Community violence among the youth can lead to a number of adverse psychiatric outcomes including post-traumatic stress disorder (PTSD). However, little research has been conducted in non-Western countries to assess this problem. This study aims to fill the void by assessing the lifetime exposure to traumatic events and burden of probable PTSD among university students in Karachi, Pakistan. A cross-sectional study was conducted at four private institutions in Karachi. Self-administered questionnaires were filled out by 320 students. Lifetime exposure and symptoms of PTSD were assessed using modified Composite International Diagnostic Interview (CIDI) and Post-Traumatic Stress Disorder Checklist-Civilian Version (PCL-C) questionnaires, respectively. A PCL-C score of 44 or above was used as cutoff for probable PTSD. Pearson chi-square test was used to assess the association between PTSD and different variables at a level of significance of 5%. Ninety-three percent of the respondents reported having lifetime exposure to at least one traumatic event with sudden unexpected death of a loved one (n = 187) and assaultive violence (n = 169) being the commonest reported traumatic events. Positive association for PTSD was seen with enduring physical attacks and motor vehicle accidents. Over a quarter of the students screened positive for probable PTSD, among them almost one third were male and 17% were female. Our results indicate a high exposure to violent events and elevated rates of lifetime PTSD among urban youth. Reduction in violence and better access to mental health facilities is warranted to decrease the health burden of PTSD in Pakistan.

Background:Ventriculostomy-associated infection (VAI) is a major concern to physicians. Limited studies have looked at the outcomes of external ventricular drain (EVD) infection and predictors of unfavorable outcomes. In this study, we assessed the outcomes of EVD infection and predictors of unfavorable outcomes.Methods:This was a retrospective medical chart review, conducted at the Aga Khan University Hospital. All the patients irrespective of age and gender, fulfilling the diagnostic criteria of VAI were included. Patients with preexisting bacterial meningitis or ventriculitis were excluded from the study. Outcome assessment was based on Glasgow outcome scale (GOS) at 1 and 3 months after procedure. Other outcomes included 30-day mortality and total length of hospital stay.Results:We included 256 patients in the study. 66 patients (25.8%) developed VAI. EVD was the primary procedure in 21 (31.8%) cases. Most patients, 24 (36.4%), had EVD as a secondary procedure for tumor surgery. Median interval between EVD placement and diagnosis of infection was 3 days. Mean length of stay in VAI patients was 31.85 ± 20.53 days. Seven patients required ICU care. Ten patients (15.2%) expired during hospital stay or within 30 days of discharge and further four had GOS of 2 or 3. A total of 52 patients had a favorable outcome after 6 months.Conclusions:Rate of VAI in this cohort was high. VAI is associated with increased morbidity, mortality, and prolonged hospital stay.

Objective: 'Neuro-robotic exoscope' is a recent advance. Reports on the use of this operative visualization system are few. In this study we have described our initial experience with the use of Bright Matter TM system for various neurosurgical procedures. Methods:All patients who underwent neurosurgery using Bright Matter TM (Synapive Medical) at the Aga Khan University Hospital (AKUH) from April 2016 to October 2016 were included in this retrospective study. Data was collected from medical charts. Descriptive analysis was performed using SPSS v 21.Results: Bright Matter TM systems were used for a total of 71 cases. The exoscope was used with neuro-navigation and Diffusion Tractography Imaging (DTI) in 28 cases while in 7 cases it was used without navigation. During the same study period, neuro-navigation alone was performed for 36 additional cases but the exoscope was not used. The exoscope was used for a total of 53 hours while the Operating Microscope (OM) was used for 33.5 hours. A total of 12 cases were completed using the exoscope alone, without the need of the OM. Twenty-four lesions were found to be involving different white matter tracts of the brain. Gross Total Resection was done in 17 (of 30) patients. Perioperative mortality was 0%. Five patients had a new neurologic deficit postoperatively. Conclusion:Early experience with the use of exoscope is promising. Upcoming improvements in the exoscope such as three-dimensional stereoscopic system and angled lenses will further improve the functionality of this system.

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INTRODUCTION: Navigation and robotic pedicle screw placement systems have been developed to improve the accuracy of screw placement. However, the literature comparing the safety and accuracy of robotic and navigated screw placement with freehand screw placement in thoracolumbar spine surgery has been limited.METHODS: PubMed and EMBASE were systematically searched according to PRISMA guidelines. The search included indexed terms and text words from database inception to the date of the search (April 7th, 2022). Only randomized controlled trials comparing robotic assisted or navigated screws with fluoroscopic freehand screws in the thoracolumbar spine were included. Data and estimates were pooled using randomeffects meta-analysis. Risk of bias was assessed using the Joanna Briggs Institute risk of bias tool. The main outcome measures were odds ratio estimates for screw accuracy according to the Gertzbein-Robbins scale and relative risk for various complications.RESULTS: A total of 14 papers encompassing 12 randomized controlled trials were identified. The pooled analysis demonstrated that robotic and navigated pedicle screw placement techniques were associated with increased odds of screw accuracy (OR 2.66, 95% CI 1.24-5.72, p = 0.0118). Robotic and navigated screw placement was associated with a lower risk of facet joint violations (RR 0.09, 95% CI 0.02-0.38, p = 0.0011) and major complications (RR 0.31, 95% CI 0.11-0.84, p = 0.0215). No differences were found in nerve root injury (RR 0.50, 95% CI 0.11-2.30, p = 0.3704), return to the operating room for screw revision (RR 0.28, 95% CI 0.07-1.13, p = 0.0744).CONCLUSIONS: These analyses suggest that robotic and navigated screw placement techniques are associated with higher odds of screw accuracy and superior safety profile compared to freehand techniques. Additional randomized controlled trials will be needed to further validate these findings.

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