Musawer Khan, Naeem-ul-Haq, Sajid Khan, Muhammad Zubair Bashir
Objective: To analyze the outcome of ventriculoperitoneal (VP) shunts in terms of improvement and complications. Material and Methods: This retrospective observational study is done in MTI Mardan medical complex and Prime teaching hospital from September 2017 to March 2020. The hospital record of all patients who underwent ventriculoperitoneal shunts was reviewed for improvement and complications. Patients undergoing ventriculoperitoneal shunt for normal pressure hydrocephalus were excluded from this study. Revision of ventriculoperitoneal shunt was the primary endpoint of the study. Results: A total of 167 patients were operated on for ventriculoperitoneal shunts with males 106 (63.47%) and females 61 (36.52%). Age ranged from 1 month to 75 years with a mean of 14 years. The most common indication for surgery was congenital hydrocephalus in 102 patients (61.1%) while brain tumors caused hydrocephalus in 25 (15%) patients. Common presenting symptoms were the increase in head size in 75 (44.9%), and headaches in 84 (50.2%) patients. Symptomatic (headache, vomiting, and increase in OFC) improvement occurred in 145 patients (86.82%). Shunt revision was needed in 50.29% (84 patients) in one year. Conclusion: VP shunt is a life-saving procedure and is an effective treatment of hydrocephalus but is not risk-free. Almost half of the shunted patients will need revision surgery in one year period. Keywords: Hydrocephalus, Ventriculoperitoneal Shunt, Occipitofrontal Circumference (OFC).
{"title":"Early Outcome of Ventriculoperitoneal (VP) Shunt in Terms of Improvement and Complications","authors":"Musawer Khan, Naeem-ul-Haq, Sajid Khan, Muhammad Zubair Bashir","doi":"10.36552/pjns.v26i1.641","DOIUrl":"https://doi.org/10.36552/pjns.v26i1.641","url":null,"abstract":"Objective: To analyze the outcome of ventriculoperitoneal (VP) shunts in terms of improvement and complications. \u0000Material and Methods: This retrospective observational study is done in MTI Mardan medical complex and Prime teaching hospital from September 2017 to March 2020. The hospital record of all patients who underwent ventriculoperitoneal shunts was reviewed for improvement and complications. Patients undergoing ventriculoperitoneal shunt for normal pressure hydrocephalus were excluded from this study. Revision of ventriculoperitoneal shunt was the primary endpoint of the study. \u0000Results: A total of 167 patients were operated on for ventriculoperitoneal shunts with males 106 (63.47%) and females 61 (36.52%). Age ranged from 1 month to 75 years with a mean of 14 years. The most common indication for surgery was congenital hydrocephalus in 102 patients (61.1%) while brain tumors caused hydrocephalus in 25 (15%) patients. Common presenting symptoms were the increase in head size in 75 (44.9%), and headaches in 84 (50.2%) patients. Symptomatic (headache, vomiting, and increase in OFC) improvement occurred in 145 patients (86.82%). Shunt revision was needed in 50.29% (84 patients) in one year. \u0000Conclusion: VP shunt is a life-saving procedure and is an effective treatment of hydrocephalus but is not risk-free. Almost half of the shunted patients will need revision surgery in one year period. \u0000Keywords: Hydrocephalus, Ventriculoperitoneal Shunt, Occipitofrontal Circumference (OFC).","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"49 16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76372835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Study provides proof to support the promised benefits of employing stand-alone zero-profile cages in multilevel ACDF procedures, as the stand-alone zero-profile device has proven safety and a reduction of the risk of dysphagia in single-level ACDF surgeries. Materials and Methods: This is a retrospective descriptive study, conducted at the Punjab Institute of Neurosciences, Lahore, Pakistan. Data of 36 patients evaluated for post-operative dysphagia and fusion, who had multi-level ACDF surgery employing stand-alone zero-profile cages. Results: Total of 36 patients underwent ACDF surgeries. 86.1% (31/36) patients operated for 2 levels and 13.9% (5/36) patients operated for 3 levels. Dysphagia developed postoperatively in 2 (5.6%) patients in which zero-profile stand-alone cages were used. Fusion was achieved in 94.4% (34/36) patients. Conclusion: Stand-alone zero-profile cages in multi-level ACDF surgeries have a good outcome in terms of post-operative less dysphagia and higher fusion rates. Keywords: Anterior Cervical Discectomy (Decompression) And Fusion (ACDF), Zero-Profile Cages, Cervical Spondylotic Myelopathy.
{"title":"Anterior Cervical Discectomy and Fusion Surgery: Results with Zero-Profile Spacer/Cage","authors":"Tariq Imran Khokhar, Sumaira Kiran, Muhammad Naveed Majeed, Khawar Anwar, Asif Bashir","doi":"10.36552/pjns.v26i1.656","DOIUrl":"https://doi.org/10.36552/pjns.v26i1.656","url":null,"abstract":"Objective: Study provides proof to support the promised benefits of employing stand-alone zero-profile cages in multilevel ACDF procedures, as the stand-alone zero-profile device has proven safety and a reduction of the risk of dysphagia in single-level ACDF surgeries. Materials and Methods: This is a retrospective descriptive study, conducted at the Punjab Institute of Neurosciences, Lahore, Pakistan. Data of 36 patients evaluated for post-operative dysphagia and fusion, who had multi-level ACDF surgery employing stand-alone zero-profile cages. Results: Total of 36 patients underwent ACDF surgeries. 86.1% (31/36) patients operated for 2 levels and 13.9% (5/36) patients operated for 3 levels. Dysphagia developed postoperatively in 2 (5.6%) patients in which zero-profile stand-alone cages were used. Fusion was achieved in 94.4% (34/36) patients. Conclusion: Stand-alone zero-profile cages in multi-level ACDF surgeries have a good outcome in terms of post-operative less dysphagia and higher fusion rates. Keywords: Anterior Cervical Discectomy (Decompression) And Fusion (ACDF), Zero-Profile Cages, Cervical Spondylotic Myelopathy.","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"59 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81023313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muhammad Tariq, Adnan Munir, Mushtaq Ahmad Mian, Muhammad Farooq, Irfan Jan, Faiqa Filza
Objectives: The study examined the surgical outcome of supratentorial gliomas in terms of improvement in seizures in patients who presented to a tertiary care institution. Material and Methods: A descriptive case series was conducted in Neurosurgery Department at Northwest General Hospital & Research, Peshawar. Patients (n = 95) with supratentorial gliomas with seizures between 18 – 70 years were included. Supratentorial gliomas were diagnosed by neuroimaging as MRI brain with contrast, diffusion-weighted, Fluid-attenuated inversion recovery, and magnetic resonance spectroscopy. The patient was observed for seizures postoperatively. Data was stratified for age and gender. Results: The majority of patients (36.8%) were in 41 – 50 years. 55.78% of patients were males whereas 44.21% of patients were females. 42 (44.21%) involved the frontal lobe, 16 (16.84%) involved the parietal lobe, 26 (27.36%) involved the temporal lobe, and 11 (11.57%) patients involved the occipital lobe. According to Engel’s classification, 53 patients were in class I, 16 in class II, 10 in class III, and 5 in class IV. 84 (88.42%) experienced post-op seizure reduction. An insignificant association was found with the seizure improvement (yes/no) with different age groups and gender. Conclusion: The frontal lobe was the most prevalent location for supratentorial gliomas. After surgery, a large proportion of patients improved in terms of seizure management. Keywords: Seizures, Supratentorial gliomas.
{"title":"The Efficacy of Surgery for Supra-Tentorial Gliomas in Preventing Seizures","authors":"Muhammad Tariq, Adnan Munir, Mushtaq Ahmad Mian, Muhammad Farooq, Irfan Jan, Faiqa Filza","doi":"10.36552/pjns.v26i1.653","DOIUrl":"https://doi.org/10.36552/pjns.v26i1.653","url":null,"abstract":"Objectives: The study examined the surgical outcome of supratentorial gliomas in terms of improvement in seizures in patients who presented to a tertiary care institution.\u0000Material and Methods: A descriptive case series was conducted in Neurosurgery Department at Northwest General Hospital & Research, Peshawar. Patients (n = 95) with supratentorial gliomas with seizures between 18 – 70 years were included. Supratentorial gliomas were diagnosed by neuroimaging as MRI brain with contrast, diffusion-weighted, Fluid-attenuated inversion recovery, and magnetic resonance spectroscopy. The patient was observed for seizures postoperatively. Data was stratified for age and gender.\u0000Results: The majority of patients (36.8%) were in 41 – 50 years. 55.78% of patients were males whereas 44.21% of patients were females. 42 (44.21%) involved the frontal lobe, 16 (16.84%) involved the parietal lobe, 26 (27.36%) involved the temporal lobe, and 11 (11.57%) patients involved the occipital lobe. According to Engel’s classification, 53 patients were in class I, 16 in class II, 10 in class III, and 5 in class IV. 84 (88.42%) experienced post-op seizure reduction. An insignificant association was found with the seizure improvement (yes/no) with different age groups and gender.\u0000Conclusion: The frontal lobe was the most prevalent location for supratentorial gliomas. After surgery, a large proportion of patients improved in terms of seizure management.\u0000Keywords: Seizures, Supratentorial gliomas.","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87766977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: The purpose of this study was to characterize the epidemiologic characteristics, a pattern of traumatic subaxial cervical spine injuries, and their surgical outcomes in a tertiary care hospital in Khyber Pakhtunkhwa, Pakistan. Materials and Methods: This retrospective descriptive study was conducted at the Department of Neurosurgery at Lady Reading Hospital Peshawar. The records of 40 patients between the ages of 15 and 60 who had cervical spine injuries were evaluated to characterize the injuries and surgical outcomes. We employed the anterior route for surgery regularly and the posterior method only when the reduction failed or substantial instability. We used a tricortical bone graft or titanium cages with autologous bone and secured them through titanium plates to achieve fusion. Results: 80% of patients presented with sub axial cervical injury. Regarding the etiology of injury, 37.5 % had motor vehicle accidents, 28.12% had a history of height falls, and the remaining had sustained injuries due to other causes. The majority of the patients, 68.75% (n = 22), had isolated subluxation injury.87.5% (n = 28) underwent surgical intervention; surgical outcomes such as pain relief were measured using the VAS, which was 6.09 ± 1.42 preoperatively while 4.5 ± 1.29 postoperatively with a difference of means of 1.59. There was a significant improvement in neurological functions as measured through the ASIA impairment scale. Conclusion: Most cervical spine injuries occurred in young male patients, motor vehicle accidents were the most prevalent cause, and isolated subluxation was the most frequent injury pattern.
{"title":"Epidemiology and Surgical Outcome of Traumatic Sub Axial Cervical Spine Injuries in a Tertiary Care Hospital of KPK, Pakistan","authors":"Hamayun Tahir, Naseer Hassan, Afzal Raza, Hina Arooj, Samina Feroz, Farooq Azam","doi":"10.36552/pjns.v26i1.582","DOIUrl":"https://doi.org/10.36552/pjns.v26i1.582","url":null,"abstract":"Objective: The purpose of this study was to characterize the epidemiologic characteristics, a pattern of traumatic subaxial cervical spine injuries, and their surgical outcomes in a tertiary care hospital in Khyber Pakhtunkhwa, Pakistan.\u0000Materials and Methods: This retrospective descriptive study was conducted at the Department of Neurosurgery at Lady Reading Hospital Peshawar. The records of 40 patients between the ages of 15 and 60 who had cervical spine injuries were evaluated to characterize the injuries and surgical outcomes. We employed the anterior route for surgery regularly and the posterior method only when the reduction failed or substantial instability. We used a tricortical bone graft or titanium cages with autologous bone and secured them through titanium plates to achieve fusion.\u0000Results: 80% of patients presented with sub axial cervical injury. Regarding the etiology of injury, 37.5 % had motor vehicle accidents, 28.12% had a history of height falls, and the remaining had sustained injuries due to other causes. The majority of the patients, 68.75% (n = 22), had isolated subluxation injury.87.5% (n = 28) underwent surgical intervention; surgical outcomes such as pain relief were measured using the VAS, which was 6.09 ± 1.42 preoperatively while 4.5 ± 1.29 postoperatively with a difference of means of 1.59. There was a significant improvement in neurological functions as measured through the ASIA impairment scale.\u0000Conclusion: Most cervical spine injuries occurred in young male patients, motor vehicle accidents were the most prevalent cause, and isolated subluxation was the most frequent injury pattern. \u0000 ","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79164511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zubair Mustafa Khan, Hannan Tayyab, Syed Ahmad Faizan, Sumaira Kiran, Aqeel Butt, Asif Bahsir
Background/Objective: A minimally invasive surgical method is in use to create endoscopic transsphenoidal surgery. Because of the intricate dissection of the sellar region, surgical treatment of large pituitary adenomas is challenging. The study focused to determine the frequency of complications after endonasal endoscopic transsphenoidal resection of giant pituitary macroadenomas. Materials and Methods: A descriptive case series study was conducted at the Neurosurgical Department of Lahore General Hospital, Lahore. A total of 70 patients fulfilling the selection criteria were enrolled. Major vascular injury was noted when there is an injury to the internal carotid artery or cavernous sinus. After discharge, patients were followed-up in OPD for 3 months. After 3 months, patients were evaluated for CSF leak and vision. The presence of complications was recorded. During surgery, operative time was noted. Results: Mean age of patients was 55.7 ± 6.5 years. 45.71% of patients were male while the remaining 54.29% of patients were female Total of 41.43% of patients had disease < 2 years, whereas the duration of surgery was ? 3 hours in 64.3% of patients. A total 15.71% had complications which included diabetes insipidus (8.57%), infections (5.71%), pituitary dysfunction (4.29%), CSF leak (2.8%) and vascular injury (1.43%). The mortality rate was 1.43%. Conclusion: The complication rate after endonasal endoscopic transsphenoidal resection of giant pituitary macroadenomas was high. Keywords: Endonasal Endoscopic, Transsphenoidal Resection, Pituitary Macroadenomas, Complications
{"title":"Results of Resection of Giant Pituitary Adenomas through Endoscopic Endonasal Approach","authors":"Zubair Mustafa Khan, Hannan Tayyab, Syed Ahmad Faizan, Sumaira Kiran, Aqeel Butt, Asif Bahsir","doi":"10.36552/pjns.v26i1.644","DOIUrl":"https://doi.org/10.36552/pjns.v26i1.644","url":null,"abstract":"Background/Objective: A minimally invasive surgical method is in use to create endoscopic transsphenoidal surgery. Because of the intricate dissection of the sellar region, surgical treatment of large pituitary adenomas is challenging. The study focused to determine the frequency of complications after endonasal endoscopic transsphenoidal resection of giant pituitary macroadenomas. \u0000Materials and Methods: A descriptive case series study was conducted at the Neurosurgical Department of Lahore General Hospital, Lahore. A total of 70 patients fulfilling the selection criteria were enrolled. Major vascular injury was noted when there is an injury to the internal carotid artery or cavernous sinus. After discharge, patients were followed-up in OPD for 3 months. After 3 months, patients were evaluated for CSF leak and vision. The presence of complications was recorded. During surgery, operative time was noted. \u0000Results: Mean age of patients was 55.7 ± 6.5 years. 45.71% of patients were male while the remaining 54.29% of patients were female Total of 41.43% of patients had disease < 2 years, whereas the duration of surgery was ? 3 hours in 64.3% of patients. A total 15.71% had complications which included diabetes insipidus (8.57%), infections (5.71%), pituitary dysfunction (4.29%), CSF leak (2.8%) and vascular injury (1.43%). The mortality rate was 1.43%. \u0000Conclusion: The complication rate after endonasal endoscopic transsphenoidal resection of giant pituitary macroadenomas was high. \u0000Keywords: Endonasal Endoscopic, Transsphenoidal Resection, Pituitary Macroadenomas, Complications","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79396373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mahmood Khan Kibzai, Muhammad Shoaib Kibzai, Muhammad Haroon, Zeenat-un-Nisa
Objective: The purpose of this study was to report on the result and complications of titanium mesh cranioplasty in patients with trauma. Materials and Methods: The patients who underwent craniectomy previously for acute subdural hematomas (20 cases) or depressed fractures (40 cases) following RTA (road traffic accidents) were included in the study. Titanium mesh was placed on the skull defect 3 – 6 months later in the private hospitals of Quetta. The resulting complications were reported. Results: There were 50 male and 10 female patients. The majority (66.66%) of patients were from the age group 15 – 40 years. The majority of patients (83.33%) did not develop any complications. 8.3% of patients had wound infections, 3.3%had mesh exposures, 1.6% developed loosening screws and 1.6% had mesh indentation due to external pressure. Conclusion: This study concludes that there are few patients (< 20%) who develop complications after cranioplasty. The study’s findings will assist neurosurgeons in the clinical decision-making process. Keywords: Titanium Mesh Cranioplasty, Acute Subdural Hematoma, Road Traffic Accident, Depressed Fractures.
{"title":"Outcome of Severe Traumatic Head Injury in Children","authors":"Mahmood Khan Kibzai, Muhammad Shoaib Kibzai, Muhammad Haroon, Zeenat-un-Nisa","doi":"10.36552/pjns.v26i1.636","DOIUrl":"https://doi.org/10.36552/pjns.v26i1.636","url":null,"abstract":"Objective: The purpose of this study was to report on the result and complications of titanium mesh cranioplasty in patients with trauma.\u0000Materials and Methods: The patients who underwent craniectomy previously for acute subdural hematomas (20 cases) or depressed fractures (40 cases) following RTA (road traffic accidents) were included in the study. Titanium mesh was placed on the skull defect 3 – 6 months later in the private hospitals of Quetta. The resulting complications were reported.\u0000Results: There were 50 male and 10 female patients. The majority (66.66%) of patients were from the age group 15 – 40 years. The majority of patients (83.33%) did not develop any complications. 8.3% of patients had wound infections, 3.3%had mesh exposures, 1.6% developed loosening screws and 1.6% had mesh indentation due to external pressure.\u0000Conclusion: This study concludes that there are few patients (< 20%) who develop complications after cranioplasty. The study’s findings will assist neurosurgeons in the clinical decision-making process.\u0000Keywords: Titanium Mesh Cranioplasty, Acute Subdural Hematoma, Road Traffic Accident, Depressed Fractures.","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86528516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kauser Aftab Khan, Hareem Arif, Huma Azeem, Umama nadeem, Ahmmad Mustafa Cheema, Slah ud din khan
Objective: To determine a student's performance. A survey of undergraduate medical students was done to determine the factors linked to increased stress and emotional tiredness among medical students at Gujranwala Medical College (GMC) Pakistan. Material and Methods: Data was collected using a structured questionnaire collected from undergraduate medical students. Information related to stress, nervousness, being upset, daily life restlessness, being irritated, being focused, satisfaction with the lecturing, financial strains, family-related stress, living problems, and career, was collected from the respondents via proforma with permission. Results: 40.4% of students felt they had often faced stress during their last month with 37.1% facing unexpected events. Often students (34.4%) found restlessness during their last month with 39.1% of subjects feeling irritated by things happening around them. Some 35.8% of subjects had given thoughts to the future, 26.5% felt worthless and 33.1% forgot simple things or tasks. 39.1% felt they had difficulty focusing on the tasks given to them. Financial strain was always there in 3.3% and was rarely felt in 33.8% of subjects. Family-related problems were always there in 7.3% of subjects. 33.1% always felt dissatisfied with the quality of food in the mess. 29.8% of subjects felt they were unable to fulfill their parents’ expectations while 22.5% felt they face stress about their career. Conclusion: 40% of students are experiencing various forms of stress and emotional exhaustion. 33 percent of students always felt tension due to messed-up food, and 26.5 percent felt they always felt alone to deal with their problems.
{"title":"Perceived Stress and Emotional Exhaustion among Undergraduate Medical Students of Gujranwala Medical College, Pakistan","authors":"Kauser Aftab Khan, Hareem Arif, Huma Azeem, Umama nadeem, Ahmmad Mustafa Cheema, Slah ud din khan","doi":"10.36552/pjns.v26i1.632","DOIUrl":"https://doi.org/10.36552/pjns.v26i1.632","url":null,"abstract":"Objective: To determine a student's performance. A survey of undergraduate medical students was done to determine the factors linked to increased stress and emotional tiredness among medical students at Gujranwala Medical College (GMC) Pakistan.\u0000Material and Methods: Data was collected using a structured questionnaire collected from undergraduate medical students. Information related to stress, nervousness, being upset, daily life restlessness, being irritated, being focused, satisfaction with the lecturing, financial strains, family-related stress, living problems, and career, was collected from the respondents via proforma with permission.\u0000Results: 40.4% of students felt they had often faced stress during their last month with 37.1% facing unexpected events. Often students (34.4%) found restlessness during their last month with 39.1% of subjects feeling irritated by things happening around them. Some 35.8% of subjects had given thoughts to the future, 26.5% felt worthless and 33.1% forgot simple things or tasks. 39.1% felt they had difficulty focusing on the tasks given to them. Financial strain was always there in 3.3% and was rarely felt in 33.8% of subjects. Family-related problems were always there in 7.3% of subjects. 33.1% always felt dissatisfied with the quality of food in the mess. 29.8% of subjects felt they were unable to fulfill their parents’ expectations while 22.5% felt they face stress about their career.\u0000Conclusion: 40% of students are experiencing various forms of stress and emotional exhaustion. 33 percent of students always felt tension due to messed-up food, and 26.5 percent felt they always felt alone to deal with their problems.\u0000 ","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78219471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Samra Majeed, Muhammad Irfan, Muhammad Hammad Nasir, Ajmal Khan, Azam Niaz, Jahangir Khan
Objective: This study identified the relationship between posterior fossa craniectomy, expansion neuroplasty, and radiological appearances in patients with Chiari malformation with and without clinical syringomyelia with the surgical outcomes in an attempt to correct the lesion. Materials & Methods: Eighty-eight patients with Chiari malformation (CM) were included in the study where 70 had associated syringomyelia. All underwent posterior fossa craniotomy, expansion duroplasty without fiddling with cerebellar tonsils. Patients were evaluated at 1 month, 3 months, and 12 months. The MRI studies were done at 12 months when symptomatic relief and radiological findings were evaluated and matched. Results: Most of the patients were young adults between the age range of 25 – 40 years. The most common complication was pseudomeningocele (5.68%) formation followed by CSF leak (4.54%). Patients with a longer history of Chiari malformation or syrinx-related symptoms and signs had partial relief in symptoms and signs. The poor outcome as expected was seen in patients with atrophic changes in upper limbs and hypertonia in lower limbs, especially in patients with loss of joints position sense and poor balance. Patients showed maximum improvement in headaches both suboccipital as well as generalized. Syringomyelia was decreased in size in 49 patients and remained unchanged in 21. Dysesthesias were improved in 31 patients. Conclusion: Clinical improvement was related to the expansion of the posterior fossa and subarachnoid cistern and reduction in the size of the syrinx. Surgical decompression of the posterior fossa should create adequate space for its contents and reduce the syrinx cavity. The relationship between symptomatic improvement and radiological findings is not always linear. Keywords: Chiari Malformation, Tonsillar Herniation, Syringomyelia, Duroplasty.
{"title":"Chiari Malformation with and without Syringomyelia: Surgical Technique and Outcome in 88 Adult Patients","authors":"Samra Majeed, Muhammad Irfan, Muhammad Hammad Nasir, Ajmal Khan, Azam Niaz, Jahangir Khan","doi":"10.36552/pjns.v26i1.650","DOIUrl":"https://doi.org/10.36552/pjns.v26i1.650","url":null,"abstract":"Objective: This study identified the relationship between posterior fossa craniectomy, expansion neuroplasty, and radiological appearances in patients with Chiari malformation with and without clinical syringomyelia with the surgical outcomes in an attempt to correct the lesion. \u0000Materials & Methods: Eighty-eight patients with Chiari malformation (CM) were included in the study where 70 had associated syringomyelia. All underwent posterior fossa craniotomy, expansion duroplasty without fiddling with cerebellar tonsils. Patients were evaluated at 1 month, 3 months, and 12 months. The MRI studies were done at 12 months when symptomatic relief and radiological findings were evaluated and matched. \u0000Results: Most of the patients were young adults between the age range of 25 – 40 years. The most common complication was pseudomeningocele (5.68%) formation followed by CSF leak (4.54%). Patients with a longer history of Chiari malformation or syrinx-related symptoms and signs had partial relief in symptoms and signs. The poor outcome as expected was seen in patients with atrophic changes in upper limbs and hypertonia in lower limbs, especially in patients with loss of joints position sense and poor balance. Patients showed maximum improvement in headaches both suboccipital as well as generalized. Syringomyelia was decreased in size in 49 patients and remained unchanged in 21. Dysesthesias were improved in 31 patients. \u0000Conclusion: Clinical improvement was related to the expansion of the posterior fossa and subarachnoid cistern and reduction in the size of the syrinx. Surgical decompression of the posterior fossa should create adequate space for its contents and reduce the syrinx cavity. The relationship between symptomatic improvement and radiological findings is not always linear. \u0000Keywords: Chiari Malformation, Tonsillar Herniation, Syringomyelia, Duroplasty.","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90706548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Low back pain is incredibly painful and demoralizing due to the physical restrictions it causes as well as the psychological ramifications it brings. The calcium and alkaline phosphatase were favorably connected with vitamin D. The issue of low back discomfort presents a difficulty to healthcare practitioners. In developing nations, the problem is exacerbated by a failure to report for early treatment, vocational compulsions in rural regions, and sedentary lifestyles among urban youngsters 1. In Pakistan, there was a significant incidence of vitamin D insufficiency, with 53.5 percent of residents studied being vitamin D deficient, 31.2 percent being inadequate vitamin D, and just 15.3 percent having normal vitamin D (25-hydroxyvitamin D) levels. High levels of Vitamin D insufficiency were also seen, regardless of the various quantities of sunlight in the five city sites 2. In observational studies, consumption of carbonated beverages has been linked to an increased risk of fracture. The most common reason is that one or more of the beverage ingredients raise urine calcium. 3 There is a role of optimized levels of calcium, vitamin D & uric Acid in order to treat patients with low backaches. 1,4 The over intake of carbonated caffeine drinks and artificial fruit juices adversely impacts the proper absorption of vitamin D and calcium. Hence, good doses of supplements of Vitamin D and Calcium should be optimized for patients reporting muscles and joint pains. Severe back pain and lower extremities weaknesses have been reported in altered levels of vitamin D and uric acid. 5 We strongly recommend early and regular screening for vitamin D, Calcium, and uric acid as part of a comprehensive health assessment for low back pain.
{"title":"Management of Calcium, Vitamin D, and Uric-Acid Levels for Spinal Pain","authors":"Muhammad Anwar Chaudary, Saman Shahid","doi":"10.36552/pjns.v25i4.631","DOIUrl":"https://doi.org/10.36552/pjns.v25i4.631","url":null,"abstract":"Low back pain is incredibly painful and demoralizing due to the physical restrictions it causes as well as the psychological ramifications it brings. The calcium and alkaline phosphatase were favorably connected with vitamin D. The issue of low back discomfort presents a difficulty to healthcare practitioners. In developing nations, the problem is exacerbated by a failure to report for early treatment, vocational compulsions in rural regions, and sedentary lifestyles among urban youngsters 1. In Pakistan, there was a significant incidence of vitamin D insufficiency, with 53.5 percent of residents studied being vitamin D deficient, 31.2 percent being inadequate vitamin D, and just 15.3 percent having normal vitamin D (25-hydroxyvitamin D) levels. High levels of Vitamin D insufficiency were also seen, regardless of the various quantities of sunlight in the five city sites 2. In observational studies, consumption of carbonated beverages has been linked to an increased risk of fracture. The most common reason is that one or more of the beverage ingredients raise urine calcium. 3 There is a role of optimized levels of calcium, vitamin D & uric Acid in order to treat patients with low backaches. 1,4 The over intake of carbonated caffeine drinks and artificial fruit juices adversely impacts the proper absorption of vitamin D and calcium. Hence, good doses of supplements of Vitamin D and Calcium should be optimized for patients reporting muscles and joint pains. Severe back pain and lower extremities weaknesses have been reported in altered levels of vitamin D and uric acid. 5 We strongly recommend early and regular screening for vitamin D, Calcium, and uric acid as part of a comprehensive health assessment for low back pain.","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"74 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74849427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To study the Pattern and Practice of Paediatric neurosurgical procedures during one year among patients presenting to Children Hospital, Faisalabad. Materials and Methods Retrospective case series of 778 consecutive cases done in Paediatric Neurosurgery Department, Children Hospital, Faisalabad over the period of one year (October 2019- November 2020). Patients of age less than 15 years, any gender, admitted in Paeds Neurosurgery ward for management were included and studied for their demographic data hospital stay, procedure done and outcome. Results A total of 778 patients who required some neurosurgical intervention were admitted, 725 underwent various types of procedures and remaining were treated conservatively. 320 (44.14%) were male and 405 (55.86%) were female. Age range was 20 days to 13 years. The most common diagnosis was hydrocephalous, and then was Meningomyelocele (MMC). First three common procedures performed included monitoring of Cerebrospinal fluid (CSF) in 36% cases, Placement of shunt (21%), and placement of external ventricular drain (EVD) in 13% cases of cerebrospinal fluid ( CNS) infections in patients of hydrocephalous. Conclusion Pattern of presentation of paediatric neurosurgical cases take in almost all types of diseases like neural tube defects, hydrocephalous, cranial trauma, tumors, cysts and infections but surgical procedures in routine practice in Faisalabad district cover mainly hydrocephalous and its complications. Endoscopic or advanced procedures are not commonly practiced due to multiple factors but existing constrains do not prevent best management of paediatric neurosurgery patients. Key Words: Paediatric neurosurgery, Neurosurgical procedures, Children hospital, Faisalabad
{"title":"Pattern and Practice of Paediatric Neurosurgical Procedures- An analysis of one year initial experience at resource challenged setup of Children Hospital, Faisalabad.","authors":"Faisal Feroz Rana, Mazhar Mahmood, Uzma Amin","doi":"10.36552/pjns.v25i4.614","DOIUrl":"https://doi.org/10.36552/pjns.v25i4.614","url":null,"abstract":"Objective \u0000To study the Pattern and Practice of Paediatric neurosurgical procedures during one year among patients presenting to Children Hospital, Faisalabad. \u0000Materials and Methods \u0000Retrospective case series of 778 consecutive cases done in Paediatric Neurosurgery Department, Children Hospital, Faisalabad over the period of one year (October 2019- November 2020). Patients of age less than 15 years, any gender, admitted in Paeds Neurosurgery ward for management were included and studied for their demographic data hospital stay, procedure done and outcome. \u0000Results \u0000A total of 778 patients who required some neurosurgical intervention were admitted, 725 underwent various types of procedures and remaining were treated conservatively. 320 (44.14%) were male and 405 (55.86%) were female. Age range was 20 days to 13 years. The most common diagnosis was hydrocephalous, and then was Meningomyelocele (MMC). First three common procedures performed included monitoring of Cerebrospinal fluid (CSF) in 36% cases, Placement of shunt (21%), and placement of external ventricular drain (EVD) in 13% cases of cerebrospinal fluid ( CNS) infections in patients of hydrocephalous. \u0000Conclusion \u0000Pattern of presentation of paediatric neurosurgical cases take in almost all types of diseases like neural tube defects, hydrocephalous, cranial trauma, tumors, cysts and infections but surgical procedures in routine practice in Faisalabad district cover mainly hydrocephalous and its complications. Endoscopic or advanced procedures are not commonly practiced due to multiple factors but existing constrains do not prevent best management of paediatric neurosurgery patients. \u0000 Key Words: Paediatric neurosurgery, Neurosurgical procedures, Children hospital, Faisalabad","PeriodicalId":19963,"journal":{"name":"Pakistan Journal Of Neurological Surgery","volume":"96 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90665041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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