Psychosocial implications of blindness and low vision in students of a school for children with blindness

Objective: To find out the psychosocial implications of blindness and low vision in students of blind school Bahawalpur

Methods: A cross sectional descriptive study was carried out in Higher Secondary School for blind, Bahawalpur after getting approval from Institutional review board of Quaid-e-Azam Medical College, Bahawalpur and Principal of Blind School, Bahawalpur. Forty willing students filled a customized questionnaire, consisting of questions about logistic variables and questions regarding areas of satisfaction. Statistical analysis was performed using SPSS version 18

Results: Out of 40, 55% [22/40] of them were found depressed [as assessed through DSM-lV], 50% [20/40] were having difficulty in making new contact but 52.5% [21/40] were satisfied with family care

Conclusion: Sixty percent [24/40] of blind school children experienced difficulty in their life. This study showed that blindness or low vision does have psychological implications like feeling of guilt, anxiety, sadness and depression

Short term donor outcomes after hepatectomy in living donor liver transplantation

Objective: to determine the outcome of living-donor liver transplant [LDLT] donors from the first liver transplant program in Pakistan

Study Design: cohort study

Place and Duration of Study: shifa International Hospital, Islamabad, from April 2012 to August 2014

Methodology: a total of 100 live donors who underwent hepatectomy were included. Demographics, etiologies, graft characteristics and operative variables were retrospectively assessed. Outcome was assessed based on morbidity and mortality

Results: median donor age was 28 [17 - 45] years and median body mass index [BMI] was 24 kg/m[2] [15 - 36]. Male to female ratio was 1.5:1. Hepatitis B and C were the most common underlying etiologies and accounted for 79/100 [79%] of LDLT's. Overall, 93/100 [93%] donors donated a right lobe graft. Median estimated graft weight to recipient body weight [GW/BW] ratio was 1.03 [0.78 - 2]. Standard arterial anatomy was present in 56% donors. The 90-day morbidity was 13/100 [13%] and overall morbidity was 17/100 [17%]. Bile leak was encountered in 3 [3%] patients. There was no donor Mortality

Conclusion: acceptable short-term donor outcomes were achieved in an LDLT program in Pakistan with careful donor selection and planning

role of 320 slice CT angiography in predicting vascular trauma

Objective: To determine the accuracy of multidetector CT angiography [MDCT angiography] as initial diagnostic technique in depicting and characterizing post traumatic vascular injuries, looking for additional injuries and confirming the findings with intervention and follow-up

Study Design: Descriptive analytical study

Place and Duration of Study: Department of Radiology, Shifa International Hospital, Islamabad, from June 2010 to October 2013 Methodology: Patients who underwent MDCT angiography for clinically suspected post traumatic vascular injury were included. All MDCT angiographies were performed on 320 slice CT [Aquilion One[TM]] and were reviewed by two independent consultant radiologists. The sites of injury were intracranial, neck and maxillofacial, chest, abdomen and extremities. The presence and characteristics of vascular injuries were confirmed by post-operative findings or digital subtraction angiography [DSA]. Sensitivity and specificity was calculated

Results: The age of the patients ranged from 7 to 90 years with 94% [48] males and 6% [3] females. Blunt trauma was commoner than penetrating trauma. The site of injury in majority was extremities. Majority of patients had post-traumatic pseudoaneurysm formation followed by arterial occlusion, thrombosis, active extravasation, spasm, arteriovenous malformation and combination injuries. Twenty-one [41%] patients were reported as having vascular injury and confirmed by surgery or DSA. Fifteen [29.5%] patients were reported as normal and had no intervention on follow-up. The sensitivity and specificity of MDCT angiography was found as 100% and 88%, NPV of 100%, PPV of 94% and accuracy of 96%

Conclusion: MDCT angiography can be reliably used as an initial diagnostic technique for the evaluation and characterization of post-traumatic vascular injuries

MRI in the pre operative evaluation of perianal fistula

Objective: To assess the diagnostic accuracy of Magnetic Resonance Imaging [MRI] in the pre operative evaluation of perianal fistulae

Methodology: Between Decemebr 2010 and January 2013, thirty patients with clinical suspicion of perianal fistulae had MRI scans done for evaluation of extent of disease. Out of these 11 patients underwent surgery in our hospital and were included in the study. All patients had body-coil MR Imaging examinations including the following sequences for anatomic and pathologic information: T2 sagittal, T1, T2 and STIR axial oblique, T2 and STIR coronal oblique and post contrast T1 FAT SAT sagittal, axial oblique and coronal oblique planes. Scans were interpreted by a senior radiologist with more than 5 year experience in body MR imaging. Surgical findings were accepted =as the gold standard and were recorded independently by the surgeon. MRI findings were compared with surgical findings using Park's classification

Results: The MRI findings were in accordance with surgical findings in 10 out of 11 patients regarding type and extent of fistula in ano. In one patient peroperatively diagnosed and treated fistula did not show on MRI. Statistical parameters showed that MRI has a sensitivity of 90%, specificity of 100% and diagnostic accuracy of 90% in determining type and extent of perianal fistula

Conclusion: MRI is an accurate and non invasive imaging modality for determining type and extent of peri-anal fistula and helps in pre operative management and surgical planning by giving correct assessment of extent of disease

A case report of subependymal giant cell astrocytoma in 7 month old patient with tuberous sclerosis

Tuberous sclerosis is a neurocutaneous syndrome with a wide variety of clinical, pathologic, and radiologic manifestations. Intracranial phakomatosis has been reported to include subependymal nodules; cortical, and subependymal giant-cell astrocytomas. Subependymal giant-cell astrocytomas are rare, benign typically slow growing tumors of mixed neuroglial lineage, which can become aggressive and cause increased intracranial pressure, seizures, and focal neurologic signs. The standard treatment of these tumors is total neurosurgical resection [1,2,3]. We report a 07 month old male patient with tuberous sclerosis who underwent surgery for a large subependymal giant-cell astrocytoma [SEGA]. It is rare to find SEGA in this age period