Comparison of Low – Versus Medium-Pressure Shunts in Pediatric Hydrocephalus – A Study of the Children Hospitals, Lahore

Objective:  This prospective cross-sectional study was aimed to assess the effectiveness of low-pressure vs. medium-pressure shunts in children with hydrocephalus. Material and Methods: 52 children with different types of hydrocephalus were admitted through OPD and Surgical emergency at The Children Hospital, Lahore. All Children were gone through Ultrasonography and CT Brain plain after admission. The pediatric hydrocephalus was resolved into two groups. All patients treated with Chhabra differential pressure VP (ventriculoperitoneal) shunt in either low pressure or medium pressure. CT scans were used to assess the postoperative clinical and radiological outcomes to monitor the ventricle hemispheric ratio (VHR). Results:  A low-pressure shunt was implanted in 26 individuals, whereas a medium-pressure shunt was implanted in 26 individuals. Patients varied in age from one day to thirteen years old. In group A, the average VHR was 57.58% preoperatively, but it dropped to 42.88% after surgery. Similarly, in group B, the pre-and postoperative VHR was 59.35% and 42.81%, respectively, which was statistically significant. In both groups, the incidence of shunt complications and redo shunt operation were not statistically significant. Conclusion:  In this study, individuals with pediatric hydrocephalus who had a low-pressure shunt or a medium-pressure shunt had similar outcomes

Incidence of Development of Hydrocephalus after Excision and Repair of Spina Bifida Aperta in Infants

Objective:  To find out the incidence of hydrocephalus after excision and repair in infants presenting with Spina Bifida Aperta. Materials & Methods:  This prospective cohort study was conducted at the Pediatric Neurosurgery Department, Children Hospital & The Institute of Child Health, Lahore, Pakistan, from January 2021 to October 2021. A total of 62 infants of both genders presenting with spina bifida Aperta undergoing repair were included. Data of the patients, i.e., name, age, gender, head circumference, location, and width of the defect, accompanying bladder, limb anomalies, radiological, laboratory findings, and diagnosis (meningocele or meningomyelocele) were noted. Patients were followed postoperatively for 1-month, and the incidence of post-surgery hydrocephalus was noted. Results:  Out of 62 children, 36 (58.1%) were male and 24 (41.9%) female. The mean age was noted to be 138.82 days. Most children, 36 (58.1%), were found to have meningocele. The most frequent local meningocele/meningomyelocele was noted to be lumbosacral, 22 (35.5%). Post-surgery hydrocephalus was noted among 11 (17.1%) cases. No significant association of gender, age, head circumference, defect size, the maximum dimension, diagnosis (meningocele or meningomyelocele), or location was noted with post-surgery hydrocephalus among study cases (p > 0.05). No mortality was reported. Conclusion:  Meningomyelocele and lumbosacral location of the defect were among the prominent factors affecting the incidence of post-surgery hydrocephalus. Keywords:  Spina Bifida Aperta, Meningiocele, Myelomeningocele, hydrocephalus, lumbosacra

Vestigial Accessory Limbs with Spina Bifida: Our 5 – Year Experience

Background: Accessory limb on the back of trunk with spina bifida is an exceedingly rare entity which has perplexing morphogenesis. We are sharing our 5 – years’ experience of managing 5 patients with accessory vestigial limbs on the back associated with spina bifida.Materials and Methods: The medical record of 5 patients with accessory limbs on the back of the trunk was reviewed for mode of presentation, investigations, management, and outcome.Results: There were 5 infants, one was male while rest were females (M: F = 1: 4). Ages ranged from 1.5month to 1 year (mean age 6.3 months). All patients presented with a vestigial limb attached to the lumbosacral region. One patient had anal pit like depression on the vestigial accessory limb. Every patient had associated spina bifida. One patient had associated lipomeningocele. Another patient had associated right clubfoot. All patients were investigated with X-rays and MRI and underwent excision of the accessory limbs. One patient developed wound dehiscence and CSF leak post-operatively which settled on conservative management. Stillanother patient had repeated wound infections and is booked for release of tethered spinal cord. All patients survived. Two patients required physiotherapy for lower limb weakness.Conclusion: Accessory limbs on the back are quite rare anomalies and are associated with a number of other anomalies. It is more common in females. The anomaly is a psychosocial dilemma for the parents. Early excision is necessary to allay the anxiety of the parent

Management of Post Traumatic Epilepsy in Pediatric Population in Pakistan

Objective:  To investigate the efficacy of seizure prophylaxis in the prevention of early and late-onset seizures after the traumatic brain injury known as post-traumatic epilepsy (PTE). Material and Methods:  A retrospective study was performed on children aged 0 to < 12 years who were presented to a level 1 trauma center during the six months with the diagnosis of mild to severe TBI. Data included is of 66 patients from Children’s Hospital, Lahore. It was analyzed according to a patient’s demographic data, mechanism of injury, clinical and radiological presentation, management, and follow-up. History of seizures was tracked through guardian referral or staff witnesses. Results:  Among 66 pediatric cases of acute brain injury from June 2019 to December 2019, 45 were males (68%) and 21 were females (32%) with a male to female ratio of 2:1. The mean age in our study was 3.8 years. 60% of children were managed under observation, 30% of children required medical pharmacological treatment, 9% of children needed surgical intervention, and 13% of children required artificial ventilation. Overall mortality is 4.5%. In our study, we found a considerable relationship between residual neurological deficits and severity of injury (p = 0.3), there is no noteworthy relationship between mechanism of injury and outcome (p = 0.5). The mean length of stay was 3.9 days but 60% of patients had stayed less than 3 days. Conclusion:  Analyzing the underlying mechanisms of post-traumatic epilepsy can lead us to propose effective treatments to prevent seizures following traumatic brain injury

Patterns of Head Injuries in Pediatric Patients Treated in Emergency Department of Children Hospital and Institute of Child Health Lahore

Objective:  To analyze the pattern of head injuries along with characteristics and outcomes among pediatric age group presenting in The Children hospital Lahore, Pakistan. Material and Methods:  A cross-sectional study was conducted and a total of 384 children of both genders aged up to 12 years presenting with head injuries were included. After initial review and resuscitation by the trauma unit or neurosurgery unit, children were evaluated clinically and radiologically and the plan was decided for further treatment. Gender, age, place of injury occurrence, etiology of injury, Glasgow coma score (GCS) at the time of enrollment, the interval between injury and admission, management, outcome, and total duration of hospital stay were recorded on a predesigned proforma. Results:  In a total of 384 children, 249 (64.8%) were boys. Overall, the mean age was 5.8 ± 3.3 years. Falls were the commonest etiology in 210 (54.7%) children while motor vehicle accidents were the cause of head trauma among 78 (20.3%) children. The mean interval between injury and presentation was noted to be 3.2 ± 2.1 hours. Mortality was reported in 56 (14.6%) children and it was observed that a significant association was noted between outcome and GCS at the time of presentation (p < 0.0001). Conclusion:  The majority of the pediatric head injury cases were male and aged above 5 years. The most common etiology of head injuries was falls followed by motor vehicle accidents. GCS ? 8 at the time of presentation was significantly linked with poor outcomes

Prevalence of active HCV infection among the blood donors of Khyber Pakhtunkwa and FATA region of Pakistan and evaluation of the screening tests for anti-HCV

Hepatitis C is a fatal liver disease caused by the hepatitis C virus. In this study, blood donors, from various districts of the KPK province and the federally administered tribal area (FATA) of Pakistan were tested for anti-HCV antibodies and HCV RNA by ICT (Immuno-chromatographic test), ELISA and RT-PCR. Out of the 7148 blood donors, 224 (3.13%) were positive for anti-HCV antibodies by ICT, 135 (1.89%) by ELISA while 118 (1.65%) blood donors had active HCV infection as detected by RT-PCR. We suggest that ELISA should be used for anti-HCV screening in public sector hospitals and health care units

SEQUESTERED BOWEL IN ATRESIA

Atresia is derived from Greek words “a” (no) and “tresis” (orifice); and refers to congenital obstruction of intestine due to complete occlusion of the bowel lumen.The sequestered bowel may resorpt partially or completely. Complete resorption occurs in majority, however, when the event of volvulus and atresia occurs late in gestation the necrotic bowel may be present at birth