Journal of the Pakistan Medical Association最新文献

Brain hydatid cysts are rare and mostly occur as solitary supratentorial cysts in children. Multiple primary intracranial hydatid cysts are even rarer. A 26-year-old cattle farmer, diagnosed as a case of brain hydatidosis, had undergone multiple surgeries. He presented with headache and right hemiparesis, and was re-diagnosed with recurrent hydatid disease. He underwent surgery using Dowling technique and was discharged on tablet Albendazole. Brain hydatidosis should be ruled out in patients who present with raised intracranial pressure symptoms in endemic regions. Recurrent disease may require multiple surgeries and long-term treatment and follow-up.

Objective: To investigate the nutrition-related knowledge, attitude and practice levels of children and adolescents with early severe obesity, and to analyse the influencing factors.

Methods: The cross-sectional study was conducted from January 2022 to January 2023 in Qinhuangdao city, China, and comprised children and adolescents with early-onset severe obesity. Based on the median nutrition-related knowledge, attitude and practice level, the subjects were divided into a 'high' group A and 'low' group B. The baseline data of the two groups was compared, and the relevant factors affecting nutrition-related knowledge, attitude and practice levels were analysed. Data was analysed using SPSS 22.

Results: Of the 250 subjects, 127(50.8%) were females, 123(49.2%) were males, 79(31.6%) were aged >14 years, 70(28%) 6-14 years, 69(27.6%) 2-6 years and 32(12.8%) were <2 years. There were 127(50.8%) subjects in group A and 123(49.2%) in group B. The overall mean knowledge, attitude and practice score was 12.52±2.38 (range: 6-19), with median score 13(IQR=4). Body shape assessment, parental obesity, and parents' education level were the influencing factors of nutrition-related knowledge, attitude and practice levels (p<0.05).

Conclusion: Children and adolescents with early-onset severe obesity in Qinhuangdao were found to have a medium level of nutrition-related knowledge, attitude and practice, and the level was influenced by body shape assessment, parental obesity and parental education level.

Objective: To compare the outcomes of Fenestrating and Reconstituting subtypes of laparoscopic subtotal cholecystectomy in technically difficult cases.

Methods: The retrospective study was conducted at the Department of Surgery, Khyber Teaching Hospital, Peshawar, Pakistan, from August 1, 2023, to July 31, 2024, and comprised data of patients who underwent Fenestrating or Reconstituting laparoscopic subtotal cholecystectomy between January 1, 2014, and December 31, 2023, for gallstone disease. Postoperative length of hospital stay, frequency of bile leak, bile collections, requirement of endoscopic retrograde cholangiopancreatography and reoperations were the parameters noted and compared. Data was analysed using IBM® SPSS® Statistics 26.0.

Results: Of 1,579 patients, 78(4.9%) had undergone laparoscopic subtotal cholecystectomy. Of them, 6(7.7%) cases were i excluded due to incomplete records, and the final sample comprised 72(92.3%) patients; 44(61.2%) females and 28(38.8%) males with mean age 56.91±16.28 years. Overall, 43(59.7%) patients were in the Fenestrating group and 29(40.3%) in the Reconstituting group. Mean postoperative hospital stay was significantly different between the groups (p<0.05), while the frequency of bile leak, bile collection, requirement of endoscopic retrograde cholangiopancreatography and the rate of reoperations were not significantly different between the groups (p>0.05).

Conclusions: Compared to the Fenestrating type, the Reconstituting type of laparoscopic subtotal cholecystectomy resulted in reduced postoperative hospital stay.

A porencephalic cyst is a rare intracranial lesion characterised by a cerebrospinal fluid-filled cavity within the cerebral hemisphere, typically surrounded by gliotic or spongiotic white matter. These cysts often present with neurological symptoms such as seizures, developmental delays, or motor impairments, depending on their size and location. We present the case of a 19-year-old male with a three-month history of recurrent seizures. Initial management with valproic acid led to significant improvement, with the patient remaining seizure-free during follow-up. Cerebral MRI revealed a porencephalic cyst with a mural nodule in the left temporo-occipital region; however, angiographic studies demonstrated no vascular abnormalities. Treatment approaches for porencephalic cysts are primarily symptomatic, including the use of antiepileptic medications and physiotherapy to address motor deficits. Surgical intervention may be considered in cases complicated by hydrocephalus or raised intracranial pressure. This case underscores the importance of tailored management strategies in achieving optimal outcomes.

Objective: To compare the treatment recommendations of the thoracolumbar injury classification and severity score system and the thoracolumbar Arbeitsgemeinschaft für Osteosynthesefragen spine injury score in case of thoracolumbar spine injury.

Methods: The cross-sectional study was conducted at the Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, from July to December 2023, and comprised patients aged at least 18 irrespective of gender, who had traumatic thoracic and lumbar vertebral spine fractures. Data regarding age, gender, mode of trauma, findings of neurological examination and imaging was collected. All cases were independently scored by an experienced spine surgeon, and a radiologist provided standardised imaging interpretation. The scorers were blinded to clinical outcomes and treatment decisions. Interrater agreement between thoracolumbar injury classification and severity score system and the thoracolumbar Arbeitsgemeinschaft für Osteosynthesefragen spine injury score was assessed using Cohen's kappa coefficient. Data was analysed using SPSS 23.

Results: Of the 335 patients with mean age 32.24±13.32 years, 279(83.3%) were males. The most common mode of trauma was fall from height 189(56.4%), and the most common site of fracture was L1 vertebrae 109(32.5%). Based on the thoracolumbar injury classification and severity score system, the most common fracture morphology was burst fracture 257(76.7%). The most common fracture type based on the thoracolumbar Arbeitsgemeinschaft für Osteosynthesefragen spine injury score was Type A compression injuries 300(89.6%). The thoracolumbar Arbeitsgemeinschaft für Osteosynthesefragen spine injury score had more patients in the grey zone 30(9%) compared to thoracolumbar injury classification and severity score system 22(6.6%). Treatment recommendations were the same in both the classification systems for 306(91.3%) patients (Cohen's kappa = 0.812, p<0.001).

Conclusions: There was no significant difference between the treatment recommendations suggested by the thoracolumbar injury classification and severity score system and the thoracolumbar Arbeitsgemeinschaft für Osteosynthesefragen spine injury score. The differences in grey zone classification highlighted the complexity of thoracolumbar injury assessment.