Resistance to anti TB drugs is an indication for TB spinal surgery – Prof. Amir Aziz

Education should not be a business. Form your own
Akhuwat or join us-Amjad Saqib

37th annual PSN Conference Proceedings

KARACHI: Prof. Tariq Salah Uddin from Lahore was the first speaker in the main session of the 37th annual conference of Pakistan Society of Neurosurgeons held at Aga Khan University on second day of the conference held from November 7th November 10th 2024. The topic of his presentation was Endoscopic Endo nasal Transphenoidal approach for Anterior Skull Base Lesions. He discussed in detail the anatomy landmarks and advantages of this approach with surgical steps. He also talked about extended radical anterior skull base surgery, Inlay and Outlay graft besides Balloon inflation. This technique, he opined, offers excellent results in up to 95% of cases. The likely infection rate is about 4%. EEASB, he said, was a pioneering approach and these patients need multidisciplinary management. He also announced the publication of Manual of Neurosurgery: Book for Neurosurgical Residents which was formally launched on January 9th 2024. Foreword for this book has been written by Dr. Ghaus Malik a renowned Neurosurgeon from Henry Ford Hospital, United States. It takes ten years to learn how to operate and another ten years to learn when not to operate, he remarked.

Prof. Amir Aziz from Ghurki Trust Teaching Hospital Lahore was the next speaker who talked about Tuberculosis of Spine and presented details of about two thousand patients which they have managed so far. Drug resistant Tuberculosis, he said, is quite common and we see lot of patients with spinal tuberculosis with deformities. Anterior Column is destroyed in 90% of these patients. It is a disaster presentation of patients. Almost 95% of these patients suffer from anterior column and 5% from posterior column. Laminectomy in such patients gives disastrous results and the patient may suffer from paraplegia. Six weeks after surgery the patient is stand out as we extend it by 2mm daily. Almost 25% of TB patients in Pakistan are multi drug resistant because of use of inadequate drugs. Resistance to anti TB drugs is an indication for spinal surgery.

He then described the case of a patient with death of column which had rib graft with plate and titanium cage. It resulted in adequate graft consolidation. Pus has to be drained before treatment as such patients cannot be treated with drugs alone, he remarked. He then discussed at length the advantages of anterior approach. Combined anterior and posterior approach, he stated, is an effective method for tuberculosis of spine.

Dr. Ayesha Kamal from Aga Khan Univesity spoke about surgical intervention for acute stroke. The target systolic blood pressure for such patients should be 130-140 and blood pressure must remain under control. She then spoke about indications for surgery and timing of surgery. Early surgery, she opined, is a good idea.

This was followed by panel discussion on Future of Scientific Societies in Pakistan. The panelists included Prof Athar Enam, Prof.Asif Bashir, Prof Riaz Raja, and Prof. Mumtaz Ali, Prof. Naqeebullah Achakzai. During the discussion the importance of collaboration at national and international level was highlighted. It was also pointed out that multiple avenues are available for collaboration, one of them is to bring back people to Pakistan who have gone abroad and benefit from their experience. The society should sponsor young residents to attend international conferences as well as the regional conferences. One of the participants remarked that the Society should also give due representation to women as women empowerment has its own advantages.

Dr. Sabahat Asim Wasti made a presentation on Neuro Rehabilitation and Neurosurgery. He laid stress on early mobilization of patients and opined that stroke patients must be made mobile within forty eight hours. Early detection of any deficit is important, he added.
Dr. Farah Khan discussed physician’s rights in a volatile environment. It was stated that in the resent years the incidences of violence against healthcare professionals and healthcare facilities has increased. Sindh Healthcare Commission has introduced a protective Act. Unless negligence is proved against the healthcare professional, no action has to be taken. If negligence is proved against the treating doctor, then appropriate action has to be initiated. Physicians in Paksitan it was further stated are exposed to litigant society. Patient’s attendants often do not understand and threaten litigation. In many cases, residents and junior doctors were beaten up. At trims no one is punished for negligence and the society is interested in physical justice.

Dr. Salman Sharif from Liaquat National Hospital spoke about Social Media and Neurosurgery. He discussed in detail the professional ethics, ethical issues involved, limitations of e learning. Social media also offers some benefits if used responsibly, he remarked.

Dr. Amjad Saqib Founder of Akhuwat Foundation delivered Prof. Bashir memorial lecture. Prof Asif Bashir son of late renowned neurosurgeon of the country Prof. Bashir Ahmad described salient features of Prof. Bashir’s career and recalled his contributions to the discipline of neurosurgery.

Dr. Amjad Saqib who resigned from civil service to do welfare work and founded Akhuwat in his presentation narrated the story of a women who came to him and requested for some financial assistance so that she can buy a sewing machine to look after his family and children since his husband had died. She asked for Qarze Hasna and also promised to return it after some time. Dr. Amjad Saqib further stated that he was surpirzed to see that lady after few years and she returned the money but requested that it may be used to help and support someone else like me. That episode changed his life. He further stated that we have often noted that one cannot do much work while in government institution. We do more work when out of the government. We learn from others.

Today Akhuwat Foundation, he said, was supporting about forty lac families. We give them Qarze Hasna. Let us support others and eliminate this disparity between different sections of the society and help the poor, needy. You can help those in your family who need help and assistance. We have now established Akhuwat Univesity in Kasur near Lahore. Our aim is to provide free education. Students for the university are selected on merit throughout the country and they are provided free education and boarding, lodging. We are running numerous schools which would have been closed. The government has now given us some more schools and provide some financial assistance to run these institutions. We are training these talents students from the future generation and hope that once they start earning getting employment, they will pay back and this movement will continue. It is our succession plan as well, he remarked. Iman, Ehsas and Ikhlas are very important.

Education, Dr. Amjad Saqib stated should not be a business. During the first ten years we gave one billion rupees as Qarze Hasna and now we give one billion rupees in fifteen days. He concluded his presentation by urging those present to either form their own Akhuwat or join us in this welfare project.

Quality in Scientific Publishing

One of the sessions during the conference was organized in collaboration with Pakistan Journal of Medial Sciences. Mr. Shaukat Ali Jawaid Chief Editor of the journal gave details of Certificate in Medial Editing and Certificate in Medical Journalism and Editing started at University of Health Sciences Lahore which is a joint project of PAME, UHS and EMAME. The objective is professional capacity building of healthcare professionals to take up medical editing and Medical Journalism as an additional carrier. So far six batches of CME and two batches of CMJE have qualified. In the first two batches, editors of medical journals were enrolled with the result that now the number of Impact Factor Journals from Pakistan has increased from three to twelve.

It was followed by panel discussion. The panelists included Prof.Athar Enam, Dr. Fatema Jawad Chief Editor JPMA, Dr. Chaudhry Editor of Pakistan Journal of Neurological Surgery. Issues related to gift authorship, paper mills, predatory journals came up for discussion. It was the unanimous view of the participants that gift authorship was a menace and intellectual corruption which should not be tolerated at any cost. Regulatory authorities were asked to check the mushroom growth of predatory journals which trap authors willing to get quick publication and were also bringing bad name to the country.