES are right ventricular failure, pulmonary hypertension crisis, arrhythmia and stroke [1]. ES is a very rare condition in pregnant women. The incidence of ES is about 3% of the pregnant patients with congenital heart defects [4]. Although ES progresses slowly in non-pregnant women, the increased blood volume during pregnancy may advance the disease during a relatively short time [5]. When pulmonary hypertension exceeds 70% of systemic blood pressure, pregnancy may be associated with complications and cause maternal death [6]. In a review, the maternal mortality rate from 1978 through 1996 due to ES was 36% and the risk of maternal death remained unchanged over the period [5]. Neonatal outcome of pregnancy with ES is also poor. ES is a strong risk factor for spontaneous abortion, preterm birth, and intrauterine growth retardation (IUGR) [7].

As a rule, pregnancy in women with ES must be prevented or terminated in the first trimester [1,4,8,9]. In women who choose to continue pregnancy, a team consists of an obstetrician, perinatologist, cardiologist and an anesthesiologist is needed to care the pregnancy and labor [4,9]. Women with ES should be hospitalized in the second trimester of pregnancy [10]. Pulmonary vasodilator agonists have been used for lowering pulmonary hypertension with good results [9,11,12]. The best mode of delivery is a non-instrumental vaginal delivery using a labor pain relief through epidural block. Spinal analgesia is also preferred for cesarean in these women [5,9]. In general, treatment of ES is supportive [13] and includes oxygen therapy, the use of digitalis, diuretics, vasodilators and anticoagulants [4]. Usually anticoagulant therapy is prescribed to prevent thrombotic events; however, it may increase the risk of hemorrhage in the postpartum. Kahn reported a pregnancy in a 23-year old woman G4P3 with ES who was transferred to the hospital at 38 weeks with a two-month history of dyspnea and edema. After vaginal birth, she was treated with heparin to prevent thromboembolism. In the next day, severe vaginal bleeding developed and finally she expired [8]. We present two consecutive pregnancies with ES and good outcomes in a 21- year old woman, with poor prenatal care. If she had regular visits during her pregnancy by specialists in obstetric, perinatology and cardiology she would have a higher chance of elective termination in later gestational age of her pregnancies; however, in emergent situations, a good teamwork can lead to saving both the patient and her neonate as it happened in both pregnancies in this patient. Therefore, women with ES may have a chance to experience motherhood.

Case Presentation

A 21-year old mother G1P0 in 34 weeks of pregnancy was admitted in the emergency ward of Imam Hossein teaching hospital affiliated to Shahid Beheshti University of Medical Sciences with labor pain and dyspnea. She was a known case of ES since 25 weeks of her pregnancy. The most important findings were pulse rate (PR) of 100beat/min, respiratory rate (RR) of 24/min, blood pressure (BP) of 100/60 mmHg, O2 SAT of 92% and no cyanosis was seen. The echocardiography revealed a mild right ventricular enlargement, a mild left atrial enlargement, a mild reduced right ventricular function, a mild left ventricular hypertrophy (LVH), ejection fraction (EF) of 50%, Pulmonary artery systolic pressure (PAPs) of 50mmHg, and a large ventricular septal defect (VSD) progressing to ES. She continued her pregnancy until presented dyspnea and cyanosis in the 34th week of pregnancy. The vital signs were as follows: PR=100 beat/min, RR=34/min and BP=100/70mmHg. The second echocardiography reported EF of 50% and PAP of 98 mmHg. O2 SAT was 86%. Due to severe pulmonary hypertension, viability of fetus and low Bishop score, cesarean was performed, and a neonate was born with Apgar score 9/10 and birth weight of 2kg. She was admitted to the intensive care unit (ICU) and after four days, she was discharged from the hospital in good condition.

Again, in her second pregnancy, she was admitted for an elective therapeutic abortion in the 16th week of pregnancy but she did not accept and left the hospital. In physical examination she had PR of 110 beat/min, RR of 32/min, BP of 110/70mmHg and O2 SAT of 85%. The patient also presented acrocyanosis. Echocardiography in the 16th week of pregnancy detected EF of 50%, PAP of 80mmHg, mild systolic dysfunction and mild right ventricle enlargement. In electrocardiography, a sinus tachycardia was seen. After 12 weeks, she hospitalized in emergency ward with labor pain and dyspnea. Blood pressure, pulse rate, and respiratory rate were 100/70 mm Hg, 112 beat/min, and 30/min, respectively. Finding in arterial blood gas analysis (ABG) were as follows: PH = 7/52, partial pressure of carbon dioxide (PCO2) = 18mm Hg, bicarbonate (HCO3) = 27mEq\L and O2 SAT = 90%. In the electrocardiogram, a sinus tachycardia was detected. Echocardiography indicated a PAP of 120mmHg. Immediately oxygen was administered, emergency consultation with a cardiologist was done According to consultation with an anesthesiologist, pethidine was injected to reduce the labor pain. Supportive management such as oxygen and pain control continued. While stabilizing the patient, magnesium sulfate for neuroprophylaxis of the baby and betamethasone for fetal lung maturity were administered. The patient was admitted to the ICU. After 8 hours, because of intensified labor pain, cesarean was done under general anesthesia and a preterm baby girl with Apgar score of 7/8 and birth weight of 1800gm was born. Tubal ligation was performed and again she was transferred to the ICU ward. Enoxaparin was administered to prevent thromboembolic events in the postpartum period. The result of the echocardiography after cesarean showed PAPs of 110mm Hg and EF of 48%. Four days later, she transferred to the post-cesarean ward and after one week, she discharged with good general condition.

Ethics

We obtained patient’s informed consent for publishing this report.

Discussion

It is strongly recommended that women with ES be discouraged having pregnancy or be advised to terminate in the first trimester of pregnancy [4,9]; however, few reviews and case reports indicated that outcomes for women with ES have been improved [11-16]. Geohas and McLaughlin reported a 21-year old woman G3P2 in the 34th week of pregnancy with ES who suffered from dyspnea and edema in the third trimester. She was treated with epoprostenol and was terminated by cesarean. The outcome was good and a newborn with good Apgar score was born [13]. Our patient was belonging to an underprivileged social group and did not have appropriate prenatal care during her pregnancies. She was a known case of ES since second trimester of her first pregnancy which was continued until gestational age of 34 weeks. In her second pregnancy, she maintained her pregnancy and finally was terminated in 28 weeks of pregnancy. The outcome of both pregnancies was good similar to the results reported in previous studies [10,13,17] while in Duan’s report, the perinatal outcome of pregnant women with ES were poor [1]. In a systematic review from 1978 through 1996 on 73 women with ES, patient`s age was a risk factor of maternal death [5]. Our patient was young, and it can be one of the reasons leading to good outcome. In addition, O2 sat and hemoglobin did not show any relationship to the outcome in ES [5].

Although vaginal delivery is preferred in these patients [4] other factors such as Bishop score and maternal and fetal condition are important to determine delivery route. In our case cesarean was preferred. In three reviews, 65% to 100% of patients gave birth by cesarean due to deteriorating maternal condition during the third trimester of pregnancy [4,12,18]. In a review study by Wang, and colleagues on 13 pregnancies, no pregnancy continued to term [19]. In our study, both pregnancies were preterm and terminated at the gestational age of 34 and 28 weeks of pregnancy, respectively. Despite poorly controlled prenatal care, the mother saved because she was young and received proper care in a tertiary center during labor and postpartum period. Besides, preterm labor at the 34th and 28th week of pregnancy may contribute to the successful outcomes of the patient due to stopping the progress of hemodynamic changes and worsening the condition. On the other hand, the patient was referred to the same hospital and we had access to her past medical history. Because she was not supervised between her pregnancies, we were not aware of the medications and the cares she received and whether she was adherent to the treatment.

Conclusion

Although prevention of pregnancy or termination in the first trimester is usually recommended in patients with ES, in this case, two consecutive pregnancies developed with good outcomes. Although the patient received no proper prenatal care including visiting a cardiologist before pregnancy and having timely care by a perinatologist or even an expert obstetrician in managing high risk patients, receiving a significant treatment in a tertiary center during labor and postpartum period resulted in good outcomes in this patient. Women with ES may have a chance to experience motherhood.

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inkagnedotv · 3 years ago

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Snoop Dogg thinks it's time for some fundamental change. In a "Corner Office" interview with The New York Times, the rapper and entrepreneur said that it's time corporate America stopped treating Black people "like they're less." Asked what he thinks about NBA icons Kevin Durant and Steph Curry making investments in startups, Snoop zeroed in on a key gap that he thinks need to be filled right away. "They're always the ones who do the hard work, the groundwork, but we never but them in," Snoop said of Black businesspeople. "Like, why don’t we have an owner in an NFL? That’s just racist. Period, point blank," he said of the century-old football league that currently has two minority co-owners -- Pakistani American Shahid Kahn of the Jacksonville Jaguars, and Asian American Kim Pegula of the Buffalo Bills -- but which has never had a team fully owned by a Black businessperson. "We need to own an NFL team. We got one half-owner in the NBA, Michael Jordan. But the whole league is 90 percent Black. So we still the slaves and they still the masters." —Gil Kaufman, Billboard Follow @inkagnedotv ⁣ .⁣ .⁣ .⁣ .⁣ .⁣ #2pac #50cent #90s #art #biggiesmalls #california #deathrowrecords #drdre #eazye #eminem #hiphop #hiphopmusic #icecube #instagood #losangeles #love #makaveli #music #nwa #oldschool #oldschoolhiphop #rap #snoopdogg #snoopdoggy #snoopdoggydog #snoopdoggydogg #tupac #tupacshakur #westcoast #westside https://www.instagram.com/p/CSXip8DJoZ8/?utm_medium=tumblr

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piquira · 7 years ago

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Pique is in London today with his little group of friends. He was in Shahid Kahn's yacht... I wonder what he is up to. Pique seems to have very rich friends.

No idea tbh, this is the first I heard of it.

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newingtonnow · 7 years ago

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ICYMI in NFL Week 3: Owners, players lock arms for anthems

The most memorable images of an usual and memorable day for the NFL might very well be teams owners such as Shahid Kahn of the Jaguars or Daniel Snyder of the Redskins locking arms with players during the national anthem. from WFSB - Sports http://www.wfsb.com/story/36441650/icymi-in-nfl-week-3-owners-players-lock-arms-for-anthems

#Sports

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bollywoodupdate-bysejuti · 5 years ago

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30 Bollywood Highest Grossing Movies List All Time | Salman Kahn, Aamir Khan, Hrithik Roshan, Bollywood Highest Grossing movies all time, highest grossing bollywood movies in india, bollywood movies 2020,Dangal,Aamir Khan,Bajrangi Bhaijaan,Salman Khan ,Sanju,Ranbir Kapoor, War,Hrithik Roshan, Andhadhun,Ayushmann Khurrana,Chennai Express,Shah Rukh Khan ,Simmba,Ranveer Singh,Tanhaji,Ajay Devgn,Kabir Singh,Shahid Kapoor,Uri The Sergical Strike,Vicky Kaushal,Good Newwz,Akshay Kumar, highest grossing hindi movies, top 10 bollywood movies of all time, Bollywood box office report

#Bollywood #Bollywood News #Bollywood Updates #Box oFFICE #highestgrossin #Movies #salman khan #hrithik roshan #ajay devgn

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slimlastforskolins · 5 years ago

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Poetry

POETRY

Poetry

Agha Shahid Ali, Nilima Sheikh, Izhar Patkin, Carol Ann Duffy, Forough Farokhzad, Shiva Sanjari, Imtiaz Dharker, M Ayodele Heath, MAureen Aslop, Scott Kahn, Ryusui, Utagawz Kuniyoshi, Sudeep Sen, Janet Pierce, Usha Akella, Farhad Hussain

Yes, actually this is another poem about race. (Maybe they all are. (This time, the arrival ritual is metaphor; next time, a…

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gyrlversion · 6 years ago

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Christchurch massacre hero makes emotional return to shooting scene

The two heroes of the Christchurch mosque massacre have made an emotional return to the scene of the bloodshed.

Linwood mosque Imam Abdul Lateef Zirullah, better known as Brother Lateef, and ‘Eftpos machine hero’ Abdul Aziz, from Australia, were re-united for a traditional Maori ‘cleansing’ ceremony at the Linwood mosque, where the pair’s heroics saved many lives on Friday.

An emotional Mr Lateef broke down in tears during the service and was comforted by mourners, including a police officer who was seen laying a friendly hand on the Imam’s back.

The service was held just metres away from a growing mountain of flowers, and on a street where strangers have spent the weekend spontaneously hugging Muslims.

A picture of Mr Lateef soaked in blood has become one of the enduring images of the tragedy, which has been described as New Zealand’s ‘darkest day’ with the loss of 50 lives.

Mr Lateef was the first to spot gunman Brenton Harrison Tarrant and raise the alarm outside the second mosque on Friday afternoon, warning worshippers to get down.

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Brother Abdul Lateef Zirullah (left) and Abdul Aziz (right), the two surviving heroes of the mass shooting at Linwood mosque attack, have made an emotional return to the scene three days on

Brother Lateef broke down in tears during a traditional Maori ceremony at the mosque. He was the first person to spot accused gunman Brenton Harrison Tarrant out the window and warned worshippers inside, saving countless lives

During Monday’s ceremony a policeman placed a comforting hand on the back of Mr Lateef as he broke down in tears

‘From the window, I sighted him (and) I thought maybe he was a policeman,’ Mr Lateef told Daily Mail Australia.

‘But then when I saw on the floor next to him was another (dead) lady, I said “no”.’

Mr Lateef could hear the killer’s muffled, but clearly offensive, yelling, through the window.

‘I can’t hear him very well clearly inside but I know he was saying something, like using this vulgar word,’ he said.

‘I realised he is amiss and something must be done. Initially people didn’t understand but eventually people got to know what happened.’

After being alerted to the gunman by Mr Lateef, Mr Aziz picked up the first thing he could find – an Eftpos machine – and ran to confront the attacker.

When he got outside Tarrant had returned to his car to swap guns.

Mr Lateef told Daily Mail Australia that he saw Brenton Harrison Tarrant (pictured) out the window of the mosque and initially thought he was a policeman, before noticing a dead body on the ground nearby

Moments after the gunman fled the scene Mr Lateef was photographed on the street wearing a bloodstained garment

An emotional Mr Lateef was comforted by dozens of mourners during the traditional cleansing ceremony

Mr Lateef told how after he warned worshippers, Abdul Aziz (right) grabbed an Eftpos machine and ran outside to chase the accused gunman

When Tarrant returned to his car to get another gun Mr Aziz chased after him and hurled the gun at the car, shattering the windscreen and scaring him away

Mr Aziz (right) said he could hear his two young sons inside the mosque urging him to come back inside and away from danger

‘From the window, I sighted him… I thought he was a policeman,’ Brother Lateef said. He then noticed dead bodies outside the mosque and yelled out to the worshippers at Friday prayers

Mr Aziz then saw a discarded weapon on the ground and picked it up, before aiming at Tarrant and squeezed hard on the trigger – but it was empty.

‘He got into his car and I just got the gun and threw it on his window like an arrow and blasted his window… that’s why he got scared,’ Mr Aziz said.

Inside the mosque Mr Aziz said he could hear his two young sons, aged 11 and five, calling for him to come back inside.

Mr Lateef said he had seen the iconic photograph of his robe covered in blood just moments after the massacre.

‘I was trying to rescue some brothers,’ he said.

‘I was thinking I could do something to save their lives, but, unfortunately, some of them, most of them had passed.’

Maori leader performs the traditional cleansing ceremony at the Linwood Mosque on Monday

The ceremony, known as a karakia, is regularly held after tragic deaths and is similar to rituals performed by indigenous Australians

Nearly three days since the horrific terror attack in Christchurch which left 50 worshippers dead, new details about the innocent victims are emerging

VICTIMS OF THE NEW ZEALAND MOSQUE MASSACRES

As of 2am AEDT Monday

Mucad Ibrahim, 3

Abdullahi Dirie, 4

Sayyad Milne, 14

Khaled Mustafa, 45, and son Hamza, 16

Naeem Rashid and his son Talha, 21

Tariq Omar, 24

Ozair Kadir, 24

Syed Areeb Ahmed, 26

Ansi Alibava, 25

Ramiz Vora, 28

Farhaj Ahsan, 30

Mojammel Hoq, 30

Atta Elayyan, 33

Hussein Al-Umari, 36

Mohammed Omar Faruk, 36

Junaid Ismail, 36

Osama Adnan Abu Kwik, 37

Zeehan Raza, 38

Kamel Darwish, 39

Dr Haroon Mahmood, 40

Husne Ara Parvin, 42

Syed Jahandad Ali, 43

Mohammad Imran Kahn, 47

Mathullah Safi, 55

Amjad Hamid, 57

Lilik Abdul Hamid, 58

Arifbhai Mohamedali Vora, 58

Ghulam Hussain, in his 60s

Karam Bibi, in her 60s

Musa Vali Suleman Patel, 60

Abdelfattah Qasem, 60

Ashraf Ali, 61

Mohsin Al-Harbi, 63

Linda Armstrong, 65

Maheboob Khokhar, 65

Muhammed Abdusi Samad, 66

Ali Elmadani, 66

Mounir Soliman, 68

Ahmad Gamaluddin Abdel Ghani, 68

Hussein Moustafa, 70

Abdukadir Elmi, 70

Haji-Daoud Nabi, 71

Still Missing:

Zakaria Bhuiyan

Mr Lateef said he was ‘very pleased’ with a Maori cleansing of the land and blessing, which was held at the mosque on Monday morning.

The ceremony, known as a karakia, is regularly held after tragic deaths and was organised by the staff of New Zealand deputy police commissioner Wallace Haumaha.

Mr Haumaha said the process was much like an indigenous Australian cultural ritual.

‘It’s important to have that cleansing,’ he told Daily Mail Australia.

‘We use it … to ensure we have cleansed all the evilness – not so much evilness, but everything left behind by those deaths, to allow the living to move on.’

It came after a Maori gang earlier performed a touching haka during a memorial at the Al Noor mosque on the other side of Christchurch.

Around ten members of Black Power, which was first formed in 1970, gathered near the police cordon at the mosque to perform the ceremonial dance on Sunday.

The death toll from the terror attack has risen to 50, with new details about the innocent victims continuing to emerge.

They include, Junaid Ismail, 36, who left behind a wife, three young children and a mother who relied on him to care for her.

Another, Ansi Alibava, 25, was eagerly awaiting her graduation ceremony from her masters degree in May, while Hussein Al-Umari, 36, was a regular at the Masjid Al Noor mosque.

Ozair Kadir (pictured), 24, was a student pilot at the International Aviation Academy of New Zealand and had been in Christchurch for just a year when he was killed on Friday

Syed Jahandad Ali, 43, from Pakistan was one of the 50 victims killed in the terror attack in Christchurch on Friday

Maheboob Allarakha Khokhar (left), 65, who was due to return to India on Sunday after visiting his son in Christchurch and Husna Ara Parvin (right), who was reportedly gunned down as she tried to save her quadriplegic husband from the shooter

Ashraf Ali (pictured) a respected imam at the Masjid Al Noor mosque who was originally from Fiji, is also thought to be among the dead

Also among the dead is Tariq Omar, 24, who is remembered for his kind and humble nature and was a former student of Cashmere High School in Christchurch.

Kamel Darwish, 38, who moved to Christchurch from Jordan six months ago and was awaiting the arrival of his wife and three children – was convinced to go to New Zealand by his brother, who had lived there since 2007 and said it was a ‘safe place to raise a family’.

Sixty-year-old Abdelfattah Qasem, from Palestine, was also killed on Friday at the Masjid Al Noor mosque – he was the Muslim Association of Canterbury’s former secretary.

Another among the dead is Musa Vali Suleman Patel, 60, who was visiting Christchurch to see his son and was a highly respected leader of the Fiji Muslim League – he left behind his wife Saira Bibi Patel, three daughters and two sons.

Ramiz Arifbhai Vora, 28, and his father Arifbhai Mohamedali Vora, 58, were both shot dead on Friday.

The 28-year-old lived and worked in Christchurch and had a baby daughter a week before he was killed in the vicious attack – his father was visiting him from India at the time.

Syed Areeb Ahmed (pictured), 26, from Karachi, Pakistan lost his life in the horrific shooting attacks in Christchurch on Friday

Linda Armstrong (left), 65, and Tariq Omar, 24, were also brutally killed by the shooter on Friday in Christchurch

Sixty-year-old Abdelfattah Qasem from Palestine was also killed on Friday at the Masjid Al Noor mosque – he was the Muslim Association of Canterbury’s former secretary

Ali Elmadani (right), 65, was a retired engineer who immigrated to New Zealand in 1998. Sohail Shahid (left), from Pakistan was also killed

Ozair Kadir, 24, was a student pilot at the International Aviation Academy of New Zealand and had been in Christchurch for just a year when he was killed on Friday.

Another among the victims is Maheboob Allarakha Khokhar, 65, who was due to return to India on Sunday after visiting his son in Christchurch.

Four-year-old Abdullahi Dirie was also named among the dead after both he and his father Adan were shot at one of the mosques, while four of his siblings escaped unhamed.

Abdullah’s family fled Somalia in the 1990s and made New Zealand their home, he was the youngest in his family.

Before he was brutally killed, Amjad Hamid, 57, was a senior Medical Officer and Rural Hospital Consultant at Hawera Hospital who has been remembered for his kindness, compassion and sense of humour.

National-level futsal player Atta Elayyan (right) was reportedly killed on Friday. He is being remembered as an ‘inspiration’

A recently identified victim is 38-year-old Kamel Darwish who moved to New Zealand from Jordan six months ago (pictured)

Ramiz Arifbhai Vora (left), 28, and his father Arifbhai Mohamedali Vora (right), 58, were both shot dead by the gunman on Friday.

Mohammed Omar Faruk (pictured), 36, from Bangladesh was shot dead on Friday at the mosque attacks in Christchurch

Another among the victims is Mounir Soliman, 68, from Egypt who was a design engineer working at Scotts Engineering in Christchurch since 1997.

Zeehan Raza, 38, is also among those killed and was a mechanical engineer who moved to New Zealand from Pakistan in 2018 – both he and his parents Ghulam Hussain and Karam Bibi, were killed at the Linwood Masjid mosque.

Another believed to be among the dead is Bangladeshi Husna Parvin, who was reportedly gunned down as she tried to save her wheelchair-bound quadriplegic husband from the shooter.

Three-year-old Mucad Ibrahim died in the arms of his father and brother, who only survived because he played dead.

Mucad Ibrahim was attending Friday prayers with his father and older brother Abdi Ibrahim when a gunman stormed the al Noor mosque in Christchurch and opened fire on the worshippers.

It’s believed that at the time of the horrific attack, Mucad ran from the gunman while his father and brother played dead.

Tarrant dismissed his lawyer on Monday morning and now plans to represent himself in future court proceedings.

Richard Peters said the gunman had informed him he wanted to represent himself as his case heads to a trial.

Ansi Alibava (pictured) came to New Zealand to pursue a Master of Agribusiness Management at Lincoln University

Lilik Abdul Hamid, 58, from Medan, Indonesia (pictured), who died in the mosque left behind two children

Three-year-old Mucad Ibrahim (left) was also named among the dead after he passed away in the arms of his father and brother, who only survived because he played dead. Cardiologist Amjad Hamid (right) was mowed down after moving to New Zealand 23 years ago because he wanted a better future for himself and his wife

Haji Daoud Nabi (pictured), 71, a father-of-five and retired engineer, moved to New Zealand from Afghanistan in 1977 and set up a new life as one of the ‘first Muslims in New Zealand’. He is thought to be among the dead in the Christchurch shooting

Khaled Mustafa (pictured) arrived in New Zealand only a few months ago from Syria with his family, his son Hamza, 16 also died

Osama Adnan Abu Kwik, 37, from Palestine (pictured) was in the process of applying for New Zealand citizenship when he was killed

Mojammel Hoq, 30, from Bangladesh (left) and Musa Vali Suleman Patel, 60, from Fiji (right) also died in the shooting on Friday

Talha Naeem, 21, (pictured) was shot at the Masjid Al Noor in Deans Ave, his father was also killed on Friday

Hussein Al-Umari, 35, (pictured) was a regular at the Masjid Al Noor in Deans Ave, Christchurch, where he was killed

Muhammed Abdusi Samad, 66, from Bangladesh (pictured) was a lecturer at Lincoln University and frequently led prayers at the Masjid Al Noor in Deans Ave

Mr Peters said while the decision may seem irrational, Tarrant appeared to be ‘clear and lucid’, and did not appear to be mentally unstable.

Tarrant never told him why he wanted to represent himself, but Mr Peters said he ‘presumes the basis for that is that he thinks the job would be done better himself’.

The shock decision has raised concerns Tarrant will use what will be a high-profile murder trial as a platform to spread hate and vile anti-Muslim rhetoric.

‘I suspect that he won’t shy away from publicity, and that will probably be the way he runs the trial. The job of the trial judge will be to deal with that,’ Mr Peters said.

‘But it’s not a place for any views to be put forward. It’s simply there to determine innocence or guilt.

‘The court is not going to be very sympathetic to him if he wants to use the trial to express his own views.’

Tarrant is currently facing one charge of murder, but more charges are expected to be laid in the coming days.

The 28-year-old who grew up in Grafton, in regional New South Wales, live-streamed his alleged attack on Facebook.

He did not apply for bail or for his name to be suppressed during a brief appearance in court on Saturday, and is expected to front the High Court on April 5.

Naeem Rashid (pictured), from Abbottabad in Pakistan, was hailed a hero after he tried to wrestle the gun from the Christchurch shooter on Friday. But he was badly wounded after sadly died later in hospital

Cashmere High School student Sayyad Milne (pictured), 14, who was at Friday prayers when the shooting started, is believed to be dead. Although it’s not been officially confirmed, his father has spoken of his loss

Dr Haroon Mahmood (pictured) leaves a wife and two children aged 13 and 11

A spokesman for Pakistan’s Ministry of Foreign Affairs confirmed that five Pakistani citizens are missing (pictured missing person Syed Jahandad Ali)

At least one Jordanian was killed in the attacks and two are critical among the eight injured, Jordan’s Foreign Ministry announced

A woman (pictured) was seen distressed outside a community center near Masjid Al Noor in Christchurch, and said her husband has been missing since Friday’s mosque attack

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footballaktuell · 6 years ago

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Jacksonville Jaguars kaufen das Wembley Stadion in London

Wenn Milliardäre einkaufen gehen, packen sie sich schon mal etwas mehr in die Einkaufstasche als der Normalverdiener. So auch Shahid Kahn, der 68-jährige US-amerikanisch-pakistanischer Unternehmer wird auf rund 7 Milliarden US-Dollar (etwa 6,1 Milliarden Euro) geschätzt. Weiterlesen

#allaboutfootball.de #nfl

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conservativeamericatoday · 7 years ago

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Like Our Facebook Page - http://ift.tt/2yLlg6t MUSLIM JACKSONVILLE JAGUARS OWNER Just Made Disgusting Announcement Ahead of Tomorrow’s Game | Conservative America Today - https://youtu.be/2NC26YK3pRs Subscribe us now to get the REAL NEWS updates - https://goo.gl/Jak4Sa ✪ Latest News ✪ ✔ NFL Star Vows To Quit If Forced To Stand For Anthem, Then Trump Jr Slammed Him - https://youtu.be/h8SJQmc9Z30 ✔ The NFL Is In FULL Panic Mode | Louisiana Sheriff’s Office Just Did The UNBELIEVABLE - https://youtu.be/h8SJQmc9Z30 ✔ Cheerleaders Kneel for the National Anthem | Find Out That It’s a Bad Idea Instantly - https://youtu.be/SdflIC6jUnk ✔ Breaking: Barbara Walters Knew About Abuses, But She Silenced Victim | Conservative America Today - https://youtu.be/C_blzeRpXsk ✔ BRUTAL: Benghazi Hero Sees Eminem’s Anti-Trump Rap, Makes Absolute Fire Response - https://youtu.be/mWUHHNoqNMA ✔ BREAKING: More Bad News For NFL…Dolphins Coach Resigns After Woman Uploads Shocking Facebook Video - https://youtu.be/HSX8Yck3IW0 ✔ SHE'S FIRED: ESPN SUSPENDS JEMELE HILL FOR SOCIAL MEDIA ‘VIOLATION | Conservative America Today - https://youtu.be/nPqq8xkiiIA ✔ Shocking: FIRST NHL PLAYER FLASHES ‘BLACK POWER’ FIST IN AIR DURING NATIONAL ANTHEM - https://youtu.be/eJI5ZHNsa94 ✔ JERRY JONES: PLAYERS WHO DISRESPECTS THE ANTHEM WILL BE BENCHED | Conservative America Today - https://www.youtube.com/watch?v=v2QYDMjwawQ ✔ Shock poll: NFL now least liked sport in America, They are officially loosing their ground - https://youtu.be/E4irK2aXIFE ----------------------------------------------------------------------------------- ✪ Buy a Tshirt/Mug to support us - https://goo.gl/LF3cGL ✪ Liberal Tears Mug - https://goo.gl/GZg6s9 ----------------------------------------------------------------------------------- Copyright Disclaimer: Citation of articles and authors in this report does not imply ownership. Works and images presented here fall under Fair Use Section 107 and are used for commentary on globally significant newsworthy events. Under Section 107 of the Copyright Act 1976, allowance is made for fair use for purposes such as criticism, comment, news reporting, teaching, scholarship, and research. Contact us: [email protected] ------------------------------------------------------------------------------- News Source: # http://ift.tt/2ym8ESf # http://ift.tt/2hIClTA # http://ift.tt/2yLiUES Muslim Jacksonville Jaguars owner Shahid Khan calls all other NFL owners ‘a bunch of racists’. The only Muslim owner in the NFL just made this disgusting announcement ahead of tomorrow’s game. Khan attended in an interview with Crain’s Chicago Business today. This NFL team owner spoke on his fellow club owners, President Donald Trump and the politics of divisiveness in that interview. "You've got a bunch of 85-year-old guys who don't think they're racist, but they are racist," he said. Why and how they are racist, the answer wouldn’t come authentically by the Muslim owner. But after the interview Khan clarified that he had heard the other owners were racist and it was not something that he actually knew. “I had heard from a lot of the players what their feelings were, how offended they were (by Trump’s comments) and what they were going to do and my concern was that they don’t do anything to hurt themselves. We wanted to do something as a team, because a team divided against itself cannot stand,” Kahn said. Khan then called Trump “the great divider” and accused of exploiting fear and anger for political gain though he actually gave $1 million to Trump’s inauguration earlier. Recommended Tags the next news network, News, Breaking News, Breaking, abc news, top news. world news today, today news, world news, cnn, fox news, nbc news, usa morning news, local news, top news, world news today, Conservative America Today - News Network, cat#$%cat Channel Tags: live news, breaking news, Conservative America Today - News Network, Conservative America Today, conservative news, constitution, freedom, liberty, gun right, Make America Great Again, Donald trump, TRUMP LATEST NEWS, President Donald Trump, today news, world news, politics, news, alternative media, guns, Conservative, News

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