Pattern and Practice of Paediatric Neurosurgical Procedures- An analysis of one year initial experience at resource challenged setup of Children Hospital, Faisalabad.

patients presenting to Children Hospital, Faisalabad. Materials and Methods:  Retrospective case series of 778 consecutive cases admitted in Pediatric Neurosurgery Department, Children Hospital, Faisalabad over one year (October 2019- September 2020). Patients of age less than 15 years, any gender, admitted in Pediatric Neurosurgery ward for management were included and studied for their demographic data hospital stay, a procedure done and outcome. Results:  A total of 778 patients who required some neurosurgical intervention were admitted, 725 underwent various types of procedures and the remaining were treated conservatively. 320 (44.14%) were male and405 (55.86%) were female. The age range was 20 days to 13 years. The most common diagnosis was hydrocephalous, and then was Meningomyelocele (MMC). The first three common procedures performed included monitoring of Cerebrospinal fluid (CSF) in 36% of cases, Placement of shunt (21%), and placement of external ventricular drain (EVD) in 13% of cases of cerebrospinal fluid (CNS) infections in patients of hydrocephalous. Conclusion:  Pattern of presentation of pediatric neurosurgical cases take in almost all types of diseases like neural tube defects, hydrocephalous, cranial trauma, tumors, cysts, and infections but surgical procedures in routine practice in Faisalabad district cover mainly hydrocephalous and its complications. Endoscopic or advanced procedures are not commonly practiced due to multiple factors but existing constraints do not prevent the best management of pediatric neurosurgery patients

COVID-19 Pandemic: Influences on the Practice of Neurosurgeons all over Pakistan

Objective:  The aim of this survey was to observe the impacts of COVID-19 pandemic on neurosurgery practices during this pandemic, assess various types of adaptations taken by them, protective measures during patient examination and effects on their health, family and socioeconomic life. Material & Methods:  A Questionnaire comprising 32 questions was circulated among practicing Neurosurgeons of Pakistan by social media, e-mails for 8 weeks (January-February 2021) and their responses were analyzed. Results:  108 participants were involved from all over Pakistan. 32% respondents stated reduction in clinical practice to a level of less than 25%. While, 10% reported complete closure of outpatient services during pandemic. There were varied responses on the use of protective measures and most used N95 mask only (31%). Pandemic also affected the research work, finances and leisure time activities. Conclusion:  Our study showed that neurosurgical practice was influenced by COVID-19 pandemic in many aspects in Pakistan. Proper method of protective measures and COVID testing of patients were lacking among them. Neurosurgeons should follow standard guidelines according to institutional directives in local neurosurgical practices so as to avoid being influenced by such crisis.

Brain Abscesses in Children: A Study of Microbiological Spectrum and Outcome of 80 Cases

Objective:  Brain abscess is a focus of pus in the brain due to infection somewhere else in the body. It is common in males than females and the average age in children ranges from 4 to 7 years. It develops by skull trauma or contiguous or hematogenous spread of infection. The study aimed to identify the pattern of microbiological involvement in the etiology of pediatric brain abscesses and the outcome so as to enable us to ensure definitive treatment with the appropriate and specific antimicrobial regimen. Materials and Methods:  A prospective study was conducted in 80 pediatric patients of brain abscess admitted to the Pediatric Neurosurgery Department, Children Hospital, Lahore, Pakistan. Results:  The median age was 5.2 years with a predominance of males (60%). The most common presentation was fever (72.5%) and then fits (35%). Congenital heart disease was the commonest factor in 32% of cases. Streptococcus was a commonly isolated pathogen in 17% cases out of 70% of culture positive cases. Recovery was seen in 70% of cases and the mortality was 7.5%. Conclusion:  Congenital heart disease is the most common causative factor in pediatric brain abscesses and most of the abscesses were found culture negative. There is a pressing need to carry out multicenter studies over a large sample size over extended study duration in developing countries to help establish guidelines in treating pediatric brain abscesses

Identification of Suitable Sites for Jatropha curcas L. Bioenergy Plantation Using the AquaCrop Model

Jatropha curcas (JC), as a biofuel plant, has been reported to have various desired characteristics such as high oil content seeds (27–40%), fast-growth, easy cultivation, drought tolerance, and can be grown on marginal soil and wasteland, requiring fewer nutrients and management and does not interfere with existing food crops, insects, and pest resistance. This investigation was the first study of its type to use climatological data, blue/green water footprints, and JC seed production to identify suitable sites for JC bioenergy plantation using the AquaCrop FAO model across the Khyber Pakhtunkhwa province in northwest Pakistan. The JC seed yield (10 ton/ha) was at a maximum in the districts of Bannu, Karak, Hangu, Kurram, North Waziristan, Lakki Marwat, South Waziristan, and Dera Ismail Khan, in addition to its frontier regions, Tank, Peshawar, Mohmand, Orakzai, Khyber, Kohat, Charsadda, Mardan, Swabi, and Nowshera, respectively. Green water footprint (264 m3/ton of JC seed) and blue water footprint (825 m3/ton) was less in these areas. Furthermore, the results revealed that, depending on climatological circumstances, the southern part of the Khyber Pakhtunkhwa province is more appropriate for JC bioenergy plantation than the northern region. The districts of Bannu, Karak, Hangu, Kurram, North Waziristan, Lakki Marwat, South Waziristan, Dera Ismail Khan, and its frontier regions, Tank, Peshawar, Mohmand, Orakzai, Khyber, and Kohat, in Khyber Pakhtunkhwa province were identified to be the most ideal places for JC bioenergy plantation. As a result, under the Billion Tree Afforestation Project (BTAP) and the Green Pakistan Project, the Forest Department of Khyber Pakhtunkhwa should consider planting JC species in the province’s southern region. Furthermore, this research will provide scientific information to government and private sector officials for better management and optimum yield of the JC biofuel crop, as well as for the promotion of energy forestry in Pakistan

Identification of Suitable Sites for <i>Jatropha curcas</i> L. Bioenergy Plantation Using the AquaCrop Model

Jatropha curcas (JC), as a biofuel plant, has been reported to have various desired characteristics such as high oil content seeds (27–40%), fast-growth, easy cultivation, drought tolerance, and can be grown on marginal soil and wasteland, requiring fewer nutrients and management and does not interfere with existing food crops, insects, and pest resistance. This investigation was the first study of its type to use climatological data, blue/green water footprints, and JC seed production to identify suitable sites for JC bioenergy plantation using the AquaCrop FAO model across the Khyber Pakhtunkhwa province in northwest Pakistan. The JC seed yield (10 ton/ha) was at a maximum in the districts of Bannu, Karak, Hangu, Kurram, North Waziristan, Lakki Marwat, South Waziristan, and Dera Ismail Khan, in addition to its frontier regions, Tank, Peshawar, Mohmand, Orakzai, Khyber, Kohat, Charsadda, Mardan, Swabi, and Nowshera, respectively. Green water footprint (264 m3/ton of JC seed) and blue water footprint (825 m3/ton) was less in these areas. Furthermore, the results revealed that, depending on climatological circumstances, the southern part of the Khyber Pakhtunkhwa province is more appropriate for JC bioenergy plantation than the northern region. The districts of Bannu, Karak, Hangu, Kurram, North Waziristan, Lakki Marwat, South Waziristan, Dera Ismail Khan, and its frontier regions, Tank, Peshawar, Mohmand, Orakzai, Khyber, and Kohat, in Khyber Pakhtunkhwa province were identified to be the most ideal places for JC bioenergy plantation. As a result, under the Billion Tree Afforestation Project (BTAP) and the Green Pakistan Project, the Forest Department of Khyber Pakhtunkhwa should consider planting JC species in the province’s southern region. Furthermore, this research will provide scientific information to government and private sector officials for better management and optimum yield of the JC biofuel crop, as well as for the promotion of energy forestry in Pakistan