department of physical medicine & neuro-rehabilitation · • short wave diathermy (swd) •...

Introduction

Physical Medicine & Rehabilitation Department, National Institute of Neuroscience & Hospital provides services to

the patients with neurological problems and musculoskeletal disorders from the beginning. This department tries

to correlate with other departments in providing facilities, faith and satisfaction to the patients. Under proper

academic environment, it maintains all academic & clinical records. Now-a-days the department tries to open a

new era regarding comprehensive patient care with its full effort and to create Physiatrist who spread the subject

throughout the country and try their best to make it a unique subspecialty of medicine. So more people will gain

access to this specialty as the problems of disability are increasing day by day due to RTA, TBI, Stroke etc.

Department of

PHYSICAL MEDICINE & NEURO-REHABILITATION

GROUP PHOTO OF FACULTY

05 Year Book - Nins 2058 1

Designation Number

Associate Professor 01

Assistant Professor 01

Medical officer 02

Physiotherapist 05

Medical Technologist (Physiotherapy) 03

Speech Therapist 03

Occupational Therapist 03

ORGANOGRAM

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Photo of Technologist

Name of the Faculty

Dr. Khurshid Mahmood

Associate Professor

Academic activities

Departmental academic activities

• Case presentation/ Assessment

• Integrated teaching with different departments

• Seminar/ Symposium

• Journal club

Physiotherapy students (Govt. / Other private institutions)

• Lecture / Tutorial classes

• Case presentation / Assessment

• Physical therapy practical demonstration

• Evaluation

Patient profile/Total Patient turn over:

Patient Care

Inpatient

• Indoor admitted patient

• Referred patient

Out patient

Management

• Drugs

• Physical therapy (Physical agent & exercise)

• ADL training

• Counseling

• Follow up

Other Facilities

• Departmental Library

• Computer

• Internet

Patient Profile (January, 2016 to December, 2016)

The total number of patients at Physical Medicine Department has been increasing day by day. Almost

all the patients coming to this department from different areas of Dhaka city by themselves or referred

by physicians from different department of National Institute of Neurosciences and Hospital. In

January-2016 to December-2016 about 14668 patient were treated by Physical Medicine Department

of National Institute of Neurosciences and Hospital.

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Sex of the patients

Total number of Patients were14668. Among which 59.73% were male and 40.27% were female.

List of Instrument

Sex Frequency Percentage

Male 8761 59.73

Female 5907 40.27

Total 14668 100.0

Sl. No. Name of Instrument Unit

1 Ultrasound Therapy 02

2 Short Wave Diathermy 02

3 Infrared Radiation 04

4 Wax Bath 02

5 Hydrotherapy Unit 02

6 Neurotome 02

7 Cervical and Lumbar Traction 04

8 Microwave Diathermy 02

9 CPM 02

10 LASER 02

11 Transcutaneous Electrical Nerve Stimulation (TENS) 02

12 Walker 10

13 Rolator 10

14 Static Bicycle 10

15 NK Table 04

16 Vibrator 04

17 Electrical Stimulation Therapy 04

18 Treadmill 02

19 EN-tree 01

20 Hand Ergometer 02

21 Wall bar 01

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Activities of the Department:

Daily Activities in The Department: Patients attending in the department of Physical Medicine either

directly or referred from other department of National Institute of Neurosciences and Hospital are

managed empathetically in a systemic and dynamic way by the doctor, physiotherapist under

supervision of the head of the department.

• Daily patients (OPD, referred) are seen by the doctors from 8:00-2:30 pm.

• From 8:00am to 9:00am other academic activities such as seminar, journal club and case

presentation are going on.

• Physiotherapist and occupational therapist are trained up by the department doctors with

regular tutorial classes according to their curriculum from 11:00 am – 12:00pm during their

placement.

• ADL instructions are provided by the department to the patients for their better management.

Facilities Available In the Department

Regarding patients management the following facilities are available in physical Medicine

department.

List of Instrument

Sl. No. Name of Instrument Unit

22 Shoulder Wheel 02

23 Parallel Bar (Plain & Stairs) 01

24 Vestibullar Ball 04

25 Exercise mat 01

26 Tilt table with Hoist 02

27 Occupational therapy set 01

28 Suspension therapy set 01

29 Correction element (Presso-therapy) 01

30 Dumble 01

31 Wristlets 01

32 Wrist Roller resistances 02

33 Arm Balancer 02

34 Standing frame 02

35 Mobile poster mirror 05

36 FES unit 01

37 Tropic stimulator 01

38 Respiratory meter 16

39 Peak flow meter 16

40 Quad’s chair 01

41 Bobath bed 04

42 Theraband 02

43 Putty 02

44 Interferential Therapy (IFT) 01

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List of Equipment

1. Thermotherapy:

• Short Wave Diathermy (SWD)

• Micro Wave Diathermy (MWD)

• Ultra Sound Therapy (UST)

• Infra Red Radiation (IRR)

• Wax Bath

2. EST

3. Transcutaneous Electrical Nerve Stimulation (TENS)

4. Traction

• Cervical

• Pelvic

5. Static bicycle

6. N-K table

7. Hand Ergo meter

8. Interferential Therapy (IFT)

9. FES

10. Shoulder Wheel

11. Pully

12. Vibrator

13. Occupational Therapy set

14. Theraband

15. Dumble

16. Wrist mobilizer

17. CP facilities

18. Walking Aids

• Walker

• Parallel Bar with & without stairs

Exercise: Different exercises & transfer activities prescribed by the doctors are demonstrated by the

physiotherapist to the patients and their care givers/attendants.

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NEUROSURGERY

&

ALLIED DEPARTMENTS

DEPARTMENT OF NEUROSURGERY

1. Clinical Neurosurgery Department (Green unit)

2. Clinical Neurosurgery Department (Blue unit)

3. Clinical Neurosurgery Department (Pink unit)

4. Pediatric Neurosurgery Department (Orange unit)

5. Neuro-Spine Department (Yellow unit)

6. Neuro-Trauma Department (red unit)

a. Unit 1

b. Unit 2

7. Gama Knife Surgery Department

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Introduction

Neurosurgery Green unit is the leading neurosurgery unit of the National Institute of Neurosciences

providing neurosurgical care for the people of the country. By this time it becomes popular and known

in this country as well as abroad. Dedicated team works make the things possible. The unit is headed

by Prof. Dr. Sk. Sader Hossain FCPS, FICS who started working here with other co workers since the

hospital open the doors to the people.

Department of

NEUROSURGERY

GROUP PHOTO OF FACULTY


SL. No. Name Designation

1. Prof. Dr. Sk. Sader Hossain Professor & Head

2. Dr. Md. Abdullah Alamgir Assistant Professor

3. Dr. Md. Shafiul Alam Assistant Professor

4. Dr. Amir Mohammad Khan Assistant Professor

5. Dr. Kaisar Haroon Assistant Professor

6. Dr. Ferdous Ara Isalm Medical officer

7. Dr. Arif Reza Medical officer

8. Dr. Khaled Mahmud Komol Medical officer

9. Dr. Sujit Paul Assistant Registrar

10. Dr. Farzana Arafat Medical officer

Surgeons

GREEN UNIT

Human resources:

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Designation Number

Nurses 08

Ward Boy 04

Aya 04

Cleaner 06

Supporting Staff

Available Instruments/Equipments

SL. no. Instruments Quantity

1. Steel patient beds 32

2. Saline stand 32

3. View Box 02

4. Bed side locker 32

5. Sucker machine (portable) 01

6. Opthalmoscope 01

7. Pulse oxymeter 01

8. Wall white Board 01

9. Nebulizer machine 04

10. Steel bowl 82

11. Steel almirah 06

12. Ambu bag 01

13. Glucometer 01

14. ECG machine 01

15. Lifter & jar 02


16. Oxygen flowmeter 08

17. Torch light 04

18. BP machine 04

19. Stethoscope 04

20. Weight machine 01

21. Pts screen 02

22. Telephone 01

23. Hammer 05

24. Wheel chair 02

25. Dressing drum 11

26. Scale 02

27. Scissors

Stich cutting 16

Bandage cutting 02

Plain 03

Available Instruments/Equipments (Cont’d)


28. Kidney tray 12

29. Artery tray 16

30. Wall sucker 04

31. Oxygen cylinder 01

32. Gali pot 15

33. Food table 32

34. Plastic stool 32

35. Chair 12

36. Dressing Trolley 03

37. Steel cabinet 04

38. Patients stretcher 02

39. Bed pan 08


40. Urinal 08

41. BP handle 03

42. Magil’s forcep 02

43. Calculator 01

44. Tooth dissecting forcep 04

45. Plain dissecting forcep 04

46. Needle holder 04

47. Tongue depressor 04

48. Personal locker 01

49. Refrigerator 01

50. Sterilizer machine 01

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Wings of activities:

Neurosurgical

green unit

Neuro surgery &

Neurosurgical care

services

Academic Research

Neurosurgery & neurosurgical care services

Like other parts of the hospital Green unit provides In-patient and Out-patient services for those who

need different types of neurosurgery like cranial case surgery, spinal case surgery, nerve injury repair

etc. There are two major weekly operation dates. Emergency surgery is also performed by the unit.

Along with this, several types of minor cases are treated in outdoor service. Postoperative care is also

provided by the unit. Follow up of the patient is strictly monitored following discharge.

Academic services:

The unit provide resources for academicians like journals, research works, scientific paper writing,

scientific paper presentation, bed side discussion, discussion of surgical updates and other relevant

medical updates. Grand round is given every week days except two operation dates. Academic

teaching, bed side teachings are also available for the post graduate and residency course students.

The unit also participate in journal club, anatomy session.

Research activities:

The unit provide adequate services for the researchers, post graduate students who show interest in

research in similar fields. There are three research projects running in the unit.

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SL. no. Major events

1. 6th South Asian Neurosurgical congress & 8th International scientific conference held

in Pan Pacific Sonargaon Hotel from 22-24 February.

2. 2nd Minimally invasive spinal surgery live workshop held in NINS from 23-24 April.

3. 1st Bangladesh Neurovascular conference (BNVC) held in NMC auditorium and cath

lab, DMCH from 26-27 September.

4. Neuroendoscopic live surgery for hydrocephalus held in NINS.

5. Scientific session on Neuroendocrine aspect of Hypothalmo pitutary disorder held in

NINS on March 15.

Conference/ Live workshop/ Scientific session/ CME:

Green unit regularly participate in national and international neurosurgical conferences, live

workshops, scientific sessions, CMEs and others. Unit doctors took part on these sessions’ present

papers, sharing their research, improve skills and training in different surgical methods and

procedures. Green unit doctors also took part in similar programs in neurology. Last year major

programs the unit participated:

Surgical management of sellar and paraseller

tumours

Distribution and determinants of Endoscopic third

ventriculostomy (ETV)

Pattern of brain tumour and Economic impact among

admitted patients in a specialized center of Dhaka

city: A cross sectional study

1

2

3

Distribution of bed:

85

a. Patient record (January’2016-June’2016): Cranial cases

Cases January February March April May June

Glioma 1 1 - - - 2

Insular

GBM - 2 - 1 1 -

ICSOL 6 4 1 3 1 4

Meningioma 6 6 4 1 3 6

Craniopharyngioma - 1 1 - - -

Sellar tumor

/Parasellar 2 1 - 2 2 2

Pituitary tumor 2 - 1 1 2 3

CP angle tumor 1 3 3 3 1 1

Posterior fossa SOL 2 - - - 3 -

Arachnoid Cyst - 2 - - 1 -


Total Patient profile: (January’16-December’16):

In-Patient profile (Jan 01, 2016- Dec 31, 2016):

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b. Patient record (July’2016-December’2016): Cranial cases

Cases July August September October November December

Glioma 2 1 2 1 1 -

Insular - - 1 - - -

GBM - 1 1 - - 2

ICSOL 3 4 4 4 - 1

Meningioma 2 4 2 2 2 1

Craniopharyn

gioma - 1 - - 1 -

Sellar tumor

/Parasellar - - - - - -

Pituitary tumor 1 1 - 1 3 -

CP angle tumor - 2 - 2 - 3

Posterior fossa SOL - 2 1 3 - 1

Arachnoid Cyst - - 2 - - 2

Chiari malformation - - - - - -

a. Patient record (January’2016-June’2016): Cranial cases (Contd.)

Chiari malformation 2 - - - - -

Thalamic SOL - - - - - -

Pineal cyst/Tumor - 1 2 - - -

ACOM/Aneurysm

/AVM 1 1 2 - - 1

Fibrous Dysplasia 1 1 - - - -

Haemogioblastoma - 1 - - - -

V-P shunt/HCP - 1 2 2 2 1

AAD - 1 1 - - -

Meduloblastoma - - - 1 - -

IIH - - - 1 1 -

Schwanoma - - - - 1 -

Metastatic ca. - - - - - -

Nerve Injury - - - - - -

CSDH - - - - - -

Others 7 - 2 1 2 6

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c. Patient Record (January’2016 – June’2016): Spinal Cases

Cases January February March April May June

Spinal SOL - - - - - 1

Cervical - - 1 1 - -

Dorsal - 1 - - - 1

Lumber - - - - - -

PLID 3 3 6 3 4 3

PID - 1 - 1 1 1

Pott’s Disease - - 1 - - -

Fracture Spine - - - - - -

Nerve Injury - - - - - -

Fracture Spine 1 - - - - -

Spinal AVM - 1 - - - -

Spinal Absces - - - 1 - -

Others 2 - 1 1 - 1

b. Patient record (July’2016-December’2016): Cranial cases


Thalamic SOL - - - - - -

Pineal cyst/Tumor - - - 1 - -

ACOM/Aneurysm/AVM - - 2 1 3 1

Fibrous Dysplasia - - - - - -

Haemogioblastoma - - - - - -

V-P shunt/HCP 2 - 3 2 1 4

AAD - - - - - -

Meduloblastoma - - - - - -

IIH - - - 1 - -

Schwanoma - - - - - -

Metastatic ca. - 1 - - - -

Nerve Injury - 1 - - - 1

CSDH - 1 - - - -

Others 9 - 1 3 3 5

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d. Patient Record (July’2016 – December’2016): Spinal Cases


Spinal SOL

Cervical - - - - - -

Dorsal - - - - - -

Lumber - - - - -

PLID 1 4 3 3 3 4

PID 1 - - - - 1

Pott’s Disease - - - 1 - -

Fracture Spine - - - - - -

Nerve Injury 1 - - - - -

Spondylolisthesis

Cervical - - - - - -

Lumber - 1 - 1 - -

Others - - - - - -

e. Death record (January’2016 – December’2016)

Month Disease wise death Number of death

January ICSOL 1

February - -

March ICSOL 1

April Rt. Parietal SOL 1

Colloid cyst with HCP 5

Spinal TB

ICSOL

Recurrent Insular Glioma

May Posterior fossa SOL with HCP 1

June Fronto temporo Parietal GBM with HCP 3

Lt. Sphenoid wing Meningioma

CP angle tumor

July Lt. Frontal SOL 1

August Pott’s Disease 2

ICSOL

September Corpus callosal Glioma 2

Craniopharyngioma

October Rt. Thalamic Glioma 1

November Rt. Cerebellar SOL with HCP 2

Craniopharyngioma

December ICSOL 3

Posterior fossa SOL

Pitutary Macroadenoma with ICH

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Inadequacy & limitations:

1. Inadequate doctor, nurses and supporting staff which put intense the service pressure overload to

provider time to time.

2. Though the corridors and other parts of the hospital are well lit, adequately ventilated, the wards

and doctor rooms of green unit are poorly ventilated having no/ less natural lights. Rooms are also

humid and always in high temperature specially in summer.

3. Only one wash room (toilet) for the doctors which is inadequate. No separate wash rooms for the

female doctors which are equally needed.

4. There is no female changing area/room for female doctors in OT. One available room occupied by

nurses.

5. Inadequate number of trolley to transfer patients.

6. One wheel chair sometimes put into patient queue.

7. Only one privacy screen hampers privacy.

8. Inadequate hand washing facility with improper hand wash, soap supply.

9. Only one hand wash basin is available in nursing station area. There is no separate sluice area for

cleaning, washing. All the instruments are washed in hand washing areas which is very risky in

view of infection control and prevention. The scenario is similar in the rest of the hospital.

10. Patients stay for long times. Their bag and baggage sometimes cause serious trouble in the

working areas. Pest control becomes also difficult.

Recommendations:

1. Adequate manpower facility with proper distribution of duties and responsibilities.

2. Immediate response to repair all the instruments, equipments, devices.

3. Improvement of the hospital indoor environment. Besides surface cleaning improve the air quality

inside hospital with long term temperature and humidity control which are vital for bacterial growth.

4. Adequate toilets for doctors and other staff.

5. Adequate hand washing facility with adequate supply of soaps, hand wahes.

6. Establishment of separate sluice area for cleaning.

7. Adequate supply of instruments whenever required.

8. Adequate supply of transferring trolley, wheel chairs etc.

9. Preservation of privacy for everyone.

10. Arrange a place where long term staying patients can keep their bag and baggage and other

necessary things outside working areas preferably basement area or anywhere else.

Steps take to develop public relationship:

Researcher/patients can easily reach/communicate to the department doctors through contact number

and on popular facebook page. Currently it has 2096 followers. Valued questions are immediately

responded there. NINS & H activities, surgery videos, information of workshop, seminar, live surgery

and other medical science related information available here. Global updates of health

sciences/research also available in this page. Through this page we want to expand relationship to our

patients, researcher and learner which is growing day by day.

90


“Neurosurgery is challenging, and it can be done only by those people who can take challenges in life.”

Department of

NEUROSURGERY

GROUP PHOTO OF DOCTOR

BLUE UNIT


No. Name of faculty members Designation

1 Dr. S. M. Noman Khaled Chowdhury Associate Professor & unit head

2 Dr. Asit Kumar Saha Assistant Professor

3 Dr. Mokhlasur Rahman Mukul Assistant Professor

4 Dr. Forhad Hossain Chowdhury Assistant Professor

5 Dr. Rustom Ali Registrar

6 Dr. S. M. Monir Hossain Assistant Registrar

7 Dr. Sanjoy Kumar Saha Medical Officer

8 Dr. Md. Mizanur Rahman Medical Officer

Name of the Faculty

Human resources:

91



Male beds Male paying beds 8

Male non-paying beds 4

Total 12

Female beds Female paying beds 4

Female non-paying beds 4

Total 8

Cabins As per availability

Total Beds 20

Number of Beds

Patient profile/Total Patient turn over

92


Bed occupancy Rate of 2016:

Number of bed days : 20 X 365 = 7300

Inpatient days of care : 7197

Bed occupancy rate = 7197 x 100

7300= 98.6%

93


94


Activities:

OPD

• Clinical Neurosurgery ( Pink Unit) Tuesday

Follow up of Postoperative patients

• Clinical Neurosurgery ( Pink Unit) Wednesday

Department of

CLINICAL NEUROSURGERY

GROUP PHOTO

PINK UNIT


1. Dr. Md. Joynul Islam Associate Professor

2. Dr. ATM Ashadullah Associate Professor

3. Dr. Kazi Hafiz Uddin Registrar

4. Dr. Md. Masum Ali Assistant Registrar

5. Dr Md. MizanulHaque Medical Officer

Name of the Faculty

95


Indoor Service:

Grand Round for patient Evaluation:

Every Sunday and Wednesday

OT Date:

Every Monday and Thursday

Total bed:

Pink unit 20 (Male & Female)

Total Patient Admission:

Pink unit - 217

Surgery Done:

Pink unit 198

Mortality:

Male and Female patient ratio:

Pink unit 217

Male 126

Female 91

Disease with total no. of patients Pink unit

PLID (Prolapse lumbar intervertebral Disc) 91

Cervical Compressive Myelopathy 35

Brain Tumor 48

Spinal SOL 31

Pott’s Disease 02

Lumbar Spondylolisthesis 03

Others 07

Total 217

Age Pink unit

1-20 28

21-40 100

41-60 66

61- above 23

Total 217

Patient Profile according to age

Top 5 disease profile

96


Academic Activities:

Clinical Class (Morning session) Every Saturday

Recommendations

• Establishment of Surgical Neuro ICU.

• Replacement and Repair of Surgical Instruments

• Data entry operator for proper documentation.

• Duty Medical Officer for Floor and Postoperative ward separately.

Limitations

• Inadequate number of Scrub nurses in OT.

Insufficient number of Anesthesiologists in the evening and night

97


Department of

PEDIATRIC NEUROSURGERY

GROUP PHOTO

ORANGE UNIT

No. Name of the members Designation

1. Dr. Sheikh Md. Ekramullah Associate Professor and Head

2. Dr. Sudipta Kumer Mukherjee Assistant Professor

3. Dr. D. M. Arman, Assistant Professor (OSD)

4. Dr. Lailatul Kadir Assistant Registrar

5. Dr. Sharifuzzaman Medical Officer

6. Dr. Soumen Samaddar Medical Officer

Name of the Members

98


Activities of the department

Outdoor service: 3800 patients

Services

• Operation - 4 days in a week

• Outdoor service - 2 days in a week

• Round - 4 days in a week

• Clinical meeting – once in a week

Academic activities

• Academic discussion on different topics - 3 days in a week in the department

• Academic discussion through Skype in home and abroad about difficult cases once in a week

Research activities

• Does arsenic increases risk of neural tube defects in highly exposed population? In collaboration

with Boston children hospital

• Accuracy of VP shunt placement

• Hydrocephalus & spine bifida demography outcome

• Comparison between septated & simple hydrocephalus

Patient profile/Total Patient turn over

• Total operation – 308

• Total death: postop. 9, preop. 14

Number of operation

VP shunt 82

ETV and related 45

Brain Tumour 55

Spinal tumour 8

Myelomeningocele 31

Encephalocele 16

Brain abscess 13

EDAS for MoyaMoya disease 8

Craniosynostosis 5

Tethered cord 4

Arachnoid cyst 2

AAD 2

Fibrous dysplasia 2

Colloid cyst 1

Others 35

99


Limitations

1. Inadequate Manpower

2. Unavailability of ICU bed

3. Training in Pediatric Neurosurgery is not recognized

4. Postgraduate course in Pediatric Neurosurgery is not established yet

Future Plan&Recommendation

1. Creation of post of Associate Professor – 1, Assistant Professor – 2,Registrar – 1, Assistant

Registrar 1,Medical officers – 4

2. To ensure ICU bed availability after surgery

3. Recognition of training in Pediatric Neurosurgery

4. To start Postgraduate course in Pediatric Neurosurgery

100


“Neurosurgery is challenging, and it can be done only by those people who can take challenges in life.”

Department of

SPINE-NEUROSURGERY

GROUP PHOTO OF DOCTOR

YELLOW UNIT



1. Dr. Mirza Md. Hafizur Rashid Associate Professor

2. Dr. Fazle Elahy Associate Professor

2. Dr. Misbah Uddin Ahmad Assistant Professor

3. Dr. Masud Rana Assistant Registrar

4. Dr. Faruk Ahmed Medical Officer

Name of the Faculty

Name of the Faculty

Clinical Neurosurgery

Spine – Neurosurgery

101


Activities:

OPD

• Neurosurgery - Spine Unit ( Yellow Unit) Saturday

Follow up of Postoperative patients

• Neurosurgery - Spine Unit (Yellow Unit) Sunday

Indoor Service:

Grand Round for patient Evaluation :

Every Sunday and Wednesday

OT Date :

Every Monday and Thursday

Total bed :

Yellow unit 20 (Male & Female)

Total Patient Admission :

Yellow unit : 275

Surgery Done :

Yellow unit : 265

Mortality :

Yellow unit

Age Yellow unit

1-20 30

21-40 123

41-60 89

61- above 33

Total 275

Patient Profile according to age

Disease with total no. of patients Yellow unit

PLID (Prolapse lumbar intervertebral Disc) 135

Cervical Compressive Myelopathy 56

Brain Tumor 25

Spinal SOL 28

Pott’s Disease 07

Lumbar Spondylolisthesis 09

Others 15

Total 275

Top 5 disease profile

Male and Female patient ratio

Yellow unit 275

Male 160

Female 115

102


Academic Activities:

Clinical Class (Morning session) Every Saturday

Recommendations

• Establishment of Surgical Neuro ICU.

• Replacement and Repair of Surgical Instruments

• Data entry operator for proper documentation.

• Duty Medical Officer for Floor and Postoperative ward separately.

Limitations

• Inadequate number of Scrub nurses in OT

• Insufficient number of Anesthesiologists in the evening and night.

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