bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparative Study on the Effectiveness of Posterolateral Fusion vs. Interbody Fusion in Isthmic/Degenerative Spondylolisthesis
Authors: Syed Ahmad Faizan  , Mudassir Masaud  , Zubair Mustafa Khan  , Tariq Imran  , Asif Bashir  
Published: May 2024

Objective: To compare the effectiveness of posterolateral fusion versus transforaminal lumbar interbody fusion in degenerative/isthmic spondylolisthesis in terms of postoperative pain and postoperative complications.
Materials & Methods: A quasi-experimental study was conducted and 74 patients were included. Group A (n=37) patients underwent PLF, whereas Group B (n = 37) patients underwent TLIF. The pain was assessed with a visual analog scale (VAS), and for disability, the Oswestry Disability Index (ODI) was used.
Results: In Group-A, pre- and post-op back pain mean scores were 3.86 & 0.78, leg pain mean scores were 1.32 & 0.54 while ODI mean scores were 22.51 & 8.59, respectively(P ? 0.05). In Group B, pre- and post-op back pain mean scores were 3.41 & 0.46, leg pain mean scores were 0.84 & 0.30 and ODI mean scores were 19.89 & 6.59, respectively (P > 0.05). The prevalence of minimal disabilities in the TLIF (73%, 78%, 81%, 86%, & 91%) group was relatively more than in the PSF (70%, 75%, 78%, 81%, & 86%) group during pre-op, and post-op phases (2 & 6 weeks, 3 & 6 months). Relatively more patients (8.1% vs. 5.4%) with moderate disability were found in the PSF group as compared to the TLIF group.
Conclusion: The study concluded that TLIF is a safe and more effective procedure than PLF for isthmic/degenerative spondylolisthesis. It is a better surgical procedure for post-operative back pain, leg pain, complications, and disability.
Efficacy of Electromagnetic Based Neuronavigation-Guided Biopsy of Supratentorial Lesions of the Brain at Jinnah Hospital Lahore
Authors: Usman Ahmad Kamboh  , Mehwish Manzoor  , Hafiza Arisha Fayyaz  , Zaid Sami  , Mehreen Mehboob  , Manzoor Ahmad  
Published: May 2024

Objective: The study aims to establish the efficacy of electromagnetic-based neuro navigation-guided biopsy of supratentorial lesions (including deep-seated, multiple, and suspicious lesions) in selected patients.
Materials & Methods: After being admitted to the neurosurgery department, all patients who satisfied the inclusion criteria were recruited for the research. Patients received neuroimaging in the form of CT/MRI brain with contrast using the neuronavigation protocol, and the data was uploaded to the Medtronic neuronavigation system. Under general anesthesia, all patients had a biopsy. On the console, the surgical trajectory for the biopsy was planned. Following the AxiEM system's usual operating protocols, a Sedan needle was used to biopsy lesions after its stylet was replaced with an EM stylet.
Results: Out of 19 patients, 11 (60%) were male and 8 (40%) female while age ranged from 13 to 70 years. Out of 19 patients, 4 patients (21%) had parietal, occipital, and thalamic lesions respectively. 4 patients (21%) had low-grade glioma (grade 2) and 3 (15.7%) patients had Burkitt lymphoma, adenocarcinoma (likely from lungs), and blue cell tumor respectively. As regards complications, 2 patients (10.5%) developed hemorrhage, 1 patient (5.26%) developed postoperative cerebral edema, and 1 patient (5.26%) expired.
Conclusion: Electromagnetic neuronavigation using the biopsy needle (Sedan needle) is a safe and effective neuronavigation system. It offers a high degree of accuracy required for the establishment of a definitive diagnosis and adequate treatment.
Radiological Verses Histological Evaluation of Spinal Space Occupying Lesions
Authors: Sabika aftab  , Rabail Akbar  , Tanweer Ahmed  , Lal Rehman  , Iram Bokhari  , Sana Akbar  
Published: May 2024

Objective: This study set out to evaluate radiology's diagnostic capacity in accurately establishing a preliminary working diagnosis for various spine tumor types.
Materials and Methods: This is a prospective study carried out and examined patients who had surgical resection with the collection of histopathology samples, regardless of age or gender. A full MRI examination from every angle and contrast-enhanced pictures were required. Inclusion criteria consisted of Patients of all ages of both genders, who underwent surgery a tissue sample was collected for histopathological diagnoses, and a complete MRI study with all views and contrast-enhanced images was available to give a preliminary diagnosis.
Results: Based on the evaluation by the senior radiologists, the lesions were most commonly intradural-extramedullary (50%) in position according to the dura, followed by intramedullary in 14 (26.9%) patients. Despite our series having a total of 16 misdiagnosed cases, the overall diagnostic accuracy of the MRI remained high at 69.2%.
Conclusion: MRI has superior diagnostic accuracy in diagnosing meningiomas as compared to nerve sheath tumors such as meningiomas. It also has good predictive accuracy of intramedullary lesions such as ependymomas.
incidence of cervical spine injuries in paediatric patients and their outcome in tertiary care hospital
Authors: Ahmed Sahibzada haseeb , Abbas khan  
Published: May 2024

Objective: The incidence of mortality after cervical trauma in the pediatric population is very high. The purpose of this study was to determine the treatment given, morbidity and mortality of patients with cervical spine injuries, and their outcome after 6 months of management which includes both surgical and conservative treatment.
Materials & Methods: A prospective study was conducted at Lady Reading Hospital, Peshawar with a total number of patients n = 187 included in our study. Patients were stratified according to their age, mortality, mechanism of injury (fall, motor vehicle accident, bicycle injuries, &sports-related injuries), level of cervical spine injury, presence of neurologic deficit, presence of bony injury (fractures, &dislocations), ligamentous injuries & SCIWORA. The primary outcome was the functional status at 6 months following treatment.
Results: There were 78 females and 109 males. In comparison to the lower cervical spine (C3 – C7), which was involved in 86 patients (46%), the higher cervical spine level (C0 – C2) was involved in 101 patients (or 54%). The most frequent cause of cervical spine injuries in the older age range was a history of a fall, followed by a motor vehicle accident. Among the treatment groups, mortality was highest in patients who underwent surgery.
Conclusion: Younger age groups, higher cervical spine levels, and mechanisms of injury such as high energy impact trauma were independent risk factors for increased mortality. Compared to incomplete neurological abnormalities, a complete neurological disability increases mortality.
The Outcome of Prolactinoma in the Postpartum Period: a Study from a Tertiary Care Hospital in Pakistan
Authors: Shirin Gul Suhail  , Omair Afzal  , Zahra Safdar  , Rizwan Ahmad Khan  , Uzma Zia  
Published: May 2024

Objective: Prolactin is an essential hormone secreted by the pituitary gland of pregnant women. The pituitary gland undergoes growth, due to lactotroph hyperplasia in response to placental estrogen during pregnancy. Research on the postpartum outcomes of prolactinomas is less. This study evaluates the prevalence of Prolactinoma and the occurrence of spontaneous resolution of Prolactinomas after pregnancy.
Materials and Methods: A cross-section study was conducted at the Punjab Institute of Neurosciences, Lahore. 200 pregnant women were recruited; their blood samples were collected to evaluate serum prolactin levels. Women diagnosed with prolactinomas exhibiting positive symptoms were given dopamine agonists. The administration of dopamine agonist was discontinued at the 24th week of gestation. All participants were monitored till birth, at 40 days after delivery, and throughout breastfeeding. Their prolactin levels were evaluated, and magnetic resonance imaging (MRI) was conducted to verify the resolution of prolactinoma.
Results: The mean age of females in the study was 29.03 ± 7.20 years. Out of 200, 40 (20%) females had prolactinoma. Out of 40, 13 (32.5%) were given Bromocriptine while 27 (67.5%) were given Cabergoline. At presentation, the mean serum prolactin level was 138.91 ± 149.02 ng/ml, which reduced to 21.38 ± 9.80 ng/ml. The mean tumor size at presentation was 7.23 ± 2.07 mm, which reduced to 0.79 ± 0.66 mm after delivery. Out of 40, 30 (75.0%) had spontaneous resolution.
Conclusion: The occurrence of prolactinoma is low in symptomatic patients and can resolve spontaneously after delivery in the majority of cases.
Recurrence Rate After Using Subdural Drain in Patients with Chronic Subdural Hematoma
Authors: Hameed Ullah  , Amer Zaman  , Waseef Ullah  , Junaid Alam  , Atta Ullah  , Bilal Ahmad  
Published: May 2024

Objective: One of the most often carried out procedures in the neurosurgical field is the drainage of chronic subdural hematomas (CSDHs). According to Scotti, subdural hematoma was identified radiologically as a subdural collection that was hypodense to parenchyma and manifested 21 days following trauma. This definition was based on the CT scan. In this study, we want to find the effectiveness of subdural drain in managing chronic subdural hematoma from the perspective of recurrence in our setup.
Materials and Methods: After the procedure, the patients were admitted to the ward for 48 hours and the drain was removed after 48 hours. Then the patients were discharged and follow-up was taken one month for diagnosis of recurrence. Recurrence was labeled positive if postoperative symptomatic recurrence of hematoma that needs re-operation of any type within one month of primary surgery.
Results: Among 85 patients mean age was 51 years with a standard deviation ± 7.55. 60(71%) patients were male and 25(29%) patients were female. Moreover s10 (12%) patients had recurrence while 75(88%) patients didn’t have recurrence.
Conclusion: According to our research, patients with Chronic Subdural Hematoma (CSDH) had a 12% recurrence incidence following the placement of a subdural drain.
Depressed Skull Fracture Surgical Management and Outcome among Head Injury Patients: Experience at Tertiary Care Hospital
Authors: Aurangzeb Kalhoro  , Muhammad Hamid Ali  , Vashdev Khimani  , Raiz Ahmed Raja  , Mahesh Kumar Luhano  
Published: May 2024

Objective: To evaluate outcomes in patients with managed depressed skull fractures operatively having head injuries.
Methods: This study was conducted at Liaquat University of Medical and Health Sciences, Jamshoro. We analyzed 76 patients who underwent operative management for skull fractures. Patient selection included both children and adults with skull fractures evident on CT brain scans using bone windows.
Results: Our study included 76 patients, with 48 males and 28 females, and a mean age of 28.68 ± 10.33 years. Among them, 45 (59.21%) were under 30 years old, and the highest incidence of depressed skull fractures occurred in the 21 – 30 age group. Road traffic accidents were the leading cause, accounting for 42 (55.25%) cases, while falls from heights contributed to 24 (31.57%) cases, and 7 (9.21%) resulted from objects falling on the patients.
Conclusion: Patients with head injuries can be fatal if not managed promptly. Neglecting the management of a depressed fracture can also impact the outcome in these cases and lead to a series of complications.
Complications of Post-Traumatic Spinal Surgery
Authors: Mohammad Daniyal Mumtaz  , Iram Bokhari  , Tanweer Ahmed  , Raheel Gohar  , Sanam Daniyal  , Sehrish Altaf  
Published: May 2024

Objective: The study aimed to evaluate the frequency and complications of post-traumatic spinal surgeries.
Materials and Methods: A prospective observational study was conducted at JPMC for six months and included 55 patients presenting with post-traumatic spinal injuries who were operated on. Information on the patient’s demographics, clinical findings, radiological findings, type of surgical procedure, and postoperative complications were recorded. A chi-square test was employed to compare difficulties with demographic characteristics.
Results: Our study comprised of patients with an age of 39.55+/-6.19 years; of them, 72.7 percent were males, and overall complications occurred in 30.9 percent of patients, which included wound infection (10.9%), CSF fistula (3.6%), wound dehiscence (1.8%), pneumonia (3.6%), heart arrhythmia (1.8%), lung congestion (1.8%), instrumental loosening (1.8%), postoperative visual loss (1.8%), and diathermy burns (3.6%).
Conclusion: 30.9 percent of patients operated for spinal traumatic injuries developed complications. A few of these complications are dreaded and need to be communicated to patients/attendants and necessary steps should be taken to prevent them.
Evaluation of Outcomes and Complications of Sphenoid Wing Meningiomas in Tertiary Care Hospital of KPK
Authors: Ahmad Qarnain Aafaq , Mumtaz Ali  , Akramullah  , Sajid Khan  , Zubair Bashir  
Published: May 2024

Objective: The objective of this study is to evaluate the outcomes and complications associated with pterional craniotomy and extended pterional craniotomy for the resection of Sphenoid Wing Meningiomas.
Material and Methods: A prospective study was conducted on 34 patients at the Neurosurgery department, Prime Teaching Hospital, Pakistan, and Ali Institute of Neurosciences. We examined 34 recently diagnosed cases of sphenoid wing meningiomas, selected through a total enumerative sampling method. Diagnosis of these meningiomas was confirmed by comprehensive neurological assessment and imaging studies. Various surgical techniques, such as Pterional and Extended Pterional approaches, were employed in the procedures. Assessment of clinical outcomes and complications was conducted during follow-up evaluations. A total of 34 patients diagnosed with sphenoid wing meningiomas were covered as the study’s target population. All patients met certain criteria to be included in the study.
Results: 25 (73.6%) of the total number of patients were females and 9 (26.4%) were males. The mean age at diagnosis was 47 ± 5 years. Presenting symptoms included headache, seizures, visual loss, motor deficit, and cognitive decline. Surgical techniques used in tumor resection were pterional craniotomy and extended pterional craniotomy. Post-operative evaluation after follow-up studies showed that the symptoms reversed, including a reduction in headache, vision restoration, seizure control, and motor and cognitive function improvement.
Conclusion: Pterional approach and extended Pterional approaches related to SWM removal are satisfactory rates of an acceptable and safe surgical treatment with satisfactory results concerning the total resection rate and related clinical improvement.
Coccydynia: Do Corticosteroid Injections Hit the Mark Over NSAIDs?
Authors: Naveed Gul  , Kashif Ramooz  , Yasir Shehzad  , Shafiq ur Rehman Jamil  , Faraz Mehmood  , Sania Bhatti  , Eesha Yaqoob  , Saad Javed  
Published: May 2024

Objective: Coccydynia is a medical ailment that causes discomfort at the coccyx, or tailbone, which can make it difficult for a person to go about their regular business. Nonsteroidal anti-inflammatory medications taken orally, and corticosteroid injections are two potential treatments for Coccydynia. However, the most effective and appropriate course of treatment for this condition must be identified. The study aimed to compare the effectiveness of Corticosteroid Injection vs. NSAID for pain relief in Coccydynia patients.
Materials & Methods: A total of 47 patients with idiopathic coccydynia were allocated to receive either oral NSAIDs plus a tailbone cushion (n=24) or fluoroscopic corticosteroid injection (n=23). Pain levels were measured by a visual analog scale at baseline and 2-, 3-, and 4-months post-treatment. Chi-square and t-tests were used to compare treatment efficacy.
Results: The two treatment groups showed no significant differences. Both groups demonstrated reduced pain over time, with no significant difference between injections and NSAIDs (p=0.209). While injections provided more relief for mild pain, NSAIDs showed better results for no-pain patients. Overall mean pain scores were similar between groups. The treatments differed in effectiveness for certain pain levels but exhibited comparable efficacy in reducing overall coccyx pain. The hypothesis of differing treatment efficacy was not supported.
Conclusion: As a result, it can be considered a viable alternative therapy for patients who have difficulty adhering to oral medication regimens due to its one-time administration and affordable cost. To achieve optimal therapeutic outcomes, it is critical to choose the appropriate patients.
Analyzing Spondylolisthesis in Patients with Proven Spinal Stenosis Using Plain X-Rays and Supine MRI: A Retrospective Study of Five Years
Authors: Mumtaz Ali  , Akram Ullah  , Ramzan Hussain  , Hanif Ur Rahman  , Sajid Khan  , Amjad Ali  , Abdul Haseeb Sahibzada  
Published: May 2024

Objective: This study aimed to evaluate the frequency of cases in which patients were diagnosed with lumber spinal stenosis using MRI and later were categorized as having spondylolisthesis when evaluated through plain X-rays.
Material and Methods: This retrospective study was conducted at the Ali Institute of Neurosciences, Irfan General Hospital from 2017 to 2022. All those patients were included in the study who underwent lumbar spine MRI between 2017 and 2022 with evident findings of spinal stenosis, patients who subsequently underwent plain X-rays of the lumbar spine, and patients with available medical records and imaging data for review. While all those were excluded who did not undergo plain X-rays following MRI. Data was analyzed using SPSS version 22. Descriptive statistics, such as frequencies and percentages, were used to summarize the categorical data while mean and standard deviation were reported for numerical data.
Results: The mean age of the study population was 45 years, with a range from 26 to 65. Among the patients included in the study (1156), 380 were the cases missed initially on MRI and later diagnosed with spondylolisthesis on plain X-rays. This corresponds to a frequency of 33% of misdiagnosed spondylolisthesis cases based on MRI.
Conclusion: This study highlights that the frequency of missed spondylolisthesis cases on lumbar spine MRI was one-third of the cases and the importance of additional imaging modalities, such as plain X-rays, for accurate diagnosis.
The Prevalence of Post-operative Complications Following Meningomyelocele Repair
Authors: Sahibzada Haseeb Ahmed  , Adnan Khan  , Muhammad Hassan Abid  , Muhammad Daud  , Maria Nisar  , Muhammad Kashif Jamal  
Published: May 2024

Objective: To assess the incidence of post-operative complications after meningomyelocele repair in patients presenting with Meningocele.
Materials & Methods: All the patients presenting with meningocele and myelomeningocele, age between 1 day to 5 years, both genders and patients with ASA grade I and II were included. All the baseline /routine hospital investigation was done, the lesions were assessed for age, size duration of symptoms, and location and were checked for cerebrospinal fluid leaks. The presence of associated abnormalities was evaluated. The patients were given antibiotics as per protocol before and after surgery to prevent infection. All patients were observed closely in the post-operative period for development and timely management of any complications.
Results: Among 145 children, 9% of children had defects in the cranio cervical and 91% of children had defects in the lumbosacral. 15% children had myelomeningocele size ?3 cm while 85% of children had myelomeningocele size >3 cm. 83% of children were male and 17% of children were female. 18% of children had wound infection, 6% of children had wound dehiscence and 26% of children had CSF Leak. Stratification of postoperative complications concerning age, gender, location of NTD (cranio cervical/lumbo sacral), size (? 3 cm & > 3 cm), duration of symptoms (? 1 month & 1 month), malnourished (yes/no) showed the insignificant differences.
Conclusion: The frequency of post-operative complications i.e. wound infection was 18%, wound dehiscence was 6% and CSF Leak was 26% after meningomyelocele repair in patients presenting with Meningocele.
Navigating Peril: Unraveling the Consequences of violation of Lane by bike riders on Traumatic Brain Injury Outcomes in a Developing Country's Neurosurgical department
Authors: Usman Ahmed Kamboh  , Muhammad Irfan Sheikh  , Syed Shahzad Hussain Shah  , Muhammad Rizwan  , Atiqa Arif  , Mehwish Manzoor  , Zaid Sami Ullah  
Published: May 2024

Objective:
To infer the impact of violation of lane by the bike riders on the severity of injury and clinical outcome.
Materials & Methods:
prospective observational study conducted from 1st January 2023 to 30th June 2023.50 patients who met inclusion criteria were studied for impact of violation of lane on the severity of injury and clinical outcome. Data was analyzed for gender distribution, valid driving license, helmet wearing, trauma scene violation of lane, duration of stay in ward, severity of injury, mode of injury and outcome was assessed by Glasgow outcome scale extended after 1 month.
Results:
In our study 49(98%) patients were male and 1(2%) female. 37 (74%) patients had documented evidence by 1122 regarding lane violation group while 13(26%) patients of lane non violation group. 14(28%) patients had STBI, and 18(36%) patients were categorized in moderate and mild traumatic brain injury each. Neuro monitoring was done in 14(28%) patients. Operative intervention was done in 31(62%) patients and 9(64%) patients were those who had STBI.11(78%) out of 14 patients with severe injury were from lane violation group. Patients of lane violation group were having higher disability i.e. 12 (32.4%).
Conclusion:
Violation of lane is an aberrant driving behavior. It has emerged as a common cause of bike related road traffic accidents leading to mortality. A prevailing disregard for traffic norms adds fuel to this perilous fire, paving the way for grave outcome.

Key words: Severe Traumatic brain injury (STBI), Road traffic accident (RTA), Violation of lane, Bike rider, Intracranial pressure (ICP), Glasgow outcome scale extended.
Chat GPT Develops Multiple Choice Questions (MCQs) for Postgraduate Specialty Assessment – A Reality or a Myth?
Authors: Faridah Amir Ali  , Sharif Salman Yousuf , Madiha Ata  , Nirali Patel  , Muhammad Rafay  , Hasan Raza Syed  , Saima Perwaiz Iqbal  
Published: May 2024

Objective: Multiple Choice Questions (MCQs) are a valuable assessment tool, but creating them to match learning goals needs experts. AI, like ChatGPT, might offer an alternative. A study showed MCQs made for medical programs by ChatGPT and the faculty. This study compares faculty-made MCQs to ChatGPT-made ones for a post-grad program.
Material & Methods: Specific learning objectives of a module from a medical and surgical program were extracted. One mid-level faculty and the AI software developed MCQ from each learning objective with a clinical scenario. Two subject and medical education experts from each specialty were blinded and given a standardized online tool to rate the technical and content quality of the MCQs in five domains; the item, vignette, question stem, response options, and overall quality.
Results: For the medicine and allied specialty, 23 MCQs in each set were assessed. There was no significant difference between each variable, the overall quality of MCQs, or the odds of the decision to accept the questionnaire. Two sets of 24 MCQs were assessed for the surgical and allied specialty. There was no difference between the domains for “Item” and “Vignette”. For the domain “question stem”, MCQs developed by faculty were more grammatically correct (p-value 0.02). There was no difference in the quality or odds of the decision to accept.
Conclusions: AI's impact on education is undeniable. Our findings indicate that in specific areas, faculty outperformed ChatGPT, though overall question quality was comparable. More research is necessary, but ChatGPT could potentially streamline assessment development, saving faculty substantial time.