Objective: To compare the effectiveness of Endoscopic (Endonasal transsphenoidal) repair of CSF leak with transcranial approach in terms of post-operative complications like infection, recurrence and hospital stay. Material and Methods: The comparative experimental randomized study was conducted in the Department of Neurosurgery Unit I, PGMI, Lahore General Hospital, Lahore. After approval from ethical committee this study was carried out in our unit. 40 subjects with the history of CSF leak were randomly divided into two groups; one was treated with endonasal trans-sphenoidal repair and another was treated with trans-cranial approach, the subjects were followed up for 1 year. Detailed history, neurological examination, preoperative CT and MRI scans were performed in all patients. Results: The mean age of patients with CSF leak was 25.58 ± 14.38 years. Among the patients, 17 were females and 23 were male. The mean age of the female was 31.70 ± 14.29 years. The mean age of the male was 21.04 ± 12.95. The recurrence was observed in 2 (10%) of the patients treated with endoscopic technique and 1 (5%) of the patients treated with trans-cranial approach. Those patients were successfully repaired in a second operation. Overall success rate was 92.5%. One patient (2.50%) among the trans-cranial approach develops infection which was treated successfully. Conclusion: The endoscopic repair of CSF leak is both safe and effective and should be considered as the standard procedure of choice in most of the cases.
Objectives:Despite the clinical guidelines regarding the use of combined antipsychotics and the limited evidence for its benefits, use remains high in psychiatric practice. The aim of this study was to examine prescribing practices and investigate reasons for initiating and continuing combined antipsychotics in stable psychiatric illnesses.Method:A cross-sectional case record survey of antipsychotic prescribing practices in a community psychiatric rehabilitation service. A total sample (n = 75) of patients with chronic and enduring psychiatric illnesses was studied. The age, gender, diagnosis and prescribed antipsychotics were examined. The proportional prevalence and documented reasons for combined antipsychotic prescribing were analysed.Results:Seventy-three of the 75 patients were prescribed antipsychotic mediations. Of these, 44 (60%) received a combination of two or more antipsychotics. The most common reason for combined prescribing was a switch of antipsychotic (n = 18; 41%). No reason was documented in 19 cases (43%).Conclusions:In this study, slow cross-tapering or incomplete switch process of antipsychotics contributed to the prolonged period of combined antipsychotics treatment. Adequate documentation regarding indication and review of medications cannot be overemphasized.
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