Pakistan Journal Of Neurological Surgery
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Usage Frequency, Barriers, And Effectiveness of Functional Electrical Stimulation as An Intervention for Stroke Patients
No full textObjective: 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.
Materials & Methods: 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.
Results: 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 >50% agreed strongly agreed, while <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.
Conclusion: 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
Day Care Spine Surgery Versus Conventional Spine Surgery: A Comparative Analysis
Get PDFObjective: To evaluate the effectiveness, cost-efficiency, and patient benefits of daycare spine surgery as compared to traditional spine surgery.
Materials & Methods: This study was conducted at the neurosurgery department of Bakhtawar Amin Trust and Teaching Hospital Multan from January 2022 to October 2023. This was a prospective study involving 103 patients diagnosed with cervical PIVD, lumbar PIVD, IDEM, and extradural spinal tumors. Participants were equally split into two groups, one undergoing daycare and another with conventional spine surgery. They were analyzed by Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI), Neck Disability Index (ODI), time of operation, duration of hospitalization, cost of surgery, and follow-up duration.
Results: Results showed that daycare spine surgery had significantly less hospital stay duration (p-value< 0.01), low costs (p-value < 0.01), and low post-operative VAS scores (p-value < 0.05) relative to traditional spine surgery. Additionally, improvements in ODI and NDI scores were more in the daycare group (p-value< 0.01). The duration of surgery and blood loss was also less than the conventional surgery.
Conclusion: Daycare spine surgery has proved to be a better replacement for conventional surgery, having decreased resource use, enhanced cost-effectiveness, and better patient outcomes
Evaluation of Outcomes and Complications of Sphenoid Wing Meningiomas in Tertiary Care Hospital of KPK
Get PDFObjective: 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.
Material and Methods: 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.
Results: 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.
Conclusion: 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
Awake Craniotomy Versus Surgery Under General Anaesthesia for Resection of Brain Tumour; A Systematic Review of Randomized Control Trials
Get PDFObjectives: To evaluate the clinical evidence on the comparison of results between an awake craniotomy and general anesthesia surgery for brain tumor removal.
Materials & Methods: A systematic literature search was carried out using the PubMed, Cochrane Library, EMBASE, and MEDLINE databases using key terms such as awake craniotomy, awake brain surgery, awake craniotomy, anesthesia craniotomy, asleep craniotomy, asleep brain surgery, and general anesthesia. The PICO (Participant, Intervention, Comparison, and Outcome) approach was used to extract the studies contrasting the impact of awake craniotomy versus general anesthesia on outcomes included in this systematic review. PRISMA guidelines were followed throughout.
Results: 102 records were identified out of which 8 were included in the final qualitative synthesis (2 RCTs, Cohort). All reported neurological impairments in both groups, except 2. Six studies indicated early language abnormalities and early motor deficiencies. Six studies indicated early language abnormalities and early motor deficiencies. The mean operation time of the General Anesthesia group was more than that of Awake Craniotomy. Awake craniotomy surgery was associated with an average reduction of 4 to 8 days in the hospital.
Conclusion: Under GA, AC (add abbreviations of these) offers a workable substitute for craniotomy for individuals with gliomas penetrating expressive areas; awake craniotomy with electrical stimulation is linked to improved long-term neurological and language abilities as well as a shorter hospital stay
Prevalence and Impact of Hyponatremia on Hospital Stay in Subarachnoid Hemorrhage Patients
Get PDFIntroduction: 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.
Materials & 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. 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.
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<0.002).
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
Results of Comparison of Burr Hole Evacuation Versus Surgical Excision of Multiloculated Subdural Empyema
Get PDFObjectives: We studied the results of results of comparison of burr hole evacuation versus surgical excision of multiloculated subdural empyema.
Material and Methods: 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.
Results: 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.
Conclusion: The results of surgical excision of multiloculated subdural empyema are better than burr hole evacuation if the patient is for surgical excision
The Chat GPT Develops Multiple Choice Questions (MCQs) for Postgraduate Specialty Assessment – A Reality or a Myth?
No full textObjective: 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.
Material & Methods: 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.
Results: 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.
Conclusions: 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
The Impact of Time till Surgery on Post-Operative Outcome of Traumatic Extradural Hematoma
Get PDFObjective: 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.
Materials and Methods: 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.
Results: In our study mean and SDs for age were 21.83±31.57. Most of the patients i.e., 54(69.2%) were from the 2nd and 3rd 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).
Conclusion: 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
Frequency of Intraventricular Haemorrhage (IVH) in Early Preterm Neonates Born at DHQ Teaching Hospital Gujranwala
Get PDFObjective: 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.
Materials & Methods: This cross-sectional study involved 282 very low birth weight neonates (birth weight <1500 gm.) delivered very preterm (gestational age <32 weeks). These neonates were assessed for intraventricular hemorrhage which was diagnosed on cranial ultrasound performed on 3rd 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.
Results: 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; <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).
Conclusion: 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
Evaluating Mean Platelet Volume as an Independent Risk Factor for Stroke
Get PDFObjective: The study aimed to evaluate the effects of mean platelet volume on stroke.
Materials & Methods: A cross-sectional study was conducted at Muhammad Medical College, Mirpurkhas, Pakistan. The sample size of this study was 200 participants including 50 stroke patients and 150 controls. Participants were aged 40-80 years, with a baseline NIHSS score of ? 5. Blood samples (5 ml) were collected and analyzed for mean platelet volume (MPV). Blood pressure was measured manually.
Results: The results show that individuals with raised MPV have a higher incidence of stroke than individuals with normal MPV. The Chi-Square test revealed a significant association between elevated MPV and stroke incidence (p = 0.0001). The demographic data showed that the stroke group had a higher mean age (59.32±8.14 years) compared to the control group (52.19±12.30 years), with a significant p-value of 0.0002. Systolic and diastolic blood pressures were significantly higher in the stroke group (p < 0.05). MPV was significantly elevated in stroke patients (11.94±0.65 fL) compared to controls (7.90±0.83 fL), with a p-value of 0.0001.
Conclusion: There is a significant relationship between raised MPV in patients with stroke compared to the normal population