A Study of Various Shunt Related Complications in a Tertiary Care Hospital

Objective: The purpose of this study is to evaluate the frequency of various complication in patients with ventri-culoperitoneal shunt (VP shunt) for hydrocephalous in a tertiary care hospital.Material and Methods: This descriptive study on patients for whom Ventriculoperitoneal shunt was done for hydrocephalus was carried out in neurosurgery department, Hayatabad Medical Complex, Peshawar from 1st May 2010 to 30th February 2013. Only patients of hydrocephalous with established complication from both gen-ders without age discrimination were included in the study and patients with complications after revised shunts were excluded as complications rate is different in the two entities and will bias the study results. The patients were seen either in emergency room, ward or neurosurgical OPDs. Routine follow up schedule was examination at discharge, one month and then 6 months post operatively on outpatient bases. History, Clinical examination and full investigations which included FBC,CRP , CSF R/E (if required to rule out infection), X-Ray shunt series and CT scan brain and ultrasound abdomen pelvis were done as required in all patients. The clinical data was put into semi structured Performa and analyzed by SPSS version 10. Frequency and percentage was calculated for categorical variables. Mean ± SD was calculated for age. Results were presented as graphs and tables.Results: The total number of children operated upon was 112 of whom 71 (63.39%) males and 41 (36.61%) females. Forty one patients (36.61%) were less than one year at the time of presentation. Thirty seven (33.03%) patients were in age range of 1 – 10 years, 19 (16.96%) were in 11 – 20, 10 (8.92%) were in 21 – 30 age range, 4 (3.57%) were from 31 – 40 and one patient (0.89%) was in the age range of 41 – 50. Shunt blockage was seen in 54 (48.21%) followed by infection 38 (33.93%). Shunt erosion was seen in 11 (9.82%), extrusion in 5 (4.46%). While 4 patients died in the study period due to shunt related complications.Conclusion: The commonest shunt related complication is shunt blockage followed by shunt infection. Upper end of the shunt is more prone to complications than the lower end .Shunt related complications are serious clinical conditions and may lead to death of the patient

Epidural Hematoma in Different Ages Due to Road Traffic Accidents on Computed Tomography Scan Brain

OBJECTIVES: In developing countries, road traffic accidents are common and primarily affect middle-aged men. The aim of this study was to evaluate the frequency of epidural hematoma in people of various ages owing to road traffic incidents on computed tomography scan brain. METHODOLOGY: From February 2018 to January 2021, a cross-sectional descriptive study was done in the Department of Neurosurgery. A total of 460 individuals were chosen from emergency room visits due to traffic accidents. Individuals who had suffered a head injury and had an epidural hematoma on a computed tomography scan were included in the study. The frequency of epidural hematoma in different ages was determined. RESULTS: A total of 460 patients were enrolled in the trial, with 196 (42.60%) having epidural hematomas and 264 having no epidural hematomas (57.39%). Males accounted for 152 (77.55%) of the 196 epidural hematoma cases, while females accounted for 44 (22.45%), with an average age of 19 years and a range of 2-55±9.59 years. All the people who had a head injury were divided into three groups. The prevalence of epidural hematoma varied by age, with 75.51% (15-44 years), 20.40% (14 years), and 4.08% (>45 years) being the most common. CONCLUSION: It was concluded from this study that epidural hematoma determined by computed tomography scan brain is more frequent in middle age

Perception of Neurosurgical Residents about Learning in Operation Theatre in Tertiary Care Hospitals

OBJECTIVES To explore Neurosurgical postgraduate residents perceptions of their learning environment in operating rooms.METHODOLOGY From March 2022 to August 2022, this cross-sectional study will be carried out in the Department of Neurosurgery Hayatabad Medical Complex, Peshawar, Lady Reading Hospital Peshawar, and Ayub Teaching Hospital Abbottabad. The STEEM survey examined how surgical theatres were perceived as educational environments. After receiving informed consent, a printed questionnaire was provided to 32 surgical residents. SPSS 24 was used to conduct descriptive and inferential data analyses. RESULTS Thirty-one (31) of the 32 surgical residents that were surveyed (or 98.3%) answered. Residents' average age was 29.27 years (2.37); 27 were male, and 05 were female. Most residents were in their third (34.4%) and fourth (21.3%) years of residency. 147.66 (18.57) was the overall mean score. Participants' age and gender did not affect the mean scores; nevertheless, responses were statistically more favorable for residents in their first or fifth year of residency. Fifty-three locals responded favorably or positively overall. CONCLUSION Overall, residents had positive opinions of their training, their supervisors, the opportunities for learning in the operating room, the environment, and the monitoring they received

Role of anterior decompression with internal fixation in dorsal spine tuberculosis

This observational study was conducted in the Department of Neurosurgery Lady Reading HospitalPeshawar from July 2010 to June 2012 (2 years).There were 38 patients with dorsal spine tuberculosis who underwent anterior decompression and fusion using anterior spinal instrumentation and allograft replacement. We included those patients in our study, who undergone anterior decompression with internal fixation for dorsal spine tuberculosis, of both genders irrespective of their age. We excluded those patients who were unfit for surgery, treated conservatively, involved spine other than dorsal spine or undergone procedure other than anterior approach for Carrie’s spine.Clinical outcome of the patients was assessed using the frankle grade. The patients were observed for post-operative complications, neurological improvement and bony fusion

Results of Lumbar Transpedicular Fixation for Spondycolisthesis, in Terms of Back Pain Relief

Objective:  The goal of this study was to see how transpedicular fixation for degenerative spondylolisthesis affected lumbago. Methodology:  A retrospective observational study was conducted at the Department of Neurosurgery in Hayatabad Medical Complex, Peshawar between May 2018 and February 2020. Degenerative spondylolisthesis was diagnosed using static and dynamic spinal X-rays. The research excluded the patients with grade 5 spondylolisthesis, congenital anomalies, or prior spinal surgery. The visual rating scale was used to assess pain alleviation (GRS). Dynamic or static lumbosacral X-rays and 3D CT scans were used to assess union. Results:  In total 70 patients, 38 (54.3%) were male and 32 (45.7%) were female. L5–S1 was impacted in most of the cases (68%). 40% of patients were having Meyerding grade II. All patients had pedicle screw fixation. Following surgery, 44 (63%) patients reported no pain, and 12 (17%) patients reported mild discomfort. 8 (11%) patients reported moderate pain and 6(9%) patients experienced severe pain. There existed a significant difference between pre/postoperative moderate-severe GRS scores (p-value: 0.000336). After surgery, we were able to negotiate surgical unions with 91.4% of the patients. Conclusion:  For individuals with spondylolisthesis who need pain relief, transpedicular fixation is a safe, straightforward, and effective treatment. It also aids with the surgical union and the improvement of the neurological condition. Keywords:  Spondylolisthesis, Meyerding grading, Transpedicular fixation

Source of Bleeding and Per-Operative Findings in Extradural Hematoma (EDH): A Three-Year Experience in a Teaching Institute

Objective: The objective of this study was to analyze the main source of bleeding and operative findings in an extradural hematoma (EDH). Material and Methods: A descriptive study was conducted at the Neurosurgery Department of Hayatabad Medical Complex Peshawar from March 2017 to April 2020.The study included 550 patients that met the criteria of inclusion well. Demographic profile, location of Extra-Dural hematoma, the source of bleeding, presence or absence of skull fracture and per operative findings were documented in structured proforma. Results: 69% were male and 31% were female patients. The middle age group of 21 – 40 years mostly affected. Rupture or laceration of middle meningeal artery was the communal source of bleeding in 355 (64.5%) patients, followed by fracture bone in 285 (51.8%) of patients and dural venous sinus in 70 (12.7%) of patients. Preoperative findings in our study were linear skull fracture in 250 (45.4.0%), underlying contusion in 165 (30%), and contralateral hematoma in 70 (12.7%) of cases. Conclusion: Rupture or laceration of a Middle meningeal artery (MMA) was the most communal source of bleeding in extradural hematoma. Therefore, per-operative cauterization of this vessel is important to prevent the chances of re-bleed and re-do surgeries

Incidence, Pattern, and Outcome of Stray Bullet Injuries: Three Years’ Experience in a Teaching Institute

Objectives:  The purpose of this study is to better define the incidence, pattern, and outcome of a stray bullet. Materials & Methods:  The current study summarizes the data on stray bullet injuries presented to the Emergency Department (ED) Hayatabad Medical Complex, Peshawar. A total of 24 subjects were included for three years. We enrolled all patients who had head or spine injuries caused by a stray bullet. Data were extracted on demographic profile, site of injury, operative procedure, complication, and mortality, and were recorded on prescribed proforma. Results:  A total of 24 subjects were included for 3 years. 17 (70%) were male patients and 7 (30%) were females. Male to female ratio was 2:1. out of 24 cases, 9 (37.5%) were from District Peshawar, 3 (12.5%) cases were from Mardan and Charsadda District, and 2 (8.3%) cases were from Swat. 12 cases had a bullet in the Head and face. out of which 7 were supratentorial 3 cases had a bullet in the posterior fossa. Out of 24 cases, 13 (54.1%) were operated for the removal of bullets. 5 (20.8%) developed focal or generalized fits. 13 (54.1%) developed a neuro deficit. 4 (16.6%) of cases remain in a vegetative state, and the overall mortality rate is 20%. Conclusion:  Morbidity and mortality due to stray bullets is an increasing problem in our society. This study aims to bring awareness among the concerned authorities to try and bring an end to this menace resulting in deaths and misery

Types of Non-Acute Headache and Neuroimaging in the Evaluation of Patients with this Type of Headache

The aim of this study was to find the type of non-acute headache and to estimate the frequency of significant intracranial lesions in this type of headache. Non-acute headache was defined as any type of headache that had begun at least four weeks before. All the patients aged > 15 years attending the neurology and neurosurgery clinics of Post Graduate Medical Institute (PGMI), Lady Reading Hospital (LRH) Peshawar with non-acute headache were included in the study. The pregnant women and patients with facial pain alone were excluded from the study. They were followed prospectively for over a year. Detailed history and through neurlogic exami-nation was performed. The headache was classified according to the International Classification of Headache Disorder (ICHD) second edition of the International Headache Society (IHS). Every patient was investigated by neuroimaging studies. The computed tomography (CT) was done in all patients. Magnetic resonance imaging (MRI) was done in 86 patients to improve their diagnosis. Neuroimaging results were classified as “significant abnormalities”, “non-significant abnormalities” or “normal”. Significant abnormalities included neoplastic disease, hydrocephalus, vascular malformations, chiari malformation, large aracnoid cysts, intracranial hemorrhage and acute cerebral infarcts. The total number of patients was 1200; 795 women and 405 men. Their mean age was 38 years (15-75 years). Neuroimaging studies detected significant lesions in 18 patients (1.5%). The proportion of patients with headache and intracranial lesions is relatively small but neither neurological examination nor the features in the clinical history permit us to rule out such abnormalities

Effect of drought stress on growth, yield and seed quality of tomato (Lycopersicon esculentum L.)

Plant growth is seriously affected by abiotic stresses such as drought, salinity or temperature. Drought is one of the most important limiting factors for agricultural crops and vegetable production in particular all around the world. Drought stress during vegetative or early reproductive growth usually reduces yield by reducing the number of seeds, seed size and seed quality. To assess the effect of drought stress on seed yield, seed quality and growth of tomato, the experiment was conducted in green house in plastic pots at Pen-y-Fridd field station, University of Wales, Bangor, U.K. during 2003-2004. Tomato cv. ‘Moneymaker’ was used as a test crop. There were four treatments i.e. early stress (when first truss has set the fruits), middle stress (when fruits in first truss were fully matured and started changing their colour), late stress (when fruits on first truss were ripened fully), whereas in control no stress was imposed. Analysis of data regarding various attributes (fruit weight and shoot dry weight per plant, number of seeds per fruit, total number of seeds and seed weight per plant and vigour of seed) showed that drought stress had non-significant effect on vigour, quality and yield of tomato seed. Plant height, number of leaves and number of fruits per plant showed significant results toward drought stress signifying drought effects on growth of tomato

Neurological Complications of Eclampsia

Objective: Neurological complications contribute significantly to maternal mortality in eclampsia. We studied neurological and obstetric outcome of such patients.Material and Methods: A descriptive study was done at Gynaecology, Neurosurgery and Neurology Units of PGMI Lady Reading Hospital Peshawar, from January 2008 to December 2008. A total of 132 cases of eclampsia were included. Twenty seven cases of eclampsia with neurological complications were studied. We excluded cases with primary neurological abnormalities.Results: During this period one hundred and thirty two patients were admitted with eclampsia. Among 132 cases 27 had neurological abnormalities. One hundred and eight cases were antenatal and twenty four were postnatal. None of them had any antenatal care. Management included initial stabilization followed by early delivery in antenatal cases. Primary anticonvulsant was magnesium sulphate. Phenytoin controlled convulsions in all cases with recurrent seizures. Neurological complications were seen in twenty seven patients. Minor complications like transient impairment of consciousness (97%), blurred vision (22.22%), and Bell’s palsy (07.40%) were observed. Serious neurological complications like CVA (11.11%), recurrent seizures (37.03%) and deep coma occurred in (22.02%) of cases. The cesarean section rate was 18%. Fifty four perinatal deaths and five maternal deaths were recorded. Neurological recovery was complete in all survivors.Conclusion: Critical care backup is essential at tertiary referral centers for a large proportion of neurological abnormalities in eclampsia. High mean arterial pressure and accompanying coagulation defects may be key factors in cerebral pathology. CT scan is a simple and effective investigation in these cases. Phenytoin is an effective second line anticonvulsant. Early delivery prevents worsening of systemic status