Penetrating head injuries can be the result of numerous intentional or unintentional events, including missile wounds, stab wounds, motor vehicle and occupational accidents (nails, iron rods) or assaults (screw-drivers). Penetrating head injuries caused by screw-drivers constitute only a small part of the total number of traumatic head injuries seen in casualty. We report a case of neuro-trauma who was operated in our institution. A 25 years gentleman presented in casualty on with a screw-driver penetrating into the skull, as an unusual case of violence.
Background and objective Low back pain (LBP) and sciatica are major healthcare issues globally. Since patients may seek various ways to cure their ailments, these conditions are managed not just by physicians, but many other health-related professionals provide alternative treatment options for it as well. We conducted this study to examine a local subset of patients who used stabbing their back and legs as a treatment option for curing LBP and sciatica. Materials and methods This cross-sectional study was conducted in the outpatient clinic of the Neurosurgery unit of Government Naseer Ullah Babar Memorial Hospital, Peshawar, Pakistan, from July 2019 to March 2020. Patients who presented to the outpatient department (OPD) with complaints of LBP with or without sciatica, with a history of invasive therapy in the form of stabbing the back or leg, or drawing blood from the veins of the lower limbs, were included. All other patients with LBP seeking neurosurgical advice were excluded from the study. The study was approved by the management of the hospital and informed consent was obtained from the patients before interviewing them. Special permission was taken for publishing the photographs. The demographics and clinical information related to patients, such as age, gender, duration of symptoms, time since the local therapy, particulars of the treatment provider, any relief experienced by the patient, duration of relief, the patient beliefs/notions about the therapy and disease, and education level of the patients, were recorded on a predesigned form after taking informed consent. The study was done on purposive sampling. The data was presented in tables and charts and was analyzed using SPSS Statistics version 20 (IBM, Armonk, NY). Results During the study period, more than 8,000 patients visited the neurosurgical OPD, and the majority of them (>70%) sought treatment for LBP and sciatica. Of them, around 130 patients had a history of undergoing some alternative therapy that is not scientifically proven, and it was either in the form of stabbing the back or drawing blood from the veins in the lower limbs. Amongst these patients, almost 80% were males and 20% were females who had undergone this kind of treatment. The age range among the cohort was 25-68 years and the mean age was around 43 years. The duration of symptoms ranged from two months to nine years, and the time since the therapy and patient seeking medical advice ranged from three months to 4.5 years. The treatment had been provided by a local individual who did not hold any medical degree according to the patients in 100% (n=130) of the cases; 67% of patients felt they had experienced some relief from the therapy for a short period, which ranged from three days to one month. About the condition, none of the patients seeking the therapy knew it was nerve-related and were often confused about the term rugg (vessel in the native language) but could not differentiate it from the nerve. Of these patients, 76 required surgery while 54 were managed conservatively for LBP and sciatica. Conclusion A subset of the local population in our part of the world used stabbing the back and leg as a form of therapy for treating the problems of the lower back and sciatica. This has not been previously reported and has no scientific basis. Also, the majority of the patients were uneducated and had very little knowledge of the disease, and the treatment provider was a non-health-related professional.
Objective: To determine the different patterns of motorbike related head injuries in patients presenting to a tertiary care hospital of Peshawar.Materials and Methods: It was a prospective (observational) study, which was conducted at the Neurotrauma ward of Neurosurgery department, Lady Reading Hospital, Peshawar from January 2016 to June 2016. Total number of patients were 246. We included those patients who were having impaired Glasgow Coma Scale (GCS), danger signs and having some abnormal findings on CT brain. We excluded those patients who were having GCS 15/15 and those patients of head injury having associated co-morbid conditions.Results: There were 230 (93.49%) males and 16 (6.5%) females. Age range was 1 to 80 years. Majority of pati-ents were drivers (55.28%). Only 6 (2.43%) drivers used helmet. Ninety patients (36.58%) had an ICU stay of more than one week. Seventy six (30.89%) patients were operated and 170 (69.1%) patients were treated con-servatively. Mortality was 14.63% in our study.Conclusion: Majority were males in our study, most of the patients who sustained head injury in motorbike accidents were drivers. Thirty six percent of the patients needed ICU stay of more than 1 week. Maximum of the patients needed conservative treatment.
Objectives: Thoracic disc herniations are rare relative to lumber and cervical spine herniations and account for 0.25% to 0.75% of cases in the general population. This case report presents a rare case of a 65-year-old male diagnosed with thoracic disc herniation and managed through full endoscopic thoracic discectomy. Clinical Presentation: A 65-year-old wheelchair-bound male presented to OPD with complaints of paresthesia and sensory symptoms along with motor weakness from the past 2 weeks. No Symptoms of bowel and bladder dysfunction were present. Diagnosis/Intervention: Sagittal and axial MRI findings revealed disc herniation at the T11 – T12 level. Full endoscopic thoracic discectomy through a transforaminal approach was performed to decompress the spinal cord. Conclusion: Acute thoracic disc herniations although rare, can present with variable clinical manifestations. Full endoscopic thoracic discectomy through a transforaminal approach is a safe and effective surgical procedure associated with improved patient outcomes, increased satisfaction scores, and decreased chances of complications. Keywords: Acute thoracic disc herniation, endoscopic discectomy, full endoscopic thoracic discectomy.
Objective: To compare the infection rate in patients who underwent carpal tunnel surgery with and without instilling local antibiotics into the surgical wound. Method: The retrospective cohort study was conducted at the Department of Surgery, Unit of Neurosurgery, Government Naseer Ullah Babar Memorial Hospital, Peshawar, Pakistan, and comprised data from July 2019 to July 2021 related to non-diabetic patients without any comorbidity who had undergone fresh carpal tunnel surgery. The cases had been operated by two surgeons having a different approach to preventing infection in carpal tunnel surgery cases. The surgeon in group A did not use any local antibiotics after completing the surgery, while the surgeon in group B instilled local gentamicin in the open wound for 3 minutes after completing the nerve release. All patients were put on oral antibiotics for a period of 5 days after the procedure in both the cohorts, and were assessed fortnightly for any infection and removal of stitches. Demographics of the patients, use of antibiotics and the occurrence of infection were recorded on a proforma. Data was analysed using SPSS 20. Results: Of the 177 patients operated during the period, 13(7.3%) was discarded owing to missing data. Of the 164(92.7%) patients analysed, 138(84.14%) were females and 26(15.85%) were males. The overall mean age was 32.46±8.97 years. The total surgeries conducted were 176; 96(54.54%) in group A and 80(45.45%) in group B. Infections were found in 3(1.7%) patients; all in group A (p=0.160). Conclusion: Although not statistically significant, instillation of local antibiotics may play a role in preventing surgical site infections in carpal tunnel surgery cases. Key Words: Topical antibiotics, Local antibiotics, Carpal tunnel surgery, Gentamicin, Infection.
ABSTRACT OBJECTIVE: To determine the frequency and pattern of primary brain tumors of infancy and childhood in hospitalized patients at neurosurgery department Lady Reading hospital Peshawar. METHODS: This descriptive cross sectional study was conducted from January 2013 to December 2013 at neurosurgery department Lady Reading hospital Peshawar, Pakistan. Pediatric patients under 14 years with primary brain tumor were included. Data was then collected on a predesigned proforma from the hospital charts, radiographic and histopathological reports and was analyzed for age, gender and tumor morphology. RESULTS: Out of 66 patients of primary brain tumour during the study period, 31 cases (46.96%) were supratentorial and 35 cases (53.04%) were infratentorial. Most commonly affected age group was 5-9 years and 10-14 years. Both male and female were equally affected with male to female ratio of 1:1. Twenty one cases (31.81%) were glioma, 17 cases (25.76%) were craniopharyngioma, 12 cases (18.18%) were medulloblastoma, 9 cases (13.65%) were ependymoma, 4 cases (6.06%) were choroid plexus papiloma and 3 cases (4.55%) were meningioma. Out of 21 cases of glioma, 11 cases (52.38%) were pilocytic astrocytoma, 7 cases (33.33%) were glioblastoma multiformis (GBM) and 3 cases (14.29%) were brainstem low grade astrocytoma. CONCLUSIONS: Most of the pediatric primary brain tumours are infratentorial. Glioma is the most common primary brain tumour in children followed by craniopharyngioma, medulloblastoma and ependymoma. The commonest age groups of presentation were 5-9 years and 10-14 years with equal male to female ratio. KEY WORDS: Glioma (MeSH), Astrocytoma (MeSH), Craniopharyngiomas ((Non-MeSH),), Medulloblastoma (Non-MeSH), Ependymoma (MeSH), Meningioma (MeSH), Papilloma Choroid Plexus (Non-MeSH).
This is the first case report to test the efficacy of three-level endoscopic spine surgery for the treatment of lumber spinal stenosis. The patient was a 50-year-old entrepreneur with pain on standing and walking and all activities that compress the canal such as lumber extension. Three-level endoscopic surgery was performed at L3-L4, L4-L5, and L5-S1. Certain clinical and surgical outcomes were selected such as the Visual Analogue Scale for pain, Oswestry Disability Index score for level of disability and functional limitation, pain on certain aggravating activities involving extension like walking and moving downstairs, spinal and core stability using prone segmental instability test and patient satisfaction values taken at baseline and after the endoscopic surgery at two levels i.e. immediately after surgery and after one month follow up. Multiple-level interlaminar endoscopic surgery was successful in terms of reducing pain, improving score on the Oswestry disability index, improving daily life activities, increasing spinal and core stability, and increasing patient satisfaction
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.
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.
Objective: To determine the etiology of brain abscess in patients presenting to Neurosurgery Department of Lady Reading Hospital, Peshawar.Materials and Methods: This retrospective study was conducted in Neurosurgery Department, Lady Reading Hospital, Peshawar from March 2015 to February 2016. All patients admitted with brain abscess were included in the study while patients with meningitis, encephalitis, subdural empyema, and tuberculoma were excluded. Patient’s age, gender, pre-operative symptoms and etiology of brainabscess were recorded on a designed Proforma from hospital charts.Results: Out of 42 patients, males were 30 (71.42%) while females were 12 (28.58%). They were most common in first three decades, having total number of patients of 35 (83.33%) with the mean age of 30.15 ± 2 SD. The three most common pre-operative symptoms were fever, headache and vomiting. Most common sources of infect-ion were otitis media 20 (47.61%) and congenital heart diseases 7 (16.66%). In 31 (73.80%) patients temporal and parietal lobes were involved.Conclusion: Brain abscess is common in young to middle age population due to unhygienic status of ears with malepredominance. Temporal lobe of the brain is most common site of abscessand majority of the patients present with nausea, vomiting, fever, signs of raised intracranial pressure and meningism.
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