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Objective: The aim of this study is to determine the frequency of complication among patients after endoscopic third ventriculostomy in obstructive hydrocephalus. Study Design: Descriptive study Place and Duration: Conducted at the department of Neurosurgery, Bacha Khan Medical College Mardan/ Medical Complex Mardan and Frontier Medical and Dental College, Abbottabad for duration of 06 months from April 2021 to September 2021. Methods: There were one hundred and fifteen patients of both genders with ages 1-40 years were presented. Included patients had obstructive hydrocephalus. Detailed demographics, including age, sex, and BMI, were obtained from all patients with signed permission. Patients underwent CT scan and brain MRI. Endoscopic third ventriculostomy was performed among all the cases after indication of symptoms. Post-treatment effectiveness and complication were assessed after follow up within duration of 2-weeks. SPSS 25.0 version was used to analyze all data. Results: Mean age of the patients was 6.2 ±3.25 years. Among 115 cases, 70 (60.9%) were males and 45 (29.1%) were female patients. Aqueductal stenosis was the most common disease found in 77 (67%) cases followed by posterior fossa tumours 20 (17.4%), VP shunt blocked in 17 (14.8%) and CSF ascites in 3 (2.6%) cases. We found complications in 24 (20.9%) cases CSF leak was the most common found in 12 (10.4%) cases, meningitis in 4 (3.5%), seizures and bleeding in 3 (2.6%). Mortality found in 2 (1.7%) cases. Conclusion: We concluded in this study that the endoscopic third ventriculostomy is an effective and safe method for the patients of obstructive hydrocephalus in terms of minimum complication with lower rate of mortality. Keywords: Endoscopic Third Ventriculostomy, Obstructive Hydrocephalus, Mortality, Complications

Objective: Aim of current study is to determine and compare the outcomes of surgical versus conservative treatment of traumatic extradural hematoma in the supratentoral region. Study Design: Prospective/ Randomized study Place and Duration: Conducted at Neurosurgery department of Bacha khan Medical College / Mardan Medical Complex Mardan and Frontier Medical and Dental College Abbottabad for duration of six months from April 2021 to September 2021. Methods: There were one hundred and eight patients of both genders with ages 14-55 years were included. Included patients had traumatic extradural hematoma in the supratentoral region. Demographically detailed included cause of trauma, age and gender were calculated after taking informed written consent. CT scan was performed among all the patients to diagnose hematoma. Patients were equally categorized into two groups. Group I received surgical treatment and group II received conservative treatment. Symptoms and complications among both groups were assessed. Glasgow comma score was used. Post treatment outcomes were compared among both groups by using t-test. We used SPSS 21.0 version to analyze complete data. Results: Among 54 patients in group I 31 (57.4%) cases were males and 23 (42.6%) patients were females and in group II 35 (64.8%) were male patients and 19 (35.2%) females. Majority of the patients 65 (60.2%) among both groups were in age group 21-35 years followed by 14-20 years 30 (27.8%) cases. Road traffic accident was the most common cause found in 27 (50%) and 29 (53.7%) in groups I and II. Consciousness loss, vomiting and headache were the most common symptoms. Mean hematoma volume in group I was 29.11±6.38 ml and in group II 22.16±8.47 ml. Mean GCS in group I was 15.07±3.13 and in group II was 16.18±5.38. We found that conservative treatment presented favorable outcomes 53 (98.4%) as compared to surgical treatment in 50 (92.6%) cases. No any mortality found in this study. Conclusion: We concluded in this study that the conservative for the extradural hematoma in supratentoral region was effective and safe treatment as compared to surgical. Most common cause was RTA. There is no any mortality found in both treatments. Keywords: Supratentoral Region, Extradural hematoma, GCS, Outcomes

Background: For identification of the coronary artery diseases the neutrophil to lymphocyte ratio is considered as a well-known marker. Objective: To evaluate the relationship of neutrophil to lymphocyte ratio (NLR) with CAD severity and to determine the reference value of NLR for prediction of the CAD. Study design: It was a cross-sectional study with statistical approach, Peshawar institute of cardiology and Punjab Institute of cardiology Lahore from May 2021 to October 2021. Material and Methods: The 132 patients visited the Peshawar institute of Cardiology and Punjab Institute of cardiology Lahore were included in this research. The patients who had undergone the coronary angiography for angina with ischemic ECG changes were selected. SYNTAX score was used to assess the CAD severity. The high, intermediate and low SYNTAX group was created on the basis of results. The BeneSphera analyzer was used to determine the neutrophil and lymphocyte count. The NLR was calculated. The Pearson’s correlation test, ANOVA and logistic regression analysis was performed for the statistical analysis. Results: Out of the 132 patients were selected, the average age range was between 24 years to 85 years. Among them 67 % of the patients were male and 40 % of patients had a low score of SYNTAX. On the other hand, 33 % of the patients had medium syntax scores. The range of the NLR was between 1.1to9.76 (median 2.54 and mean 3.31 ±1.90). The average standard deviations in low SYNTAX group was 57.12 ±12.018. While it was 61.92±12.23 in intermediate SYNTAX group and 63.01±12.54 high SYNTAX group. The dyslipidemia, diabetes mellitus were more commonly observed in the high SYNTAX group. This group also had low lymphocyte count and high neutrophil count. Conclusion: For the prediction of CAD, the ratio of neutrophils to lymphocytes can be considered. By the calculation of this ratio, it is easy to highlight the correlation between CAD and severity level. Keywords: Coronary angiography, SYNTAX, neutrophil to lymphocyte ratio (NLR), Cardiovascular diseases (CAD).

Objective: In the present study, the researchers want to establish the outcome of spine fixation for unstable fractures at the dorsolumbar junction, including fractured vertebrae, while using pedicular screw fixation techniques. Study Design: Prospective study Place and Duration: The study was conducted at Orthopaedics Department, Hayatabad Medical Complex, Peshawar and Neurosurgery Department, Frontier Medical and Dental College, Abbottabad for the duration of six months from May 2021 to October 2021. Methods: There were hundred and nineteen patients of both genders had unstable fracture at dorslumbar junction. Patients were aged between 20-55 years. Transpedicular screws were used to secure the fractured vertebra. Both radiographic and clinical assessments of back pain and impairment were conducted using the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) to evaluate patients (ODI). Before surgery, shortly after surgery, and eight months afterwards, all of these data were assessed. SPSS 23.0 version was used to analyze complete data. Results: Mean age of the patients was 33.5±5.42 years. 85 (71.4%) cases were males and 34 (28.6%) patients were females. Falling from the height was the most common reason found in 60 (50.4%) cases followed by road traffic accident 45 (37.8%) cases and 14 (11.8%) were others. L1 fractures were majority found in 67 (56.3%) cases followed by L2 in 40 (33.6%) cases. Post-operatively, we found significantly improvement in Cobb angle, anterior vertebral height, posterior vertebral height and sagittal index with p value

Background: Coronary artery bypass graft (CABG) surgery can result in serious complications for the patients. It is being currently performed with cardiopulmonary bypass with cardiac arrest in 80% of the cases across the world. There have debate in the past regarding the cardiac revascularization via CABG approaches. Aim: The aim of this study is to study the difference in the patient’s ICU stay who have low ejection fraction and are undergoing cardiac revascularization between off pump and on pump coronary artery bypass grafting. Methodology: A sample size of 60 patients has been taken in the study with 30 patients' in the on-pump surgery group and 30 patients' in the off-pump surgery group. The data has been collected from department of Cardiac Srugery AFIC/NIHD, Rawalpindi. Results and Conclusion: The study concludes that the on-pump CABG patients tend to have shorter ICU stay than the off-pump CABG patients who have low ejection fraction and are undergoing cardiac revascularization. Therefore, on-pump treatment is recommended in the study. Keywords: Off pump, on pump, coronary artery bypass grafting, ICU stay, low ejection fraction, cardiac revascularization