To Know the Effectiveness of Disc Excision in the Treatment of Herniated Lumbar Intervertebral Disc

OBJECTIVES To evaluate the effectiveness of disc excision in the treatment of herniated lumbar intervertebral disc.METHODOLOGY METHODOLGY This study was conducted in the Department of Neurosurgery, Lady Reading Hospital, Peshawar. A total of 62 patients had moderate to severe radicular pain due to Prolapsed intervertebral disc at L4/5 or L5/S1. All the enrolled patients were subjected to disc excision surgery. Postoperatively the patients were kept for 48 hours for observation and then discharged. All the patients were advised to come after 2 weeks for the follow-up to check effectiveness. RESULTS The mean age of patients was 34.59± 7.49 years. There were 64.5% male and 35.5% female. 53.2% of patients had L4-L5, 33.9% of patients had L5-S1 and 12.9% of patients had both L4–L5 and L5–S1 level disc herniation. 85.5% of patients had no pain, 8.1% had mild pain and 04.8% had moderate pain. Postoperatively 79.0% of patients were satisfied. CONCLUSION As compared to conservative care limited disc excision is safe, effective, and reliable in terms of pain. Disc excision technique provides immediate relief from radicular pain

Source of Bleeding and Per-Operative Findings in Extradural Hematoma (Edh): A Three-Year Experience in Lady Reading Hospital Peshawar

OBJECTIVES: The purpose of this study was to analyze the main source of bleeding and operative findings in an extradural hematoma (EDH).   METHODOLOGY: This study was conducted in the Department of Neurosurgery, Lady Reading Hospital, Peshawar. The sample size of the study was analyzed through WHO sample size calculator and 300 diagnosed patients were recruited by purposive sampling technique. Ethical approval was taken from the College of Physicians and Surgeons Pakistan (CPSP) and the hospital’s ethical committee. By using the SPSS version 23.0, all the collected data were analyzed. RESULTS: The mean age of enrolled patients was 27.96±12.71 years. There were 65.7% male and 34.3% female. The most common age group was 21–30 years followed by 31 to 40 years and 11 to 20 years with the most common source of bleeding was middle meningeal artery, 39.7% of patients fall in the temporal parietal category. CONCLUSION: Middle meningeal artery is the most common source of bleeding in EDH. Therefore, proper management of this vessel is significant to avoid the chances of re-bleed and re-do surgeries.

Surgical outcome of benign intracranial hypertension in terms of improvement in vision

To know about surgical outcome of benign intracranial hypertension in terms of improvement of vision.METHODOLOGY ; This Prospective observational study was conducted at of 22 patients operated in neurosurgery unit lady reading hospital Peshawar from Jan 2011 to Jun2014. Written consent was obtained from all the patients or their relatives All patients of either age and sex with Diagnosed cases of BIH were included in the study, Patients with depressed conscious level, malignant hypertension, space occupying lesion in brain on MRI and those Patients unfit or unwilling for surgery were excluded from the study. Patients particulars like age ,gender , and post operative outcome was documented on predesigned proforma . All the results were analyzed by spss version 16 and represented in the form o graphs/charts and tables. RESULTS;- Total 22 patients of BIH were studied which were all females (100%) having age range of 18 to 58 years with mean of 38 ± 5 years SD. Headache was present in all (100%) patients followed by visual deterioration having 20(90.90%) cases. CSF manometery showed opening pressure from 28cm of H2O to 50 cm of H2O, with mean of 39. 19. Post operatively headache improved in 16(72%) patients, Papilledema in 18(81.81%) caseswhile 4(18%) patients did not improved. In 2(9.09%) cases there was and CSF leak was in 1(4.54%) case.CONCLUSION; BIH has good surgical outcome in terms of improvement in vision, if managed before advanced stage of Papilledem

Outcome Comparison of Endoscopic (Endonasal Trans-Sphenoidal) Repairs of CSF Leak vs. Transcranial Approach

OBJECTIVES: To compare the effectiveness of Endoscopic (endonasal transsphenoidal) repair of CSF leak with transcranial approach in terms of post-operative complications.  METHODOLOGY:   This study was conducted in the Department of Neurosurgery, Lady Reading Hospital, Peshawar. Total of 40 patients diagnosed according to inclusion criteria were enrolled and were divided into two groups. One group was treated with endonasal trans-sphenoidal repair, and another was treated with a trans-cranial approach. All patients were followed for 1 year.  RESULTS:  The mean age of enrolled patients was 35.4±11.6 years. There were 62.5% male and 37.5% female. In the endoscopic group the recurrence rate was observed in 3 (15%) of the patients while in the trans-cranial group the recurrence rate was observed in 2 (10%) of the patients. The overall recurrence and success rate was 8% and 92% respectively. About 4 patients developed an infection, which was treated successfully.  CONCLUSION:  It is concluded that the endoscopic approach is safe and effective. The endoscopic approach should be considered as standard procedure for treatment

The Effect of Epidural Steroids on Postoperative Pain and Hospital Stay in Patients Having a Single-Level Lumbar Discectomy

OBJECTIVES To determine the effect of Epidural steroids on postoperative pain and hospital stay in patients having a single-level lumbar discectomy. METHODOLOGY A quasi-experimental study was conducted at the Neurosurgery department, Qazi Hussain Ahmad Medical Complex, Nowshera.  Sixty patients with a mean age of 40.3±9.21 years were enrolled. The enrolled patients were divided into two groups: Group A patients were given intraoperative epidural methylprednisolone 80 mg, while Group B patients were given only normal saline. Pre- and post-operative pain was assessed after 6 hours, 12 hours and at the discharge time from the hospital. The duration of hospital stay was also noted. RESULTSOut of 60 patients, 55.0% were male, and 45.0% were female, with an overall mean age of 40.3±9.21 years. The VAS score in Group A was 0.82±0.26 compared to 2.30±0.71 in group B (P <0.000). And at first follow-up, the VAS score was 0.13±0.05 and 1.25±0.33 in groups A and B, respectively.   The length of hospital stay was 1.39±0.44 and 1.98±2.50 in groups A and B, respectively. CONCLUSION Intra-operative epidural steroid is beneficial in reducing post-operative pain and hospital stay

Symptom Outcome of Walant Technique for Carpal Tunnel Release – A Prospective Study in the Tertiary Care Hospital, Nowshera

OBJECTIVES The study aims to determine the outcome of the WALANT technique for Carpal Tunnel Release CTR.METHODOLOGY A descriptive study was done in the Neurosurgery department at Qazi Hussain Ahmad Medical Complex, Nowshera, from 15th September 2020 to 15th March 2021. A total of 29 consecutive patients of carpal tunnel syndrome (CTS) were undergoing carpal tunnel release (CTR) under wide awake local anaesthesia no tourniquet (WALANT) technique, using a mixture of lidocaine and epinephrine for local anaesthesia, and the outcome was assessed for patient satisfaction by Boston Carpal Tunnel Questionnaire (BCTQ) (symptom severity scales (SSS)) at pre-operatively and six weeks postoperatively.RESULTSWide awake CTR was done in 29 patients; 86.2% were female and 13.8% male. The mean age was 47.3 years. The average time of return to daily activity was three weeks. No complications were noted, like wound infection and dehiscence. BCTQ symptom (BCTQ-S) score significantly improved at six weeks postoperatively. 86% significantly reduced the symptom severity score (SSS). Mean SSS improved from preoperative 3.2 points to 1.7 points postoperatively. There was a significant decrease in distal latencies (p <0.01).   CONCLUSIONWide awake surgery is an excellent technique with favourable outcomes and good satisfaction rates for CTR. The study shows that clinical symptoms resolve rapidly after CTR. Without the need for monitored anaesthesia, the cost could decrease dramatically

Blending Old and New Teaching Methods and Tools in Medical Education

OBJECTIVES To identify a preference for current teaching methods and use new teaching aids through feedback by medical students and teachers of first and second-year MBBS. METHODOLOGY This cross-sectional study was conducted on 91 MBBS students and teachers of Nowshera Medical College (NMC), Nowshera. Both male and female students and teachers of NMC of class first and second-year MBBS participated in the study. A feedback proforma-based questionnaire was filled out by all the participants online using Google forms. Participants were given the option to select more than one option in the case of the mode of teaching and tool of teaching. The data was collected, analyzed and presented in tabular and graphical forms using SPSS version 23. RESULTS Out of the 91 participants who responded to our research, 45 (49.5%) were males, and 46(50.5%) were female. The majority, 74 (81.3%), were MBBS students, while 17(18.7%) were MBBS teachers. Most of the participants selected more than one option. Most 48(52.7%) of the participants preferred lectures as the mode of delivery while 35(38.4%) opted for SGD, for demonstrations 14(15.3%), PBL 33(36.2%), assignments 13(14.2%0 and notes opted by 4(4.39%). 60.4% (55) were selected to use whiteboards and markers. Only 15.3% (14) were in favour of Powerpoint use, dissection 25(27.4%), models 29(31.86%), and figures 11(12%). CONCLUSION Lectures remain the most preferred teaching method in basic medical sciences among teachers and students, along with other teaching methods. Multiple teaching tools must be used during the class instead of solely depending on Powerpoint presentations

Recurrence of Benign Astrocytoma in a Benign form 20 Years after Surgery and Radiotherapy Treatment

A 43 years old male primary school teacher presented with the chief complaints of headache for 20 days, double vision for 20 days, unsteady gate and 04 episodes of vomiting in last 20 days before presentation. He had presented 20 years back with the same complaints and on workup he was found to have posterior fossa tumor with resultant hydrocephalus. He had undergone ventriculoperitoneal shunting followed by posterior fossa crani-ectomy with tumor excision followed by radiotherapy. Histopathology examination of his biopsy done at that time was showing grade ΙΙ Astrocytoma

Epidemiology and Surgical Outcome of Traumatic Sub Axial Cervical Spine Injuries in a Tertiary Care Hospital of KPK, Pakistan

Objective:  The purpose of this study was to characterize the epidemiologic characteristics, a pattern of traumatic subaxial cervical spine injuries, and their surgical outcomes in a tertiary care hospital in Khyber Pakhtunkhwa, Pakistan. Materials and Methods:  This retrospective descriptive study was conducted at the Department of Neurosurgery at Lady Reading Hospital Peshawar. The records of 40 patients between the ages of 15 and 60 who had cervical spine injuries were evaluated to characterize the injuries and surgical outcomes. We employed the anterior route for surgery regularly and the posterior method only when the reduction failed or substantial instability. We used a tricortical bone graft or titanium cages with autologous bone and secured them through titanium plates to achieve fusion. Results:  80% of patients presented with sub axial cervical injury. Regarding the etiology of injury, 37.5 % had motor vehicle accidents, 28.12% had a history of height falls, and the remaining had sustained injuries due to other causes. The majority of the patients, 68.75% (n = 22), had isolated subluxation injury.87.5% (n = 28) underwent surgical intervention; surgical outcomes such as pain relief were measured using the VAS, which was 6.09 ± 1.42 preoperatively while 4.5 ± 1.29 postoperatively with a difference of means of 1.59. There was a significant improvement in neurological functions as measured through the ASIA impairment scale. Conclusion:  Most cervical spine injuries occurred in young male patients, motor vehicle accidents were the most prevalent cause, and isolated subluxation was the most frequent injury pattern. 

Extension of dynamic source routing protocol in mobile ad hoc network

In a large dynamic network, data can be copied anywhere to make it fault tolerant and easy accessed but there must be an efficient protocol to manage the replicas and make sure the data is consistent and high in availability with a low communication cost. In this paper, we introduced a new protocol, named Diagonal Replication in Mesh (DRM) for data replica control protocol for a large dynamic network by using quorum and voting techniques to improve the availability and the communication cost because quorum techniques reduce the number of copies involved in reading or writing data.The protocol of DRM replicates data for large dynamic network by putting the protocol in a logical mesh structure and access consistent data by ensuring the quorum not to have a nonempty intersection quorum.To evaluate our protocol, we developed a simulation model in Java.Our results proved that DRM improves the performance of the response time compare to Three Dimensional Grid structure Protocol (TDGS)