Comparison of Outcome of Decompressive Craniectomy with Wide Dural Flap Duraplasty Versus Dural Slits in the Management of Post Traumatic Acute Subdural Hematoma in Terms of Postoperative CSF Leak

Objective: To compare the frequency of postoperative cerebrospinal fluid (CSF) leak after decompressive craniectomy with wide dural flap duraplasty versus dural slits in patients with post traumatic acute subdural hematoma.Material and Methods: The study was conducted from August 2017 to February 2018 in the Department of Neurosurgery, PIMS, Islamabad. A total of ninety-two (n = 92) adult patients of either gender between age 15-55 years presented with isolated, unilateral traumatic acute sub dural hematoma (ASDH) with midline shift of 5mm were categorized into 2 groups; Group A (DC with open dural flap) and Group B (DC with dural slits). Patients were observed for CSF leakage for four weeks.Results: Results showed that the overall frequency of CSF leak was not significantly different in both groups and revealed that the CSF leak was observed in 10.9% (n = 5/46) in group A (DC plus open dural flap) and in 21.7% (n = 10/46) in group B (DC plus dural slits) (P = 0.158). The difference was not significant in terms of frequency of CSF leak in both groups when results were stratified with respect to gender, age, duration of trauma and baseline GCS. P value (chi-square) was found to be > 0.05 in all cases.Conclusions: The postoperative CSF leak was observed in higher percentages in patients who underwent DC with dural slits as compared to the patients who underwent DC with open dural flaps for surgical management of ASDH. The difference, however, was not statistically significant

Adverse Childhood Experiences in Patients Admitted with Depression at A Tertiary Care Hospital in Pakistan

Objective: To consider adverse childhood experiences in patients admitted to a tertiary care hospital in Pakistan with depressive disorder. Study Design: Comparative cross-sectional study. Place and Duration of Study: Fauji Foundation Hospital, Rawalpindi Pakistan from Sep 2018 to Aug 2020. Methodology: All the patients who were admitted to the psychiatry ward of the hospital after being diagnosed with depression were included in the study. Detailed history and mental state examination were carried out on all patients by a psychiatrist, and the adverse childhood experience questionnaire was administered. Results: Out of 400 patients admitted with a diagnosis of depressive episode in the hospital during the study period, 59(14.75%) were males, and 341(85.25%) were females. The mean age of the study participants was 39.49±8.926 years. 153(38.25%) did not have significant adverse childhood experiences, while 247(61.75%) had significant adverse childhood experiences. The severity of depressive episodes and substance use had a statistically significant relationship with the presence of significant adverse childhood experiences in our study participants (p-value<0.001). Conclusion: The presence of significant adverse childhood experiences was alarmingly high in patients admitted with a depressive episode in our study. These experiences were associated with the more severe forms of depressive illness and comorbid illicit substance use

Association of Sociodemographic Factors and Vitamin-D Levels with the Severity of Depressive Symptoms

Objective: To study the association of sociodemographic factors and Vitamin D levels with the severity of depressive symptoms in patients with depression. Study Design: Cross-sectional study. Place and Duration of Study: Psychiatry Department, Fauji Foundation Hospital, Rawalpindi Pakistan, from May to Nov 2021. Methodology: This study included all the patients diagnosed with depression per ICD 10 criteria by the consultant psychiatrist. Depression was further categorized in severity using Beck’s Depression Inventory. Vitamin D levels were sent to all the patients diagnosed with depression in the laboratory of our hospital. The cut-off score of less than 50nmol/l was taken as low vitamin levels. Results: Out of 103 patients studied, 23(22.3%) had mild, 49(47.6%) had moderate, and 31(30.1%) had severe depression. In severely depressed patients, 19(61.3%) were above 50 years of age, 12(38.7%) had no formal education, and 21(67.7%) had low vitamin D levels. Among mildly depressed patients, 5(21.7%) were above 50 years of age, 2(8.7%) had no formal education,and 17(73.9) had low vitamin D levels. We found that vitamin D levels, age of the patient, and level of education had a statistically significant relationship with the severity of depression, (p-valve less than 0.05). Conclusions: The level of vitamin D, age, and the level of education had a significant association in the target population with the severity of depressive symptoms

Prophylaxis of Surgical Site Infection in Cranial Surgery with Vancomycin Powder Application into Wound

Objective: To see the effect of application of Vancomycin powder directly into the subgaleal space in reducing the postoperative surgical site infections.Materials and Methods: All the patients who underwent consecutive elective craniotomies from April 2017 to May 2018 Dept of Neurosurgery, szabmu, PIMS, Islamabad. The control group received the standard routine prophylaxis according to the hospital protocols, whereas the treatment group, in addition to the standard prophylaxis, received Vancomycin powder in the surgical wound in addition to the standard routine prophylaxis.&nbsp;Results: 182 patients were enrolled in the study, 91 allocated to each the control and treatment group (Vancomycin). Six patients were lost to follow up. There were 90 patients in the control group and 86 patients in the treatment (Vancomycin) group. Both the groups were almost statistically similar. In the control group, 34.09% (n = 60) were male and 17.04% (n = 30) were female. In the treatment group, 29.54% (n = 52) were male and 19.31% (n = 34) were female. The overall rate of surgical site infection (SSI) was 3.97% (7 out of 176 cases). A statistically significant difference found in infection rate between the treatment group, 0% (0 out of 86 cases) and the control group, 7.77% (7 out of 90 cases) with the p value of 0.002.&nbsp;Conclusions: The use of topical Vancomycin powder in surgical wounds may significantly reduce the incidence of infection in patients undergoing elective craniotomies. It is a promising means of preventing devastating and harmful postoperative wound infections

EFFECT OF HIGH ALTITUDE ON ERECTILE FUNCTION IN OTHERWISE HEALTHY INDIVIDUALS

Objective: To determine the effect of high altitude on Erectile function in otherwise healthy individuals and associated socio demographic factors. Study Design: Cross sectional descriptive study. Place and Duration of Study: January 2014 to March 2014 at Goma, Siachin. Material and Methods: One hundred & twenty two married male subjects living at an altitude of more than 15000 feet for more than 3 month and less than one year were included in the study. Erectile dysfunction (ED) was assessed using International Index of Erectile Function-5 (IIEF-5). Age, education, smoking, monthly income, any drug intake, altitude, duration of stay and weather conditions were correlated independently with ED. Results: Out of 122, 26 (21.3%) had no ED, 18 had mild, 28 (14.8%) had mild to moderate, 36(29.5%) had moderate and 14 (11.5%) had severe ED. Advancing age, low monthly income, smoking, high altitude, cold weather and longer duration of stay had significant association with ED (p-value<0.05) while education and use of any drug were not found significantly associated in our study. Conclusion: This study showed a high prevalence of erectile dysfunction among otherwise healthy individuals when exposed to high altitude. Special attention should be paid on individuals with more age, less income and those working or residing at higher altitudes in peak winter season. Smoking and stay for longer durations should also be discouraged

Contributing risk factors of common psychiatric disorders in the Pakistani population

With an increasing incidence of psychiatric disorders worldwide, there is a need for a better understanding of the population-specific contributing risk factors that are associated with common psychiatric conditions. This study aimed to assess the correlation between socioeconomic, environmental and clinical features associated with major depression (MDD n = 479), bipolar disorder (BD n = 222) and schizophrenia (SHZ n = 146), in the Pakistani population. Multinomial logistic regression and Pearson's correlation were applied to assess the association and correlation between demographic, socioeconomic, environmental, and clinical features of MDD, BD and SHZ. In the present study, MDD was found to be more prevalent than BD and SHZ. The average age at onset (AAO), was observed to be earlier in females with BD and SHZ, in addition, females with a positive family history of MDD, BD and SHZ also had an earlier AAO. The fitted multinomial logistic regression model indicated a significant association of; aggression, tobacco use, drugs abuse, history of head injuries and family history with BD as compared to MDD, while insomnia and suicidality were significantly associated with MDD. Strong positive correlations were observed mainly between age/AAO, AAO/tobacco use and aggression/insomnia in all three cohorts. In conclusion, the present study identifies possible contributing socio-demographic, biological and environmental factors that are correlated and associated with the psychiatric conditions in the Pakistani population. Graphical abstract: [Figure not available: see fulltext.]. 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.The study was supported by the Higher Education Commission of Pakistan (Grant No. 3738) to MA and Pakistan Academy of Sciences (Grant No. 5-9/PAAS/1082) and the COMSATS core grant given to RQ. This research was also supported by COMSATS University Islamabad (CUI), Pakistan CRGP grant (16-38/CRGP/CIIT/ISB/17), to ZA.Scopu

Comparison of effectiveness between Haloperidol and Quetiapine in acute manic episode

This study was conducted to compare the response rate of Quetiapine and Haloperidol in patients with acute manic episodes. A total of 120 patients with acute episode of mania with baseline Young Mania Rating Scale (YMRS) of more than 20 were included and randomly allocated to either Quetiapine (Group A) or Haloperidol (Group B). Each patient was assessed at baseline. YMRS was administered at the start and at follow-up visit after six weeks. Comparison of response rate (>50% reduction in YMRS) was not statistically significant between the two groups (70% vs. 71.7%; p=0.410) after six weeks in acute manic episode. Quetiapine and Haloperidol emerged as equally effective pharmacological strategies for the treatment of bipolar mania. Quetiapine may be used as an alternative to conventional antipsychotics; Haloperidol can be used as replacement of Quetiapine as well, as it is of low cost. Key Words: Acute manic episode; Quetiapine; Haloperido