Postoperative functional outcome of intradural extramedullary spinal tumors through posterior approach

Objective: To determine functional outcome of intradural extramedullary spinal tumors in patients undergoing excision through the posterior approach alone

Study Design: Interventional study

Place and Duration of Study: Neurosurgery Department, JPMC, Karachi, from March 2011 to February 2014

Methodology: Patients with intradural extramedullary spinal tumors [IDEM], confirmed on MRI, were admitted through Outpatient Department. Those with bleeding disorders, diabetes mellitus, previously operated and with no histopathological evidence of tumor on biopsy, were excluded. Clinical signs, symptoms and location of the tumor were noted. These patients then underwent laminectomy and excision of tumor through the posterior approach, regardless of the location or type of tumor. Transpedicular screw was placed where the tumor was so large, as to cause posterior instability. The functional outcome was evaluated by assessment of Medical Research Council [MRC] Scale for Muscle Strength preoperatively and at 6 months follow-up postoperatively. Good outcome was labelled when there was improvement from previous grade before surgery to higher grade, as assessed by muscle strength on follow-up at 6 months after surgery

Results: The mean age of the 38 patients was 42.6 +/- 10 years. Majority were females [68.42%]. Meningioma was the commonest tumor [63.15%]. The commonest location was thoracic spine [73.68%]. Backache was present in all [100%] patients, motor weakness in 30 [78.92%] patients, sensory disturbance in 5 [13.5%] patients, sphincter disturbance in 7 [18.42%] patients, and shortness of breath in 1 [2.63%] patient. Preoperatively, there were 10 patients [26.31%] in grade 3, 9 [23.68%] patients in grade 0, 8 [21.05%] in grade 1, 7 [18.42%] patients in grade 2. After 6 postoperative months, there were 23 [60.52%] patients in grade 5, 5 [13.15%] patients in grade 3, 5 [13.15%] patients in grade 2 and 2 [5.26%] patients in grade 1. Postoperative complications were CSF leak, respiratory distress, wound infection and incontinence

Conclusion: Functional outcome of intradural extramedullary spinal tumors was found to be good

Availability and suitability of rapid diagnostic kits for screening donated blood in Afghanistan

As health infrastructure is being rebuilt in Afghanistan, military, public, and private facilities offer donor blood collection/ transfusion services. This study aims to measure availability and type of blood screening test kits in the military, public and private facilities in Afghanistan. This national cross-sectional assessment targeted all facilities providing donor blood collection/transfusion services across all sectors. Descriptive statistics were generated with screening test availability compared by setting [urban vs. rural], province/region, and facility type [private vs public] using Chi-square test. A total of 243 facilities were assessed, with all 34 provinces represented with urban settings containing 63% of the facilities. Screening rapid tests were widely present for most pathogens, including HIV [87.7% of facilities], hepatitis B surface antigen [HB[s]Ag] [93.8%], hepatitis [HCV] antibody [90.5%], and syphilis [70.0%]. Private facilities were less likely to have syphilis tests available [51.4% vs. 84.1% [public], p<0.01]. Nineteen percent of facilities use the WHO evaluated test kit for HIV, 2.1% for HB[s]Ag, and none for HCV Ab. Of sites with available test kits, 7.5% of HIV, 0.9% of HB[s]Ag, 2.3% of HCV, and 6.5% of syphilis tests were expired at time of assessment. For expired tests, private facilities were more likely to have expired HIV and syphilis tests [p=0.07 and p=0.02, respectively] than other facility types. Blood collection/transfusion is a multisectoral service in Afghanistan, with substantial differences in test availability and type between sectors. Mechanisms are needed that ensure availability of quality test kits at all levels where blood collection/transfusion is performed. Test kits that have been evaluated by the WHO should be used for blood screening in all facility types