Identification and crop damage assessment of indian crested porcupine (Hystrix indica) in selected zones of Abbottabad, Pakistan / Avaliação de identificação e dano de cultura de porco-espinho indiano (Hystrix indica) em zonas selecionadas de Abbottabad, Paquistão

Indian crested porcupine is the largest rodent pest that damages a wide variety of crops, vegetables, and tree species which ultimately causes huge economic loss in Pakistan, which is an agricultural country. It prefers to live in hilly terrain but common in temperate and tropical forests, shrublands, and grasslands. This study focused on the identification and assessment of crops damaged along with the main precautionary measures used by the local farmers. The data was collected from twenty-four villages of two union councils i.e. Chamhad and Slahad of district Abbottabad. Two types of data (primary and secondary) were collected from the study area. Primary data was collected for identification and estimation calculation of total crop damaged through direct field observation by taking random quadrates in each village of the study area. The damage in the crop was assessed by randomly selecting a quadrate of 1x1 m² for the wheat, pearl millet, and Sorghum fields. While 4x4 m² quadrates were taken for maize and vegetables. At least three quadrate samples were taken from each field including one quadrate taken from the center of the field area. In union council Chamhad, damage to maize (11.31%) and wheat (0.73%) by the Indian crested porcupine while in union council Salhad, damage of maize (6.95%) and wheat (1.6%) was observed. In the entire study area, overall damage to maize crop (8.01%) and wheat (0.88%) was calculated. Based on information obtained from the farmers, the Indian porcupine inflicted damage to potato, tomato, cauliflower, chili pepper, turnip, radish, pea, and onion, etc. Secondary data obtained through a questionnaire survey to explore the human porcupine conflict and precautionary measures used by the farmers and landowners. Open and close ended questionnaires (159) highlighted the presence of Indian crested porcupine in the study area and 96% of the respondents have seen porcupine directly. Many types of precautionary measures [...].

O porco-espinho indiano é a maior praga de roedores que danifica uma grande variedade de culturas, vegetais e espécies de árvores, o que acaba por causar enormes perdas econômicas no Paquistão, que é um país agrícola. Prefere viver em terrenos montanhosos, mas comuns em florestas temperadas e tropicais, arbustos e pastagens. Este estudo concentrou-se na identificação e avaliação das lavouras danificadas, juntamente com as principais medidas de precaução utilizadas pelos agricultores locais. Os dados foram coletados de 24 aldeias de dois conselhos sindicais, ou seja, Chamhad e Slahad, do distrito de Abbottabad. Dois tipos de dados (primário e secundário) foram coletados da área de estudo. Foram coletados dados primários para identificação e cálculo de estimativa do total da cultura danificada por meio da observação direta do campo, tomando quadrantes aleatórios em cada aldeia da área de estudo. O dano na cultura foi avaliado pela seleção aleatória de um quadrante de 1x1 m2 para os campos de trigo, milheto pérola e sorgo, enquanto quadrantes de 4x4 m2 foram tomados para milho e legumes. Pelo menos três amostras de quadrante foram colhidas de cada campo, incluindo um quadrante retirado do centro da área do campo. No Conselho Sindical de Chamhad, houve danos ao milho (11,31%) e ao trigo (0,73%) pelo porco-espinho indiano, enquanto no Conselho Sindical de Salhad, danos ao milho (6,95%) e ao trigo (1,6%) foram observados. Em toda a área do estudo, danos gerais à cultura do milho (8,01%) e ao trigo (0,88%) foram calculados. Com base em informações obtidas dos agricultores, o porco-espinho indiano infligiu danos à batata, tomate, couve-flor, pimenta, nabo, rabanete, ervilha, cebola, etc. Dados secundários foram obtidos por meio de um questionário para explorar o conflito suíno humano e as medidas de precaução utilizadas pelos agricultores e proprietários de terras. Questionários abertos e fechados (159) destacaram a presença de porco-espinho indiano na área [...].

Identification and crop damage assessment of indian crested porcupine (Hystrix indica) in selected zones of Abbottabad, Pakistan

Abstract Indian crested porcupine is the largest rodent pest that damages a wide variety of crops, vegetables, and tree species which ultimately causes huge economic loss in Pakistan, which is an agricultural country. It prefers to live in hilly terrain but common in temperate and tropical forests, shrublands, and grasslands. This study focused on the identification and assessment of crops damaged along with the main precautionary measures used by the local farmers. The data was collected from twenty-four villages of two union councils i.e. Chamhad and Slahad of district Abbottabad. Two types of data (primary and secondary) were collected from the study area. Primary data was collected for identification and estimation calculation of total crop damaged through direct field observation by taking random quadrates in each village of the study area. The damage in the crop was assessed by randomly selecting a quadrate of 1x1 m2 for the wheat, pearl millet, and Sorghum fields. While 4x4 m2 quadrates were taken for maize and vegetables. At least three quadrate samples were taken from each field including one quadrate taken from the center of the field area. In union council Chamhad, damage to maize (11.31%) and wheat (0.73%) by the Indian crested porcupine while in union council Salhad, damage of maize (6.95%) and wheat (1.6%) was observed. In the entire study area, overall damage to maize crop (8.01%) and wheat (0.88%) was calculated. Based on information obtained from the farmers, the Indian porcupine inflicted damage to potato, tomato, cauliflower, chili pepper, turnip, radish, pea, and onion, etc. Secondary data obtained through a questionnaire survey to explore the human porcupine conflict and precautionary measures used by the farmers and landowners. Open and close-ended questionnaires (159) highlighted the presence of Indian crested porcupine in the study area and 96% of the respondents have seen porcupine directly. Many types of precautionary measures were used by the farmers such as fencing, night stay, night firing, and dogs to decrease the crop damage, respondents (63.91%) use guns for hunting. however, due to the largely agricultural area and nocturnal behavior of Indian crested porcupine majority of the respondents (51.57%) did not use any precautionary measure. Biological control of Indian porcupine is recommended in the study area. Farmers should be encouraged and provide incentives and killing through current should be banned while proper hunting license should be issued to overcome overhunting. Scientific studies are required to control the reproduction of porcupine specifically in the more damaged areas.

Resumo O porco-espinho indiano é a maior praga de roedores que danifica uma grande variedade de culturas, vegetais e espécies de árvores, o que acaba por causar enormes perdas econômicas no Paquistão, que é um país agrícola. Prefere viver em terrenos montanhosos, mas comuns em florestas temperadas e tropicais, arbustos e pastagens. Este estudo concentrou-se na identificação e avaliação das lavouras danificadas, juntamente com as principais medidas de precaução utilizadas pelos agricultores locais. Os dados foram coletados de 24 aldeias de dois conselhos sindicais, ou seja, Chamhad e Slahad, do distrito de Abbottabad. Dois tipos de dados (primário e secundário) foram coletados da área de estudo. Foram coletados dados primários para identificação e cálculo de estimativa do total da cultura danificada por meio da observação direta do campo, tomando quadrantes aleatórios em cada aldeia da área de estudo. O dano na cultura foi avaliado pela seleção aleatória de um quadrante de 1x1 m2 para os campos de trigo, milheto pérola e sorgo, enquanto quadrantes de 4x4 m2 foram tomados para milho e legumes. Pelo menos três amostras de quadrante foram colhidas de cada campo, incluindo um quadrante retirado do centro da área do campo. No Conselho Sindical de Chamhad, houve danos ao milho (11,31%) e ao trigo (0,73%) pelo porco-espinho indiano, enquanto no Conselho Sindical de Salhad, danos ao milho (6,95%) e ao trigo (1,6%) foram observados. Em toda a área do estudo, danos gerais à cultura do milho (8,01%) e ao trigo (0,88%) foram calculados. Com base em informações obtidas dos agricultores, o porco-espinho indiano infligiu danos à batata, tomate, couve-flor, pimenta, nabo, rabanete, ervilha, cebola, etc. Dados secundários foram obtidos por meio de um questionário para explorar o conflito suíno humano e as medidas de precaução utilizadas pelos agricultores e proprietários de terras. Questionários abertos e fechados (159) destacaram a presença de porco-espinho indiano na área de estudo e 96% dos entrevistados viram o porco-espinho diretamente. Muitos tipos de medidas de precaução foram utilizados pelos agricultores, como esgrima, estadia noturna, fogo noturno e cães para diminuir os danos na lavoura. Dos entrevistados, 63,91% usaram armas para caçar. No entanto, devido à área ser em grande parte agrícola e ao comportamento noturno da maioria dos porcos-espinhos indianos, 51,57% não usaram nenhuma medida de precaução. O controle biológico do porco-espinho indiano é recomendado na área de estudo. Os agricultores devem ser encorajados e fornecer incentivos, e o uso da corrente para matar os animais deve ser banido, assim como deve ser emitida a licença de caça adequada para superar a caça excessiva. Estudos científicos são necessários para controlar a reprodução de porco-espinho, especificamente nas áreas mais danificadas.

Students' Perceptions about Current Use, Effectiveness and Barriers in Implementation of Interactive Learning at College Of Medicine, Northern Border University, Arar

Objectives: To understand the perceptions of medical students about the current use of interactive learning, its effectiveness and barriers in its implementation. Method: A cross-sectional study was carried out at the College of Medicine, Northern Border University, Arar, Kingdom of Saudi Arabia. Study participants were fifth and final year medical students. A semi-structured questionnaire was used to collect the information in relation to perceptions regarding the use of interactive learning, its effectiveness, and barriers. The questionnaire consisted of Likert scale ranking and close-ended questions. The student’s response was analyzed by frequency analysis. Results: A total of 150 students participated in the study. The most frequently used methods for interactive learning at the College of Medicine were small group discussions (68%) and problem-based learning (56%). Educational games and online videos were used rarely. There was positive feedback regarding the effectiveness of interactive learning in generating interest in learning (84%) and understanding of subject (85%). 80% of the students also reported an improvement in exam scores as a result of interactive learning. The main barriers reported to adoption of interactive learning were inadequate class time (70%), faculty is accustomed to traditional lectures (66%) and lack of trained faculty members (40%). Conclusion: The data suggest despite barriers interactive teaching is being frequently and effectively used at the College of Medicine, Northern Border University, Arar. It is suggested more interactive learning techniques should be incorporated in the curriculum and barriers in adoption can be overcome by following faculty development programs and administrative support.

Attributable risk of Capillaria species in domestic pigeons (Columba livia domestica) / Risco atribuível de espécies Capillaria em pombos domésticos (Columba livia domestica)

Fecal samples were collected from 120 domestic pigeons to determine the Attributable risk of Capillaria spp. The Capillaria spp. was observed in 64 out of 120 (51%) pigeons (70 males and 50 females) under this study. A total of 64 (39 males and 25 females) were found naturally infected with Capillaria spp. with infection percentage of 51% and 50% in males and females respectively. Qualitative examinations include the direct microscopy and faecal floatation while quantitative examination includes McMaster technique (worms load was calculated per gram of the faeces). Month wise Attributable risk showed that eggs of the worms were found to be abundant in the month of July during the present study (60% to 73%) because of high humidity. Very high and very low temperature is not suitable for the proper development of the eggs. Qualitative and quantitative examination revealed that Capillaria spp. was more prevalent in males (51%) than females (50%) but overall there was no significant difference (P>0.05) in the male and female because both individuals invest equal amount of energy in search of food and incubating the eggs. Different breeds of pigeons gave different Attributable risk in different months during the study. Groups of pigeons from different locations showed different variable Attributable risk. Areas with high humidity were more suitable for the development of eggs, which is the reason why higher Attributable risk was observed in Shahdara (75%) area of Lahore, Pakistan.(AU)

Amostras de fezes foram coletadas de 120 pombos domésticos para determinar os fatores de risco de Capillaria spp. Capillaria spp. foi observado em 64 de 120 (51%) pombos (70 machos e 50 fêmeas) neste estudo. Um total de 64 (39 machos e 25 fêmeas) foram naturalmente infectados com Capillaria spp. sendo 51% em machos e 50% em fêmeas. Exames qualitativos incluem microscopia direta e suspensão de fezes, e exames quantitativos incluem a técnica McMaster (vermes são calculados por grama de fezes). O risco por mês demonstrou que ovos dos vermes foram encontrados em abundância no mês de Julho durante o presente estudo (60% a 73%) por causa da alta umidade. Temperaturas muito altas e muito baixas não são adequadas para o desenvolvimento adequado de ovos. O exame qualitativo e quantitativo revelou que Capillaria spp. era mais prevalente em machos (51%) que em fêmeas (50%), mas no geral não houve diferença significativa (P>0.05) entre machos e fêmeas porque ambos investem a mesma energia na busca por alimento e incubação de ovos. Diferentes raças de pombos tem diferentes riscos em diferentes meses durante o estudo. Grupos de pombos de diferentes locais demonstraram risco diferenciado. Áreas com alta umidade eram mais propensas para o desenvolvimento de ovos, o motivo pelo qual maior risco foi observado em shahdara (75%).(AU)

Enhanced leucopoiesis in Ghrelin treated myelosuppressed rats

Objective: To determine the role of ghrelin in stimulating leukopoiesis of myelosuppressed rats by stimulating growth hormone release

Study Design: Randomized controlled trial

Place and Duration of Study: It was conducted at Department of Physiology, Foundation University Medical College, in collaboration with National Institute of Health, Islamabad, from February 2013 to June 2014

Material and Methods: Out of 130 Sprague-Dawley rats, 10 were used for baseline sampling and rest was randomly divided into four groups. Group I received ghrelin only while group II and III were administered intraperitoneally with both carboplatin and 5-flurouracil with and without rat ghrelin. Group IV in addition to chemotherapy and ghrelin received growth hormone releasing hormone antagonist [GHRH antagonist]. Total leukocyte count, differential leukocyte count and growth hormone levels were measured on day 7 and 14

Results: The fall in leukocyte count of chemotherapy and ghrelin group on day 7 was less as compared to the chemotherapy-only treated group and chemotherapy, ghrelin and growth hormone releasing hormone antagonist treated group [p<0.05]. Further decreases were also prevented in the chemotherapy and ghrelin group. The serum growth hormone levels in chemotherapy and ghrelin treated group were higher as compared to the chemotherapy and chemotherapy, ghrel in, GHRH antagonist treated group [p< 0.05]

Conclusion: Enhanced leukopoiesis in ghrelin treated myelosuppressed rats as compared to the chemotherapy group [p<0.05] suggest role of ghrelin in enhancing leukopoiesis. While the failure of enhanced leukopoiesis and growth hormone level to rise in chemotherapy, ghrelin and GHRH antagonist treated group suggested the possibility of growth hormone as possible mediator of ghrelin in leucopoiesis

Intracranial tuberculomas: presenting symptoms and outcome with anti tuberculosis drugs treatment

Background: Tuberculosis is still common in developing countries, and sometimes involves central nervous system, proper diagnosis and early treatment effectively reduces the mortality and morbidity associated with this disease

Objective: Observe presenting symptoms and outcome on anti-tuberculosis drug treatment

Material and Methods: This prospective study was conducted in the Department of Neurosurgery in collaboration with Department of Pathology, Ayub Teaching Hospital Abbottabad from March 2010 to December 2016. 22 patients; 8 females and 14 males were studied for their signs and symptoms and outcome after anti-tuberculosis drug treatment

Results: The most common location of tuberculous lesions was supratentorium [81%] particularly in parietal lobe [50%] followed by frontal lobe [22.7%] and occipital lobe [18.2%]. 45% patients had prior history of tuberculosis. Headache was the predominant complaint [72.7%] followed by altered sensorium [31%], seizures [27.3%] and cranial nerve palsies [22.7%]. After 12 months of anti-tuberculosis treatment ATT, about 87% of patients had either resolved or regressed tuberculoma

Conclusion: Brain tuberculomas are benign lesions with" malignant" behavior. Early diagnosis and anti-tuberculosis drug treatment can effectively treat this lesion forever. So in developing countries like Pakistan, when there is cystic, nodular or multiple lesions, there should be suspicion for brain tuberculoma and work up should be done because of very good prognosis associated with anti-tuberculosis drug treatment

Patterns of radiographic damage to cervical spine in polyarticular juvenile idiopathic arthritis patients presenting to tertiary care hospital in Pakistan

To see the radiographic cervical spine damage in polyarticular juvenile idiopathic arthritis [PJIA] coming to a tertiary care hospital in Islamabad, Pakistan. Cross-sectional descriptive study. The study was conducted in department of Rheumatology at Pakistan Institute of Medical Sciences from Jun 2013 to Dec 2013. A total of 50 patients of PJIA coming to Rheumatology Outpatient Department were recruited in the study after informed consent. Radiographs of cervical spine were performed for each patient in antero-posterior, lateral with flexion and extension and open-mouth views. Radiographs were reviewed for the following features: loss of cervical lordosis, odontoid process erosion, anterior atlantoaxial subluxation, C1-C2 arthritis, atlantoaxial impaction, inflammation of disc, apophyseal joint arthritis, anterior ankylosis, apophyseal joint ankylosis, anterior and posterior subaxial subluxation and growth disturbances. Data was analysed using SPSS version 18. Out of the total 50 patients, 28 [56%] were females while 22 [44%] were males. The mean duration of pJIA was 5.54 +/- 3.28 years. Radiological cervical spine involvement was seen in 52% patients. The most common structural lesions were anterior atlantoaxial subluxation [30%], C1-C2 arthritis [22%] erosion of the odontoid process [18%], and apophyseal joint arthritis [16%]. Loss of cervical lordosis was found in 7 [14%] patients. There was no growth disturbances observed in vertebra. Cervical spine involvement is common in patients of PJIA. It is mostly asymptomatic, so routine cervical spine radiographs in all patients suffering from PJIA is recommended

GBS and AFP [acute flaccid paralysis] system in AJK

Main objective of the study is to highlight the major cause of AFP and% of GBS represents the AFP during the study period. Retrospective analytical study. This study was conducted in AJK, for the duration of three years from January 2011 to December 2013. Retrospective analysis of AFP cases reported during 2011-2013. Primarily the AFP cases investigated through history and clinical examination. Principal cause of AFP [Acute flaccid Paralysis] cases were investigated through specific tests like serum electrolytes, CSF [cerebrospinal fluid], electromyogram and viral culture from stool sample to exclude poliovirus. All the cases reported from AJK and taken on the line list labeling as GBS were included in the study during 2011-2013. Three years data analysis shows more than 50% GBS cases presenting AFP and the numbers are increasing every year. Most of the GBS and even AFP belong to 6-59 months age group. More than 55% GBS cases recover completely and this proportion increased from 2011-2013. Data analysis revealed GBS is a major cause of AFP in AJK and needs not to be overlooked to keep poliovirus transmission ceased here. AFP surveillance system is huge resource and this is a high time to study all the causes responsible for acute flaccid paralysis to strengthen polio eradication efforts and to develop understanding for prevention and control, to avoid acute flaccid paralysis related morbidity and mortality amongst children in Pakistan

Evaluation of AFP surveillance sensitivity in AJK

Main objective of the study is to analyse sensitivity of the surveillance system, required to keep poliovirus circulation ceased in AJK. Retrospective analysis of AFP cases reported during the study period. This study included all the AFP cases reported during the study period in AJK from Jan. 2011 to Dec. 2013. Historical data is used to analyse AFP surveillance for detecting poliovirus infection in children age <15 years in the study area based on few assumptions that all the results are negative and adequate information were available to make ultimate diagnosis of each AFP case reported in the area during study period. Surveillance sensitivity analysed using AFP surveillance criteria recommended by WHO and variable used in AFP surveillance system. Surveillance sensitivity is analysed based on two indicators "non polio AFP rate" and stool adequacy. Sensitivity level analysed in AFP cases aged 6-59 months for >/= 7 OPV doses including routine and SIAs revealed 6/10 districts have high sensitivity. Long absence of Polio virus in the area, creeping up of boredom among health human resource, Clinician's failure to notify all AFP cases resulting in down going Surveillance sensitivity

Spectrum of trigeminal neuralgia

Trigeminal neuralgia [TN] is a very painful condition characterized by paroxysmal shock like pain in the distribution of one or more branches of trigeminal nerve caused by neurovascular conflict at the root entry zone of trigeminal nerve. This study was conducted to analyse the demography and pattern of TN in our setup. This descriptive study was conducted in the Oral Surgery unit, Department of Dentistry, Ayub Medical College, Abbottabad, from April 2009 to October 2011. A total of 117 patients were included in study by convenience [non probability] sampling technique. All the patients presenting with the clinical features of TN were included in study. Out of 117 cases, 49 [41.9%] were males and remaining 68 [58.1%] were females. Age of the patients ranged from 32-72 [53.90 +/- 10.21] years. Right side was involved in 63 patients [53.8%], while the left side was involved in 51 patients [43.6%]. In only three cases [2%] there was bilateral involvement. The maxillary division was involved in 68 cases [58.1%] and mandibular division was involved in 37 cases [31.6%]. The most common site of involvement was infra-orbital, which was involved in 68 cases [58.11%]. The next common site was the mental nerve which showed involvement in 35 cases [29.9%] followed by inferior alveolar nerve which was affected in 14 cases [12%]. Thirty three [28.2%] patients were having mild pain, 54 [46.2%] patients having moderate, 21 [18%] patients with severe and 9 [7.7%] patients were having very severe pain. No patient in our study had a family history of TN. Among our patients 103 [88%] patients underwent dental extraction for the same pain. The incidence of TN is more in old age especially in females. TN is frequently misdiagnosed in with tooth ache, so there is need to educate the medical practitioners and masses in order to avoid un-necessary tooth extractions

Comparison of sirolimus-, paclitaxel-, and everolimus-eluting stent in unprotected left main coronary artery percutaneous coronary intervention

This retrospective study evaluated the outcomes of patients who underwent unprotected left main coronary artery [ULMCA] percutaneous coronary intervention [PCI] with different types of drug-eluting stents [DES]. The standard of care for patients with ULMCA is coronary artery bypass surgery. However, current guidelines recommend PCI in clinical conditions where there is an increased risk of adverse surgical outcomes. Clinical outcomes of patients undergoing ULMCA PCI with different types of drug-eluting stents [DES] are unknown. Data from a multicenter international registry, which included 239 consecutive patients from four institutions who ULMCA PCI with DES, were collected. There were 42 patients receiving paclitaxel-eluting stent [PES], 158 patients receiving sirolimus-eluting stent [SES], and 39 patients receiving everolimus-eluting stent [EES]. There was no statistical difference in major adverse cardiovascular events, cardiac death, myocardial infarction, target lesion revascularization, and stent thrombosis among PES, SES, and EES at 30 days and 1 year. There are no differences in clinical events among patients receiving PES, SES, and EES for ULMCA disease

Frequency of conservatively managed traumatic acute subdural haematoma changing into chronic subdural haematoma

Traumatic brain injury represents a significant cause of mortality and permanent disability in the adult population. Acute subdural haematoma is one of the conditions most strongly associated with severe brain injury. Knowledge on the natural history of the illness and the outcome of patients conservatively managed may help the neurosurgeon in the decision-making process. We prospectively analysed 27 patients with age ranges 15-90 years, in whom a CT scan diagnosis of acute subdural haematoma was made, and in whom craniotomy for evacuation was not initially performed, to the neurosurgery department of Ayub Teaching Hospital Abbottabad [2008-2011]. Patients with deranged bleeding profile, anticoagulant therapy, chronic liver disease, any other associated intracranial abnormalities, such as cerebral contusions, as shown on CT, were excluded from this study. All patients were followed by serial CT scans, and a neurological assessment was done. There were 18 male and 9 female patients, Cerebral atrophy was present in over half of the sample. In 22 of our patients, the acute subdural haematoma resolved spontaneously, without evidence of damage to the underlying brain, as shown by CT or neurological findings. Four patients subsequently required burr hole drainage for chronic subdural haematoma. In each of these patients, haematoma thickness was greater than 10 mm. The mean delay between injury and operation in this group was 15-21 days. Among these patients 1 patient required craniotomy for haematoma removal due to neurological deterioration. Certain conscious patients with small acute subdural haematomas, without mass effect on CT, may be safely managed conservatively, but due to high risk of these acute subdural haematoma changing into chronic subdural haematoma these patients should be reinvestigated in case of neurological deterioration.

Outcome of transcranial repair of traumatic csf rhinorrhea

Traumatic brain injury represents a significant cause of mortality and permanent disability in the adult population. Posttraumatic CSF rhinorrhea is one of the conditions most strongly associated with severe brain injury. Knowledge on the natural history of the illness and the outcomes of patients with transcranial subfrontal approach for posttraumatic CSF rhinorrhea approach may help the neurosurgeon in the decision-making process. This study was conducted to analyse the outcome of trans-cranial sub-frontal approach for traumatic CSF rhinorrhea, with duroplasty and fibrin glue. This study was carried out in the Department of Neurosurgery, Ayub Medical College, Abbottabad from Jan 2007 to Jun 2011. All patients undergoing trans-cranial sub-frontal repair of traumatic CSF fistulas were included. Where possible primary dural repair was performed under hypotensive general anaesthesia and in the cases where it was not possible, graft was used. This was followed by application of fibrin glue at the repaired site. Graft materials used in this study were taken from fascia lata, pericranium, and temporalis fascia. Out of 27 patients 21 were men and 6 were women. Age of the patients ranged from 17 to 56 [34.5 +/- 4.6] years. Main causes of trauma were road traffic accidents [23, 85%], fall from height [3, 11%], and assaults [1, 4%]. In 23 [85%] cases no CSF leak was observed in immediate postoperative period as well as during the follow-up visits while in 3 [11%] cases additional lumber punctures were required to augment the repair. One patient failed to respond to surgery and lumbar drainage. The CSF rhinorrhea is commonly seen in patients with anterior skull fractures secondary to head injury. Initially conservative trail should be given to the patients, if it fails then on-lay dural technique followed by fibrin glue application through transcranial approach has good outcome with less chances of complications.

Efficacy of endoscopic third ventriculostomy in noncommunicating hydrocephalus

Hydrocephalus is common problem requiring either extra-cranial [shunts] or intracranial [ventriculostomy] diversion of cerebrospinal fluid. Endoscopic third ventriculostomy obviates all the complications of shunts and has been accepted as the procedure of choice for the treatment of obstructed hydrocephalus in adults and children because of the minimally invasive nature. This study was conducted to determine the efficacy of endoscopic third ventriculostomy in the treatment of noncommunicating hydrocephalus. This cross sectional descriptive study was done in neurosurgery department of Hayatabad Medical Complex, Peshawar, from 2[nd] February 2011 to 1[st] march 2012. A total of 171 patients with non-communicating hydrocephalous, irrespective of gender discrimination and Glasgow coma scale score of 10 and above were included in this study. Patients below one year of age, with lesion in the floor of the third ventricle or near basilar artery, and hydrocephalus with infected CSF or haemorrhage were excluded. Hydrocephalous was diagnosed on CT-scan brain. All the patients were followed up till 72 hours post-operatively for the determination of effectiveness in terms of improvement in Glasgow coma scale by at least 2 points. All the above mentioned information including name, age, gender and address were recorded in a predesigned proforma. The data was analysed using SPSS-17. Frequency and percentage was calculated for categorical variables. Mean +/- SD was calculated for age. A total of 171 patients with noncommunicating hydrocephalous were included in the study. Out of 171 patients, there were 104 [60.8%] males and 67 [39.2%] females. Age ranged from 1-70 years with majority of the patients was below 10 years of age. Majority of the patients had hydrocephalus due to tuberculous meningitis 39.2% of the whole. In 134 [78.4%] patients the procedure was effective. Procedure was more effective in hydrocephalus due to space occupying lesion. Endoscopic third ventriculostomy is a very effective procedure for the treatment of non-communicating hydrocephalus.

Management of war injuries - experience at CMH Rawalpindi during 2008 - 2010

To see the changing mode of injury from firearm to blast, pattern of injury with modern body armor and improved surgical options with results of different procedures done. Descriptive study. Department of Plastic Surgery Combined Military Hospital Rawalpindi between Jan 2008 and Dec 2010. All victims of low intensity conflict whether civilian or military personnel from all age groups without sex discrimination were included. Data was collected from history, transferring notes from the forward medical facility to this hospital, case record documents in this hospital and `patients follow up proforma. All these cases were managed in collaboration with other concerned specialties including orthopedic surgery, general surgery, otolaryngyology, maxillofacial surgery and vascular surgery. Plastic surgery department managed 212 patients over last three years i.e. 2008-2010. Age range was 14-58 years and male to female ratio was 71:1. Primary surgical wound management was done at field military hospitals in majority of cases and few were air evacuated directly to CMH Rawalpindi. Majority of injuries were caused by explosions followed by firearms. Simultaneous injuries were 68.9% and isolated injuries were 31.1%. Decision of wound closure was usually dependent on level of tissue damage, contamination and infection. Concept of reconstructive ladder was followed. Majority of wounds were closed in delayed primary setting. Infection was the most common complication followed by partial or complete graft or flap loss. Minimum complication rate was encountered in the wounds which were closed in delayed primary setting. All war wounds are primarily contaminated. If these wounds are closed in delayed primary setting after 2-3 debridements, best results can be achieved. Although infected wounds, wounds with severely damaged structures and injuries associated with tendon or nerve injuries or bone loss will require secondary reconstructive procedures.

Posterior reversible encephalopathy syndrome

Posterior reversible encephalopathy syndrome [PRES] is a clinico-neuro-radiological entity may develop in patients with pre-eclampsia, eclampsia or delayed postpartum eclampsia, immunological conditions and with certain anti-neoplastic agents. This case report describes about a patient with pregnancy induced hypertension who developed PRES postnatally. Early recognition and treatment prevented serious morbidity

Transnasal endoscopic repair if cerebrospinal fluid rhinorrhoea

Background: Cerebrospinal fluid [CSF] leaks can arise as a complication of trauma, hydrocephalus, endoscopic sinus surgery or it may occur spontaneously without any identifiable cause. Surgical repair is recommended in patients who do not respond to the conservative management. In recent years transnasal endoscopic approach has become the preferred method for repairing the CSF leaks and better outcomes have been reported as compared to the intracranial approaches that were previously used. Objective of this study was to analyse the outcome of transnasal endoscopic repairof CSF rhinorrhoea. Methods: This prospective study was conducted in the Department of Neurosurgery, Ayub Medical College, Abbottabad, from March 2007 to March 2010. Twenty-one patients with CSF rhinorrhoea were included in study that were diagnosed on the basis of clinical evaluation, glucose concentration of nasal discharge, computed tomography [CT] and magnetic resonance imaging [MRI]. These patients did not respond to conservative management and were operated transnasally using rigid endoscope. Patients were followed up for a mean duration of 9 months and the outcome was analysed. Results: The patients included in the study ranged in the age group of 12–55 years. Among the patients 13 [57%] were female and 8 [38%] were males. The cause of CSF rhinorrhoea was traumatic in 16 [76.19%], Idiopathic or spontaneous in 4 [19.04%] and 1 [4.7%] case was related to endoscopic surgery for pituitary macroedenoma. In 10 [47.6.8%] patients the site of leak was cribriform plate, 5 [23.8%] had from sphenoid, 4 [19.04%] from frontal sinus and in 2 [9.5%] Ethmoid was affected. Primary surgery was successful in 17 [80.95%] of cases. In 2 [9.5%] cases re-exploration had to be performed. In 1 patient re-exploration had to be done for the third time. Overall success rate was 95%. One patient presented with CSF leak and meningitis 1 month after surgery and unfortunately died. Conclusion: Transnasal endoscopic repair of CSF rhinorrhoea is highly successful, safe and less traumatic. Keywords: Transnasal endoscopic repair, CSF Rhinorrhoea, CSF leak, transnasal endoscopic duroplasty

Accuracy of surgeon - performed abdominal utrasound for gallstones

Gallstone disease is common in Pakistan. It is primarily diagnosed by ultrasonography, which is traditionally done by radiologists. If surgeons could perform ultrasonography, it would enable early diagnosis in one-stop clinic. This study was done to evaluate the accuracy of surgeon-performed abdominal ultrasonography to detect gallstones. This study was carried out at Surgical A and Surgical C units of Ayub Teaching Hospital, Abbottabad from July. 2000 to December, 2002. One hundred fourty two patients with signs and symptoms of gallstone disease who had ultrasonography performed by a surgeon, trained in ultrasonography were exclusively studied. These patients were referred for further scanning by the radiologists who were unaware of the surgeons interpretation. The results of surgeon and radiologist performed ultrasonography were compared. The interpretation of surgeon-performed ultrasonography was correct in 100 patients and incorrect in 42 patients. There were 100 True Positive. 41 True Negative, One False Negative and Zero False Positive scans yielding 99%, Sensitivity, 100% Specificity and 99.3% Accuracy. Sensitivity of surgeonperformed ultrasonography in detecting gallstones compared to operative findings was 100%,. Conclusions: Abdominal ultrasonography performed by an ultrasonography trained surgeon can detect gallstones as accurately as by a radiologist