Early Complications of Ventriculoperitoneal Shunt in Pediatric Patients With Hydrocephalus.

Objective Ventriculoperitoneal shunt (VPS) is the most commonly used procedure for the treatment of hydrocephalus (HDC), especially in children. However, this is prone to many complications, and requires repeated surgeries, which as such increases the morbidity of the patients. It is estimated that majority of the complications occurs in the immediate post-operative period and the rate of complications decreases over the time, with no impunity to these, though. We conducted this study to know about the complications of VPS in the early post-operative period, in pediatric patients with hydrocephalus. Materials and methods This descriptive study was conducted in the Department of Neurosurgery, Lady Reading Hospital, Peshawar, between June 2019 and January 2020 (seven months). All patients with hydrocephalus below 12 years of age, operated for the first time were included after taking an informed consent, while those with repeated shunt procedures and elderly patients requiring shunt were excluded from the study. Patients' details like age, gender, location, contact number, cause of hydrocephalus, date of shunt placement, type of surgery (elective or emergency) and any follow-up complications like failure, erosion, infections, ileus were noted on a predesigned proforma. After the surgery, patients were followed for a period of one month, and contacted either through the telephone or asked to visit in the outpatients on the specified days, and were evaluated for any shunt-related complications, and any of these complications suspected were further evaluated and noted. The data was analyzed using the statistical program SPSS version 19 (IBM Corp., Armonk, NY). Results are presented in the form of charts, tables and graph. Results During the study period, we evaluated a total of 151 patients; there were 78 (51.65%) males and 73 (48.34%) females with a male to female ratio approaching 1.1:1. The age range was from 22 days to 12 years. The mean age was 38.46 ± 7.53 months. The primary indications for the insertion of VP shunt were: congenital hydrocephalus in 70 (46.4%), post infectious hydrocephalus in 57 (37.7%), hydrocephalus due to tumor in 22 (14.6%), and post traumatic hydrocephalus in two (1.4%) patients. Among the total number of patients, 85 patients (55.6%) were done as elective cases and 66 patients (44.4%) were done as emergency cases. Complications were encountered in 30 patients (19.87%) during the follow-up of 30 days. Complications occurred between day 1 and day 20 of follow-up with a mean of 9.10 ± 1.69 2SD days. Conclusion VP shunt is the most widely used treatment for HDC, but is predisposed to complications and almost every fifth case of VP shunt comes across with complications. Shunt blockage, infections and abdominal wound-related complications are common earlier complications in pediatric patients with hydrocephalus.

Vitamin D Levels and Bone Mineral Density in Premenopausal Women Compared to Postmenopausal Women: A Multi-Centre Study From Pakistan.

Introduction Despite the sunny climate, women in Pakistan are prone to vitamin D deficiency and subsequent low bone mineral density. The current study explores the extent of this deficiency in both pre- and postmenopausal women in our setting.  Methodology A cross-sectional study was conducted at the outpatient departments of Lady Reading Hospital and Hayatabad Medical Complex Peshawar, Pakistan during the time period between March 2018 and June 2019. Hundred premenopausal women (control group) and 100 postmenopausal women (study group) were inducted in the study. Serum vitamin D levels were determined in patients with suspected vitamin D deficiency. Bone mineral density (BMD) was determined for each patient and the cost of each scan was afforded by our department. A dual-energy x-ray absorptiometry (DEXA) scan was used to perform the bone mineral density assessment. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 26 (IBM, Chicago, IL). Results Serum 25OHD concentration in postmenopausal women was significantly lower compared to premenopausal women (p<0.001). In the study group, 36.0% of women had a severe deficiency of serum vitamin D levels, whereas, in the control group, only two women suffered from severe deficiency of vitamin D. Similarly, bone mineral density was also significantly correlated with the menopausal status of the women (p<0001). It was found that three-fifths of the postmenopausal women had a low bone density. Twenty-four percent of postmenopausal women had very low BMD. In comparison, only a single premenopausal woman was found to have a Z-score of below -2.0. Conclusion The current study highlights the impact of menopause on vitamin D levels and BMD. In our study, we found a significant difference between vitamin D levels and BMD in women of reproductive age compared to postmenopausal women.

A Rare Case of Bertolotti's Syndrome in a Young Patient: A Case Report and Literature Review.

Bertolotti's syndrome is a congenital condition characterized by the sacralization of the lower lumbar vertebrae or the lumbarization of the sacral vertebrae. The cause of pain in Bertolotti's syndrome is multifactorial. This lumbosacral transitional vertebra has a prevalence of 4% to 30%. Rarely, it is considered in the differential diagnosis of low back pain in young people. Therefore, every aspect of Bertolotti's syndrome needs to be meticulously addressed, and it should be included in the differential diagnosis of chronic back pain. Herein, we present a case of Bertolotti's syndrome presented with chronic lower back pain, confirmed on X-ray and magnetic resonance imaging (MRI). He was managed with analgesics and steroids injection with regular follow-up.

Sociodemographic and Clinical Features in Patients Presented With Accidental and Deliberate Self-Poisoning: A Comparative Study from Lady Reading Hospital Medical Teaching Institution, Peshawar, Pakistan.

Objectives To evaluate the sociodemographic and clinical characteristics of patients presented with acute self-poisoning at a tertiary care hospital in Pakistan. Methods and Patients A comparative study was conducted at Lady Reading Hospital MTI between May 2018 to May 2019 for a duration of 12 months. All patients diagnosed with acute self-poisoning were included in the study. Patients with inconclusive diagnosis, who were dead prior to the arrival to the hospital, or had an incomplete history of poison exposure were excluded from the study. At the time of arrival to the emergency department, the patient was first stabilized. Patients were grouped into two according to the type of exposure, i.e., accidental self-poisoning and deliberate self-poisoning (DSP). Sociodemographic and clinical characteristics of patients were recorded in a preformed proforma. The data were analyzed using Statistical Package for the Social Sciences (SPSS) Version 26 (IBM Corp., Armonk, NY, USA). Results The mortality rate in patients with accidental poisoning was 9.62%, whereas it was 26.28% in DSP patients. Data were stratified according to the mode of poisoning, i.e., accidental vs DSP, and variables were assessed in patients who did not survive. It was found that 60% of patients who died in the accidental group were aged 0-15 years. In contrast, only one patient between aged 0-15 years died in the DSP group and the majority of the deaths occurred in those aged 25.1-35 years (31 [75.6%]). Conclusions In conclusion, women more often attempted suicide, whereas males suffered accidental poisoning more frequently. Firstly, we found a female predominance in the DSP group, whereas males were more prevalent in with young children experiencing accidental poisoning. Longer time from ingestion of poison to the arrival is associated with poor patient prognosis.