Pakistan Journal Of Neurological Surgery <p>Pakistan Journal of Neurological surgery (PJNS) is an official Journal of the Pakistan Society of Neurosurgeons (PSN), Department of Neurosurgery, Punjab Insitute of Neurosciences (PINS) Lahore Pakistan. It has been in print since 1998.</p> <p>Journal archives: (<a href=""></a>)</p> <p>Journal Email:</p> <p>Publisher link: (<a href=""></a>)</p> <p>Email:</p> Pakistan Society of Neurosurgeons (PSN). Website: Email, Email: en-US Pakistan Journal Of Neurological Surgery 1995-8811 <p>The work published by PJNS is licensed under a Creative Commons Attribution-<a href="" target="_blank" rel="noopener">NonCommercial 4.0 International (CC BY-NC 4.0).</a> Copyrights on any open access article published by Pakistan Journal of Neurological Surgery are retained by the author(s).</p> Targeting cytokine- therapy to alleviate neuropathic pain caused by the spinal damage Saman Shahid Muhammad Anwar Chaudary Copyright (c) 2024 Saman Shahid, Muhammad Anwar Chaudary 2024-03-09 2024-03-09 28 1 X XII 10.36552/pjns.v28i1.969 Complications of Post-Traumatic Spinal Surgery <p><strong>Objective:</strong> The study aimed to evaluate the frequency and complications of post-traumatic spinal surgeries.</p> <p><strong>Materials and Methods:</strong> A prospective observational study was conducted at JPMC for six months and included 55 patients presenting with post-traumatic spinal injuries who were operated on. Information on the patient’s demographics, clinical findings, radiological findings, type of surgical procedure, and postoperative complications were recorded. A chi-square test was employed to compare difficulties with demographic characteristics.</p> <p><strong>Results:</strong> Our study comprised of patients with an age of 39.55+/-6.19 years; of them, 72.7 percent were males, and overall complications occurred in 30.9 percent of patients, which included wound infection (10.9%), CSF fistula (3.6%), wound dehiscence (1.8%), pneumonia (3.6%), heart arrhythmia (1.8%), lung congestion (1.8%), instrumental loosening (1.8%), postoperative visual loss (1.8%), and diathermy burns (3.6%).</p> <p><strong>Conclusion:</strong> 30.9 percent of patients operated for spinal traumatic injuries developed complications. A few of these complications are dreaded and need to be communicated to patients/attendants and necessary steps should be taken to prevent them.</p> Mohammad Daniyal Mumtaz Iram Bokhari Tanweer Ahmed Raheel Gohar Sanam Daniyal Sehrish Altaf Copyright (c) 2024 Mohammad Daniyal Mumtaz, Iram Bokhari, Rabail Akbar Qazi, Tanweer Ahmed, Raheel Gohar, Sanam Daniyal, Sehrish Altaf 2024-03-01 2024-03-01 28 1 1 8 10.36552/pjns.v28i1.882 Comparison of Transpedicular Fixation with Fusion with Transpedicular Fixation Alone in Spondylolisthesis <p><strong>Objective:</strong>&nbsp;&nbsp;This research evaluated the clinical outcomes of two surgical methods used to treat degenerative lumbar spondylolisthesis in the short term. Fixation through the pedicles with or without inter-body fusion. Utilizing a spinal cage for first- and second-degree condition patients is one of the two methods being compared.</p> <p><strong>Materials &amp; Methods:</strong>&nbsp;&nbsp;A total of 28 individual lumbosacral spondylolisthesis were incorporated in the research. Based on the surgical method and fixation technique employed for their care, they were split into two groups at random. Posterolateral intertransverse bone fusion, transpedicular screw fixation, and posterior lumbar decompression operations were performed on Group A. Conversely, Group B underwent posterolateral interbody fusion via the implantation of interbody cages, transpedicular screws, and posterior decompression.</p> <p><strong>Results:</strong>&nbsp;&nbsp;There existed no statistically significant association in terms of the two groups that is intraoperative and postoperative complications, clinical outcomes, and patient satisfaction, while noteworthy significance was observed about blood loss and rates of post-operative fusion.</p> <p><strong>Conclusion:</strong>&nbsp;&nbsp;Incorporating a spinal implant in conjunction with transverse body fusion results in superior fusion rates and post-operative clinical improvements, while intertransverse bony fusion alone yields comparable patient satisfaction with reduced surgical times.</p> Muhammad Idris Khan Adnan Munir Sajjad Ullah Farooq Sherzada Haider Ali Khan Syeda Farwah Copyright (c) 2024 Muhammad Idris Khan, Adnan Munir, Sajjad Ullah, Farooq Sherzada, Haider Ali Khan, Syeda Farwah 2024-03-09 2024-03-09 28 1 9 16 10.36552/pjns.v28i1.952 Anterior Lateral Approach for Anterior Decompression, Corpectomy, and Fixation with Webb Morley Procedure for Dorsolumbar Spinal Fracture <p><strong>Objective:</strong>&nbsp;&nbsp;Efficacy of anterolateral approach Webb Morley procedure in a low-income country.</p> <p><strong>Materials &amp; Methods:</strong>&nbsp;&nbsp;A descriptive study was conducted at the Department of Neurosurgery, Liaquat University of Medical and Health Sciences, Jamshoro. Patients of any gender presented to us with dorsal or lumber injury, plus a presentation on X-ray / MRI as spinal fractures having bone fragments pressing the cord, especially from the anterior side were included in the study. The assessed tool was based on clinical findings of Frankel's grading.</p> <p><strong>Results:</strong>&nbsp;&nbsp;We had 64 patients, who had dorsal and lumber fractures and went through the procedure of Webb Morley 43 were male and 31 were female patients The male-to-female ratio was 2:1 and the mean age was 39±3 yrs. with a median age was 42.5yrs. Fall (n = 34, 53.12%) was the common cause, road traffic accidents were (n = 16, 25%), fall of heavy objects (n = 11, 17.18%), and assault (n = 03, 4.68%).</p> <p><strong>Conclusion:</strong>&nbsp;&nbsp;Based on the current study of our Centre the anterior lateral approach for lower dorsal and upper lumber level with decompression and fixation with Webb-Morley procedure is a safe and effective method.</p> Aurangzeb Kalhoro Vashdev Khimani Muhammad Hamid Ali Mubarak Hussain Mahesh Kumar Luhano Copyright (c) 2024 Aurangzeb Kalhoro, Vashdev Khimani, Muhammad Hamid Ali, Mubarak Hussain, Mahesh Kumar Luhano 2024-03-01 2024-03-01 28 1 17 23 10.36552/pjns.v28i1.953 Coccydynia: Do Corticosteroid Injections Hit the Mark Over NSAIDs? <p><strong>Objective:</strong>&nbsp;&nbsp;Coccydynia is a medical ailment that causes discomfort at the coccyx, or tailbone, which can make it difficult for a person to go about their regular business. Nonsteroidal anti-inflammatory medications taken orally, and corticosteroid injections are two potential treatments for Coccydynia. However, the most effective and appropriate course of treatment for this condition must be identified. The study aimed to compare the effectiveness of Corticosteroid Injection vs. NSAID for pain relief in Coccydynia patients.</p> <p><strong>Materials &amp; Methods:</strong>&nbsp;&nbsp;A total of 47 patients with idiopathic coccydynia were allocated to receive either oral NSAIDs plus a tailbone cushion (n=24) or fluoroscopic corticosteroid injection (n=23). Pain levels were measured by a visual analog scale at baseline and 2-, 3-, and 4-months post-treatment. Chi-square and t-tests were used to compare treatment efficacy.</p> <p><strong>Results:</strong>&nbsp;&nbsp;The two treatment groups showed no significant differences. Both groups demonstrated reduced pain over time, with no significant difference between injections and NSAIDs (p=0.209). While injections provided more relief for mild pain, NSAIDs showed better results for no-pain patients. Overall mean pain scores were similar between groups. The treatments differed in effectiveness for certain pain levels but exhibited comparable efficacy in reducing overall coccyx pain. The hypothesis of differing treatment efficacy was not supported.</p> <p><strong>Conclusion:&nbsp;&nbsp;</strong>As a result, it can be considered a viable alternative therapy for patients who have difficulty adhering to oral medication regimens due to its one-time administration and affordable cost. To achieve optimal therapeutic outcomes, it is critical to choose the appropriate patients.</p> Naveed Gul Kashif Ramooz Yasir Shehzad Shafiq ur Rehman Jamil Faraz Mehmood Sania Bhatti Eesha Yaqoob Saad Javed Copyright (c) 2024 Naveed Gul, Kashif Ramooz, Yasir Shehzad, Shafiq ur Rehman Jamil, Faraz Mehmood, Sania Bhatti, Eesha Yaqoob, Saad Javed 2024-03-01 2024-03-01 28 1 24 31 10.36552/pjns.v28i1.954 The Prevalence of Post-operative Complications Following Meningomyelocele Repair <p><strong>Objective:</strong>&nbsp;&nbsp;To assess the incidence of post-operative complications after meningomyelocele repair in patients presenting with Meningocele.</p> <p><strong>Materials &amp; Methods:</strong>&nbsp;&nbsp;All the patients presenting with meningocele and myelomeningocele, age between 1 day to 5 years, both genders and patients with ASA grade I and II were included. All the baseline /routine hospital investigation was done, the lesions were assessed for age, size duration of symptoms, and location and were checked for cerebrospinal fluid leaks. The presence of associated abnormalities was evaluated. The patients were given antibiotics as per protocol before and after surgery to prevent infection. All patients were observed closely in the post-operative period for development and timely management of any complications.</p> <p><strong>Results:</strong>&nbsp;&nbsp;Among 145 children, 9% of children had defects in the cranio cervical and 91% of children had defects in the lumbosacral. 15% children had myelomeningocele size ?3 cm while 85% of children had myelomeningocele size &gt;3 cm. 83% of children were male and 17% of children were female. 18% of children had wound infection, 6% of children had wound dehiscence and 26% of children had CSF Leak. Stratification of postoperative complications concerning age, gender, location of NTD (cranio cervical/lumbo sacral), size (? 3 cm &amp; &gt; 3 cm), duration of symptoms (? 1 month &amp; 1 month), malnourished (yes/no) showed the insignificant differences.</p> <p><strong>Conclusion:</strong>&nbsp;&nbsp;The frequency of post-operative complications i.e. wound infection was 18%, wound dehiscence was 6% and CSF Leak was 26% after meningomyelocele repair in patients presenting with Meningocele.</p> Sahibzada Haseeb Ahmed Adnan Khan Muhammad Hassan Abid Muhammad Daud Maria Nisar Muhammad Kashif Jamal Copyright (c) 2024 Sahibzada Haseeb Ahmed, Adnan Khan, Muhammad Hassan Abid, Muhammad Daud, Maria Nisar, Muhammad Kashif Jamal 2024-03-01 2024-03-01 28 1 39 49 10.36552/pjns.v28i1.956 Analyzing Spondylolisthesis in Patients with Proven Spinal Stenosis Using Plain X-Rays and Supine MRI: A Retrospective Study of Five Years <p><strong>Objective:</strong>&nbsp;&nbsp;This study aimed to evaluate the frequency of cases in which patients were diagnosed with lumber spinal stenosis using MRI and later were categorized as having spondylolisthesis when evaluated through plain X-rays.</p> <p><strong>Material and Methods:</strong>&nbsp;&nbsp;This retrospective study was conducted at the Ali Institute of Neurosciences, Irfan General Hospital from 2017 to 2022. All those patients were included in the study who underwent lumbar spine MRI between 2017 and 2022 with evident findings of spinal stenosis, patients who subsequently underwent plain X-rays of the lumbar spine, and patients with available medical records and imaging data for review. While all those were excluded who did not undergo plain X-rays following MRI. Data was analyzed using SPSS version 22. Descriptive statistics, such as frequencies and percentages, were used to summarize the categorical data while mean and standard deviation were reported for numerical data.</p> <p><strong>Results:</strong>&nbsp;&nbsp;The mean age of the study population was 45 years, with a range from 26 to 65. Among the patients included in the study (1156), 380 were the cases missed initially on MRI and later diagnosed with spondylolisthesis on plain X-rays. This corresponds to a frequency of 33% of misdiagnosed spondylolisthesis cases based on MRI.</p> <p><strong>Conclusion:</strong>&nbsp;&nbsp;This study highlights that the frequency of missed spondylolisthesis cases on lumbar spine MRI was one-third of the cases and the importance of additional imaging modalities, such as plain X-rays, for accurate diagnosis.</p> Mumtaz Ali Akram Ullah Ramzan Hussain Hanif Ur Rahman Sajid Khan Amjad Ali Abdul Haseeb Sahibzada Copyright (c) 2024 Mumtaz Ali, Akram Ullah, Ramzan Hussain, Hanif Ur Rahman, Sajid Khan, Amjad Ali, Abdul Haseeb Sahibzada 2024-03-01 2024-03-01 28 1 32 38 10.36552/pjns.v28i1.955 Improved Outcomes in the First 72 Days of Medical Management of Cerebral Abscess in Post-Traumatic Patients <p><strong>Objective:</strong>&nbsp;&nbsp;We studied the results of medical and surgical management of cerebral abscesses in post-traumatic patients after road traffic accidents (RTA).</p> <p><strong>Material and Methods:</strong>&nbsp;&nbsp;It is a comparative observational study of 40 patients in Lahore General Hospital/Punjab Institute of Neurosciences (PINS), Lahore. Our patients were presented with fever, vomiting, headache, fits, etc.</p> <p><strong>Results:</strong>&nbsp;&nbsp;The age range of our patients was 15-60 years. The mean age of our patients was 40 years, we gave medical management along with bed rest to all 40 patients (100%) for 3 weeks. Anti-epileptic, mannitol, antibiotics, and painkillers were the medication that was given. Our 30 (75%) patients who were managed medically, had headaches, and vomiting which did not resolve for we had to operate on the patients. Surgical management was done in 10 (25%) patients. Surgical excision was done in 9 (97%) patients and burr hole evacuation was done in 1 (3%) patients. All patients who recovered from medical management are those who were treated within 1<sup>st</sup> week after the occurrence of cerebral abscess.</p> <p><strong>Conclusion:</strong>&nbsp;&nbsp;The results of medical management of cerebral abscess are better than surgical management if patients are treated during the first week after the occurrence of cerebral abscess. With good antibiotics etc.</p> Rana Zubair Mahmood Mukhtiar Ahmed Lakho Muhammad Ajmal Khan Ayaz Shahzeb Ahmad Usama Mansoor . Yasin Khan Muhammad Anwar Copyright (c) 2024 Rana Zubair Mahmood, Mukhtiar Ahmed Lakho, Muhammad Ajmal Khan Ayaz, Shahzeb Ahmad, Usama Mansoor, . Yasin Khan, Muhammad Anwar 2024-03-01 2024-03-01 28 1 81 85 10.36552/pjns.v28i1.959 Results of Comparison of Burr Hole Evacuation Versus Surgical Excision of Multiloculated Subdural Empyema <p><strong>Objectives</strong>:&nbsp;&nbsp;We studied the results of results of comparison of burr hole evacuation versus surgical excision of multiloculated subdural empyema.</p> <p><strong>Material and Methods:</strong>&nbsp;&nbsp;A total of 40 patients were admitted with the disease. We will analyze the results of 20 patients. It is a comparative observational study of 20 patients treated at the Punjab Institute of Neurosciences (PINS), Lahore. Presenting complaints of patients were fever, vomiting, headache, fits, etc.</p> <p><strong>Results:</strong>&nbsp;&nbsp;The age range was 15 – 60 years. The mean age was 36 years, Medical management was given to 20 patients (100%) for 3 weeks. All patients were advised to take complete bed rest for 3 weeks. Anti-epileptic, Mannitol, antibiotics, and painkillers were the medications that were given. In this study, we will focus on the 20 patients treated surgically, and the analysis of 20 patients will be presented in complete detail. Our 10 (50%) patients were managed by burr hole evacuation of multiloculated subdural empyema. Surgical excision was done in 10 (50%) patients with multiloculated subdural empyema. Burr hole evacuation was done in patients who were old and unfit for surgery. Recurrence occurred in 5 (25%) patients who underwent management with burr hole evacuation and 1 (5%) patient in the excision group.</p> <p><strong>Conclusion:</strong>&nbsp;&nbsp;The results of surgical excision of multiloculated subdural empyema are better than burr hole evacuation if the patient is for surgical excision.</p> Rana Zubair Mahmood Mukhtiar Ahmed Lakho Muhammad Ajmal Khan Ayaz Shahzeb Ahmad Usama Mansoor Yasin Khan Muhammad Anwar Copyright (c) 2024 Rana Zubair Mahmood, Mukhtiar Ahmed Lakho, Muhammad Ajmal Khan Ayaz, Shahzeb Ahmad, Usama Mansoor, Yasir Khan, Muhammad Anwar 2024-03-09 2024-03-09 28 1 74 79 10.36552/pjns.v28i1.958 Transpedicular Fixation for the Alleviation of Neurogenic Claudication and Backache in the Management of Spondylolisthesis <p><strong>ABSTRACT</strong></p> <p><strong>Objective: </strong>To evaluate the surgical outcome of transpedicular fixation for degenerative spondylolisthesis in terms of alleviation of neurogenic claudication and backache</p> <p><strong>Materials &amp; Methods: </strong>This prospective observational study was carried out at the department of Neurosurgery, Medical Teaching Institute, Bacha Khan Medical Complex, Swabi over a period of two years i.e. from 1<sup>st</sup> July, 2021 to 30<sup>th</sup> June, 2023. Patients presenting with backache and neurogenic claudication and having spondylolisthesis on radiological investigations were subjected to transpedicular fixation and evaluated for improvement in symptoms and fusion rate at 6 months follow up.</p> <p><strong>Results: </strong>60 patients participated in the study. Mean age was 41.42±7.29 years and 63.3% were females. L5-S1 was the most common level involved in 40% of the patients and 50% of the patients had Grade 2 spondylolisthesis. There was significant reduction in mean back-pain score on NRS post-operatively (Pre-op was 6.73±1.94 Vs. post-op was 1.57±1.34, P value = 0.00). The neurogenic claudication reduced from 88.3% Vs. 10% (P value = 0.00). The fusion rate was 90% at 6 month follow up.</p> <p><strong>Conclusion: </strong>Transpedicular fixation for degenerative spondylolisthesis is the most effective procedure in terms of relief of neurogenic claudication and backache.</p> Sajjad Ahmad Mian Iftikhar ul haq Copyright (c) 2024 Sajjad Ahmad, Mian Iftikhar ul haq 2024-03-01 2024-03-01 28 1 50 57 10.36552/pjns.v28i1.949 Outcome of Dual Stability and Decompression through Single Posterior Approach in Tuberculosis of Dorsolumbar Spine <p><strong>Objective:</strong>&nbsp;&nbsp;To evaluate the outcome of dual stability and decompression through a single posterior approach in patients with tuberculosis of the dorsolumbar spine in terms of Oswestry Disability Index and Frankel Neurological Grading.</p> <p><strong>Material and Methods:</strong>&nbsp;&nbsp;It was a prospective cohort study involving 34 patients with tuberculosis of the dorsolumbar spine who underwent dual stability and decompression through a single posterior approach. Follow-ups were done at 2<sup>nd</sup>, 6<sup>th</sup>, 12<sup>th</sup> and 16<sup>th</sup> weeks. The outcome was assessed using the Oswestry Disability Index and Frankel Neurological Grading.</p> <p><strong>Results:</strong>&nbsp;&nbsp;In 34 patients, the mean age was 36.59±13.51 years. There were 20 (58.8%) males and 14 (41.2%) females. There were 9 (26.5%) patients who had dorsal spine tuberculosis, while lumbar spine TB and dorso-lumbar spine TB were diagnosed in 13 (38.2%) and 12 (35.3%) patients respectively. The mean surgery time was 4.20±0.66 hours. According to the Oswestry Disability Index, before surgery, 2 (5.9%) patients had minimal disability while after 16 weeks of follow-ups, these numbers increased to 23 (67.7%) showing statistically significant improvements. According to Frankel Neurological Grading, before surgery, 3 (8.8%) patients had normal function while after 20 weeks of follow-up following surgery, 20 (58.9%) had normal functions.</p> <p><strong>Conclusion:</strong>&nbsp;&nbsp;Dual stability and decompression through a single posterior approach were found to have good functional and fusion outcomes according to the Oswestry Disability Index and Frankel Neurological grading.</p> Waqar Ahmed Khizer Ghalib Adeel Hamid Muhammad Shakeel Muhammad Qasim Muhammad Khalid Syed et al. Copyright (c) 2024 Waqar Ahmed, Khizer Ghalib, Adeel Hamid, Muhammad Shakeel, Muhammad Qasim, Muhammad Khalid Syed et al. 2024-03-09 2024-03-09 28 1 110 117 10.36552/pjns.v28i1.966 Evaluation of Outcomes and Complications of Sphenoid Wing Meningiomas in Tertiary Care Hospital of KPK <p><strong>Objective:</strong> The objective of this study is to evaluate the outcomes and complications associated with pterional craniotomy and extended pterional craniotomy for the resection of Sphenoid Wing Meningiomas.</p> <p><strong>Material and Methods:</strong> A prospective study was conducted on 34 patients at the Neurosurgery department, Prime Teaching Hospital, Pakistan, and Ali Institute of Neurosciences. We examined 34 recently diagnosed cases of sphenoid wing meningiomas, selected through a total enumerative sampling method. Diagnosis of these meningiomas was confirmed by comprehensive neurological assessment and imaging studies. Various surgical techniques, such as Pterional and Extended Pterional approaches, were employed in the procedures. Assessment of clinical outcomes and complications was conducted during follow-up evaluations. A total of 34 patients diagnosed with sphenoid wing meningiomas were covered as the study’s target population. All patients met certain criteria to be included in the study.</p> <p><strong>Results:</strong> 25 (73.6%) of the total number of patients were females and 9 (26.4%) were males. The mean age at diagnosis was 47 ± 5 years. Presenting symptoms included headache, seizures, visual loss, motor deficit, and cognitive decline. Surgical techniques used in tumor resection were pterional craniotomy and extended pterional craniotomy. Post-operative evaluation after follow-up studies showed that the symptoms reversed, including a reduction in headache, vision restoration, seizure control, and motor and cognitive function improvement.</p> <p><strong>Conclusion:</strong> Pterional approach and extended Pterional approaches related to SWM removal are satisfactory rates of an acceptable and safe surgical treatment with satisfactory results concerning the total resection rate and related clinical improvement.</p> Aafaq Ahmad Qarnain Mumtaz Ali Akramullah Sajid Khan Zubair Bashir Copyright (c) 2024 Aafaq Ahmad Qarnain, Mumtaz Ali, Akramullah, Sajid Khan, Zubair Bashir 2024-03-09 2024-03-09 28 1 118 127 10.36552/pjns.v28i1.909 The Chat GPT Develops Multiple Choice Questions (MCQs) for Postgraduate Specialty Assessment – A Reality or a Myth? <p><strong>Objective:</strong> Multiple Choice Questions (MCQs) are a valuable assessment tool, but creating them to match learning goals needs experts. AI, like ChatGPT, might offer an alternative. A study showed MCQs made for medical programs by ChatGPT and the faculty. This study compares faculty-made MCQs to ChatGPT-made ones for a post-grad program.</p> <p><strong>Material &amp; Methods:</strong> Specific learning objectives of a module from a medical and surgical program were extracted. One mid-level faculty and the AI software developed MCQ from each learning objective with a clinical scenario. Two subject and medical education experts from each specialty were blinded and given a standardized online tool to rate the technical and content quality of the MCQs in five domains; the item, vignette, question stem, response options, and overall quality.</p> <p><strong>Results:</strong> For the medicine and allied specialty, 23 MCQs in each set were assessed. There was no significant difference between each variable, the overall quality of MCQs, or the odds of the decision to accept the questionnaire. Two sets of 24 MCQs were assessed for the surgical and allied specialty. There was no difference between the domains for “Item” and “Vignette”. For the domain “question stem”, MCQs developed by faculty were more grammatically correct (p-value 0.02). There was no difference in the quality or odds of the decision to accept.</p> <p><strong>Conclusions:</strong> AI's impact on education is undeniable. Our findings indicate that in specific areas, faculty outperformed ChatGPT, though overall question quality was comparable. More research is necessary, but ChatGPT could potentially streamline assessment development, saving faculty substantial time.</p> Faridah Amir Ali Salman Yousuf Sharif Madiha Ata Nirali Patel Muhammad Rafay Hasan Raza Syed Saima Perwaiz Iqbal Copyright (c) 2024 Faridah Amir Ali, Salman Yousuf Sharif, Madiha Ata, Nirali Patel, Muhammad Rafay, Hasan Raza Syed, Saima Perwaiz Iqbal 2024-03-09 2024-03-09 28 1 142 149 10.36552/pjns.v28i1.963 Frequency of Intraventricular Haemorrhage (IVH) in Early Preterm Neonates Born at DHQ Teaching Hospital Gujranwala <p><strong>Objective:</strong>&nbsp;&nbsp;The reported frequency of intraventricular hemorrhage in preterm neonates varied greatly. We determined the frequency of IVH in premature neonates in the pediatric unit of DHQ Hospital Gujranwala.</p> <p><strong>Materials &amp; Methods:</strong>&nbsp;&nbsp;This cross-sectional study involved 282 very low birth weight neonates (birth weight &lt;1500 gm.) delivered very preterm (gestational age &lt;32 weeks). These neonates were assessed for intraventricular hemorrhage which was diagnosed on cranial ultrasound performed on 3<sup>rd</sup> day of life. The frequency of IVH was compared across various attributing factors i.e., gestational age at delivery, gender, birth weight, mode of delivery, and maternal antenatal steroids.</p> <p><strong>Results:</strong>&nbsp;&nbsp;The mean gestational age at delivery was 27.5±2.3 weeks while the mean birth weight was 1120.5±190.2 grams. 172 (61.0%) neonates were delivered vaginally while C-section was performed in 110 (39.0%) cases. 263 (93.3%) mothers received antenatal steroids. Intraventricular hemorrhage was diagnosed in 64 (22.7%) early preterm neonates. The frequency of IVH increased significantly with increasing prematurity; 24-27 weeks vs. 28-31 weeks (28.9% vs. 17.0%; p-value=0.017), decreasing birth weight; &lt;1 kg vs. ?1kg (31.8% vs. 18.6%; p-value=0.014) and lack of antenatal steroids (52.6% vs. 20.5%; p-value=0.001).</p> <p><strong>Conclusion:</strong>&nbsp;&nbsp;The intraventricular hemorrhage was observed in 22.7% of early preterm neonates which advocates routine screening of preterm neonates for IVH so that timely identification and anticipated management may improve the outcome of such neonates. We also identified increasing prematurity, decreasing birth weight, and lack of antenatal steroids as potential attributing factors that can be used for risk stratification and management planning of such cases.</p> Azher Abbas Shah Saima Umar Aysha Ghayyur Muhammad Arsalan Cheema Zulfiqar Ali Saqib Meraj Aslam Bajwa Saman Shahid Syed Shahzad Hussain Copyright (c) 2024 Azher Abbas Shah, Saima Umar, Aysha Ghayyur, Muhammad Arsalan Cheema, Zulfiqar Ali, Saqib Meraj Aslam Bajwa, Saman Shahid, Syed Shahzad Hussain 2024-03-09 2024-03-09 28 1 128 134 10.36552/pjns.v28i1.968 Demographic Profiling of Patients on Drug Dependence Admitted in Punjab Institute of Mental Health, Addiction Treatment Centre, Lahore <p><strong>Objective:</strong>&nbsp;&nbsp;Drug dependence is a global public health concern, affecting millions and contributing to widespread negative consequences. This research delves into the demographic characteristics of drug abuse patients at the Punjab Institute of Mental Health (PIMH) Addiction Treatment Center in Lahore, Pakistan.</p> <p><strong>Materials and Methods:</strong>&nbsp;&nbsp;Utilizing a cross-sectional research-based descriptive design, the study employs purposive sampling and a comprehensive questionnaire to collect data from 100 drug abusers. The analysis considered age, gender, socioeconomic status, residential area, occupation, education, marital status, and family system, shedding light on the diverse factors contributing to the drug dependence of the patients.</p> <p><strong>Results:</strong>&nbsp;&nbsp;The results revealed a diverse age range (18-80 years) among participants (M=33,4, SD=10.3), most of them belonging to lower (34%) and middle class (39%); 67 respondents residing in the urban region and 32 from the rural areas. Heroin (32.3%) was reported to be the most consumed substance while cannabis (25.8%) and crystal methamphetamine (16.4%) were the second and third respectively taken mostly through sniffing. Among the reasons for using drugs, peer pressure came out to be the most reported cause.</p> <p><strong>Conclusion:</strong>&nbsp;&nbsp;The findings underscored the complexity of drug dependence, necessitating targeted interventions that consider demographic variations that are crucial for effective treatment and prevention strategies. The study contributed valuable knowledge to the existing scientific understanding of drug dependence, paving the way for more informed public health initiatives.</p> Farakh Abdullah Aqila Unbrin Muhammad Ahmad Faisal Tahira Arshad Copyright (c) 2024 Farrakh Abdullah, Farrakh Abdullah, Aqila Unbrin, Muhammad Ahmad Faisal, Tahira Arshad 2024-03-09 2024-03-09 28 1 94 103 10.36552/pjns.v28i1.965 Efficacy Of Short-Segment Transpedicular Fixation for Thoracolumbar Fractures in Terms of Improvement in Neurological Status <p><strong>Objective:</strong> To determine the efficacy of short-segment transpedicular fixation for thoracolumbar fractures in terms of improvement in neurological status.</p> <p><strong>Materials and Methods:</strong> A prospective observational research was conducted at Bacha Khan Medical Complex, Swabi, Section of Neurosurgery. Patients having traumatic thoracolumbar fractures with neurological deficits were subjected to short-segment transpedicular fixation and evaluated for post-operative improvement in neurological status at a 6-month follow-up.</p> <p><strong>Results:</strong> 48 patients participated in the study. Mean age was 35.69±8.22 years and 60.4% were males. History of falls was the most common mechanism responsible for spinal injury i.e. 56.3%. D12 vertebra was fractured in 43.8% of patients. The leading type of fracture was, AO type B in 37.5% of patients. 23 (47.9%) of the patients showed one or more grade improvements in their neurological status on the ASIA scale at 6-month follow-up. Surgical site infection was the common postoperative complication (8.3%).</p> <p><strong>Conclusion:</strong> Short-segment transpedicular fixation is an effective procedure for traumatic thoracolumbar fractures in terms of improvement in neurological status.</p> Sajjad Ahmad Mian Iftikhar ul haq Copyright (c) 2024 Sajjad Ahmad, Mian Iftikhar ul haq 2024-03-01 2024-03-01 28 1 58 64 10.36552/pjns.v28i1.948 Prevalence and Impact of Hyponatremia on Hospital Stay in Subarachnoid Hemorrhage Patients <p>Introduction: This research study was designed to ascertain the prevalence of hyponatremia and its impact on the duration of hospital stay in patients with subarachnoid hemorrhage (SAH) in our local population.</p> <p>Materials &amp; Methods: We carried out this study at the Department of Neurology, Lady Reading Hospital Peshawar for 1 year, which started in March 2022. The total sample size was 90 and a consecutive sampling method was used for sampling the study population<strong>. </strong>Patients aged between 20 to 70 years and who had a diagnosis of SAH were involved in included in the study, while those with confounding conditions were put in the exclusion criteria.</p> <p>Results: Our study showed a high prevalence of hyponatremia (42%) in patients with SAH, and it was associated with a prolonged duration of hospital stays of 8.2 days (SD±3.5). There was a statistical difference in the mean hospital stay between the patients with hyponatremia and those without hyponatremia (t=3.2, p&lt;0.002).</p> <p>Conclusion: Our study reported a high prevalence of hyponatremia in SAH patients and has established an association with longer hospital stays. Thus, identifying and managing patients of hyponatremia with SAH promptly should be emphasized for better results and to lessen the financial burden on families and the hospital.</p> Zeeshan Ullah Ihtisham Ullah Imad Majeed Muhammad Fawad Khan Saad Ali Hina Nawaz Asim Ali Shah Copyright (c) 2024 Zeeshan Ullah, Ihtisham Ullah, Imad Majeed, Muhammad Fawad Khan, Saad Ali, Hina Nawaz, Asim Ali Shah 2024-03-09 2024-03-09 28 1 135 141 10.36552/pjns.v28i1.932 The Impact of Time till Surgery on Post-Operative Outcome of Traumatic Extradural Hematoma <p><strong>Objective:&nbsp;&nbsp;</strong>Traumatic extradural hematoma (EDH) is a common complication of head injuries, predominantly affecting the working-age male population due to increased outdoor activity. This study aimed to assess the impact of timing in surgical intervention and identify factors influencing outcomes.</p> <p><strong>Materials and Methods:&nbsp;&nbsp;</strong>Seventy-eight consecutive patients diagnosed with traumatic EDH at Lady Reading Hospital, Peshawar, were included. Patients were categorized into two groups based on the timing of presentation: within 6 hours (early) and after 6 hours (late). Craniotomy and hematoma evacuation were performed, and outcomes were assessed at discharge.</p> <p><strong>Results:&nbsp;&nbsp;</strong>In our study mean and SDs for age were 21.83<strong>±</strong>31.57. Most of the patients i.e., 54(69.2%) were from the 2<sup>nd</sup> and 3<sup>rd</sup> decade of life. The mean hematoma volume was 37.17 ml. The majority of the patients were males 65(83.3%) and RTA 32(42.02%) was the most common cause followed by falls and physical assault respectively. The outcome of early operated (within 6 hours) patients was favorable in 44(95.65%) while 2 (4.34%) did not improve (GOS 2,3). Favorable outcomes (GOS 4,5) in delayed presented patients who operated after 6 hours were 23 (71.87%). 5(15.6%) were not improved (GOS 2,3) and 4(12.5%) died (GOS 1).</p> <p><strong>Conclusion:</strong>&nbsp;&nbsp;Outcomes of patients who operated early are more favorable than those who were operated late. Delayed presentation and intervention increase the mortality and morbidity of patients having traumatic extradural hematoma.</p> Waseef Ullah Amer Zaman Junaid Alam Hameed Ullah Irfan Ali Irfan Ali Irfan Ali Faisal Shahzad Copyright (c) 2024 Waseef Ullah, Amer Zaman, Junaid Alam, Hameed Ullah, Irfan Ali, Irfan Ali, Irfan Ali, Faisal Shahzad 2024-03-09 2024-03-09 28 1 86 93 10.36552/pjns.v28i1.964 Navigating Peril: Unraveling the Consequences of violation of Lane by bike riders on Traumatic Brain Injury Outcomes in a Developing Country's Neurosurgical department <p><strong>Objective:</strong></p> <p>To infer the impact of violation of lane by the bike riders on the severity of injury and clinical outcome.</p> <p><strong>Materials &amp; Methods</strong>:</p> <p>prospective observational study conducted from 1<sup>st</sup> January 2023 to 30<sup>th</sup> June 2023.50 patients who met inclusion criteria were studied for impact of violation of lane on the severity of injury and clinical outcome. Data was analyzed for gender distribution, valid driving license, helmet wearing, trauma scene violation of lane, duration of stay in ward, severity of injury, mode of injury and outcome was assessed by Glasgow outcome scale extended after 1 month.</p> <p><strong>Results:</strong></p> <p>In our study 49(98%) patients were male and 1(2%) female. 37 (74%) patients had documented evidence by 1122 regarding lane violation group while 13(26%) patients of lane non violation group. 14(28%) patients had STBI, and 18(36%) patients were categorized in moderate and mild traumatic brain injury each. Neuro monitoring was done in 14(28%) patients. Operative intervention was done in 31(62%) patients and 9(64%) patients were those who had STBI.11(78%) out of 14 patients with severe injury were from lane violation group. Patients of lane violation group were having higher disability i.e. 12 (32.4%).</p> <p><strong>Conclusion:</strong></p> <p>Violation of lane is an aberrant driving behavior. It has emerged as a common cause of bike related road traffic accidents leading to mortality. A prevailing disregard for traffic norms adds fuel to this perilous fire, paving the way for grave outcome.</p> <p>&nbsp;</p> <p><strong>Key words:</strong> Severe Traumatic brain injury (STBI), Road traffic accident (RTA), Violation of lane, Bike rider, Intracranial pressure (ICP), Glasgow outcome scale extended.</p> <p><strong>&nbsp;</strong></p> <p><strong>&nbsp;</strong></p> Usman Ahmed Kamboh Muhammad Irfan Sheikh Syed Shahzad Hussain Shah Muhammad Rizwan Atiqa Arif Mehwish Manzoor Zaid Sami Ullah Copyright (c) 2024 Usman Ahmed Kamboh, Muhammad Irfan Sheikh, Syed Shahzad Hussain Shah, Muhammad Rizwan, Atiqa Arif, Mehwish Manzoor, Zaid Sami Ullah 2024-03-09 2024-03-09 28 1 104 109 10.36552/pjns.v28i1.962 Usage Frequency, Barriers, And Effectiveness of Functional Electrical Stimulation as An Intervention for Stroke Patients <p><strong>Objective:</strong>&nbsp;&nbsp;To determine the frequency of Functional Electrical Stimulation (FES) use in stroke rehabilitation and to identify the barriers and effectiveness of its usage as an intervention for stroke patients.</p> <p><strong>Materials &amp; Methods:</strong>&nbsp;&nbsp;This prospective observational study was performed in different clinics and hospitals in Hyderabad. Physical therapists actively practicing in healthcare facilities within Hyderabad, with a minimum of one year of clinical experience in stroke rehabilitation of either gender were included. A questionnaire was structured to collect data on the usage frequency, perceived barriers, and effectiveness related to the utilization of FES in stroke rehabilitation.</p> <p><strong>Results:</strong>&nbsp;&nbsp;Most of the participants were using FES frequently and sometimes for shoulder subluxation, improving arm function, enhancing walking function, improving muscle strength and endurance, addressing hypertonia and spasticity, and improving sensation. Respondents when asked about having sufficient time to apply FES, lack of evidence justifying FES use, and regards to workplace support most of the cases &gt;50% agreed strongly agreed, while &lt;50% of study subjects’ believed that does not provide advantages for individuals having a chronic stroke. FES utilization among healthcare professionals in stroke patient rehabilitation, highlighting its potential benefits in improving arm function, shoulder subluxation, walking performance, and hemiplegic shoulder pain. However, there were no significant barriers identified.</p> <p><strong>Conclusion:</strong>&nbsp;&nbsp;There was a significant use of FES by physical therapists in Hyderabad to address various aspects of stroke rehabilitation. The study overall highlights its potential for improving arm function, preventing shoulder subluxation, enhancing walking, and reducing hemiplegic shoulder pain, without significant identified barriers.</p> Mehreen Niaz Fozia Baloch Asma Bilal Prem Sagar Nadeem Ahmed Memon Copyright (c) 2024 Mehreen Niaz, Fozia Baloch, Asma Bilal, Prem Sagar, Nadeem Ahmed Memon 2024-03-01 2024-03-01 28 1 65 73 10.36552/pjns.v28i1.957