Comparison of two interactive tutorial methods: Results from a medical college in Karachi

Objective: To compare perception of students on usefulness of interactive tutorials and clinically-oriented problem-solving tutorials.Methods: The cross-sectional study was carried out from January 2012 to November 2013 at Bahria University Medical and Dental College, Karachi. The perception of medical students on usefulness of interactive tutorials and clinically-oriented problem-solving tutorials was acquired through a questionnaire distributed to medical students having completed the first two years of studies. The responses on various aspects of learning of physiology were acquired on a scale of poor, good or excellent. The learning abilities and acquired skills were compared in terms of not at all, to some extent, and to great extent. Data was analysed using SPSS 15.Results: Of the hundred students initially enrolled, complete response was obtained from 83(83%). Of them, 47(57%) were females. There was significant difference in understanding of structure and function by clinically-oriented problem-solving tutorials (p=0.04). The students preferred clinically-oriented problem-solving tutorials as far as understating of difficult concepts was concerned (p\u3c0.01). Presentation skills were improved by interactive tutorials (p=0.02) whereas clinical reasoning skills acquired by clinically-oriented problem-solving tutorials was found to be significantly better (p\u3c0.05). Both tutorials helped in the learning of content of Physiology.Conclusions: Clinical reasoning skills were acquired more by clinically-oriented problem-solving tutorials that helped in better understanding of structure and functions

Blue Energy and Its Potential: The Membrane Based Energy Harvesting

The present energy generation is largely dependent on fossil fuels which results in the emission of greenhouse gases and is also characterized by vulnerability and eminent scarcity. In order to meet the respective concerns, the energy supply should be based on (i) an environmental-friendly non-combustion energy conversion, (ii) a freely available alternative energy source, and (iii) a renewable energy source. In this chapter, the authors want to explore an alternative and the hardly known renewable energy source, i.e. salinity gradient energy. It is the most promising renewable energy source and also termed as ‘blue energy’. Estimates from literature predicted coverage of over 80% of the current global electricity demand when applied in all river mouths. From thermodynamic calculations, it can be derived that each m3 of river water can yield 1.4 MJ when mixed with the same amount of seawater. Two membrane-based processes are available to convert blue energy into electricity: Pressure retarded osmosis (PRO) and Reverse electrodialysis (RED). Blue energy along with its technical and economic potential would be the major focus of this chapter

Association of hyperglycaemia at admission with in-hospital mortality and severity of illness among patients with COVID-19.

Objectives The association between hyperglycemia at admission and COVID-19 severity and in-hospital mortality is an area of active medical research. Our study aims to explore this association across diabetics and hyperglycemic patients while keeping normoglycemic patients as control. Methods This retrospective cohort study involved a total of 90 patients with confirmed diagnosis of COVID-19 infection. Patients were divided into three equal groups based on their history and BSR levels (diabetics, hyperglycemic, normoglycemic). Various laboratory parameters and inflammatory markers were compared across the study groups using Kruskal Wallis test. Finally, chi-square test was use to assess the association of severity and mortality across the study groups. Results Out of 90 patients, 38 (42.2%) were males with a mean age of 57.1 ± 14.7 years. Serum ferritin, LDH and lymphocyte levels were significantly higher in diabetics and hyperglycemic patients than in normal COVID-19 patients (p<0.05). hyperglycemia at admission was significantly associated with disease severity (p=0.03) but not with in-hospital morality (p=0.07).   Conclusion Patients with diabetes and stress hyperglycemia have increased levels of inflammatory markers than normoglycemic patients. Hyperglycemia at admission is associated with poor COVID-19 severity. More studies a required to validate and further explore this relationship

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

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

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

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

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