Outcome of Topical Epidural Methylprednisolone Versus Control in Lumbar Disc Surgery Patients

Objective:  The use of topical intraoperative methylprednisolone in lumbar disc surgery leads to significant improvement in pain relief and early resumption of daily life activities. The study determined the outcome of topical epidural methylprednisolone. Materials & Methods:  60 patients included with diagnosed cases of the herniated lumbar disc with ASA Grade 2 and below. Group A was for patients who had to receive topical methylprednisolone while group B was the control group where no topical methylprednisolone had been used. The outcome was measured from OLBI and VAS scores. Results:  In Group A, the mean hospital stay was 2 days, mean OLBI score was 35%, mean VAS score was 3, mean time to resumption of ADL was 7 days, mean dose of paracetamol (per day) was 3 mg, mean dose of Ketorolac (per day) was 90 mg. Whereas Group B, mean hospital stay was 3 days, mean OLBI score was 45%, mean VAS score was 5, mean time to resumption of ADL was 10 days, mean dose of paracetamol (per day) was 4 mg, mean dose of Ketorolac (per day) was 100 mg. In Group A, 91% of patients had a favorable outcome and 9% of patients had an unfavorable outcome. Whereas in Group B, 83% of patients had a favorable outcome and 15%of patients had an unfavorable outcome. There existed insignificant results in outcomes concerning diabetic/non-diabetic, and hypertension/non-hypertension. Conclusion:  The use of topical intraoperative methylprednisolone in lumbar disc surgery leads to significant improvement in pain relief and early resumption of daily life activities as compared to without the use of topical methylprednisolone. Keywords:  Outcome, Epidural Methylprednisolone, Lumbar Disc Surgery, OLBI (Oldenburg Burnout Inventory), ADL (Activities Of Daily Life)

The Efficacy of Surgery for Supra-Tentorial Gliomas in Preventing Seizures

Objectives:  The study examined the surgical outcome of supratentorial gliomas in terms of improvement in seizures in patients who presented to a tertiary care institution. Material and Methods:  A descriptive case series was conducted in Neurosurgery Department at Northwest General Hospital & Research, Peshawar. Patients (n = 95) with supratentorial gliomas with seizures between 18 – 70 years were included. Supratentorial gliomas were diagnosed by neuroimaging as MRI brain with contrast, diffusion-weighted, Fluid-attenuated inversion recovery, and magnetic resonance spectroscopy. The patient was observed for seizures postoperatively. Data was stratified for age and gender. Results:  The majority of patients (36.8%) were in 41 – 50 years. 55.78% of patients were males whereas 44.21% of patients were females. 42 (44.21%) involved the frontal lobe, 16 (16.84%) involved the parietal lobe, 26 (27.36%) involved the temporal lobe, and 11 (11.57%) patients involved the occipital lobe. According to Engel’s classification, 53 patients were in class I, 16 in class II, 10 in class III, and 5 in class IV. 84 (88.42%) experienced post-op seizure reduction. An insignificant association was found with the seizure improvement (yes/no) with different age groups and gender. Conclusion:  The frontal lobe was the most prevalent location for supratentorial gliomas. After surgery, a large proportion of patients improved in terms of seizure management. Keywords:  Seizures, Supratentorial gliomas

Two stage flexor tendon reconstruction in hand: our experience

Background: Flexor tendon injuries in the digital flexor sheath area (zone II) are the most difficult to treat and remain a focus of both clinical attention and basic investigations. This prospective study was designed to evaluate the results of staged zone II flexor tendon repair.Methods: Seventy digits in thirty five patients were treated by Two Stage flexor tendon reconstruction and followed for an average of one and a half year. The procedure included placing a silicone catheter (cut to desire size) as an active implant and reconstruction of A2, A4 or both pulleys if damaged in first stage. During the second stage (performed three to eight months later), tendon graft replaced the silicone catheter in the pseudo sheath formed around the catheter. The proximal end of the transplanted tendon was fixed with flexor digitorum profundus tendon of respective finger using the Pulvertaft method, and the distal end of the graft was fixedwith the distal stump of respective flexor digitorum profundus tendon. Early controlled motion protocol was instituted in all cases.Results: As per Buck Gramcko scale total active motion obtained was Excellent in 70%, Good in 20%, Fair in 7.1%, and Poor in 2.9% of patients.Conclusions: Flexor tendon reconstruction using two stage tendon reconstructions is an effective way to restore digital tendon function in delayed zone II flexor tendon injuries

GIS-based flood susceptibility mapping using bivariate statistical model in Swat River Basin, Eastern Hindukush region, Pakistan

Frequent flooding can greatly jeopardize local people’s lives, properties, agriculture, economy, etc. The Swat River Basin (SRB), in the eastern Hindukush region of Pakistan, is a major flood-prone basin with a long history of devastating floods and substantial socioeconomic and physical damages. Here we produced a flood susceptibility map of the SRB, using the frequency ratio (FR) bivariate statistical model. A database was created that comprised flood inventory as a dependent variable and causative factors of the flood (slope, elevation, curvature, drainage density, topographic wetness index, stream power index, land use land cover, normalized difference vegetation index, and rainfall) as independent variables and the association between them were quantified. Data were collected using remote sensing sources, field surveys, and available literature, and all the studied variables were resampled to 30 m resolution and spatially distributed. The results show that about 26% of areas are very high and highly susceptible to flooding, 19% are moderate, whereas 55% are low and very low susceptible to flood in the SRB. Overall, the southern areas of the SRB were highly susceptible compared to their northern counterparts, while slope, elevation, and curvature were vital factors in flood susceptibility. Our model’s success and prediction rates were 91.6% and 90.3%, respectively, based on the ROC (receiver operating characteristic) curve. The findings of this study will lead to better management and control of flood risk in the SRB region. The study’s findings can assist the decision-makers to make appropriate sustainable management strategies for the mitigation of future damage in the study region

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Перехресне дослідження COVID-19 та психологічного дистресу з використанням шкали впливу подій, на основі спільноти пацієнтів, які одужали від COVID-19

COVID-19 infection is a potentially traumatic experience in terms of the risk of running a Severe Acute Respiratory Syndrome in addition to the social implications of the disease in terms of being isolated and follow up of strict quarantine measures of close contact. The purpose of this study was to assess the prevalence of psychological distress and its risk factors in patients who develop COVID-19 infection. There is scanty evidence regarding the magnitude of COVID-19-related psychological distress (PD) among the general population of India, and Post Traumatic Stress Disorder (PTSD) is a Mental Disorder that develops after a traumatic event that has a life-threatening impact. The aim of this study was to assess COVID-19 infection. Material and methods: This study was conducted among 672 COVID-19 survivors of district Budgam from (March to August 2020). They were contacted by telephone, and psychological distress in the post-COVID recovery period was assessed using the IES-R scale. This is a 22-item scale, and each item is rated on a scale ranging from 0-4. Suitable Statistical Analysis was done to analyze risk factors for the development of any psychological distress. Methods: Descriptive cross-sectional study. Study design: Cross-sectional study from District Budgam of Kashmir Division. Study tool: using the IES-R scale for PTSD. Result: In our study prevalence of psychological distress using IES –R was mild in (7.08 %) of the study participants and moderate in (1.06 %) of the study participants. Psychological distress in study participants was examined by age, sex, employment status, family history, COVID-19 disease status and history of hospitalization. No statistical significance between age, gender, days of hospitalization and PTSD was seen. However, statistical significance with the IES–R score was seen between family history and the presence and absence of symptoms in the study subjects. Conclusion: As the pandemic crisis seems to be ebbing, the current findings help us to identify risk factors and devise pragmatic strategies to curtail the burden of mental issues and successfully meet the challenges that follow the pandemicІнфекція COVID-19 є потенційно травматичним досвідом з точки зору ризику розвитку важкого гострого респіраторного синдрому на додаток до соціальних наслідків захворювання з точки зору ізоляції та дотримання суворих карантинних заходів з метою попередження контактів. Метою цього дослідження було оцінити поширеність психологічного дистресу та його факторів ризику у пацієнтів, у яких розвивається інфекція COVID-19. Є мізерні докази щодо масштабів психологічного дистресу (ПД), пов’язаного з COVID-19, серед населення Індії в цілому, а посттравматичний стресовий розлад (ПТСР) — це психічний розлад, який розвивається після травматичної події, що загрожує життю. Метою цього дослідження було оцінити інфікування COVID-19 та його наслідки. Матеріал і методи: це дослідження було проведено серед 672 осіб, які пережили COVID-19 з Будгамського району (з березня по серпень 2020 р.). З ними спілкувалися по телефону та оцінювали психологічний стрес у період одужання після COVID за допомогою шкали IES-R. Це шкала з 22 пунктів, і кожен пункт оцінюється за шкалою від 0 до 4. Для аналізу факторів ризику розвитку будь-якого психологічного дистресу було проведено відповідний статистичний аналіз. Методи: описове перехресне дослідження. Дизайн дослідження: перехресне дослідження в районі Будгаму, Кашмірського округу. Інструмент дослідження: використання шкали IES-R для ПТСР. Результат: у нашому дослідженні поширеність психологічного дистресу при використанні IES-R була легкою у (7,08 %) учасників дослідження та помірною у (1,06 %) учасників дослідження. Психологічний дистрес учасників дослідження вивчався за віком, статтю, статусом зайнятості, сімейним анамнезом, статусом захворювання на COVID-19 та історією госпіталізації. Не спостерігалося статистичної значущості між віком, статтю, днями госпіталізації та посттравматичним стресовим розладом, однак статистична значущість за шкалою IES–R спостерігалася між сімейною історією, та наявністю або відсутністю симптомів у суб’єктів дослідження. Висновок: оскільки пандемічна криза, схоже, йде на спад, поточні результати допомагають нам визначити фактори ризику та розробити прагматичні стратегії, щоб зменшити тягар психічних проблем і успішно протистояти викликам, пов’язаним з пандеміє