Cerebrospinal Fluid Leak after Repair of Congenital Spinal Pathologies, Incidence and Management

Objective:  To know the incidence of CSF leak and role of tincture benzoyl in the management of CSF leak after the repair of congenital spinal deformities like myelomeningocele, meningocele and tethered cord syndrome.Materials and Methods:  All patients who were operated for congenital spinal surgeries in the form of MMC, Meningocele and TCS by a single surgeon were followed for a minimum of 3 months. Patients with already CSF leak/ruptured MMC prior to surgery were not part of the study. The particulars like gender and type of surgery, days since first surgery, associated infection, hydrocephalus and type of management were noted on a proforma.Results:  A total of 73 patients with spinal dysraphism were operated during the study period and of them about 13 patients returned with problems of the CSF leak. The mean duration and duration since the CSF leak was from 6 days to 16 days. Among them, 10 patients had an MMC repair and one patient had TCS release, while 2 patients were having meningocele repair. The patients were stitched and one patient was re-operated two times for repair of CSF leak. Two patients had a CSF leak along with post op signs of HCP that settled by placing a shunt along with primary repair of the wound reinforced with tincture benzoyl in a single setting. Conclusion:  CSF leak is a common complication following repair of spinal dysraphism and most patients can be managed with the application of tincture benzoyl alone or after simple skin reinforcement

Causes of Carpal Tunnel syndrome (CTS)

Objective: To know about the pathological causes of carpal tunnel syndrome.Materials and Methods: This is retrospective cross sectional study on the patients operated by the senior author at his private clinic between January 2008 and March 2014. All the patients operated for carpal tunnel syndrome during the study period were included while those managed conservatively were excluded from the study. Pre-operatively all patients had undergone Nerve conduction studies and the procedure was performed under local anaesthesia. The pathology responsible for causing CTS was noted.Results: A total of 73 patients were operated for CTS during the study period by the senior author. There were 18 males and 55 females with a male to female ratio approaching 3.0:1. The age range was from 24 – 58 years with a mean age of 43.6 ± 4 years. The pathology was hypertrophied transverse carpal ligament in 66 (90%) cases, abnormal vessels in 1 (1%), neuroma in 1 (1%), fracture distal end of the radius in 2 (5%), ganglion com-pressing the nerve in 1 (1%), post cellulitis in 1 (1%) and direct trauma to the nerve in 1 (1%).Conclusion: Thickened ligamentum flavum is the most common cause of carpal tunnel syndrome and space occupying lesion constitute a considerable percent of pathology

Surgical Outcome of Open Carpal Tunnel Release Using Global Symptom Severity Score

Objective:  Purpose of conducting this study was to evaluate the surgical outcome of open carpal tunnel release using Global Symptom Severity score (GSS) in our local setting. Material and Methods:  This prospective analytical study was conducted in the Neurosurgery Department Hayatabad Medical Complex, Peshawar. We operated consecutive 105 Carpal tunnel syndrome cases over a period of 2 years via open carpal tunnel release (OCTR) method. All of these cases were surgically indicated. All patients were evaluated preoperatively with clinical assessment and NCS. Cases were operated under local anesthesia as a day case surgery. Patients were evaluated at 3 months follow-up visit using global symptom severity score (GSS) and compared with pre operative GSS. The paired sample test was applied to obtain p value. Results:  Total 105 patients were operated during study period. 72 (69%) patients were women and 33 (31%) were men. The mean age of patients was 41 years. 70 (66.66%) procedures were done for the right hand and 35 (33.33%) were performed for left hand. Pre-op Mean GSS score was 27 ± 2.5 which decreased to 2.1 ± 0.43 postoperatively (P < 0.005). Conclusion:  Carpal tunnel syndrome is more commonly affecting the dominant hand of middle aged females. Open carpal tunnel release procedure is the safe and effective treatment for this compressive neuropathy

Incidence and Management Outcome of Incidental Durotomy in Spinal Procedures in Tertiary Care Hospital

Objective: To know the incidence and management outcome of incidental durotomy in spinal procedures in tertiary care hospital. Materials and Methods: This descriptive study was carried out in Neurosurgery Department, Hayatabad Medical Complex, Peshawar, from 1st July 2015 to 30 June 2017. All those patients in whom lumber spinal procedures were done were included in the study without age or gender discrimination. Exclusion criteria included patients in whom dura was intentionally opened as in cases of intradural tumors or in rare cases of transdural discectomies. Those patients were also excluded in whom procedure was done elsewhere and they were admitted in ward for management. All patients were reviewed by age, sex, indications of surgery and subsequent management of durotomy. Data was analyzed in SPSS version 10. Results: Total 560 patients qualified the selection criteria. There were 342 (61.07) male and 318 (38.93%) female patients. Amongst those operated, 294 (52.5%) patients had lumbar disc herniations, 143 (25.54%) patients were operated for lumbar spinal stenosis, 75 (13.39%) patients were treated for traumatic lumbar vertebral fractures, 38 (6.79%) patients had extradural spinal tumors and 10 were operated for lumbar spondylolisthesis. We noticed incidental durotomies in 50 (8.92%) cases. Of 342 male patients the incidence of durotomy was 20 (3.57%) while of 318 female patients the incidence was 30 (5.36%). All dural tears were recognized during the operation. Forty seven (47) dural tears were repaired primarily. We did re exploration in one patient for persistent leak in whom dural stitches were torn. Kerrisonrongeur was responsible for dural tear in 14. In 11 cases dissector tear the dura. Three dural tears were caused by pituatery rongeur. One tear was caused directly by knife. Air drill was responsible for 4 tears when lamina was being drilled to thin out. We could not find any cause of dural tear in one case. Conclusion: Unintentional duratomy is not an uncommon complication in neuro spinal procedures. This is more common female population and elderly patients with degenerative spinal diseases

Surgical Outcome of Organised Chronic Subdural Hematoma With Internal Septae in a Tertiary Care Hospital

Objective: This study presented the surgical outcome of craniotomy and membranectomy (outer membrane excision) for the organized Chronic Subdural Hematoma (OCSDH) which have already developed thick internal septations.Materials and Methods: We retrospectively reviewed a series of consecutive patients operated via.craniotomy method for OCSDH in Neurosurgery Department Hayat Abad Medical Complex. Patients with both genders and all ages diagnosed as OCSDH with septae either diagnosed preoperatively via imaging CT/MRI or intraoperatively while getting operated by single burhole drain or two burhole wash method were enrolled in the study and operated via craniotomy/outer membranectomy method.  All data was recorded in pre-formed Performa and demographics, clinical data analysed to quantify outcomes statistically.Results: Total 30 patients were operated in the 3 years study duration. Post-operative Recurrence of symptomatic hematoma was seen in only one patient, i.e. 3.33% and hence 29 (96.66%) had excellent outcome and remained symptom free at 6month followup visit. Out of 30 cases, we operated 27 (90%) were males and 3 (10%) were females, most of the cases were in the elderly age group (sixty five years was the mean age). Six cases (20%) had postoperative new onset seizures, all these patients were seizures free at 1month follow-up. Our three patients (10%) had a superficial wound infection.Conclusion: Craniotomy and outer membranectomy is a safe procedure for the management of OCSDH offering good results and fewer/no recurrence, unless the adherent inner (cortical) membrane removal is attempted, which may result in new onset seizures and neurological deficits

Haplotype Analysis for DFNB4/PDS Locus in Hearing Impaired Families of Punjab (Pakistan)

Abstract: Deafness is one of the most common genetic disorders affecting 1 in 1000 newborns worldwide, while in Pakistan, its prevalence is 1.6/1000.The present study was conducted to map reported autosomal recessive deafness locus DFNB4/PDS in highly consanguineous families in Punjab. For this purpose families with deafness were identified . Blood samples of these families were studied for linkage analysis of common reported deafness locus DFNB4/PDS. Genomic DNA was isolated from the blood samples of these families. Linkage analysis was then performed by amplifying microsatellite markers through PCR, Genotyping was done by ABI PRISM ® 3730 Genetic Analyzer. The Deaf Family was found linked to microsatellite markers of DFNB4/PDS. Linkages analysis showed that all three affected were homozygous for three STR markers for DFNB4/PDS while individuals V: 3 was heterozygous i.e., is carrier for DFNB4. Therefore individuals V: 3 were phenotypically normal but genotypically he is carrier. As the ages of that affected individuals' ranges from three years to seven years they might develop goiter at a later age. Therefore at present this family is linked to an overlapping nonsyndromic/ syndromic locus DFNB4/PDS

Mapping the Research between Foreign Direct Investment and Environmental Concerns; Where Are We and Where to Go?

Research on the relationship between Foreign Direct Investment (FDI) and environmental concerns has been drastically growing, providing opportunities to conduct systematic and bibliometric overviews. Surprisingly, to date, there has been no bibliometric study on the relationship to analyze the large volume of data. To fill the gap, we conducted a bibliometric study to address the statistical evaluation of the published studies and measure the role of the publications in the scientific community. We utilized the Scopus data from 2000–2021 and applied VOSviewer for co-citation and bibliographic coupling and SciMAT for conceptual structure and evaluation. In addition to the most influential authors, journals, and countries, we have discussed theoretical foundations and current research streams in the field of FDI and environmental concerns. We have discussed how research streams in the fields of FDI and environment transformed during 2000–2005, 2006–2010, 2011–2015, and 2016–2021. Concerning future research directions, we strongly recommend studying public policies and government incentives for environmental concerns. Consequently, we have also discussed several future research directions that can further strengthen the field

Mapping the Research between Foreign Direct Investment and Environmental Concerns; Where Are We and Where to Go?

Research on the relationship between Foreign Direct Investment (FDI) and environmental concerns has been drastically growing, providing opportunities to conduct systematic and bibliometric overviews. Surprisingly, to date, there has been no bibliometric study on the relationship to analyze the large volume of data. To fill the gap, we conducted a bibliometric study to address the statistical evaluation of the published studies and measure the role of the publications in the scientific community. We utilized the Scopus data from 2000–2021 and applied VOSviewer for co-citation and bibliographic coupling and SciMAT for conceptual structure and evaluation. In addition to the most influential authors, journals, and countries, we have discussed theoretical foundations and current research streams in the field of FDI and environmental concerns. We have discussed how research streams in the fields of FDI and environment transformed during 2000–2005, 2006–2010, 2011–2015, and 2016–2021. Concerning future research directions, we strongly recommend studying public policies and government incentives for environmental concerns. Consequently, we have also discussed several future research directions that can further strengthen the field

Preparation of Electrochemical Supercapacitor Based on Polypyrrole/Gum Arabic Composites

The current research focused on the super capacitive behavior of organic conducting polymer, i.e., polypyrrole (PPy) and its composites with gum arabic (GA) prepared via inverse emulsion polymerization. The synthesized composites material was analyzed by different analytical techniques, such as UV-visible, FTIR, TGA, XRD, and SEM. The UV-Vis and FTIR spectroscopy clearly show the successful insertion of GA into PPy matrix. The TGA analysis shows high thermal stability for composites than pure PPy. The XRD and SEM analysis show the crystalline and amorphous structures and overall morphology of the composites is more compact and mesoporous as compared to the pure PPy. The electrochemical properties of modified solid state supercapacitors established on pure polypyrrole (PPy), polypyrrole/gum arabic (PPy/GA) based composites were investigated through cyclic voltammetry (CV), electrochemical impedance spectroscopy (EIS) and galvanostatic charge–discharge (GCD). The specific capacitance of the PPy modified gold electrode is impressive (~168 F/g). The specific capacitance of PPy/GA 1 electrode has been increased to 368 F/g with a high energy density and power density (~73 Wh/kg), and (~599 W/kg) respectively

Synthesis, Characterization and Evaluation of Supercapacitive Response of Dodecylbenzenesulphonic Acid (DBSA) Doped Polypyrrole/Zirconium Dioxide Composites

An in-situ chemical oxidative method was used to effectively synthesize a promising supercapacitor material based on PPy/ZrO2 composites. The synthesized materials were characterized by different analytical techniques, such as UV/visible (UV/Vis) spectroscopy, Fourier-transform infra-red spectroscopy (FTIR), X-ray diffraction (XRD), thermogravimetric analysis (TGA), and scanning electron microscopy (SEM). The inclusion of ZrO2 into the PPy matrix was verified by vibrational spectra and structural analyses. The (TGA) results showed that incorporating ZrO2 into the polymeric matrix improved its thermal stability. In addition, the electrochemical properties of the synthesizedmaterials were investigated byusing cyclic voltammetry (CV) and galvanostatic charge/discharge (GCD). The PPy/ZrO2 composite demonstrated excellent super capacitive performance, and high specific capacity of 337.83 F/g, with an exceedingly high energy density of 187.68 Wh/kg at a power density of 1000 W/kg. The composite materials maintain good stability after 1000 charge and discharge cycles, with 85% capacitance retention. The PPy/ZrO2 possesses a high capacitance, an attractive micro-morphology, and a simple synthesis method. The findings indicate that the PPy/ZrO2 composite could be a promising electrode material for high-performance supercapacitor applications