Pakistan Journal Of Neurological Surgery

Re-Operation Rates after Burr-Hole Aspiration of Brain Abscess

2023-09-10T15:54:20+00:00

Objectives: To determine the re-operation rates after burr-hole aspiration of brain abscess.

Materials & Methods: The cross-sectional study was conducted from August 2022 to January 2023 at Jinnah Postgraduate Medical Centre (JPMC). A single burr-hole aspiration was used to treat a total of 64 cerebral abscess patients. Demographics, clinical presentation, predisposing variables, abscess location on imaging, and clinical outcomes were examined in medical records.

Results: The study included 64 patients with 60.9% males and 39.1% females. Patients most commonly presented with headache (90.6%) and fever (81.2%) with the majority of patients (92.1%) aged less than 30 years. The commonest source of infection was congenital heart disease (29.6%) in both aspiration and re-aspirations (46.6%). The parietal region was the most common location in both aspiration (32.8%) and re-aspiration (40%) of abscesses with the majority (40%) of re-aspirations done in the 3^rd postoperative month.

Conclusion: Single burr-hole aspiration is a safe and effective method for the management of brain abscesses. It is a less invasive procedure and is associated with minimal complications. The learning curve is short and safely be performed by neurosurgeons in training.

Keywords: Brain abscess, Burr-hole aspiration, Re-aspiration, Infection, Meningitis.

Incidence and Outcomes of Diastematomyelia in Spina Bifida Patients

2023-09-10T16:11:13+00:00

Objective: To determine the prevalence of diastematomyelia in spina bifida patients and to assess the efficacy of surgical intervention.

Material and Methods: This prospective research study was conducted at the Jinnah Postgraduate Medical Center in Karachi in the Neurosurgery department. We included 55 patients after fulfilling the inclusion criteria. All of the patients had craniospinal MRI, and the results, as well as any anomalies discovered, were noted for future reference during their therapy. Patients suffering from these diseases were treated surgically, which included sac excision and repair, cord detethering, and ventriculoperitoneal shunting. Throughout the postoperative period, all of these patients' outcomes were documented and assessed.

Results: The majority of patients were under 1 month old (29 patients, 53.70%), whereas 13 patients were between one month and 1 year old. The patients were 2.8 years old on average. There were 23 males (42.60%) and 32 females (58.18%). Dermal sinuses, hypertrichosis, and skin dimples (signs of spina bifida occulta), with prevalence rates of 5.55 percent, 3.70 percent, and 1.85 percent, respectively. Spina bifida occulta was less frequent (17 cases) than spina bifida aperta (37 occurrences). 33 patients (61.11%) have myelomeningocele, followed by meningocele in three (5.5%), lipomyelomeningocele in six (10.9%), diastematomyelia in six (10.9%), dermal sinus in two (3.70%), along with spinal lipoma in one (1.85%) instance.

Conclusion: The overall prevalence of Diastematomyelia in patients with spinal dysraphism is low. However vigilant assessment and management is crucial for optimal surgical benefit.

Keywords: Diastematomyelia, Spina Bifida, Spinal Dysraphism.

The Lower-Back Painkiller Challenge: Efficacy of Tramadol Versus Tapentadol

2023-09-10T16:15:45+00:00

Introduction: To reduce pain levels in people with lower back pain, the study looked at the comparative efficacy and tolerability of Tramadol and Tapentadol taken by oral route.

Materials & Methods: This comparative study consisted of a total of 126 patients divided into 2 groups, the Tapentadol and Tramadol groups for managing low back pain. Participants aged 18-60 with moderate or higher pain intensity were included. Data on pain intensity, adverse events, and patient-reported outcomes were collected at baseline, day 7, and day 14. Participants were randomly assigned to Tapentadol or Tramadol groups, receiving respective medications for 14 days. Data analysis involved t t-test to compare groups. Means and SD were also calculated.

Results: The mean age of the patients in the Tramadol group was 33.1 ± 19.1 and in the Tapentadol group was 37.6 ± 19.9, respectively. Sixty of the total participants were men and sixty-five were women. Participants were split equally between groups A and B, with 30 men and 33 women in group A and 30 men and 32 women in group B. The findings demonstrated that both medications considerably lessened moderate to severe chronic lower back pain (CLBP) patients' pain levels. At 28 days after the baseline, the mean VAS scores for groups A and B were 34.57 and 37.55, respectively.

Conclusion: According to the study's findings, these two medications effectively reduce pain in those with chronic lower back pain. Tapentadol is observed to be tolerated well and more effective than Tramadol.

The Text Neck Epidemic: Unveiling the Hidden Burden of Neck Pain among Medical Students

2023-09-22T09:28:54+00:00

Objective: Text neck syndrome, caused by prolonged mobile device use, is increasingly common, especially among teenagers. Neck pain is a significant public health issue, affecting 40% of the population. Little research has focused on musculoskeletal pain in children and adolescents, including medical students. A cross-sectional study is needed to investigate text neck syndrome among medical students and provide effective prevention and treatment strategies.

Materials & Methods: This cross-sectional study (n=508) utilized an online self-designed questionnaire incorporating the Neck Disability Index and the Nordic Musculoskeletal questionnaire. Descriptive and inferential statistics, including chi-square tests and p-value calculations using SPSS version 25, were employed. The study aimed to examine neck pain prevalence and consequences to inform interventions for improved health outcomes.

Results: Among the 508 participants, 69.4% reported past neck pain. Females, those with higher stress levels, individuals using laptops/tablets for four or more hours, and medical students studying for 4 to 6 hours daily had higher neck pain prevalence (52.0%, 88.2%, 61.9%, and 57.5% respectively). Prevalence remained consistent between pre-clinical and clinical-year medical students. Multivariate analysis revealed a significant association between neck pain and longer mobile phone use, extended study hours, and lack of exercise. Only 16% sought treatment from a chiropractor/physiotherapist for their neck pain.
Conclusion: The study emphasizes the importance of better education on neck pain prevention and seeking professional help. Adding exercise to daily routines can also be extremely helpful in preventing neck pain. To fully understand the effect on medical students and develop effective interventions