bluuebunny/crossref_metadata_2025 huggingface dataset:
Validation of the Brazilian Portuguese version of the University of California San Diego Shortness of Breath Questionnaire in patients with interstitial lung disease
Authors: Silva1 Humberto , Cruz Mantoani1 Leandro , Ludovico Zamboti1 Camile , Florentin Aguiar1 Wagner , L. Ries2 Andrew , Ferreira Lima Gonçalves1 Aline , Garcia da Silva1 Thatielle , Ribeiro3 Marcos , Pitta1 Fabio , Augusto Camillo1,4 Carlos
Published: January 2022

Objective: To investigate the reliability, internal consistency and validity of the Brazilian Portuguese version of the University of California San Diego Shortness of Breath Questionnaire (UCSD SOBQ) in patients with interstitial lung disease (ILD). Methods: Patients with ILD completed the questionnaire at three different time points, one week apart, with the assistance of two independent assessors. Intra- and inter-rater reliability were analysed via the intraclass correlation coefficient (ICC). Internal consistency was assessed with the Cronbach's alpha coefficient. For the validity analysis, associations between variables were assessed with Spearman's or Pearson's correlation coefficient. Results: Thirty patients with ILD (idiopathic pulmonary fibrosis, connective tissue disease-associated pulmonary fibrosis, sarcoidosis, asbestosis or non-specific interstitial pneumonia) were included (15 men; mean age, 59 ± 10 years; DLCO: 46 [33-64] % predicted). UCSD SOBQ scores showed excellent agreement and internal consistency in the intra-rater analysis (ICC: 0.93 [0.85-0.97]; Cronbach alpha: 0.95) and in the inter-rater analysis (ICC: 0.95 [0.89-0.97]; Cronbach alpha: 0.95), as well as correlating significantly with dyspnoea (as assessed by the Medical Research Council scale; r = 0.56); Medical Outcomes Study 36-item Short-Form Health Survey domains bodily pain, general health, vitality and physical functioning (-0.40 = r = -0.74); six-minute walk distance (r = -0.38); and quadriceps muscle strength (r = -0.41). Conclusions: The Brazilian Portuguese version of the UCSD SOBQ is valid, is reliable and has internal consistency in patients with ILD in Brazil.
Efficacy of Prophylactic Intraoperative Povidone-Iodine Solution Irrigation in Preventing Surgical Site Infection Following Spinal Surgery
Authors: Altaf Imran , Liaqat Ammara , Ahmad Manzoor
Published: January 2022

Objective:  Deep wound infection can worsen clinical outcome and increase costs following spinal surgery. The bactericidal activity of povidone-iodine covers a broad spectrum of pathogens including methicillin-resistant Staphylococcus aureus. Our study aimed at evaluating the role that intraoperative dilute povidone-iodine solution irrigation could play in preventing post-operative wound infection following spinal surgery.

Material and Methods:  The clinical data of 41 patients that had undergone posterior spinal surgery in the department of neurosurgery Allama Iqbal hospital Sialkot was retrospectively analyzed. We divided the patients into two groups. In group 1patients wounds were irrigated with 0.35% povidone-iodine solution prior to closure. In group 2 patients wounds were irrigated with normal saline only. The two groups were then compared for evaluation of efficacy of peroperative povidone-iodine solution irrigation in preventing post-operative wound infection.

Results:  No infection occurred in the 16 patients in group 1 in whom wounds had been irrigated with povidone-iodine solution, compared to 3 deep infections developing in the 25 patients in group 2 in whom wounds had been irrigated with normal saline only. In the 3 patients that suffered from deep infections the duration of hospital stay was also significantly increased (P < 0.05).

Conclusion:  Our study supports the notion that perioperative povidone-iodine irrigation is an effective adjunct measure for prevention of surgical site infection following spinal surgical interventions.
Frequency of Extradural Hematoma in Patients with Skull Fracture after Head Injury
Authors: Ul Haq Muhammad Ammad , Abbas Ghayur , Ali Anam , Hamid Mamoona , Ahmed Daniyal , Javed Saad , Yaqoob Eesha
Published: January 2022

Objective:  To assess the frequency of patients with extradural hematoma who have a skull fracture on x-ray skull presenting with a head injury.

Material & Methods:  A descriptive case series was conducted at the Department of Neurosurgery, RMU & Allied Hospital, Rawalpindi. 322 patients fulfilling the selection criteria were enrolled in the study from Emergency Ward. Patients with head injury having skull fracture undergone a CT scan for assessment of presence or absence of extradural hematoma. CT scan was done by a single senior radiologist for all patients.

Results:  Mean age of patients in this study was 41.31 ± 14.67 years. Among the patients 259 (80.4%) were male and 63 (19.6%) were females. The mean duration of injury of the patients was 6.37 ± 3.40. Extradural hematoma was diagnosed in 104 (32.3%) patients. Age and site of fracture showed a statistically significant association for extradural hematoma. Whereas gender, duration of injury, and type of fracture did not show significant association for extradural hematoma.

Conclusion:  Results of this study showed a low frequency of extradural hematoma in patients who presented with a head injury. Still, any patient suspected of head injury leading to skull fractures must be examined on CT scan to avoid and timely detect the intracranial bleeding in order to avert the complications and mortality after traumatic head injury.
Surgical Outcome of Anterior Cervical Decompression and Fusion in Patients with Cervical Spondylotic Myelopathy and Radiculopathy in Terms of Improvement of Pain
Authors: Tahir Hamayun , Raza Afzal , Ali Mumtaz , Hassan Naseer , Ayaz Mohammad , Arooj Hina , Shah Zulfiqar Ali
Published: January 2022

Objective: Cervical spondylosis is a common degenerative condition leading to compression of nerve roots or spinal cord, causing radiculopathy or myelopathy. Anterior cervical decompression and fusion (ACDF) techniques are commonly recognized procedures in treating axial cervical spine pain and upper extremity radicular discomfort. The study analyzed the surgical outcome of anterior cervical decompression and fusion (ACDF) in cervical spondylotic myelopathy (CSM) and radiculopathy patients in terms of pain improvement.

Material and Methods: This descriptive case series analysis was performed at the Neuro Surgery department, Lady Reading Hospital Peshawar. A total of 146 patients between age 18 – 65 years meeting the inclusion criteria underwent anterior decompression &post-procedure improvement in pain of neck and arm/shoulder was determined using patient reported outcome (PRO) measure, namely visual analog scale (VAS) of 0-10 and a final outcome that is an improvement of pain, i.e., Mild to no pain (VAS score ?3) was considered after 12 months.

Results: The mean age was 52 years ± 8.273. As regards gender distribution, 78% of patients were male, while 22% were female. The mean baseline VAS score was 6.5 ± 2.37, mean postoperative VAS score was 3.5 ± 1.161 with a mean point improvement in pain of 3.0 points (p-value < 0.05). 80% of patients had shown improvement in reducing pain, while 20% did not have shown any improvement.

Conclusion: This study revealed that independent of symptoms duration and presentation, patients reported dramatic improvements in neck and arm pain after ACDF.
COVID-19 Pandemic: Influences on the Practice of Neurosurgeons all over Pakistan
Authors: Rana Faisal Feroz , Mahmood Mazhar , Amin Uzma , Butt Rizwan Masood
Published: January 2022

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.c
Comparison of the Operative Time and Post-Operative Pain with Peek Cage versus Autologous Iliac Crest Bone Graft in Anterior Cervical Discectomy and Fusion
Authors: Faizan Syed Ahmad , Bilal Syed Ahmad
Published: January 2022

Objective:  To compare the operative time and post-operative pain with PEEK cage method versus autologous iliac crest bone graft in anterior cervical discectomy and fusion in the cervical spine.

Material & Methods:  This randomized control trial study (RCT). 90 patients with cervical disc disease, cervical stenosis with or without myelopathy and cervical trauma (fractures or facet jumps with disrupted disc) were included in the study from the Department of Neurosurgery, LGH, PINS, Lahore. Patients were evaluated with plain X-rays and MRI scans of the cervical spine. All patients underwent anterior cervical decompression and fusion. In 45 patients (group A), cervical fusion was achieved with PEEK cage method and in other 45 patients (group B), autologous Iliac Crest Bone graft was used.

Results:  Mean age in group A was 57.1 years and in group B, it was 54.7 years. In group A, 31.1% patients were of cervical disc disease, 28.8% of cervical degenerative stenosis and 40% were of cervical trauma. In group B, 15 patients 33.3% were of cervical disc disease, 24.4% of cervical degenerative stenosis and 42.2% were of cervical trauma. The mean Postoperative Visual Analogue Scale (VAS) score for pain was 2.8 in group A and 5.4 in group B patients.

Conclusion:  The patients of group A (PEEK cage method) could be easily mobilized within bed and out of bed depending upon their neurological status. Decreased operative time and less post-operative pain makes PEEK cage method superior to autologous iliac crest bone graft in anterior cervical decompression and fusion.
Endoscopic Discectomy versus Microscopic Discectomy
Authors: Hussain Wadd Ijaz , Ijaz Sidra , Hasan Naem-ul-
Published: January 2022

Objective:  A randomized control trial was conducted to compare the outcome of an endoscopic discectomy with microdiscectomy in lumbar spine disc disease.

Material and Methods:  A randomized control trial was conducted at the Department of Neurosurgery, Punjab Institute of Neurosciences (PINS), Lahore. We included 80 patients of ages between 13 – 65 years, with low backache with radiation towards legs and prolapsed intervertebral disc at L5 – S1 and L4 – L5 levels on MRI were included in the study. Endoscopic/microscopic discectomy was done in a randomized manner under general anesthesia in a prone position with fluoro guidance. Postoperatively, all patients stayed in the recovery room for two hours for monitoring and then shifted to the ward. All patients followed-up-to one year clinically with the help of the Oswestry disability index (ODI).

Results:  There were 37 female and 43 male patients in the ages between 13 – 65 years. The mean age of patients was 53.5 years. The 53 patients were having prolapsed disc at L5 S1 levels and 27 patients with disc prolapse at L4 – 5 levels. A good improvement was observed in visual analog scores after surgery in both endoscopic and microscopic discectomy groups. But endoscopic discectomy group required a lesser hospital stay, early mobilization, and lesser postoperative analgesia requirements than the microscopic group.

Conclusion:  Endoscopic/microdiscectomy both are equally effective and safer techniques. They both can relief. However, the endoscopic discectomy was found better in terms of early mobilization and lesser postoperative pain.
Computerized Tomographic Based Study of Thoracic Spine Morphology in Relevance to Pedicle Screw Fixation in Pakistani Population
Authors: Noor Chughtai Waqas , Adeel Razzaque Muhammad , Ahmad Tanveer , Nighat Sumera , Tahir Rahila , Ahmad Bashir
Published: January 2022

Objective: To study the thoracic spine anatomy for accurate placement of pedicle screws using computerized tomography.

Material and Methods: CT scans of 200 patients were included in our study. T1 to T12 vertebrae morphology was studied for each patient. Following measurements were taken, 1: Transverse pedicle width, 2 = Depth of anterior cortex along pedicle axis, 3 = Transverse pedicle angle, 4 = canal dimensions, 5 = vertebral body height anterior and posterior, 6 = mid vertebral body width.

Results:  Transverse pedicle width decreased from T1 (4.06 ± 0.50 mm) to T4 (3.72 ± 0.17 mm) and then gradually increases to T12 (6.08 ± 0.60 mm). Depth of the anterior vertebral cortex remained constant from T1 to T4 and gradually increases up to T12. Transverse pedicle angle remained constant from T1 to T4 with a maximum at T4 (23.39 ± 3.15 mm) and then gradually decreased to T12 (3.99 ± 2.16 mm). Anteroposterior (AP) canal dimensions were minimum at T7 (17.03 ± 1.01 mm) and maximum at T2 (21.2 ± 1.07 mm). Interpedicular (IPD) canal dimensions were minimum at T6 (19.18 ± 1.6 mm) and maximum at T3 (23.18 ± 1.2 mm). Anterior vertebral body height was minimum at T1 (16.9 ± 1.34 mm) and maximum at T12 (27.14 ± 1.34mm). Posterior vertebral body height was minimum at T1 (18.8 ± 1.13 mm) and maximum at T12 (29.76 ± 1.43 mm).

Conclusion:  A detailed anatomy of the thoracic spine is essential for surgical planning to decrease postoperative complications.
Assessment of Modes of Injury and Outcome in Patients with Traumatic Posterior Fossa Extradural Hematomas: A Study of a Tertiary Care Hospital
Authors: Kalhoro Aurangzeb , Panezai Abdul Samad , Hassan Sher , Rehman Lal , Javed Farrukh
Published: January 2022

Objective:  The aim of study to assess the prevalence of divergent modes of injuries in traumatic posterior fossa extradural hematomas (PFEDH) along with the description of surgical and clinical management.

Material and Methods:  A descriptive study was performed at the Jinnah Postgraduate Medical Centre (JPMC), Karachi from May 2014 to October 2020. Total 37 patients who presented with posterior hematoma of any age and gender were included. CT scan Brain plain with the bone window was performed for a basic diagnosis to assess the volume, and any associated fracture, or any injury in the posterior fossa. The outcome was calculated from the scores of the Glasgow Coma Scale (GCS).

Results:  70% were male and around 30% were female patients. The mean calculated age was 32 ± 5.33 years. A road traffic trauma was the major cause of brain injury in 25 (67.56%) cases. The majority (56.75%) of patients reported headache, nausea and vomiting. 35% of patients were conservatively managed, with an average hematoma size of 3 cm on CT scan and GCS > 12 while 64.86% patients were operated, with the average size of hematoma > 3 cm and GCS < 10 while 61% of the patient had an occipital fracture. The majority of patients (8.1%) reported complications such as brain contusions and post-traumatic hydrocephalus.

Conclusion:  Post fossa EDH should be managed aggressively, especially those with low GCS (< 8), and volume > 3 cm. Patients who are to be managed conservatively also require close observation.
Outcome of patients operated for depressed skull fracture with dural tear
Authors: Tariq Muhammad , Ahmad Mian Mushtaq , Filza Faiqa , Ayub Shahid , Daud Khan Sohail , Jalal Khial
Published: January 2022

Objective:  The objective of this study was to determine the outcome of patients operated for depressed skull fracture with a dural tear.

Material and Methods:  A descriptive case series (n = 155) was carried out in the Department of Neurosurgery, Hayatabad Medical Complex Peshawar for six months.

Results:  The mean arrival GCS was 10.64 ± 2.33. About 21.9% (n = 32) patients presented with a GCS of ? 8, while the remaining 78.1% (n = 123) presented with a GCS of ? 8. About 8.4% (n = 13) patients died due to the complications of the brain injury. The most common postoperative complication was found to be progressive neurologic deficit (PND) occurred in 21 (13.5%) patients. Penetrating injury to the head was also associated with unfavorable outcomes after surgery (p = 0.046), which shows that penetrating injury is associated with increased brain damage and hence consequently poor outcomes.

Conclusions:  The neurologic status as denoted by the Glasgow coma scale is one of the most important factors which predicts the outcome. Surgical management of depressed skull fractures with dural tear has favorable outcomes in about two-thirds of patients. The remaining one-third patient remains in the severely disabled group. Every effort should be made to reduce the occurrence of complications as they are directly related to postoperative functional outcomes.
Success Rate of Endoscopic Third Ventriculostomy (ETV) in Non-Communicating Hydrocephalus in Pediatric Age Group
Authors: Pathan Sanaullah , Memon Riaz Ahmed Raja , Qureshi Peer Asad Aziz , Aghani Suhail Ahmed , Memon Abdul Rauf , Hussain Mubarak
Published: January 2022

Objective:  To evaluate success rate of the endoscopic third Ventriculostomy (ETV) in non-communicating type of hydrocephalus in pediatric age group.

Material and Methods:  This study was carried in the department of neurosurgery at Liaquat university hospital, Jamshoro in which an endoscopic third Ventriculostomy procedure was performed in patients (n = 55) with non-communicating hydrocephalus from October 2016 to April 2017. Post-operative follow-up was done on the 15th day post-operative to assess clinical and radiological improvement.

Results:  55 patients were included in this study, 26 (47.27%) males and 29 (52.73%) females. The mean age was 3.96 years. The most common etiology was aqueductal stenosis 28 (50.90%) patients followed by posterior fossa tumors in 18 (32.72%) patients. The operative technique was successful in 41 (74.55%) patients. Out of 41 successful patients, 34 (82.92%) patients had clinical as well as radiological improvement whereas 7 (17.07%) patients had clinical improvement only.

Conclusion:  The success rate of ETV was 74.55% in the non-communicating hydrocephalus in the pediatric age group in our study. Endoscopic third Ventriculostomy is an effective treatment for non-Communicating hydrocephalus in pediatric age groups by diversion of CSF intracranially. This procedure provides shunt freedom and can be used alternative to shunts in pediatric age groups with non-communicating hydrocephalus.
Pediatric Head Injury: A Study of 120 Cases
Authors: Asif Muhammad , Rehman Waqar Aziz , Serwar Sumaira , Younas Hamza , Younas Fatima
Published: January 2022

Objectives:  This study aimed to evaluate incidence, mode, and severity of injury, treatment options and to determine the outcome in pediatric age group patients with head injury.

Patients & Methods:  120 pediatric patients with a head injury, with ages up to 15 years or less, were included. Detailed history, general and neurological examination including GCS were noted. The CT scans were conducted and the patients managed as per said protocol. Various surgical procedures were performed including craniotomies and evacuation of hematoma, the elevation of depressed fractures and repair of the dura, decompression craniotomies, and evacuation of Subdural collections and contusions.

Results:  60.1% of patients were boys and 39.16% were girls. In the majority (63%) of the children, the ‘fall’ was reported. The majority of children (68.3%) in our study had a mild head injury with GCS 13 – 15. 35.83% patients had normal CT scans, and 23.33% had isolated skull fractures. 68.75% patients were with a severe head injury and had a poor outcome. A poor outcome was noted in patients having brain edema, subdural hematoma, and brain contusions.

Conclusion:  Head injury in the pediatric age group still continues to be a significant cause of mortality and morbidity. The outcome is directly being related to the severity of injury i.e., GCS. Falls and RTAs are the most common causes and preventive measures in different forms need to be addressed.
Shunt Migration into Scrotum: A Case Report
Authors: Assad Javed Muhammad , Ahmad Khan Niaz , Us-Saba Ain- , Sana Huda
Published: January 2022

Ventriculoperitoneal shunting (VPS) is a common procedure involved in the management of hydrocephalus. VP shunt has many inherent complications including obstruction, infection, breakage, and migration of the shunt. The incidence of scrotal shunt migration is around 14% VPS migration into the scrotum manifests as reducible trans-illuminant scrotal swelling, which is more like hydrocele. Mostly migration occurs into the right hemi-scrotum within the first 6 months of performing a ventriculoperitoneal shunt. Bilateral herniotomy with repositioning of the distal shunt catheter is the treatment of choice.
Improvement of Headache in Patients after Occipital Extradural Hematoma (EDH) with Less Than 15 ml of Volume after Single Burr Hole Evacuation and Placement of Drain
Authors: Zubair Mahmood Rana , Ali Dehraj Sikandar , Khan Sarfraz , Mansoor Usama , Mansoor Usama , Zayed Qamar Muhammad , Ahmad Touqeer
Published: January 2022

Objective:  We hypothesized that if we operate occipital extradural hematoma (EDH) having a volume less than 15 ml by single burr hole evacuation of extradural hematoma (EDH) and placement of drain without doing craniotomy then clinical status of the patients particularly headache improves.

Method:  An observational study of 15 patients (with presenting GCS: 8–13) was conducted on patients who were operated in Punjab Institute of Neurosciences (PINS). All patients had acute extradural hematoma less than 15 ml after a road traffic accident (RTA). The age range was 22 – 45 years. All patients were operated on within 12 hours of road traffic accident. The timing of surgery was in the range of 1-2 hours.

Results:  In all patients, surgery was performed by a single burr hole at the occipital region at the site of occipital EDH and the drain was placed in an extradural position. Co-morbidities in our patients were DM, polytrauma. Receiving GCS was 9 in 2 (13.33%) patients, was 13 in 10 (66.67%), was 8 in 1 (6.66%) patient and receiving GCS was 15 in 2 (13.33%) patients. All patients were assessed clinically on 5th post-operative day. It was seen headache was relieved on 5th post-operative day in all patients except 1 (6.66%) patient. Our 1 (6.66%) patients came for follow-up with the complaint of headache and vomiting which was managed conservatively.

Conclusion: Surgery by single burr hole evacuation and placement of drain is a safe method if occipital EDH is less than 15 ml in volume
Recurrent Occipital Dermatofibrosarcoma Protuberans: Multidisciplinary Management of a Rare Case
Authors: Malik Mubashir , Ahmed Khan Zubair , Saleem Rabia , Safdar Shahzad , Ahmed Touqeer
Published: January 2022

Dermatofibrosarcoma protuberance is a skin tumor arising from dermis, slow growing in nature and locally invasive. Most commonly present on extremities and rarely on head and neck region. We are presenting a case of 24 years old male with huge recurrent DFSP lesion in occipital region. We did wide local excision with tumor free skin margins of 2.5cm followed by excision of involved occipital bone and wound coverage with carotid artery flap. DFSP is challenging skin tumor with high recurrence rate and should be managed by multidisciplinary approach.
Frequency of Post-Operative Cerebrospinal Fluid (CSF) Leak in Retromastoid Surgery for Vestibular Schwannoma: A Three-Year Experience of a Tertiary Care Hospital
Authors: Amir Sohail , Ahmad Ayaz , Amman Atif , Ali Numan Muhammad , Ayub Shahid
Published: January 2022

Objective:  Descriptive study was aimed is to find out the frequency of CSF leak in retro mastoid surgery for Vestibular Schwannoma.

Material and Methods:  From 2017 to 2020, 63 patients underwent microsurgical excision of Vestibular Schwannoma with retro sigmoidal approach in the Department of Neurosurgery, Hayatabad Medical Complex, Peshawar. All patients of either sex underwent retro mastoid approach for Vestibular Schwannoma surgery, having complete dural closure per operatively were included in this study. Data was collected which included symptoms, clinical assessment, radiological findings, per-operative and postoperative findings. Patients were monitored for 30 days after surgery and checked for any CSF leaks.

Results:  There were 36 male and 27 female patients. In our study, the postoperative CSF leak was present in 9(14%) of cases. There was no significant difference (p-value 0.097) whether the dura was closed with graft and without graft. Insignificant differences existed in CSF leak vs. different age groups (p-value 0.964) and gender (p-value: 0.917).

Conclusion:  Our study found that after retro sigmoid approach for vestibular Schwannoma surgery, the frequency of CSF leak was 14%, which gives us insight into our complication rate and allows us to change our surgical procedure technique, such as using fibrin glue or less frequently artificial dura, to reduce this rate.
Complications Following Comparison of Surgery for Chronic Subdural Hematoma, With and Without Postoperative Drainage Tube
Authors: Altaf Imran , Shams Shahzad
Published: January 2022

Objectives:  Chronic subdural hematoma (CSDH) is one of the most common entities treated in neurosurgery. Postoperative subdural drainage employed after burr hole evacuation for treating CSDH reduces recurrence, but whether it leads to increased surgical complications compared to no postoperative drainage is debatable. The present study was designed to assess whether postoperative subdural drainage leads to increased surgical complications following burr hole evacuation of CSDH compared to no drainage.

Materials and Methods:  The medical records of 69 patients treated with burr hole evacuation for chronic subdural hematoma between July 2013 to April 2014 were retrospectively analyzed. The patients were divided into two groups. In group A patients, postoperative subdural drainage had been employed following burr hole evacuation of CSDH, while in group B patients there was no drainage. The two groups were then compared for the development of surgical complications other than recurrence.

Results:  Sixteen patients developed complications. Acute Subdural hematoma formed in 3 patients. There was intraparenchymal drain insertion in 6 patients. An empyema developed in 2 patients, while one patient each developed an Extradural hematoma, fits, contusion, and hemorrhagic infarction. All the complications occurred in the group A patients receiving postoperative subdural drainage. Postoperative subdural drainage tube was found to be significantly associated (p = 0.0017) with complications.

Conclusion:  We conclude that postoperative subdural drainage following burr hole evacuation of chronic subdural hematoma is associated with increased surgical complications compared to no drainage.
Surgical Outcome of Transpedicular Fixation for Degenerative Spondylolisthesis in Terms of Relief from Backache
Authors: Haq Naeem-ul- , Ishaq Muhammad , Khan Musawer , Ahmed Adnan , Ali Gohar
Published: January 2022

Objective:  To document the outcome of transpedicular fixation for degenerative spondylolisthesis in terms of relief from backache.

Materials & Methods:  This retrospective observational study was conducted in Mardan Medical Complex, Mardan. Static and dynamic spinal X-rays were used to diagnose degenerative spondylolisthesis. This research looked at how patients' pain levels, neurological state, and union improved after surgery. Patients with grade 5 spondylolisthesis, having congenital spinal anomaly, or who had previous spinal surgery were excluded from the study.

Results:  In total 35 patients were included, 54.3% were male and 45.7% female. The primary reason for surgery was severe backache with 24 individuals having normal neurological status and 11 patients having some neurological abnormality. L5–S1was the most commonly involved level in 24 patients. Meyerding grades were used to determine the slip grade. The average duration of follow-up was two years and five months, with a maximum of five years and a minimum of six months. 83 percent of patients had pain reduction, whereas neurological improvement was achieved in 64 percent of instances and surgical union was achieved in 91 percent of cases. There was no neurological impairment in the patients treated with transpedicular fixation. Significant differences exist between preoperative and postoperative GRS scores in the following pain categories: no pain, mild, server and excruciating.

Conclusion:  Transpedicular fixation is a protected, simple, and successful procedure for patients with spondylolisthesis for pain relief in backache. It also contributes to surgical union and improvement in the neurological status of the patients.
Stereotactic Thalamotomy – A Conventional But A Valuable and Effective Surgical Strategy for Parkinsonian Tremors
Authors: Ahmed Khan Rizwan , Ali Amjad , Yasin Abu Bakar , Mahmood Khalid
Published: January 2022

Objective:  To determine the frequency of improvement in tremors in Parkinsonian patients after stereotactic thalamotomy.

Material & Methods:  A descriptive case series was conducted in the department of Neurosurgery Unit II, Lahore General Hospital from January 2016 to March 2020. The study included65 patients of Parkinson’s disease with tremors refractory to medicines for 6 months who fulfilled the inclusion criteria. Outcome and possible complications were explained before taking informed consent. An outcome like reduction in tremors was used as a research instrument. It was determined by a modified unified Parkinson's disease rating score (UPDRS). Patients were diagnosed based on history, clinical examination, and MRI brain by a team comprising of neurologists and neurosurgeons. Thalamotomy was done by one surgical team. Patients were examined and scored post-operatively at 3 weeks and 3 months. Improvement was labeled as a reduction in tremors upto grade 1 or more from baseline after thalamotomy.

Results:  Improvement in tremors after thalamotomy was observed in 58.5% of patients whereas there was no improvement in tremors after thalamotomy in 41.5% of patients. There was no significant association between age and improvement in tremors after thalamotomy (p-value = 0.786). No significant association was found between the duration of medical treatment and improvement in tremors after thalamotomy (p-value = 0.681).

Conclusion:  Improvement in tremors after thalamotomy was observed in 58.5% of parkinsonian patients. Effect modifiers like age and duration of medical treatment were not significantly associated with improvement in tremors after thalamotomy.
Sub arachnoid hemorrhage and vasospasm
Authors: Anwar Chaudary Muhammad , Shahid Saman
Published: January 2022

Spontaneous sub arachnoid hemorrhage develops vasospasm in the 3-8 days. It should be dealt with conservative symptomatic treatment in this risky phase. Commonest presentation of vasospasm is headache. Usually headache increases with the onset of vasospasm at day 3 and diminishes as the vasospasm subsides after 8-10 days. Surgical interventions like clipping and coiling should be avoided in this period and patients should be given plenty of fluids (hemodilution, hypervolemia and hypertension). This triple H therapy holds good for asymptomatic vasospasms but were found less effective in symptomatic patients of SAH. Constipation should be avoided. Grade is supported by evidence from placebo-controlled study. There are some guidelines available for the prevention and the treatment of cerebral vasospasms with Nimodipine (oral). The use of triple H treatment as a preventative measure is a grade B recommendation. The treatment of symptomatic vasospasm with therapeutic hypertensive hypervolemia hemodilution is advised, however no prospective trials are available (grade C recommendation). There is no evidence that antifibrinolytics, steroids, or anticonvulsive prophylaxis should be used routinely. Current prophylaxis and treatment of cerebral vasospasm are still insufficient, according to clinical data, and vigorous triple-H-therapy is linked to an increased risk of sequelae.
Immediate postoperative complications of sellar suprasellar lesions operated via pterional approach
Authors: Tahir Hamayun , Ali Shah Zulfiqar , Hassan Naseer , Ayaz Muhammad , Ali Mumtaz , Azam Farooq , Feroz Samina
Published: January 2022

Objective:  In neurosurgical facilities, lesions that occur in the sella turcica and suprasellar area are frequently encountered. Different complications have been documented in the past studies following surgical management of sellar suprasellar lesions. This study's rationale was to get data from our local population on complications related to the transcranial approach for sellar suprasellar lesions. The study aimed to determine the immediate (within one week) postoperative complications of sellar suprasellar lesions operated via a pterional approach

Material and Methods:  This descriptive case series study was conducted from June 2019 to June 2020 at the neurosurgical facility lady reading hospital Peshawar. A total of 117 patients, meeting inclusion criteria irrespective of gender, diagnosed with the sellar suprasellar lesion between 18 to 60 years of age operated through a pterional approach. Post-op patients were followed for seven days to access main outcome measures such as CSF leak and diabetes insipidus.

Results:  CSF leak found in 7.7% (n = 9) of patients while diabetes insipidus was detected in 14.5% (n = 17) patients. Gender and age-based stratification showed no statistically significant difference for both postoperative complications.

Conclusion:  Diabetes insipidus was a more frequent postoperative complication in patients undergoing the pterional approach for sellar suprasellar lesions followed by CSF leak. However, no statistically significant correlation was observed between different age groups and gender for all these complications.
A Criticism and study of “The Arabic translations of contemporary Persian novels” (“Translations of Muhammad Alauddin Mansour” as a model) قنقـــد و بررسی ترجمـــــه¬ی عربی رمــــان¬های معـــــاصر فــــارسی (ترجمه¬های محمد علاء الدین منصور- بررسی نمونه¬ای
Authors:   University of Baghdad,College of Languages - Department of Persian Language, Baghdad, Iraq., Mahmoud Jassim Raddam
Published: January 2022

Arab translators have always paid great attention to the translation of the Persian literary genres, in particular, contemporary Iranian novels. They have always translated for the most prominent Iranian novelists such as Jalal Al Ahmad, Sadiq Hidayat, Mahmoud Dowlatabadi, Bozorg Alavi, Ismail Fasih‎, Houshang Golshiri, Gholam-Hossein Saedi, Simin Daneshvar, Sadiq Chubak, Samad Behrangi and others that have succeeded in perfectly picturing the Iranian society. Within the perspectives of Arab translators and by using the descriptive - analytical approach, the present study provides an analytical study of the translation into Arabic some of the modern Persian novels. Moreover, the study also gives a critical analysis of the translation of the Egyptian Muhammad Alauddin Mansour into Arabic two of the selected models of the Iranian novels: (Termite) by Bozorg Alavi and (Winter 84) by Ismail Fasih. The study also elucidates a critical analysis of some semantic and stylistic aspects of the translation as well as some of the translator’s committed mistakes between the original and the translated texts. چکیده رمان فارسی یکی از ژانرهای ادبی است که مترجمان عرب­زبان به آن توجه زیادی نشان داده­اند و می­توان گفت که به ویژه رمان­های معاصر ایرانی همواره مورد اقبال مترجمان عرب بوده­اند. و مترجمان عرب بسیاری ازرمان­های نویسندگان مشهور ایرانی را ترجمه کردند که از طریق آن­ها تصویر جامعه ایران را به جهان عرب منتقل می­کردند. در این تحقیق با روش توصیفی - تحلیلی به نقد و بررسی " ترجمه­ی عربی رمان­های معاصرفارسی" در قالب بررسی موضوعاتی همچون نگاهی به ترجمه­های مترجمین عرب از رمان­های معاصر فارسی ، نقدی کوتاه بر ترجمه­ی رمان­های معاصر فارسی به عربی و نقد وبررسی نمونه­های برگزیده­ای از ترجمه­ی مترجم مصری محمد علاء الدین منصور از رمان (موریانه) نوشته بزرگ علوی رمان (زمستان 62) نوشته اسماعیل فصیح پرداخته­ایم. بدین ترتیب که ضمن مطالعه­ی دو رمان مذکور و مقابله متن ترجمه شده با متن اصلی ، برخی مسائل معنایی و سبک­شناختی و اشتباهات مترجم را با مقایسه متن ترجمه شده با متن اصلی بررسی و تحلیل کرده­ایم.
Pragmatics and Speech Act- History, Importance and Stages of Development הפרגמטיקה ופעולת־הדיבור- התולדות, החשיבות ושלבי ההתפתחות (יישמוים בלשון העברית)
Authors:   MA. Candidate, Abid Noor Fadhel , Rasheed Ghazwan Majeed ,   University of Baghdad, College of languages, Department of Hebrew Language, Baghdad, Iraq.
Published: January 2022

The present study stresses two of the most significant aspects of linguistic approach: Pragmatics” and the “Speech Act Theory”, revealing its importance and the stages and levels of development through Hebrew language’s speech acts analysis including (political speech, the Holy Bible, Hebrew stories). Chronologically, Pragmatics has always been the center of linguists’ interests due to its importance in linguistic decryptions, particularly, through “Speech Act Theory” that has been initiated and developed by the most prominent philosophers and linguistics. The present study discloses that “Speech Act Theory” is the backbone of Pragmatics. This is due to the fact that its scope doesn’t only include the language message sender, but rather (the sender, the receiver, the environment, the context, and the speaker’s social standards and attitude of the language). Reflecting the social culture as well as the society standards and morals, “Speech Act Theory” can effortlessly facilitate grasping the message of the speaker’s intentions by the message receiver. תקציר המחקר הזה שופך אור על שני מושגים עיקריים בחקר הלשון "הפרגמטיקה" ו"פעולת־הדיבור" ועל תודלותיהם ושלבי התפתחותם דרך ניתוח פעולות הדיבור בלשון העברית בכל רבדיה ושלביה (השיח הפוליטי, התנ''ך, סיפורים עבריים). הפרגמטיקה עברה שלבים חשובים במרוצת הזמן. בימינו החוקרים התעניינו בגישה הזאת ובמיוחד בתחום התקשורת הלשוני משום שהיא מסייעת אותם בפענח המסרים בין השוחחים, באמצעות התיאוריה המרכזית בחקר הפרגמטיקה "תיאורית פעולת הדיבור", שהופיעה והתפתחה על ידי קבוצה של פילוסופים ובלשנים מפורסמים בחקר הלשוני. ממצאי המחקר מגלים כי תיאורית פעולת הדיבור היא הבת הבכורה של הפרגמטיקה, משום שהיא אינה מתעניינת אך ורק בדיבור המוען, אלא היא עברה לממדים אחרים כגון (מקבל הפעולה, הסביבה שמתרחשת בה הפעולה, ההקשר הלשוני והחוץ לשוני, נורמות החברה, מעמד הדובר והשומע... וכן הלאה). באמצעות התיאוריה הזאת אנו יכולים להבנת כוונותיו של הדובר כלפי הנמען, בנוסף לכך היא משקפת את התרבות החברתית של חברה מסוימת ואת נורמות המבנים החברתיים והמוסריים שלה.
High-Stakes Interpretation
Authors: Doerfler Ryan
Published: January 2022

Courts look at text differently in high-stakes cases. Statutory language that would otherwise be “unambiguous” suddenly becomes “less than clear.” This, in turn, frees up courts to sidestep constitutional conflicts, avoid dramatic policy changes, and, more generally, get around undesirable outcomes. The standard account of this behavior is that courts’ failure to recognize “clear” or “unambiguous” meanings in such cases is motivated or disingenuous, and, at best, justified on instrumentalist grounds.

This Article challenges that account. It argues instead that, as a purely epistemic matter, it is more difficult to “know” what a text means—and, hence, more difficult to regard that text as “clear” or “unambiguous”—when the practical stakes are raised. For that reason, this Article insists, it is entirely rational for courts to be more cautious when interpreting text in high-stakes cases than they would be if the stakes were low. Drawing on contemporary work in philosophy of language and epistemology, this Article grounds its argument in the observation that ordinary speakers’ willingness to attribute “knowledge” or “clarity” decreases as the practical stakes increase. And while the technical explanations of this phenomenon vary, they all reflect a basic insight: that one needs greater epistemic justification to act on some premise the higher the practical stakes.

To illustrate, this Article applies the above insight to various interpretive settings. Considering judicial review, for example, this Article explains that it makes good epistemic sense for a court to wait until it is really sure that a statute means what it thinks it means before taking the extraordinary step of invalidating that statute as unconstitutional. Similarly, this Article urges that it is just sound epistemic practice for a court is to construe a statute in a way that would unsettle an existing implementation regime only if it is especially well justified in its reading of the statutory text—that is, only if it really knows that its reading is correct.

This Article thus offers at least a partial justification of courts’ seemingly loose treatment of statutory text when the practical stakes are raised. And it does so, in contrast to prior scholarly efforts, by appeal to reasons that both formalists and instrumentalists can accept.
Humanizing the Corporation While Dehumanizing the Individual: The Misuse of Deferred-Prosecution Agreements in the United States
Authors: Amulic Andrea
Published: January 2022

American prosecutors routinely offer deferred-prosecution and nonprosecution agreements to corporate defendants, but not to noncorporate defendants. The drafters of the Speedy Trial Act expressly contemplated such agreements, as originally developed for use in cases involving low-level, nonviolent, noncorporate defendants. This Note posits that the almost exclusive use of deferrals in corporate cases is inconsistent with the goal that these agreements initially sought to serve. The Note further argues that this exclusivity can be attributed to prosecutors’ tendency to only consider collateral consequences in corporate cases and not in noncorporate cases. Ultimately, this Note recommends that prosecutors evaluate collateral fallout when deciding whether to prosecute noncorporate, as well as corporate, defendants and that the Department of Justice adopt departmental guidelines to ensure compliance with this goal.
Corpus Linguistics: Misfire or More Ammo for the Ordinary - Meaning Canon?
Authors: Ramer John
Published: January 2022

Scholars and judges have heralded corpus linguistics—the study of language through collections of spoken or written texts—as a novel tool for statutory interpretation that will help provide an answer in the occasionally ambiguous search for “ordinary meaning” using dictionaries. In the spring of 2016, the Michigan Supreme Court became the first to use corpus linguistics in a majority opinion. The dissent also used it, however, and the two opinions reached different conclusions. In the first true test for corpus linguistics, the answer seemed to be just as ambiguous as before.

This result calls into question the utility of corpus linguistics. If the Michigan Supreme Court could reach opposite conclusions about the ordinary meaning of a word when both opinions used the same database, can one really consider corpus linguistics an effective aid to statutory interpretation? This Note first argues that the Michigan Supreme Court’s majority opinion conducted a flawed search of the database and that the dissent’s contrary conclusion was correct.

In addition, this Note contends that transparency—the greatest strength of corpus linguistics—outweighs the risk that judges may fail to use a corpus-linguistics database accurately because that transparency permits advocates, other judges, and legal scholars to review the court’s analysis, aiding appellate review. Lastly, this Note includes recommended steps to guide the use of a corpus-linguistics database in the search for ordinary meaning.
Opening the Gates of Cow Palace: Regulating Runoff Manure as a Hazardous Waste Under RCRA
Authors: McCalib Reed
Published: January 2022

In 2015, a federal court held for the first time that the Environmental Protection Agency (“EPA”) may regulate runoff manure as a “solid waste” under the Resource Conservation and Recovery Act (“RCRA”). The holding of Community Ass’n for Restoration of the Environment, Inc. v. Cow Palace, LLC opened the gates to regulation of farms under the nation’s primary toxic waste statute. This Comment argues that, once classified as a “solid waste,” runoff manure fits RCRA’s definition of “hazardous waste” as well. This reclassification would expand EPA’s authority to monitor and respond to the nation’s tragically common groundwater-contamination emergencies.
SELF-ESTEEM OF GRADE 9 STUDENTS IN DRESSMAKING
Authors: Mrs. Josie G. Bueno
Published: January 2022

Confidence in one’s value as a human being is a precious psychological resource and generally a highly positive factor in life; it is correlated with achievement, good relationships, and satisfaction asserted by Kraybill (2018). Possessing little self-regard can lead people to become depressed, to fall short of their potential, or to tolerate abusive relationships and situations.
Grade 9 students are not really interested in dressmaking they find it hard to learn this area the researcher wants to know the self-esteem among Grade 9 students in dressmaking to help them overcome and find the reasons behind it.
The respondents of the study were ninety-eight (98) from Grade 9 students. It was limited only in three (3) questions. It was qualitative and quantitative designs through interview and using percentage for presentation of the result.
The self-esteem of Grade 9 students with regards to dressmaking has total of 95.42% answered no, 2.76% answered yes and 1.9% answered maybe. Based on the result of the interview by the researcher the Grade 9 students were not interested in dress making, their self-esteem towards dressmaking was low.
The reasons of the students why they did not take the dressmaking first in the list was boring with 35.11%, second was difficult with 19.47%, third was not interested with 17.18%, fourth was not in demand with 14.50%, fifth was no career opportunity and the last was scared with 3. 82% with the total of 100%.
After the strategy used by the researcher the self-esteem of the students increases in choosing the dressmaking, from 95.42% down to 80.92% with the difference of 14.5% answered “no”, from 2.76% increased to 9.17% with the difference of 6.41% answered yes, while the students answered “maybe” from 1.9% to 9.92% with the difference of 8.02%.
The researcher concluded that the Grade 9 students need to have orientation about the dressmaking and allow them to do hands-on activity to become more familiar before they choose which course to take in Grade 9 on their TLE. Various aspects of the class can be examined, such as routines, use of time, schedule, participation, teaching strategies, management strategies, learner interest, and much more. A teacher will naturally look for support on an issue that is difficult for him or her, but it is often a great method of being exposed to a new and different approach to teaching.