Upper limb lacerations are a common injury. Traditionally, these have been assessed and treated in the Emergency Department (ED). This has become increasingly rare. A number of different reasons have been postulated. These include the increasingly junior status of those that work within the ED and the 4 hour target within the ED. After referral to the orthopaedic department, these patients are often assessed by increasingly junior staff. Thus, when these patients are assessed by a sufficiently qualified practitioner, there exists no option but to take them to theatre for repair of their injury. The aim of our study was identify the number of patients requiring surgery for hand and wrist lacerations and identify if these patients could be managed without the need for theatre. We collected data in a prospective fashion from 1/9/9 to 3/11/9 at a large district general hospital. Over this period, 36 patients required surgery for their hand or wrist laceration. 27 were male and 9 were female. The average age was 34 years. The average length of procedure from was 21 minutes. 32% of patients were admitted overnight. In two thirds of cases, the operating surgeon felt the procedure could have been performed in a suture room rather than in theatre. Among those patients who could9ve been operated on within a suture room, 21 would not have required an admission for any other reason. It seems likely that the number of referrals from the ED regarding patients with upper limb lacerations is not likely to decrease. It is, therefore, important to ensure that orthopaedic departments develop new ways of working to try and ensure that patients are treated in a prompt fashion. We believe that the addition of a suture room to the orthopaedic trauma room remains one possible way of achieving this.
This study looked at the effects of sleep quality on cognitive function in 100 Parkinson's patients from Pakistan. 100 Parkinson's patients from Pakistan, aged 18 and older, participated in this cross-sectional study from January 2022 to January 2023 at the Neurosurgery Department of the Naseerullah Khan Babar Memorial Hospital in Peshawar. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the participants in comparison to controls. The Montreal Cognitive Assessment (MoCA) was used to measure cognitive ability. The findings showed that lower cognitive performance ratings were substantially correlated with poor sleep quality. Furthermore, elderly Parkinson's patients showed a more obvious impact of poor sleep quality. The results of this study demonstrated the significance of higher sleep quality for cognitive function in Parkinson's patients, especially in those 65 years of age and older. In order to enhance cognitive function and maintain quality of life, recommendations were made to improve sleep quality in Parkinson's patients.
Background: The global incidence of fatal head injuries is greater than the number of non-fatal cases. The presence or absence of a skull fracture, its type and site along with the type of intracranial hemorrhage has immense significance in the final outcome in cases of head injuries.
Objective: To determine the frequency of intracranial hemorrhage and its different pattern in patients presented with skull fracture following blunt head injury in a tertiary care setting.
Material and Methods: The study employed cross sectional study design and was conducted in Neurosurgery Unit of Lady Reading Hospital, Peshawar. The study duration was six months after approval of synopsis (29-06-2019 to 29-12-2019). A sample size of 196 patients was calculated using WHO calculator. Non probability consecutive sampling was used for patient’s selection. Ethical approval and consent forms were taken. Diagnosis of skull fracture and intracranial bleeding were made on the basis of CT brain and per op findings. Data was analyzed using SPSS version 17. Post stratification chi-square test was applied. P value ≤0.05 was considered significant.
Results: Total 196 patients were included in study. There were 129(65.8%) male and 67(34.2%) female. Mean age of patients was 35.7 years±9.9SD. Intracranial hemorrhage was present in 32(16.3%). Type of intracranial hemorrhage was subdural in 10(5.1%), intrcerebral 3(1.5%), subarchnoid 3(1.5%), intraventricular 4(2%), contusion 2(1%), combination 2(1%), and extradural 8(4.1%). Intracranial hemorrhage is significantly associated with GCS, Occupation, cause of injury, location of injury and type of intracranial injury (p<0.001).
Recommendation: According to the findings, frequency of intracranial hemorrhage was relatively high. This study recommend all patients with skull fractures due blunt head trauma be subjected to thorough brain damage check-up. The type and location of skull fracture is an indirect indicator of the severity of force of impact which leads to damage to the underlying brain and results in fatality.
Background: This trial tested surgery therapy for numerous glioblastomas. A multi-centre study enlisted 32 multiple GBM cases. The outcomes were overall survival, progression-free survival, time to return, and quality of life. Biopsy, debulking, and excision were performed. Overall survival was 13.5 months, and progression-free survival was 8.5 months. Postoperative quality of life improved considerably. Multiple glioblastomas can be treated safely and effectively with surgery. Objective: This study aims to evaluate the outcomes of glioblastoma patients' surgical resections. Study design: A Retrospective observational study. Place and duration of study: department of Neurosurgery, LRH Peshawar from Between 05-January 2015 and 05-January 2018 Methods: the research was carried out at MTI LRH Peshawar Hospital. To find 30 patients with progressing GB, records for everyone who had a glioblastoma biopsy or had it removed between January 2015 and January 2018 were identified and evaluated retrospectively. The median survival and 90% CI were derived by the Kaplan-Meier method. The multivariate analysis was conducted for age, Karnofsky score, amount of resection, tumour size, and tumour multifocality of survival following the advancement of the disease using the Cox Proportional Risks model. Results: Patients with advanced illnesses underwent the first known resection. Patients who had not yet had resections had median survival after progression of 10.6 months for them and 4.0 months for them. In multivariable analysis, surgical intervention and KPS 0.70 (HR 0.411) were associated with improved survival after GBM progression. The median overall survival was 13.5 months, with a 90% CI of 8.2 to 18.8 months. The median progression-free survival was 8.5 months, with a 90% CI of 5.3 to 11.7 months. Quality of life scores improved significantly postoperatively. Conclusions: Operative intervention for progressing Glioblastoma effectively treats the symptoms in the current maximum non-operative treatment, but the survival of the patients is restricted. More research is needed to determine ifsurgical surgery can lengthen post-progressive endurance in people with progressive GB. Keywords: Surgical Intervention, Treatment, Multiple Glioblastomas
Objective: The study was conducted on the incidence of meconium aspiration syndrome which is still high in the developing world and contributing significantly to the neonatal mortality. The study was aimed to know the risk factors contributing to meconium aspiration syndrome and neonatal outcome in a tertiary hospital (Punjab) Department of pediatric Medicine PAK Emirates Military hospital Rawalpindi in the Pakistan.
Materials and Methods: It was a hospital based cross sectional study This descriptive case series was carried at Department of Peadiatric Medicine PAK Emirates Military hospital Rawalpindi in the Pakistan over a period of one year, from Jan 2019 to Dec 2020, involving 2820 patients; All live newborns born through meconium-stained liquor were enrolled and all the details regarding the mother and neonate were recorded. Odd’s ratio and bivariate analysis was done to assess the risk factors for meconium aspiration syndrome.
Results: Out of all the deliveries 12.4% were born through meconium-stained amniotic fluid and meconium aspiration syndrome developed in 5 .6% of the neonates. Low Apgar score and premature rupture of membranes was significantly associated with the risk of occurrence of meconium aspiration syndrome. Neonates who developed meconium aspiration syndrome had mortality of 6.7%
Conclusion: The Perinatal asphyxia and premature rupture of membranes were significantly associated with the development of meconium aspiration syndrome and neonates who developed meconium aspiration syndrome had high mortality.
Purpose: To determine the outcome of microscopic carpal tunnel release in patients with carpal tunnel syndrome who failed to respond to conservative treatment.
Methodology: This descriptive case series was carried at Department of Neurosurgery, D.H.Q Hosptial Charsadda over 1 year from Jan 2019 to Dec 2020, indicate the sampling method used to select the study participants involving 94 patients; both men and women with ages in the range 30-70 years diagnosed of carpal tunnel syndrome who failed to respond to conservative treatment and were planned for surgical release. Microscopic CTS release was performed and outcomes were assessed in terms of improvement in VAS score for wrist pain, symptom severity score and function status scale 3 and 6 months after the surgery. Recurrence of symptoms was also noted. A written informed consent was obtained from every patient. Indicate the method of data collection and data analysis
Findings: The mean age of the patients with carpal tunnel syndrome was 41.6±7.9 years. There was slight female predominance with male to female ratio of 1:2.1. History of diabetes was recorded in 29 (31.0%) patients while 34 (37.0%) patients were obese. Right hand was more frequently involved (53.0%) than the left hand (47.0%). The mean VAS score for wrist pain reduced from 7.9±1.2 at baseline to 1.8±0.7 3 months after the surgery (p- value<0.001). Similar improvements were also noted in symptom severity score (3.8±0.8 to 1.6±0.8; p- value<0.001) and function status scale (2.7±0.8 to 1.5±0.8; p-value<0.001) at the end of 3 months after the surgery. Recurrence was not observed in any patient at the end of 6 months follow-up.
Recommendation: Microscopic carpal tunnel release was found to relieve patient’s symptoms and improve wrist function yet with minimal scarring and without recurrence which advocates its preferred use in future practice provided necessary surgical skills and hardware are available.
Background: Chronic Subdural Hematoma (C.S.D.H.) is familiar with the collection of blood on the brain's surface, and in everyday neurological practices, it is the most ordinary clinical entity. This leads to the commendatory prognosis of infection. Surgical therapy is linked with numerous complications because of patients' medical problems and advanced generations. C.S.D.H. is commonly not being out symptoms, but it requisite surgical approaches when it occurs. C.S.D.H. has very well diagnosis and treatment approaches that are most effective, but some essential factors that lead to this disease are still unknown. This study is to know about the surgical outcome. Method: Out of 80 C.S.D.H. Patients between 60 to 70 years were selected.50 male and 30 female C.S.D.H. patients were treated with one burr hole and catheter drainage. The study was conducted at the neurosurgery unit of MartbaChuhan Medical College and Mardan Medical Complex from April 2018 to March 2021. A total of 80 patients were included in this study. Burhhole and Cather Drainage were performed for all patients. These patients were reviewed after 2, 5, and 6 weeks at O.P.D. Results: Mostly the patients, 94% show a good recovery, and 4% represent no recovery. However, only 2% show the complications against this approach. As for the burr hole and catheter drainage, there was a remarkable reduction of the C.S.D.H. However, 5% of the sample patients show the repetition of Hematoma after the 1 week of operation. In contrast, 2% suffered from some operative complications. Conclusion: Burr hole and Catheter drainage is an affected way of treatment for the patients suffering from C.D.S.H.
Introduction: Heart disease and cancer are the top two killers in the world, but strokes are the third most common cause of death worldwide. Furthermore, one-third of stroke victims are left with long-term disabilities. An Ischemic-strokes account for 80% of all strokes, while hemorrhagic strokes account for 20% of all strokes. Aim of this study: The main aim of this study is comparing the haemorrhagic and ischemic stroke patients – analysis of mortality, clinical development and relationship between stroke variables. Research Methodology: The design of this research is descriptive and exploratory. The current study included 100 patients with an acknowledged stroke incidence (57 men and 43 women). The difference of statistics between infarct and haemorrhage on the demographic & clinical variables was discovered through the use of univariate and Multivariate analysis. Data analysis: The data have been analyzed on a total of 100 patients based on the two types of strokes using various statistical tools on clinical and demographic variables. Conclusion: It is concluded that in comparison to ischemic stroke, hemorrhagic stroke affected a younger age group. Stroke patients with a history of hypertension had a statistically insignificant link between their hypertensive history and the occurrence of the disease, according to the univariate analysis.
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