Awake Surgery for Lesional Epilepsy in Resource-Limited Settings: Case Report and Review of Literature

Epilepsy surgery is a well-established treatment for drug-resistant epilepsy, with awake craniotomy being used in certain cases to remove epileptogenic foci while preserving crucial brain functions. We are presenting the first reported case from Pakistan of a 19-year-old woman who underwent awake epilepsy surgery to treat cortical dysplasia. She had a history of generalized tonic-clonic seizures since her childhood and was referred to our clinic due to an increase in seizure frequency. EEG and MRI identified the epileptogenic focus in the right parieto-temporal region. The patient underwent a neuro-navigation guided awake craniotomy and an excision of the epileptogenic focus in the right parieto-temporal region. The procedure was carried out using a scalp block and dexmedetomidine for conscious sedation, enabling the patient to remain awake throughout the surgery. Intraoperative mapping and electrocorticography were used for complex multidisciplinary care. Post-resection corticography showed no spikes along the resected margins. The patient was discharged without any complications and remained free of symptoms a year after the surgery. Awake epilepsy surgery is a viable option for removing epileptogenic foci while preserving vital cognitive functions. However, it is seldom used in low- and middle-income countries such as Pakistan. The successful outcome of this case underscores the need for greater awareness and availability of epilepsy surgery in resource-limited settings. Cost-effective measures, such as using small subdural strips for intraoperative localization, can be implemented.

Awareness of Injectable Polio Vaccine among Doctors of Government Hospitals in Abbottabad

Introduction: IPV was introduced in areas of northern KPK, Quetta, and Karachi. The success of polio eradication and endgame strategic plan 2013-2018 depends upon doctors’ knowledge and approval of IPV. Aim of this study was to assess doctors’ knowledge and perception regarding IPV. Methodology: A descriptive cross-sectional study was conducted on doctors in government hospitals of Abbottabad, Pakistan from January 2017 to June 2017. A sample size of 250 was calculated using WHO sample size calculator at 95% confidence level. A pretested questionnaire was used to collect data after taking informed consent. The analysis was done in SPSS version 21. Results: IPV’s advantage of being administered exclusively as well as a booster dose was known to 36%. Other merits of IPV like, no requirement of special cold chain storage and no incidence of VAPP (Vaccine Associated Poliomyelitis) was known by 7.6% and 56.54% respectively. Only 25% of doctors knew about latest endgame strategic plan 2013-2018 and National Emergency Action Plan. Conclusion: Doctor’s knowledge and acceptance regarding IPV was very low. Most of the doctors still preferred OPV over IPV as they fear injection pain due to IPV and are not much aware of IPV’s advantages over OPV. Thus clear-cut strategies need to be established for sensitization and education of doctors and correspondingly the masses regarding IPV.

role of endoscopic surgery in the management of juvenile nasopharyngeal angiofibroma

Endoscopic sinonasal surgery [ESNS] as an adjuvant to transpalatal approach cum lateral rhinotomy in grade II juvenile angiofibroma [JNA] is experienced in two cases. Superselective embolization provided the optimal use of this approach. Intraoperative ESNS is found immensely helpful in identifying the residual tags and site of origin of JNA. Eventually this may also be helpful in reducing the recurrence usually seen with all other surgical approaches. Two cases of JNA were dealt in our department during May 1999 and April 2000

Laser phototherapy for neonatal jaundice

Since 1989 the authors have routinely used laser-phototherapy for the treatment of neonatal jaundice.The laser phototherapy unit used in this study was installed by the authors at the neonatal intensive care unit of Maadia Armed Forces Hospital in Cairo. The laser power unit is a Coherent Model 90-5 argon ion Innova laser. Animal studies on Gunn rats were done to establish safety in the clinical application of laser in phototherapy. The following recommendations for therapy were advised [1] Type of laser: argon ion laser [2] power of irradiation: 400mW [3] Wavelength selection: 488 nm [4] Use of fiber optic delivery system for laser irradiation. Four hundred and eighty-one neonates with neonatal hyperbilirubinemia and fufilling the entry criteria were included in the study. Analysis of the results have shown the mean percentage reduction in total serum bilirubin concentration was 7.73 mg% over a mean duration of therapy of 2.9 hours. The high efficacy of laser phototherapy made it possible to avoid hospitalization in 82.3% of the cases. The use of laser instead of fluorescent light in phototherapy opens a new horizon for the treatment of neonatal jaundice