Culture and sensitivity pattern in patients with external ventricular drain infection

Background: External ventricular [EVD] is a life saving procedure and involves insertion of a catheter in ventricular space to drain cerebrospinal fluid [CSF]. Our objective of this study was to determine the culture and sensitivity [C/S] pattern in patients with EVD infection. Methods: This cross sectional study was conducted in Department of Neurosurgery, Pakistan Institute of Medical Sciences [PIMS], Islamabad from December 1, 2008 to January 31, 2010. All admitted patients who had acute hydrocephalus, underwent EVD insertion after excluding meningitis and ventriculitis by physical examination and per operative CSF sampling. The EVD was done at right Kocher's point. Prophylactic third generation antibiotic [Ceftriaxone] was started and continued till EVD was in place. C/S was sent to PIMS laboratory on first documented fever and or change of CSF color or when plan was to replace EVD with Ventriculo-peritoneal shunt [VP]. Once infection was there CSF was sent for C/S initially and routine examination [R/E] daily. Antibiotics were changed according to C/S report and continued till they were needed. Infection rate was also estimated. Results: Among 76 patients 41 [53.9%] were male and 35 [46.1%] were females. Most were adults and were between 31 to 40 years of age. Mean duration of EVD was 11.41 days. Overall infection rate was 11.8%. Among causative organisms Staphylococcus Aureus [44.4%] was most common followed by Acenitobacter and Enterobacter and commonly used prophylactic antibiotic [Ceftriaxone] had considerable resistance. Conclusion: EVD is a simple and life saving procedure. Most common organisms causing infection are Staphylococcus Aureus followed by Acenitobacter. Conventional used antibiotic Ceftriaxone has considerable resistance. Keywords: External Ventricular Drain, organisms, antibiotics

Correlation between clinical features and magnetic resonance imaging findings in patients with lumbar disc herniation

To find out the correlation of clinical features and magnetic resonance imaging [MRI] findings in determining the level of lumbar disc herniation. It was an analytic study, which was conducted in the department of Neurosurgery, Pakistan Institute of Medical Sciences [PIMS], Islamabad, from 1st May 2002 to 1st March 2003. The total number of patients with prolapsed intervertebral disc, selected for this study was fifty. The clinical level of disc herniation was determined and was correlated with MRI findings. For data analysis, SPSS 10 soft ware was used. In 29 [58%] patients there was right sciatica, while eighteen [36%] had bilateral sciatica. Straight leg raising test was positive in 47 [94%] patients. On MRI, 48 [96%] cases had prolapsed intervertebral discs [PIVD] at L4-L5 and L5-S1 levels and 2 [4%] patients had L3-4 disc herniation. Thirty-eight patients had posterolateral disc herniation and 12 patients had central disc herniation. At L4-L5 level, the sensitivity, specificity, positive predictive value and negative predictive value of all clinical features was 92%, 96%, 95.85 and 88.46% respectively. The chi square value for L4-L5 and L5-S1 was 38.78 [P=0.000] and 22.12 [P=0.000] respectively, while for multiple level disc herniation, it was 3.42 [P=0.064]. Majority of PIVD lie in lower lumbar region. There is excellent correlation between the clinical features and MRI findings in the diagnosis of single level disc herniation but no correlation occurs in case of multiple level disc herniations

Pattern of satisfaction among neurosurgical inpatients

To measure satisfaction among patients receiving indoor neurosurgical care and analyse the profile of the dissatisfied patients. Cross-sectional study. This study was undertaken at the Department of Neurosurgery, Pakistan Institute of Medical Sciences [PIMS], Islamabad from March to April 2005. A total of 133 patients were included in the study by convenience sampling technique. All the patients, who received indoor care for a minimum of 24 hours and were discharged home, were included in the study. Patients who remained hospitalized for more than 4 weeks and those not consenting to participate were excluded. A questionnaire was used for the study that covered five fundamental areas of hospital care i.e. availability and behaviour of the staff, communication of information, residential and management issues. A five-point response scale was used to rate responses to the questions in each of these areas. The demographic profile of the patients and respondents, mode of admission, diagnosis, operation and duration of hospitalization were also recorded. The average of the responses to the questions in each of the five areas was taken as the fundamental area score [FAS] and the average of all these individual area scores was taken as the patient satisfaction score [PSS]. Overall satisfaction index [OSI] was measured by calculating the average of PSS, willingness to return score and willingness to recommend score. Response rate was 100%. Generally, patients were satisfied with care and rated various areas favourably. Behaviour of the staff was the highest rated area [95% score] while management was the lowest rated area [86.97% score]. Dissatisfaction was more frequent among the young, the educated, the male and the relatives. The PSS was 91.32%. Willingness to return score was 97.89% while willingness to recommend score was 95.48%. The OSI was 94.89%. Analysis of patients' dissatisfaction over specific aspects of health care serves to identify areas that could be improved by simple interventions, hence, patient satisfaction surveys should be conducted on regular basis in order to utilize patients' critical feedback for achieving service excellence and improved quality of care