Short term outcomes following surgery in brain tumours sans neuronavigation.

OBJECTIVE: To determine the presentation and frequency of various intracranial neoplasms and assess outcomes for patients who underwent surgery without neuronavigation. METHODS: This retrospective study was conducted at Combined Military Hospital, Peshawar, Pakistan, and comprised medical records related to the period from August 2011 to July 2014. Patient histories, examination reports and preoperative and post-operative radiological scans were reviewed and extent of excision was determined based on these coupled with recurrence rates. Intraoperatively, tumour excision was determined largely by the experience of the surgeon and preoperative planning using bony landmarks and radiological scans as an objective guide to resection. SPSS 21 was used for data analysis. RESULTS: Of the 143 patients, 83(57.9%) were males and 60(42.1%)were females. Gliomas were the most common tumours, occurring in 20(33.3%) females and 35(42.2%) males. One-year survival rate for grade 4 astrocytomas was poor (39.4%) and was excellent for meningiomas (100%) and pituitary tumours (100%). CONCLUSIONS: Time-tested methods of careful neurological examination and knowledge of neuroanatomy can allow a surgeon with limited resources to plan and accommodate for accurate tumour resection with adequate margins.

Prevalence of myths concerning growth and health of children among females of local population of Pakistan.

OBJECTIVE: To analyse the prevalence of myths among women regarding growth and health-related issues of children, and to study the impact of basic demographic factors in this regard. METHODS: The educational, cross-sectional, descriptive study was carried out at the Combined Military Hospital, Peshawar, Pakistan, from January 2016 to January 2017. It comprised women reporting to paediatric outpatient clinics, and the subjects were selected using convenience sampling. A self-designed questionnaire was used which contained demographic details and 15 closed-ended questions encompassing common myths concerning child health-related issues. Total answers given by a client as YES (beliefs in myths) were grouped as >50% YES or <50% YES; and was cross-tabulated with independent variables. SPSS21was used for statistical analysis. RESULTS: Of the 422 subjects, 301(71.3%) believed in the existence of 'Garam' foods. Overall, 278(65.9%) subjects had <50% YES, and 144(34.1%) had >50% YES answers. Three most commonly believed myths were: a neonate must be tied for better growth 281(66.6%), 'Garam' food should not be given to children in summers 225(53.3%), and diseases like 'Kala Yarqaan' are transmitted through lactation 223(52.8%). There was a significant impact of education (p<0.001) and regional background (p=0.006) on predilection for harbouring myths. There was no significant impact of age (p=0.415), marital status (p=0.790) or socio-economic class (p=0.196) on the matter. CONCLUSIONS: Significant prevalence of myths pertinent to children's health-related issues among ladies was observed. The lacunae identified must be aptly addressed at clinical level as well as via lectures and seminars.

Changing spectrum of traumatic head injuries: Demographics and outcome analysis in a tertiary care referral center.

OBJECTIVE: To determine the causes, epidemiological characteristics and clinical outcomes related to cases of head trauma. METHODS: The retrospective study was conducted at Combined Military Hospital, Quetta, and comprised data from September, 2007, to September, 2011. Treatments offered to each patient and their outcomes were recorded. Glasgow coma scale score was noted on admission and Glasgow outcome scale was used to determine the outcome at 6-month follow-up. Data was analysed using IBM SPSS statistics 21. RESULTS: Of the 1056 patients in the study, 805(76%) were males. Majority of patients 498(47.2%) belonged to 21-40 years age group, with average age of 27±16 years. The most common cause identified were road traffic accidents 461(43.6%), followed by fall injuries 266(25%). Bomb blast injuries were 60(5.6%). The commonest finding on computed tomography scan was contusion in 124(11.7%) patients. Of the total, 709(63.9%) patients were treated conservatively. Major surgical procedure was done in 125 (11.8%) patients. Excellent recovery was seen in 907(85.8%) patients. CONCLUSIONS: In our environment, risk of head injury is increasing. The government should take measures for the improvement of infrastructure and strict implementation of traffic laws. Trauma centres with trained staff need to be ensured.

Analysis Of 1058 Lumbar Prolapsed Intervertebral Disc Cases In Two Tertiary Care Hospitals Of Pakistan.

BACKGROUND: Characteristics of Prolapsed Intervertebral Disc (PID) in two tertiary care hospitals of Pakistan. The objective of this was to study the demographic characteristics of lumbar PID by age, gender, clinical presentation, levels of spinal column involvement, treatment options and post-operative complications for lumber disc prolapse. METHODS: One thousand and fifty eight cases (708 males, 350 females) of prolapsed intervertebral disc over six years between January 2009 and December 2014 were studied for location of prolapsed disks, gender, age, clinical presentation, treatment options and complications of surgery. RESULTS: Of the determined locations L5/S1 was the commonest (34.6%), followed by L4/L5 (33.4%). 24.2%of the patients had prolapsed disks at 2 levels (L3/L4, L4/L5 andL4/L5, L5/S1). Prolapsed disc was commonest in the 31-49 year age group. Male were mostly affected with male to female ratio of 2.02%. Most common surgery performed was discectomy with fenestration (60.64% of total surgeries performed) and most common postoperative complication being mechanical backache (4.8%). CONCLUSIONS: Prolapsed intervertebral disc is common in the lower lumbar region at the level of L4/L5 and L5/S1. The outcome of the patients who underwent surgery is very good with 92.19% of patients, being free of postoperative complications.

EXPERIENCE WITH TITANIUM CAGES IN ANTERIOR CERVICAL DISCECTOMY AND FUSION.

BACKGROUND: Anterior cervical discectomy is a common procedure for treating patients for cervical disc prolapse. This study was conducted to study the surgical outcome and demographic characteristics of patients who were treated for anterior cervical disc prolapse. METHODS: Study was conducted in the combined military hospital (CMH) Peshawar. Study interval was 3 years from 1st September, 2011 to 31st August, 2014. Total numbers of patients were 84. Males were 54 (64.28%) and females were 30 (35.71%). All the patients had undergone the procedure of anterior cervical discectomy and fusion with titanium cages (ACDF). All the patients had plain MRI cervical spine done for diagnosis of anterior cervical disc prolapse. RESULTS: Total 84 patients were operated. In the patients who complained of brachialgia, 100% improvement was seen after the operation. Three (3.5%) of the patients, who presented with axial neck pain, continued to complain of pain and 2 (2.5%) of the patients complained of pain at the donor site after the operation. One of the patients had dural tear which resulted in subcutaneous cerebrospinal fluid (CSF) accumulation and was treated conservatively with repeated aspiration. Fusion rate was 100% with titanium cages used for fusion after anterior cervical discectomy. No complications were noted after the surgery at 1 year of interval. CONCLUSION: Results with titanium cages are expectedly good. Symptoms resolved and fusion rate was 100% at 1 year follow up.

Trends of contraception among ladies of local population in Pakistan; why, how, when and what?

OBJECTIVE: To analyze trends of use of methods of contraception along with study of impact of various demographic and social factors on contraception in Peshawar, Pakistan. METHODS: A cross-sectional descriptive study with random purposive sampling was conducted at Combined Military Hospital Peshawar, from Mar 2015-Nov 2015. Self-designed questionnaire with demographic details and questions pertinent to contraceptive practices was utilized as study instrument. Females reporting to concerned hospital for contraceptive advice and prescription were distributed with questionnaire and written informed consent form. Formal approval was taken from ethical committee of hospital. Data was analyzed via descriptive analysis (SPSS-21), qualitative data was expressed as frequencies and percentages; quantitative as mean±standard deviation (SD). Main outcome variable i-e contraceptive device used; was cross-tabulated with independent variables. RESULTS: Response rate was 53.2% (n-426). Usage of contraceptive device was as follows; 51.2% Nil, 9.4% barriers, 22.3% oral/injectable hormones, 13.4% IUCDs, 3.8% sterilization. There was a strong relationship between type of contraceptives used and age (p<0.001), client's education (p<0.001), husband's education (p<0.001), number of children (p<0.001), religion (p0.013), socioeconomic class (p<0.001), and religious beliefs about use of contraceptives (p<0.001). More Muslims considered contraception irreligious than non-Muslims (p 0.02). There was no significant impact of husbands' pressure to not to use contraceptives on type of contraception practised (p 0.114). CONCLUSION: Contraceptive devices are under-utilized in the study participants. Multidisciplinary approach should be applied to enhance client education, awareness and counseling to utilize these devices more appropriately and regularly.

Son Preference in Pakistan; A Myth or Reality.

OBJECTIVE: To analyze desire for sons/daughters among ladies of Peshawar, Pakistan, with a view to rule out son preference and to study impact of various demographic characteristics on the subject. METHODS: Cross-sectional descriptive study conducted at Combined Military Hospital, Peshawar, from August 2015 - January 2016; sampling technique was random/probability/non-purposive. Self-designed questionnaire was utilized; carrying questions pertinent to desire for sons/daughters during marital life, and demographic details. Data analyzed via descriptive analysis (SPSS-21), expressed as frequencies/percentages and mean ± standard deviation(minimum/maximum). Sons and daughters desired (dependent variables) were cross-tabulated with independent variables. RESULTS: Response rate was 63.25% (n-506). Data revealed following: Sons desired 3.05±2.061(1/12); Daughters desired 1.15±0.767(0/4); 6.1%(n-31) and 0.6%(n-3) desired infinite number of sons and daughters respectively, 18.2%(n-92) did not desire to have even one daughter, while 2.2%(n-11) considered it immaterial to have daughters or sons. There was a significant relation between sons desired and client's education (p<0.001), husband's education (p<0.001) and socioeconomic class (p<0.001). There was no significant impact of religion (p-0.142) on desire for sons. Impact of independent variables on daughters desired was similar but less pronounced. CONCLUSION: There was candid son preference among the respondents. Gender discrimination can be attenuated by adequately addressing son preference at all tiers.

VON HIPPEL LINDAU SYNDROME AND SURVEILLANCE: A FIVE YEAR FOLLOW UP CASE REPORT.

Von Hipple Lindau disease is a rare genetic autosomal dominant disorder, characterized by formation of tumors and fluid-filled cysts (sacs) in multiple organs of the body, which also carry a potential for malignancy. We are reporting a case of a young 20 years old female who presented to our department with von Hipple Lindau disease.

Bilateral Intractable Trigeminal Neuralgia due to a Prepontine Epidermoid Tumour: An Unlikely Duo.

Prepontine epidermoid is a rare congenital tumour which arises during 3rd - 5th week of embryogenesis due to incomplete separation of neuroectoderm from surface ectoderm. This is slow growing benign tumour with late presentation in adult life. The clinical symptoms depend on the location of the tumour. In this case, the patient had intractable bilateral trigeminal neuralgia. The patient was given conservative treatment for 8 weeks with carbamazipine, but it did not respond to the neuralgic pain medication. Another trial of combined neuropathic medications including carbamazepine, gabapentin, pregabalin and baclofen were given for another 8 weeks, but the symptoms continued. MRI brain showed hypodense tumour on T1 weighted image which was hyperdense on T2 weighted images. The roots of both trigeminal nerves were involved in the prepontine area, proximal to the trigeminal ganglion. Surgical resection of the tumour was carried out in a two-stage operation. After complete surgical removal, patient's symptom of pain along trigeminal nerve was relieved.

Subdural Hematomas Following Intracranial Aneurysm Rupture: A Rare Phenomenon.

Acute Subdural Hematoma (aSDH) due to aneurysm rupture and no subarachnoid bleeding are very rare with only 29 cases reported in literature. A 56-year female presented with headache and drowsiness and a previous history of loss of consciousness. Clinical examination revealed a GCS of 14 and a right sided hemiparesis. Workup revealed a pure subdural hematoma due to a middle cerebral artery aneurysm rupture with no subarachnoid hemorrhage. Laboratory workup was otherwise normal and she had no history of falls or head trauma consistent with the usual etiology of an aSDH. She underwent evacuation of the hematoma with clipping of the aneurysm. She had an uneventful recovery with good outcome and no residual neurological deficits at one-year follow-up.