Pakistan’s Trade Performance vis-à-vis Its Major Trading Partners

In contrast to earlier empirical research that documents the import and export price elasticities at an aggregate level, this article estimates bilateral price and income impacts on Pakistan’s trade performance with its four major trading partners, i.e., USA, UK, Germany, and Japan. Using quarterly data for the period 1982-I-1996-IV and the Three-stage Least Square technique, the study documents the impact of real devaluation, real income, export incentives, and domestic inflation on trade performance with respect to each of the four trading partners

Efficacy of Ventriculoperitoneal Shunt For The Management of Cerebellar Haematomas

Object:  To determine the role of ventriculoperitoneal shunt in the management of cerebellar haemotoma with obstructive hydrocephalus. Result:  A total of 10 cases were included in the study. Six (60%) were male and 4 (40%) were female. Age range was from 35 – 63 years. The clinical presentation was sudden severe headache, vomiting, loss of consciousness. Glasscow coma score was 6/15 to 13/15.. C T Scan brain revealed cerebellar haematoma compressing the fourth ventricle with obstructive hydrocephalus. The range of volume of cerebellar haemotoma was from 20 ml to a maximum of 80 ml. Various management plan were offered, decision was done case to case basis. Three (30%) patients with mean cerebellar haemotoma volume of 30 ml (range 20-40) obstructive hydrocephalus were managed by a ventriculoperitoneal shunt (V.P. Shunt) alone. All three patients had excellent post operative recovery within a period of 2 to 4 weeks. Seven (70%) patients were operated for removal of cerebellar haematoma alongwith external ventricular drain (EVD.), which was removed on 5th – 7th day but in one case V.P. shunt was inserted post operatively. Result were good in 3 cases, excellent in 2 cases, fair in one case due to persistant hydrocephalus and mortality in one case. The patient who died was operated for removal of cerebellar haematoma and external ventricular drain was passed He died due to chest infection post operatively. Thus out of 10 cases V.P. shunt was done in 4 cases

Insular Glioma Esoteric Precinct

Background and Objective:  The complex insular anatomy and its proximity to eloquent areas make this area almost inaccessible for safe surgical resection of Glioma. Aim of our study is to determine outcome assessment after surgical resection. Materials & Methods:  This was a retrospective analysis of 59 patients over a period of 5 years from July 2013 till June 2018. All patients of insular Glioma were included in our study irrespective of age and sex. Degree of surgical resection, Post-operative neurological deficits and complications were assessed. They were followed in the outpatient department at 3, 6 and 12 months. Results:  Total 59 patients were included 38 (64.40%) male and 21 (35.59%) females. 36 (61%) patients had right sided insular Glioma and 23 (38.98%) have left sided. Seizures were main presentation in 46(77.96%) patients. Trans-sylvian route adopted in 34 (57.6%) patients followed by transcortical route. Near total Resection was Possible in 30 (50.84%) patients and partial in 29 (49.15%) patients. Focal neurological deficits the motor weakness & dysphasia were main post-operative complications in 18 (30.5%) patients. Three (5.08%) patients died. In all grade II and grade III Gliomas no increase in size was discovered on MRI Brain at 6 and 12 months. Conclusion:  Maximum safe resection of insular Glioma with acceptable morbidity is possible with improved overall survival and disease free interval

Clinical Presentation and Surgical Outcomes of Chronic Subdural Hematoma

Objective: The aim of this study was to access clinical presentation of chronic subdural hematoma and to evaluate the surgical outcome of evacuation of chronic subdural hematoma after single burrhole craniotomy with a close drainage system under local anesthesia. Material & Methods:  A descriptive study conducted in the Neurosurgery Department of Khairpur Medical College Sindh. 30 patients of chronic subdural hematoma were included. Patients prepared for evacuation of chronic subdural hematoma through single burr hole followed by closed drainage system for two days. Results:  The most common feature was gait disturbance followed by Hemiparesis and headache. Coexisting diseases were hypertension, Diabetes mellitus and Chronic Liver Disease, etc. and causes of CSDH were head injury (trivial trauma) and anticoagulant. Surgical decisions were taken on the bases of clinical presentation and radiological findings of patients. Surgical procedure single burrhole craniotomy followed by irrigation with normal saline and close drainage system for two days. On post-operative follow-up, a recurrence of CSDH occurred in two patients. Conclusion:  Single burrhole craniotomy with close drainage system is a simple and safe procedure under local anesthesia for treatment of chronic subdural hematoma. Keywords:  CSDH (chronic subdural hematoma), GCS (Glasgow coma score), Burrhole craniotomy, Neurosurgery & Subdural drain

Brain Death Islamic Perspective

Western world has well defined criteria for declaring the patient brain dead and discontinuation of life support treatment. However in the Muslim world these methods and practices are seen with skepticism as to their acceptance from Islamic and Sharia point op view, which in fact is incorrect and is due to lack of knowledge and absence of Institutional guidelines on this matter. Islamic law permits the withdrawal of futile treatment, including life support, from brain dead patients allowing death to take its natural course. “Do not resuscitate” is permitted in Islamic law in brain dead patients. Euthenesia is however unacceptable in Islam. Although debate continues about the details of brain death criteria within Islamic scholars, brain death is accepted as true death by the majority of Mulim scholars and there is concensus on discontinuation of life support treatment in brain dead patients

Out Come of Surgical Management of Tethered Cord Syndrome

Objective: To determine neurological outcome after surgical management of tethered cord syndrome. Material and Methods: This descriptive study was conducted in the department of Neurosurgery, Lahore General Hospital Lahore. Over a period of Three Years From 2012 to 2014. Study Comprised of Fifty Patients after fulfilling the inclusion and exclusion criteria. Results: The mean age of the patients was 36 ± 10 Years There were 30 (60.0%) male and 20 (40.0%) female patients. There was improvement in neurological status. The distribution of improvement in neurological status, revealed 35 (70.0%) patients had improvement in back pain, 18 (36.0%) improved motor function and 17 (34.0%) improved urinary incontinence. Conclusion: It is concluded from this study that back pain, motor function and urinary incontinence improve postoperatively in the majority of patients. The rate of symptomatic improvement was greatest for back pain, followed by motor, and then urinary improvement. Abbreviations: TCS: Tethered Cord Syndrome. ATCS: Adult Tethered Cord Syndrome

Spectrum of Skull Lesions in Pediatric Population: A Single Institutional Experience

Background: Pediatric skull lesions are rare. Here, a single institutional experience dealing with such lesions is presented.Methods: A retrospective review of 18 consecutive pediatric patients was done, who were treated for a variety of skull lesions at Department of Neurosurgery, King Faisal Specialist Hospital and Research Centre, Riyadh from 2010 to 2015. The clinical and pathological features, diagnosis, management and outcome were noted and analyzed.Results: In this study, eighteen skull lesions were identified in 10 male (55%) and 8 female (44%) patients, with a mean age at diagnosis of 9.5 years. These lesions were usually benign and most commonly presented as a painless mass (n = 11). Fronto-orbital (n = 6) was the most frequent site encountered in this study followed by temporo-parietal (n = 3) and parieto-occipital area (n = 2). Gross total resection achieved in 15 patients (83.3%) and reconstruction of skull defect was possible in 11 (61.1%) of them. Excluding the malignant lesions, no recurrence was found in this study cohort for a mean follow up time of 2.8 years.Conclusions: Majority of the skull lesions in children are benign. Pre-operative angiography and embolization is helpful to reduce the intraoperative blood loss. Gross total resection with reconstruction is the treatment of choice. Recurrence is uncommon after gross total resection