Common Histopathological spectrum of Posterior Fossa Tumors in Pediatric Age Group

Objective:  To know about the common posterior fossa tumors in the pediatric age group on basis of Histopathology in Neurosurgery Department, Hayatabad Medical Complex Peshawar. Material and Methods:  This descriptive cross-sectional study was conducted in the department of MTI Hayatabad medical complex Peshawar from January 2017 to January 2020. We included a total of 52 patients who operated for posterior fossa tumors and biopsy reports were observed to know the histological pattern of the tumor. We included all those patients who have posterior fossa tumors except those tumors which involved or arise from brain stem and infections. The data was collected and analyzed using SPSS version 21. Results:  Our study shows that the mean age was 6 years with a standard deviation ± 2.81. Fifty-eight percent of children were male and 42% of children were female. Histopathologic patterns were analyzed as 48% of children had Medulloblastoma, 25% of children had Astrocytoma, 19% of children had Ependymoma, 8% of patients had other histopathologic patterns. Conclusion:  Our study concludes that common histopathologic patterns of posterior fossa tumors in children were medulloblastoma (48%), Astrocytoma (25%), ependymoma (19%) respectively

Pattern of Presentation of Spinal Dysraphism: A Study of 72 Patients in Hayatabad Medical Complex Peshawar, Pakistan

Objective:  To review the pattern of presentation and current understanding of patients with spinal dysraphism in our local population. Material and Methods:  Cases of spinal dysraphism of any gender and age were admitted via OPD, emergency or referred from another department were included in the study. Information on demographics, developmental history, presenting symptoms , presence/absence of back swelling, hairy patches, a nevus, dimple, an appendage/ skin tag, lower limb function, sensory/ motor deficit, bowel and bladder dysfunction were recorded. MRI spine was done in all patients to know the exact diagnosis. Results:  Out of 72 cases, 52 (72.2%) presented with spina bifida Aperta (spina bifida cystica) while 20 (27.7%) with spina bifida occulta. Total 53 (73.6%) patients presented at the age of 0 – 1 years. 41 (56.9%) of the patient presented with visible sac, 35 (48.6%) swelling over the back, in 5 (6.9%) of patient have hairy patch and dermal sinus each, while 28 (38.8%) patients have neurological deficit. Most common type of spinal dysraphism was myelomeningocele 45 (62.5%). Postoperative course of patients with spinal dysraphism was found to be uneventful in 56 (77.7%), wound infection was seen in 11 (15.2%), deterioration of neurological status in 3 (4.16%) of cases. Conclusion:  Spinal dysraphism is not an uncommon condition in our local population its clinical presentation and features are in line with internationally reported literature. Our population is least aware of the adverse neurological outcomes of the condition and face difficulties to access the adequate healthcare for spinal dysraphism

Sprengel\u27s deformity

Various shoulder bone deformities have been identified in the pediatric age group, with the most common being undescended scapula. Sprengel\u27s deformity is dysplasia and malposition of the scapula, especially in the supraspinatus portion, mainly due to abnormal descent in the embryonic period. The clavicle is shorter and has a different contour. In some patients cervical spine deformities are also noted. This is a case of 3 years old girl presented to the clinic with difficulty in abducting right shoulder and sleeping with an internal rotation of the right arm. With physical examinations and radiological investigations sprengel\u27s deformity was diagnosed. Sprengel\u27s deformity is a male predominant disease which almost never occurs in isolation and is usually associated with deformities in the thoracic rib cage and the cervical and thoracic vertebrae. Our patient also had hyperpigmentation along the lines of Blaschko, which has never been previously reported with Sprengel\u27s deformity. Sprengel\u27s may have an association with cutaneous mosacism syndrome

Incidence, Pattern, and Outcome of Stray Bullet Injuries: Three Years’ Experience in a Teaching Institute

Objectives:  The purpose of this study is to better define the incidence, pattern, and outcome of a stray bullet. Materials & Methods:  The current study summarizes the data on stray bullet injuries presented to the Emergency Department (ED) Hayatabad Medical Complex, Peshawar. A total of 24 subjects were included for three years. We enrolled all patients who had head or spine injuries caused by a stray bullet. Data were extracted on demographic profile, site of injury, operative procedure, complication, and mortality, and were recorded on prescribed proforma. Results:  A total of 24 subjects were included for 3 years. 17 (70%) were male patients and 7 (30%) were females. Male to female ratio was 2:1. out of 24 cases, 9 (37.5%) were from District Peshawar, 3 (12.5%) cases were from Mardan and Charsadda District, and 2 (8.3%) cases were from Swat. 12 cases had a bullet in the Head and face. out of which 7 were supratentorial 3 cases had a bullet in the posterior fossa. Out of 24 cases, 13 (54.1%) were operated for the removal of bullets. 5 (20.8%) developed focal or generalized fits. 13 (54.1%) developed a neuro deficit. 4 (16.6%) of cases remain in a vegetative state, and the overall mortality rate is 20%. Conclusion:  Morbidity and mortality due to stray bullets is an increasing problem in our society. This study aims to bring awareness among the concerned authorities to try and bring an end to this menace resulting in deaths and misery

Sowing Dates and Sowing Methods Influenced on Growth Yiled and Yield Components of Pearl Millet under Rainfied Conditions

The objective of this study was to determine the effects of sowing dates and sowing methods on yield and yield components of pearl millet (Pennisetum glaucum L.). Therefore the field experiment was carried out at New Developmental Farm of The University of Agriculture, Peshawar, Pakistan during summer 2012. The experiment was laid out in randomize complete block design having five replications. The treatments consisted of three sowing dates (20th June, 10th July and 30th July) and two sowing methods (Direct seeding and transplanting seedling) were used. Sowing dates were significant for all parameters. Crop sown on 20th June had the maximum  leaves plant-1 (93), plant height (230 cm), panicle length (26.3 cm), panicle weight (14.3 cm), grains panicle-1 (73.4), thousand grains weight (12.3 g) and grain yield (398 Kg ha-1) as compared with other sowing dates but panicle weight and grains panicle-1 were statistically at par with 10th July sowing. Transplanted crop had significantly maximum leaves plant-1 (81), plant height (208 cm), grains panicle-1 (64), thousand grains weight (11.2 g) and grain yield (297 Kg ha-1) as compared with direct sowing method. The interaction between sowing dates and sowing methods indicated that crop sown on 20th June through transplanted method had maximum panicle weight, grains panicle-1, thousand grains weight and grain yield. It was concluded from this study that millet sown on 20th June with transplanted method seems to the best choice for millet producer under rainfied condition in Peshawar valley. Keywords: Pennisetum glaucum, growth, yield, sowing methods, sowing date

Missing Dimensions in Addressing Child Malnutrition in Pakistan: Lessons from the Tawana Experience

This article uses the Tawana Pakistan Project (TPP) as a case study of how to promote self?sustaining improvements in nutrition status. The programme used a participatory approach to mobilisation around malnutrition, had a transparent information system for monitoring resources, and brought a focus on deeper structural issues to the analysis of malnutrition. We argue that Tawana was cancelled because it did not provide sufficient opportunities for leakage and diversion. This amply illustrates the political nature of nutrition. Yet efforts to reduce malnutrition continue to focus primarily on technical fixes. For long?term change researchers and programme implementers will need to understand the political space they operate within. Tawana was not perfect but it offered a glimpse of a different way forward, one that struck a balance between inclusiveness and action; transparency and accountability; and health and social science perspectives. It affected politics and was undone by them. It is not too late to include these concepts and approaches in future nutrition policies and interventions

Comparison of One vs. Two Burr Hole Craniostomy in Chronic Subdural Hematoma Recurrence

Introduction/Objective:  Chronic subdural hematoma (CSDH) is most frequent neurosurgical conditions. To find the recurrence rate of chronic subdural hematoma in patients who underwent one vs. two burr craniostomy. Material And Methods:  A randomized controlled trial was conducted at the Neurosurgery department, Ayub Teaching Hospital, Abbottabad. In the current study, a total of 76 (38 in each group) patients were observed. ASA-I, ASA-II, ASA III patients, symptomatic radiologically proven Chronic subdural hematoma. Patients were randomly allocated into two groups of 38 patients each. randomization with blocks. Group A was treated with intraoperative epidural methylprednisolone while Group B was treated with normal saline only. Clinical information was recorded on a pre-designed proforma. Results:  Mean age was 54 years in group A, and 56 years in group B. In group A, 74% were male and 26% of patients were female. In Group B, 76% were male and 24% were female. The group A, 5% of patients had recurrence while in Group B, 13% of patients had a recurrence. There existed a significant difference between effectiveness and not-effectiveness of one/two burr hole craniostomy among patients who were less than 40 years. Conclusion:  The recurrence rate of chronic subdural hematoma is higher in patients undergoing two burr hole craniostomy as compared to one burr craniostomy

Association of Extradural Hematoma with Linear Skull Fracture: a Clinical Study of 79 Cases in a Teaching Institute

Objectives: To determine the frequency of extra dural hematoma in patients with linear skull fracture due to head injury.Material and Methods: This cross-sectional study was conducted in the Department of Neurosurgery, Mardan Medical Complex, Mardan from June 2016 to May 2017. Patients of either gender with linear skull fracture and above 2 years of age were included in the study, while patients with bleeding disorder or on anti-coagulants and those presenting 72 hours after injury were excluded from the study. Patient’s demographic profile, type of injury, location of injury and CT findings were recorded and documented on pre designed proforma. Data was analyzed using SPSS version 20.0Results: Out of 79 patients, 55 (70%) were male and 24 (30.3%) were female. Age ranged from 2 years to 60 years (mean 33 years ± 2.54 years). Among these patients the most common cause of head injury was road traffic accident in 44 (55%), followed by fall from height in 20 (25.3%) and assault in 10 (12.6%) of patients. The most commonly fractures skull bone was parietal in 38 (48%) of patients, followed by temporal bone in 21 (26.5%), frontal in 12 (15.1%), and occipital in 8 (10%) of patients. The frequency of extradural hematoma in linear skull fracture was 21 (26.5%).Conclusion: There is strong association of extradrual hematoma with linear skull fracture, therefore a fully conscious person having head injury with skull fracture should be highly suspected for intracranial hematoma

Isolated ligamentum flavum ossification in primary hypoparathyroidism

Basckground: The ligamenta flava can undergo ossification and calcification resulting in myelopathy. Only seven cases of ligamentumflavum ossification in association with hypoparathyroidism have been reported, most of which had concurrent osseous changes in other spinal ligaments. Here, we report a patient with hypoparathyroidism who presented ith ligamentum flavum ossification causing both cervical and thoracic myelopathy. Case description: A 43-year-old male presented with backache, urinary retention, and lower limb weakness for the last few days. Magnetic resonance imaging scan showed ossification of the ligamentum flavum in the cervical and thoracic regions, with severe spinal stenosis. Following spinal decompressive surgery, the patient made a complete recovery. Primary hypoparathyroidism was found to be the underlying cause for ligamentum flavum ossification. Conclusion: Ossification of ligamentum flavum secondary to hypoparathyroidism should be considered as a possible cause of myelopathy in all patients presenting with symptoms of spinal cord compression

Tobacco control laws in Pakistan and their implementation: A pilot study in Karachi

Objective: In order to limit the high prevalence of tobacco use in Pakistan various tobacco control laws have been implemented. The objective of this study is to serve as a pilot study to assess the implementation of these laws in the largest city of Pakistan, Karachi. Methods: A cross-sectional study was conducted in Karachi. The implementation of tobacco control laws in \u27smoke-free\u27 places, the adherence of tobacco companies to these laws, the regulation of cigarette sale, and the awareness and views of the general public regarding tobacco control laws were assessed via direct observation by visits and through self-administered questionnaires. Results: The implementation of tobacco control laws in \u27smoke-free\u27 public places was found to be poor. Out of 37, only 23(62%) brands displayed pictorial warnings on their packs. 3(8%) of the brands were available in two different kinds of packs, both with and without pictorial warnings. Cigarette sale to minors was taking place at 80(85%) of the visited cigarette outlets. 50(53%) of the outlets displayed cigarette advertisements in the form of posters. 46(40%) of the persons questioned had awareness regarding the existence of ban on smoking in public places and 126(90%) of these were in favour of it. CONCLUSIONS: The implementation of tobacco control law in Pakistan is poor. Non adherence to the law in public places was alarmingly high. Also, the study demonstrates the poor compliance to the tobacco control laws by tobacco companies. The sale of cigarettes is almost unregulated