Microdiscectomy in Relieving Neurological Symptoms in Patients with Lumbar Disc Herniation

Introduction: Minimally invasive spine surgical approaches such as microdiscectomy have gained attention in recent years due to less tissue damage, speedy and acceptable neurological improvement with less complication.Objective: To assess efficacy of microdiscectomy in improving neurological status in patients with lumbar disc herniation.Material and Methods: A Quasi experimental study comprising 70 consecutive cases though non-probability purposive sampling technique of both the sexes admitted in Neurosurgery department, Mayo Hospital operated for the 1st time for any disc pathology with no other spinal lesions giving consent themselves or though legal guardians was conducted. Pain for leg and back was measured pre and post-operatively was done by VAS which had 42 days of follow up. Standard Neurological examinations were conducted pertaining to muscle power (by MRC), sensory status and SLR test pre and post-operatively. Variables according to their nature were expressed in the form of Mean ± SD, Median (Range) and Frequency (percentage). Mc Neumer’s chi square test and paired t test were used to see association between pre-operative and post-operative Neurological status (MRC grade, sensory status, SLR) depending on their nature viz: qualitative or quantitative respectively in SPSS version 15 and hence efficacy of microdiscectomy was assessed.Results: Out of 70 patients 74% were male and 26% were females. Mean ± SD of patients was 37.6 ± 13.0 years. Majority were Laborers after housewives. Illiterates, Poor lifting techniques were the most common characteri-stics in the respective headings of education and employment. Most common level of disc herniation was L4-L5, L5-S1 level (96%) where Prolapse and extrusion were most common MRI findings. As compared to pre-operative (3.4) muscle power 1st and 42nd day power were respectively 4.0 and 4.7 (p = 0.001). Pre-operatively only 32 (45.7%) had normal sensation which improved to 38 (54.3%) and 51 (72.9%) respectively in 1st and 42nd day of surgery (p = 0.001). Pre-operative mean SLR improved to 98.6 degrees in 1st POD and continued to be the same till 42nd day (p = 0.001). All the MRC findings, sensory status and SLR values in each post-operative days were statistically significant with the baseline by paired t test (p = 0.001).Conclusion: Microdiscectomy is one of the effective procedures which can be adopted for symptomatic unilateral lumber disc herniation with significant improvement in Neurological statuses

Roles of Sociodemographic Characteristics in Determining Neurological Outcomes in Patients with Lumbar Disc Herniation after Microdiscectomy

Introduction: Socio-demographic characteristics like age, gender, occupation has important role in causation of lumbar disc herniation which may even affect their recovery after the surgery. We want to explore the difference in improvement in Neurological status in terms of difference in socio-demographic characteristics of patients.Objective: To find variation in improvement in Neurological status in post microdiscectomy lumbar disc herniation patient stratified in terms of socio-demographic characteristics.Material and Methods: A Quasi experimental study comprising 70 consecutive cases though non-probability purposive sampling technique of both the sexes admitted in Neurosurgery department, Mayo Hospital operated for the 1st time for any disc pathology with no other spinal lesions giving consent themselves or though legal guardians was conducted. Pain for leg and back was measured pre and post-operatively was done by VAS which had 42 days of follow up. Standard Neurological examinations were conducted pertaining to muscle power (by MRC), sensory status and SLR test pre and post-operatively. Variables according to their nature were expressed in the form of Mean ± SD, Median (Range) and Frequency (percentage). Comparisons between categorical and continuous variables were done with the help of t test and one way ANOVA and comparison between both categorical variables was done with the help of chi square test in SPSS version 15.Results: Out of 70 patients 74% were male and 26% were females. Mean ± SD of patients was 37.6 ± 13.0 years. Majority were Laborers after housewives. Illiterates, Poor lifting techniques were the most common charac-teristics in the respective headings of education and employment. Most common level of disc herniation was L4-L5, L5-S1 level (96%) where Prolapse and extrusion were most common MRI findings. Improvement in motor power, sensory status was not dependent on any of socio-demographic characteristics. Improvement on SLR was associated with male genders on 1st (p = 0.03) as well as 7th, 21st and 42nd PODs (p = 0.001).Conclusion: Except gender in SLR value improvement, no other socio-demographic characteristics alter the improvement status in LDH patient after microdiscectomy

Prognostic Indicators in Patients with Severe Head Injury: A 2 Year Retrospective Experience at Mayo Hospital, Lahore

Introduction: Traumatic brain injury (TBI) is an important public health care problem in the western world and equally being pandemic in the developing world. It is one of the most common causes of death in young adults and it can affect people’s lives enormously. Since many years the prognostic indicators of severe head injury had been field of research. Knowing the factors responsible for poor prognosis and preventing them outcome of severe head injury can be improved.Material and Methods: A retrospective study was conducted analyzing past records of the patients in department of Neurosurgery, Mayo Hospital from Nov 2011 to Nov 2013 with diagnosis of severe head injury (Glasgow Come Scale < 9). All patients except the patients with brain death, associated poly trauma, spinal injuries were excluded from the study. Total sample of 236 either managed conservatively or surgical and observed in Intensive care unit were study population. Prognosis was assessed with Glasgow Outcome Score (GOS) on or before (if patient expired before 30 days) 30 post admission day. Age, GCS, CT findings, Pupils were compared with GOS to find probable predictors of prognosis. GOS of less than 4 was regarded as poor prognosis. Categorical variables like GCS, pupils, CT findings were presented in the form of frequency (percentage) whereas continuous variables like age were presented in the form of mean ± SD and median (range). Association between GOS and probable prognostic indictors was seen by chi square test.Results: Out of 236 patients, 188 were male and 48 were female. Mean ± SD age of patient was 32.8 ± 14.6 years. Age group 15 – 45 years had maximum number of patients. Road traffic accident was major cause of severe head injury and majority had GCS 3 after resuscitation. More than half of the patient had bilaterally reactive pupils, 10% patient had post traumatic fits and half of the patients had features of base of skull fracture. 208 (8%) patient had abnormal CT findings. 30% patient on CT scan had closed cisterns and half of the patients has midline shift of 1.5 – 3 mm. More than 35% cases had surgical lesions over CT scan. Patients with age group < 15 years, GCS < 4, with closed cisterns, with surgical lesions and with midline shift of more than 3 mm had 30 day GOS < 4, which is regarded as poor prognostic marker.Conclusion: Prognosis in patient with severe head injury is determined by age, presenting post resuscitation GCS, mode of injury, CT findings and surgical lesions

Prevalence of depression and associated risk factors among persons with type-2 diabetes mellitus without a prior psychiatric history: a cross-sectional study in clinical settings in urban Nepal

Background Diabetes is a growing health problem in South Asia. Despite an increasing number of studies exploring causal pathways between diabetes and depression in high-income countries (HIC), the pathway between the two disorders has received limited attention in low and middle-income countries (LMIC). The aim of this study is to investigate the potential pathway of diabetes contributing to depression, to assess the prevalence of depression, and to evaluate the association of depression severity with diabetes severity. This study uses a clinical sample of persons living with diabetes sequelae without a prior psychiatric history in urban Nepal. Methods A cross-sectional study was conducted among 385 persons living with type-2 diabetes attending tertiary centers in Kathmandu, Nepal. Patients with at least three months of diagnosed diabetes and no prior depression diagnosis or family history of depression were recruited randomly using serial selection from outpatient medicine and endocrine departments. Blood pressure, anthropometrics (height, weight, waist and hip circumference) and glycated hemoglobin (HbA1c) were measured at the time of interview. Depression was measured using the validated Nepali version of the Beck Depression Inventory (BDI-Ia). Results The proportion of respondents with depression was 40.3%. Using multivariable analyses, a 1-unit (%) increase in HbA1c was associated with a 2-point increase in BDI score. Erectile dysfunction was associated with a 5-point increase in BDI-Ia. A 10mmHg increase in blood pressure (both systolic and diastolic) was associated with a 1.4-point increase in BDI-Ia. Other associated variables included waist-hip-ratio (9-point BDI-Ia increase), at least one diabetic complication (1-point BDI-Ia increase), treatment non-adherence (1-point BDI-Ia increase), insulin use (2-point BDI-Ia increase), living in a nuclear family (2-point BDI-Ia increase), and lack of family history of diabetes (1-point BDI-Ia increase). Higher monthly income was associated with increased depression severity (3-point BDI-Ia increase per 100,000 rupees, equivalent US$1000). Conclusions Depression is associated with indicators of more severe diabetes disease status in Nepal. The association of depression with diabetes severity and sequelae provide initial support for a causal pathway from diabetes to depression. Integration of mental health services in primary care will be important to combat development of depression among persons living with diabetes

Prevalence of depression and associated risk factors among persons with type-2 diabetes mellitus without a prior psychiatric history: A cross-sectional study in clinical settings in urban Nepal

Background: Diabetes is a growing health problem in South Asia. Despite an increasing number of studies exploring causal pathways between diabetes and depression in high-income countries (HIC), the pathway between the two disorders has received limited attention in low and middle-income countries (LMIC). The aim of this study is to investigate the potential pathway of diabetes contributing to depression, to assess the prevalence of depression, and to evaluate the association of depression severity with diabetes severity. This study uses a clinical sample of persons living with diabetes sequelae without a prior psychiatric history in urban Nepal.Methods: A cross-sectional study was conducted among 385 persons living with type-2 diabetes attending tertiary centers in Kathmandu, Nepal. Patients with at least three months of diagnosed diabetes and no prior depression diagnosis or family history of depression were recruited randomly using serial selection from outpatient medicine and endocrine departments. Blood pressure, anthropometrics (height, weight, waist and hip circumference) and glycated hemoglobin (HbA1c) were measured at the time of interview. Depression was measured using the validated Nepali version of the Beck Depression Inventory (BDI-Ia).Results: The proportion of respondents with depression was 40.3%. Using multivariable analyses, a 1-unit (%) increase in HbA1c was associated with a 2-point increase in BDI score. Erectile dysfunction was associated with a 5-point increase in BDI-Ia. A 10mmHg increase in blood pressure (both systolic and diastolic) was associated with a 1.4-point increase in BDI-Ia. Other associated variables included waist-hip-ratio (9-point BDI-Ia increase), at least one diabetic complication (1-point BDI-Ia increase), treatment non-adherence (1-point BDI-Ia increase), insulin use (2-point BDI-Ia increase), living in a nuclear family (2-point BDI-Ia increase), and lack of family history of diabetes (1-point BDI-Ia increase). Higher monthly income was associated with increased depression severity (3-point BDI-Ia increase per 100,000 rupees, equivalent US$1000).Conclusions: Depression is associated with indicators of more severe diabetes disease status in Nepal. The association of depression with diabetes severity and sequelae provide initial support for a causal pathway from diabetes to depression. Integration of mental health services in primary care will be important to combat development of depression among persons living with diabetes. © 2013 Niraula et al.; licensee BioMed Central Ltd