Objective: To assess the shunting rate and the results of control measures in patients having central neurocytoma who underwent total and subtotal resection. Study design: A cross-sectional study Place and Duration This study was conducted in People's University of Medical and Health Sciences for Women Nawabshah from Septmeber 2016 to Septmber 2020 . Methodology: In this study, overall 15 patients were included. Every patient had a follow-up of 2 years. The age of participants was between 13 to 49 years. The data of every patient was recorded which included the demographics (age, gender), early mortality and morbidity, presentation of clinical factors, and radiological findings. The radiological findings include features, tumor location, hydrocephalus, recurrence, and residual. A transcortical approach was used for the treatment of individuals for both, total or subtotal excision. EVD (External Ventricular Drain) was installed which was later replaced by a shunt. For confirmation of diagnosis and guidance of the follow-up, the MIV index and histopathology were used. For residual tumor and recurrence, radiosurgery of Gamma knife or adjuvant radiotherapy was used. Results: There were 3 patients who died due to sepsis and thalamic infarction after the total and subtotal excision. There were 9 patients who had a total excision and 6 patients who had a subtotal excision. Among the 9 patients with a total excision, 3 of them showed small recurrence at 1 year and 18 months follow-up along with a high MIB index. A total of 2 of them needed a shunt. In the remaining participants,the shunt was not placed. Among the 6 patients who had a subtotal excision, 2 of these patients had an early shunt insertion. Five patients were controlled by radiotherapy while one was controlled by radiosurgery. One patient, who was controlled by radiotherapy, failed radiotherapy in his second treatment at 18 months of follow-up. Practical implication : total excision has better results for central neurocytoma and should be considered procedure of choice Conclusion: Central neurocytoma may have a better chance of recovery than other intraventricular tumors if treated with total excision, with a lower incidence of shunt insertion throughout its course. Keywords: neurocytoma, shunt insertion, excision, radiotherapy, total excision

Covid-19 had a profound effect on many parts of life during 2020. Our country, much like the majority of other nations across the globe, saw a Covid-19 epidemic, a wave reaching its height from the middle of March through April of 2020. This brought about significant difficulties for our civilization in a variety of spheres, including the medical, social, and economic spheres. On February 27th, the first patient in our country to be diagnosed with Covid-19 was identified. Objective: To evaluate the Covid-19 effect on the prevalence of thoracolumbar vertebral compression fractures in elderly people. Methods: A total of 172 individuals with vertebral compression fractures (VCF) were above the age of 65 years. The age and gender of the patients were comparable across the two research groups. Only those people who exhibited symptoms for less than four weeks were taken into account. We analyzed every patient's medical records and obtained all essential data, including demographics (gender, age, and compression fracture risk factors), fracture mechanism, and location of the fracture. Results: In 2020, we observed a greater percentage of high-energy VCF (10.5% versus 6.7%). In 2020, there were 7.5 times more recurrent fractures and the proportion of Ankylosing Spondylitis was much higher. Similar admission rates to VCF ED were observed, with 60% receiving conservative care. The number of procedures performed on admitted patients increased in 2020 (66.7% vs. 60%, P =.71), and PBK plus fixation tended to be more common in 2020 compared to 2018-19 (15.8% versus 7.5%, P =.29). In the Covid-19 epidemic, the RR for BKP Plus fixation vs. BKP alone was 1.95, indicating increased risks for difficult operation. In 2020, there were significantly more complications (18.4% vs 3.7%, P.001). Time to surgery also increased somewhat in 2020, from 6.25 days to 5.3 days (P =.55), and admission duration increased marginally (12.2 days vs. 9.9 days, P =.27). Most of the patients choose home treatment over inpatient care during the Covid-19 pandemic (72.2% vs. 58.8%). Conclusions: The frequency of VCF did not vary as a result of the Covid-19 pandemic; nevertheless, the features of patients did change, which had an effect on hospitalizations, institutional rehabilitative services, and a predilection for extensive surgery as opposed to BKP alone. Although it is not yet known whether or not COVID-19 will continue to be a problem in the years to come, the effects and lessons it has provided are still valuable.

Objective: To compare the efficacy of intra-articular steroid injection and Platelet rich plasma in patients with Osteoarthrithis. Methodology: A randomized controlled trail study was conducted at Rheumatology Division of the Department of Medicine, Pakistan Institute of Medical Sciences, Islamabad after the acceptance of synopsis from  . A total of 122 adult patients with unilateral or bilateral osteoarthritis of knee and were randomized into two treatment groups. In Group I, patients received intra-articular steroid injections and in Group II, patients received platelet rich plasma (PRP). WOMAC score was calculated at baseline and was subsequently assessed after 06 weeks and 3 months. Results: Age and gender distribution and mean WOMAC and VAS scores were similar in both groups at baseline (p>0.05).  At six weeks, mean WOMAC score in steroid group was 32.1 ± 24.1 and it was 24.9 ± 21.3 in PRP group (P=0.084).  Mean VAS in steroid group was 4.5 ± 2.5 and it was 3.9 ± 2.6 in PRP group (P=0.0.158).  At three months, mean WOMAC score in steroid group was 39.1 ± 24.3 SD and it was 27.1 ± 21.9 SD in PRP group (P=0.005).  At three months, mean VAS in steroid group was 5.6 ± 2.6 and it was 4.1 ± 2.7 in PRP group (P=0.003).  Conclusions: The study outcomes were better in patients treated with PRP as compared to intra-articular steroid injection. Mean WMOAC and VAS scores were significantly lower after three months in PRP group as compared to steroid group.

Introduction: Patients with tethered cord syndrome become symptomatic during the period of their growth spurt. Apart from progressive foot and spinal deformities, patients also develop motor deficits and bladder and bowel dysfunction. Early diagnosis and adequate release of the tethered cord are indispensable to successful management. Objectives:  To study the trends in the neurological outcome after surgical treatment of cord tethering in pediatric population. Methodology: Study was carried out from January 2018 to December 2019 at neurosurgery department, Fauji Foundation Hospital Rawalpindi. Thirty-five patients were included in the study who fulfilled the inclusion criteria. Results: The average age of the patients at the time of the intervention was 11 years. There were 21 females (60.0%) and 14 males (40.0%). The distribution of neurological status improvement tells improvement in back pain in 28 patients (80%), improvement in motor function in 14 patients (40%), and improvement in urinary incontinence in 7 patients (20%). Conclusion: This study concludes that back ache improves significantly after surgery while urinary incontinence is the least benefited symptom. Untethering along with the rehabilitation also helps majority of the patients with motor deficit. The ratio of symptomatic relief was best for backache and motor function and then improvement in the urinary control.

Aim: To determine the clinical characteristics of pediatric thoracolumbar spinal injuries Study design: A retrospective study Place and Duration:This study was conducted at Pakistan Institute of Medical Sciences Islamabad from Jan 2021 to Jan 2022 Methodology:An analysis of pediatric thoracolumbar (TL) injuries was conducted to determine the epidemiology, risk factors, mechanisms, patterns, and management of pediatric TL injuries. A plain radiograph (anteroposterior and lateral view) was taken on all patients for diagnosis. In the case of surgical intervention or doubtful skeletal abnormalities observed on plain radiographs, thin-slice computerized tomography (CT) scans were obtained. In patients with neurological deficits or those who were scheduled for surgical intervention, magnetic resonance imaging (MRI) was performed. Results:A total of 90 children were treated at our institute for TL spine injuries, representing 2% of all spine injuries. Males predominate (3:1) with a mean age of 15.9 plus 3.2 years (range: 2–18 years). Falling from a height was the most common mode of injury. Most children (71.1%) sustained injuries after falling from height, 18/90 (20%) after a motor vehicle accident, and the rest after a heavy object fell over their neck. A total of 27.8% of the patients (the majority) had Grade A injuries. The most common spinal level injured was the lumbar spine (53.3%), and fractures accounted for 93.3% of all injuries. A total of 18/90 (20%) children underwent surgical fixation. There were 21 children available for follow-up, of which 13 (62%) were ambulant. Conclusion:The lumbar area is most affected by TL injuries, which are uncommon and most often occur in youth older than 10 years. When necessary, a surgical fusion of the affected vertebrae is a secure and reliable procedure. Keywords: Pediatrics, epidemiology, spine, thoracolumbar, injury