To determine patients' perceptions and attitudes for blood transfusion

Background: Blood transfusion is a risky procedure due to transmission of various infections and reactions of unmatched blood transfusion. Many blood transfusion related problems can be prevented to some extent if patients and their family members are involved in transfusion related procedure

Objectives: To determine patients' perceptions for the recall of consent process, risks, benefits and attitude for blood transfusion

Study design, settings and duration: Hospital based cross-sectional study done on adult patients admitted in Orthopedic and Surgical wards of Civil Hospital, Karachi from November 2014 to January 2015

Patients and Methods: Using convenient sampling, a total of 350 patients who were admitted and received blood transfusion were included in the study. Variables included age, gender, educational status, language spoken, recall of consent for blood transfusion, risks, benefits and attitudes for blood transfusion. Questionnaire based instrument was used for data collection. SPSS version16 was used for descriptive frequencies

Results: Of the total 98% patients were neither asked nor recalled for the consent of blood transfusion. Only 19 [5%] patients were informed about the risks and 77 [22%] about the benefits of blood transfusion. About 236 [67%] patients were of the opinion that blood of family members, if transfused, carries fewer chances of risk/reactions and 213 [61%] patients stated that they will prefer to receive blood transfusion from their family members. Only, 16 [5%] said that would refuse blood transfusion even if it was needed and will prefer blood alternatives. Overall 326 [93%] patients had poor perception and 262 [75%] good perception for blood transfusion

Conclusion: The consent for blood transfusion was missing in majority of the cases and risks and benefits were not explained to the patients

Policy statement: Institutional Bioethics Committees should take notice of these shortcomings

Case-control study for measles outbreak in a tertiary care hospital

Objectives: To compare the profile of measles patients [cases] with non-measles [controls] admitted in Pediatric units of Civil Hospital, Karachi during the measles epidemic

Study type, settings and duration: Retrospective, case control, hospital record analysis of children admitted in pediatric units of Civil Hospital, Karachi from October 2012-March 2013

Subjects and Methods: From the list provided by the ward authorities, case records of children [cases] admitted in pediatric units of Civil Hospital, Karachi with the clinical diagnosis of measles were selected using convenient sampling. From the same wards, age and gender matched non-measles cases [controls] were also selected. The signs, symptoms, mortality and hospital stay of cases and controls were taken from the hospital record, while some information like socio-economic status, vaccination status, symptoms, number of days ill before presenting to health facility, health status of the child, history of similar illness in the family, neighbors, relatives and history of calamity in the area in recent past was taken from the parents or care givers telephonically. Sample size of 300 children [150 cases, 150 controls] was calculated

Results: Out of 150 children having measles, 84 [56%] were females. Most cases reported to health facility after a median of 8 days of onset of symptoms. Almost 98 [65%] children were vaccinated for measles and 52 [35%] were not vaccinated Median age of cases, vaccinated for measles was 30 months while median age of cases not vaccinated for measles was 21 months. All cases had history of fever and maculo-papular rash. Death occurred in 10 [7%] cases due to pneumonia. There was history of measles in their family in 90 [60%] cases, 54 [36%] had measles in neighbors and 30 [20%] in relatives. Out of 150 controls, 76 [51%] were vaccinated for measles and 74 [49%] were not vaccinated. The main reason for admission was pneumonia in 78 [52%] and bronchial asthma in 45 [30%]. The risk of measles was 0.83 times higher for cases who were vaccinated for measles as compared to controls who were vaccinated for measles. Using univariate analysis, symptoms of breathlessness and lower respiratory tract infection at the time of admission were significantly associated with measles disease. Using multivariate analysis, children between 9 to 60 months of age, presenting with breathlessness and lower respiratory tract infection had a significantly high chance of suffering from measles disease

Conclusion: Almost 65% who had received measles vaccination as per their mothers statement suffered from measles

Policy message: Measles outbreak occurring in many children despite getting measles vaccine needs further workup both for the timing of vaccination, actual verification of vaccination and its efficacy

To determine the factors responsible for diagnostic delay of breast cancer among women

Background: Breast cancer is the most common cancer among women throughout the world. Early diagnosis of this cancer is important for its early treatment and favorable outcome. The diagnostic pathway is divided into patient, doctor and system interval. This study will look into the reasons for delay in diagnosis

Objectives: To determine the frequency of diagnostic delay [patient, doctor and system delay] of breast cancer among adult women [>/= 18 years] and factors responsible for it. Study design, settings and duration: Hospital based cross-sectional study conducted at Oncology/ Radiotherapy unit of Jinnah Post Graduate Medical Centre. Karachi from February 2015 to December 2015

Subjects and Methods: Adult women [2 18 years] diagnosed with breast cancer and reporting at Oncology/Radiotherapy unit of Jinnah Post Graduate Medical Centre, Karachi were enrolled. Convenient sampling was used, sample size was 288 women with breast cancer. Variables included age strata, socio-demographic characteristics, age at menarche, parity and breast feeding history [if applicable], intervals of diagnostic pathway [patient, doctor and system] and reasons of delay. Questionnaire based instrument was used for data collection. SPSS version 16 was used for data analysis and descriptive frequencies

Results: The mean age of the patients was 42 years [range 21-80 years]. Breast lump was the main presenting symptom [90%,]. Complete physical and breast examination was performed by health care provider in 97% cases. Median patient, doctor and system interval was 90, 45 and 35 days respectively. Median diagnostic pathway [patient+ doctor+ system] was 165 days [5.5 months] and ranged from 2- 405 days [13.5 months]. It was further found that after confirmation of the diagnosis, median interval to report to oncology/radiotherapy unit was 18 months. First consultation with the health care provider was delayed due to carelessness in 57%, due to financial reasons in 55%, due to fear of cancer in 23% and due to time constraints to visit hospital by the family members in 13% cases. Univariate regression analysis showed that late presentation to first health care provider by the patient [patient interval] was mostly seen in women having children who were less educated [illiterate/primary] without any ethnic group being specific. Univariate regression analysis showed that delay in reporting to oncology/radiotherapy unit was seen in women without any ethnic group been specific and those having children. Multivariate regression analysis showed that delay in reporting to oncology/radiotherapy units was mostly seen in women aged between 18-25 years who had children and belonged to either Sindhi, Baluchi or Pushto origin

Conclusion: Delay in the diagnosis of breast cancer among adult women attending the tertiary care public sector hospital as not due to doctor or system interval but was due to fear of cancer. Policy statement: Awareness campaigns should be used to communicate to women folks that breast cancer is curable if diagnosed and treated early

Craniopharyngioma total or near total surgical resection: an outcome based learning experience

Background: Craniopharyngiomas are benign slow growing tumours that are located within the sellar and para sellar region of the central nervous system. It is a rare but significant health problem in Pakistan. The point prevalence of this tumour is approximately 2/100,000

Objective: To determine the outcome of complete resection in patients with craniopharyngioma and to determine the relationship of different factors with outcome at 3 months of follow up

Methods: A case series study conducted in thirty five patients, who were diagnosed as cases of craniopharyngioma on the basis of history, clinical examination, CT and MRI appearances and histopathological examination. All patients underwent complete resection of craniopharyngioma. The study was conducted at the Department of Neurosurgery, Dow University of Health Sciences/ Civil Hospital, Karachi from 27th December, 2006 and 27th December, 2007

Results: Good outcome was seen in thirty four [97%] patients, one [3%] had poor outcome in term of mortality. Age, Preoperative presence of neurological deficit, localization of the lesion and preoperative hydrocephalus just before placement of VP shunt and radical excision were the most important predictor of good outcome. The rest of factors studied such as Glassgow coma, duration of illness, and signs of meningeal irritation postoperative hydrocephalus had no effect on outcome

Conclusion: A complete excision of the tumour is recommended, if there is no hypothalamic invasion and in the presence of hypothalamic invasion, near total resection with post-operative radiotherapy. Endocrine disturbances need careful follow up and replacement

Assessment of hepatitis B vaccination coverage in children under 5 years of age in two major public sector hospitals of Karachi

To assess Hepatitis B Vaccination coverage of children under 5 years of age attending Paedriatic units of Civil Hospital and National Institute of Child Health Karachi and to identify the reasons for non-compliance. Descriptive cross-sectional survey conducted in Paedriatic units of Civil Hospital and National Institute of Child Health of Karachi over period of eleven months. Subjects and A total 971 children under 5 years of age attending the selected hospitals were randomly selected. A structured questionnaire was used which included age, gender, EPI vaccination status, age at first dose of hepatitis B vaccination [Pentavalent vaccine], services utilized and payment if any, birth history, educational status of the respondent, knowledge about Hepatitis B vaccination, history of Hepatitis B in the family and reasons for non-compliance. SPSS version 15 was used for data analysis and chi-sq at 0.05 alpha level for statistical significance. Univariate and multivariate analysis were used for association of the variables. Out of 971 children who were enrolled, data of 969 children was analyzed. Majority [71%] were out door cases and only 284[29%] were indoor patients. Age distribution showed 447[46%] up to 12 months of age and overall male to female ratio was 1.3:1. Almost 80% children had received one dose of Hepatitis B vaccine, 72% had received two and 65% received all three doses. Age at vaccination showed that 677[70%] children were age appropriately vaccinated and out of these 469[48%] had received their first dose of Hepatitis B vaccination at six weeks. Reasons for non-compliance were parental/family objection 172[18%], intercurrent illness of children 44[5%], and other causes including no knowledge for the vaccination, long distance, loss of vaccination cards and non-availability of vaccine in 63[6%] cases. Univariate analysis showed that children who were vaccinated for BCG, Polio and Measles were more likely to be also vaccinated with Hepatitis B vaccine [significant]. Multivariate analysis showed that apart from above variables education of the respondent and place of delivery were significantly associated with Hepatitis B vaccination of the children. Only 65% children had received all three doses of vaccine and 48% received first dose at six weeks. Major reasons for non-compliance were parental/family objection. Policy message: Efforts should be made to increase the uptake of all 3 doses to ensure full protection against hepatitis B along with education of public to remove misconceptions about vaccination

Computer based assessment [CBA]: perception of residents at dow university of health sciences

During the past few years, Computer-based assessment [CBA] has gained popularity as a testing modality. This assessment offers several advantages over paper based assessment [PBA] testing. The objective of this study was to find out residents' perception of this method of assessment. The post graduate residents of Dow University of Health Sciences in the field of Surgery, Medicine, Gynecology and Obstetrics experienced their first formative Computer-based assessment [CBA] in year 2013.Immediately after formative CBA, an anonymous paper based questionnaire was distributed amongst the residents and response was sought for their self-perceived computer usage competence before starting residency, perceptions regarding CBA method and to determine their preference for PBA or CBA in future assessment preferences. Total 173 residents completed the questionnaire. More than half of residents, 56.1% had no prior experience of CBA. Three fourth, 76.4% of the residents were less than confident before sitting in CBA, while after completing CBA, 64.8% were either confident or extremely confident for CBA. Most common problem encountered by students was logging in 28.9%. More students [53.2%] believed that paper assessment took longer to complete than CBA. Majority of the students [61.8%] rated CBA as better than PBA despite experiencing it for the first time. Resident's perception for CBA is good and they recommend its use in future assessment as well. However, to take maximal advantage of this technology, faculty should be trained to develop questions not only with text and pictures but with audio and video support

Pneumococcal infections in children under 5 in karachi: a retrospective analysis

To analyze the hospital case records of children under five years of age for Pneumococcal pneumonia. Retrospective case record analysis of children admitted in pediatric units of Civil Hospital, Karachi, from 2011 to 2012. This case record analysis was conducted on children under 5 years of age who were admitted and diagnosed to have pneumonia. The clinical criteria used for the diagnosis of pneumonia were taken from WHO [IMCI]. Variables studied included age, gender, birth and feeding history, vaccination status, symptoms/signs on admission and diagnosis. Information was collected on a questionnaire. SPSS version 15 was used for analysis. Out of 820 case records retrieved, diagnosis of pneumonia was written on the files in 637 [78%]. Fifty two percent [333] children were age appropriately vaccinated. Majority [62%] of children were up to 11 months of age and male to female ratio was 1.4:1. Commonest symptoms were fever, cough and respiratory distress. Pneumonia was severe in 124 [19%] children and out of these 96 children were less than 12 months of age and they had a respiratory rate of more than 50 per minute with more than two danger signs. Pneumonia was more severe among un-vaccinated [schedule EPI immunization] group. Blood culture reports were available in only 14 children and none were positive for Streptococcalpneumoniae. Majority of the children with pneumonia were less than 12 months of age and severity of pneumonia was more in un-vaccinated children. This study can be used as a baseline for pneumonia or pneumococcal disease in children under 5 years and compared with the drop in the pneumonia cases after the introduction of Pneumococcal Conjugate Vaccine in schedule EPI programme

Factors affecting academic performance of primary school children

To determine the socio-economic, psychosocial, environmental and student related factors affecting academic performance of public and private primary school children. Descriptive cross-sectional survey of 600 students [300 each from public and private primary schools] using randomly selected children from Saddar town, Karachi. Using selected schools and children, information was collected on a questionnaire. The factors studied included socio-economic, psychosocial, school and home environment and student related factors. SPSS version 15 was used for data analysis and chi-sq at 0.05 alpha level for significance test. Univariate and multi variate analysis were used to find out the association of the variables. A total of 600 students filled the questionnaire of whom 300 were from private and 300 from public sector schools. The mean age of children was 11.37 +/- 1.52 with male to female ratio of 1:1.8 in public schools and 1:0.9 in private schools. Socio-economic status was classified as good, fair and poor using the parent's job and number of family members working. Almost 34% children belonging to public and 65% to private schools were categorized as good. Among the public school children 65% fathers and 58% mothers were literate while, these figures were 62% and 67% among private school children. Overall 25% school children did not regularly take breakfast. Almost 50% public and 20% private school children remained absent once a week. Overall 35% children did not have adequate sleep and 22% children of public and 14% of private schools were suffering from some kind of illness. Based on BMI overall 24% children were underweight while, obesity was seen in 3% public and 11% private school students. Parent's help in completing school homework was twice more in those studying in private school [11% public and 22% private] thus showing a better academic performance of students in private school [poor performance seen in 40% public and 16% private]. Cognitive behavior evaluated from learning habits and overall psychosocial condition was good in both types of school children and school environment of 43% public and 54% private school was also good. Majority of the schools had no sports or physical training facilities. Using univariate and multivariate analysis it was found that younger age, female gender, better socio-economic condition, habit of taking breakfast, better condition of school, and regular attendance were significantly associated with better academic performance. Academic performance of public school children was poor as compared to private schools. Socio-economic, psychosocial, school and home environment and student's own factors, affected their academic performance. School and out of school factors both need to be improved for achieving good school achievement of primary school children

Perceptions and practices for the control of dengue fever in Karachi - A school based survey

To determine the perceptions and practices for the control of Dengue fever in secondary school children of Saddar town Karachi. Cross-sectional survey based on cluster sampling done over 6 months. Data was collected from 1320 secondary school children of both gender belonging to public and private schools [total 14] of Saddar town, Karachi. A structured self administered questionnaire was used which included variables like age, gender, class pass, knowledge of dengue fever, its control and preventive methods used at their homes. Data was analyzed on SPSS version 15 and chi square was applied for statistical significance. Data was analyzed for 1270 students as others had incomplete information. Participation was 650[51%] from public and 620[49%] from private schools. Majority 517[41%] of the students were 15-16 years old [mean 14.5 STD +/- 1.6] with male to female ratio of 1.1:1. About 890[70%] students had knowledge about dengue fever and its control methods mostly received from television [82%]. Though 72% knew that mosquito is the causative agent but only 13% were aware of its biting habits. Almost 66% students believed that dengue infection could be controlled and 33% thought that mosquito elimination is a good method to the control disease. Majority [90%] students stated that they keep water utensils covered at their homes. Overall 59% students had good knowledge about dengue fever and its control methods but only 21% were practicing it. School students had sufficient knowledge about dengue fever and its control but this knowledge did not change their behavior was not translated into practice. Educational programmes should focus on translating knowledge into practice

Outcome of open transcortical approach in the management of intraventricular lesions

To evaluate the outcome of management of intraventricular lesions operated by an open transcortical [nonendoscopic] approach. Case series. Department of Neurosurgery, Dow University of Health Sciences and Civil Hospital, Karachi, from January 2009 to December 2011, with six months follow-up. All cases with lesions in the lateral ventricle and anterior third ventricle operated by open transcortical approach, were included after informed consent. Total excision of the lesion was attempted in all cases. Patients were analyzed for outcome in terms of establishment of diagnosis, completeness of resection, morbidity and mortality. A total of 33 patients were operated. Twenty three were males and 10 were females. Colloid cyst was diagnosed in 14 patients [42%], giant cell astrocytoma and choroid plexus papilloma in 4 cases each and subependymoma and central neurocytoma in 2 cases each, epidermoid, choroid plexus carcinoma, oligodendroglioma, metastasis, meningioma, ependymoma and cavernous hemangioma in one patient each. The overall outcome could be labeled as good in 24 out of 33 cases [73%] and in 8 cases [24%] it was fair. One patient died due to ventriculitis and was categorized as poor outcome [3%]. Postoperative complications included meningitis, seizures, intraventicular haemorrhage, subdural collection and transient hemiparesis. Nine patients had persistent hydrocephalus requiring ventriculoperitoneal shunt. Conventional open transcortical approach is still effective in getting conclusive biopsy or near total excision of the lesion with minimum morbidity.

Prevalence of shisha smoking in college, university and madarsa students aged 20-25 years in Pakistan

To estimate the prevalence of shisha smoking, its trends and associated factors in college, university and madarsa students aged 20-25 years in Pakistan. This survey was done on 7582 subjects belonging to 71 institutions from five cities and Federal Capital Islamabad, using a population based sample. Data was collected using cluster sampling from public/private colleges, universities and madarsas. After taking informed consent, about 10% students from each speciality including both genders were collected using a structured self administered questionnaire designed in Urdu and English. Variables included age, gender, socio-economic status, habits, trends, knowledge and perceptions about shisha smoking. The study was approved by Institutional Review Board. Data was analyzed on SPSS version 15 and chi square was used for statistical significance. Out of 71 educational institutions, 43 were public and 28 private including 8 madarsas. There were 2971 students from professional and 4174 from non-professional institutions. Overall prevalence of shisha smoking was 19.7% [n=1410] being more common in males [29.8%] than females [10.4%] Students started smoking shisha at 17-18 years age [57.2%] and almost 75% started this habit in year 2009-2010. The highest prevalence of shisha smoking was seen in Federal Capital Islamabad [28.1%], and lowest in Peshawar [11.2%]. The shisha smoking was more in professional and private educational institutions [p<0.000] with almost 29% students using it in engineering colleges and none using it in madarsas [alma/alia courses]. The trend was highest in students belonging to high socio-economic status [30.7%] and those already smoking cigarettes [74.1%] Pleasure seeking was the commonest reason for smoking shisha [7.1%] and almost 11% students were influenced by their friends. Shisha cafe's were site used by most smokers and majority preferred double apple or mint flavor. Almost a quarter [23.8%] students smoked shisha just for enjoyment and 12.1% thought that it is less harmful than cigarette smoking. Almost 20% students in colleges and universities are smoking shisha. Majority thinking shisha to be harmless or less harmful than cigarette smoking indicating that knowledge about adverse effects of shisha smoking is tremendously low in this educated youth of our country. Shisha should be subjected to the same regulation as cigarettes and other tobacco products and public should be educated about its harmful effects

Lumbar Disc Degenerative Disease: Disc Degeneration Symptoms and Magnetic Resonance Image Findings

STUDY DESIGN: Cross sectional and observational. PURPOSE: To evaluate the different aspects of lumbar disc degenerative disc disease and relate them with magnetic resonance image (MRI) findings and symptoms. OVERVIEW OF LITERATURE: Lumbar disc degenerative disease has now been proven as the most common cause of low back pain throughout the world. It may present as disc herniation, lumbar spinal stenosis, facet joint arthropathy or any combination. Presenting symptoms of lumbar disc degeneration are lower back pain and sciatica which may be aggravated by standing, walking, bending, straining and coughing. METHODS: This study was conducted from January 2012 to June 2012. Study was conducted on the diagnosed patients of lumbar disc degeneration. Diagnostic criteria were based upon abnormal findings in MRI. Patients with prior back surgery, spine fractures, sacroiliac arthritis, metabolic bone disease, spinal infection, rheumatoid arthritis, active malignancy, and pregnancy were excluded. RESULTS: During the targeted months, 163 patients of lumbar disc degeneration with mean age of 43.92+/-11.76 years, came into Neurosurgery department. Disc degeneration was most commonly present at the level of L4/L5 105 (64.4%).Commonest types of disc degeneration were disc herniation 109 (66.9%) and lumbar spinal stenosis 37 (22.7%). Spondylolisthesis was commonly present at L5/S1 10 (6.1%) and associated mostly with lumbar spinal stenosis 7 (18.9%). CONCLUSIONS: Results reported the frequent occurrence of lumbar disc degenerative disease in advance age. Research efforts should endeavor to reduce risk factors and improve the quality of life.

Initial experience of elearning research module in undergraduate medical curriculum of Dow University of Health Sciences: development and students perceptions

To describe the course development and student perception of eLearning Research module for the undergraduate medical students of Dow University of Health Sciences, Karachi. In December 2011 and January 2012, Dow University of Health Sciences [DUHS] started first six-weeks eLearning Module of Research Methodology for the 1[st] semester MBBS students. All university campuses have digital libraries equipped with computers with networking and internet facility. 'Articulate Studio 09' was used to made flash based presentations with interactions followed by assessment with the use of kwik surveys. Student perception was evaluated after each session by quantitative and qualitative methods. Total 539 students of all three colleges affiliated with DUHS completed the evaluation Form. Most of the students [492, 93.1%] rated highly the overall layout of eLearning module. Text of the module was found to be clear and informative by 81.1%. Contents were judged as not according to student's level of understanding by 34.5%. Overall experience of the first session was rated excellent by 23% and good by 64% with [cumulative 87.2%]. However, students had mixed opinion about requirement of their computer skills for this eLearning module. Qualitative evaluation showed very good experience of students and they want more topics to be covered with this modality. This module proved to be not only a good experience for our faculty members about eLearning instructional design and its execution but was also rated very highly by the students. Our experience will be helpful for other institutes as well, who are planning to start eLearning in their medical curriculum

Intramedullary spinal tuberculoma

Spinal intradural intramedullary tuberculoma is extremely rare entity of tuberculosis involving the nervous system. Because of its atypical symptomatology, it must be considered in differential diagnosis of spinal cord lesions, especially where prevalence of tuberculosis is high. In this case report this atypical disease is described where good outcome was achieved by surgical excision of the intramedullary lesion followed by antituberculous therapy

Contusion index: its importance in management of traumatic brain contusions

To describe the changes of Glasgow Outcome Scale [GOS] and Glasgow Coma Scale [GCS] after surgical and / or conservative management of patients with contusions based on Contusion Index [C. I.]. Descriptive Study. Department of Neurosurgery, Dow University of Health Sciences/ Civil Hospital, Karachi. Two years and five months between August 2006 and January 2009. 50 patients of ages between 6 to 75 years, including both sexes were evaluated on the basis of contusion index as determined by computerized tomographic scan [C.T. Scan] findings and their Glasgow outcome scores were established. Patients with contusion index 0-3 should be conservatively managed. Patients with contusion index 6 should be given the benefit of some sort of surgical procedure first, which showed best results with surgical management and poor results with conservative management. Patients with contusion index 9, no matter what, always show a poor outcome. We recommend that a future study should be done to arrive at a decision regarding conservative versus surgical management of patients with cerebral contusions based on Contusion Index which will help us avoid unnecessary surgeries and vice versa

Spinal injuries: experience of a local neurosurgical centre

To find out the pattern of traumatic spinal injuries and their management in patients admitted to a neurosurgical unit of a tertiary care hospital in a developing country. All patients admitted with spinal injuries between July, 2003 and June, 2007, in the Department of Neurosurgery, Civil Hospital, Karachi, were included. Information was recorded and analysed with respect to demographic data, mechanism of injury, level of bony injury, neurological degree [complete, incomplete and intact], duration between injury and admission, associated injuries, management, hospital stay and outcome. A total of 214 patients were admitted. These included 189 males [88.3%] and 25 females [11.7%]. Most affected patients [72/214 - 33.6%] were in their third decade of life, followed by second and fourth decades, 38 /214 [17.7%] in each decade. The commonest cause of injury was fall from height in 122 patients, [57.0%], followed by fall while carrying weight in 23 [10.7%], road accidents in 50 [23.4%] and gunshot injuries in 10 [4.7%] cases. Cervical spine was affected in the majority 101 [47.2%] cases followed by thoracic spinal injury, 64 cases and lumbar spine with 59 cases [27.6%]. Seventy seven patients [36%] had complete neurological loss, 119 [55.6%] had partial deficit while 18 patients [8.4%] were neurologically intact. Surgery [decompression and fixation] was performed in 50 cases. Long bone fracture was the commonest associated injury. The average time between injury and admission was 6.2 days [range 0-60]. Mean hospital stay was 8.4 +/- 7.6 days. Twenty three [10.7%] patients died during hospitalization. This study shows that young adults, predominantly males in their most productive years of life, are especially prone to spinal cord injury. Fall from height is the most common preventable cause of spinal injury. Recognizing the pattern of spinal injury helps to identify high-risk groups which will then help us to design more appropriate preventive measures

Peritumoral Cystic Meningioma

A case of 39 years old male is described who presented with headache, right-sided focal fits and decreased power in the right hand. CT scan brain showed a left fronto-parietal cystic lesion with centrolateral intramural nodule with homogenous enhancement. At surgery, the extra-axial lesion with cyst containing xanthochromic fluid had a well-defined capsule that could easily be separated from the peri-lesional cortical surface. The dural-based nodule with its cyst wall was resected in toto. The histopathology of mural nodule was reported as meningioma while the cyst wall histology revealed meningothelial cells

experience with four cases of split notochord syndrome and review of literature

To evaluate the rarity of split notochord syndrome, to access frequency of various associated anomalies and to find out compatibility of this condition with survival. All those cases who presented with vertebral abnormalities and those who presented with spina bifida associated with gastrointestinal and urological abbarasion were further investigated for possible association of split notochord syndrome. The study was conducted at the Department of Paediatric surgery the Children Hospital Pakistan Institute of Medical Sciences from 1987-2001. All those children and aborted fetuses who had gross spinal cord defect, accessory limb, or teratoma like lesion associated with mylomeningocele or those who had gross duplication of pelvic genitourinary organs were further assessed by detailed examination of the local lesions and further radiological, contrast and histopathological studies. We could identify four such cases, each had completely different anatomical presentation. One was an aborted fetus of 24 weeks gestation. Another child died soon after the delivery. One had pelvic skeletal and organs duplication with enteric fistulae, double exstrophy of bladder, double penis, and split lumbosacral spine, and the fourth case had complete duplication of external genitourinary organs in the form of fully formed double vulvae and split spinal column in the region of sacrum and coccyx. Split notochord syndrome is perhaps rare abnormality, but often it may not be identified especially if it is not specifically looked for. Fifty percent of our cases were either aborted or still-born, therefore to assess the actual incidence of split notochord syndrome it is suggested that study should be conducted by antenatal ultrasounds and all fetuses who show spinal column defects and aborted should be examined with detailed dissection and histopathology analysis of the tissues

experience with rectal duplications and review of literature

We are reporting eight cases of rectal duplications over a period of 11 years from 1989 to year 2000. Three of these cases were associated with colonic duplications and were of tubular variety whereas rests were cystic. Presentation of each was completely different. Mode of presentation, methods of diagnosis and management strategies are discussed along with the review of literature