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

ten year review of emergency peripartum hysterectomy in a tertiary care hospital

Emergency peripartum hysterectomy [EPH] is a life saving procedure considered in cases of severe haemorrhage unresponsive to medical and conservative surgical procedures.The aim of present study was to review the frequency, indications, maternal morbidity and mortality associated with emergency peripartum hysterectomy in a tertiary care hospital in a developing country. This was a cross sectional study in which data was retrospectively collected from January 2000 to December 2010. Main outcome measures were maternal morbidity and mortality associated with EPH. The incidence of EPH was 10.52/1000 deliveries. The main causes of EPH were rupture uterus 76 [34.86%], atonic uterus 65 [29.81%], placenta accreta 19 [8.71%], placenta previa 17 [7.7%], and placental abruption 36 [16.5%]. Mostly subtotal hysterectomy was the preferred method done in 196 [89.9%] of cases, while total abdominal hysterectomy was done only in 22 [10.09%] of cases. The over all complication rate was 81.2% which included both minor and major complications like hypovolemic shock 180 [82.5%], febrile morbidity 108 [49.5%], wound infection 40 [18.3%], bladder injury 6 [2.75%], and thrombophlebitis 22 [10.09%]. The maternal mortality in present review was [10.5%]. Frequency of EPH was found to be high in this study. Obstetricians must be skilled in it particularly in developing countries where the main indication of hysterectomy is rupture uterus.