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

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

Pediatric Posterior Fossa Brain Tumor Surgical Outcome

Objective:  The study analyzed the complications and satisfactory surgical outcomes of posterior fossa brain tumor surgery in Lahore Medical City Lahore. Materials and Methods:  A prospective study was conducted and included 40 children who were diagnosed with posterior fossa brain tumors by history, physical examination, and later radiologically were admitted and operated on at the Pediatric Neurosurgery Department in Lahore medical City Lahore between the period of March 2021 and March 2022. Results:  There were 26 (65%) male and 14 (35% females) individuals among the 40 patients. The average age was 12.5 years. This study found that great surgical outcomes were observed in 10 instances (25 percent), good outcomes in 20 cases (50%), and bad outcomes in 10 cases (25%). The most frequent clinical manifestations were headache (38%), vomiting (30%), ataxia (10%), blurred vision (10%), and cranial nerve palsy (12.5%). The best prognosis is shown in children with Pilocytic astrocytoma, followed by ependymoma, while the poorest outcome is seen in children with medulloblastoma. Conclusion:  Pediatric neurosurgeons continue to face particular difficulty in the surgical treatment of posterior fossa brain tumors. Our study compares the outcomes, complications, and surgical outcomes to prior clinical investigations

Surgical Outcome of Traumatic Posterior Fossa Extradural Hematoma in Paediatric Population: Our Experience at UCHS, The Children’s Hospital, Lahore

Objective:  Most common location for Extradural hematoma (EDH) is within the supratentorial region. The incidence of Posterior fossa extradural hematoma (PFEDH) is1.2% to 12.9% of all EDH. The purpose of this study is to evaluate the management, clinical outcomes, and epidemiological features of posterior fossa EDH. Materials and Methods:  A cross-sectional study was conducted at the department of pediatric neurosurgery Children Hospital and the University of child health sciences, Lahore from September 2021 to December 2021. Thirty patients presented with posterior fossa extradural hematoma in the pediatric age group were included. A plain CT scan Brain with the bone window was done for initial diagnosis to assess any injury in the posterior fossa including volume of hematoma and any associated fracture. Glasgow Coma Scale (GCS) was used to evaluate the outcome. Results:  Twenty-five patients were surgically treated, and five patients were managed conservatively. There was no mortality observed and the overall results were good in all the patients. Conclusion:  As compared to supratentorial extradural hematoma the Posterior fossa epidural hematoma is uncommon. For all suspected cases early and serial CT scans must be carried out. There was an excellent prognosis in pediatric patients who underwent surgical management

Minimal Invasive Burr – Hole Management of Traumatic EDH

Introduction: Epidural hematoma (EDH) is a neurosurgical emergency. Delay in urgent treatment may lead to severe morbidity and even mortality. Conventionally, EDH was treated by formal craniotomy. Rarely, minimally invasive burr – hole drainage is employed especially in critically sick patients. We believe every case of pediatric EDH can be successfully drained by minimally invasive burr – hole drainage.Materials and Methods: This study was conducted at the Department of Pediatric Neurosurgery, The Children’s Hospital and the Institute of Child Health Lahore, between 19-01-2014 and 24-03-2016. The medical record of patients with EDH managed by minimally invasive burr – hole technique was reviewed in prospective way for history, clinical examination, investigations, management given, complications, and outcome.Results: There were a total of 50 patients. Thirty four were male and 16 were female patients (M:F 2.1:1). Age was ranged between 45 days and 12 years (6.48yr ± 3.30yr). In 27 patients etiology of EDH was fall from roof and in 5 patients it was fall from bed/sofa, in 3 children fall from lap, in 8 fall from stairs, in 6 children it was road traffic accident, and brick fall over head in 1 child. Preoperative GCS was 3 – 8 in 11 patients, between 9 - 12 in 18, and between 13 – 15 in 21 patents. CT scan/MRI was performed in all patients for diagnosis, as per availability. All patients were operated by minimally invasive burr – hole drainage technique. Postoperatively, 1 patient required re-drainage by the same technique. There was one expiry in our series. All the 49 patients are discharged at GCS 15/15.Conclusion: A survival rate of 98% is evident of safety and effectiveness of minimally invasive burr – hole drainage of EDH in children with added benefits of less operative time, operative morbidity, and hospital stay

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

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

Microalgae-based biofuels, resource recovery and wastewater treatment: a pathway towards sustainable biorefinery

Intense utilization of natural fuel resources is threatening the global environment and societal sustainability. It triggers up the need for finding environmental-friendly and sustainable sources of energy. In this perspective, microalgae have emerged as a potential alternative. Microalgae are featured with distinct ability to provide ecological services and respond to the sustainability challenges simultaneously. Microalgae can fix atmospheric CO2, valorize waste resources and can produce a wide variety of bio-products. The promising features of microalgae pitch the idea of establishing a sustainable bio-refinery to draw multifaceted benefits and reinforce the objectives of resource efficient bio-economy. Unfortunately, in the last few years, preferential studies have been carried out to assess the potential of microalgae-based integrated bio-refinery. This review critically discussed the recent developments, opportunities, and barriers in the microalgae bio-industry and wastewater treatment. Particularly, microalgae potentials for biofuels and resources recovery are addressed towards sustainable biorefinery. Moreover, techno-economic and commercial viability of microalgae-led bio-refinery is reviewed to drive this technology towards practicality

Single Burr Hole Evacuation of Extradural Hematoma in Pediatric Population: An Experience from the Biggest Children Hospital of Pakistan

Objective:  To observe the outcome of single burr hole evacuation of EDH in a pediatric population. Material and Methods:  We included 52 children who had had a head injury and were diagnosed with EDH on a CT scan. Over three months, they were all admitted to the pediatric neurosurgery ward. Serial CT scans and neurological evaluations were performed on all of the youngsters regularly to monitor their progress. Results:  52 pediatric and adolescent patients were included. The age range was 6 months to 18 years. There were 30 male and 22 female patients. All of the children have EDH as a result of head injuries sustained in various accidents. All of the youngsters underwent surgery to remove EDH through a single burr hole. On the second postoperative day, five infants underwent reoperation owing to neurological deterioration, and two children died. The result was good (mRS 0) in 44/52 (84.6%) instances, mild deficits (mRS 1–2) in 4/52 (7.6%), and severe impairments (mRS 3–5) in 2/52 (3.84%) cases six months after the event. Conclusion: Although, EDH is a life-threatening surgical disease if not treated promptly, EDH evacuation by a single burr hole has a satisfactory prognosis in the juvenile population, with fewer complications and recurrences