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Objective: To compare the infection rate in patients who underwent carpal tunnel surgery with and without instilling local antibiotics into the surgical wound. Method: The retrospective cohort study was conducted at the Department of Surgery, Unit of Neurosurgery, Government Naseer Ullah Babar Memorial Hospital, Peshawar, Pakistan, and comprised data from July 2019 to July 2021 related to non-diabetic patients without any comorbidity who had undergone fresh carpal tunnel surgery. The cases had been operated by two surgeons having a different approach to preventing infection in carpal tunnel surgery cases. The surgeon in group A did not use any local antibiotics after completing the surgery, while the surgeon in group B instilled local gentamicin in the open wound for 3 minutes after completing the nerve release. All patients were put on oral antibiotics for a period of 5 days after the procedure in both the cohorts, and were assessed fortnightly for any infection and removal of stitches. Demographics of the patients, use of antibiotics and the occurrence of infection were recorded on a proforma. Data was analysed using SPSS 20. Results: Of the 177 patients operated during the period, 13(7.3%) was discarded owing to missing data. Of the 164(92.7%) patients analysed, 138(84.14%) were females and 26(15.85%) were males. The overall mean age was 32.46±8.97 years. The total surgeries conducted were 176; 96(54.54%) in group A and 80(45.45%) in group B. Infections were found in 3(1.7%) patients; all in group A (p=0.160). Conclusion: Although not statistically significant, instillation of local antibiotics may play a role in preventing surgical site infections in carpal tunnel surgery cases. Key Words: Topical antibiotics, Local antibiotics, Carpal tunnel surgery, Gentamicin, Infection.

Background: Neurosurgical task shifting and task sharing (TS/S), delegating clinical care to non-neurosurgeons, is ongoing in many hospital systems in which neurosurgeons are scarce. Although TS/S can increase access to treatment, it remains highly controversial. This survey investigated perceptions of neurosurgical TS/S to elucidate whether it is a permissible temporary solution to the global workforce deficit. Methods: The survey was distributed to a convenience sample of individuals providing neurosurgical care. A digital survey link was distributed through electronic mailing lists of continental neurosurgical societies and various collectives, conference announcements, and social media platforms (July 2018–January 2019). Data were analyzed by descriptive statistics and univariate regression of Likert Scale scores. Results: Survey respondents represented 105 of 194 World Health Organization member countries (54.1%; 391 respondents, 162 from high-income countries and 229 from low- and middle-income countries [LMICs]). The most agreed on statement was that task sharing is preferred to task shifting. There was broad consensus that both task shifting and task sharing should require competency-based evaluation, standardized training endorsed by governing organizations, and maintenance of certification. When perspectives were stratified by income class, LMICs were significantly more likely to agree that task shifting is professionally disruptive to traditional training, task sharing should be a priority where human resources are scarce, and to call for additional TS/S regulation, such as certification and formal consultation with a neurosurgeon (in person or electronic/telemedicine). Conclusions: Both LMIC and high-income countries agreed that task sharing should be prioritized over task shifting and that additional recommendations and regulations could enhance care. These data invite future discussions on policy and training programs. Key words: Global health, Global neurosurgery, LMIC, Neurotrauma, Task sharing, Task shifting, Workforce

Objective: To ascertain diagnostic accuracy of paediatric urinary tract infection (UTI) in a general paediatric unit of a district hospital. Methods: Retrospective case note review and comparing to the final computerised database of Human in-Patient Enquiry (HIPE) at Portiuncula Hospital, Galway, Ireland. All children from 0-16 years of age with the diagnosis of UTI were enrolled within the 3 year study period. The information was first retrieved from HIPE system to capture list of patients. Case notes revision was followed to extract data under standardized pro-forma for demography, accuracy of diagnosis, treatment instituted and investigation ordered. Patients' data was reviewed according to updated definition. Results: There were 85 cases treated for UTI during the 3 year period, and only 45 cases were considered as genuine UTI according to diagnostic criteria. Out of 45 cases, 16 cases were considered as suspected UTI cases. Escherichia coli was noted to be the commonest organism. Cephradine has been used as the first line treatment as per local guideline; however, different antibiotic regimes were based on physician's preferences. The sensitivity of the current method of UTI diagnosis remained at 64% when comparing final diagnosis in the HIPE system. Conclusions: UTI can be difficult to accurately diagnosis in certain clinical cases. Decisions made should be individualized and tailored according to clinical suspicion and presentation of the patients. Improvement to ensure accurate diagnosis is vital to ensure correct data capture in the HIPE system thus giving valuable information and resource for future care.

ABSTRACT OBJECTIVE: To determine the frequency and pattern of primary brain tumors of infancy and childhood in hospitalized patients at neurosurgery department Lady Reading hospital Peshawar. METHODS: This descriptive cross sectional study was conducted from January 2013 to December 2013 at neurosurgery department Lady Reading hospital Peshawar, Pakistan. Pediatric patients under 14 years with primary brain tumor were included. Data was then collected on a predesigned proforma from the hospital charts, radiographic and histopathological reports and was analyzed for age, gender and tumor morphology. RESULTS: Out of 66 patients of primary brain tumour during the study period, 31 cases (46.96%) were supratentorial and 35 cases (53.04%) were infratentorial. Most commonly affected age group was 5-9 years and 10-14 years. Both male and female were equally affected with male to female ratio of 1:1. Twenty one cases (31.81%) were glioma, 17 cases (25.76%) were craniopharyngioma, 12 cases (18.18%) were medulloblastoma, 9 cases (13.65%) were ependymoma, 4 cases (6.06%) were choroid plexus papiloma and 3 cases (4.55%) were meningioma. Out of 21 cases of glioma, 11 cases (52.38%) were pilocytic astrocytoma, 7 cases (33.33%) were glioblastoma multiformis (GBM) and 3 cases (14.29%) were brainstem low grade astrocytoma. CONCLUSIONS: Most of the pediatric primary brain tumours are infratentorial. Glioma is the most common primary brain tumour in children followed by craniopharyngioma, medulloblastoma and ependymoma. The commonest age groups of presentation were 5-9 years and 10-14 years with equal male to female ratio. KEY WORDS: Glioma (MeSH), Astrocytoma (MeSH), Craniopharyngiomas ((Non-MeSH),), Medulloblastoma (Non-MeSH), Ependymoma (MeSH), Meningioma (MeSH), Papilloma Choroid Plexus (Non-MeSH).