Neurotoxicity: A rare side effect of programmed cell death 1 (PD-1) inhibitors

Immunotherapy is a biological therapy that helps the body\u27s immune system to fight against cancer cells. The Food and Drug Administration (FDA) approved the first immune checkpoint inhibitor in 2011. Since 2011, many immune checkpoint inhibitors have been approved. Programmed cell death 1 (PD-1) inhibitors are now commonly used in multiple malignancies due to their remarkable response. Thus, immune-related adverse events are now coming into the limelight due to the increasing use of PD-1 inhibitors. Here, we present a case of a 54-year-old female with non-small cell lung cancers (NSCLC) treated with pembrolizumab and later presented with severe neurotoxicity

Role of surgery in brain metastases

Abstract Brain metastases remain the commonest type of brain tumour, being four times more common than primary brain tumours. Although surgical intervention may be recommended for one of various reasons in the management of these tumours, including but not limited to conformation of diagnosis, relief of mass effect, improvement of neurological status and prolongation of survival, the guidelines for management of brain metastases remain largely subjective and therefore controversial. Herein the authors have attempted to review some of the existing evidence on role of surgery in the management of brain metastases and have presented their selected guidelines for the readers

Treatment options for Primary CNS Lymphoma

Primary CNS lymphoma (PCNSL) is a rare and aggressive brain tumour that is uniformly fatal. The rarity of the disease and the poor response to treatment makes it difficult to reach a consensus with regards to treatment options. In this review, the authors have discussed different treatment modalities used in the management of PCNSL including chemotherapy, surgery and radiation, as well as the results of recent clinical trials on treatment options for PCNSL

Choice of therapeutic anti-seizure medication in patients with brain tumour

Seizures are common in patients with brain tumours, even though prophylactic anti-seizure treatment for all patients with brain tumours is not recommended. Newer anti-epileptic drugs have shown benefits that outweigh the side effects of treatment and can also be given in combination with traditional anti-epileptic drugs. The authors have reviewed the literature on the various combinations of anti-epileptics in patients with seizures and brain tumours

Lefort 1 Access for Juvenile Nasopharyngeal Angiofibroma Treated Without Angiographic Embolization.

To assess and analyze the clinical presentation of Juvenile nasopharyngeal angiofibroma and analyze the complications associated with JNA resection without pre surgical embolization using LeFort 1

Correlation of duration of diabetes with upper limb musculoskeletal problems

Long standing uncontrolled diabetes is associated with many clinical problems and it frequently involves hands and shoulder causing stenosing tenosynovitis (trigger finger), Dupuytren\u27s contracture, carpal tunnel syndrome, limited joint mobility and shoulder capsulitis. The prevalence of hand symptoms has been variable in different studies. Data from our part of world is scares. Our study aimed at looking at frequency of these hand symptoms with duration of the diabetes

Hypertensive supratentorial intracerebral Hemorrhage: early surgery and functional Outcome; a tertiary care hospital experience from Karachi, Pakistan.

BACKGROUND: Spontaneous supratentorialintracerebral hemorrhage (ICH) has a high morbidity and mortality and places a significant burden on health and social services.The role and timing of operative neurosurgical intervention remain controversial and the practice and timing of surgery continue to be haphazard. METHODOLOGY: Our study was a descriptive study conducted at Civil hospital Karachi, Pakistan. Sample size was calculated. The sampling technique of our study was non probability. The data was collected and analyzed using spssvs 17. Data was observed for any descriptive and inferential statistics. RESULTS: There were 38 males (63.3%) and 22 females (36.7%). The mean age of patients was 52.7 years. 36 patients (60%) had right hemispheric hemorrhage while 24 patients (40%) had left hemispheric hemorrhage. 48 patients (80%) had typical putaminal hemorrhage while 6 (5%) patients had subcortical and 6 (5%) occipital bleed. Regarding the improvement of neurological status, 16 patients (26%) were able to perform daily activities. 9 patients (15%) were able to take care of themselves at home while 07 patients (11%) required partial care. 10 patients (16%) were vegetative and 18 (30%) patients died. CONCLUSION: Our study revealed that early evacuation of large hematoma resulted in short ICU and short hospital stay, less postoperative complications and overall good functional recovery particularly in middle aged and younger patients with non dominant hemispheric hemorrhage therefore early surgical intervention definitely has the role in the management of extensive intracerebral hemorrhage

Development of criteria highly suggestive of spinal tuberculosis

Background: In a developing country there is a need for development of criteria that can be used for the diagnosis of spinal tuberculosis, which is common in that region.Methods: Demographic, clinical, and radiologic features of spinal tuberculosis and spinal epidural tumors have been compared statistically, and inferences have been drawn in terms of P values, sensitivity, specificity, positive predictive values, and negative predictive values.Results: A statistically significant relationship was found between spinal tuberculosis and spinal pain, fever, gradually progressive lower limb weakness, contrast-enhancing epidural ± paravertebral lesions, continuous levels affected, spinal deformity, and raised erythrocyte sedimentation rate.Conclusions: These relationships were considered the most probable criteria for the diagnosis of spinal tuberculosis

Surgical management of traumatic extra dural hematoma in children: Experiences and analysis from 24 consecutively treated patients in a developing country

Background: Children with epidural hematoma (EDH) present differently thanadults. The outcome of treatment is also different. We aim to report our experiences with EDH in pediatric age group in terms of mode of injury, presenting features, management, and outcomes. We also aim to identify different prognostic indicators in pediatric patients with EDH. Methods: We prospectively collected data from 24 consecutively surgically treated pediatric patients. The data collected included presenting features, radiological imaging, details of management, and outcomes. Descriptive analysis was performed and different variables were tested for any statistical significance with Glasgow Outcome Score (GOS). Results: There were 19 male and 5 female patients. The mean GlasgowComa Scale (GCS) score at presentation was 9.3 ± 4.4. Falls were the mostcommon cause of EDH. Outcome assessment was done at 3 month follow up.A total of 15 patients had a GOS score of 5, 4 patients had a GOS score of4, 2 patients had a GOS score of 3, while 3 patients had a GOS score of 1.On univariate analysis, admitting GCS score, patient’s age, the time frominjury to admission and injury to surgery, anisocoric pupils at presentation andeffacement of basal cisterns were significantly associated with the outcome ofGOS score. Conclusion: Falls are the most common mode of injury leading to EDH inchildren. Lower GCS at presentation, younger age at trauma, increased timesince trauma to surgery and admission, anisocoria and effacement of basalcisterns are statistically significant variables in surgically treated pediatric patients of EDH that confer a poorer prognosis. A timely surgical intervention can result in excellent outcomes

Outcome of decompressive craniectomy in traumatic closed head injury

Objective: The aim of the current study was to observe functional outcomes of patients undergoing decompressive craniectomy (DC) for raised intracranial pressure (ICP) after blunt head injury and to assess possible predictive factors.Methodology: This study was a prospective cohort study which was conducted at Aga Khan University Hospital, Karachi over a period of 2 years (January 2015-December 2016). Adult patients, aged between 15 and 65 years of both genders undergoing DC during the study period were selected. Outcomes of DC were assessed at an interval of 3 months following injury using the Glasgow outcome score. The data were analyzed on IBM statistics SPSS version 21.Results: Seventy-two patients underwent DC for raised and refractory ICP. Glasgow Outcome Scale (GOS) at discharge, 1-month and 3-month follow-up were reported. GOS at 3-month follow-up showed 21 patients (29.2%) patients had a good recovery, moderate disability was reported in 16 patients (22.2%), and severe disability in 12 patients (16.7%), persistent vegetative state was seen in five patients (6.9%). Eighteen patients had in hospital mortality (25.0%). Tracheostomy and sphenoid fractures were found to be negative predictors of good functional outcome.Conclusions: DC is associated with an in hospital mortality of 25.0%. Favorable outcomes were seen in 51.4% patients. Tracheostomy and sphenoid fractures were negative predictors of good functional outcome. The results are comparable to international literature