Punjab Institute of Cardiology

Background: Post-craniotomy neurosurgical infections pose a major challenge in everyday neurosurgery, impacting patient recovery and adding financial strain on healthcare systems. Even with improvements in surgical methods and infection prevention measures, these infections continue to lead to complications and deaths related to surgery. Objective: Screening and isolation of pathogenic strains from Post- craniotomy infections and sensitivity assessment against different antibacterial agents. Method: Collected samples were streaked onto Nutrient Agar medium and isolated colonies were streaked for pure culture. Pure cultures were subjected to Blood Agar Test for isolation of pathogenic bacteria (beta-hemolytic strains) from infections. Molecular characterization was done to confirm and identify the pathogenic strain and accession number was obtained by nucleotide blast at NCBI site. Sensitivity of pathogenic strains against antibiotics and plant extracts was checked and zone of inhibition was measured. ONE WAY ANOVA was applied for statistical analysis and Tuckey’s PostHoc test for comparison. P>0.05 was set as significant. Results: P. aeruginosa exhibited resistance against Erythromycin while B. subtilis showed sensitivity against Erythromycin with 21.56±0.06 zone of inhibition, Levofloxacin exhibited maximum antibacterial activity against P. aeruginosa with 19.97±0.12 and 16.36±0.04 zone of inhibition exhibited by B. subtilis against Levofloxacin. Gentamicin, showed moderate antibacterial activity against both P. aeruginosa and B subtilis with 15.78±0.02 and 13.51±0.07 zone of inhibition, respectively, but antibiotics exhibited non-significant difference with p>0.05. Both P. aeruginosa and B subtilis, showed sensitivity against plant extracts and plant extracts showed significant difference with p<0.05, C. zeylanicum exhibited maximum 18.77±0.09 and 15.26±0.31 zone of inhibition against B. subtilis and P. aeruginosa, respectively. Z. jujube showed minimum but antibacterial activity with zone of inhibition 7.98±0.09 and 7.66±0.44 against P. aeruginosa and B. subtilis, respectively. Both P. aeruginosa and B subtilis showed intermediate sensitivity against E. cardamomum with zone of inhibition 10.11±0.13 and 12.13±0.08, respectively. Conclusion: The current study concludes that antibacterial agents should be used instead of antibiotics against microbes, as excessive use of antibiotics leads to side effects and their continuous use also contributes to microbial resistance.

Simultaneous biatrial myxoma is an extremely rare form of primary cardiac tumor, which is often an acute life-threatening problem given its potential to cause simultaneous tricuspid and mitral valve obstructions. A 25-year-old woman presented with a history of persistent low-grade fever, 6 kg of weight loss, and progressive dyspnea for 6 months. Transthoracic echocardiography showed a large mass from the interatrial septum and right atrial wall originating from the left atrium. This giant tumor was causing severe tricuspid obstruction and severe narrowing of the mitral valve. There was evidence of associated pulmonary emboli on computed tomography and computed tomography pulmonary angiography as well. The patient underwent successful urgent surgical excision. This case describes the rare presentation of giant biatrial myxoma in the form of chronic systemic illness. It emphasizes the role of early cardiac imaging in young patients with unexplained constitutional symptoms and features of biventricular heart failure. Giant biatrial myxoma is very rare and is life threatening. Prompt and definitive surgical resection results in good outcome and is the treatment of choice.

BackgroundPatients with non-ST-segment elevation myocardial infarction (NSTEMI) often have three vessel disease (TVD). The Thrombolysis in Myocardial Infarction (TIMI) risk score is a commonly used bedside tool for risk stratification; however, its diagnostic accuracy for predicting TVD remains uncertain. Therefore, this study was conducted to assess the diagnostic performance of the TIMI score in the prediction of TVD among patients with NSTEMI with coronary angiography as the reference standard.Material and methodsA total of 185 patients with NSTEMI were included in this cross-sectional study. TIMI risk scores were assessed on admission, and the patients underwent coronary angiography. Diagnostic performance was then evaluated using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).ResultsThe mean age of the cohort was 62.78±9.29 years, and 70.3% were male patients. TVD was angiographically validated in 85.4% of patients. Using a TIMI score > 4, the sensitivity was 71.5%, specificity 66.7%, PPV 92.6%, and NPV 28.6%. Post hoc analysis revealed significantly higher TIMI scores in patients with TVD (p<0.001), male patients (p=0.032), diabetics (p=0.041), and urban residents (p=0.028).ConclusionThe TIMI score demonstrates moderate diagnostic performance for predicting TVD in patients with NSTEMI, with high PPV but low NPV. It could be a useful preliminary screening method; however, it cannot substitute angiography for a final, definite diagnosis.

Background: Families of children with neurodevelopmental disorders frequently encounter stigma and social exclusion that extend beyond the diagnosed child and influence parental identity, emotional health, and social participation. Although quantitative research has documented caregiver burden and affiliate stigma, less is understood about how parents interpret and negotiate these experiences within their sociocultural contexts. A deeper exploration of lived experience is essential to inform culturally responsive, family-centered support strategies. Objective: To explore how parents of children with neurodevelopmental disorders experienced, interpreted, and made meaning of stigma and social exclusion within their everyday sociocultural environments. Methods: A qualitative design grounded in Interpretative Phenomenological Analysis was employed. Purposive sampling was used to recruit 10 primary caregivers of children formally diagnosed with autism spectrum disorder, attention-deficit/hyperactivity disorder, or intellectual disability from special education institutions in three major urban centers of Pakistan. In-depth semi-structured interviews lasting 60–90 minutes were conducted in participants’ preferred language. Interviews were audio-recorded, transcribed verbatim, translated where necessary, and analyzed through iterative idiographic and cross-case thematic procedures consistent with established IPA guidelines. Results: The sample comprised 10 parents, each representing one child with a diagnosed neurodevelopmental disorder. Three interrelated themes were identified. Perceived parental blame and moral judgment were reported by 9 of 10 participants, with 8 describing recurrent public scrutiny and 7 reporting unsolicited parenting advice. Social withdrawal as a protective strategy was described by 8 participants, of whom 6 simultaneously reported feelings of isolation and loss of belonging. All 10 participants described processes of meaning reconstruction over time, with 8 explicitly reframing stigma as societal misunderstanding rather than personal failure. Advocacy or selective engagement with supportive networks was reported by 6 participants. Findings indicated that stigma operated through both overt and subtle social mechanisms, contributing to self-doubt, emotional fatigue, and anticipatory stress, while also prompting adaptive coping and identity renegotiation. Conclusion: Stigma and social exclusion were experienced as cumulative and relational processes that shaped parental identity and social participation. Parents actively interpreted and negotiated these experiences, demonstrating resilience through meaning reconstruction and selective engagement. The findings underscore the importance of culturally responsive, family-centered, and community-level interventions that address both structural stigma and parental psychological adaptation.

Esophageal cancer is a significant health concern globally. In Punjab, where pesticides use and heavy metal exposure are widespread esophageal squamous cell carcinoma is among the leading cancers. This study aims to investigate the association between these environmental factors and esophageal carcinoma, for instituting preventive strategies. We conducted a case-control study in Punjab, with 380 carcinoma cases and 760 age, gender, and district-matched controls from hospital and community settings. The participants completed a case report form with validated questions on risk factors. The urine, water, oral cytology, blood, and esophageal biopsies samples were collected from a subset of the population to evaluate pesticide metabolites, heavy metal exposure, cytological changes and infections like H. pylori and HPV. The mean age of cases was 57.17 ± 9.54 (SD) years, similar to that of controls, 56.96 ± 8.93 (SD)years (p>0.05).The key risk factors for esophageal carcinoma were, Dimethylphosphate presence in urine (5.41 (95% CI: 1.42-20.67, p<0.05), tobacco use (OR 1.60, 95% CI 1.24-2.06, p < 0.001), alcohol use (OR 1.65, 95% CI 1.31-2.08, p < 0.001) and hot beverages (OR 1.81, 95% CI 1.44-2.28, p < 0.001), with population attributable fraction of 86.7%, 10.8%, 16.5%, and 16.7%, respectively.. The daily intake of fruits (OR 0.74, 95% CI 0.59-0.92, p = 0.008) and vegetables (OR 0.81, 95% CI 0.65-0.99, p = 0.045) had protective association, with inadequate intake contributing to 27% and 26.8% of risk, respectively. The exposure to heavy metals from drinking water was higher in both groups but not statistically significant. This study confirms established risk factors like tobacco, alcohol, and diet contribute to esophageal squamous cell carcinoma in Punjab, while identifying pesticide exposure as a new risk factor. It calls for stricter regulations, public health interventions, and further research into environmental risks.

ABSTRACTObjective:To evaluate how pre-operative trans-arterial embolization (TAE) affects the surgical outcomes of patient undergoing excision of vascular head and neck tumors.Methodology:This retrospective observational study was conducted at Department of Neuroendovascular Surgery, Punjab Institute of Neurosciences, Lahore, Pakistan from February 2024 to January 2025. It is a non-probability based consecutive case series, including 16 patients in accordance with the inclusion criteria.Results:Out of the 16 Patients enrolled in the study, 14 were male and 2 females with a mean age of 19.7±7.71 Years (Range; 14-37 Years). Except two patients with meningioma, all of the patients had JNA. The mean time between surgical excision and embolization was 38.6±18.9 hours, with most operations performed within 24–48 hours. Devascularization was graded as good in 12 patients (75%), fair in 2 (12.5%), and poor in 2 (12.5%). Mean operative times were 4.3 hours for good, 5.0 hours for fair, and 6.0 hours for poor devascularization. Corresponding ICU stays were 30, 48, and 72 hours, while ward stays averaged 2.2, 2.5, and 3.0 days, respectively. Better devascularization correlated with shorter surgery duration, reduced ICU time, and earlier discharge.Conclusion:Preoperative TAE is effective for highly vascular head and neck tumors, enabling shorter surgeries, easier debulking, and reduced blood loss. Polyvinyl alcohol (PVA) particles provide clear tumor margins and satisfactory devascularization.

ABSTRACTObjective:To assess the neurosurgical residents’ perspectives on surgical neuro-oncology specialty training in Pakistan.Methodology:A nationwide survey-based observational study was conducted among neurosurgery residents registered with the accredited residency programs in Pakistan. A structured questionnaire assessing knowledge, training, mentorship, and institutional support in surgical neuro-oncology was disseminated via Google Forms (Google Inc., USA). Data collection took place from January to March, 2025 across both public and private sector training institutes. Responses were analyzed using Statistical Package for the Social Sciences, with categorical variables presented as frequencies and percentages and continuous variables as means with standard deviations.Results:A total five hudnred residents were targeted among whom one hundred residents responded, yielding a response rate of 20%. While 90% (90) rated their knowledge of brain and spinal tumors as good or excellent, only 67% (67) felt confident interpreting imaging studies. Notably, 33% (33) had received no formal training in surgical neuro-oncology. Exposure to spinal cord tumor surgeries was limited, with only 14% (14) having participated in such procedures. Mentorship and interdisciplinary collaboration were inadequate; only 20% (20) reported access to dedicated neuro-oncology mentors, and just 12% (12) rated interdepartmental collaboration as excellent. Resources were considered limited or insufficient by 69% (69) of respondents. Despite these challenges, 84% (84) supported the establishment of a dedicated neuro-oncology fellowship, and 67% (67) expressed definite interest in pursuing such training.Conclusion:This nationwide analysis highlights critical insights into the clinical exposure, training quality, and perceptions of neurosurgical residents in Pakistan regarding surgical neuro-oncology. While the majority of residents demonstrated enthusiasm and self-reported strong theoretical knowledge, substantial gaps were identified in hands-on experience, formal training, mentorship, and access to specialized resources, particularly in spinal neuro-oncology. Limited interdisciplinary collaboration and insufficient institutional support further hinder comprehensive skill development. National-level reforms are essential to align with global standards in neurooncological education and care.

ABSTRACTBackground and Objective:Cerebellopontine angle (CPA) is an important anatomical landmark hosting important neurovascular structures. Hydrocephalus presents a great challenge in CPA lesions management. We aimed to highlight the significance of intraoperative cisternostomy and without the need of preoperative and postoperative cerebrospinal fluid (CSF) diversion.Methodology:This retrospective observational study was conducted at Punjab Institute of Neurosciences involving consecutive, single-surgeon led cases of CPA space occupying lesions (SOL) between 2022 and 2024. Data was collected for demographic and clinical presentation, extent of resection and the need for post-operative CSF diversion while making use of intraoperative cisternostomy in all cases.Results:A male preponderance of 51.90% (42) patients was identified with an overall mean age of 39.13±13.18 years. Eighty-one patients underwent intra-operative cisternostomy of which 98.80% (80) cases were adult patients. The commonest clinical manifestations at presentation were headache in 91.4% (74) and sensorineural hearing loss in 92.60% (75) cases. Mean preoperative Glasgow coma scale (GCS) score was 14.9±0.6. Mean pre-operative KPS (Karnofsky performance status) score was 81.35 ± 13.1. About 91.40% (74) patients underwent gross total resection. Schwannoma was seen in 80.2% (65) patients making it the most common CPA pathology. Mean immediate postoperative GCS was 13.93±2.26. Mean postoperative KPS score was 78.76±15.11. Only 13.80% (12) patients required post-operative CSF diversion in the form of ventriculoperitoneal (VP) shunt during first year of follow up.Conclusion:Retrosigmoid approach with intraoperative cisternostomy for excision of cerebellopontine angle lesions is a safe and efficient approach with better outcomes, mitigating the need for pre-operative and post-operative CSF diversion.