Does Early Tracheostomy Improve Outcome in Severe Head Injury?

Object:  To determine if early tracheostomy reduces the duration of mechanical ventilation, Intensive Care Unit (ICU) stay and morbidities associated with it in patients with severe head injury. Methods:  This 5-yr retrospective review included 60 ICU patients with severe traumatic head injury requiring mechanical ventilation and tracheostomy. Early tracheostomy (ET) was defined as tracheostomy within 7 days, and prolonged endotracheal intubation (EI) as endotracheal intubation for more than 7 days. Among 60 patients, 30 underwent early tracheostomy and 30 remained on prolong EI for ventilation. All patients were comparable in term of age and initial Glasgow Coma Scale (GCS). We evaluated groups regarding clinical outcome in terms of ventilator associated pneumonia (VAP), ICU stay and Glasgow Outcome Score (GOS). Results:  The incidence of Ventilator Associated Pneumonia (VAP) was significantly higher in prolonged Endotracheal Intubation EI group, relative to Early tracheostomy ET group (63% vs. 43%, respectively). ET group showed significantly less ventilator days (9 days vs. 12 days), ICU stay (10 days vs. 13 days), complication rate (13% vs. 18%) and mortality (10% vs.25%). Clinical outcome assessed on the basis of Glascow Outcome Score (GOS) was better in ET group. Conclusions:  In severe head injury early tracheostomy decreases total days of ventilation and ICU stay. Tracheostomy is associated with a decrease in the incidence of Ventilator Associated Pneumonia (VAP). Early tracheostomy should be considered in severe head injury patients requiring prolong ventilatory support. &nbsp

Role of multi-parametric (mp) MRI in prostate cancer

Multi-parametric magnetic resonance imaging is increasingly being recommended as standard imaging modality for prostate cancer diagnosis and staging. It comprises structural T2 and T1 sequences supplemented by functional imaging techniques, i.e. diffusion-weighted, dynamic contrast enhanced and spectroscopic imaging. Pre-biopsy multi-parametric magnetic resonance imaging is recommended for both detection and staging as it avoids biopsy artefact, and when normal, has a negative predictive value of 95% for significant cancer. Magnetic resonance imaging-guided prostate biopsy targets only area(s) considered to be suspicious for prostate cancer, hence resulting in improved accuracy. Dynamic contrast enhancing helps in the detection of cancer and for the assessment of extra-capsular extension, distal urethral sphincter and seminal vesicles involvement. The role of multi-parametric magnetic resonance imaging in follow-up of patients on active surveillance is also increasingly recognised. Its role is now further expanded to facilitate targeted therapies. This review focuses on the evolving role of multi-parametric magnetic resonance imaging in diagnosis and management of prostate cancer

Neurorobotics In Pakistan

Neurosurgery demands highest degree of accuracy and precision. A surgeon’s dexterity may be tested to the human limit when it comes to negotiating with delicate structures inside cranial cavity. Robotic devices can help surgeons cross these human limits and achieve better precision and less invasiveness. With enhanced accuracy, precision and dexterity it is possible to work through small corridors and trajectories causing minimal injury to the normal brain. Unfortunately however, robotics in neurosurgery is not as advanced as it is in other surgical specialties like gynecology and urology….

A Study on Bangladeshi Biscuit Industry: Consumer Perception Towards Packaging

The aim of this study is to figure out the packaging effects on consumers’ perception, which influences the consumers in buying Bangladeshi biscuits. The research is conducted in two phases; primary and secondary. The objective of both of the researches is to find out the buying pattern and consumer preferences for buying biscuits on the basis of packaging. A survey questionnaire was prepared and the number of respondents is 106. The survey questions contain both close and open ended questions. Primary analysis is collected through structured questionnaires and graphical interpretations are used for analysis functions. The study shows how the packaging of the product helps to build consumer brand image. It shows that the quality of the packaging has a direct effect on the perceived quality of the product. It also helps to promote the product through its packaging. The study emphasizes on consumer perception based on packaging of biscuits made in Bangladesh. Keywords: Packaging, Consumer Perception, Perceived Quality and price, Biscuits etc. DOI: 10.7176/EJBM/11-30-01 Publication date:October 31st 201

Establishment of a comprehensive epilepsy center in Pakistan: initial experiences, results, and reflections

Background. Developing countries, home to 80% of epilepsy patients, do not have comprehensive epilepsy surgery programs. Considering these needs we set up first epilepsy surgery center in Pakistan. Methods. Seventeen teleconferences focused on setting up an epilepsy center at the Aga Khan University (AKU), Karachi, Pakistan were arranged with experts from the University of Alberta Hospital, Alberta, Canada and the University of West Virginia, USA over a two-year period. Subsequently, the experts visited the proposed center to provide hands on training. During this period several interactive teaching sessions, a nationwide workshop, and various public awareness events were organized. Results. Sixteen patients underwent surgery, functional hemispherectomy (HS) was done in six, anterior temporal lobectomy (ATL) in six, and neuronavigation-guided selective amygdalohippocampectomy (SAH) using keyhole technique in four patients. Minimal morbidity was observed in ATL and, SAH groups. All patients in SAH group (100%) had Grade 1 control, while only 5 patients (83%) in ATL group, and 4 patients (66%) in HS group had Grade 1 control according to Engel\u27s classification, in average followups of 12 months, 24 months and 48 months for SAH, ATL, and HS, respectively. Conclusion. As we share our experience we hope to set a practical example for economically constrained countries that successful epilepsy surgery centers can be managed with limited resources

Intracranial cavernous angiomas

Objective: To describe the clinical presentation, diagnosis, and management of patients presenting with intracranial cavernous angiomas (CAs) at a tertiary care hospital in Pakistan.Study Design: Case series. Place and Duration of Study: Section of Neurosurgery, The Aga Khan University Hospital (AKUH), Karachi, from January 1990 to September 2008.Methodology: A retrospective case note review of all patients diagnosed with intracranial CAs at AKUH during the study period. The studied variables included patient demographics, clinical presentation, family history of intracranial CAs or other space occupying lesions, modality of diagnosis, management, and outcome. Results were described as frequency percentages.Results: During the review period, 18 patients (11 males and 7 females) were diagnosed with intracranial CAs. The median age at diagnosis was 28.5 years. The most common location of malformations was cerebrum (n=13) followed by brain stem (n=3), and cerebellum (n=2). Nine patients had multiple lesions. Family history was present in 2 patients. Seizures and focal neurologic deficits were the main clinical manifestations. The detection rate was 93.8% with magnetic resonance imaging, but less with angiography and computerized tomography. Ten cases were treated surgically; 8 were managed conservatively. The outcome was satisfactory except for one patient, who died within 6 months of diagnosis. Surgery was performed for gross haemorrhage, rapidly increasing neurologic deficits, and intractable or long-standing seizures.Conclusion: Cavernomas tend to occur at younger age in females than males. This data raises a possibility of a higher frequency of multiple cavernomas in Pakistani patients. The main clinical manifestations are seizures and focal neurologic deficits. MRI is most sensitive and specific neuroradiologic modality for detecting this vascular malformation

Surgical research: Exploring our history - navigating the future

In the fifteenth century, trained individuals called' barber surgeons' mastered the art of handling sharp instruments and performing basic surgical procedures. They even founded a 'United Company of Barber Surgeons' in 1540.1 Besides shaving and haircutting, they were trained to perform dental extractions and a few surgical procedures. Later in 1745, qualified doctors and surgeons came together and founded 'Company of Surgeons' in the UK, which later became the Royal College of Surgeons in London.2 This progression from anecdotal experiences of the guild of barbers to a formal society that helped the implementation of scientifically reasoned decisions by Royal College Surgeons was only possible because surgeons were able to appreciate the value of the evidence and incorporate it into their practices. Continuous..

Use of preoperative apparent diffusion coefficients to predict brain tumor grade

Introduction: The apparent diffusion coefficient (ADC) sequence is based on the diffusion properties of water molecules within tissues and correlates with tissue cellularity. ADC may have a role in predicting tumor grade for gliomas, and may in turn assist in identifying tumor biopsy sites. The purpose of this investigation was to assess the competence of preoperative ADC values in predicting tumor grades.Methods: This was a retrospective investigation. We calculated the ADC values in the areas of greatest restriction in solid tumor components, and we recorded the pattern of contrast enhancement. Pathology reports masked to the imaging results were reviewed independently. We calculated the differences in the mean values of different tumor grades and high-grade and low-grade gliomas. A receiver operator curve (ROC) analysis assessed the predictive potential of ADC values for low-grade gliomas.Results: Forty-eight cases of glioma were included in our study. We noted a statistically significant difference in the lowest mean ADC values for the tumor regions of Grade IV lesions (333.83 ± 295.47) compared with Grade I lesions (653.20 ± 145.07). On ROC analysis, we noted an area under the curve (AUC) of 0.80 for the lowest ADC value in the whole tumor region, which was a predictor of low-grade glioma with 95 % confidence interval (CI) of 0.675-0.926. The sensitivity of the lowest ADC value was 84.5% for high-grade lesions.Conclusion: Given our findings that the means of the lowest ADC value are significantly different between low and high-grade gliomas with an AUC of 0.80 for ADC as a predictor of low-grade lesions and a sensitivity of 84.5% for high-grade lesions, ADC values contain some predictive properties of tumor grading. ADC values may be a valuable parameter in the assessment and treatment of tumors

Depression and anxiety: A snapshot of the situation in Pakistan

Background: Depression is a great cause of morbidity around the world. Not one person seems to escape the hollow dread that the disease can bring forth.Aims: Although living in a large extended family which serves as a social support is common in Pakistan, why we still suffer from anxiety and depression just as often if not more than those in other countries?Method: We checked studies conducted in different localities of Pakistan over the past 10 years to find prevalence values of anxiety and depression. Results: The values of anxiety and depression ranging from 22% to as high as 60% in a given population high rates necessitate the spread of awareness and action against mental health issues.Conclusions: It is a mental disorder that can create numerous concerns in many aspects of the sufferer’s life. The disabling moods of depression can damage a person\u27s marriage, family relationships, friendships, job performance, and health. The longer depression persists, the more widespread the damage. Major depression can result in people shutting themselves off from the support of friends and family or striking out violently by verbally and physically attacking other