Outcome & Complications of Decompressive Craniectomy with Expansion Duroplasty in Severe Head Injury

Objective:  A descriptive case series was conducted to find the frequency of complications and complications of decompressive craniectomy with expansion duraplasty in severe head injury. Material and Methods:  189 patients fulfilling the selection criteria were included. All patients had TBI which was confirmed by CT scan. Surgery was performed on the day of admission under general anesthesia and a large trauma flap. Patients were monitored daily by evaluators from the date of surgery until hospital discharge or death. Patients were followed up for 3 months and the outcome was assessed using the Glasgow outcome scale (GOS). Results:  Mean age of the patients was 36.57 years. There were 61.4% (116) males and 38.6% (73) females. 3.7% had CSF leakage. 1.6% had meningitis. Wound infection was seen in 7.4% of patients. Forty percent had a favorable outcome and 60% had a poor outcome. Fifty patients out of 111 patients between 18 – 40 years showed good outcomes. Twenty-six out of 78 from the 41 – 60 years age group showed good outcomes. Out of 189 total, 76 patients had a good outcome. The outcome was good in 63 patients out of 148 patients with GCS 5 – 8, whereas 13 (out of 41) patients had a good outcome with GCS below 5. Conclusion:  We discovered that the result was good in 40% of patients, with 11 percent of complications recorded. Therefore, we concluded that decompressive craniectomy with expansion duraplasty is an effective procedure for the treatment of the severe head injury

Genetic variability, heritability and genetic advance for various quantitative and qualitative traits in Chilli (Capsicum annuum L.)

Genetic variability, heritability and genetic advance for different quantitative and qualitative characters were studied in 64 genotypes of chilli. The study indicated the existence of considerable amount of genetic variability for all the traits under study. Analysis of variance revealed significant differences among genotypes for almost all the traits studied. The maximum range was recorded for fruit yield per plant (150-900 g) followed by vitamin-C content at red ripe stage (35.50 -207.17 mg/100g), vitamin-C content at green stage (24.93-195.83 mg/100g), capsanthin content (39.58-180.35ASTA units, number of fruits per plant (21.32-100.27) and plant height (50.20-105.00cm). The highest phenotypic and genotypic coefficients of variability were observed for average fruit weight followed by seed yield per plant, average seed weight per fruit, number of fruits per plant, fruit yield per plant and fruit diameter. In general the phenotypic coefficients of variation (PCV) were slight higher than genotypic coefficients of variation GCV), which indicates the minor role of environment in the expression of traits under observation. The estimates of heritability in broad sense was high for all the characters. The present investigation indicates a great scope of in the improvement of these traits as these characters in general possessed high estimates of heritability coupled with high genetic advancement except for days to first fruit set, days to first green fruit harvest, days to first ripe fruit harvest and dry matter content (high heritability but moderate genetic gain) indicating the preponderance of additive gene action for control of these traits

The reciprocal ledge closing wedge osteotomy for post traumatic coxa vara

To report a proximal femoral osteotomy with retention of bone ledges in a reciprocal position to increase bone contact and stability. The method was applied to 5 patients over a 3-year period. All patients had coxa vara. The average length gained was 1.5 cm, and the average neck shaft angle improvement was 30°. The Harris hip score improved from an average of 63 to 82. The reciprocal ledge osteotomy is technically less demanding and also allows conversion of normal shear forces around the upper femur to stabilizing forces. This method allows easier use of the DHS implant as potential rotation about the axis of the screw is negated by the ledges and the dynamic forces

Posterior Lumbar Interbody Fusion in Degenerative Lumbar Spine Disease and Risk of Adjacent Segment Disease

Objective:  To determine the chances of adjacent segment disease (ASD) and risk factors after posterior lumbar interbody fusion (PLIF). Material and Methods: 110 patients of both genders with degenerative lumbar instability at L4/5 level were included in my study. We did PLIF in all our patients and followed our patients for one year. The following parameters were measured: the degree of lumbar lordosis, the degree lumbosacral angle, the disc space height and their dynamic angulation and the displacement of L3 over L4. We checked the outcome with the help of the Japanese orthopedic association (JOA) and Oswestry disability index (ODI). We divided the patients into groups A and B; group A includes patients with progression of degeneration at the proximal level (L3-L4), while group B with no progression of disease at proximal level. Results:  The 86 patients (78.18%) were in group A, and 24 patients (21.88%) were in group B. There were no significant difference in radiological parameters of both groups; lumbosacral angle of lordosis, L3 laminar inclination angle, preoperative degenerative changes at proximal level, L4–L5 lordosis and BMD before surgery. The clinically and statistically significant differenceswere of the age of the patients falling in two groups. We found that at the completion of study ODI and JOA were not significantly different in both groups (P >0.05). Conclusion:  Degenerative lumbar disease is an age related disease with no significant effect of radiological degenerations on the final outcome of our patients.No other possible risk factor has a significant effect on outcome

Outcome of Lateral Mass Fixation and Fusion – A Comprehensive Analytical Study of 205 Lateral Mass Screws in 35 Patients at Punjab Institute of Neurosciences

Objective: To see outcome, accuracy and expected complications in passing lateral mass screws in patients with cervical spine injury, degenerative disease at the cervical spine level and neoplastic lesions.Materials and Methods: In this study, 35 patients were included and 205 screws passed in lateral mass patients’age ranged from 12-70 years (25 males and 10 females) with trauma to the cervical spine, degenerative disease at the cervical spine level and Intradural extramedullary benigntumors and extradural malignant neoplasm.Patients less than 12 years and more than 65 years of age,patients with traumatic ruptured disc causingspinal cord compression anteriorly and operated for cervical spine were excluded from our study.In all patients,we did lateral mass fixation with polyaxial screws and rods under fluoroscopic assistance.For assessment of screws trajectory and position, CT scan cervical spine with 3D reconstruction was performed on a first post op day to confirm screw orientation and direction and for fascet, foraminal, foramen transversarium violations.Results: All screws were passed by using Megrel’s trajectories. Not a single patient had nerve root, cord injury nor vertebral artery injury. One patient had screw pullouts requiring reoperation.12 to 14mm size screws were used under fluoro guidance. On postoperative CT cervical spine with 3D reconstruction shows no breach or violations of any foramen transversarium, nerve root injury or neural foramen penetration by screws. In all patients polyaxial screw/rod construct was used. Conclusion: Cervical spine lateral mass fixation with polyaxial screws is a safe and effective technique in expert hands under fluoroscopic assistance

Open reduction and internal fixation in a case with transscaphoid perilunate dislocation 8 months after the injury: a patient with a 5-year follow-up

The management of perilunate dislocations diagnosed later than three months continue to elicit debate with literature being scarce. We report a 22-year-old male with transscaphoid perilunate dislocation who reported to our hospital 8 months after sustaining the injury. Open reduction was done along with bone grafting. Five years after the surgery the patient is symptom-free with an excellent range of motion

Viral outbreaks: A real threat to the world

Global public health is facing significant challenges in terms of emerging and re-emerging pathogens. The world is facing a new public health crisis emergence and spread of Coronaviruses outbreaks especially COVID-19 after nine deadliest viral outbreaks including Marburg virus, Ebola virus, Rabies, HIV, Smallpox, Hantavirus, Influenza, Dengue and Rotavirus. Coronaviruses (enveloped non-segmented positive-sense RNA viruses) belong to the Coronaviridae family, broadly distributed in humans as well as in other mammals. In December 2019, the COVID-19 outbreak was reported in the Wuhan, Hubei province of China. WHO confirmed that COVID-19 is associated with Huanan seafood (Wuhan). COVID-19 virus outbreak is more dangerous than its ancestors MERS-CoV and SARS-CoV. Although the case fatality rate is lower, it has alarmed the world because of its rapid spread during this era of the modern world where the whole world is connected through different channels of trade. As the world is already facing economic challenges, underdeveloped countries are not capable of facing such challenges, and this outbreak may become worse than ever before.Keywords: Coronaviruses; COVID-19; Marburg virus; Ebola virus; Rabies; HIV; Smallpox; Hantavirus; Influenza; Dengue; Rotaviru

Craniovertebral Junction Lesions and Single Stage Anterior Decompression Followed by Posterior Fusion

Objective: To asses the outcome of transoral microsurgical excision of anterior placed craniovertebral junction (CVJ) lesions excision followed by posterior craniocervical stabilization. Study Design: Qausi Experimental study. Setting: Department of neurosurgery PINS/Lahore General Hospital, Lahore. from May 2017 to Aug 2018. Inclusion Criteria: Male and Female patients of 12-65 yrs of age with compressive lesion at the ventral aspect of craniovertabral junction. Exclusion Criteria: Lateral and posterolateral lesions, lesion below C2 vertebral body, patient unfit for anaesthesia and surgery. Material and Methods: 12 consecutive patients coming in OPD and emergency department of our unit and fulfilling the inclusion criteria were studied. All patients were prepared for the surgery and written informed consent taken from all our patients. The patients underwent anterior trans oral microsurgical excision of the tumour followed by posterior fixation. Results: Out of 12 patients (range 12–65 years); Rheumatoid arthritis in 1 patient, tumor in 5 patients or trauma in 4 case and basilar invaginations in 2 patients. All my patients had headache (cranial and/or high-cervical pain), 73% of patients presented with quadriparesis, and 29% presented with basal cranial nerves involvements. Anterior decompression followed by posterior craniocervical fixations was done in all patients in same sitting. Out of 5 patients having severe neurological deficits preoperatively 3 improved. The remaining 7 patients have mild to moderate neurological deficits improved gradually throughout the follow-up periods to independent level. Among complications mortality in 1 patient and morbidity in the form of dural tear, CSF leak and infection in 2 patient). Craniocervical instability was seen in one patients after 3 months of surgery. Conclusion: A good surgery with proper decompression at the craniovertebral junction is technically difficult procedure and demands expertise. It needs proper preoperative planning and investigations and adequate decompression and stabilization with proper implants

Climatic Events and Natural Disasters of 21st Century: A Perspective of Pakistan

In recent years, the frequent occurrence of natural calamities in the world has gained much attention due to infrastructure and life losses. Increase in global temperature has threatened the earth’s climate, causing unpredictable and extreme weather events more often. These events were both short-term as well as long-term. In spite of insufficient monitoring coverage of inner areas and high altitudes, an intensification of average yearly temperature has been observed after the 20th century in many regions of Asia. Pakistan has faced a number of natural disasters including severe floods, devastating earthquakes, disturbing droughts, distressing smog, extreme temperature and torrential rainfall patterns. These calamities have affected people economically, socially, physically and mentally by posing a threat to earth, its species and their livelihood. This paper was aimed to document the natural calamities in Pakistan since the beginning of 21st century till date. The country is facing the problem of intense and longer summers and has witnessed two intense heat waves. Moreover, in some areas, extensive droughts are threatening crops, freshwater supply and wildlife. In recent years, the problem of smog has emerged in Pakistan, especially in Punjab. The problem is getting worse in every coming year due to overpopulation, cities expansion, increased emission of greenhouse gases, open burning of crop residues and extreme reliance on fossil fuels for energy purpose. So far in this century, Pakistan has faced 3 droughts, 2 heat waves, 10 severe floods, 27 major earthquakes, 2 consecutive sessions of severe smog and extreme high and low temperature events. Some of the deadliest events were; 2005 Kashmir earthquake claiming 87,350 human lives and 2010 flood impacting nearly 20 million people with 1,781 causalities. Change in climate is posing a severe threat to species, livelihood of the human beings and the earth. Global warming is causing warming of oceans and consequently rise in sea level. Climate change affects average as well as extreme temperatures hence increasing the probability climate-related disasters. Thus, global warming is causing a chain of catastrophic events that make the problem even more complex to understand